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CDC Telebriefing Transcript
Update on Severe Acute Respiratory Syndrome
(SARS) May 22, 2003 DR.
GERBERDING: Good afternoon. I'm here today for two reasons. One is to provide
an overview and an update on some of the information in today's MMWR, and
second, to report on a situation involving a CDC employee who's coming home
after being diagnosed with suspected SARS in Taiwan. The
WHO is reporting 7,890 cases of SARS, plus the cases in the United States
which currently are 65 probably cases in the United States. The good news is
that Hong Kong does appear to be increasingly successful in its containment. For
several days now they have reported single-digit numbers of increased cases
and have not had a case in a health care worker in the last four days. So
that represents, I think, a significant process in containing spread in the
hospital and in the community and we continue to be cautiously optimistic
that containment will ultimately be achieved there. The
more disturbing news is the situation in Taiwan. As described in today's
MMWR, there is ongoing transmission primarily in health care facilities in
several parts of Taiwan, but in addition there is transmission in community
contacts as well. The
report in the MMWR describes a situation where an index patient present in
the hospital, actually a health care employee, was ill for several days with
fever and other illness, actually a cellulitis that was eventually treated by
a surgeon, and in the course of his employment and his hospitalization, he
had contact with several thousand employees and patients in that facility. So
there was an opportunity for ongoing transmission of SARS. That
initiated a cascade of transmission which is ongoing in those facilities, and
has resulted in many diagnosed cases. We fully expect the case counts to go
up because of reporting delays, recognition delays, and the overall
complexity of trying to track such a rapid and complex outbreak in real time.
The
Taiwanese are taking all of the appropriate steps to achieve containment, including
quarantine of the hospitals that are most affected, quarantining of
potentially exposed people, isolation of case patients while they are in the
infectious stage, and implementing a whole variety of infection control
precautions in health care facilities. But
it's a huge challenge and one that is going to take continued effort on the
part of the entire health system in Taiwan, and they are continuing to
request and utilize technical assistance from WHO, CDC, and many other
agencies who are in country, on the ground, doing what they can to provide
assistance. It's
a very serious and sobering situation and I think we remain hopeful that
ultimately, they too will be able to achieve containment as they did in the
early stages of the epidemic, but this is an extremely challenging situation
right now. Now
let me discuss a situation that's hitting a little bit closer to home. We
have, since the beginning of the SARS outbreak, deployed more than 30 people,
internationally, to Asia, to provide technical assistance and a variety of
other kinds of support to the investigations that are ongoing there. We
currently have a team of individuals in Taiwan and on Monday morning, in
Taiwan, one of our physician/scientists developed a fever. It was a very
low-grade fever, had no respiratory illness or nothing to suggest SARS at
that point in time, but he was specifically in Taiwan to evaluate the
adequacy of infection control measures in health care settings. As
we do with all of our employees, before he left for Asia he was trained, he
underwent fit testing for a respirator, and while in the health care
facilities there, he was dressed in all of the appropriate infection control
equipment that we recommend, and was observed to be highly compliant as was
the rest of the team with that measure. Nevertheless,
he did develop a fever and so he spent a day in his hotel room under the
supervision of another physician on the team who was checking in on him
periodically. The
next afternoon, he felt well, his fever was gone, he really had no evidence
of any kind of infectious disease, and was trying to busy himself in the
hotel, and the next morning he frequented the breakfast room, the business
center, and some other areas in the hotel. Unfortunately,
on Thursday afternoon, he was found to have again a fever, and developed a
cough which immediately signaled a potential for SARS, and so he was admitted
to the hospital, to an isolation area where he continues to be present. Fortunately,
his chest x-ray is not showing evidence of pneumonia at this point in time,
he's doing very well, but we are very worried about him, obviously, and as
his employer, we have made the decision that it is in his best interest to
come home. So
we have arranged for air ambulance to transport him back to an Atlanta
hospital and that is being accomplished over the next few hours and we expect
that he'll be home some time this weekend. But
this is a sobering situation for all of us, and as we've been saying from the
very beginning, SARS is a problem for everyone, not just people in Asia. I
think it's also important to stress that some additional steps have been taken
in Taiwan as a consequence of this individual's residence in the hotel while
he was potentially infectious. As I mentioned, he did not develop a fever--I
mean he did not develop a cough until yesterday, so it's unlikely that he was
contagious, and in fact the clinicians involved are not particularly
confident that he even has SARS, but as we do here, a wide net was cast, and
so the hotel has been temporarily closed and cleaned, and the personnel in
the hotel who had direct face-to-face contact with this individual have also
been put into precautionary quarantine to be sure that they were not exposed
to him during a period of contagion. So
the bottom line is one of the CDC scientists has developed symptoms that are
an indication for isolation. Three
of our scientists are in quarantine and all four of these people are on their
way home, and we'll be real glad when they get here. Questions?
QUESTION:
Diana Davis from WSB in Atlanta. Doctor, if this man does indeed turn out to
have SARS, and you say that he followed all these precautions, as we believe,
we're sure he did, how troubling is it to you that even despite all those
precautions, he may have contracted SARS, and what does it say to you about
the spread of this illness? DR.
GERBERDING: I would say that as we've seen in other health care facilities,
even when we know people are following the precautions as they've been
prescribed, you have to be 100 percent compliant in order to be absolutely
certain that there isn't an inadvertent airborne exposure, and that's exactly
the same puzzle that we had in Canada. However,
we also know that these individuals are in a community where there is ongoing
SARS transmission in other settings. So while we are worried about the health
care as a source, we can't exclude the possibility that exposure occurred
somewhere else in the community. Of course, we also can't exclude the
possibility that he's ill with some other, you know, some other unrelated
infectious disease, but it will definitely be a place where we will be
looking hard and long at the adequacy of the measures to be absolutely
certain that we haven't overlooked anything. And
this morning I requested that we inventory our team and personnel available
for deployment to Taiwan to make sure that we have our absolute best experts
in infection control being able to weigh in on this, and I know WHO also is
adding to their team some individuals with extreme credibility and experience
in on-the-ground infection control. So we'll be looking at that with a fresh
set of eyes as we go forward. QUESTION:
[Inaudible]. DR.
GERBERDING: He is not requiring any intubation or any extra oxygenation. He
has a fever. I understand that his fever has been controlled fairly easily on
other antipyretics, and he's just under close observation, and I'm sure he's
real anxious to get home too. Yeah?
QUESTION:
Can you give us a little insight into his work history with the CDC and how
long was he in Taiwan, and are you taking any other precautions with the
personnel that are still there as far as protecting them from SARS? DR.
GERBERDING: He had just been in Taiwan for a few days, and let me just add
that we really do feel a strong sense of responsibility for his health and
safety, but we also feel a strong sense of responsibility for his
confidentiality, and we would request that all of you respect that as well. He
is, as I said, a physician-scientist who has expertise in infection control,
and he had arrived in Taiwan a few days before he visited the health care
facilities and this scenario unfolded. I'll
take a phone question, please. OPERATOR:
And as a reminder, if you have a question from the phones, please press the 1
at this time. Our first question comes from the line of Miriam Falco with
CNN. Please go ahead. QUESTION:
Good afternoon, Dr. Gerberding. I have a couple of questions. Specifically
with this incident of the CDC worker becoming ill, do you think that there
needs to be a change in the guidelines and how to protect yourself, not just
for CDC employees but just in general? And
I have what might sound like a very silly question. But there's a Lancet
article coming out this evening about SARS from outer space, a theory that
the origin of this--I know. I just want to ask it so that you can say
whatever you have to say, and so we can go from there. These scientists have
put this theory out before that infectious diseases might be dropping off of
meteors, but do you have any comment on that? Have you seen the study, and do
you know what I'm talking about? DR.
GERBERDING: Well, let me answer your second question first. I'm so glad you
asked it because I think we could use a moment of levity. We have no
scientific evidence that SARS or any other infectious disease has dropped off
a meteor at this point in time, but we have an open mind, and should we
discover any evidence supportive of that, we would let you know. And
of course in all seriousness, I think what we're seeing here is a situation
that is most explainable by natural evolution of coronaviruses either from an
animal or a poultry source, or possibly a coronavirus that's evolved in a
human. And we don't know the source of the coronavirus, but we have many
hypotheses that are far more plausible than meteorites. With
respect to your first question, which is a very serious one in terms of the
adequacy of our infection control precautions in the field, we have, as I
mentioned, a protocol here for ensuring that people who are dispatched in
situations that could pose an infection threat are not only trained in the
basics, but are actually specially fitted to be sure that their respirators
are tight and that they know how to use them, and that they have the proper
safety equipment. They generally are transported with an adequate supply of
the safety equipment that they would need. These
measures are adequate for protection and are the kinds of measures that we
use when we go and deal with ebola or any other kind of disease that poses a
high degree of communicable threat. I
think the concerns are that the physical environment of a health care
facility and the air handling in a health care facility can be very variable,
and we have learned that there are examples where you think you have the
proper airborne precautions in place, but the mechanics of the ventilation in
the room fail, or the degree of air exchanges expected are not adequate to
provide that level of ventilation. And in a time of crisis and when these
health care facilities in Taiwan are undergoing rapid expansion and the whole
system is under extreme stress, it's entirely plausible that there could be
breeches in infection control. So
what we need to do is step back and say, are our current measures adequate to
address that kind of contingency, is there anything else that we
realistically could add to the safety profile to be sure for us, but also for
the people who are living and working in these conditions, is there any other
sensible thing that could be done to provide that level of protection? I
think that is part of the reason why we were very pleased with the invitation
to collaborate in the Canadian hospital in Toronto because our hope was that
we would learn things there that would help inform our own infection control
precautions, and so far we haven't identified anything that needs to be
changed, but we are definitely looking, and we will continue to look hard at
that. Let
me take another telephone question. OPERATOR:
And our next question comes from the line of Seth Borenstein with
Knight-Ridder. Please go ahead. QUESTION:
Yes. Thank you, Dr. Gerberding. In terms of your CDC worker, is it--would you
say it's more probable that he got in the--which are you leaning toward, more
in the hospital or in the hotel, in his buzzing around on that one day? And
second, has he been--have you--has he been tested for either the antibodies
or the other test that you've developed there? DR.
GERBERDING: Let me say that I just don't want to speculate on this. This is
an evolving situation for us, and we are collecting information and trying to
go backtrack over his activities for the past several days, but we're not
really talking directly to him right now, because we want to respect the fact
that he's ill. I
think we couldn't say what was the most likely source of his infection if
this is SARS. Certainly, we know that transmission in health care settings
has accounted for the vast majority of cases in Taiwan, and that's the
leading hypothesis, but there are people who have been exposed in the
community. Also
our team is interacting with a great number of health care workers who are
there and have been there for some time trying to solve the problem there,
and any one of them could potentially be a person who's been exposed or
potentially infectious. So the chain of transmission is extremely complex in
Taiwan, and it may be that we'll never exactly know when or where his
exposure occurred, if again, if this even proves to be SARS. Let
me take a question from here in the room. QUESTION:
Maryn McKenna, Atlanta Journal Constitution. Just to clarify, was the CDC
employee involved in direct contact with recognized SARS patients? DR.
GERBERDING: The employee was not taking care of patients. My understanding is
that he was there assessing the infection control protocols, so he was not a
care deliverer, but he was part of an assessment team providing technical
consultation to the infection control staff there on the ground. I'll
take a telephone question, please. OPERATOR:
And our next question comes from the line of C.C. Connelly with the
Washington Post. Please go ahead. QUESTION:
Thank you. I actually have two questions, Dr. Gerberding. I'm wondering first
if you can tell us a little more in terms of how you're getting the CDC team
home from Taiwan? I'm guessing that they're not going to be flying
commercially. You mentioned something about an air ambulance. But if you
could tell us how exactly that works. And
also I wanted you to perhaps discuss a little bit more of the situation in
Taiwan. In reading the MMWR, I'm flabbergasted, frankly, at how this spread. And
I wonder if to you there have been some suggestions and some claims that
there have been cover-ups of this by hospitals and doctors in Taiwan? Do you
think that the MMWR article lends some credence to those charges? DR.
GERBERDING: With respect to the air transfer of the ill CDC employee, we are
using a means of transportation that we refer to as an air ambulance. And
what this basically means, that under contract with the U.S. Government there
is an entity that is in the business of moving ill people out of countries
where their care needs demand a return to a different facility, or a return
home, and so it's simply a matter of working with the State Department,
contacting these individuals and arranging for a plane to be flown to Taiwan,
and to pick up the patient. Now
the air ambulance is equipped with a flight crew that is capable of providing
advanced medical services if something should go wrong on the flight, or his clinical
condition deteriorates. They are fully equipped to provide additional
respiratory care, even mechanical ventilation, if that would become
necessary. There's
also room on the plane for the other three CDC employees and the crew and
flight attendants on this flight are also skilled and trained in the use of
appropriate infection control measures to protect themselves en route. So the
transport is in progress, in terms of getting the plane there and making the
arrangements to load and go with the team, and as I said, it'll be coming
home some time before the end of the weekend, certainly. I
can't comment at this point in time about the reliability of information in
Taiwan, but I think our team has had a strong sense that the information is
coming forward in the way that we would expect it to, that they are receiving
reports. When I mentioned a potential lag or that we would expect the numbers
to go up, part of that is that there are two layers to the reporting process
in Taiwan. One
is that cases are reported and public health action is taken, and the second
is that there is sort of an advisory group that reviews all of the reported
cases to make sure that they actually meet the definition of SARS, and when
they are evaluated by experts and are found to meet the WHO case definitions,
then they are reported to WHO. As
you can imagine with the number of cases that are currently in the queue,
that reporting process is taking a bit longer, but I think the important
thing is that they are responding to the suspected cases on the ground with
the appropriate public health interventions and our team is, been very highly
respected. I think they've been enthusiastic that the WHO and CDC expertise
has been welcomed, and there really is a team effort. So
I'm not concerned at this point in time about a cover-up on the part of the
government. There is another element to cover-up, however, that I do think
it's important that we all be aware of, and that is individuals sometimes are
frightened or fearful of seeking attention because of concerns about
consequences. In
this country, I think we have demonstrated that we treat people with SARS
humanely and fairly, and are doing our very best to minimize any unnecessary
consequences, but there are people in other parts of the world that don't
benefit from that perspective or that knowledge and there is always the
concern that someone would be reluctant to come forward and seek care, even
though they were ill. Let
me take a question from here in the room. QUESTION:
Thank you, Dr. Gerberding. Betsy McKay from The Wall Street Journal. Two
questions. One, could you just tell us what care these employees, the sick
one as well as the three who are accompanying him, what the care they will
have when they get back to Atlanta. Secondly, there have been some comments
made in the past few days about fears of a recurrence or resurgence of SARS
next fall, in the next flu season. I
was just wondering if you could update us on your thinking alone those lines.
Thanks. DR.
GERBERDING: The patient will be hospitalized for medical evaluation and will
be in an isolation area. He will, like all of our probable or suspect SARS
patients in the hospital, he will be on airborne droplets and contact
precautions to avoid extending any infectious disease that he may have to
someone else. There
is no specific treatment for SARS, so obviously the main measures will be to
make sure that his oxygen status is good and that his hydration status is
optimized, and the usual kinds of supportive measures, and we of course still
continue to remain hopeful that this will prove to be a false alarm and that
we'll find some other diagnosis. With
the people who are in quarantine right now in Taiwan, they too will be
evaluated to make sure that they're not febrile or developing any symptoms,
but assuming that they still remain asymptomatic, we would have them in an
active monitoring system that would be orchestrated through the health
department here in Georgia, the same way that we would for anyone who had
been potentially exposed to SARS. So
the health officials in Georgia are already in the loop and will be making
those decisions because that really is their jurisdiction. I
think you asked a question about what is in the future for SARS. Do we
anticipate a resurgence? What do we expect coming down the road? The
bottom line is we don't know. This is a respiratory illness. Most respiratory
illnesses are worse in the winter months and improve or disappear over the
summer months; but it is anybody's guess what's going to happen in the fall. We
need to be prepared for the possibility that we'll see a resurgence or even
expansion of SARS next fall, and so we are prepared, and the Department of
Health and Human Services under Secretary Thompson's direction, we are currently
in the process of developing a contingency plan for the potential for a
resurgence or an expansion. I
think that's a prudent measure, I pray we don't need it, but we want to be
ready and we'll be ready if we have to go there. Let
me take a phone question, please. MODERATOR:
And our next question comes from the line of John Lauerman, Bloomberg News. Please
go ahead. QUESTION:
Hi; thanks for taking my call. I'd like to get a little more detail on the
patient. What, right now, separates him from having a SARS diagnosis, and
what would have to change for him to be diagnosed with SARS? Is
there a possibility--or when will we know whether or not he has SARS or not? DR.
GERBERDING: Right now, the patient meets the suspect case definition of SARS
in that he's been in a SARS area or had exposure to people who've had SARS,
and he has a fever, and he has respiratory symptoms. He has a cough. And
so those are the criteria for a suspect case of SARS. He does not have
pneumonia, so he does not meet the probable case definition of SARS, and
therefore he is not going to be included on our list of probable case reports
unless his condition evolves consistent with WHO case criteria. He
will be of course medically evaluated here. He's under the care of a team of
infectious disease physicians in Taiwan also. The
reason that there is some optimism that this is not SARS is because he did
have sort of an unusual presentation. He had a very low-grade fever and then
had a day or two where he felt completely well, without any fever, and now
his fever has recurred, accompanied by a pretty mild cough. That could still
be consistent with SARS, but it could also be that he has had any number of
other respiratory illnesses that are all too common and particularly among
travelers and other parts of the world. So
we just to have more information. When he gets here, assuming that his
clinicians who are responsible for his care agree, we would want to make
available the same kinds of testing that we make available to other SARS
patients, and that would include PCR testing, as well as antibody testing
during the convalescence of his illness. And,
you know, we will be careful about sustaining his confidentiality as we go
forward with this, but we understand that everyone is interested, and this is
a special case, so we'll give you all the information that we can as it
evolves. DR.
GERBERDING: Let me take a question over here. QUESTION:
Janice McDonald, Fox News. Could
you address the decision to bring him back here, as opposed to treat him
there, and talk about what precautions are being taken in the transport to
make sure it doesn't spread, if it is indeed SARS. DR.
GERBERDING: Yes. As you will note, if you read today's MMWR, the health care
delivery system in Taiwan is under enormous stress. Hospitals are closed,
hospitals are quarantined. There are additional pressures as they anticipate
the expansion of the epidemic there. This
is not a time for us to add to their burdens by having an additional person
in the health care system there, and we felt that it was in the best
interests of our employee to have him come home and receive care here in
Atlanta, where he could be with his family and with the other people who care
about him. So
the decision was based, in part, on the fact that the health care system in
Taiwan is under duress and also a desire to make sure that he was home in the
place where he chose to receive care until such time that we know that he's
either going to get better or, in the worst-case scenario, should he get
worse, then he will be in a place where we're confident he'll receive the
best possible care. En
route, the infection control managers will be based on the same premises that
we use in the health care setting. So basically precautions will be taken to
prevent airborne spread on the plane, to prevent droplet spread on the plane,
and to prevent contact transmission on the plane. So the individuals on the
plane will wear properly fitting masks. He
will probably wear a mask because he's not compromised from the respiratory
standpoint, so he should be able to tolerate wearing a mask, and that will
eliminate the possibility of droplets or splatter entering that environment. People
will have face protection on so that all of their mucous membranes are
protected from splash or splatter, and they will of course wear gloves and
gown. So it's just simply like a little hospital room flying through the air.
DR.
GERBERDING: I'll take a telephone question, please. OPERATOR:
The next question is from the line of Larry Altman, New York Times. Please go
ahead. QUESTION:
Yes, Dr. Gerberding, in the line of the questions just asked, with a
tight-fighting mask, this is going to be an extremely long flight, so how is
somebody going to be able to have the same mask on in terms of the other
individuals or the patient and how will that be taken care of? And,
secondly, related to that, how is the decision justified, beyond the reasons
that you've given, when I believe, and correct me if I'm mistaken, the
recommendations have been not to transfer a patient once in a hospital if
infected. And,
lastly, how long was he in Taiwan? DR.
GERBERDING: The issue about wearing the mask for such a long period of time
is going to be a challenging one. This particular aircraft is one that does
not have long flying times, so it goes up, it comes down, it refuels, it goes
up, it comes down, it refuels. And
so I don't want to characterize it as a puddle jumper because that would be
an exaggeration, but this is not a nonstop flight, let me just put it that
way. So there will be opportunities for the crew to rest, for example, and
for--he can remain on the plane, but the others on the plane can change out,
and relax, and you know make sure that they are still in quarantine, but at
the same time get a breather. And
this is one of those situations where the personnel on board the plane have a
great deal of experience working on this kind of situation, and so we can
trust that they will have figured this out. The
justification for transferring a patient out of a country to receive care in
another country is a bit different than moving a patient from one hospital to
another in-country. This is not a commercial aircraft. We are not posing a
risk to other passengers or other individuals. We are basically putting a
patient into a health care environment and moving him in an expeditious
manner to another health care environment. We
are, of course, aware that this means that we will be admitting him to
another hospital in the United States, but the hospital has already prepared
to receive SARS patients, and they are confident that they have the
appropriate precautions in place to protect their staff and their personnel,
and we have confidence in their capability as well. I
forgot your last question, Larry. QUESTION:
If you have the length of time that he was working in Taiwan. DR.
GERBERDING: Yes, I don't actually know when he arrived in Taiwan. We can get
back to you with that information if you just give our press office a call. Can
I take a question from here in the room? QUESTION:
Just to clarify again, you said that in addition to the patient, three other
members of the CDC team are returning with him. DR.
GERBERDING: Correct. QUESTION:
Does that leave you with anyone from the CDC on the ground in Taiwan? DR.
GERBERDING: Yes. We still have CDC personnel in Taiwan. We also have
personnel in Southern Taiwan, where there's an ongoing evaluation of
additional clusters there, and I'm not sure when the next team is due to
leave, but I think it's imminently. As
I said, we had already planned a passing of the baton, and we're just moving
that up a bit faster to make sure that we still are there and can maintain
the continuity of our operation. I'll
take another telephone question. OPERATOR:
And it's from the line of Joanne Silberner with NPR. Please go ahead. QUESTION:
Hi. I want to thank you for taking these questions. I wanted to clarify the
blood testing. You mentioned that he'll have a PCR and the antibody test when
he gets back. Has anyone done a PCR on him yet? And, if so, when would those
results be available? DR.
GERBERDING: I'm not aware of what testing is being done in Taiwan, and we are
not aware of what tests they are doing in Taiwan in terms of their quality
concerns or how they would compare to the tests that we're doing here. So if
we got information about test results from his experience there, of course,
we would take it seriously, but I think, regardless, we would want to have
him go through the same kind of assessment that the other SARS patients in
the United States experience, if he's willing. I'll
take a question over here. I know you've been waiting. QUESTION:
Well, actually, we just got here. So I'm sorry I'm going to ask you to repeat
a little bit of the information. Can
you tell me what kind of work this employee was doing and how he might have
been exposed. DR.
GERBERDING: The employee is a medical epidemiologist, so he was there in
Taiwan as part of the team of people from CDC providing technical support to
the Healthy Ministry there, and he was specifically involved in assessing
infection control measures in the hospitals and advising on any opportunities
for improvement. I'll
take a telephone question. OPERATOR:
And it's from the line of Anita Manning, USA Today. Please go ahead. QUESTION:
Oh, hi. Thank you very much. Dr. Gerberding, you mentioned that people who
came in contact with the CDC employee who were in the hotel are now in
quarantine. Do you have any idea how many of those people are in quarantine? DR.
GERBERDING: Off the top of my head, I don't know, but again we can find out
the estimates from the folks on the ground and provide you with that
perspective. It's not a huge number of people, but it's more than a couple. I
think I can take one more telephone question. OPERATOR:
And that will be from the line of Robert Bazell, NBC. Please go ahead. QUESTION:
Hi. What will happen to the people who are traveling back with the
epidemiologist on the plane? Are they going to come right back to work at CDC
or are they going to be encouraged to take a few days off to see if they feel
okay? And it's a serious question because what, in this kind of, where you
have a mildly suspect case, what should the other people who have been around
that suspect case be doing? DR.
GERBERDING: Well, as we would advise any individual who was a household
contact or who's had exposure to a SARS patient, we want to, first of all,
assess their overall health status. I'm sure this has been very stressful for
them, and they'll probably be very tired when they get home. So a good
night's sleep in a comfortable bed would probably be extremely welcome. But
we would also advise them to assess their temperature on a regular basis, and
the health officials in Georgia will make additional recommendations,
depending on their assessment of the situation. More
than likely they will have a generous opportunity to take a little bit of
time off, and then knowing the CDC teams, I'm sure they'll be back at work as
soon as the health officials deem that it's appropriate. Thank
you very much for your interest in this. As we learn more about this
situation or as the situation with our employee unfolds, we will be sure to
update you. Thank you. This page last updated May 22, 2003 United States
Department of Health and Human Services |