SARS Still Fooling Doctors

By Maggie Fox
Health and Science Correspondent

BETHESDA, Md. (Reuters) - Here's the good news about SARS -- if you are sneezing and have a runny nose, you probably don't have it.
Here's the bad news -- its symptoms look like those of countless other viral diseases, meaning that it can easily fool doctors, nurses and the patients themselves, spreading despite all but the best defenses.
The resurrection of Severe Acute Respiratory Syndrome in Toronto this past week illustrated how easy it is to let down your guard and let the virus come back with a vengeance, experts told a meeting on Friday.
"We have seen how complacency can lead to the re-emergence of this disease," Klaus Stohr, who has been helping lead the World Health Organization's SARS effort, told a conference sponsored by the U.S. National Institutes of Health.
Doctors know that SARS kills about 15 percent of patients, that the incubation period is between five and 10 days with very few exceptions, and that people do not seem to transmit the infection to others until they develop symptoms.
It is also transmitted by droplets through coughing, but the virus may also linger on surfaces, waiting to be picked up and rubbed into an eye, nose or mouth, and the possibility remains that it can become airborne.
Bits of the virus can be found in the stool, urine, tears and saliva of patients. No one knows if these play a role in spreading the disease.
And while children have become infected, they do not seem to spread it -- unlike many other viral diseases from the common cold to influenza, measles and chickenpox. "What role do children play?" Stohr asked.
While SARS is defined as a respiratory disease and is caused by a relative of one of the common cold viruses, its symptoms are not always obvious.
Dr. Allison McGeer, director of infection control at Toronto's Mount Sinai Hospital, said at one point in Canada's outbreak, "at least half" of patients later found to have viral infections were sent home with useless antibiotics.
The only symptom that 100 percent of SARS patients have is fever, which is a hallmark of hundreds of other diseases. McGeer said her team found only 10 percent have a runny nose.
Only 29 percent of SARS patients McGeer's team studied had a cough. Pneumonia often does not show up on an X-ray until people have been sick for a week -- long enough for them to spread this disease to many others.
There are several tests for SARS but all are experimental and unreliable. One can only be given 21 days after infection -- useless for controlling the spread of disease.
Most puzzling has been the death rate.
"This is a slowly progressive disease," McGeer said. "We are used to seeing the greatest mortality right away. ... That is not true of SARS. Mortality peaks at day 15 to 17. It takes four, five, six, seven weeks for some people to die."
Also puzzling is why some people seem able to infect dozens of others at one fell swoop and other infect no one else.
"In the early stages of the outbreak we were pretty cavalier about saying if you don't have pneumonia, go home and spend time in isolation," Dr. Donald Low, McGeer's colleague at Mount Sinai, told another recent conference.
"People were going to malls, they were going to saunas and trying to sweat out the fever but it was not spread in the community. What this says is that this is not a good virus for transmitting outside certain settings."
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From Astraea Kelly
Also of the Kaiser Vallejo Saga, I reported as early as April 2nd or thereabouts to my manager that I had SARS symptoms. It was AFTER our first SARS suspect was placed in isolation and I was helping other RT's on that floor, but I was not directly inside of the isolation room with the patient.
On April 7th, because I still had the flu symptoms and appropriate fever earlier in the week, but had now dropped the fever, I was screened for SARS. I did not have pneumonia and I was given the "regular flu" diagnosis of the SARS team.....the physician who did not wear a mask around me or gloves to handle my equipment or to touch me. I was told to go home and whatever I do for the flu, but I did not have a "SARS throat". I was not off for 14 days. I was still tired returning and easily fatigued after shifts and I worked with terribly sick pneumonia patients from that point on, almost exclusively.
By WHO citeria for Canada, I just met the definition for "SARS suspect" had it been used at our hospital. It was not, therefore, I was not quarantined and then I got sick again and they tried to force me back to work with others in a hospital setting. For all I know, all those patients that I had after April 2nd......need to be followed for symptoms and contacted. ALL of them and the staff I worked around.
Because I was never given any blood tests for WBC or SARS tests except visual......"nope, not a SARS throat, "regular flu" go home, come back when you don't run a temp for a day or two." And I am sure ALL of us were treated like that who had any symptoms.....even though we had SARS isolations going and very sick pneumonia patients, one right after the other for months.



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