Posted on 03/26/2003 5:39:19 PM PST by Mother Abigail
Today, 80 clinicians from 13 countries participated in an electronic "grand rounds" on clinical features and treatment for patients with Severe Acute Respiratory Syndrome, known as SARS. Their discussion, organized by the WHO network of clinicians focused on the disease's features at presentation, treatment, progression, prognostic indicators, and discharge criteria. No therapy demonstrated any particular effectiveness. Clinicians agreed that a subset of SARS patients, perhaps 10 percent, decline and need mechanical assistance to breathe. These people often have other illnesses that complicate their care. In this group, mortality is high.
Based on their experiences with patients, SARS clinicians are drawing the following conclusions:
Disease presentation:
All of the clinicians described presentations of SARS patients and the general consensus is that presentation is relatively consistent across all nations. Presentation is of a prodromal illness with a sudden onset of high fever. In a great number of cases this sudden, high fever is associated with myalgia, chills, rigors, and non-productive cough. At presentation (which is often 3 to 4 days after onset of symptoms), a large proportion of patients have characteristic changes on chest x-rays.
Disease progression:
Following presentation, chest x-rays continue to worsen and most patients demonstrate bilateral changes with interstitial infiltrations (fluid build-up between cells in the lungs). These infiltrations produce x-rays with a characteristic cloudy appearance. Patients then fall into one of 2 groups. The majority, 80 to 90 percent of patients at day 6 or 7, show improvement in signs and symptoms. A second smaller group, progress to a more severe form of SARS, many of whom develop acute respiratory distress syndrome and require mechanical ventilatory support. Though mortality associated with the more severe group is high, a number of patients have remained on ventilator support for prolonged periods of time. Mortality in the severe group appears to be linked to a patient's other illnesses (co-morbid factors).
Prognostic indicators:
Generally, patients over 40 with other illnesses are more likely to progress to the severe form of the disease.
Therapy:
Numerous antibiotic therapies have been tried to date with little clear effect. Ribavirin with or without use of steroids has been used in an increasing number of patients. But in the absence of clinical indicators, its effectiveness has not been proven. Currently the most appropriate management measures are general supportive therapy, insuring the person is hydrated and treated for subsequent infections.
What next:
Planning these grand rounds regularly. The clinicians involved in establishing management guidelines (treatment, management of patients and contacts, discharge).
The participants agreed to "meet" regularly using electronic communications and to rapidly develop international guidelines for the care of SARS patients.
In a city with 1,000,000 (one million) people, 37,000 people would die from the virus. The 37,000 people would require medical treatment, including mechanical ventalation. I could not imagine what would happen if this hit a city with 22-23 million people.
It seems to me that the WHO, CDC, and any other group willing to work on the problem to help prevent a health catastrophe should do so immediately.
I think starting this thread is a great place to summarize or collect information/links related to SARS, I hope you can keep it up!
Can I get on your ping list?
SARS Update: HK Says Identifies Deadly Virus, Closes Schools
This got me thinking,
because south of Chicago
last summer we had
a lot of bird deaths.
In fact, I was privately
told by an Oak Lawn
policeman that some
authorities were afraid
to publicize it
as they didn't want
to risk creating panic.
So, I compared lists,
the new list of SARS
states, with the CDC list
of West Nile case counts.
I'm conspiracy
minded, but I don't see links
between the two lists.
Illinois was the
hardest hit by the West Nile,
but has just one SARS.
Whatever SARS is,
it doesn't appear to be
West Nile follow-on...
Never once on all your threads have you promoted panic, in fact you have always been a voice of reason.
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