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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/