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Santa Clara County Public Health Department News Conference

Aired April 1, 2003 - 16:30   ET


JUDY WOODRUFF, CNN ANCHOR: We want to focus now on that plane that flew from Tokyo to San Jose, California, held on the ground at the airport for almost two hours after several passengers and crew, we believe, exhibited symptoms of this Severe Acute Respiratory Syndrome, SARS, this illness that has cropped up in Asia in the last few weeks.
CNN's Rusty Dornin is there at the San Jose Airport, and there is a news conference, I'm told, that's also under way, the Santa Clara County Health -- Public Health Department. Let's listen to what they are saying.

DR. KAREN SMITH, SANTA CLARA COUNTY DEPT. OF PUBLIC HEALTH: ... we were concerned perhaps had Severe Acute Respiratory Syndrome or SARS. As is standard in medical emergencies, the San Jose Airport and airport police coordinated with (UNINTELLIGIBLE) the health department are responding.

The airport personnel decided that the safest thing to do for everyone was to segregate this airplane, so the airplane was taken over to cargo area D, at which point the patients -- the individuals on the plane who had been reported by the crew to be symptomatic, were escorted off the plane by paramedics, and into ambulances.

Three people were transported by ambulance from the airport to Valley Medical Center. Two of the individual who were on the plane, who had been reported as having had a cough, actually were evaluated by myself on the plane, and I did not feel that their presentation was, in any way, concerning for SARS, so I medically cleared them.

At that point, the plane, with all the passengers remaining on it was toed back to the terminal where the passengers were allowed to deplane in the usual fashion with one exception. And that is that each person on the plane, as they were deplaning, was given a copy of the CDC's travel alert that is given to every person coming back from mainland China or Hong Kong.

And the alert essentially says you may have been exposed to SARS. You should monitor your health for the next seven to 10 days, and if you develop respiratory symptoms or fever, you should see your physician.

And I also spoke briefly to the remaining passengers on the plane to reassure them and also to instruct them to read the health alert and follow its instructions if they do become sick, to seek medical care from their physician at their destination. QUESTION: Were the other passengers in any danger of contamination from the three that you suspect?

SMITH: Well, let me say that I don't actually know whether the three passengers who were taken off the plane actually have SARS or anything consistent with SARS. We were responding to a report that the airline crew was concerned about that. And because of the circumstances, we were not able to evaluate those individuals on site at the airport. And so we made the decision that they would be transported by ambulance to the emergency department where physicians could fully evaluate them.

QUESTION: What signs were they showing?

SMITH: The crew reported that the patients had respiratory symptoms including cough. And that's as much detail as we were provided.

QUESTION: What's the possibility -- they'll be at the hospital for how long? How long with the evaluation take?

SMITH: Well, it depends on the individual. I'm going to let Dr. Hurst speak to that. But basically, they'll have a standard medical evaluation as they would for anybody presenting with respiratory symptoms. And I'll let Dr. Hurst elaborate on that a little bit more.

Do you want to go on to let Dr. Hurst...

QUESTION: ... given how this has spread, any thought to spray (ph) all the flights from Asia?

SMITH: You know what? Let's let...

QUESTION: We're going to -- let's hear from the other doctor...

SMITH: ... do questions at the end.

DR. TAD HURST, VALLEY MEDICAL CENTER: OK. We have three patients in our emergency department here at Valley Medical Center, who were transported from the airport, as Dr. Smith explained. They are in isolation in our emergency department, and they are being evaluated by emergency physicians to see if there is any reason to be suspicious of them having SARS or any other significant respiratory complaint.

Right now, it's very clear that they are not -- at least they are not very ill, and exactly what the condition is and whether they have anything worrisome is still being determined right now.

QUESTION: How long will they be in isolation, doctor?

HURST: Do you want me to go ahead and do all the questions at once or do you want to -- how do you want to -- I don't want to get railroaded here.

QUESTION: Why don't we let Dr. Cody go, and then we'll do all -- and then the three of you can handle the appropriate questions.

HURST: All right.

DR. SARA CODY, HEALTH OFFICER, SANTA CLARA COUNTY: I just wanted to give you a quick update on the SARS cases in Santa Clara County. We now have a total of seven suspect SARS cases -- and I say suspect because all the cases are suspect since we don't have a way to laboratory confirm them.

So over the weekend, we had an additional three. At this point, the additional three that were reported to us are all on home isolation and doing well and no one is very ill. Thanks.

QUESTION: So, why don't all three of you stay there for questions.

QUESTION: Dr. Hurst, how long until you can confirm whether or not this is -- the three individuals from the American Airlines flight are SARS cases?

HURST: Well, the approach you would take in the emergency department is, first, of course, make sure they didn't have any life- threatening conditions or symptoms and then, after an appropriate evaluation, be able to see if they fit this case definition of being suspicious.

So I would suspect that, within a short time, they'll know whether the patients appear to be fine and can just go home with these same warnings that everyone else on the airplane was given -- that were given or whether some more work up would be needed.

And, as Dr. Cody, mentioned, there's not any test to find out if they have this or not. And so they would get a battery of tests, x- rays and things like that in the emergency department, at which time the decision would be made whether it looks like it was suspicious enough to carry on with further evaluation.

So within just a short period of time, we'll know which way, whether they are going to be fine and go home or whether they'll need more testing.


HURST: Yes, yes, yes.

QUESTION: What do you get from the x-ray? Do you look for typical symptoms of pneumonia or what kinds of signs do you look to that are seemingly confirming criteria?

HURST: Well, pneumonia would -- shows up by a change on the x- ray that would be consistent with pneumonia. And, of course, pneumonia can be caused by a lot of things besides this. And so, again, the diagnosis isn't made by an x-ray. The diagnosis is made by this whole constellation of travel exposure and the symptoms and then some evidence of pneumonia or respiratory difficulty, which might show up on the x-ray. QUESTION: ... were they visiting Asia? Did they live there? What can you tell us about the patients?

SMITH: We -- the -- are you talking about the individuals who were transported to VMC?

QUESTION: The three that are there right now.

SMITH: We actually don't have details on them. Their travel history, specifically where they transferred from to get on to this airplane, will need to be elucidated. That's part of the work-up that the emergency room physicians will be doing is finding out whether or not these people have actually been to areas where SARS is.

QUESTION: Do they appear to be local residence, however, that had traveled over there?

SMITH: Don't have -- oh, I have no idea where these people's residences are.

QUESTION: Dr. Smith, can you talk about the two patients you cleared medically on the tarmac?

SMITH: Sure.

QUESTION: Why did you...

SMITH: Actually on the plane.

QUESTION: Why did you clear them? What caused you to clear them there?

SMITH: OK. Well, what I did essentially was to do a screening for SARS. And remember that, as Dr. Hurst and Dr. Cody have both said, there's no diagnostic test. The way we consider somebody a suspect for SARS is they have to meet three criteria.

They have to have come from an area where there is SARS. They have to have temperatures greater than 100.4 degrees Fahrenheit, and they have respiratory symptoms.

These two individuals, the only thing out of those three criteria that they had was a dry cough, which they'd had for over two weeks and actually could pinpoint exactly why they had it to my satisfaction.

So medically, in my opinion, these individuals were not suspicious for SARS and were otherwise well, and that's why I cleared them.


HURST: Yes, well, there are two elements of the isolation. One is keeping any potential illness that they might have from spreading to other people. And that's simply done by putting a mask on the patient. And then the other is having people who are associated with them not be exposed if there is something to be exposed to. And so the personnel in the emergency department are using the standard recommendations that have come from CDC, including a face shield, mask, a respiratory mask, and gown and gloves. And so that if somebody did turn out to have something, it would be less likely they would pass it on to the personnel in the emergency department.

Now, as far as public health goes, Dr. Cody or Dr. Smith could answer that question better than I could.

CODY: I just want to note that what's going to be most important is the exposure history, which we don't have yet. We don't know whether these patients have been to a part of the world where SARS is being transmitted in the community. So that's an incredibly important part of the history.

Until that comes out and you can really say, we're not worried, you're not SARS or, gosh, you could be SARS, we err on the side of caution and take all the infection control precautions and do all the isolation, until we can say, your not SARS, you weren't even in a -- you know, maybe these people got on connecting flights. Maybe they originated in Tokyo, and there's not been SARS cases in Japan. So that would not be of concern.

QUESTION: What preventive measures should people take -- the general public take here in Santa Clara County to avoid being infected, if (OFF-MIKE)?

CODY: I think the predominant recommendation from the Centers for Disease Control and Prevention is that if you are considering travel to one of those areas that does have transmission of SARS and you can postpone it, that the best idea is to postpone travel.

So we don't have evidence of any transmission within Santa Clara County. Everyone in our county who's been a case has had a history of travel to one of these areas. So probably the most important thing that you could do is reconsider your travel plan to Hong Kong, Saigon, et cetera, et cetera.

QUESTION: Because you've dealt with seven cases so far, are you kind of becoming the California experts or the West Coast experts at handling this?

CODY: We are, by no means, the SARS experts. I don't know what the updated case counts are in other counties in California or the U.S. to date.

QUESTION: But because you've had previous cases, you're able to procedurally know, maybe have a better grip on how to handle it?

CODY: We're certainly comfortable with the case definitions, and our physicians in the community are certainly comfortable with calling us and discussing cases that they are concerned about. And that's working extremely well.

QUESTION: Can you give us an idea of how the people look in the emergency room right now? HURST: OK. OK. The people that I saw come into the emergency department look just fine.

QUESTION: Well, one of them waved at the cameras. Are they calm or are they scared? How would you describe (OFF-MIKE)?

SMITH: When they were at the airport?

QUESTION: Right. Or when they arrived at...

SMITH: Oh, when they had...

HURST: No, they looked calm and perhaps somewhat entertained by the whole adventure that they were going through.

QUESTION: Can you be more specific about what exactly you are going to be looking for over the next how many hours, a certain rise in temperature, more pneumonia symptoms, what?

HURST: There probably is not going to be particularly an observation period in the emergency department. As Dr. Cody said, you've got to identify the things that would make somebody possibly have it. And if they don't, then there won't -- and they are not sick looking, then they won't need anything. They'll go home.

QUESTION: ... check their travel history. Help us understand. Besides the travel history, what else are you looking for?

HURST: Fever -- fever and respiratory symptoms, including cough. It's really simple; it's really straightforward. And if somebody has the travel history, the respiratory symptoms and the fever, then they're going to get more evaluation, blood tests, x-rays, that sort of thing.

If they don't have those things and they are not sick looking, there's no reason -- of course, any person who comes to the emergency department, you're going to look to make sure they don't have something else besides this because, obviously, they are a lot more likely to have something besides SARS, even if they have these three things. And we're -- the big picture is to make sure that they are not sick and make sure there's not a public health issue and then go on from there.

QUESTION: Do the three of them already have a fever over 100.4?

HURST: I can't tell you that. I don't know that.

QUESTION: Is there a chance the flight crew overreacted to this with what's going on in the media and perhaps (OFF-MIKE)...

HURST: That's a public health question.

QUESTION: ... might be at play here?

SMITH: Well, I'm sure that the flight crew's knowledge about SARS played a role because, clearly, if they hadn't been knowledgeable about it, they wouldn't have even been concerned.

As to whether or not they overreacted, that's a difficult call to make. We don't know yet if any of these patients meet the SARS criteria. I do think it's an issue that's going to need to be discussed at the national level, however, because, as you can see, it took a tremendous amount of resources to do this this morning.

And if every flight coming back from Asia, on which someone is coughing, has to go through a similar process, I just don't see how that's feasible. And so I suspect that the Centers for Disease Control and others at the national level are going to be addressing that very issue.

And I think that it actually speaks well to the flight crew, on this particular airline, that everything was handled in a very professional, very calm manner. There was no hysteria; there was no attempt to sort of freak anyone out. I was actually very impressed by everyone's demeanor and manner.

It was taken very seriously and yet, still, the passengers' comfort and care was really looked to.

QUESTION: How did the other passengers react?

SMITH: How did the other passengers react? Mostly they were exhausted. They had come in from a very long flight overseas, overnight and were being made, then, to wait on the tarmac for an additional hour-and-a-half or so. And so when I spoke to them, they were very calm, very matter of fact.

QUESTION: Did the flight crew take any action to isolate some of the passengers they suspected might have SARS?

SMITH: I don't know the answer to that. I would direct you to American Airlines, who could tell you what went on in the plane before it actually landed in San Jose.


SMITH: Yes, I'm not sure what you mean by screen. First of all, that would be a decision that would be made by the Division of Quarantine, part of the Centers for Disease Control & Prevention, at the national level.

I do know that they are meeting flights from all the areas of the world that have (UNINTELLIGIBLE) SARS. And passengers who are coming off those flights are being provided with health alerts.

We've also heard stories that certain airlines and certain airports in other countries are screening passengers prior to their embarking on a flight. But that's not something that we have control over. And so that sort of decision, and what kind of approach will be taken, those are decisions that are made at a national level.

QUESTION: Doctor, you were talking about getting the location where these patients had traveled to. How specific are we talking? Is it anyone who's been anywhere in Hong Kong could be susceptible to SARS? Are there specific areas? How specific do you guys get or do you need to get?

CODY: Right now, this is a recently revised case definition from the CDC. Anyone who has been in Mainland China, which includes Guangdong Province and Hong Kong, anyone who has been in Hanoi, Vietnam or Singapore. Those are the areas.

So if someone says that they have been traveling in one of those areas, then they meet the travel history.

QUESTION: So you said Mainland China. Is it just Guangdong Province or...

CODY: No. It used to be just Guangdong Province and Hong Kong. And it's now been expanded to all the People's Republic of China.

QUESTION: OK. But Vietnam, it's just Hanoi. So if you just went to Saigon, you wouldn't be considered at risk?

CODY: Correct. At this point, the criteria is just Hanoi.

QUESTION: In some cases you talked about -- the three case over the weekend, it doesn't include these cases, correct?

CODY: Right. I want to emphasize, we don't know yet whether these three people being evaluated in the ER are cases or not.

QUESTION: (OFF-MIKE) where they were taken, how they were screened after arrival at the airport?

SMITH: Well, after arrival at the airport, the persons who were reported to be symptomatic were escorted off the plane by paramedics and transported by ambulance to Valley Medical Center Emergency Department. And I'll let Dr. Hurst tell you what's happening there.

HURST: OK. There are three patients in the emergency room, who came off this airplane, and they are, right now, being evaluated by emergency physicians to see if they meet these criteria, these three criteria, where they might be considered to be cases.

And right now, it's just too early to say anything about what's going on with them more specifically than that.

QUESTION: Do you know what's happening with the plane? Has it been released back to American or does it have to go through any kind of decontamination process?

SMITH: I don't actually know what's happening to the plane. If you called American Airlines, I'm sure they could tell you. I did direct them to -- the CDC has put out guidelines for how to handle aircraft after there have been suspected cases on there. But I don't know what American Airlines is doing. I recommend that you talk directly to them.

QUESTION: And, doctor, what is it about those three patients that you sent to VMC? What did they have specifically that made you think, well, they shouldn't be released, they ought to go to the hospital?

SMITH: Well, actually, I didn't evaluate the patients. What we were doing was acting on the report of the flight crew, which, at that point, we really don't have much choice about the captain of a flight -- of an airplane actually has control of that airplane. And they were sufficiently concerned that they wanted these people evaluated.

And I was unable to do that evaluation of those people in that setting. The two individuals that I did evaluate, I essentially evaluated only because they flatly refused to be transported to the emergency department. That would not have been my chosen way of doing it on the airline. I think it -- but, however, I was able to convince myself, after discussing with them, that they didn't meet the travel history and they also did not meet the symptom criteria.

Had I had any concerns, however, that they did potentially meet the criteria and needed a more complete work-up, we would have transported them to Valley Medical Center with the other passengers.


SMITH: I'm sorry?

QUESTION: Was that because (OFF-MIKE) in Bangkok?

SMITH: I can't answer that. I don't actually know if they were in Bangkok.

QUESTION: Do have any sense if flight crews members were among the three that did come in?

SMITH: The three individuals who were taken off the plane were all in civilian clothing. So if they were employees of American Airlines, they were being transported. I don't believe that any of them were working actually working on that flight.

QUESTION: Were they all from the first class section? We've heard they were all from first class.

SMITH: I have no idea where they were sitting. I saw them getting off the plane, so...

QUESTION: (OFF-MIKE) male, and what their ages are?

SMITH: Do you have -- you want to do that?

HURST: I can tell you that. There was a 70-year-old woman, a 50-year-old woman and a 74-year-old man, if I've got my facts correct.


HURST: I can't answer that question. I don't know.

QUESTION: You said a 70-year-old woman, 50-year-old woman and a...

HURST: A 74-year-old man.

QUESTION: Are they related at all?

HURST: I can't -- I don't know.

QUESTION: What races, do you know?

HURST: I don't want -- I don't think I should answer that.


CODY: Are you wondering if the general public should be concerned about this particular airline flight?

QUESTION: Just in general, (OFF-MIKE) getting -- it's obviously contagious (OFF-MIKE), so should we be concerned about this?

CODY: Right. We don't have any evidence to date of any transmission going on within Santa Clara County. Again, all of our cases are people who have acquired it through their travel. So I don't think that there should be undue concern from the general public.

QUESTION: Doctor, can you talk at all about why Santa Clara County is seeing such a large number of cases? These are -- alleged number of cases in the state are in a close count behind L.A. County.

CODY: I think it has to do with the demographic of the population in Santa Clara County. We have a very large Asian population, and a lot of them travel for business or pleasure. I think that's the primary reason.

QUESTION: And just to re-clarify, you said there are seven suspected cases in Santa Clara County. That doesn't include the three at VMC today, or does it?

CODY: It does not include the three at VMC. And I want to emphasize that those three cases -- those three patients haven't been fully evaluated, so we don't know whether they meet the SARS case definition or not.

QUESTION: Then the seven that you did talk about, you said they are suspected cases and there's no way of knowing, that there's no real diagnostic test for that. When do you know for sure that it's SARS or not, if they...

CODY: All of the cases that you've heard about so far, in Santa Clara County, and in California and in the U.S., are essentially all suspect SARS cases because there is no laboratory test to confirm them.

QUESTION: Is it true there are no reports of this (OFF-MIKE) passenger line flight? CODY: There are reports of other flights, not within the U.S., of transmission on an aircraft, which is why, I think, that the American Airlines' crew was so concerned.

QUESTION: Just to be really clear, the total number of people who are either suspected SARS (OFF-MIKE)...

CODY: Santa Clara County is reporting seven suspect SARS cases. As of Friday, we were reporting four. As of today, we are reporting seven.

QUESTION: Including these three?

CODY: No, it does not include these three because we don't know whether -- maybe these three were never anywhere other than Tokyo, so they may not be SARS cases at all.

QUESTION: Are any of the seven hospitalized are now (OFF-MIKE)?

CODY: Some of them were hospitalized and then released. And some of them were never hospitalized and were just put on home isolation.

QUESTION: So currently one case was hospitalized of the seven, only one?

CODY: Yes. One case...

QUESTION: ... case is not being disclosed.

CODY: Yes. One case remains hospitalized.

QUESTION: One case today...

CODY: Of our seven, one case remains hospitalized.

QUESTION: Of the others, are any of them being quarantined at home?

CODY: The other six are in home isolation, which means they stay in their home. They don't go to work; they don't go to school. And they wear a mask when in contact with other household members.

QUESTION: How long do they have to stay in that isolation?

CODY: Ten days.

QUESTION: Can you take us through a timeline, kind of...

WOODRUFF: We've been listening to health officials in Santa Clara County, California, the site of that American Airlines passenger plane that was kept on the tarmac for almost two hours while authorities came on board and, as you just heard, interviewed some of the passengers.



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