Barbara Carroll, NewsMax.com Monday, April 14, 2003 - "Since the discovery of the SARS cases, I feel very worried. I feel anxious for the masses," Chinese President Hu Jintao said today. Hu visited hospitals with SARS patients in Guangdong, where cases were first reported.
Prime Minister Wen Jiabao admitted for the first time that the situation was grave. He demanded tough measures to fight severe acute respiratory syndrome.
Two deaths have been reported in China's remote northern region of Inner Mongolia. This increases concern in the medical community that China probably has many more SARS cases and deaths than have been previously revealed. Ten new cases of SARS have been identified in the regional capital of Hohhot.
These new cases in previously unreported Hohhot and the near doubling of cases in Shanxi province to 79 has prompted Henk Bekedan, director of the World Health Office office in Beijing, to say today, "We're very concerned about what may be happening out in the provinces."
Healthy People Succumb
Five more SARS patients have died in Hong Kong, including four who were young and healthy before catching the pneumonia-type illness. Although they were given the standard treatment that has helped many weaker patients survive, these four failed to respond, their condition deteriorating rapidly. The latest deaths pushed Hong Kong's total to 40 and raised concerns that SARS is able to kill younger, fitter patients who were previously seen as having a good chance of recovering. "Their situation fluctuated wildly when they were admitted into hospitals," said the senior executive manager of Hong Kong's Hospital Authority, Dr. Liu Shao-haei.
The continuing rapid spread in China, especially the Hong Kong area, have medical experts giving more credence to the “super spreader” theory. Infected individuals showing no signs of the disease could be passing the virus to others.
U.S. Transmission of SARS
SARS might no longer be just a visitor in America. It is highly possible that the deadly atypical pneumonia was transmitted from one person to another last week, which would put the U.S. on the list of “affected countries.”
Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, said in a briefing Thursday: “One situation, in particular, involved a person who traveled to Asia and developed an illness consistent with SARS. In the very early phases of that illness, the individual did go to work, and during the active monitoring of contacts that the Florida Health Department is conducting, an individual in the workplace who has respiratory illness was identified.
"So that worker is now on the list of suspected SARS patients but it's far too early to indicate whether any of these individuals actually has SARS.”
There are now 166 suspected cases in the U.S. under investigation. Other affected countries include: Canada, Taiwan, Beijing, Singapore, United Kingdom and Vietnam.
There are 3,169 cases worldwide, 213 new cases since Friday, 144 deaths, with 1,499 recovered.
Indonesia, Japan and the Philippines are reporting their first cases, involving people who had traveled to Hong Kong or Singapore. Germany, France, Australia, Ireland, Switzerland, Romania, Spain and Brazil are reporting suspected cases.
SARS Socks the Economy
Disney World in Florida, which caters to tourists from every part of the world, is suffering a big loss in revenue. The amusement park, which had to lay off workers and close some events after Sept. 11, is experiencing a further drop-off in business due to decreased air travel.
Arrivals and departures at Hong Kong airport were down nearly 50 percent, and 20 percent of daily flights have been canceled. The Wall Street Journal cite cancellations by Continental, Cathay Pacific Airways, Singapore Airlines, All Nippon Airways, Japan Airlines, British Airways and Qantas.
It was "pretty bleak" for the world's airlines already fighting for survival after 9/11, said Cathay Pacific's manager for New Zealand and the Pacific Islands, David Figgins.
New Zealand's $90 million Hong Kong-China live lobster market is suffering from lack of tourism and the near shutdown of travel to Hong Kong. Auckland, another rock-lobster exporter, is also citing huge losses.
Scientists Shed Light on Mysterious SARS
The New England Journal of Medicine and The Lancet have published reports with new findings on the epidemic of the pneumonia-like illness causing panic and economic strain around the world. The reports confirm that SARS is a new virus, most probably from the coronavirus family. It is suspected that the virus came from an animal source, but this has yet to be proven.
The Lancet states: “A coronavirus was isolated from patients with SARS that might be the primary agent associated with this disease. The biological, genetic, and clinical data taken together show that the new virus is not one of the two known human coronaviruses.”
The NEJM adds, “Preliminary studies suggest that this virus may never before have infected the U.S. population.”
The article continues: “The apparent lack of antibody in all serum specimens except those from patients with SARS suggests that this virus has not previously circulated. Certainly it has not circulated widely among humans. Presumably, this virus originated in animals and mutated or recombined in a fashion that permitted it to infect, cause disease, and pass from person to person. The available sequence data on this coronavirus suggest that is it sufficiently distinct from those previously reported in animals and humans that its source may be yet to be discovered. ... it appears that SARS-related coronavirus may be the first example of a coronavirus that causes severe disease in humans.”
CDC researchers published an update today on the identification of the virus. It said that “the Urbani strain of the SARS-associated coronavirus is distinct from all previously recognized coronaviruses and sequence studies are not likely to identify a source for this novel coronavirus.”
To positively identify the virus, “there are two additional steps that must be fulfilled before we could make that claim,” says Gerberding at the CDC.
“We've seen the virus in tissue, and we've seen evidence of pneumonia, but we need to see them both together in the same specimen to really show that the virus is geographically associated with infection.
"The second important aspect to prove definitive relationship is that we must have an animal model where we inoculate the coronavirus into an animal, the animal gets sick and develops pneumonia, and then we isolate coronavirus from the affected tissue in that animal model.”
Because patients have such varied responses to the SARS virus, it has brought up new questions about treatment. About 80 percent of the people who contract the virus fight it successfully. The other 20 percent become severely ill and might develop fluid in the lungs requiring intensive care and the use of a respirator. The mortality rate is thought to be around 4 percent, higher than previously reported.
According to the article in The Lancet, dry cough, fever, myalgia, and chills were the most frequently cited symptoms.
The article continues: “The mean time between onset of symptoms and worsening was 3-8 days. The outbreak of SARS is unusual in several ways, especially in the appearances of clusters of patients with pneumonia in health-care workers and family contacts. A window of opportunity of around 8 days exists from the onset of symptoms to respiratory failure. Severe complicated cases are strongly associated with underlying disease and delayed use of ribavirin and steroid treatment.”
With this course of treatment, the article continues, there is a mortality rate of only 2 percent, at least among the 50 patients in the study.
Dr. Donald Low of Mount Sinai Hospital in Toronto is in isolation from being exposed to SARS by patients, an example of the front-line risks that health workers are experiencing.
Low has been using the steroids/ribavirin treatment on his patients, but he thinks the use of antibodies, a successful treatment for other deadly infections, is the best approach.
“The challenge is to find patients who have recovered and to harvest antibodies from them,” he says. “My big concern is that if it goes into countries with no resources, no expertise, no infrastructure, it will become a pandemic.
“If we can control the outbreak in this country now, it will give us the lead time to get vaccines and better treatments, so we’ll be more prepared when it comes back.”
Here to Stay
Low's words are echoed in many hospitals and research labs. SARS is probably on the list of diseases here to stay.
Gerberding at the CDC comments on the availability of a vaccine. “In the best-case scenario, if everything goes well and we have a good system for growing the virus and we have a good animal model for demonstrating that it works, we're still at least a year out from any kind of investigational vaccine.”
Imagine the Outrage if the U.S. Did This
Since November 2002, the SARS virus has been transmitted in China, unreported by health or government officials until recently. This allowed the virus to spread to nearby Hong Kong by the end of February 2003 when clusters of patients reported the signature SARS symptoms. The disease then spread around the world during March and April.
In the eloquently written article on SARS in the NEJM, the authors state, “The investigation of the SARS outbreak serves as a model for laboratory and epidemiologic reponses to possible future pandemics of infectious disease.”
In a global effort of cooperation and teamwork, the world’s health organizations and scientists have worked together in an unprecedented timely manner to discover the origin and cure for this potential pandemic. There are 17 laboratories from nine countries with clinicians from 11 countries involved in testing, diagnosis of patients and research.
Not since the determined work by World Health Organization members in 1967 that resulted in the defeat of naturally occurring smallpox a decade later, or the battle to isolate and find a cure for AIDS began in the 1980s have we seen anything like the dedication to research and health care for SARS.
It is this spirit of world community effort to defeat a common enemy that keeps humankind civilized, and will perhaps be the reason we survive nature’s vicissitudes and our own weaknesses.
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