On the third day after his father's death from a respiratory infection, Hussein al-Sheikh began to feel feverish.

Shortly afterwards, says the 27-year-old Saudi, "I was almost dead".

Hussein, who had often visited his father's bedside in his last days, was admitted to intensive care in a hospital in Dhahran, in the Eastern Province oil heartland of Saudi Arabia.

Then his brother, Abdullah, and later his sister, Hanan, became ill. They got treatment in hospitals in the nearby oasis district of al-Ahsa.

Their father Mohammed, doctors now say, was probably a victim of what doctors believe was novel coronavirus, the new SARS-like infection that first emerged in the Gulf last year and has gone on to claim 18 lives, nine of them in the kingdom.

There is international concern, because it was a virus from the same family of pathogens that triggered the outbreak of Severe Acute Respiratory Syndrome (SARS) that swept the world after starting in Asia in 2003 and killed 775 people.

Some of the cases of the new virus were in Britain and France, among them people who had recently traveled from the Middle East. A total of 34 cases worldwide have been confirmed by blood tests so far.

"My temperature was really high, my blood oxygen levels were very low. I was so tired I couldn't walk for days and any kind of activity made me cough," said Hussein, a PhD student who studies in Canada. To avoid spreading infection, he wore a green face mask.

World Health Organization (WHO) experts this week visited Ahsa, a sleepy oasis of around a million people, to work with Saudi authorities in investigating the latest outbreak.

Much of the attention has focused on the private al-Moosa General Hospital in Hofuf, Ahsa's main town, where many of those infected, including Mohammed al-Sheikh, were treated in the intensive care unit.

A senior WHO official said on Sunday it appeared likely that the virus could be passed between people in close contact.

WHO Assistant Director-General Keiji Fukuda said, however, that there was no evidence so far that the virus was able to sustain "generalized transmission in communities", a scenario that would raise the specter of a pandemic.

A public health expert, who declined to beidentified,, said "close contact" in this context meant being in the same small, enclosed space with an infected person for a prolonged period of time.

Mohammed al-Sheikh, who suffered from diabetes and had been admitted to hospital with a high fever and low blood sugar never knew what had infected him. He lost consciousness two days before he died.

"The doctors said they didn't know what was wrong," said Hussein. "During his first two days in intensive care he could talk and eat by himself and go to the washroom. But then it got worse. He was on the highest level of oxygen and they had to drug him.” Then, al-Sheikh died.

“He left without saying goodbye," Hussein said.

Some families of people who were hospitalized said they had been asked by authorities not to speak to media.

Separated from the big cities of Riyadh and Dammam by large stretches of desert, Ahsa is a pretty area famous for its date farms. Drive through its dusty villages and goats appear grazing beneath the palm fronds. Between the trees jut pale rocky outcrops carved by the elements into outlandish shapes.

There was little sign in the al-Moosa General Hospital's reception area late on Saturday that it was at the center of a global health concern.

Visitors, doctors and nurses hurried down the corridors. Two women waited with their babies outside a door marked "vaccination room".

Hussein al-Sheikh said he believed his father contracted novel coronavirus in the hospital's intensive care unit and that he then caught it there himself during the hours he spent visiting his father in the days before he died on April 15.

But Malek al-Moosa, the hospital's general manager, denied this suggestion and said he believed the patients were in fact exposed to a common source of the virus outside Moosa General Hospital.

Fukuda of the WHO said it was not yet clear how the virus was transmitted.

Of the four members of the Sheikh family who got sick, only one, Abdullah al-Sheikh, 33, has so far been tested positive for the new coronavirus.

Samples from Mohammed, Hussein and Hanan are still being tested but Moosa said it was likely that they also had the virus.

A poster-sized portrait of Mohammed al-Sheikh, a 56-year-old former employee of the national oil company Saudi Aramco, is displayed in the Sheikh family's reception room, where three of his 10 children sat to describe what they call the calamity that has hit their family.

"Our father's dream was that we should all live in one house with a big garden. He had started building it and finished almost 50 percent. This is just killing us," said Hussein.

Related:

• US safe from two new viruses so far
• WHO: new virus probably spread person to person
• Second French coronavirus case confirmed

Centers for Disease Control and Prevention

A CDC scientist harvests H7N9 virus that has been grown for sharing with partner laboratories for research purposes.

More than 50 travelers just back in the United States from China who had flu-like symptoms have been tested for the H7N9 bird flu virus, federal health officials say. So far, none has tested positive.

But the fact that they’re being tested at all shows just how worried the U.S. government is about this new strain of bird flu, which threatens at the same time as a still-mysterious coronavirus from the Middle East. The test kits had to be specially made up and distributed under an emergency provision.

“While no cases of H7N9 have been detected at this time in the U.S., 54 people with flu-like symptoms after travel to China have been tested. All have 54 tested negative for H7N9; while six tested positive for seasonal influenza A, and three tested positive for seasonal influenza B,” the Centers for Disease Control and Prevention says in its latest update on the virus.

Emergency operations centers are running 24/7, keeping an eye on both situations. While it's not unusual for the centers to be operating around the clock, it is rare to have two pandemic threats at once to plan for, says Edward Gabriel, who heads preparedness and response issues at the health and Human Services Department. 

"We want the latest and best information that we can get," Gabriel told NBC News. "We also need to look and see where it is moving to. To try to isolate its motion is a pretty significant thing."

If either virus turns into a form that spreads easily from person to person, a pandemic could follow within weeks. Both seem especially deadly in their current form: H7N9 seems to have about a 20 percent fatality rate, while the new coronavirus appears to have killed more than half its victims.

“In the case of the two latest threats — the H7N9 influenza virus and the new coronavirus — the number of infected people is small, and the infections are occurring thousands of miles away from the United States. Yet we should be seriously concerned about both,” Mike Osterholm, an infectious disease expert at the University of Minnesota, wrote in the New York Times on Friday.

“Our public health tools to fight these viruses are limited. We have no vaccines or effective drugs readily available to stop or treat the new coronavirus in the Middle East,” Osterholm adds. 

CDC

Influenza A H7N9 as viewed through an electron microscope. Both filaments and spheres are observed in this photo.

The H7N9 flu can spread silently, as people transmit influenza before they’re sick themselves. If the flu did mutate into a pandemic form, it would probably take at least six months to make enough vaccines to protect large numbers of people.

“It may take longer than it takes the virus to spread,” says Dr. John Treanor, a flu vaccine expert at the University of Rochester Medical Center. “The technology that we have today is such that the bulk of the pandemic disease may have already taken place before a vaccine is in place and can be used,” he added.

“The virus can spread very, very quickly. You are in a race against time.”

That happened in 2009, when the new strain of H1N1 swine flu broke out to cause the first pandemic of a new flu in 40 years. Companies raced to make vaccine but it was months before it was ready.

There are drugs to fight flu – a pill called Tamiflu and an inhaled powder called Relenza. Neither is a cure, however, and both need to be given very quickly to do much good at all.

Right now, H7N9 seems mostly confined to China and the spread has slowed. The World Health Organization reports 32 people have died out of 131 lab-confirmed cases.

“The drop-off in newly reported H7N9 cases in China may be the result of containment measures reportedly taken by Chinese authorities, including closing live bird markets, a venue where the risk of exposure to bird flu viruses can be high," the CDC says. “However it may also be a result of changing seasons, or a combination of both.”

Researchers in Hong Kong did a computer analysis of the outbreak and estimate that at least 200-500 more people have likely been infected with H7N9. The virus seems to cause serious illness mostly in people over 65 – doctors are not sure why yet.

“We estimated that risk of serious illness after infection is 5.1 times higher in persons 65 years and older versus younger ages,” Ben Cowling and colleagues at Hong Kong University wrote in the journal Eurosurveillance.

The evidence suggests that most of the patients got infected directly by birds, probably in poultry markets. So Cowling’s team took all the data and estimated how many younger people were likely to have been infected without knowing they had H7N9. "Our results suggest that many unidentified mild influenza A(H7N9) infections may have occurred, with a lower bound of 210–550 infections to date," they wrote. This would mean the virus isn’t that widespread, but which also confirms its high fatality rate. 

The coronavirus, which some are dubbing Middle East Respiratory Syndrome Coronavirus, or MERS, is a little different story. WHO says 33 infections have been reported, with 18 deaths. Experts are watching cases in France, where one patient who traveled from Dubai was confirmed to have the virus. 

A man who shared a hospital room with the 65-year-old man also has the virus, French officials said Sunday -- something that shows the virus and and does spread in hospitals. 

Officials were relieved that three health care workers who cared for the 65-year-old patient and who got sick have tested negative for the virus.

Also Sunday, WHO Assistant Director-General Keiji Fukuda could probably be passed between people in close contact, but there was no evidence of sustained "generalized transmission in communities."

Some reports suggest an outbreak in Saudi Arabia also affected people in the same hospital.

This worries Dr. Eric Toner of the Center for Health Security at the University of Pittsburgh Medical Center. SARS – severe acute respiratory syndrome – also spread mostly in hospitals. SARS spread to 29 countries in 2003, killing 775 people and making 8,000 sick before it was stopped.

“These cases, whether confirmed or not, should be a wake-up call,” Toner writes in his blog.

The good news is that SARS was stopped using good hospital hygiene. Face masks, gloves and careful disinfection prevented its spread. And SARS only spread once people were noticeably ill, unlike flu, which people can spread before they feel sick and after they feel better.

The bad news is that hospitals may have forgotten this lesson. “SARS was stopped by healthcare workers being aware of the disease, having a high index of suspicion of anyone with fever and respiratory symptoms who had recently been in an affected region, and quickly implementing infection control measures with any suspect case,” Toner says.

“Until now, all cases of MERS originated in the Middle East, but as the confirmed French case demonstrates, the virus is only a plane ride away from other parts of the world. In the 10 years since the SARS outbreak, many hospitals have become lax in their attention to respiratory precautions.”

Gabriel says he’s working to make sure this isn’t the case with U.S. hospitals. “Hygiene practices are now better than they ever have been,” Gabriel said. “We send out reminders daily.”

Related:

• WHO: New SARS-like virus can probably spread person to person
• US races to make new vaccines against bird flu
• New virus has officials worried about skimpy resources

This story was originally published on Sun May 12, 2013 9:33 AM EDT

AFP – Getty Images

Chinese authorities have closed some live bird markets in an attempt to stop the spread of a deadly strain of bird flu. A vendor, above, washed a chicken stall in a poultry market in Hefei, China, shortly before it was due to be closed Thursday.

BEIJING -- It began in late February when an 87-year-old man started coughing up phlegm. A high fever followed, he struggled to breathe and was dead just 13 days later.

His death in Shanghai, China, was one of 13 fatalities out of 41 known cases to date of a new form of bird flu that experts warn may pose a "serious human health risk."

On Saturday, China's center for disease control announced the first case in Beijing, and outside of eastern China. The seven-year-old girl, whose parents work in the live poultry trade, was stable in a hospital in the capital, media reports said.

Around the world, scientists are now beginning to examine samples of the virus with a significant question in mind: Could this strain of the disease cause a global pandemic?

This international network of scientists keeps constant watch for good reason.

In 1918 and 1919, a flu pandemic killed between 20 million and 40 million people, more than the total death toll of World War I, more in a year than the Black Death of 1347 to 1351. More recently, an H1N1 swine flu pandemic was blamed for more than 284,500 human deaths worldwide between April 2009 and August 2010.

So far, the signs are that this is a localized outbreak. The number of cases is low and the virus -- an H7N9 strain -- does not appear to be capable of jumping from one person to another.

But each case represents a chance for the virus to mutate into one that is highly infectious in humans. And it is an unusual strain -- normally avian diseases make birds sick first, giving an early warning sign, but this one does not.

Scientists have established it is from an "avian reservoir" but still don't know the precise source. Chinese officials have dismissed suggestions of a connection with the large number of dead pigs and other animals found recently in rivers.

Many in China are understandably worried, with some deciding to avoid eating chicken, even though it poses no threat if properly cooked.

KFC’s parent company Yum reported on Wednesday that sales in its Chinese restaurants had dropped by 13 percent in March, saying “publicity associated with avian flu in China has had a significant, negative impact.”

Even Jiangsu Zoo, just north of Shanghai, reportedly stopped feeding chicken to animals such as lions and tigers and started giving them a traditional medicinal herb called ban lan gen.

Xie Li, an accountant in Shanghai, admitted she was “kind of nervous.”

“Now, we only eat vegetables," she said. "My daughter's school is measuring students' temperatures. We were told that we should eat less eggs or not touch eggs because they might have some excrement from chickens."

But others in the city of 23 million people were more sanguine.

Yan Zhanlin, a 40-year-old businessman, said he was “not scared, because there are not many cases, and the number of deaths is not high” and the virus had not yet spread between people.

“Today, I went to a train station, and I only saw few people wearing masks,” he said.

But even he said he had stopped eating “poultry, pork and other meat.”

Tang, a company manager in his late 20s, who declined to give his full name, was also relatively unconcerned.

“I do not fear [the virus] at all. It is just a kind of flu, and will pass quickly,” he said. Avoiding poultry was “not too bad, because it forces us to eat vegetables and fish, which are nutritious,” he added.

'Watching very carefully'
Perhaps in a sign of the country's nervousness, People's Liberation Army Colonel Dai Xu claimed the U.S. was behind the outbreak, saying the U.S. had used "bio-psychological weapons" to cause the deadly 2003 Sars outbreak and the current flu one, The South China Morning Post reported.

Such allegations aside, this apparently local problem is being treated seriously on a global scale.

Samples of the virus – or non-infectious nucleic acid from it — are being sent to scientists in up to 140 national influenza centers recognized by the World Health Organization, including the Centers for Disease Control and Prevention.

Work has already started in the U.S. to make a vaccine against the new strain -- just in case.

Scientist John McCauley, of the U.K.’s National Institute for Medical Research, received his consignment on Thursday.

“We’re watching very carefully the events there [in China] because we are aware although there’s no human-to-human transmission, these are unusual infections people have been getting from an avian reservoir,” he said.

“China will need to identify the source and hopefully be able to control the cross-species transmission,” he said. “We’re watching very carefully to see how it does.”

“In the meantime, the national influenza centers around the world are developing their ability to detect this newly emerging virus” and also working on vaccines, McCauley said.

Experts needed to find out how vaccines would perform “in case this virus becomes pandemic,” he said.

Coincidentally, John Oxford, a professor of virology and an expert on the 1918 flu pandemic, was in Shanghai about eight weeks ago -- roughly the same time that the elderly man first fell ill – for a meeting about hygiene, important in the fight against viruses such as flu.

He said the situation in China was “getting a little more worrying.”

“I don’t like the sound of it. Every day I open up the reports and find out someone else has died,” he said. “I just don’t like to see the figures going up day after day.”

“So far there’s no human-to-human transmission. What’s tomorrow going to bring, what’s the next day going to bring? You don’t know and I don’t know,” he added.

But Oxford, of the U.K's Queen Mary, University of London, stressed there was “no need for anyone to start flapping at the moment.”

“I don’t think we should start thinking of 1918 scenarios, definitely not,” he said.

Bobby Yip/Reuters

Officials from the Center for Food Safety get a blood sample from a chicken imported from mainland China at a border checkpoint in Hong Kong on Thursday.

A group of Chinese scientists, writing in the New England Journal of Medicine, also warned that the “pandemic potential of these novel avian-origin viruses should not be underestimated.”

“Severe avian influenza A (H7N9) infections, characterized by high fever and severe respiratory symptoms, may pose a serious human health risk,” it added. “We are concerned by the sudden emergence of these infections and the potential threat to the human population.”

However – mirroring the split on the streets of Shanghai – other experts were less worried.

Adolfo Garcia-Sastre, a microbiology professor at Mount Sinai School of Medicine in New York and principal investigator for the Center for Research on Influenza Pathogenesis, said while it was “too early to be able to conclude anything …  the probabilities are very low” that a global pandemic is looming.

He was comforted by the lack of a surge in the numbers of people with the disease.

“It’s not that it’s increasing by ten times per week, I think right now the number of cases is what you would have expected from the original numbers,” he said.

“Right now there are no major indications to become highly alarmed.”

Ian Johnston reported from London.

Related:

Deaths from new bird flu underscore grim fears, reports show

US rushes to make vaccine against new bird flu -- just in case

New H7N9 bird flu has officials worried about skimpy resources

This story was originally published on Sun Apr 14, 2013 12:47 PM EDT

If you're someone who worries about how first responders and hospitals in your town would perform after a hurricane like Sandy, a Joplin tornado, an anthrax mailing, an outbreak of bird flu or other health threat, a new study has some pointers: stay away from Kansas and Montana.

But you might want to consider moving to Maryland, Mississippi, North Carolina, Vermont or Wisconsin.

On Wednesday, two nonprofit groups released "Ready or Not?", a 79-page analysis of public health preparedness - that is, the ability of hospitals, health departments and others to prevent and respond to emergencies ranging from bioterrorism to influenza outbreaks to catastrophic weather.

It's a grim reckoning. The assessment is based on how many of 10 key benchmarks a state met, such as whether it holds drills to make sure public health workers can respond quickly to, say, a catastrophic release of radiation, and whether its labs can work overtime to identify a mystery disease.

This year, thirty-five states met fewer than seven of the 10 benchmarks. Only five met eight of 10.

In 2010, in contrast, more states made the grade: 17 met at least nine benchmarks and 25 met seven or eight. No state met fewer than five.

In the new report, Maryland, Mississippi, North Carolina, Vermont and Wisconsin scored highest, meeting eight out of 10 preparedness benchmarks. Kansas and Montana brought up the rear, meeting three. Alabama, Arkansas, California, Delaware, Nebraska, New Hampshire, New Mexico, New York, North Dakota and Virginia met seven of the 10 criteria.

"We have not paid sufficient attention to the everyday threats" such as influenza and food poisoning and extreme weather, said Dr. Jeffrey Levi, president of the Trust for America's Health, which produced the report with the Robert Wood Johnson Foundation.

There's a reason for that, say experts on preparedness. After the September 11 attacks and the anthrax mailings of 2001, public health preparedness became synonymous with being ready for bioterrorism.

Starting in 2002, states began receiving upward of $1 billion a year from the federal government - $13.6 billion so far - to prevent and respond to public health emergencies.

"But it was all about anthrax and other bioterrorism instead of the other things that might come over the transom, such as bird flu," said health policy analyst Art Kellerman of RAND, a Santa Monica, California-based think tank, who was not involved in the report.

Because the federal money came with tight restrictions - a state health employee working on, say, early-detection systems for a bioterror attack was prohibited from working on anything else - "you had a shifting of attention and resources away from preparing for all hazards to biodefense only," Kellerman said. "It was like we built a biodefense skyscraper at the same time that we took the concrete out of the foundation."

To be sure, states are more prepared for public health disasters than they were a decade ago, says Levi. They've improved their ability to identify a rare disease, such as plague, in time to impose quarantines and trace its spread, for instance.

But budget cuts threaten even that progress, said James Blumenstock, who oversees public health programs at the Association of State and Territorial Health Officials.

Since 2008, 48 states have cut their health budgets as the recession slashed tax revenues. Federal money for state and local preparedness, mainly funneled through the Centers for Disease Control and Prevention, has fallen 38 percent since 2005 and at least 45,700 health-department workers lost their jobs.

The Trust cast a wide net to evaluate public-health preparedness. For instance, it counts vaccinations: only two states met the national goal of immunizing 90 percent of toddlers against whooping cough.

This year Wisconsin, Vermont and Washington are all in the midst of whooping cough outbreaks, with more than 10,000 cases among them. None of the three states vaccinate 90 percent of their toddlers against the disease.

The Trust also assessed readiness for events like Superstorm Sandy. Only 15 states have plans on adapting to climate change, and the more severe weather it could bring. New Jersey, where Sandy killed two dozen people, is not among them.

One critical job of public health agencies is figuring out why people are dying of flu-like illnesses in time to impose quarantines and other steps to prevent a disaster like the one depicted in the 2011 movie "Contagion." Yet 13 states do not have the staff to work five 12-hour days for six to eight weeks to identify and track an outbreak of, say, bird flu.

Outside experts said the report might paint an even grimmer picture if it counted other crucial public-health capabilities. For instance, the country cannot produce flu vaccine in time to handle an unexpected outbreak, such as swine flu (H1N1) in 2009. "It was produced in record time, but still not fast enough to affect the epidemic" before it petered out on its own, said Jeanne Ringel, a health analyst at RAND.

Related links:

• What would you do if you were attacked?
• Hospital generators fail after Sandy
• CDC preparedness blog takes on bridezillas

Global health officials are closely monitoring a new respiratory virus related to SARS that is believed to have killed at least one person in Saudi Arabia and left a Qatari citizen in critical condition in London.

The germ is a coronavirus, from a family of viruses that cause the common cold as well as SARS, the severe acute respiratory syndrome that killed about 800 people, mostly in Asia, in a 2003 epidemic.

In the latest case, British officials alerted the World Health Organization on Saturday of the new virus in a man who transferred from Qatar for treatment in London. He had recently traveled to Saudi Arabia and is now being treated in an intensive care unit after suffering kidney failure.

WHO said virus samples from the patient are almost identical to those from a 60-year-old Saudi national who died earlier this year. The agency isn't currently recommending travel restrictions and said the source of infection remains unknown. Still, the situation has raised concerns ahead of next month's annual Hajj pilgrimage, which brings millions of people to Saudi Arabia from around the world.

Health officials don't know yet whether the virus could spread as rapidly as SARS did or if it might kill as many people. SARS, which first jumped to humans from civet cats in China, hit more than 30 countries worldwide after spreading from Hong Kong.

"It's still (in the) very early days," said Gregory Hartl, a WHO spokesman. "At the moment, we have two sporadic cases and there are still a lot of holes to be filled in."

He added it was unclear how the virus spreads. Coronaviruses are typically spread in the air but Hartl said scientists were considering the possibility that the patients were infected directly by animals. He said there was no evidence yet of any human-to-human transmission.

"All possible avenues of infection are being explored right now," he said.

No other countries have so far reported any similar cases to WHO, he said, and so far there is no connection between the cases except for a history of travel in Saudi Arabia.

Hartl said the first patient may have had an underlying condition but it probably didn't make him more susceptible to catching the virus.

Other experts said it was unclear how dangerous the virus is.

"We don't know if this is going to turn into another SARS or if it will disappear into nothing," said Michael Osterholm, a flu expert at the University of Minnesota. He said it was crucial to determine the ratio of severe to mild cases.

Osterholm said it was worrying that at least one person with the disease had died. "You don't die from the common cold," he said. "This gives us reason to think it might be more like SARS." SARS killed about 10 percent of the people it infected.

Britain's Health Protection Agency and WHO said in statements that the 49-year-old Qatari became ill on Sept. 3, having previously traveled to Saudi Arabia. He was transferred from Qatar to Britain on Sept. 11 and is being treated in an intensive care unit at a London hospital for problems including kidney failure. Respiratory viruses aren't usually known to cause serious kidney problems.

In Qatar, Mohammed bin Hamid Al Thani of the Public Health Department said the patient was in Saudi Arabia for Ramadan during the summer and became ill after returning to Qatar. Doctors could not immediately identify the virus and decided he should be treated in London.

A public health official, Abdullakef al-Khal, said there is no indication that the patient's family or others were infected.

"There is no special alert for now," he said. "We are being vigilant."

David Heymann, chairman of the Health Protection Agency, said the new virus didn't appear that similar to SARS.

"It isn't as lethal as SARS and we don't know too much about its transmissibility yet," he said. "If people are getting infected, they aren't getting serious disease."

Heymann said none of the health workers involved in treating the Qatari patient had become ill.

Saudi officials said they were concerned that the upcoming Hajj pilgrimage next month could provide more opportunities for the virus to spread. They advised pilgrims to keep their hands clean and wear masks in crowded places.

Several disease outbreaks have occurred during The Hajj including the flu, meningitis and polio.

More on Vitals:

Peanut butter recall widens

Can you die of a broken heart?

Morning-after pill available to NY high school kids