Sludge Watch ==> SARS - what is protocol for fecal wastes from SARS patients?

[Maureen Reilly]

Cover Story Toronto Free Press

Aerosols, feces, sewage, SARS
People got SARS from toilet flushing
By Judi McLeod  Monday, March 17, 2008


On Thursday when Hong Kong shut all kindergartens and primary schools, 
affecting more than 500,000 children, Toronto environmentalist Maureen 
Reilly, BA sent an email to Scott Dowell, Coordinating Officer for Global 
Health, Center for Disease Control (CDC) in Atlanta, Georgia.

Reilly, who is researching the proper protocol for managing fecal waste from 
Severe Acute Respiratory Syndrome (SARS), has for the past decade studied 
the issue of pathogens in municipal effluents and land applied sludge 
wastes.


“I am wondering how SARS (or avian flu) fecal waste should be managed in a 
hospital setting,” she wrote Dowell.

Citing issues that include the aerosolization of pathogens into the washroom 
(i.e. Amoy Gardens (Hong Kong); the infection of sewage treatment workers; 
the release of pathogens into receiving waters in sewage effluents, the 
application of sludges on farm and food chain lands and the development of 
more virulent forms of the pathogen through the sewage treatment plant 
processes, the environmentalist asked “Shouldn’t the fecal waste in these 
cases be autoclaved?”

One of the most effective methods for the destruction of all types of 
micro-organisms, the autoclave is a pressurized, steam heat vessel used for 
sterilization.

“I did some SARS work long ago but didn’t focus on fecal waste,” Dowell 
wrote back to Reilly.  “And why are you interested in SARS at this point?”


“The common toilet,” says Reilly, “is not a disinfection machine.”


“I now have emails from Dr. Donald Low, microbiologist in chief at Toronto’s 
Mount Sinai Hospital and from the CDC saying that the protocol for 
SARS-infected feces is the toilet,” Reilly told Canada Free Press (CFP).  
“But reports prove that flushing toilets aerosolized the pathogen, infecting 
hundreds.

“Even one SARS hospital reported that the nurses in two infected wings 
shared a washroom.

“What is going on?  Don’t they read their own reports?

“And why is it that in 2003—the year of SARS—Toronto spread only 3% of its 
sludge on farmland”
“Do you think they decided not to because of SARS, but couldn’t tell anyone 
because how could they get the SARS across the border to the US landfill 
they were using?”

The respected environmentalist whose work appears in the Canadian Journal of 
Infectious Diseases, (see full report here) could have easily written back 
to the CDC when asked why she was interested in SARS at this point. “No 
better time to be interested in SARS then now”.

The World Heath Organization banned Toronto as a travel destination in 2003. 
  Forty-four people died from SARS when Toronto resident Sui-Chu Kwan, 78 
and her husband returned to Toronto from Hong Kong.  The couple had stayed 
at the Metropole Hotel, which was believed to be the source of the outbreak.

In addition to closing schools, the Chinese government last week named Yuen 
Kwok-yung, a University of Hong Kong microbiologist who helped discover the 
cause of the 2003 SARS outbreak, to head a panel charged with finding 
whether flu strains are mutating into a more lethal form.

Hong Kong remains on flu alert after the unexplained deaths of four young 
children with flu-like symptoms.
“Worried residents are donning surgical masks, flooding hospital waiting 
rooms and buying up supplies of antibacterial soap as they remember the SARS 
outbreak that killed 299 people five years ago.” (Bloomberg.com, March 16, 
2008).

There is no proof that the flu-like symptoms that killed four Hong Kong 
children was SARS.  But neither is there any proof that it is not SARS or 
proof that SARS, which disappeared in 2003, won’t be coming back.

“When SARS first happened, it was sporadic and no one expected it to become 
a disaster,” said Wong, who also has a 6-year-old daughter.  “The recent 
deaths are haunting me.”

The first in the current spate of deaths was that of a 21-month-old boy on 
Feb. 24, the city’s Health Department said.  Two of the victims tested 
positive for influenza A, although the disease hasn’t been identified as the 
cause of their deaths.  Two other children died after suffering flu-like 
symptoms, though tests haven’t yet confirmed the presence of influenza A, 
the subtype that causes seasonal outbreaks of the disease.

“Hong Kong is simply experiencing a seasonal flu outbreak,” said peter 
Cordingley, the Manila-based spokesman for the World Health Organization’s 
Western Pacific region.

“If you look back to SARS, you can understand why there is a high level of 
anxiety in Hong Kong among the public at the moment,” he said.  “There is 
nothing exceptional n what is happening in Hong Kong at the moment.”

But microbiologists are tying to find whether flu strains are mutating into 
a more lethal form.
Surely the time to decide the proper protocol for the management of SARS 
patients’ fecal waste should be determined before another potential 
outbreak.

“We know that the Corona virus (SARS virus) lives up to 24 hours on 
surfaces,” says Reilly.  “We know the feces are infectious.  We know 
hundreds of people in Amoy Gardens got SARS from aerosols from a flushing 
toilet.
The same people at risk during the 2003 SARS outbreak are still at risk.

“There are risks to patients and hospital staff from SARS virus aerosolized 
in the toilet (both inhaled and from later touching surfaces).

“There are risks to sewage treatment plant workers.  There are risks to the 
environment if the virus is released into surface waters, onto farms in 
sludges, and we know that there is a risk of infecting not only people but 
also animals.

“We also don’t want those virulent diseases sharing that virulent DNA and 
creating new pathogens in the sewage treatment plant.  DNA is 
shared—increasing virulence and antibiotic resistance factors during the 
sewage process.

“The infectious fecal waste should be destroyed in all instances—not passed 
along to workers, and into the environment.

Some of the answers in mitigating the SARS risk to human life lie in the 
past.

“I was told by an Environmental Health Officer in Durham Region that after 
the SARS outbreak in 2003, all the SARS patients home addresses were tracked 
down by health authorities to see if they lived on a septic system, to see 
if the system had been emptied, and if so, where was the fecal material 
placed.

“So the Public Health Department WAS worried about the potential of passing 
on SARS through placement of fecal waste into the environment.”

Meanwhile, we need to think these things through in the event of another 
SARS outbreak.
“The common toilet,” says Reilly, “is not a disinfection machine.”

http://canadafreepress.com/index.php/article/2261

...........................
Epidemiology:Volume 15(4)July 2004p S207
A LARGE URBAN OUTBREAK OF SARS: A SPATIAL AND METEOROLOGICAL ANALYSIS
[The Sixteenth Conference of the International Society for Environmental 
Epidemiology (ISEE): Abstracts]
Corbett, Stephen


"The SARS CoV is a new virus which is clearly capable of causing a severe 
respiratory illness but with the additional and unusual property that it is 
excreted in very high concentrations in the gut. This characteristic is 
likely to have been the underlying cause of the building related outbreaks 
in Amoy Gardens and in other locations in Hong Kong. This study provides 
circumstantial epidemiological and environmental evidence that a faecal 
aerosol generated by a common plumbing fault was the likely cause of this 
outbreak. Air dispersion modelling suggests that viral concentrations even 
with small releases at distance can be high. If confirmed these results have 
important implications for the current controls of faecal aerosols in 
plumbing and building systems."

http://www.epidem.com/pt/re/epidemiology/fulltext.00001648-200407000-00550
.htm;jsessionid=HpFXPPLBWVLzGSTFQJ8GFZnDsNSlQ1Dz6T9plJSLv34NmRyLpNWh!592949099!181195629!8091!-1
.........................

HARVARD GAZETTE ARCHIVES


Airborne transmission worse than thought
Call to sanitize air in airplanes, schools, and hospitals



Current thinking on how most communicable respiratory infections are spread 
- by large droplets over short distances or by coming in contact with 
contaminated surfaces (face-to-face) - needs to be reconsidered, according 
to Donald Milton, lecturer on occupational and environmental health at the 
Harvard School of Public Health and co-author of a perspective in the April 
22 issue of the New England Journal of Medicine. The perspective coincides 
with the report by Yu et al. in this issue on airborne transmission of SARS.

The authors argue that in certain cases, illustrated by the SARS Amoy 
Gardens apartment complex outbreak, where aerosolized, fine-particle spread 
of SARS was implicated, aerosol transmission of respiratory infection has 
been overlooked. This is due in part because the most widely recognized 
aerosol-transmittable diseases, measles and tuberculosis, are spread by 
airborne transmission and have been controlled, and because infectious 
aerosols are extremely dilute with fine particles that are difficult to 
collect and culture, obscuring their role in disease spread.

Calling for a critical re-evaluation of the phenomenon, the authors offer a 
novel way to classify aerosol-transmitted airborne diseases, dividing them 
into three categories: obligate, an infection that is only initiated under 
natural conditions via aerosols that are deposited in the lung; 
preferential, caused by agents that can naturally initiate infection by 
multiple routes but are predominately transmitted by aerosols deposited deep 
in the lung and opportunistic infections that require trafficking by 
pulmonary cells to produce full-blown disease and may include viral rashes 
such as measles or smallpox. The authors note all three have one common 
element, the capability of creating infection from a minute dose delivered 
to the lung in a single airborne particle. By their definition, the Amoy 
Gardens SARS outbreak would most closely resemble an opportunistic 
aerosol-transmitted airborne disease.

Milton and his colleague, Chad Roy, principal investigator in the Center for 
Aerobiological Sciences at the U.S. Army Medical Research Institute of 
Infectious Diseases, conclude that a better appreciation of aerosol-acquired 
infection is needed, especially in environments where ventilation systems in 
airplanes, apartment buildings, schools, and hospitals circulate and 
recirculate air that may at times contain infectious airborne 
aerosol-acquired diseases and viruses. They call for better measures to be 
taken toward sanitizing the air, through tools such as upper-room 
ultraviolet irradiation and through research that will help control the 
spread of airborne infection.

http://www.hno.harvard.edu/gazette/2004/04.22/10-airtrans.html

..........................

Hong Kong:
More than half a million school children told to stay home until March 28

http://www.iht.com/articles/ap/2008/03/17/asia/AS-MED-Hong-Kong-Flu-Outbreak.php