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WHO: Drop in Beijing SARS Cases May Be Due to Misdiagnosis
Doctor's Guide News ^ | May 16, 2003

Posted on 05/16/2003 2:47:13 PM PDT by EternalHope

WHO: Drop in Beijing SARS Cases May Be Due to Misdiagnosis GENEVA, SWITZERLAND -- May 16, 2003 -- China has today reported 39 new probable SARS cases and 4 new deaths, bringing the cumulative total to 5191 probable cases and 275 deaths.

Beijing reported 28 probable SARS cases today in the sixth consecutive day that the city has reported less than 50 probable SARS. From the last week of April through 3 May, Beijing was reporting a daily average of more than 100 probable cases. The daily number of new deaths has also declined from a peak of 15, reported on 22 April, to an average of 4 during the past week. Beijing reported a single death today.

WHO experts interpret the decrease in case numbers as encouraging, but have cautioned against concluding that the city's SARS cases were on a downward trend. They warned that misdiagnosis of cases could have contributed to the lower numbers of probable cases in recent days. WHO officials fear that patients with milder symptoms of SARS are being excluded as probable cases.

The number of wrongly diagnosed patients is not known, but WHO experts became concerned that this could be happening after recent visits to Beijing hospitals.

"They fit the case definition but because they get better in a few days, they are not seen as probable cases," explained Dr Daniel Chin, leader of WHO's Beijing team of SARS experts. "Clinicians are making this decision because there's an assumption that SARS patients must be very sick. But there's a spectrum of severity for SARS."

Clinicians were also basing their decision to exclude patients as probable SARS cases simply because they had not had any known previous contact with a SARS case – a definition used in areas with few SARS cases. Given the relatively large number of SARS cases in Beijing, such a criterion cannot be used, Dr Chin said.

He added that this was occurring due to confusion over the case definition, not because clinicians were trying to hide cases. WHO has asked the Beijing Government for a taskforce to be convened to address this issue.

Dr Chin said patients with milder SARS symptoms must be treated with all the same precautions. "It is still possible that they are not SARS cases, but without a reliable test, we can't confirm that," he said.

Patients with milder symptoms start off being isolated as suspect cases. But after their condition improves, they end up being sent to general medical wards, where they could infect other patients. Others may be sent home too early. "They may not need to be hospitalized but they could still be infectious," Dr Chin said.

A study of clinical progression in 75 SARS patients, published in today's Lancet by a Hong Kong laboratory in the WHO network, describes three clinical stages in patients from the Amoy Gardens cluster. In the mostly uniform three-stage pattern, the first week of illness was characterized by fever, myalgia, and other symptoms that generally improved after a few days. In the second week of illness, when infectivity is greatest, patients frequently experienced recurrence of fever, diarrhoea, and oxygen desaturation. In this study, 20% of the patients progressed to a third phase, characterized by acute respiratory distress syndrome necessitating ventilatory support.

Health authorities and clinicians need to be aware of these three phases of illness. In terms of preventing further spread, including nosocomial transmission, it is dangerous to prematurely relax precautions, notably isolation and infection control, following clinical improvement during the first week of illness.

Stability of the SARS virus in the environment

WHO has today published additional data on the stability of the SARS virus on different environmental surfaces.

The data, which come from studies conducted by laboratories in the WHO network, indicate that the SARS virus in sterilized stool can survive for 36 hours on a plastered wall or a formica surface, for 72 hours on a plastic surface or stainless steel, and for 96 hours on a glass slide.

Update on cases and countries

As of today, a cumulative total of 7739 probable SARS cases and 611 deaths have been reported from 29 countries. This represents an increase of 54 new cases and 13 deaths compared with yesterday. The new deaths occurred in China (4), Hong Kong SAR (4), and Taiwan, China (5).

SOURCE: World Health Organization, Update 57


TOPICS: Front Page News; News/Current Events
KEYWORDS: beijing; china; sars
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Clinicians were also basing their decision to exclude patients as probable SARS cases simply because they had not had any known previous contact with a SARS case – a definition used in areas with few SARS cases. Given the relatively large number of SARS cases in Beijing, such a criterion cannot be used, Dr Chin said.

In other words, the Beijing numbers are utterly worthless. (As if we didn't already know...)

1 posted on 05/16/2003 2:47:13 PM PDT by EternalHope
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To: EternalHope
A study of clinical progression in 75 SARS patients, published in today's Lancet by a Hong Kong laboratory in the WHO network, describes three clinical stages in patients from the Amoy Gardens cluster. In the mostly uniform three-stage pattern, the first week of illness was characterized by fever, myalgia, and other symptoms that generally improved after a few days. In the second week of illness, when infectivity is greatest, patients frequently experienced recurrence of fever, diarrhoea, and oxygen desaturation. In this study, 20% of the patients progressed to a third phase, characterized by acute respiratory distress syndrome necessitating ventilatory support.

In the first phase patients often seem to be getting better.

The second phase, however, is the most infectious. (The underline and bold is mine.)

Now, considering when SARS is most infectious...

Patients with milder symptoms start off being isolated as suspect cases. But after their condition improves, they end up being sent to general medical wards, where they could infect other patients. Others may be sent home too early. "They may not need to be hospitalized but they could still be infectious," Dr Chin said.

In other words, the Chicoms are sending 'em home or putting 'em with other patients when they seem to be getting better (phase I). If they really have SARS, however, that is just turning 'em loose right before they are likely to become the most infectious.

Meanwhile, the streets are being sprayed with "disinfectant". As nearly as I can tell, the Chicoms are clueless.

2 posted on 05/16/2003 3:04:18 PM PDT by EternalHope (Boycott everything French forever.)
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To: EternalHope
And all the death rates are screwed when you compare deaths vs. recovered if you count them as recovered and send them home during the second relapse - and that's when they're at their most infectious. It would seem like the Chinese government is determined to send them home, there's no problem here, they're healed.
3 posted on 05/16/2003 3:27:05 PM PDT by xJones
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To: EternalHope
Thank you for that very clear explanation. I read your posts often and find them very reasoned.

It seems a recipe for disaster.

Huck
4 posted on 05/16/2003 3:59:25 PM PDT by I'll be your Huckleberry
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To: I'll be your Huckleberry
Thanks for the kind words!
5 posted on 05/16/2003 8:36:05 PM PDT by EternalHope (Boycott everything French forever.)
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To: Judith Anne; Mother Abigail; CathyRyan; per loin; Dog Gone; Petronski; InShanghai; Ma Li; ...
Ping.
6 posted on 05/17/2003 6:56:41 AM PDT by aristeides
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To: EternalHope; aristeides
Excellent description of the three stages of SARS, that's the first I've read about those, so clearly put. I appreciate the pings to all the threads, wish I had more time to reply and offer my thoughts...

One thing I am certain of, we can never trust the Chinese numbers. And truthfully, I don't know that we'll be able to trust the numbers from ANY country, because governments seem to have an interest in minimizing the hazard due to economic concerns. That's discouraging, considering it may be here in the fall.
7 posted on 05/17/2003 7:40:48 AM PDT by Judith Anne
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To: Judith Anne
Let's hope SARS is not here already. I was disturbed by that mysteriously deleted thread yesterday alleging there are many cases of what may be SARS in a Northern California hospital. And I have been FReepmailed that there is a case in a D.C. hospital, which to my knowledge the media have not reported.
8 posted on 05/17/2003 7:48:25 AM PDT by aristeides
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To: aristeides
Whatever happened to that? I really wanted to read it.
9 posted on 05/17/2003 7:50:21 AM PDT by riri
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To: aristeides
Oh, well. There will be more articles about that hospital if there is anything to it, I'm thinking.
10 posted on 05/17/2003 7:52:09 AM PDT by Judith Anne
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To: riri
The moderator said there was no source for the thread, but the poster claimed to have spoken to somebody in the hospital on the phone.
11 posted on 05/17/2003 7:53:21 AM PDT by aristeides
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To: aristeides
I really liked FR better before all the deletions and hand slapping by moderators. Sure, some BS would make it's way through here but...
12 posted on 05/17/2003 7:59:09 AM PDT by riri
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To: riri
I wish I could be sure there isn't some policy to suppress the worst news about SARS. Actions like that deletion only fuel such suspicions.
13 posted on 05/17/2003 8:02:01 AM PDT by aristeides
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To: aristeides
Really, there's nothing we can do about SARS proactively except be as well informed as possible. Here's hoping research comes up with better treatments, that it doesn't get a foothold somewhere outside China, and that this fall and winter brings the good old-fashioned flu, and nothing more.
14 posted on 05/17/2003 8:26:51 AM PDT by Judith Anne
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To: Judith Anne
It would be a good idea if the person who posted the report about the northern california hospital outbreak would repost it as a reply to this or another new sars thread.
15 posted on 05/17/2003 8:32:41 AM PDT by dc-zoo
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To: dc-zoo
Agreed.
16 posted on 05/17/2003 8:36:06 AM PDT by Judith Anne
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To: dc-zoo
The poster had a screen name like "watch 123" or "watcher 123". But the system now says there is nobody with either name. More mystery.
17 posted on 05/17/2003 8:44:45 AM PDT by aristeides
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To: dc-zoo; Judith Anne; aristeides; riri; Watchman123
It would be a good idea if the person who posted the report about the northern california hospital outbreak would repost it as a reply to this or another new sars thread.

The poster was "Watchman123". It was unclear to me if he was saying he personally made the call, or was repeating something he had heard. The thread is gone, so I can't re-read it to be sure either.

It's the kind of info that would be extremely explosive if true. It could also make FR look very bad if it turned out to be nothing unusual.

It could be an internet hoax, or simply a hospital spokesman who doesn't realize how alarming an answer like, "Sorry, that's confidential information," can be.

Personally, I would like to see at least two Freepers make the same telephone call, each of whom would then report what they heard. For that to happen, however, Watchman123 would have to say which hospital to call.

18 posted on 05/17/2003 9:52:53 AM PDT by EternalHope (Boycott everything French forever.)
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To: EternalHope
SARS Mortality Rates [reflects treatment]
Based on World Health Organization daily tables                 (Revised:  May 17 pm)
Area Recoveries to date Deaths to date Projected Future** Death Rate Active Cases still in Danger Projected Future Deaths Projected Cumulative Mortality
China 2009 282 27.3% 2918 798 20.7%
Taiwan 50 37 87.9% 221 132 54.9%
Hong Kong 1191 243 12.1% 276 33 16.1%
elsewhere
[30 countries]
429 63 2.5% 76 2 11.4%
World-wide
[all 33 countries]
3679 625   3491 834 18.7%
Future deaths are a combination of methods formerly used here..................
The 1st method compared 7-day deaths to 7-day recoveries ......................
The 2nd method was based on findings from the Imperial College of London
that deaths take 12 days longer on average than recoveries on average
and compared TOTAL history of deaths (to date).................................
to TOTAL history of recoveries (as of 12 days ago)..............................
**  Newest method compares RECENT history of deaths (12 days)..................
to RECENT recoveries (as of 12 days ago).........................................

19 posted on 05/17/2003 12:47:51 PM PDT by Future Useless Eater (Freedom_Loving_Engineer)
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To: blam; Judith Anne; jonathonandjennifer; Mr. Mulliner; Prince Charles; Dog Gone; thinktwice; ...
SARS - Treatment/Containment tables - updated with Friday and Saturday numbers here
20 posted on 05/17/2003 12:50:44 PM PDT by Future Useless Eater (Freedom_Loving_Engineer)
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