One of the nation's leading infectious-disease experts warned Wednesday that "we have not begun to the see the worst" of the SARS epidemic. Michael T. Osterholm, chairman of the Center for Infectious Disease Research and Policy at the University of Minnesota, said it is increasingly likely that the disease will reemerge with a vengeance next winter. In addition, CDC Director Julie L. Gerberding has decided to allow an an ailing American physician to return to the country from Taiwan -- potentially risking the spread of SARS into the country out of concern that the Taiwanese -- already overwhelmed by the raging epidemic -- would not be able to provide the best care for the doctor.

Washington Post staff writer Ceci Connolly was online Friday, May 23 at 11 a.m. ET, to discuss the latest news about the SARS epidemic and the research community's efforts to battle the outbreak.

The transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

Tustin, Calif.: Why is the situation in Taiwan getting worse?

Ceci Connolly: In early April it appeared Taiwan had gotten its SARS infection under control. But a report by the CDC yesterday detailed how one infected hospital laundry worker who was not diagnosed for six days spread the virus to eight other hospitals and potentially hundreds of patients.
That appears to be the spark for the island's recent troubles.

Harrisburg, Pa.: There were flu outbreaks in the 1950s and 1960s that killed millions of people worldwide. While it is tragic that so many people have died from SARS, it is not reached these proportions. How concerned are experts that it could potentially blossom into a greater epidemic of similar proportions?

Ceci Connolly: Experts are very concerned about SARS because there are many unknowns at this point. In addition, as NIH's Anthony Fauci has pointed out in recent congressional testimony, the death rate for SARS is much higher than influenza. In a typical year, flu kills 1 percent of people infected and during the pandemic of 1918-1919 the death rate reached almost 4 percent.
By contrast, the SARS mortality rate at this point appears to be about 8 percent and could rise as high as 15 percent.

Arlington, Va.: Are airlines checking passengers both domestically and internationally for any passengers showing symptoms of SARS prior to boarding the aircraft?

Ceci Connolly: The CDC has personnel greeting every arriving flight from SARS affected regions such as China, Hong Kong and Taiwan. They distribute health alert cards and attempt to quickly screen passengers for symptoms.
Many airlines are also on alert for SARS symptoms and more extensive screening (including taking temperatures) is occurring at overseas airports.
The challenge is that sometimes it takes several days for a fever, cough or other symptoms to appear.

Ashburn, Va.: Good morning Ceci,
The SARS outbreak seems to have come out of left field and has taken the world by surprise. Did the U.S. government anticipate such an occurrence or look into the potential implications/ramifications of a world-wide health crisis like SARS?

Ceci Connolly: Government officials have worried for years about an outbreak just like the SARS epidemic we are now seeing. Many have long expected a new influenza epidemic to strike--and some preliminary plans have been made to deal with a large-scale influenza epidemic.
In the case of SARS, it is a new disease that was able to spread for several months in China.
Infection control is proving successful in making instances but experts continue to worry about this illness hitting third world countries where the medical system is not as modern.

Glen Ellyn, Ill.: Has it been determined whether anything helps to lessen the severity of SARS? I.e., do herbs, vitamins, exercise have any effect? Is it possible that SARS is more virulent in certain ethnic groups than others?

Ceci Connolly: So far, the scientists have not come up with any treatment, cure or vaccine for SARS. There has not been suggestion about SARS being more virulent in certain ethnic groups but there are some hypotheses that there may be more virulent strains circulating in some locations.
All of this is very preliminary, though.

Rockville, Md.: How susceptible is the corona virus to mutation and in what host is it most likely to mutate into other pathological forms? Thanks!

Ceci Connolly: We are still learning about this particular coronavirus, but researchers who study other coronaviruses indicate they are quite prone to mutation.

Somerville, Mass.: It seems like there are two time periods to the threat of SARS to the U.S. In the short term SARS is less of a threat to Americans than a lightning strike on a sunny day. With only 3,000 out of 20 million SARS is not a major direct health risk even in most affected city in China. In the long term SARS could potentially kill 10 percent of the world's population, so it is a major threat in the long term. So it seems that containing SARS should be a major concern of Americans, but the chance of catching it is too low to be considered.

Ceci Connolly: The chance of developing SARS for the vast majority of Americans remains quite low. The most common mode of transmission is close contact with someone who has been infected. Health care workers are at particularly high risk because they are caring for contagious patients.
That said, SARS and other emerging infectious diseases, pose a number of long-term threats to the U.S. and other countries. First is the SARS mortality rate, which is higher than other illnesses such as influenza. There are significant political and economic implications to an epidemic such as this as well.

San Antonio, Tex.: What's the history (brief) of quarantines in the United States? I know Lillian Barber of Texas, who had the last case of naturally occurring smallpox in the United States in Elsa, Texas, in 1949, was quarantined in her home, as was the rest of the family? When was the last widespread quarantine in the U.S.? Have individuals in the U.S. been quarantined -- either de facto or de jure -- because of suspected SARS infections?

Ceci Connolly: Quarantine and isolation are common practices in public health today, but they generally occur in just a single individual and is usually voluntary. Tuberculosis patients, for example, are routinely put in isolation because the disease is so highly infectious.
Large-scale quarantine has not been used in the U.S. since smallpox.
Currently, about 22 states have updated their public health laws to include quarantine provisions and due process for individuals wishing to challenge a quarantine order in court.
Many other states have laws that are more than 100 years old, do not include due process and offer few guidelines for quarantining large groups, such as an entire apartment building.

Silver Spring, Md.: I have read (and recently re-read) Gina Kolata's book on the 1918 pandemic. This also came in two waves -- the first, in the spring, being a virulent flu with few deaths and the second, in the fall, resulting in the pandemic that killed about 40 million -- give or take several million.

What are the chances of a repeat of this with SARS? I find this far more frightening than al Qaeda!

Many thanks on your excellent coverage of SARS.

Ceci Connolly: This is a very real possibility. At a Senate hearing earlier this week, Mike Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, sounded the alarm that we have probably not seen the worst of SARS.
Many respiratory illnesses, such as influenza, are seasonal, as you suggest. Public health experts are struggling to get control of this coronavirus before next fall.

New Orleans, La.: Why are there predictions there will be a winter resurgence?

I understand that many viruses, like flu, spread chiefly in winter because more people are inside and because lower humidity helps the virus survive longer, but if SARS is actually contained wouldn't these epidemiological tendencies be moot? Is there some reason other than epidemilogical ones that make a winter outbreak likely?

Ceci Connolly: This follows on the previous question and I must caution I am not a scientist or physician.
From what the experts tell us, various bugs thrive in different climate. West Nile virus, for example, tends to do better in warm weather, which is why state and local health departments are now focused on that threat.
Yes, experts are trying hard to use these summer months to contain SARS.

Kansas City, Mo.: How much can we trust what the various governments are saying about the spread of SARS and is the press taking those comments at face value or checking them out?

Ceci Connolly: Chinese officials covered up the original SARS outbreak in Guangdong province from mid-November until late February. That delay in reporting enabled the virus to spread to other countries.
Presently, the World Health Organization believes it is getting good cooperation and data from China and other countries.
But I can assure you we at the Washington Post continue to press on this story. One of the curiosities here in the United States are the large number of "suspect" SARS cases, as opposed to "probable."

Washington, D.C.: Netscape.com has a headline saying that SARS has been identified as originating in cats. I tried to open the article, but the site shut down on me. Do you know anything about this?

washingtonpost.com: WHO Traces SARS to Civet Cat, (AP, May 23)

Ceci Connolly: WHO is reporting it has traced coronavirus to the civet cat and two other small animals in China. Scientists say it is still too early to tell is this is how the bug spread to humans. We will continue to cover this.

Pittsburgh, Pa.: Toronto is mow reporting four new cases of SARS. Over a month ago there was a report from the Canadian testing facility in Winnipeg which detected virus (by PCR) in 40 percent of probable cases, 36 percent of suspect cases, and 20 percent of cases with symptoms who failed to meet the case definition.

Has this data been repeated or extended? It seems that there would be a level of viral transmission in cases who didn't meet the WHO/CDC case definition, but there has been little published about such cases.

It would seem that such cases could set the stage for sporadic outbreaks, such as the four recently reported in Toronto, or much high numbers in the Fall, when flu/cold season returns in the Northern Hemisphere.

Ceci Connolly: I cannot tell you if the data has been repeated or extended.
At a scientific conference last weekend, Dr. Donald Low said he believes many of the "suspect" cases in Toronto were indeed SARS but not classified as such because the patients did not have pneumonia.
The challenge when dealing with a new disease such as SARS is we do not yet have rapid, foolproof tests to confirm when a person has the illness.
You certainly are correct that it is possible, if not likely, that additional cases may slip in undetected.

Kaohsiung, Taiwan: I have been in Kaohsiung during the SARS outbreak here. What puzzles me most is the lack of comprehensive reporting from either the American press or the Taiwanese English language press on the severity of the illness.

For nearly seven consecutive days, new records have been set for number of new SARS cases and/or deaths. The majority of these cases have been here in Kaohsiung, and there are numerous other hospitals with SARS cases that are concealing these cases from the WHO, and the press. What this shows big picture is a disease that is accelerating, not merely continuing, and not about to run itself out, as Taiwanese president Chen would have people believe. I can understand why a country with only 10 years of civilian government would be inclined to censor its press, but I'm puzzled why the AP and the papers that rely on the AP (like The Post) are not writing this story: Small Island with 28 Million is Being Overrun by Deadly Disease; Government and Civilian Incompetence is Abetting its Spread.

Ceci Connolly: The media has been attempting to cover this rapidly unfolding epidemic, but it has not always been easy. Part of the challenge is simply the logistics of getting to some of these places to report first-hand on the situation. As you are also aware, some SARS cases have been concealed.
We would be happy to hear more about the situation.

Washington, D.C.: If the SARS virus is actually a bioterror weapon and not a result of a naturally occuring phenomenon, wouldn't the summer months of containment be moot. Practically speaking, when the temperature cools down again next October, if SARS returns in hot-spot outbreaks across the industrialized countries, won't the governments still insist that it isn't terrorism?

Ceci Connolly: While the experts say it is impossible to entirely rule out bioterrorism, there are a number of features to the SARS outbreak that fit normal disease patterns. These have to do with the coronavirus itself, the fact this began in southeastern China and the way in which it has spread.

Silver Spring, Md.: Are cases of SARS still popping up in new places? My wife, a physician in Fortaleza, Brazil, tells me that they have a couple of cases there, apparently traced to travelers from Canada (the area's main concern at the moment is a dengue epidemic, however). Did we swing from too much panic to too much "all is okay now, or will be soon?"

Ceci Connolly: Yes, there are four new possible cases in Toronto. In addition, Taiwan is reporting up to 40 new cases a day.
CDC director Julie Gerberding frequently cautions against complacency. Although the likelihood getting SARS in the U.S. is quite low, there are certainly risks to travelers and health care workers in particular.
One of the challenges for public health in a situation like this is to remain vigilant over longer periods of time.

San Antonio, Tex.: I see you recently quoted infectious disease specialist Dr. Abraham Verghese of San Antonio, Tex., in an article about SARS. My question is about quarantines. I read recently that the last federal quarantine was in 1963. Wasn't that quarantine imposed in Sweden as a result of a case of smallpox brought home by a sailor? When was the last U.S. quarantine? Was there one recently related to SARS? Prior to SARS?

I know Lillian Barber's family was quarantined in Elsa, Tex., in 1949 when she contracted smallpox, the last person in the U.S. to have variola. I believe her case was de jure. I had vaccinia's "contact eczema vaccinatum" in 1960 in California and was quarantined de facto, rather than de jure, because I was so sick.

Also, will the three individuals who recently had smallpox inoculations and who died from heart complications -- and perhaps journalist David Bloom -- get any compensation from the government as a result of recently passed smallpox compensation legislation? Thanks for answers to my questions.

Ceci Connolly: I have already written a bit about quarantine, so I won't repeat that information.
With respect to the smallpox vaccination campaign, President Bush did recently sign a law that provides compensation to individuals harmed by the vaccine. There is little evidence at this time to suggest David Bloom's death was caused by the smallpox inoculation.

Ceci Connolly: Thanks for all the wonderful questions!