Posted on 08/19/2003 5:11:53 AM PDT by Brian S
Pamela Fayerman Vancouver Sun
Tuesday, August 19, 2003
Genetic testing of blood and other samples from dead and ill Surrey nursing home residents and workers is so far consistent with SARS, the scientific director of Health Canada'
s National Microbiology Laboratory in Winnipeg told The Vancouver Sun Monday.
Dr. Frank Plummer, who doubles as the director-general of the Centre for Infectious Disease Prevention and Control in Ottawa, said the results are so intriguing that a virologist from the World Health Organization in Geneva is expected to visit the Winnipeg laboratory today to view the samples.
Dr. David Patrick, chief epidemiologist with the B.C. Centre for Disease Control, said a WHO representative is going to Winnipeg because "it may be the first time in the world that the virus has been found outside of the typical SARS picture," referring to the fact that the virus may still be lurking, in a mild way, in many communities, but B.C. is the first place to begin such a thorough search.
The investigation has been prompted by the fact that since the beginning of July, 97 of 142 nursing home residents at the Kinsmen Place Lodge nursing home and 46 of 160 staff have come down with influenza-like symptoms. Visitors are not allowed in, residents are discouraged from going out and 19 employees at Surrey Memorial Hospital who are healthy but who had contact with a nursing home resident have been forced into quarantine as a precaution.
The female nursing home resident is in isolation at the hospital with respiratory problems and the patient has tested positive for the specific coronavirus associated with SARS, or Severe Acute Respiratory Syndrome.
Although he did not say B.C. is facing a SARS outbreak, the comments by Plummer appeared to annoy B.C. public health officials, who want to prevent people jumping to the conclusion that SARS has killed seven nursing home residents since July 1, not to mention causing mild illness in 150 nursing home residents and employees.
"We do not have severe acute respiratory syndrome here -- we have some positive lab samples," insisted Dr. Roland Guasparini, chief medical health officer for the Fraser Health Authority.
Dr. David Patrick, chief epidemiologist for the B.C. Centre for Disease Control, also cautioned that the results from the Winnipeg lab do not yet draw a direct line between the cold-like symptoms in nearly 150 nursing home residents and staff at the Kinsmen Place Lodge because not enough of the SARS genome has been sequenced and the lab does not yet have sufficient samples to definitively say if a mutated or less severe SARS virus is circulating in the community.
As well, both Patrick and Guasparini said the test is so new, it may be yielding false positives. Plummer did not disagree. He said his results are proof of laboratory, not clinical, findings. Plummer said that lab testing done so far "is 100 per-cent identical to the SARS coronavirus and it is very unlikely that it is the common cold in the coronavirus family that we are misdiagnosing."
Patrick said he is withholding his judgment until further testing is done.
"The lab may be seeing a micro-organism that might be SARS and if it is, then it is different from the illness which earlier in the year was defined as a severe respiratory illness," said Patrick, referring to the fact that in Toronto and China, SARS was contagious, causing many deaths, while the current outbreak in Surrey is mild by comparison.
Patrick said seven nursing home deaths in six weeks is typical of the mortality rate seen in nursing homes; of the seven deaths, three were in people with pneumonia-like symptoms and four other deaths were ostensibly from causes like cardiovascular disease.
He did acknowledge the virus could have mutated into something that is causing less severe illness. Most medical experts agree it is unlikely SARS just suddenly vanished. B.C.'s chief medical health officer, Dr. Perry Kendall, said if the current outbreak is conclusively proven to be SARS, he doubts B.C. is the only place where the virus is circulating.
Experts agree that if it proves to be a disease that can cause few or no symptoms, as well as life-threatening symptoms, it will have to undergo a name change.
Plummer said scores of Canadians tested positive for the SARS virus but never actually got sick last spring and research is currently under way in Toronto to determine if they belong to a distinct class of viral carriers who can unwittingly infect others and if they are like the current B.C. cases who may get a mild version of the virus.
In that study, Health Canada has found evidence of the coronavirus linked to SARS in 172 out of 2,000 people tested but classified as neither suspect or probable cases. The Toronto samples were sent to the Winnipeg lab because the people they came from were either exposed to the virus at a hospital, had mild symptoms, were around a sick family member or had travelled to a SARS hot spot in Asia. Patrick said since Plummer has confirmed the preliminary findings, B.C. officials are now trying to send more tissue, blood and other samples from deceased nursing home residents and others who were ill, so that more extensive testing can be conducted.
Pathologists preserve samples for several weeks, he said.
"Our priority now is to get more tissue so they can grow the virus and get samples rich in genetic material. At this point, we can't say SARS caused these deaths. We can only say that a test designed to detect SARS found some positive results," Patrick said.
Guasparini said health officials here are now checking to see what samples were sent to Winnipeg. He said he remains somewhat skeptical about the laboratory findings because the genetic testing is too new to be definitely foolproof.
"Maybe if they tested everyone with a cold, some would test positive," he said.
Also on Monday, Kendall announced that no new cases of illness have been reported in residents and workers at the nursing home in the past three days and if the pattern continues, the quarantine on 19 health care workers will be lifted by Aug. 28, at the latest. The no-visiting policy at the nursing home will also be reviewed.
To prevent the spread of the illness to other nursing homes and health care facilities, any Kinsmen employee who also works elsewhere is being told not to go to the other job.
"It's possible they could pull the wool over employers' eyes, but I don't think that is likely," said Patrick, referring to the fact that some health care workers might not like being so restricted.
pfayerman@png.canwest.com
Where is Surrey, relative to Vancouver?
This article clears up the question I had about the two outbreaks between the nursing home and the hospital being related, they are.
19 employees at Surrey Memorial Hospital who are healthy but who had contact with a nursing home resident have been forced into quarantine as a precaution.
Once again, the folks up in SARSville seem to be more interested in covering things up rather than dealing openly with the problem.
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