Posted on 05/19/2003 5:59:06 PM PDT by CathyRyan
NEW YORK (Reuters Health) - "Super-spreaders" of SARS are unlikely to be infected with a particularly virulent form of the virus, a panel of experts said here Saturday at the New York Academy of Sciences.
Instead, it seems they spread the disease to so many people because their infection went unrecognized, the panel said.
Like other people with SARS, or severe acute respiratory syndrome, such patients are best dealt with by isolation and quarantine, according to the experts.
"We saw most clearly in Singapore that secondary cases are linked to other cases and that quarantine can limit transmission," said Dr. Larry Anderson of the Centers for Disease Control and Prevention in Atlanta. "We had a few super-spreaders -- 5 people, each of whom had infected more than 10 others. But it wasn't virus-specific -- that is, those who were infected did not then become super-spreaders."
In Toronto, the experience was similar, said Dr. Donald Low of Mt. Sinai Hospital, who treated the early cases there.
"We had one 'case B' patient who infected nine others and one congestive heart failure patient who infected 21. But this was because SARS was not recognized early enough; the patients went home and infected family members or health care workers in the emergency department and (coronary surgery) ward."
In one instance, six health care workers became infected during an intubation, an insertion of a breathing tube, which is now considered a high-risk activity in SARS patients. Infection was probably due to droplet dispersion that occurred when the intubation became "difficult," he said.
"Infection control is critical," Low continued. "It's surreal -- to talk to staff and see 200 people in front of you wearing masks, face shields, gowns, and gloves. It's changing the way we do medicine. But it has to be done if we're going to contain the disease."
How to treat current SARS patients is less clear, symposium chair Dr. Scott Hammer, chief of the division of infectious medicine at Columbia Presbyterian Medical Center in New York, told Reuters Health.
No recommendations can be made at this point, he emphasized, although interferon and protease inhibitors have shown some early promise. By contrast, experience in China and Toronto showed that the antiviral ribavirin has no benefit, and that antiinflammatory steroids may actually enhance the disease process.
"We don't blame China for trying treatments that, empirically, seemed as though they might work," Hammer said. "But the time for empiric treatment is over. Now we need clinical trials."
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