SARS Antibodies Confirmed
In BC Patients
Vancouver SARS Denial A Cause For Concern

By Andy Ho
The Straits Times Interactive

Vancouver health authorities tried to set the record straight with the Asian press last weekend regarding a mysterious viral outbreak in two nursing homes in the province.
It was concerned that the outbreak, which has infected more than 100 elderly people so far, was being portrayed as Sars. As a result, controls at Hong Kong's airport had been stepped up, the Taiwanese had cancelled trips to the province, and Singapore doctors were told to be on the alert.
But the world must be told that what the elderly residents have is the coronavirus OC43, which causes the common cold, said Dr David Patrick, director of epidemiology at the British Columbia Centre for Disease Control, at a press conference in Vancouver.
One scientist joining in by teleconference who did not entirely agree, however, was Dr Frank Plummer, who heads Canada's National Microbiology Laboratory in Winnipeg.
He does not answer to the authorities in Vancouver, as the Winnipeg laboratory is one of 11 which the World Health Organisation (WHO) uses for its global surveillance of infectious diseases.
Of 29 specimens sent to Dr Plummer so far from the nursing homes, 12 have tested positive for Sars.
The laboratory also found antibodies to Sars in some patients, including one who had died from pneumonia, a sure sign that these patients had contracted Sars at some point.
Dr Plummer said that his laboratory had found 'and continues to find' the Sars virus in samples sent from the two homes.
Also significant, he said, was that people who tested positive for the OC43 virus were generally not the same as those who tested positive for the Sars virus.
In other words, there were three possible groups of cases from the homes: Those with the OC43 virus; those with the Sars virus; and those with both OC43 and Sars or, alternatively, a virus made from parts of both viruses.
Was he mistaken? After all, even the best laboratories make mistakes, said Dr Edison Liu, who heads the Genome Institute of Singapore, to The Straits Times.
Still, it seems highly unlikely that 12 different samples could have somehow become contaminated, wrongly generating the Sars sequences in a WHO laboratory.
For whatever reason, the Vancouver authorities have lifted the quarantines on the two nursing homes, which implies that Dr Plummer got it wrong.
If he did, Canada owes the rest of the world an explanation on how he was mistaken and how such errors can be avoided in the future.
But if he got it right, then to say the outbreak was a 'summer cold' caused by OC43 could be judged premature, even irresponsible.
Dr Henry Niman, a Harvard Medical School bioengineer who has followed the trajectory of Sars closely, told The Straits Times: 'Dr Plummer's data is either something the Canadians are too embarrassed to talk about, or there are both OC43 and Sars in Vancouver but the data is being misrepresented to the world and the Canadian media is buying it.'
The Winnipeg laboratory has stood by its findings and says the outbreak could be from a recombinant virus made from parts of the Sars and OC43 viruses.
'If so, this would be cause for great concern, considering the very high rate of transmission of this bug within the homes,' said Dr Niman.
Dr Plummer himself has cautioned: 'We can't rule out anything at this point, really. How all of these different findings fit together, I think, remains a matter for further study.'
Such comments have annoyed provincial health officials whose fears of the economic fallout from a Sars outbreak may be causing them to play down the situation, said Dr Niman.
Disconcertingly, Canadian health officials did not respond to the Winnipeg data at their weekend press conference. Symptoms of this outbreak simply did not meet the case definition required by the WHO, they said.
Perhaps they were not aware that, in May, at the height of the Sars outbreak, the Hong Kong Geriatrics Society issued an alert saying that old people with Sars may have non-typical symptoms.
They may not even cough when they have pneumonia, but show merely a shortness of breath, and then only when they exert themselves a little, like sitting up in bed.
Because the elderly tend to have weaker immune defences, they could have a very mild fever or none at all. Fever is a defence mechanism which tries to slow down viruses from replicating by raising the body's temperature above the normal range.
In fact, three of Toronto's first 10 Sars cases earlier this year had lower temperatures than healthy adults, as low as 35.5 deg C to 36.5 deg C.
The bottom line is: Health-care workers must be very watchful when diagnosing the elderly for Sars.
Instead, health officials in Vancouver seem bent on denial.
Whatever it is, as Acting Health Minister Khaw Boon Wan has said pointedly: The bug has caused more than 100 infections and some deaths in Vancouver. Because of that, Singapore will treat it as Sars until it is proven otherwise.
Now, that's logic the Asian media can understand.
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