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Oncologist battles SARS, assumptions

From her hospital bed in Toronto, a doctor wonders if medical establishment is right

By GLORIA GALLOWAY

UPDATED AT 8:42 AM EDT Saturday, May. 31, 2003

Mary Tweeddale has had lots of time to worry as she lies in a hospital bed in the SARS unit of Toronto's York Central hospital.

The 51-year-old oncologist worries about the cancer patients she saw in her office a week ago Thursday, the day before she developed the fever that told her she had fallen victim to the virus.

She didn't have symptoms of SARS at the time -- something the medical establishment would suggest means she couldn't have been contagious.

But Dr. Tweeddale isn't so sure the medical establishment is always right in its assumptions about this disease that wasn't even in the lexicon four months ago.

For instance, the signs on the hospital doors tell people to be concerned about SARS if they have a cough or shortness of breath. "Well, I never had a cough. I've never been short of breath," she said. And yet her chest X-ray clearly shows the lung infiltrate that is the marker of severe acute respiratory syndrome.

"It just means I'm a little more cautious about thinking is it true that only when you have a fever are you infectious," she said.

"You kind of hope that's the case," Dr. Tweeddale said, but she has asked public health to notify her vulnerable patients of her condition because "this is just too big a disease to ignore."

Dr. Tweeddale is one of several doctors who work at North York General who are unsure of the conventional wisdoms about SARS. And one of the biggest points of contention is whether someone can be asymptomatic and contagious at the same time.

Earlier this week, Barbara Mederski, the head of infectious disease at the hospital, said she believes it is possible to spread SARS while one is apparently healthy.

The first -- or index -- case in the new cluster in Toronto was a 96-year-old pelvic-surgery patient in North York's orthopedic ward who had no known contact with anyone who had SARS.

"The missing link begs the issue of someone or something that was carrying the virus without the symptoms declaring themselves openly enough to track it but was still there as an infectious component," Dr. Mederski said.

She said she had been alerting public-health officials about cases that she and other doctors believed were SARS since March. But the definition of the disease requires a link to another known case or travel from a part of the world where virus is being spread. In the absence of such a link, public-health authorities decree a case is not SARS.

(excerpted)

http://www.theglobeandmail.com/servlet/ArticleNews/TPPrint/LAC/20030531/USICKN/TPHealth/

Another concern I have is this... The definitions they are drawing are good for the moment, but when someone comes down with it in Shippensberg, or Wheeling WV, somewhere in Arkansas, or Erie, PA who has not traveled to any of the listed areas, etc...

The requirements are good for the first few links in the chain, but what happens farther down the line of links?

I am not sure how reliable our reporting of "probable" will be then. Heck, I am not sure it is reliable now!

But I am truly hoping this burns out before we all have to run around in masks here in the states...

I think we are witnessing the chaos of the medical bureaucracy, which is not unlike the AIDS outbreak in the early 80's.

Bureaucrats are by the nature of their positions, obligated to be cautious and to not make speculative remarks. Nothing can wreck a career faster than a false or exaggerated statement.

In their effort to avoid the pitfalls of saying what they think they know, they typically rely on carefully worded announcements that can be backed up by documented facts or statements by other authorities.

Reporters are generally ignorant of the medical system and with all the mixed messages we are getting from authorities coupled with bad reporting I don't think any of us have any way to know what is really going on with SARS.

Consider the following:

1. There is not a reliable test to diagnose the disease,
2. The route of transmission is not understood,
3. We do not have an understandable definition of the disease,
4. There is no known treatment,
5. The window of transmission is unknown,
6. Medical privacy seriously restricts release of information,
7. Panic could crash the markets and ruin the government,
etc.

When you consider all the things that we don't know, you almost have to raise the question, is it a real disease? I wondered the same thing about HIV until I saw people around me get sick and die.

I have a paranoid friend who flew to California in February. Upon his return, he had a very bad cold and heard on television that someone on an airplane had SARS.

He put one and one together and concluded that he had a mild case of sars. He has since had another two or three colds, each one seemingly worse. He believes that SARS is cyclical disease, we will all become infected, get over it, and then get sick again. Interesting theory and at this point, who can refute it?