Posted on 05/09/2003 1:51:38 AM PDT by Prince Charles
SARS' strength a worry
By M.A.J. McKENNA
The Atlanta Journal-Constitution
The first major analysis comparing strains of the SARS virus from different parts of the world reveals that, contrary to expectations, the virus is not changing significantly as it spreads across continents.
The finding, published late Thursday on a medical journal's Web site, is not good news. It suggests the infectiousness and high death rate of severe acute respiratory syndrome will persist, rather than diminish over time as other new infectious diseases have done.
But the finding may have a positive side as well. If the virus remains stable, instead of mutating rapidly, it could provide scientists with a reliable target for drug and vaccine development.
And if other findings in the research -- of small mutations found only in patients from certain countries -- hold up under scientific scrutiny, they could provide a molecular tool for tracking the virus as it moves across the world.
The research, by the Genome Institute of Singapore, was published as cases of SARS topped 7,000 and the number of deaths rose above 500. Internationally, according to the World Health Organization, there are 7,053 cases of SARS -- 444 more than 90 percent of them in mainland China and Hong Kong -- and 503 deaths, 85 percent of them in China and Hong Kong.
The World Health Organization placed Taiwan and two Chinese provinces on its list Thursday of areas to which travel should be avoided.
The Taiwan travel advisory was a sharp demonstration of the island nation's reversal of fortune: Until several weeks ago, Taiwan had experienced only a few cases of SARS, all imported from elsewhere. Now, it has had 131 cases and 13 deaths.
More than 30 of those cases were caused by a single "super-spreader," a hospital patient who was not put into isolation because he was initially misdiagnosed, Taiwan's government said.
The Centers for Disease Control and Prevention in Atlanta released an analysis Thursday of the outbreak in Singapore, which has gone 10 days without a new case. Five super-spreaders, four of whom were infected by the fifth, are believed to have caused up to 172 of Singapore's 204 cases of SARS.
In another demonstration of the disease's global reach, the first Singaporean super-spreader is believed to have been infected in Hong Kong's Metropole Hotel, where a doctor from mainland China passed the disease to patients who subsequently brought SARS into Hong Kong, Vietnam, Thailand and Canada.
Researchers have not been able to identify the conditions under which a SARS patient becomes a super-spreader. "This is part of the reason why we continue to send the message as aggressively as we can here in this country that we have to remain vigilant," said Dr. Julie Gerberding, the CDC's director.
"Because if we were unfortunate enough to have someone with unrecognized SARS be admitted to a hospital, or be present in an environment where they could expose many other people, we too could have a cascade of transmission established. We are certainly not immune to that."
The death rate in Singapore -- technically called the case-fatality ratio -- has been about 14 percent, according to the World Health Organization.
Health experts around the world are grappling with the difficulty of calculating the mortality rate of SARS. Predicting how many victims will die from a disease is vital to understanding its seriousness -- but in the midst of an epidemic, it also is difficult.
Earlier this week, a team of scientists from London and Hong Kong used sophisticated statistical models to reach a death rate that averaged 20 percent but rose as high as 50 percent among patients who were at least 60 years old.
The WHO countered with an estimate that used different statistical methods of 15 percent overall, and 50 percent for those 65 and older.
Either estimate gives SARS a higher death rate than most known diseases that are passed by face-to-face contact. Influenza typically has an overall mortality rate of less than 1 percent, which can rise to 3 percent among the hospitalized elderly.
The estimates also show SARS -- a disease for which there is no diagnostic test, no treatment and no vaccine -- to be as serious as other diseases that either cannot be cured or go untreated in parts of the world. The mortality rate for untreated measles in Africa, for instance, is 10 percent. The death rate for smallpox, for which there is no cure, is 30 percent; for Ebola, 40 percent to 50 percent.
"This is an extremely serious, lethal disease, and that's true whether the mortality rate is 5 percent, 10 percent or 15 percent," said Dr. Jeffrey Koplan, former CDC director who is now a vice president at Emory University.
"But it's still too early to measure the true case-fatality ratio," he said. For that, we need to know the number of people infected, the number who develop symptoms and what the spectrum of symptoms is, how many become hospitalized and how many die. We're still just seeing the tip of the iceberg, not its full size."
Some good news.
Yes, I understand, that's the downside. If it stays 'put', maybe we can get a vaccine ready.
May 09 2003 at 06:18AM
Phnom Penh - Terrified that the deadly SARS virus is about to hit their country, Cambodians have been gulping down bowls of green bean soup, rumoured to ward off the disease.
Bean prices in markets across the country have sky-rocketed ever since word first began to spread this week that the thick sweet brew could beat the disease.
Rumours that bean soup could ward off - and even cure - Severe Acute Respiratory Syndrome (SARS)spread so quickly that the country's telephone networks were jammed as terrified Khmers phoned loved ones to pass on the message.
"My mother-in-law forced me to eat a bowl. I don't believe in it, but I don't mind because I've always liked green bean soup," one 29-year-old Cambodian television reporter told Reuters.
Cambodians are not alone in seeking alternative cures to the illness. Chinese peasants have been letting off fire-crackers and praying to images of the Buddha to scare off the "god of plague", the official Xinhua news agency reported this week.
The poverty-stricken Southeast Asian nation so far remains free of SARS, which first reared its head in China and has killed hundreds of people worldwide.
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