SARS

It has been quite some time since - as a health professional - I sat down to write a case history about a patient with a disease. With more information about SARS available every day, for this week's diary I have engaged my previously abandoned taxpayer-funded skills.

History

Pneumonia is a common cause of illness but normally speaking it isn't dangerous to be around someone with pneumonia. Although it wouldn't be wise to be closely exposed, most cases of pneumonia are caused by bacteria which are common, even in healthy people.

This is certainly not the case with Severe Acute Respiratory Syndrome (SARS). The first case seems to have been in November in the Guandong Province in Southern China and occurred in chefs and other people who handled raw meat. By January this year the authorities in Guandong were aware they were dealing with a highly infectious pneumonia. In a now-notorious cover-up the information was not passed on to the rest of the world.

It wasn't until March of this year that the epidemic was recognised by Dr Carlo Urbani, an Italian doctor working for the World Health Organisation in Hanoi, Vietnam. Urbani, an infectious disease specialist, was to die of the disease he identified. His contribution was huge in recognising that SARS was an epidemic pneumonia. With his assistance the Vietnamese were able to contain SARS. They used patient isolation, fine filter masks, double gowning and gloves which were not routine in Vietnam at the time. His wife Giuliana said that a few days before falling ill he had argued with her. She was concerned to see him working with patients with such a deadly disease. He said: "If I cannot work in such situations, what am I here for - answering emails, going to cocktail parties and pushing paper?"

By the time SARS became public the virus had spread and appeared to establish itself in Toronto where there appeared to be some lapses in isolation procedure- for example, an infected patient was transferred to a hospital that didn't have the virus.

On the positive side there was a lot of international co-operation as laboratories rushed to identify the virus. The World Health Organization announced that a new pathogen, a member of the coronavirus family never before seen in humans, is the cause of Severe Acute Respiratory Syndrome (SARS). The death rate from SARS is not established but is estimated to be between six and ten percent. There appears to be more than one strain and the death rate has been rising.

It appears that the virus leaped between species, and came from a domestic animal. Experts expect we will now have to live with SARS and many expect further outbreaks among people travelling from China. The Chinese are now mounting a huge effort to contain SARS but a Beijing official recently announced that they faced a further one hundred cases a day and they were short of isolation facilities.

New Zealand has had one confirmed case of SARS although more are suspected. The screening at our airports helps with education but as the incubation period is around seven days it is quite possible for someone to contract the disease and return to New Zealand without being aware of any symptoms.

Diagnosis

Diagnosis is not a precise science. Doctors generally consider themselves to be doing well if they accurately diagnose eighty percent of the cases they see. The diagnosis of SARS is hampered by the lack of a 'test' that gives a conclusive result. So a patient with the signs and symptoms - high temperature, sometimes with chills, headaches and muscle aches, a dry cough and an X-Ray showing signs of pneumonia - would indicate a possible case. However this needs to be combined with a history of travel to one of the countries with SARS or contact with somebody who has. The disease is spread by droplets when an infected person coughs or sneezes.

Treatment

There is no cure, although there is much work being done at the moment. Patients with severe cases and (ten-twenty percent) are ventilated to assist breathing. Scientists have discovered the DNA sequence of the virus, which is a major step towards developing treatments.

Panic and Protection

There is a balance between being vigilant - informing people to a level where they can take sensible protections - and public panic. We need to avoid situations like one that took place in Auckland last week, where a pool attendant demanded an Asian woman and her sons leave the pool on the sole basis of their ethnicity. Worldwide, there have been many more Asian victims because of where the virus first took hold, and because it was not contained. But catching this disease depends entirely on your exposure to the virus, not your race. Asians are no more and no less susceptible than anybody else.

When people are well-informed, it allows them to act responsibly. Travel to infected areas undertaken cautiously, well-equipped hospital and informed staff, and a public kept up-to-date with information, all help prevent unnecessary spread of a disease that must be treated with a great deal of respect.

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