Since this Department received the first report of the SARS on January 2, through 4 months efforts, the epidemic has been put under effective control. The reported cases have dropped to 3 or less since 9 May. No new case was reported on 13 May for the first time.

As of 10 am, May 15, the cumulative number of 1513 cases were reported. Among them, 1342 cases have been discharged from hospital, accounting for 88.70% of the total number of the cases. At present the number of hospitalized patients is 115.56 died, accounting for 3.7% of the total. Now the number of hospitalized suspected SARS patients is 367.

The epidemic has been reported in the 15 cities among the 21 cities of Guangdong provinces, namely, Guangzhou, Jiangmen, Heyuan, Foshan, Shenzhen, Zhongshan, Zhaoqing, Huizhou, Dongguan, Shantou, Shanwei, Zhanjiang, Shaoguan, Zhuhai, Chaozhou.

The epidemic of SARS in our province saw a development of four phases.

From January 2 to 31, 2003 was the initial phase. A cumulative number of 101 cases was reported from the 6 cities, with 3 deaths; among them, 25 from Guangzhou, no death; 76 from the 5 cities of Foshan, Heyuan, Zhongshan, Shenzhen and Jiangmen, with 3 deaths.

The peak phase was from February 1 to 28. A cumulative number of 688 cases was reported from 7 cities, accounting for 45.47% of the total number of the reported cases, and among them 201 cases were health care workers; 404 cases, including 114 health care workers, were discharged from the hospitals; 28 cases, including 2 heath care workers, were dead. The main characteristics of this phase were as follows: Firstly, there were many new cases reported, with an average of 25 daily and on the peak day of February 14, it reached to 56. Secondly, there were many health care workers who were infected. Thirdly, there were mainly clustering cases in Guangzhou city, with a cumulative number of 655 reported cases, accounting for 95.2% of the cases in this phase, what¡¯s more, with 24 deaths, accounting for 85.7% of the death number of this phase.

The alleviative phase was from March 1 to 31. The number of the reported cases was 364, from 10 cities of the province, with an average of 12 reported new cases daily, accounting for 24.06% of the total reported number, among them 86 were new cases of health care workers; 507 cases, including 162 health care workers, were discharged from the hospitals; 9 cases, including 1 health care worker, were dead. The main characteristics in this phase could be summarized as follows: Firstly, the average number of daily new cases saw a drop by 52%, compared with that of the last month. Secondly, we found a bigger number of those who were discharged from hospitals than that of the new cases. Thirdly, the number of the health care workers who were infected represented a decrease of 57.21%, compared with that of last month; Fourthly the death tolls presented a drop by 67.86%, compared with that of last month.

From April 1 to 30, a cumulative number of 259 cases was reported (among them 34 were health care workers) with 11 death, with an average of 8.6 new cases daily. From May 1 to 15, a cumulative number of 101 cases (including 4 health care workers) were reported, with an average of 6.7 daily reported new cases. 5 cases died.

Up to now, case report came from 15 cities of the whole province. While no SARS case has been reported from the following six cities, i.e. Maoming, Yangjiang, Yunfou, Jieyang, Meizhou and Qingyuan. No new cases have been reported for a succession of over 20 days from the following 7 cities, namely, Foshan, Zhongshan, Shaoguan, Dongguan, Zhuhai, Shanwei and Huizhou. None from such cities as Shantou, Heyuan and Chaozhou for over 15 days.

2.Main measures

2.1. The central committee of the CPC and the State Council attached more importance and showed great concern to the situation

The epidemic outbreak in Guangdong province and other places has caused the great attention of the Central Committee of the Party and the State Council. The Standing Committee of the Political Bureau of the Central Committee of the CPC and the state council held special meetings to research and deploy the prevention and treatment of the SARS. Mr.Hu Jintao, the Party General Sectary and Chairman of the state, Mr.Wen Jianbao, the Premier, made important indications for several times and paid a visit to Guandong respectively to inspect the prevention and treatment of the SARS.

Great attention and support to the SARS control of Guangdong province were given by the Ministry of Health. Several leaders from the Ministry of Health successively visited Guangdong, inspected and guided the anti-SARS work. Several expert teams have been dispatched to Guangdong by the Ministry to assist the SARS control. The Ministries or Committees concerned have issued related files to strengthen the SARS control, which has strongly supported the control of SARS.

2.2. The provincial Committee of the Party and the Provincial Government represented resolute strategy and frontline

direction.

When the epidemic broke out, great emphasis was given by the provincial Committee of the Party and Provincial Government. The party secretary and the governor have been devoted to the SARS combat in person and been responsible for the whole situation. The leaders who are responsible for this field went all out for the work and the other leaders made concerted efforts with them. Combined efforts and unanimous solidarity were formed to promote the enforcing leadership and organization support system. According to the guideline of ¡°devotion to both the SARS control and development¡± raised by the Provincial Party Committee and Government, more than 10 departments, in Guangdong province, such as health, finance, medicine, police, price, information and foreign affairs took coordinative actions and fulfilled their own duties to maintain the normal social economic order and ensure a smooth and orderly development of SARS control.

2.3. The health sector confronted the situation calmly and presented effective measures.

Under the leadership of the Provincial Committee of the Party, the Provincial Government and the Ministry of Health, Guangdong provincial Health department, in terms of politics, stability, general situation and science, united the thought and rapidly organized the health authorities at different levels, health care sectors and health care workers to be devoted positively to the SARS control. They took initiative, turned the war of suffering into initiative and contained the epidemic in time effectively.

2.3.1. A quick response and rapid deployment

On the morning of January 2, Guangdong Provincial Health Department received one report about some unclear pneumonia cases from Heyuan city. On the afternoon of the same day, an expert team was dispatched to Heyuan city to investigate and take the samples. After receiving the report from Zhongshan on January 19, the Department sent the expert team again to Zhongshan to have a locale investigation. They drafted an investigation report about the diseases in Zhongshan in regard of the epidemiological characteristics, clinical symptoms, therapeutic principles and preventive measures, etc. For the first time they put forward the opinion that this disease should belong to the atypical pneumonia without definite causes, but still with the possibility of some virus as causative agent.

On January 23, Guangdong Provincial Health Department issued the ¡°Notice on Issuing of the Provincial Expert Team's Investigation Report about the Atypical Pneumonia¡±. The Notice required the municipal health bureaus, health and medical institutes at different levels to attach more important attention to the disease, to organize the health care workers to study the ¡°investigation report¡± carefully and master the therapeutic principals and measures for prophylaxis, to enforce the construction and management of the ICU, to isolate and report in time once the patients were found.

On February 2, the Department held an urgent meeting with Guangzhou Municipal Health Bureau to research the preventive and curative measures for the atypical pneumonia of Guangzhou. On February 3, the Department issued the ¡°notice of preventing and treating the unclear pneumonia¡±, setting up the provincial coordinative team for control of the atypical pneumonia and its office, the provincial guidance team of the medical rescue experts, provincial guidance team of the epidemiological investigation, provincial technological guidance team of the etiological test. The Notice requested the municipalities to establish the related teams quickly for the prevention and treatment, and to provide a good therapy for the patients and do well in rescue and epidemic reporting. It demanded to manage the disease temporarily in reference with the B-type infectious diseases mentioned in the ¡°the law of the prevention and treatment of infectious diseases¡±, to implement the daily reporting system and zero reporting system.

2.3.2 Six work guidelines were stipulated timely to strengthen the direction of the SARS control.

While fighting the atypical pneumonia, Guangdong Provincial Health Department had stipulated the ¡°Guidance For Hospitals In Guangdong Province To Admit And Treat Patients With Atypical Pneumonia¡±,  ¡°Guidelines For The Control And Prevention Of Atypical Pneumonia In Schools, Child Card Canters and Kindergartens¡±, ¡°Guidelines For Atypical Pneumonia Prevention And Control In The Public Of Guangdong Province¡±. ¡°Guidelines For The Control And Prevention Of Infectious Atypical Pneumonia In The Public Transportation Tools¡±, ¡°Guidelines For The Prevention And Control Of Infectious Atypical Pneumonia In The Enterprises (Factories) of Guangdong Province¡±, ¡°Guidelines For The Disinfections Of The Corpses With Infectious Atypical Pneumonia¡±. Therefore a series of comparatively mature measures for prevention and treatment have been summed up.

2.3.3. To spare no efforts to rescue and treat the patients, improve the recovering rate and decrease the mortality

Firstly we put forward the preventive and curative measures of ¡°four earlies¡±, namely, early detection, early reporting, early isolation and early treatment, which were the precious experience summarized in Guandong, in the clinical practice to prevent and cure the atypical pneumonia, and are the keys to improve the recovering rate, decrease mortality rate and shorten the course of the disease.

Secondly we stipulated the definite diagnostic criteria. We set down the criteria of clinical diagnosis for the cases of atypical pneumonia, for the severe cases of AP, for the children with AP, the reference criteria for the discharged cases with AP respectively.

Thirdly We summed up the effective curative plans of combination of the TCM and western medicine. We instituted ¡°The Recommended Curative Plans for the AP¡±. In light of different disease conditions, the comprehensive curative measures, such as symptomatic treatment, preservation of the organic functions, prevention and treatment of the bacteria infections, application of the glucocorticoid, anti-virus agents or immunity strengthening drug of the TCM and the western medicine, and so on, are adopted in practice. Especially we summarized the successful experience to rescue the severe cases, which has been proven to be very effective in practice.

Fourthly we rescued and treated the patients in a relatively intensive way. We designated some hospitals to treat and rescue the patients and appointed Guangzhou Institute Or Respiratory Diseases to admit and treat the severe cases.

Fifthly we set up the diagnostic room especially for the fever patients. We insisted the responsible system of first diagnosis. Once the suspected AP patients were found, they should be admitted and treated in the special observation room, which was of importance to the early detection of the AP patients.

Sixthly we strengthen the training of the health care workers. In order to let the HCW master the preventive and curative knowledge thoroughly, from the very beginning we took the training work as one of the important measures, and extended it to the township hospitals, village health stations and private clinics. Through training to the different levels the preventive and curative ability of HCW have been intensified, which promotes the thorough implementation of the preventive and curative measures.

2.3.4 To put the preventive measures into effect and contain the epidemic development.

Firstly we enhanced the epidemiological investigation. We declared the CDC at different levels to have a detailed epidemiological investigation towards every new case and have a tracing and observation to those who have close contact with the patients.

Secondly we strictly carried out the epidemic reporting system of ¡°daily reporting¡± and ¡°zero reporting¡±. We ordered the health care sectors at different levels to strengthen the epidemic surveillance, verify the epidemic, report honestly, never to delay, cozen and omit reporting.

Thirdly in according with the principles of being practical and realistic, respecting the science, careful distinction and holding the pass strictly, we enforced the differentiated diagnosis about the infectious atypical pneumonia.

Fourthly we adopted such comprehensive preventive measures as isolation and treatment of the patients on the spot, a good infection on the environment of the disease area, a close medical observation to those with close contact with the patients, and control of the crossed infection in the hospitals. With the adoption of comprehensive preventive measures the control of crossed infection in the hospitals has achieved a very prominent effect.

Fifthly we intensified the prevention and control on the key crowd, community, the public and the schools.

2.3.5 To do well in the SARS control in rural areas, to prevent the epidemic from spreading among the rural areas.

Firstly we established the responsibility systems the levels of the county, town and village, stipulated and perfected the preventive and curative plans for the SARS and set up the urgent medical teams.

Secondly the government gave special financial support to facilitate the medical sectors in the eastern, western and northern parts of Guangdong province. The farmers (including farmer-turned workers) with SARS were free of charge in the whole course of isolation and therapy, besides, they could enjoy free lodging and accommodation.

Thirdly we organized and carried out the activities of popularization of education on the SARS control, publicity of the laws about the SARS control even in the families of the villages.

Fourthly we adopted prevention and treatment with the collective and concerted efforts. The suspected should be reported to the township hospital to have a further tracing and examination.

Fifthly we organized the medical experts to train the health care workers and the grass-root cadres of the villages.

2.3.6 Compatriotic health campaign, health education on the prevention and treatment of SARS and all man keep-fit exercise have been carried out.

Efforts have been input in the movement of improving environmental sanitation, general cleaning, and to promote the consciousness of hygiene and health protection of all people, to build up healthy body to upgrade the resistance against diseases.

2.3.7 Joint forces to actively carry out scientific research

Experts of clinical medicine, epidemiology and causative agent were organized to form a joint force group to solve the tough task of source and causative agent. In the early period the possibility of pneumonic plague, pneumonic anthrax, leptospirosis, epidemic hemorrhagic fever and F5N1 has been excluded definitely. The coronavirus was identified from the sample of a SARS patient, and was sent to the Ministry of Health for confirmation. This has contributed greatly to the finding of causative agent. To actively develop fast diagnostic reagent of SARS. During the first visit of WHO expert team in Guangdong, the team believed that the epidemic surveillance system in Guangdong was complete, sensitive, the epidemic report was true, the control measures were very good and the experience was worth spreading. In the recent visit of another WHO expert team, the team cooperated well with Guangdong counterparts to analyze the epidemiological data, and to prepare two papers to be published on international journal of medicine.

3.Further measures to be taken

3.1. To keep on the principle of early detection, early and early isolation and early treatment. To conduct close observation and tracing of close contact persons. To try every effort to stop the transmission chain of SARS.

3.2. To strengthen the surveillance of schools, factories and communities to prevent clustering cases. To continue health education and compatriotic health campaign.

3.3. To strengthen the prevention and treatment in rural areas, especially health education and health publicity to take strict precaution against the spread of epidemic.

3.4. To strengthen health institutions at the grass-root level, especially the construction of emergency facilities and ICU in those of hilly developing areas.

3.5. To continue to enhance rescue of further reduce death rate.

3.6. To continue the protection of health care workers.

3.7. To further strengthen scientific research to facilitate research and production, and clinical use of early test reagent, clinical protocols and medications.

3.8. To strengthen Guangdong, Hong Kong, Macao, Taiwan and international exchange and cooperation.

3.9. To organize experts to study and summarize the epidemic trend and features of SARS, and to adopt new measures to further control diseases.

3.10. To enforce the frontline surveillance of floating population. In the future, we will try our best to stop the transmission chain of SARS. We shall have no relaxation to strengthen the fruit, and to prevent the reoccurrence and to win the total victory of the combat against SARS.

By  The Department of Health of Guangdong Province

Editor: James