People with illness symptoms urged not to fly

In its first warning that suggests a deadly flu-like illness can be spread on airplanes, the World Health Organization (WHO) said yesterday that passengers with symptoms of the disease or who might have been exposed to it shouldn't be allowed to fly.

Airlines flying out of cities where the mystery disease is spreading should question passengers at check-in desks for signs of severe acute-respiratory syndrome (SARS), the global-health agency said.

"If the passengers are sick, health workers will be recommending to the airline that they not board the plane," said Dr. David Heymann, WHO's chief of infectious diseases.

The advice from the WHO is directed at flights leaving Toronto; Singapore; Hanoi, Vietnam; Hong Kong; Taiwan; Beijing, Shanghai and the Chinese province of Guangdong, where the earliest cases of SARS occurred.

While suspected cases have been reported in more than a dozen countries, including the United States, the illness is not considered to be spreading in most communities. The WHO says 1,408 people have fallen ill with SARS and 53 people have died; that doesn't include a death that Hong Kong officials reported yesterday.

The United States has 51 suspected cases, said Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention (CDC).

The death rate has remained around 4 percent since the outbreak began, experts said. There have been three deaths in Canada and none in the United States.

Scientists yesterday appeared to be zeroing in more precisely on the cause of the illness, which several labs report is a new type of

coronavirus. That virus is second only to rhinovirus as the cause of the common cold.

However, there is some evidence that a second germ, the paramyxovirus, also could be at play, perhaps in tandem with the coronavirus, WHO experts said.

Yesterday's advice from the WHO was the latest broad attempt at slowing the spread.

"The recommendation still remains that there should be no interruption in travel or trade, but we're shifting a little bit more responsibility to countries where there are these infected areas," Heymann said.

Gerberding encouraged Americans to defer vacations to Asia if possible.

"This is now a global epidemic and potentially a global pandemic," she said.

The WHO has teams of infectious-disease experts in affected countries. But some places continue to have problems containing the disease, which apparently got its start last winter in Guangdong. It is believed to be a virus and there is no treatment for it, although medicines are being tested.

In Hong Kong, where at least 10 people have died, the government said it would quarantine more than 1,000 people and close its schools. Weekend concerts by the Rolling Stones were postponed.

In Ontario, Canada's most populous province, health authorities declared a state of emergency and called for a 10-day quarantine of people who had visited a hospital where the outbreak spread — a number that could be in the thousands.

Canadian Health Minister Anne McLellan said she is taking the WHO screening recommendation "very seriously" and that her office has already started working with the airlines.

Heymann said experts remain convinced the infection is spread only by very close contact through coughing and sneezing.

However, some people may have a less severe bout of the illness, or may be infected but showing no symptoms, he said.

The new airline advisory also recommends a tougher approach on board if the flight crew detects someone becoming noticeably ill with fever and breathing problems.

"The passenger should be as isolated as possible from others and should be asked to wear a protective mask," WHO spokesman Dick Thompson said.

Sick passengers also should be assigned a personal toilet on board, he added. The aircraft captain should radio ahead to the airport to alert health authorities and the passenger should be quarantined, the new recommendations say.

The WHO is not suggesting all air travelers wear masks, as some in Asia have done recently.