Q & A: What Is This Disease And Why Is It So Deadly (SARS)

Independent (UK) ^ | 4-25-2003 | Jeremy Laurance

[blam]

Q & A: What is this disease and why is it so deadly?

By Jeremy Laurance Health Editor
25 April 2003

What is Sars (severe acute respiratory syndrome)?

A new disease, never seen before in humans. In its early stages it resembles flu and most patients recover. But it can rapidly progress to pneumonia, and in the most serious cases lead to breathing difficulties and death.

Why the long name?

Severe acute respiratory syndrome is an accurate description of the illness. "Severe" distinguishes it from an ordinary cold or bout of flu, which are mild by comparison. "Acute" means the illness comes on rapidly and lasts a short time, as distinct from "chronic" diseases, such as diabetes or multiple sclerosis, which are slow onset and long lasting. "Syndrome" means a collection of symptoms which, in this case, affect the respiratory system.

Is it really so scary?

Yes, for three reasons. First, it is highly contagious and spread to 26 countries in as many days. Second, although most victims have recovered, it is a serious illness with many sufferers requiring intensive care and artificial ventilation. One in twenty has died , many elderly and with other illnesses, but about one third have been younger, previously healthy people, in their thirties and forties.

Third, those worst affected are doctors and nurses. If they are put out of action, there is no one to care for the rest of us.

Is it really so contagious?

Yes and no. Sars is not an airborne infection like flu. If it were, tens or hundreds of thousands of people round the world would be infected by now, compared with the 4,000 or so that so far have had Sars. One person with flu can easily infect a whole roomful of people. To get Sars you need to be in coughing or sneezing distance – about six feet. However, the virus is highly contagious. It may also be transmitted on lift buttons, door handles and any object frequently touched. The virus can survive for two to three hours outside the body.

So how is it spread?

There are two main routes of transmission. The first is via respiratory droplets when someone coughs or sneezes, or wipes their hand across their mouth and then shakes hands or touches someone else. It is also present in the gut and can be spread via the oral-faecal route, when a sufferer who has failed to wash their hands after using the lavatory shakes hands with someone who then touches their mouth.

Are there any exceptions?

Yes. The virus thrives on organic material. This means any surface contaminated with faeces could harbour the virus for a longer period. That is why in Hong Kong there are regular clean-ups of public areas and the public are being urged to wash their hands frequently – also as a means of cleaning away respiratory droplets.

Any more exceptions?

Doctors have identified a few individuals among the thousands of victims whom they have called "super spreaders". These are people who appear to have infected scores of others, triggering outbreaks in different parts of the world. It is not known why they are so infectious – possibly because they shed large amounts of the virus or carry a particularly virulent form of it.

What are the symptoms of Sars?

It often starts with a high fever (over 38C), a dry cough and shortness of breath. Chest X-rays may show signs of pneumonia. Most people feel ill enough to seek immediate treatment.

Do we know what causes it?

We did until this week. Final confirmation that the cause of Sars was a new strain of coronavirus, the family of viruses that are a cause of the common cold, was announced by the World Health Organisation. However, this has been questioned by a team from the Canadian National Microbiological Laboratory who said they had been unable to isolate the coronavirus from 40 per cent of the Canadian victims.

How many have caught Sars and how many are dead?

Latest figures from the World Health Organisation show 4,339 cases and 263 deaths in 28 countries. The WHO says the death rate is 5 per cent but this varies from country to country.

So how serious is it?

Because most people so far infected have recovered – over 90 per cent – the view has grown that Sars is no worse than a bad dose of flu. This is a mistake. A death rate of 5 per cent is high for a disease that has spread as far and fast as Sars. Many of those who have survived have been seriously ill and have only pulled through thanks to the best that modern medical care can offer.

In Hong Kong, more than 100 people are in intensive care and all routine surgery and outpatient appointments have been cancelled for a month while the medical system struggles to cope.

What are the prospects for a cure?

Identifying the virus that causes Sars and sequencing its genome, as the WHO announced had been achieved this month, is a big step forward to developing a reliable test for the disease and ultimately a vaccine and cure. However, developing a cure, which will have to be tested in animals before being used in human trials, will take years.

Who is most at risk?

Doctors and nurses treating those with the disease. They have been cut down by the score.This is one of the most alarming features of Sars. If it disables the medical system then the population will be left defenceless.

What can be done to protect the public?

The incubation period for the disease is two to seven days, or up to 10 in rare cases. People only appear to be infectious once symptoms – starting usually with a fever – develop. That is why some airports are using thermal imaging equipment to detect passengers with a high temperature.

Should travellers from Hong Kong, China and Toronto be quarantined?

This would be the safest option but with 16,000 travellers a week arriving from the affected areas it would cause massive disruption, expense and damage to the economy. This has to be weighed against the likely benefit. Given that people only become infectious when they develop symptoms, the UK chief medical officer, Professor Liam Donaldson, has taken the view that with awareness of the disease now very high everything that can reasonably be done is being done.

Is the chief medical officer right?

The six cases that have so far arrived in Britain have been quickly identified, isolated and treated without spreading the infection to others. On that basis, Professor Donaldson is probably right. But if the number of cases arriving at Britain's airports started to rise, the case for quarantine would be strengthened.

Should Sars be declared a notifiable disease?

Yes, says Liam Fox, shadow Health Secretary. This would give local authorities powers to detain any one with Sars who was resisting treatment, to disinfect or destroy anything they had come in contact with and compel them to keep their children home from school.

No, say Professor Donaldson and the British Medical Association and other medical experts. The principal problem is that the diagnosis cannot be made quickly enough. By the time Sars is diagnosed, any patient who refused medical care would be signing their own death warrant.

Is it safe to travel?

You are unlikely to get Sars on an aeroplane because it is not an infection transmitted through the air like flu so the recycled air in the cabin poses no particular risk. There have been a couple of recorded cases of passengers being infected who sat within a few feet of a Sars victim on an aircraft. The WHO and the UK government advise against travel to Beijing, Shangxi and Guangdong province of China, to Hong Kong and to Toronto. There is no reason why travellers should not visit other destinations.

Is Sars more severe in some countries than others?

It seems to be. In Hong Kong, every Sars patient has been treated in hospital for pneumonia and taken an average three weeks to recover. About 20 per cent have required intensive care and up to half of them have required artificial ventilation. In America, only a handful of patients have required intensive care and a few have required ventilation.

Why should the impact differ in different countries?

Doctors do not know, in the same way that they do not know why some people exposed to the virus succumb while others do not. It may have to do with their inherent immunity or with different strains of the virus.

How is the disease going to develop?

Again, doctors do not know. One theory is that it is already mutating and new, more virulent strains are emerging that will cause it to spread more rapidly or cause more serious illness. This could explain its different impact in different parts of the world, Another theory is that with successive waves of infection the virus is getting weaker, causing milder illness. As it spreads and more people are infected, they will develop immunity. raising the hope that the epidemic may burn itself out. But most experts say Sars is here to stay.

[maestro]

Q & A: What Is This Disease And Why Is It So Deadly (SARS)

?...'Stem-cell',.....'research'...??

[NormsRevenge]

Ok, who broke the seal? (Revelations ?)

[Judith Anne]

Excellent post, but I take a small issue with the reporting here that it is not airborne. Aerosolized spread and long fomite survival equals might as well be airborne, imho. Furthermore, that is NOT a settled issue.

[Uncle George]

The "shelf life" of the sneeze droplets laden with virus is stated here to be 2 or 3 hours. WRONG!!!! Latest tests proved it lives over 24 hours on a door knob, dollar bill, counter top ect. That makes it a TERRIBLE THREAT. Other viruses die in 2 to 3 hours, it don't.

[poet]

Hmmm, my thoughts exactly.

[Bob J]

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[blam]

Virus (SARS) Can Live 24 Hours Outside Host, Study Finds

[Uncle George]

24 hour "shelf life" means this damn virus can come to us in the mail or UPS or a hundred other means, wow thats bad.

[blam]

Money too.

[Lijahsbubbe]

The possibilities are endless. Money, grocery items, pens, forget about that handshake!

I never thought of the mail!

[ex-Texan]

The report is packed with misinformation and half-truths. I do not believe the good doctor has read the latest reports about SARS.

I reiterate what one poster mentioned. A postal worker could be infected and sneeze on your mail. Ding-Dong ! You get SARS by mail. If the disease breaks loose in the USA our streets will look like ghost towns -- all those nifty service industry jobs will be gone in a flash. People will not eat out anymore and will rush into to buy groceries in large quantities.

Is anybody buying puts on retail and fast food stocks ? Are they from Asia .... ?

[blam]

"I do not believe the good doctor has read the latest reports about SARS."

We are probably as well informed as anyone else in the world on this site.

[Boogieman69]

Come on man, Asia is alot more cramped than us and I don't see any ghost towns. I can only name a handful of the 100's of people that i know that got the flu this year....A much smaller percertage would get SARS...don't go overboard ex-Texan....

[GirlShortstop]

 
Bump

[blam]

'Feeble and complacent' Sars policy attacked as virus claims more victims

By Celia Hall, Medical Editor
The Telegraph (UK)
(Filed: 25/04/2003)

The Government's policy on Sars, the potentially fatal pneumonia virus, was severely criticised yesterday as thousands of schoolchildren and students returned from the Far East and the World Health Organisation reported a further 343 cases in the past two days.

A traveller wears a mask at Heathrow Airport after returning from Beijing The virus has now killed 251 people, mainly in China and Hong Kong.

Dr Liam Fox, the shadow health secretary, called for the disease to be made "notifiable", which would mean that people could be required by law to be examined by doctors and held in hospital.

Dr Fox accused the Government of being "feeble, complacent and irresponsible" and said that existing legal powers should be used.

"All around the world Sars is causing immense alarm. Here, on the other hand, ministers' conduct would make people think that nothing serious is going on."

The Public Health (Control of Disease) Act 1984 has a number of provisions aimed at containing the spread of a serious infection which also include destroying material that have been in contact with it and a requirement on parents to keep children away from school.

The Liberal Democrats said the Government should make a statement to Parliament to say what it was doing to protect the public.

"The Government has not so far provided swift, direct information and guidance on Sars to the public," said Dr Evan Harris, health spokesman for the Lib Dems. People have had to hunt around on the internet for information on how to avoid the virus.

"People need reassurance that the Government has made adequate contingency plans for any widespread outbreak of Sars in the UK. They also need clear information on what they can do."

Prof Sir Liam Donaldson, the chief medical officer for England, insisted that the Government was taking sufficient precautions and that all the British cases had been detected quickly.

The six British cases have all recovered and left hospital.

A spokesman for the Department of Health said that the system of notification was cumbersome and old fashioned. "Doctors now phone us or e-mail us and we get an instant picture."

She said that "in the fullness of time", notification might be considered. "The idea that we should corral people returning to this country who have no symptoms would precipitate just the kind of scenario that people fear."

On Tuesday, the Department of Health advised people against travelling to Toronto, Beijing and the Chinese province of Shanxi as well as to Hong Kong and Guangdong in China but said that quarantining returning travellers from these places was not necessary at present.

"We are in very, very close daily contact with the World Health Organisation and the other countries involved and, far from being feeble or complacent, we are working very, very hard," Sir Liam said.

The position was fully supported by the British Medical Association yesterday which warned against a public panic.

"There is no reason to close the UK's borders," said Dr Vivienne Nathanson, head of science at the BMA.

"This is not practical as it would have to extend to all countries which have had cases, including the USA. Such a move would also stop all commerce, imports and exports like food and this would be a gross over-reaction to the threat.

"It is extremely important that the public does not panic over Sars. The Department of Health, the Health Protection Agency and the World Health Organisation are taking all appropriate steps."

Dr Julie Hall, of the WHO's Sars team, said that many of those who had died had existing health conditions and mostly were aged over 40. However, the disease has also caused deaths in younger people with no other illnesses.

"We have to work very, very quickly and there has to be an enormous global collaboration and co-operation to be able to investigate it and put control measures in place."

[Jimmyclyde]

" OH, look at me I have a bad cold!!"

Please...

The Chinese are so dirty, it's a blessing they don't bring death wherever they go....

[CyberAnt]

The samples of SARS were sent all over the world to different labs to be disected.

Only the Russian lab came back with the conclusion that this was a man-made combination of Measels and Mumps - which got out of hand.

I tend to believe this because Russia has been working with China recently and I believe they might have known about this experiment. Also, many of the labs thought this was a case where it started on animals and was transferred to humans.

[ex-Texan]

Look at This Hot From the Web:

SARS E2 Spike-protein Phylogeny

From Dr. Robert E. Lee

Enclosed are 2 .pdf file showing SARS E2-spike protein in a phylogeny with 12 other coronaviruses. The viruses in the phylogeny include:

VGL2_CVBF E2 glycoprotein precursor (Spike glycoprotein) (Peplomer protein) [Contains: Spike protein S1 (90B); Spike protein S2 (90A)]

S44241 surface protein - human coronavirus

AAF25499.1 spike glycoprotein [bovine coronavirus]

AAL80031.1 spike glycoprotein [porcine hemagglutinating encephalomyelitis virus]

AAB30950.1 S=viral surface peplomer {monoclonal antibody resistant} [murine hepatitis virus MHV, Wb 1, MAR 11F/1, Peptide Mutant, 1235 aa]

VGL2_CVMJH E2 glycoprotein precursor (Spike glycoprotein) (Peplomer protein) [Contains: Spike protein S1 (90B); Spike protein S2 (90A)]

AAF97738.1 spike protein [rat sialodacryoadenitis coronavirus]

NP_828851.1 putative E2 glycoprotein precursor; putative spike glycoprotein [SARS coronavirus]

S37664 peplomeric polyprotein precursor - avian infectious bronchitis virus (strain D1466) (fragment)

AAO34396.1 spike glycoprotein [Avian infectious bronchitis virus]

S41453 spike protein - canine coronavirus

AAA46905.1 S protein [Porcine respiratory coronavirus]

BAC05493.1 peplomer protein [feline infectious peritonitis virus]

You will notice in the pictures (the phylogenies) that SARS E2 protein is not like any other animals' E2 spike protein. It is not like the other human spike protein compared either. It is its own "branch" on the coronavirus tree. SARS E2 spike protein appears related to the avian, dog, cat, pig, and rat coronavirus E2 spike proteins but is not, apparently, derived from any of these. The common ancestor of the SARS E2 spike protein also gave rise to the rat sialodacryoadenitis coronavirus spike protein. It would appear that SARS E2 spike protein and the avian infectious bronchitis viruses and feline infectious peritonitis virus and canine cornavirus as well as the porcine respiratory virus were derived from a common ancestor.

That common ancestor... whatever it is/was... also gave birth to bovine coronavirus and murine hepatitis virus.

The common ancestor of the common ancestor virus (the grandparent, if you will)... whatever that one is/was, also seems to have given birth to porcine hemagglutinating encephalomyelitis virus.

That SARS E2 spike protein does not show a closer relatedness to the other human coronavirus spike protein is really surprising. SARS seems to be a real mixture of several different animal coronaviruses -- bird, dog, cat, pig, rat... and is not really closely related to other human coronaviruses.

But it is infecting humans... and shows no really close relationship to any other known human coronaviruses. It would appear that the disease SARS would show itself in serious bronchitis, peritonitis, and, perhaps, encephalomyelitis.

I selected the SARS E2 spike protein for this analysis as it is this spike protein that allows the virus to dock with cells and initiate infection. It is my thought that SARS is an FcgammaR agent as are some others of the coronavirus family. It is important that this be determined as it has direct bearing on what type of immunology is occurring in SARS. If SARS is an FcgammaR agent then it is likely possible that it is provoking an intense hyperimmune reaction in some people that would destroy the surfactin in their lungs and cause hypoxia.

Ergo ... looking like a virus cocktail (i.e. man-made)

[CyberAnt]

Bingo! "man-made"

I am convinced this is a biomed experiment which got out, and this is the reason China didn't want anybody investigating it.

I hope they know - we know - and it is going to cost them big time.