Mystery Ailment Watch Expands

With the number of local suspected SARS cases climbing to nine on Thursday, Santa Clara County will become one of the first areas to go beyond federal health guidelines and start monitoring a broader range of people to see whether they are infected with the mysterious respiratory illness.

The county is at the center of the country's SARS outbreak, with more suspected cases than any other locale. One of the two new patients, a 7-year-old girl from Hong Kong, is recuperating at the home of extended family, county health officer Dr. Marty Fenstersheib said Thursday. The child -- one of a handful of suspected pediatric SARS cases nationwide -- had been traveling with family members who have not been infected.

An unrelated 58-year-old man who recently traveled to China is also recovering at home, Fenstersheib said.

On Tuesday, international attention focused here when an American Airlines flight from Tokyo was grounded for two hours after its arrival in San Jose because several people aboard displayed possible SARS symptoms. None had the disease.

Now, county public health officials plan to dig deeper for potential SARS cases through what they call ``expanded surveillance.'' The county is likely to be the first in the nation to more aggressively define SARS cases.

To define a case as suspected SARS (severe acute respiratory syndrome), the U.S. Centers for Disease Control requires doctors to diagnose a fever of more than 100.5 degrees and respiratory symptoms such as a cough or difficulty breathing -- in conjunction with recent travel to China, Vietnam, Hong Kong or Singapore.

County's response

But Santa Clara County public health officials now want doctors and emergency rooms to report cases as SARS if the patient has traveled to the affected regions or has had close contact with someone who has, and displays only one other symptom of SARS, such as a fever.

These patients will be asked to stay at home for at least 10 days, the incubation period of the disease. Health workers will check their conditions daily. Any other members of the household should watch for symptoms and tell health workers if they feel ill.

The goal, Fenstersheib said, is to identify potential cases earlier. Patients could have a fever but not develop respiratory symptoms until a few days later. In the meantime, they might have infected co-workers or family members.

Fenstersheib stressed that those who have not recently traveled to Asia are not at high risk of the disease. Although experts still are unsure how SARS is spread, they do know that close contact with those infected is required.

Still, Fenstersheib said, ``we want to make sure we limit the spread of this disease. We're trying to catch it earlier.''

Local health officials certainly aren't overreacting, said Dr. Art Reingold, who heads epidemiology studies at the University of California-Berkeley School of Public Health.

``Local officials need to make, in their judgment, what is the best decision,'' Reingold said. ``Most health departments try to do at least what the CDC suggests. Sometimes they decide to be more aggressive or more proactive, or more protectionist.''

CDC guidelines

Although the CDC has established diagnostic guidelines for SARS and criteria for isolating and treating patients, communities are not legally bound to stick with them, said Charles Fallis, a CDC spokesman. The CDC's guidelines are admittedly broad and vague, he acknowledged.

``The CDC really can't make recommendations, obviously, for every city,'' Fallis said. ``But it sounds reasonable'' to screen more aggressively if you are dealing a high number of people who travel to and from Asia.

In Alameda County, public health workers are sticking with the CDC's SARS case definition, because the county now has only two suspected cases.

``But if we had nine suspected cases, we'd consider a different way of surveillance to understand what's happening at the county level,'' said public health spokeswoman Sherri Willis. ``I can certainly understand how Santa Clara County would expand its surveillance so they can make sure they're doing what's needed.''

Disease spreads

SARS, believed to have originated in China's Guangdong province, has sickened 2,270 people in 16 countries, killing 79. None of the 100 suspected U.S. cases has been fatal. There are 33 cases now reported in California.

Scientists believe the virus that causes SARS comes from the same family that causes the common cold. The disease has primarily struck residents of China, Vietnam, Hong Kong and Singapore.

But if U.S. public health officials wait too long to take an aggressive stance toward SARS, it may prove impossible to control, said Edward Richards, director of the Program in Law, Science, and Public Health at Louisiana State University.

``No one wants to see this epidemic break free,'' he said, ``and kill thousands of people in the United States.''

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IF YOU'RE INTERESTED

Go to www.cdc.gov or call the Santa Clara County Public Health Department at (408) 885-3980 for more information about SARS.

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Contact Barbara Feder Ostrov at bfeder@mercurynews.com or (408) 920-5064.