WHAT IS THE CAUSE OF SARS? ONE VIRUS, TWO VIRUSES WORKING IN CONCERT, OR A DETERMINANT UNKNOWN

PRO MED - WHO ^ | 03-25-03

[Mother Abigail]

Q. The question about the 2 viruses having been, or 2 families of viruses having been associated with this disease or with this outbreak. You said it was not normal, if I'm not mistaken. Could you give us an idea of whether or not it's possible for a single disease to be caused by 2 viruses or is it more likely that at least one of the samples might not be related to SARS?

A. Dr Klaus Stohr: Speaking as a scientist, we are looking at a very interesting and a fascinating situation. Looking from the point of infectious disease control, we are a bit puzzled because we are not only dealing apparently with one pathogen but with 2.

The reason why we believe that both pathogens should be given equal attention is that there is consistent finding of both pathogens in individual patients or of either of the pathogens in other patients.

What we are seeing actually are 3 hypotheses.

The first hypothesis is that one of the viruses, for instance the corona virus, causes the disease, and that might be a new corona virus.

The second hypothesis is that the paramyxoviruses cause the disease and if that was the case, it's certainly also a new paramyxovirus.

The third hypothesis, very obviously, is that these 2 pathogens have to come together to cause this very severe outbreak. One of the viruses, for instance the coronavirus, is known to live in immune cells, cells which are important for defense against infection. So what one could hypothesize is that this coronavirus destroys or at least diminishes the immunity in the patient so that the second virus has practically an open door to go in and to sicken the patient beyond what this virus would be able to do normally.

Dr David Heymann: Let me just add to that: there could be a fourth hypothesis. It is possible that both are common viruses: one found in all the patients, even though it's not causing disease, and the other will be the disease-causing agent, so they could both be found but not be related in any way, just there by chance. So it's a very complicated issue that's being sorted out.

[EternalHope]

Whoops! Got distracted while posting and posted wrong numbers.

With a 10 day doubling rate there would be 2,400 cases in 30 days, 19,200 cases in 60 days, and 76,800 in 80 days.

My apologies. Post in haste, repent at leisure...

[maestro]

'Lemur',....'tarsier'....measles?

[per loin]

Lets make a few simple assumptions (a full analysis would be much more complex). Doubling time = 10 days, 300 people in Hong Kong are infected as of today.

The rate of increase for the last few days in Hong Kong has been about 10% per day. That would be a doubling time of about eight days. But, of course, so little is now known, that any such figures are wildly speculative. We don't know if there are milder cases that are infectious but not reported. We don't know how widely the disease has penetrated the community or in which social classes it is spreading. We don't know if it will tend to burn itself out, or even what causes it.

[Mother Abigail]

Paramyxovirus is highly contagious.

It can spread from man to monkey, man to man, and monkey to man.

[TheErnFormerlyKnownAsBig]

No. I've heard of this flu many times but I never heard the stupid acronym that the CDC or someother alphabet group has thrown on it.

I've heard it called the "killer flu".

[maestro]

?....We can have a human-monkey-cattle-pet disaster in all the 'jungles' of the world....?

[TaxRelief]

It can spread from man to monkey, man to man, and monkey to man

Really? Which paramyxovirus spreads this way? Hmmm?

[Mother Abigail]

Fears grow about how mystery disease spreads

By DIRK BEVERIDGE, Associated Press WriterMarch 26, 2003

Airline passengers, students fall ill

HONG KONG (AP) - Concerns grew Tuesday about how the new flu-like disease coursing through this city spreads, with passengers on an airplane and school children becoming ill.

The World Health Organization again said air travel is safe, but its scientists are looking closely at Hong Kong's growing number of cases to see if early theories on the contagiousness of the disease hold true.

In recent weeks the disease has spread beyond hospitals, where dozens of health care workers became infected, to schools, with at least four schools closed for several days.

Hong Kong officials also said Tuesday that nine tourists apparently came down with the deadly disease after a mainland Chinese man infected them on a March 15 Air China flight to Beijing.

If severe acute respiratory syndrome, or SARS, can be more easily spread through the air - rather than through close contact with infected people, it could force travel and other restrictions to contain the disease.

"We would want to be sure that it was people sitting next to that person and not the ventilation system in the airplane which was spreading the disease," said Dr. David Heymann, head of communicable diseases at WHO. "We have no evidence of the latter right now."

For one thing, he said, health investigators have followed thousands of passengers who flew with SARS-infected travelers and did not become sick.

However, he said that if they find there are cases that did not involve close contact with someone sick or at high risk, "we will then be very concerned that this might have become airborne."

The airplane cases seem similar to how the disease got its start here - from one hotel guest who spread it to six strangers staying on the same floor. One expert theorized it might have spread through the air-conditioning system.

From the Hong Kong hotel, the exposed tourists took the disease to Singapore, Vietnam and Canada.

The disease has spread most rapidly through Asian hospitals, some of which lacked the surgical masks and goggles needed to prevent catching the disease from patients. WHO has been distributing such equipment.

[Mother Abigail]

MEASLES
Rubeola Virus

AGENT: Paramyxovirus

RESERVOIR AND INCIDENCE: Reservoir appears to be the human population. New world monkeys are more resistant than old world monkeys but exhibit high mortality when infected.

TRANSMISSION: Virus is excreted from the mucous membranes of the eye and pharynx and later from the respiratory and urinary tracts. Virus is shed in the prodromal phase and continues through the exanthematous phase. Highly contagious. It can spread from man to monkey, man to man, and monkey to man.

DISEASE IN NONHUMAN PRIMATES: Signs include rash, fever, facial edema, giant cell pneumonia, conjunctivitis, nasal discharge.

DISEASE IN MAN: The incubation period is 9-11 days. Signs include conjunctivitis, Koplick spots - bluish white spots on buccal mucosa 2-3 days after onset, leucopenia, rash in mouth, cheeks, neck, chest, and body. Can be complicated by middle ear infection, bronchopneumonia, encephalitis. There is fetal risk if contracted during pregnancy.

DIAGNOSIS: clinical signs, serology, histopath

PREVENTION/CONTROL: Vaccinate personnel working with nonhuman primates (Live attenuated measles vaccine) if they do not have:

1. A titer to rubeola (HI >1: 4 protective)

2. Confirmed history of previous vaccination

3. Confirmed prior disease

Consider vaccination of susceptible populations of nonhuman primates (>6 months of age) where contact with humans cannot be adequately controlled. (Live attenuated measles vaccineAttenuvax)

[TaxRelief]

This is "good". Disemminating information without a bunch of psuedoanalysis makes more sense. Remember, "Mother Abigail" in The Stand by Steven King is supposed to represent GOOD, not medical expertise.

[Mother Abigail]

New Thread

[I'll be your Huckleberry]

Hey buddy,

My wife, the expert, and I have been following Mother's threads from the beginning.

My wife says that they are accurate and timely. Also, she says she agrees that these other viruses are probably just coincidental.

Now here is what I want to say:

Why don't you take your belligerent attitude, start a thread of your own and do something positive, instead of whining like a - whatever.

And yes this is a flame, and you are an emotionally challenged freeper

[TaxRelief]

Well, that is quite honorable of you to jump to the lady's defense and I assume you mean you are married to Doctor Abigail. No offense to the little lady, but we musn't let her run around panicking folks, must we?

P.S. I love a good flame.

[twntaipan]

Hypotheis 3 says the two viruses depresses the immune system, and Hong Kong, and probably other places in Asia, they have been treating with steroids (along with anti-virals). Do not steroids further depress the immune system?

[R W Reactionairy]

"I understand that this outbreak is causing concern, but for gosh sakes; I think lots of this is just fear-mongering by the media."

It is hard to calculate the mortality rate until the disease runs it course. All of the statisics I have seen track total cases and deaths -- not recoveries and deaths. I don't know the actual mortality rate, but I suspect the Chinese are engaged in an outrageous lie and that for current cases it will turn out to be a lot higher than 3% --- but 3% constitutes a severe medical disaster if any sizeable fraction of the population gets the disease.

Also if you read the earlier reports carefully you will see that a high percentage [I seem to recal 20%+] of victims require "artificial ventilation." Image how many cases it would take to overwhelm the health system even in the US or western europe. Ater you do that add a large fraction of this 20% to the the mortality rate if thus sort of high level care is not available.

The severity of the disease is not at issue. It is a very nasty bug. The only question is how easy it is to transmit the disease, and the fact that it does not require contact with blood [a la ebola] does not bode well.

[Mother Abigail]

Anti-inflammatory steroids are often used in treating severe PCP cases...

[gnarledmaw]

NE Wisconsin