SARS infects 'protected' medical staff Gloves, gowns, masks didn't stop outbreak at Sunnybrook

SARS has killed a 14th Canadian and infected a new cluster of Toronto hospital workers even though they were protected from head-to-toe in gowns, gloves, masks and eye shields.

The latest cluster has heightened concerns the mysterious Severe Acute Respiratory Syndrome virus can be spread via objects, in addition to face-to-face contact, and can remain potent on objects for much longer than previously believed.

Also, one expert predicted yesterday that SARS is likely to remain in Canada -- despite the current battle to contain it -- because people will continue to "import" it from lesser developed countries.

The latest Canadian death was a 99-year-old man who succumbed Friday, according to an Ontario government news release that provided no further details.

The previous 13 SARS deaths have all been in the Toronto area. Most have been elderly with underlying health problems, but experts are increasingly worried the virus is now making younger, otherwise healthy people critically ill.

The new cluster erupted at Sunnybrook and Women's College Health Sciences Centre in suburban Toronto, which has treated about half the region's SARS patients over the past month. It has 20 to 25 of them admitted at any given time.

As of yesterday, four staff members, including at least one doctor, a nurse and a respiratory therapist, were in hospital and almost certainly have SARS.

Another eight hospital staff members were sent into home quarantine as potential SARS cases.

A Vancouver hospital also isolated one of its wards yesterday when a nurse who worked there was identified as a possible SARS case.

Officials said they believe the Sunnybrook infections occurred during difficult intubations, including one last Sunday that took four hours. Intubation involves placing a tube down a patient's throat to facilitate breathing.

Both patients are now believed to be "super spreaders," or viral shedders, who are much more infectious than average SARS patients.

Some staff started feeling symptoms associated with SARS on Wednesday and Thursday. Senior hospital staff became aware of the threat late Thursday night.

Dr. Mary Vearncombe, the hospital's head of infection, prevention and control, said one worker's eye shield slipped during the Sunday intubation procedure, but there is no other known breach of the staff's "full-droplet" protection.

"We were using what both Health Canada and the (Atlanta-based) Centers for Disease Control consider to be maximal precautions for these patients," she said, adding it's possible some potentially infected staff was not present at the intubations.

That raises serious questions about how the virus was spread and whether the current precautions are enough to protect health care workers.

"We're examining everything we do and we're looking at a number of different options in terms of making that particular procedure safer for the health care workers," she said. One option is anesthetizing patients for intubation to reduce saliva spread.

Dr. Andrew Simor, the hospital's head of microbiology, said the virus continues to surprise the experts.

"We know that the (precautionary) measures that have been recommended should be adequate to deal with those (patients) but we're also impressed with just how easily the virus is spread, how it might contaminate the environment," he said.

Dr. Simor added that, in a Friday night conference call with Health Canada and the Centers for Disease Control and Prevention, a CDC expert surprised the others by revealing that the virus can remain potent on objects much longer than previously thought.

"What the CDC mentioned to us last night was that, in their studies, they found that you could still culture viable virus from surfaces after as much as 24 hours, which is longer than we normally expect viruses to be able to survive in the environment," he said.

In a statement yesterday, the World Health Organization said it is also concerned about the possibility of environmental transmission. It's looking closely at how SARS spread through a Hong Kong apartment complex, linked to the building's sewage system which carried the virus from an infected person.

However, the health body concluded there is "little risk" that environmental causes are behind a probable SARS case in a Toronto condominium which health officials have not been able to directly link to a SARS-infected family in the same building. The incubation period has passed with no further cases, the WHO noted.

The WHO is closely watching a disturbing trend in Hong Kong and Canada where SARS is striking younger, healthier people with greater ferocity. In particular, it is watching efforts to contain an outbreak among a 500-member, Toronto-area Catholic prayer group. Twenty-nine of them were infected, some of whom are not old or ill.

"The outbreak is regarded as a test case of whether rigorous contact tracing and other stringent public health measures can contain further spread even when very large numbers of persons may have been exposed," the WHO said.

"The experience in Hong Kong has been a larger number of younger adults getting very severe illness, sometimes fatal," he said. "We are beginning to see that in Toronto as well."

The new cluster will further tax Toronto's almost-paralysed health care system. Instead of easing operating restrictions as it had planned, Sunnybrook has effectively closed its critical care, cardiovascular intensive care and SARS units for 10 days as a precaution.

"It's a huge burden on the system,'' said Leo Steven, the hospital's chief executive, adding that Sunnybrook, probably the biggest trauma centre in Canada, will now have to send trauma patients to other hospitals in Toronto, Hamilton and beyond.

Dr. Vearncombe predicted that even if containment measures are successful, Canada will have to learn to live with the SARS threat.

"I have some level of optimism that we can contain it in Toronto," she told reporters. "I have no optimism that we can contain it in developing areas of the world like mainland China so we will continue to import cases and we're going to have to remain absolutely vigilant."

Canada has about 300 probable and suspect cases of SARS in six provinces, mostly in Ontario.

Officials said USAMRIID scientists are testing about 2,000 drugs on the coronavirus that causes the flu-like respiratory disease. The virus is new to science with no known cure or vaccine

"We've got tons of drugs under test," said Dr. Peter B. Jahrling, senior research scientist with USAMRIID, adding that it is "too soon for results."

Jahrling said his organization received the virus from the CDC during the last week of March and that it "took a while to get the virus up and replicating."

Scientists first tested Ribaviron, a leading antiviral drug, on the virus, but quickly determined that it did not work.

Researchers at Detrick are testing about 150 to 200 drugs per week on the virus that causes SARS,………….

A USAMRIID press release said the organization will be "freely shared with CDC and other government agencies."

But for now, progress is slow.

"We don't have any hints yet," Jahrling said.

http://www.gazette.net/200316/frederick/news/154297-1.html

And lets not forget the critical contribution to the SARS epidemic from the magnificent US lawyer industry:

The new bioterrorists

Robert Goldberg

Here's a story ripped from today's headlines. A mysterious flu-like disease with no known cure which originated in southern China in November hits Hong Kong in March. It kills dozens, and sickens and infects thousands there. It spreads, leaving that health-care system on the brink of collapse, and moves like wildfire throughout the world and to America thanks to travelers.

While doctors in China recommend an ancient brew of dead silkworms and cicada-skin, American doctors and the U.S. Centers for Disease Control and Prevention go through thousands of existing drugs in a fruitless search for a treatment or a cure. Then, when all hope is lost, one biotech company, AVI BioPharma, says it should be able to develop a drug that would attack the SARS virus within a week of receiving its genetic code, which researchers in Canada just discovered this weekend. The company uses a technique that disables viral genes and has already made experimental drugs for coronaviruses similar to the SARS virus that causes illnesses in cats and lab mice.

But then, the drug doesn't get made. A group of individuals dedicated to weakening the ability of private companies to produce bioterror countermeasures and other products essential to public health make it virtually impossible for the company to invest in and develop the drug. They threaten to challenge the price and patent of the drug. And they block any effort to protect the company from any lawsuits that arise from the product's testing or use. These groups fancy themselves as opponents of high drug prices. But, what they are in practice are the new bioterrorists — organizations that through persistent tactics and organized resistance weaken our ability as a nation to respond to weapons of mass destruction and other public-health threats.

Sounds like fiction? First, meet the Prescription Access Litigation Project (PAL), which is suing to shorten the patent life of Cipro — the leading brand drug used to treat anthrax — earlier than its legal term to allow generic versions on the market. Decrying the inadequacy of the arrangement that the federal government just negotiated with Bayer, the project has organized consumer groups in eleven states — representing over a million consumers — to sign on to the litigation.

What PAL is really doing is fronting for trial attorneys awash in tobacco cash, and who are now seeking to bankrupt biotech and drug companies by suing for early termination of valid patents on a retainer basis. It acts as a holding company for plaintiffs' lawyers who have banded together and created war chests to help fund what they think will be very expensive litigation.

The law firms handling PAL's patent-killing lawsuits include those that have made millions suing tobacco firms. These firms and other companies work from a playbook that challenges the validity of every new patent, seeking to end its legal life as early as possible. Again, this has nothing to do with unlawful behavior. It is simply a matter of a law firm's trying to get state courts to rule that the patents are invalid and then get a percentage of the monopoly profit that the generic firms will get during the 180 days they will be able to sell their drug without any competition after the court ruling.

Trial attorneys have made it nearly impossible to introduce innovative drugs and vaccines to defend the homeland. Indeed, the threat of a class-action lawsuit is more certain than that of a bioterrorist attack, which is why no biotech or pharmaceutical company in its right mind will invest in countermeasures or small-market drugs without liability protection.

Consider what Scott Gottlieb of the FDA science adviser's office has to say about the growing risks of litigation, even as new drugs have become safer than everyday aspirin: "The bowel drug Lotronex caused fewer than fifty serious events in 300,000 prescriptions before it was withdrawn, and became the subject of costly litigation. Even drugs like aspirin, which cause hundreds of deaths each year, could not meet the safety standards patients expect today. All this has become a bonanza for lawyers, however, as our society gets more accustomed to taking medications for a wider range of problems. Bayer is facing more than 8,000 lawsuits after Bayer's widely used cholesterol-lowering drug Baycol was withdrawn from the market after being linked to about 100 deaths."

People who did not suffer any side-effects at all, however, are filing at least 6,000 of those lawsuits. How much will these lawsuits eventually cost? Bayer has reportedly paid about $125 million to settle the first 500 cases. As with tobacco litigation, a large slice of those payments goes to plaintiff attorneys. Which explains why they are also fighting so hard to block any effort to include any liability protection for companies like AVI Biopharma. The drugs and vaccines they produce are more indispensable and safe then ever. They are also fatter targets, too. So, it is no surprise that the haters of capitalism and the bottom-feeders of the parasite economy have found common cause in bankrupting private-sector companies in pursuit of medical progress.

(Robert Goldberg is director of the Manhattan Institute's Center for Medical Progress.)

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.