Posted on 05/01/2003 7:30:56 PM PDT by DeaconBenjamin
HONGKONG - Some health experts are wondering whether steroids used by Hongkong doctors to treat Sars may be linked to the relapse suffered by 12 patients who had recovered.
Some of the patients became ill again more than two weeks after leaving hospital, raising new concerns about the largely unknown disease. It is not clear whether they were infected a second time or whether they became ill with the same virus after seeming to recover.
While the World Health Organisation has not received any reports of relapses, Dr Mark Salter, who heads the WHO's clinical network, said that if relapses were occurring, 'we would be concerned'.
Doctors in Hongkong said many Sars patients improved after being treated with steroids and the anti-viral drug ribavirin.
But there is now concern that the relapses could be a complication of the treatment, perhaps from the use of steroids that so suppressed the patients' immune system that they did not have a chance to develop a strong enough immune defence against the virus.
Dr Salter: 'We don't have systematically collected evidence, but we do know that stopping the therapy early can actually exacerbate the symptoms.
'At the moment, the doctors in Hongkong are unsure as to the timing required to gain the maximum benefit from using the ribavirin-steroid therapy.'
Meanwhile, doctors in Hongkong have detected permanent damage, or scarring, in the lungs of some recovered Sars patients. This occurs when lung tissues die and are unable to transport oxygen.
Yesterday, Hongkong health authorities defended their decision to discharge the 12 patients the first time. Director of Health Margaret Chan denied authorities had prematurely released them before the WHO's recommended 21-day recovery period.
'Hongkong is in fact more careful and conservative than most other nations,' she said, noting the total period allowed for Sars treatment, including X-rays, blood tests and convalescence, amounted to more than three weeks.
Dr Chan did not rule out the possibility that recovered patients could still excrete a small amount of virus and infect others. 'But it is important to conduct more tests and studies to understand how long a patient will continue to excrete the virus after they have recovered.'
In Singapore, patients who are discharged are placed under home quarantine for 14 days during which their health status is checked daily by health officers. When the quarantine is over, they have to return to Tan Tock Seng Hospital for a medical check-up.
None of the relapses or recurrences in Hongkong occurred among Sars patients hospitalised in the first wave of infections, when doctors tended to delay prescribing steroids until a patient's pneumonia worsened.
The delay might have allowed enough time for a patient's immune system to begin fighting off the Sars virus before steroids began suppressing the immune defences.
Of the 12 patients, six remain in hospital while the rest have been discharged for the second time.
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