Coming home to SARS fears

When television reporter Vic Brown recently returned home from a two-week dream vacation cruising the Yangtze River in China, his colleagues at KRON in San Francisco joked about keeping a safe distance from him for fear of catching the severe acute respiratory syndrome that is ravaging much of Asia.

Brown’s boss gave facemasks to everyone in Brown’s cubicle pod. A co-worker he saw in the elevator edged as far away as she could. Worse yet, the cold that Brown had been nursing since before he left on the trip lingered, not uncommon given China’s abysmal air quality.

“When I coughed, everyone cleared out,” Brown recalls with a laugh.

It’s the kind of uneasy welcomeback many of the tens of thousands of otherwise healthy Americans returning from leisure and business travel to China, Hong Kong, Vietnam and Singapore are getting lately. These travelers are emerging as a type of “untouchable,” as their families and colleagues fear, usually irrationally, say U.S. health officials, that they may carry a disease that as of Friday was suspected of sickening 2,890 people and killing 116 worldwide. The World Health Organization has advised against travel to Southeast Asia, where the disease has been spreading fast.

Nevertheless, more than 250,000 Americans and foreign visitors have entered the U.S. from Asia in the last few weeks: Two dozen jumbo jets from Asia, each carrying hundreds of passengers, for example, touch down each day at Los Angeles International Airport alone.

So far in the U.S., the disease appears to be well under control. There have been 166 suspected cases, all but a few found in people who have traveled to the affected Southeast Asian nations. The others who have been infected have been so-called “secondary transmissions” to family members or health workers. California has reported 40 of the suspected cases. Just one -- a 38-year-old man in Santa Clara County who was hospitalized on March 19 -- has tested positive for the coronavirus that is the suspected root cause of the disease. The others haven’t been positively confirmed and could still be pneumonia, influenza or respiratory viruses.

(The Santa Clara County man has recovered, after being hospitalized in an isolation unit, then kept home for 10 days. No health workers or family members were infected, said Dr. Martin Fenstersheib, Santa Clara County health officer.)

In California counties as of Friday, there were eight cases in Los Angeles, seven in Santa Clara, three each in Orange and Alameda, two each in Placer, Contra Costa and Ventura, with all remaining counties reporting one or fewer.

The totals are in constant flux: In California, for example, three new cases were added Thursday, while three others were taken off the list when further laboratory testing determined the symptoms to be something other than SARS, which has symptoms similar to pneumonia, the flu and other viruses.

Making matters more difficult: There is no single test yet for the virus. Indeed, corona- viruses, recognized by their halo or crown-like appearance under a microscope, commonly cause moderate respiratory illnesses in humans, but the one linked to SARS appears to be a new strain. Coronaviruses typically survive in the environment for up to three hours.

But unless the traveler is showing symptoms of the disease -- a fever higher than 100.5 Fahrenheit, lower respiratory tract infection, shortness of breath or a cough -- those they come in contact with have little reason to fear, health officials say. So far, only a few of the 154 cases reported in the U.S. have been “secondary transmissions” -- to family members mostly but also to a few health care workers. It is not believed to be contagious during the two-to-10-day incubation period when a carrier isn’t showing any symptoms.

“If they’re asymptomatic, they shouldn’t worry, even if the disease is brewing,” says Dr. Susan Fernyak, director of San Francisco’s health department. She noted that even patients with low immunity, such as those who are HIV-positive or in chemotherapy, do not have to worry. Even if symptoms are present, she said, “it requires close and prolonged contact. We don’t think you can get it passing on the sidewalk or in a bus -- at least in the U.S., it is highly unlikely.”

At least, that is the present take on the disease. If the number of cases passed on to the community were to escalate, the thinking might change.

U.S. health officials believe the virus is spread when someone with the disease coughs droplets into the air and someone else breathes them in. They also suspect that it is possible that it can be spread through the air or from touching objects that have become contaminated.

This appears to have been what happened when a doctor traveling from Southern China to Hong Kong infected others who stayed in the same hotel and set off an epidemic in Hong Kong, where 998 people are believed to have been infected and 30 have died.

The disease is taking a toll on the Asian economy. Cathay Pacific Airlines Chief Executive David Turnbull said that bookings have been “annihilated.” And Hong Kong recently dropped its tourism slogan that the city “will take your breath away.” Malaysia has banned visitors from Hong Kong and mainland China.

Dr. Diana M. Bonta, director of California’s Department of Health Services, says it’s still “a puzzle” why the disease so far has been deadlier in Asia than in the U.S. “It might be the exposure level in whoever they came in contact with [in Asia]. We haven’t seen the levels of secondary transmissions that would cause concern because of close proximity.”

Certainly, in California, where two people in a car constitutes a “high-occupancy vehicle,” dense crowds are few; this is not so in Hong Kong and southern China, where a typical commuter would easily come in contact with dozens, if not hundreds, of others on overcrowded subways and buses.

The concern isn’t limited to friends and families but includes employers. Wal-Mart stores, the retailing giant with many overseas operations, took the unusual step last week of telling employees who have visited the affected Southeast Asian nations to spend 10 days at home for an “observation period.” It also banned employees from traveling to Toronto because of the rapid spread of the disease there.

And on Thursday, Bonta called on the federal Transportation Department to screen people boarding U.S.-bound flights where they originate for symptoms.

When travelers arrive here, they are met by representatives of the Centers for Disease Control and Prevention, who hand out leaflets advising about the symptoms of SARS.

Meanwhile, fear seems to be infecting far more people than the disease.

San Francisco’s public health department each day fields hundreds of calls, most from the “worried well,” their voices filled with anxiety about SARS.

One requested that the department call his supervisor and order him to send a colleague, who’d just returned from a business trip to China and sat nearby, to stay home. Another complained that local stores were sold out of facemasks, even after the health department assured him that masks are unnecessary except when a family member is infected.

Many Americans have canceled unnecessary travel to Asia, but some folks are thinking about canceling meetings planned with Asian visitors here.

After a visit from three government officials from a northern province in China, Monterey Park Chamber of Commerce executive director Lucy Kelley is reconsidering an appointment next month with 40 Chinese officials. On the last visit, one of the three Chinese visitors had a cold, which alarmed her.

“[He] sneezed and put his hands up to block his nose,” she recalls. “Then he shook my hand four or five times.” All she could think of was getting him to leave so she could rush off to wash her hands.

Those returning travelers who are well are getting a taste of what it feels like to be ostracized -- as if they’re a “Typhoid Mary,” Mary Mallon, a New York cook suspected of passing that dread disease to at least dozens in the early 1900s. The pain is worse because it’s their own families and friends, rather than strangers, who are spurning them. Instead of sympathy for escaping the epidemic unscathed in Hong Kong and having to cut his semester abroad short, UC Riverside college senior Zachary Levine got the cold shoulder when he returned home. “Nobody wants to see you,” his mother, Nettie, informed him on his arrival.

His grandmother’s response to his desire for the Jewish home-cooking he longed for while gone for the semester? “He’s not coming here.”

It didn’t help his case that some of the people in dorms where they went to school in the New Territories adjacent to Hong Kong had been infected.

Levine was forced to stay at home while the rest of the family feasted at his grandmother’s house. He made do with a doggie bag.

Still, it was better than the reception his American classmate there got when he returned to New York: His mom grounded him for 10 days.