SARS, first reported in China, Vietnam and Hong Kong, has since been identified in Europe, North America and in other parts of Asia. The illness can cause severe respiratory problems and death. In 10 to 20 percent of cases, patients need a ventilator to help them breathe. There are currently 85 suspected cases within the United States, according to the Centers for Disease Control. Worldwide, the World Health Organization has reported 2,223 cases and 78 deaths to date. The San Jose incident is the first time a plane has been stopped in the United States for fear that infected persons are aboard. Dr. Karen Smith, the assistant health officer in Santa Clara County, Calif., was one of the health officials who responded to the crisis. NEWSWEEK’s Laura Fording asked her to comment on yesterday’s events and to provide some insight as to how public health departments are dealing with concerns about SARS. Excerpts:

NEWSWEEK: What exactly caused the American Airlines flight to be quarantined upon its arrival in San Jose yesterday?

Dr. Karen Smith: During a flight from Tokyo to San Jose, the flight crew noticed several passengers had suspicious respiratory symptoms. They reported it to the pilot, who in turn called the U.S. Customs quarantine officer at the airport and notified him to possible SARS cases aboard the flight. When the plane landed it was diverted to a cargo area, where it could remain isolated until the situation was evaluated. As the plane was coming in, the San Jose police and fire departments were dispatched and the public health department was notified that there was a potential for a contagious disease exposure. So I went out to the plane, as well.

What were the people’s symptoms?

We responded to a report by the flight crew that the passengers were coughing and that several of them had diarrhea. It’s not really possible to medically evaluate people on a plane with a lot of passengers while maintaining confidentiality, so three of the symptomatic people were escorted from the plane into ambulances and were taken to the county hospital for medical evaluation. Initially reports were of five symptomatic individuals. Three were escorted off, but two refused to get off the plane. They said they didn’t have symptoms. I went onto the plane and interviewed them in private–the rest of the passengers were moved to the back of the plane and these passengers were in the first class cabin–and determined that they did not meet the criteria for SARS. So I medically cleared them on the scene.

What about the evaluations of the three who were sent to the hospital?

None met the criteria for SARS.

What exactly are the criteria for SARS?

First, the person must have traveled to an area of the world where SARS is currently being transmitted within the community or have had contact within the previous 10 days with someone who has traveled to one of these areas and is sick. Tokyo, in fact, has not had any reported cases of SARS, although I believe some people on this flight had connected from other parts of Asia. The areas [currently reporting infections] are China, Hong Kong, Singapore and Vietnam. You also need to have a fever greater than 100.4 degrees Fahrenheit and respiratory symptoms, either shortness of breath, difficulty breathing or a cough. One must meet all three criteria to be considered suspect for SARS. None of the five individuals involved in this met those criteria.

Is it realistic to expect this kind of response from public health officials? Aren’t symptoms of colds and flu pretty common on flights?

So you don’t think the flight crew overreacted.

I think they did what they knew to do given the advice that they’ve received to date. I hope that at the federal level, the CDC works with the airline industry to make sure that flight crews have appropriate advice on how to respond to this sort of situation. It’s inevitable that people flying back from Asia and anywhere else in the world are going to have respiratory symptoms. I think there needs to be some pretty clear guidance to flight crews and to health departments and airport security in how to respond to these sorts of situations. Local health departments look to the CDC for guidance in how to deal with situations like this.

How are public health officials handling the SARS situation? What is your department doing to protect the general public?

In Santa Clara County we sent out a health alert the second day SARS was reported where we said, “This is the case definition, this is what to be watching for, here’s how to report suspected cases.” When a physician sees a patient who meets the criteria for SARS, he is required to file a report by telephone any time of the day or night. If it’s during the day, our communicable-disease office provides advice to the physician and the patient. After hours, a health officer is on call. If the patient requires hospitalization, we make sure that infection-control procedures are followed in the hospital to minimize exposure to other health-care workers, which has been a real issue in other parts of the world with respect to SARS. We also contact everyone with whom the suspected SARS patient says they have had contact with and follow those individuals to see if they develop symptoms. As of last night we are asking physicians to report people who don’t quite meet the criteria I mentioned earlier, but may have the travel history plus [some of the symptoms] and to report these individuals to us even if they don’t require hospitalization. So we will be able to follow them for seven to 10 days to make sure they don’t develop SARS, and if they do, we will see that appropriate precautions are taken. I think each individual health jurisdiction will be doing slightly different things in attempts to control this.

California has reported several cases of suspected SARS. Are any of them in your county?

We have, to date, seven suspected cases within Santa Clara County. Every suspected SARS case in our county had traveled to China or Hong Kong. We’ve had no evidence thus far of community transmission. There is actually no such thing as a confirmed case of SARS. In the United States [they are identified as] suspected SARS cases because as of yet there is no diagnostic test to determine whether or not someone definitely has SARS. I know that WHO and CDC are working aggressively on such a test.

How concerned should the general U.S. population be?

Unless you have traveled to an area of the world where there is SARS transmitting in the community, or you have family members who have, I think your level of concern should not be very high. It’s important, as it always is, to use good hand hygiene and to cover your mouth when you cough–that sort of thing–but at this point in the United States, it seems to be restricted to people who have traveled to Asia or their very close contacts. Still, being aware of SARS is prudent. This is a disease that has the potential to spread very quickly.

Should the general public be taking any precautions at this time?

If you have nonessential travel scheduled to parts of the world where SARS is spreading within the community, you probably should defer it until the disease is under better control.

Are there any known cases of transmission through air travel?

There are cases worldwide that are believed to have been contracted through contact on airplanes. But it is unclear right now how the organism is spreading in any situation, including on airplanes. There are a few potential ways in which it may be spreading. [One] is through the contamination of an inanimate object which an infected person touches–a doorknob or an armrest, for example. This is one way that the common cold is known to transmit. Another way is through droplet spread, where the infected person breathes or coughs and another person breathes in the organism. The modes of contamination are currently under investigation.

Have they definitely isolated the germ?

Well, they think they have the organism. But as far as I know, as of this morning, it was not definitively identified as the causative agent.