SARS in Mongolia: Masks and Curfews
Health officials initially collected blood samples from five patients under observation at the National Center of Infectious Diseases Research (NCIDR) in the country's capital. However, the sudden 19 April death of a patient in the Chingeltei district hospital led medical personnel to suspect another case of Severe Acute Respiratory Syndrome (SARS) and add another sample to be tested.
Health officials on 21 April said they would send the blood samples to the Tokyo University laboratory in Japan, one of only 11 in the world that have been testing for infections of the virus. Health Ministry spokesman D. Tumurtogoo said officials from Tokyo University would deliver the results of the tests within one week.
As of 21 April, officials from the NCIDR have identified seven people as "suspected" and "probable" as having contracted SARS, including a woman who was admitted to the center on 19 April and the person who died.
A heightened mobilization of national and local governments, medical forces, and citizenry against an outbreak of SARS was launched on 13 April with a governmental decree. Ulaanbaatar was placed under a pre-quarantine status, and some curfew measures were introduced for public buildings and businesses.
By evening, officials ordered the capital's businesses--especially theaters, cinemas, and big markets--to close their doors for two weeks. Restaurants and bars were instructed to close by 10 p.m.--an order that will remain in effect until 28 April. The authorities sealed border trading points and halted traffic on the southern train route from Khuh Khot, China. Even an organized strike of tractor drivers and farmers of the movement "For Fair Privatization of Land" on the main square of the city was stopped. Protestors cleared the main city square outside the parliament building by midnight.
The next morning cotton masks were flying off the shelves, and much of the city's population venturing into the city center wore the thin nose-and-mouth coverings. Prices of masks have increased from 80 to 600 tugriks ($0.07 to $0.53), with decorated ones selling for up to 1,500 tugriks. Some parents have introduced a "voluntary quarantine" for their children, prohibiting them from attending schools and kindergartens.
"I decided it's better to be cautious about the disease. So we study at home now to keep up with the school program," housewife T. Dorjmaa said two days after the decree was issued. She said her only daughter goes to school with children whose parents are business people and travel extensively. "I feel lots of tension--especially given the poor medical facilities in this country," said Dorjmaa, who only stepped outdoors last week to shop for food.
According to Deputy Health Minister N. Udval, the 430 people who have traveled recently to regions where SARS cases have been confirmed have been advised to remain at home for two weeks with instructions to call medical services if they develop any symptoms. Altogether, 800 people have been identified by government health officials as having been in direct or indirect contact with the six people under treatment at the National Center of Infectious Diseases Research (NCIDR).
The six individuals still being observed are feeling "quite satisfactory," D. Bat-Ochir, head of the NCIDR, told TOL during a telephone interview on 21 April. They had demonstrated the three factors that characterize a potential SARS infection: a fever running higher than 38 degrees Celsius, a dry cough, and a recent history of travel to high-risk areas. Bat-Ochir said another 14 people, including seven medical staff, have been isolated to see if they develop any symptoms during the seven- to 10-day SARS incubation period.
On 13 April, the Mongolian National Security Council held an emergency session in connection with the possible outbreak of SARS in the country. A state emergency committee was set up with representatives from the customs police, the Health Ministry, district governments, Mongolian Railways, and the national airline, MIAT, to ensure cooperation on preventive measures.
In addition to canceling public events such as concerts and other performances, the decree also requires special inspection teams to monitor the implementation of the governmental and city measures.
Special teams of Mongolian doctors--clad in protective clothing donated by the World Health Organization--met every train and plane that arrived from Beijing, interviewed passengers for signs of symptoms, and took suspicious cases to hospitals for a medical checkup.
"I'm surprised--people are much more committed than I expected," WHO medical officer Wiwat Rojanapithayakorn told TOL. "Every train has a doctor from the railways hospital checking the passengers for fever and respiratory problems."
Preventive measures included public announcements on major broadcast news media on the dangers and prevention of the SARS infection. Three hotlines were introduced, giving advice and providing emergency help to the population, and special medical receiving rooms were opened in 26 state and district hospitals for "suspicious" patients."
"People do call our hotline," a medical doctor operating one of the lines installed at the NCIDR said. According to the doctor, who did not want to be identified, people are so worried that they perceive simple flulike symptoms so characteristic of a Mongolian springtime--when dust storms invade the city and daily temperatures can fluctuate by 20 degrees--to be the SARS virus.
"People call us and ask if they might have SARS because they have a fever and a cough," the doctor said. "We stress to people the importance of increasing the resistance and immunity of one's organism to the virus--especially during springtime, when a human organism usually gets weaker."
However, Robert Hagan, the WHO representative in Mongolia, believes the Mongolian government may be overreacting in its efforts to stem a major outbreak. On 21 April, WHO reported that 217 people had died and 3,861 had been diagnosed worldwide, mostly in China.
Hagan said the government is not overreacting considering the effect the disease's 4 percent mortality rate can have on economic and health systems, "but it's overreacting from the point of view of a return on investment."
NCIDR head Bat-Ochir said the Mongolian government has allocated 190 million tugriks ($190,000) for purchasing specialized respiratory equipment, other medical equipment, and drugs. The government also said it would spend 1.5 million tugriks to produce 800,000 multiple-layered cotton masks to be distributed to the public.
The first serious alarm of a possible SARS case in Mongolia occurred after a 57-year-old woman arrived on 4 April by plane from Khuh Khot, the capital of Inner Mongolia, China. Although WHO does not identify Inner Mongolia as an affected region, Rojanapithayakorn said 17 people there have been listed as "probable" and "suspected" of having SARS, with two deaths. The woman, her husband, and her daughter are three of the six people currently being treated at the NCIDR.
Meanwhile, due to a prolonged absence of government information on whether the SARS "probable" patients in Mongolia have acquired the disease or not, the public has been relaxing--fewer and fewer people are seen on the streets of Ulaanbaatar wearing masks.
But the city health department still recommends that people wear masks and that public offices and businesses wrap door handles with gauze bandages soaked with a special solution. According to doctors, SARS spreads not only by air but also through hand contamination.
Rojanapithayakorn emphasized that no local transmission of SARS within the country has been identified. He added that it is easier to control entry points and block the virus from entering Mongolia. "But if an unlucky situation occurs and the virus is locally transmitted, it will be a tough job for the government," Rojanapithayakorn said.
While much of the information about SARS has been spread through the mass media, many in the city do not have access to accurate information. P. Luvsandagva, who makes a living collecting cans and gathers other garbage for fuel, said he heard from people that some deadly disease is going around. But little has changed in his daily life. "I do not have money to buy a mask," he said, busily packing another pile of garbage into a big cloth sack.
With two big international events--the Conference of Countries of New and Restored Democracies and the "Visit Mongolia" tourism promotion--planned for Mongolia in June, the government is keen on keeping the country SARS-free. The country is expecting 230,000 tourists, a 16 percent increase from last year.
"Because of the spread of SARS, many airlines have stopped their flights [to various destinations]," Infrastructure Minister B. Jigjid said at a news conference after the opening ceremony of the "Visit Mongolia" tourism campaign on 9 April. "If SARS keeps spreading, it will negatively impact tourism."