SARS wars
Although there are no reported cases of SARS in Egypt, measures have been implemented at all points of entry to ensure the country remains SARS free. Rehab Saad investigates
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Travellers face another yet precautionary procedure at airports these days: having their temperatures taken in an effort to identify SARS cases
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The appearance of Sever Acute Respiratory Syndrome in southern China was announced to the public in March, although there was little or no coverage in the Egyptian media until after the fall of Baghdad on 9 April. Media attention up until then was focussed on the war on Iraq, while SARS continued its tour through the rest of the world. Now, however, it is a different story. Every day we are confronted with death tolls, numbers of cases, updates on the fight against the spread of the disease, development of a vaccine, images of a masked Chinese population and never-ending interviews with figures from the World Health Organisation (WHO).
An official Egyptian statement on the health of the nation was only made, however, with the proliferation of e-mails containing the information that 25 cases of SARS had been discovered in Cairo. Minister of Health Mohamed Awad Tageddin repeatedly issued statements to the fact that not a single case of the disease had occurred in Egypt.
This is in conjunction with assurances from officials that all manner of measures are being implemented to prevent the disease from entering the country. Up-to-date technology is being employed to screen passengers entering Egypt, while doctors are utilising the media to forward information on the disease and measures to prevent it from spreading.
SARS is a pneumonia-like respiratory illness which now affects 28 countries. The symptoms include high temperature (higher than 38 degrees Celsius), headache, general feeling of discomfort and body aches. Mild respiratory problems may also be experienced, and the patient may develop breathing problems after two to seven days.
SARS is spread via droplet infection, i.e. through coughing or sneezing, and can be transmitted through close contact with a SARS patient, contact with respiratory secretions of a SARS patient, or through surfaces which have been contaminated with infected droplets.
According to World Health Organisation (WHO) reports the number of probable cases as of 4 May totalled 6,234 while 435 deaths have been reported in a total of 27 countries. A coronavirus is the probable cause of the disease. This is the group of viruses to which the common cold belongs, and causes mild to moderate respiratory illnesses in humans and is associated with respiratory, gastrointestinal and liver disease in animals.
At a conference for African ministers of health which convened in Libya earlier this month, Egypt presented a paper on epidemics, which included the SARS disease. The paper stressed the fact that African countries should exercise strict precautions and observe all prescribed precautionary measures to ensure African countries and Egypt remain SARS free.
"We can only adhere to the precautionary procedures and monitor visitors to Egypt, those arriving from both infected as well as non- infected countries," said Tageddin.
Visitors to Egypt, explained Tageddin, are classified according to three categories. The first group contains "probable cases", i.e. travellers from any of the 28 infected countries. These travellers are examined in one of the quarantine departments located at the 31 points of entry to Egypt. The second category consists of travellers exhibiting possible SARS symptoms, namely fever, dry cough or difficulty in breathing. "These cases are immediately isolated for examination and monitored for a period of 10 days, which is the SARS incubation period," Tageddin said.
The third category contains travellers exhibiting symptoms that are "certain" SARS symptoms. The possible carriers are X-rayed to confirm their status. "These cases are isolated immediately and admitted to hospital," Tageddin said, adding that there are 39 specialised chest hospitals in Egypt in addition to a large number of fever hospitals. "There is full cooperation between the ministries of health, transportation and the Civil Aviation Authority to prevent the disease from entering Egypt," he stressed.
Travellers entering from any country must first pass through a quarantine section before completing arrival formalities. Passengers arriving from one of the infected countries are examined thoroughly, have their temperature taken, and are required to supply detailed information regarding their movements for the following 15 days, including name, address and telephone contacts.
Passengers whose journeys originated in non- infected countries must show their passports to ascertain if their journey included a stop-over in an infected country.
"A passenger suspected of being a SARS carrier, [who has a fever or cough], is examined immediately," assured Dr Hassan Shabaan, head of the quarantine department at Cairo International Airport.
Shabaan told Al-Ahram Weekly that even though EgyptAir has suspended flights to Beijing and Montreal, passengers from Southeast Asian countries could enter Egypt indirectly via Europe, Japan, Singapore, Dubai or on other international airlines. "These passengers are also subject to a thorough medical check-up. Egyptians returning from any of these countries are given the same treatment to make sure they are not carriers," he stressed.
Even before the passengers exit the plane a quarantine doctor boards the aircraft to coordinate with the aircraft crew regarding the condition of the passengers and whether there may be any suspected cases on board.
"We are also thinking about stationing a quarantine doctor on the aircraft during flights, but this option is currently under review," Shabaan said.
Passengers exiting the craft, particularly those entering from Southest Asian countries, are sprayed with an aerosol disinfectant.
"There are strict instructions for any passenger refusing to be examined to be immediately placed in isolation for 10 days before being subject to a full examination prior to entering the country. The quarantine doctor has judicial authority to implement appropriate measures in order to prevent diseases from entering the country. There are no exceptions," Shabaan said.
Certain procedures are also adopted on board. The airline crew has the power to isolate passengers exhibiting SARS-like symptoms from other passengers, as well as providing them with a separate toilet for the journey, Rashad Rifaie of EgyptAir told the Weekly. These passengers are also required to wear masks, which are currently available on all flights. The crew then informs the quarantine department, via the traffic control tower, to receive the passenger as soon as the aircraft lands.
Egypt has 31 points of entry including airports, ports and road entry points. Officials from the Ministry of Health claim that the same procedures are in place at all entry points, which are strictly monitored to prevent the disease entering the country.
In addition to these measures, the Ministry of Health has circulated information on the disease to all Egyptian hospitals. Suspected cases are required to be reported immediately to the department of health.
The ministry has also asked Egyptians to avoid travelling to Hong Kong, China, Singapore, Taiwan and countries in Southeast Asia. Those who travel to these areas for business, such as pilots, airline crew and sailors, should avoid working in closed areas lacking proper ventilation. "If they notice any SARS- like symptoms such as fever, sore throat, difficulty breathing or any symptoms associated with the respiratory system, they must go to the nearest hospital for a full check-up," Tageddin advises.
SARS has had a negative impact on the economies of Southeast Asia, and the same is expected to happen in the Middle East, particularly in the tourism and aviation sectors, which have already been hit badly by the war in Iraq.
China had recently been targetted as a potential source of tourists to this country. Tourism officials from both countries have already met and a promotional campaign was launched in China early this year. Egyptian officials saw this market as a potential for making up tourist numbers lost from Britain and America, the more traditional tourist markets.
"We were just starting to target China, Korea, Japan and Malaysia. They were promising markets and we wanted to organise promotional road shows. This is a thing of the past, now that these are 'infected' areas," said Riad Qabil, secretary-general of the Egyptian Chamber of Travel Agents. He added that EgyptAir has even stopped its direct flight to Beijing as well as its Tokyo link.
"Although tourism from Southeast Asian countries has been affected, I believe that the traditional markets might not be affected as long Egypt remains free of the disease and implements appropriate preventive measures," Qabil explained.
Some tourism experts even think the number of Arab tourists may increase this year, more than in any other year, as many used to travel in summer to places like Malaysia. "With the spread of the disease in these countries and the difficulty of obtaining visas for traditional European and American destinations, Arabs might stay in the Middle East," said an expert who requested anonymity.
The aviation sector also has its share of casualties, not only because of SARS, but also because of the US-led war on Iraq that started in March -- the same month SARS hit the headlines.
A large number of airlines have cancelled outright their flights to Southeast Asian countries, while others have reduced their of trips. EgyptAir has put a stop to direct flights to Beijing and Montreal, although according to Rifaie of EgyptAir, the Cairo-Montreal line is expected to resume by mid-May due to the WHO reclassification of Canada.
