Patient Hospitalized For Possible SARS Exposure Dies; Tests Come Back Negative

WRAL Raleigh, North Carolina ^ | 2003-06-13 | Reporter: Stephanie Hawco, OnLine Producers: Michelle Singer and Kamal Wallace

[Lessismore]

CHAPEL HILL, N.C. -- One of two patients being monitored in the Triangle for possible exposure to SARS died Friday. Preliminary tests from the Centers for Disease Control were negative. Meanwhile, dozens of people in the Triangle are under quarantine for possible exposure to SARS.

[jacquej]

I think it is interesting that they are screening outside. It is as if they know that keeping people out of buildings is a good precaution. This minimizes the "touching" of surfaces, the closed air systems, etc...

I wish we had a freeper close by who could follow up on how closely they are monitoring the "quarantined" people to make sure they conform. Also, if they are quarantining family members...

Anyone close enough to the area to be our eyes and ears to what is reported, and what the gossipy sheep are saying down there? Rumors are always very interesting to follow, even if most of them are totally wrong. You can usually get some tidbit to follow up on, or a hint of where to look for good information.

[Vinnie]

Results of the autopsy will not be available for several weeks.

Guess they have to check to see if he had ever been exposed to secondhand smoke.

[jacquej]

http://www.thestar.com/NASApp/cs/Co...ol=968350060724

Jun. 14, 2003. 01:00 AM

Experts expand criteria for diagnosing SARS
Fever not always present in older patients

Incubation period can be up to 16 days, MD says


MARTIN REGG COHN
ASIA BUREAU

HONG KONG?About one in four elderly people suffering from SARS show no signs of fever during their illness, making diagnosis more difficult, researchers here reported yesterday.

And the incubation period for typical patients can range well beyond the standard of 10 days to as much as 16 days, according to studies of Hong Kong patients, said Dr. Tim Rainer of the Prince of Wales Hospital here.

His and other researchers' findings were presented yesterday to a conference organized jointly by the World Health Organization and the Hong Kong government to compare notes on diagnosis and treatment methods for severe acute respiratory syndrome.

Medical experts at the conference noted that the WHO's original guidelines ? cough, fever, shortness of breath and lung x-rays ? were not always helpful in predicting who had the disease.

Other symptoms, such as loss of appetite, chills and fever could be more accurate, said Rainer. He noted the disparities in incubation periods and wide variations in body temperatures among patients.

Among people over age 65, only 76 per cent showed signs of fever above 38C, according to Dr. S.Y. Au of Tuen Mun Hospital.

By comparison, 90 per cent of patients below age 65 showed fever.

The absence of fever in some elderly patients could complicate efforts by public health authorities to curb the spread of SARS by installing thermal detection devices at airports and border points in Hong Kong and around the world. If body temperature is subject to individual variations, potential SARS carriers could slip through the net.

Au suggested that the absence of high temperature readings could be due to certain medications being taken by elderly patients that mask fevers, and said doctors should search carefully for atypical symptoms and whether the person had recently been hospitalized.

Indeed, one of the best ways for elderly people to avoid a SARS infection is to "avoid hospitalization," he suggested, drawing a few chuckles from his fellow physicians.

The meeting of more than 100 researchers and doctors was a sombre affair, however, with the group observing a one-minute silence for their colleagues and patients who died from the virus. Only a handful of the delegates wore surgical masks, however, with most people removing them when they entered the conference centre.

Researchers quickly agreed yesterday that the original WHO guidelines for diagnosing SARS were outdated and said they'd had to incorporate the latest findings early on in Hong Kong's outbreak last March. Symptoms shown by patients can also vary widely.

Indeed, methods of diagnosis may even have to change depending on whether physicians are dealing with widespread outbreaks or seeing only a trickle of cases, said Dr. Mike Ryan, the WHO's co-ordinator for global alerts and response.

"In six months, the same set of clinical symptoms may not be useful," Ryan observed, after hearing Hong Kong doctors describe the need for updated diagnostic guidelines in times of crisis.

Another researcher, Professor Joseph Sung from the University of Hong Kong, added that about 50 per cent of the cases seen in Hong Kong were not typical. These patients often had diarrhea and liver problems.

The two-day meeting is laying the groundwork for a consensus document to be presented next week at a larger WHO conference in Malaysia with representatives from around the world. However, the document is not scheduled to be publicly released until Tuesday.

Hong Kong has accumulated significant experience because it has suffered the second-largest number of cases, after mainland China. To date, 1,755 people have been diagnosed with SARS in Hong Kong, of whom 293 have died.

Ryan paid tribute to the delegates for taking risks in order to advance their research into a little-understood disease.

"You have been in the front lines in dealing with the SARS epidemic," he told the group.

"You're the ones who have taken risks in order to protect your populations and international populations from SARS."

Another WHO official, Dr. Mark Salter, said the "groundbreaking" efforts of researchers into the causes of SARS would be needed "until we drive it back into the box."

On Thursday, the WHO director-general urged continued global vigilance against SARS despite signs that the outbreak of the virus may be tailing off.

"We have to be very effective in our surveillance and our control measures so that we don't get setbacks," Gro Harlem Brundtland told reporters during a European health ministers' conference in Oslo.

She said the global situation "looks better than it did two months ago but we cannot be sure that that is the end of the story.

"We have to be vigilant."

[aristeides]

Ping.

[aristeides]

They're saying he died "of heart failure and pneumonia." Co-worker of patient who had SARS dies . No explanation of what caused his pneumonia. And four health care workers at Western Wake Medical Center are on furlough because they had close exposure with the man who died.

[Lessismore]

I do not share your confidence that the public health authorities in the USA will release this information in a timely manner.

Notice the artful appeals to patient privacy. HIPAA will be exploited to the fullest in order to keep information from becoming public.

[harpseal]

This is a PUBLIC health issue people who could pass on this virus are a potential threat to any uninfected persons life therefor the government has at times ordered quarantine. If people do not know where teh quarantine is in effect and who to stay away from there is additional chance of exposure. Is it a delicate balance of course but coming down totally on the privacy side makes no sense.

[aristeides]

Dr. Niman on the Agonist SARS Board is saying that this looks like the first reported U.S. SARS death:

It sounds like first reported US SARS death was UNC co-worker of visitor to Toronto. He was 45, had 3 day work overlap, and died of pneumonia. He had a cough for some time, but recently conditioned worsed, went into hospital, was intubated, and died tonight.

Toronto visitor has tested positive for virus in PCR test. He is just the second US patient to test positive via PCR (first was positive patient had traveled to Hong Kong in March).

Plot is definitely thickening.

[harpseal]

Yes the plot is thickening and the dimwitted decisions of the CDC to keep things under wraps may make the situation worse. In singapore they went fully public with every scap of information and got the public's cooperation in General. In China they have covered up and the cases just kept on coming. The same situation in Canada. It appears that Taiwan is now going the cover up route.

This does not bode well for the immediate future.

[firewalk]

bttt

[aristeides]

Dr. Niman thinks James D. Reed (apparently the name of the dead man) may have been the first SARS superspreader in the U.S.., and gives the following time line:

I suspect that James D Reed has a good chance of being the first US SARS super spreader. I think that the likelihood that he died of SARS is high as is the likelihood that he infected others prior to hospitalization on Monday, June 9.

Here is the possible time line

May 21-23 Exposure to NC index case. Reed had a chronic cough "for weeks" which may have placed him a high risk for developing infection, even though NC index case was mild and the index case did not show symptoms until May 24.

June 1 Coughing masked the onset of SARS which began around the beginning of June

June 6 Most infectious work day - if he went to work that Friday, it would be the day with most risks for employees

June 7-8 Most infectious weekend - contacts that weekend most at risk

June 9 Checked into hospital - exposure of hospital visitors, patients, and health care workers

June 13 Transferred because of deteriorating condition. DOA

June 14 Name released because of potential threat to public health

June 16-30 Exposed persons begin showing SARS signs and classified as SARS suspect and probable cases

[aristeides]

Before developing that time line, Dr. Niman had this to say about the Reed case:

I think that the likelihood that the death was due to SARS is extremely high, but won't be confirmed until next week based on PCR results from tissues taken at autopsy or cytopathic results from virus from autopsy tissue.

However, I suspect that the real proof will come in two weeks when a number of contacts begin to show symptoms.

The patient who died had a chronic cough "for weeks" and I suspect he will eventually be classified as a super spreader.

[aristeides]

Reed was in his mid-40's, and was from Wake County. This story may further indicate that he was already suffering from heart problems: Men's blood tests negative for SARS virus : Wake man dies of heart failure, pneumonia; Orange man cleared of disease .

[blam]

Looks like we could be on the verge of a Toronto 'like' colony in NC. Does anyone know how many people there are in quarantine?

[Reaganwuzthebest]

Just a matter of time before it makes it to the border states like NY and Michigan. I'm very suprised there hasn't been more cases in these areas thankfully, people go back and forth by the thousands everyday.

[Prince Charles]

Interesting comments by Dr. Niman. Bttt.

[harpseal]

Within the recesses of my memory was a post from a NC freeper who worked at ininsurance company who was talking of cases not characterized as SARS where all the symptoms were consistent with SARS. He/she and I think it was a she stated she worked at an HMO we could just be seeing the tip of the iceberg that we may be about to hit but CDC is speading smoke to obscure our vision.

[firewalk]

Thanks for the ping & the info

[Technocrat]

Interesting - once again we have a negative correlation between fever intensity and mortality. If you get this, GET YOUR TEMPERATURE UP! (Few older patients showed a fever)

[jacquej]

Yup, and I am one of those who has a very hard time getting my temp up to normal, and never run a fever. Hypothyroid. Even with replacement hormone my temp is below normal.

Live too close to Toronto as well. Gonna be an interesting summer!