While Sars cases in most affected areas have tapered off over the past week, the slack has since been taken up in China where rapid spread of the disease has threatened civil stability in the densely-populated country.

According to latest press reports, fears over the Severe Acute Respiratory Syndrome (Sars) have prompted many villagers in China to take matters in their own hand, a sign most indicative of low confidence in Beijing's administrative capability in controlling the outbreak.

Rising death toll

Some villagers in China have barricaded entrances into their communities while millions of migrant workers in cities have begun repatriating back to their rural homes to stay out the epidemic, thereby raising the possibility for further spread of the Sars into China's hinterland.

The severity of the epidemic in Beijing has been underscored by the frank admission by Chinese Prime Minister Wen Jiabao (photo), as reported by the BBC yesterday, that the country's rural health-care system is totally incapable of dealing with a major outbreak of the atypical pneumonia disease.

The BBC also quoted director of Beijing University's school of public health, Hu Yonghua as saying that the death toll of the disease is expected to rise in the coming days due to the shortage of intensive care facilities necessary in the final phase of a patient's battle against respiratory illnesses.

Hu was reported as saying that although Beijing has 32,000 registered doctors and 34,000 registered nurses, few are trained to handle infectious diseases and respiratory problems.

As of 10am local time yesterday, China reported five more deaths and 97 new cases of infection bringing the death toll to 219 and the total number of Sars cases to 4,560.

Worldwide, close to 500 persons have died of the disease out of the over 7,000 cases of infection. Most recently, o­ne probable case of Sars was reported in Colombia.

Discrepancies

Meanwhile, the Sars situation in China's equally populous neighbour, India, appears to be still under control although questions have been raised whether miscommunication between government officials and the country's WHO representative have resulted in inaccurate tabulation of Sars cases.

In a report yesterday, the Indian Express said several patients who have tested positive for the virus have not been listed as probable cases because their chest x-rays have been cleared.

In addition to this, the report also pointed out that o­n May 1, the WHO representative to India declared the republic free of Sars although the New Delhi government had o­nly the day before announced that the number of suspected cases of the disease had doubled from 10 to 20 cases.

Four days later o­n May 5, India figured again o­n the WHO list of Sars-reporting countries when a patient in Kolkata was listed as a probable case. The Indian health ministry yesterday reported another two probable cases in Gujarat and Chhattisgarh.

Under revised WHO case definitions, an individual who has high fever and breathing difficulties is considered a suspected Sars case. The person should also have had close contact with a diagnosed Sars patient or visited an area affected by Sars.

A probable case is o­ne where the patient displays chest x-rays consistent respiratory distress syndrome, tests positive for Sars coronavirus by laboratory methods, or has autopsy findings showing respiratory illnesses.

Singapore next?

The battle against Sars in other countries showed more promising progress after several locations were removed from the WHO's most-afflicted areas list.

Last week, Vietnam became the first country to be removed from the WHO local transmission list after the absence of new cases over a continuous 20-day period.

The organisation's advisory against travel to Toronto, Canada, was also lifted o­n April 30 after the critical 20-day period during which no cases of community transmission or exportation of cases were reported.

Singapore too has been keeping its fingers crossed that no other cases would surface in the next 10 days to qualify for exemption from the list, after passing more than a week without new cases being reported in the republic.

However, there remains concerns that Singapore might still be exporting cases after o­ne of its residents was declared a suspected case by the Malaysian health ministry yesterday after developing fever o­n arrival in Malaysia.

In a list of areas where local transmission of Sars had likely occurred over the past 20 days, the WHO has fine-tuned its list to include specific Chinese cities and provinces (Beijing, Tianjin, Guangdong, Shanxi, Hong Kong, Taiwan) and new areas such as Mongolian capital Ulan Bator and the Philippines.

Meanwhile, Malaysian public health announcements have continued to list the United States and United Kingdom as places where there have been reported cases of local transmission of Sars although the WHO had not issued travel warnings to these two areas.

The public health announcements are based o­n earlier reports of local transmission of cases in the two countries.

The Sars worm

In another development, the Sars disease appeared to have spread o­n to the cyberworld via a new computer virus named after the respiratory illness.

The 'Sars' worm, also known as W32/Coronex-A, is said to be delivered in email messages with subject lines, message bodies and attachments bearing names such as "Sars.exe", "corona.exe" and "Hongkong.exe".

"(The Sars worm) forwards itself to all contacts in address books and attempts to dupe innocent computer users into opening an attachment offering details o­n the current Sars epidemic," said MicroWorld Technologies Inc, a content security and IT solutions provider o­n its website.

However, MicroWorld categorised the worm as o­ne with a low probable risk rating.