WASHINGTON, April 22 (UPI) — Although the Chinese government now appears to be cooperating with international officials to control its outbreak of severe acute respiratory syndrome, the World Health Organization said Tuesday it still has concerns some of China’s provinces might not be equipped to deal with the disease.

China reported 339 previously undisclosed SARS cases in Beijing over the weekend after WHO officials accused the government of covering up the extent of the outbreak. Also, the minister of health and the mayor of Beijing were fired for their role in downplaying the number of SARS cases.

“Very clearly, China is now really ready and opening up on SARS,” Dr. Henk Bekedam, the WHO’s chief representative in the country, said during a teleconference from Beijing. “But at the same time we are also quite concerned about the other provinces,” he added. The main areas of concern are the “poorer provinces,” because they have fewer resources and “the public health system has collapsed over the last 20 years” because the government has not adequately funded it, he said. China’s poorer areas typically are its 12 western provinces, he said.

There have been indications of cases in some of those provinces, including western Guangxi, northern Gansu and Inner Mongolia. The disease also might have spread to several other provinces, such as Shanxi, Henan and Ningxia.

Bekedam said he “very clearly mentioned” to Chinese officials the central government needs to provide “sufficient human and financial support” to these provinces to help them contain SARS.

The government has said it is sending teams to all the provinces to help them deal with SARS. Also, the government has authorized the hiring of 2,500 people to monitor those infected and trace their contacts.

WHO officials are working closely with the government “to see how we can support China in dealing with SARS,” Bekedam said. “If China is not dealing with SARS, it will be very problematic to deal with globally,” he added.

China, where the disease is thought to have originated in November, has the largest number of SARS cases of any country affected by the disease. Of the 3,947 cases reported worldwide so far, more than half have occurred in China. To date, 482 of the Chinese cases have occurred in Beijing. Officials reported six new deaths from the disease Tuesday and 42 new cases, bringing China’s total to 92 SARS-related fatalities and 2,001 infections.

Bekedam said it still is possible the SARS situation in China could be contained but there is definite concern about whether the country will be successful in that effort.

“It will take longer in China than in many other countries where the health system is stronger,” he said.

Officials also are wary because they know that a few cases could start an outbreak, he said.

All hospitals in China, including the military hospitals — which were not reporting SARS cases before — now are reporting cases of the disease to the WHO, Bekedam said, adding it will be a “few weeks before we understand the extent of the outbreak in Beijing.”

About 229 people have died from SARS worldwide, and the current figures indicate the disease could be slightly more fatal than previously thought, Bekedam said.

Health officials from certain countries are reviewing the current cases and deaths from the disease and it appears the fatality rate might be around 5 percent, rather than 4 percent as previously reported, he said.

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, speaking during a separate teleconference from Atlanta, said the calculated fatality rate actually is about 5.9 percent.

“You may see the mortality rate go up as we go forward,” Gerberding added. That will be due in part to a more precise definition for a SARS case rather than the disease getting more virulent, she explained.

A tighter definition will eliminate some suspected cases, which will yield fewer cases overall, so the percentage rate of deaths could increase, assuming all are due to SARS, she said.

The number of cases in the United States to date are 39 with no reported deaths. But Gerberding urged healthcare workers to remain vigilant and continue to identify and isolate cases quickly in order to keep the disease from spreading.

“We don’t know the reasons that we’ve been lucky so far,” she said, “but we’re not taking any chances and we need to work hard to isolate cases when they present.”

Gerberding noted the CDC plans to begin distributing cards warning about SARS at land entries at the U.S. northern border, where travelers might be coming into the country after visiting Toronto, Canada.

Toronto has struggled to control the disease and Canadian officials reported seven more cases Tuesday, bringing the country’s total to 139 people infected and 13 deaths.

The CDC previously had been distributing SARS warning cards at airports to travelers arriving in the United States after having been to areas with a high prevalence of the disease, such as some of the Asian countries. But distributing the cards at land-entry points is something new and Gerberding said it will take some time before the effort becomes fully operational.

CDC officials will focus on two major bridges running from Detroit and Buffalo into Canada and two other smaller thoroughfares. These four roadways are where most land-based travelers from the Toronto area enter the United States, she noted.

Hong Kong continued to be hard-hit by SARS, reporting five more deaths and 32 new cases, bringing its tally to 1,434 cases and 99 deaths — the most of any country.

Singapore’s total stood at 186 cases and 16 deaths Tuesday after it quarantined hundreds of employees of a fruit and vegetable stand after three cases of SARS were seen in workers there. To date, as many as 22 people might have become infected due to the outbreak at the market.

Copyright 2003 by United Press International. All rights reserved.

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