SARS distinctions based in symptoms

Hope Star ^ | By KEN McLEMORE, Hope Star Writer

[DeaconBenjamin]

The disclosure this week of a "probable" case of Severe Acute Respiratory Syndrome (SARS) in Arkansas has created a new distinction for Arkansans in dealing with a largely untreated disease - the difference between "probable" and "suspect" SARS cases.

The SARS web site of the Centers for Disease Control in Atlanta, Ga., distinguishes between the two classes in medical terms of "clinical," or symptom-based and "epidemiological," or exposure-based, criteria.

In either case of "probable" or "suspect" cases of SARS, the basic symptoms remain the same: Consistent body temperature of 100.4 degrees or greater accompanied by typical respiratory disease symptoms such as a cough, shortness of breath or other breathing difficulty.

CDC also notes that a "suspect" case of SARS meets the criteria for a "moderate" respiratory illness that has not been confirmed as unrelated to SARS by laboratory testing.

A "probable" case of SARS also meets the basic symptoms but for a "severe" respiratory illness that has not been confirmed as unrelated to SARS by laboratory testing. The distinction, according to CDC, lies in whether a patient develops pneumonia or other serious respiratory distress, in which instance the case and lab tests are compared to specific, known cases of SARS for confirmation, based upon World Health Organization case studies.

A critical factor in determining whether SARS is present also involves the potential for direct exposure to the disease, according to CDC and the Arkansas Department of Health.

Persons with a history of travel to or residence in Hong Kong; the Guandong Province of the People's Republic of China; Hanoi, Vietnam; Indonesia, the Philippine Islands; Singapore; and Toronto, Canada, are more likely to have been exposed to the disease, according to ADH.

"Close direct and sustained contact with persons with respiratory illness who have traveled to one or more of these areas" is also a key factor, according to ADH, as is close contact including "having cared for, having lived with or having had direct contact with respiratory secretions and body fluids of those individuals diagnosed with SARS."

As of May 24, CDC has confirmed 358 SARS case reports, including 293 "suspect" cases and 65 "probable" cases in the United States.

During the period between Nov. 1, 2002 and May 21, 2003, the WHO reported 7,956 SARS cases from 28 countries, including the United States, with 666 known deaths worldwide from the disease.

"The number of new cases reported in the United States has been decreasing in recent weeks," according to CDC's May 23 weekly report on the disease.

[DeaconBenjamin]

Some on the other Hope Star thread were interested in this distinction.

[jacquej]

Please see this link

Oncologist battles SARS, assumptions

From her hospital bed in Toronto, a doctor wonders if medical establishment is right

By GLORIA GALLOWAY

UPDATED AT 8:42 AM EDT Saturday, May. 31, 2003

Mary Tweeddale has had lots of time to worry as she lies in a hospital bed in the SARS unit of Toronto's York Central hospital.

The 51-year-old oncologist worries about the cancer patients she saw in her office a week ago Thursday, the day before she developed the fever that told her she had fallen victim to the virus.

She didn't have symptoms of SARS at the time -- something the medical establishment would suggest means she couldn't have been contagious.

But Dr. Tweeddale isn't so sure the medical establishment is always right in its assumptions about this disease that wasn't even in the lexicon four months ago.

For instance, the signs on the hospital doors tell people to be concerned about SARS if they have a cough or shortness of breath. "Well, I never had a cough. I've never been short of breath," she said. And yet her chest X-ray clearly shows the lung infiltrate that is the marker of severe acute respiratory syndrome.

"It just means I'm a little more cautious about thinking is it true that only when you have a fever are you infectious," she said.

"You kind of hope that's the case," Dr. Tweeddale said, but she has asked public health to notify her vulnerable patients of her condition because "this is just too big a disease to ignore."

Dr. Tweeddale is one of several doctors who work at North York General who are unsure of the conventional wisdoms about SARS. And one of the biggest points of contention is whether someone can be asymptomatic and contagious at the same time.

Earlier this week, Barbara Mederski, the head of infectious disease at the hospital, said she believes it is possible to spread SARS while one is apparently healthy.

The first -- or index -- case in the new cluster in Toronto was a 96-year-old pelvic-surgery patient in North York's orthopedic ward who had no known contact with anyone who had SARS.

"The missing link begs the issue of someone or something that was carrying the virus without the symptoms declaring themselves openly enough to track it but was still there as an infectious component," Dr. Mederski said.

She said she had been alerting public-health officials about cases that she and other doctors believed were SARS since March. But the definition of the disease requires a link to another known case or travel from a part of the world where virus is being spread. In the absence of such a link, public-health authorities decree a case is not SARS.

(excerpted)

http://www.theglobeandmail.com/servlet/ArticleNews/TPPrint/LAC/20030531/USICKN/TPHealth/

[Judith Anne]

Bump to myself, thanks jacquej.

[jacquej]

Another concern I have is this... The definitions they are drawing are good for the moment, but when someone comes down with it in Shippensberg, or Wheeling WV, somewhere in Arkansas, or Erie, PA who has not traveled to any of the listed areas, etc...

The requirements are good for the first few links in the chain, but what happens farther down the line of links?

I am not sure how reliable our reporting of "probable" will be then. Heck, I am not sure it is reliable now!

But I am truly hoping this burns out before we all have to run around in masks here in the states...

[jacquej]

Judith Anne, you know far more than I do about this chain of transmission thing... Do you think the following will be used to eliminate a person with SARS from the list of "probable SARS"?

You also know far more about how "officials" follow "rules and regulations" than I do. I have watched far too much stateside political spinning, and have lost trust over the years.

I follow Reagan's advice about verification. but I switch it around. I verify, then I trust.

But how do we verify in a situation like this, when it is so new a situation, and things are so fluid, and officials know how much is at stake, both politically and economically?....

[DeaconBenjamin]

I saw that. Thanks.

[aristeides]

There seems to have been very little spread of SARS outside of hospital and household settings.

[Judith Anne]

I don't know the answer, jacque.

[hellinahandcart]

As long as it makes sense to the docs, I guess. But it would make more sense to the average Joe if they used the word "possible" for "suspect, and "suspected" for "probable".

Because when most people use the word "probable", they mean "probably IS", not "could very well be".

My head hurts.

[Judith Anne]

Whole lotta obfuscation goin' on...

[Bluewave]

I think we are witnessing the chaos of the medical bureaucracy, which is not unlike the AIDS outbreak in the early 80's.

Bureaucrats are by the nature of their positions, obligated to be cautious and to not make speculative remarks. Nothing can wreck a career faster than a false or exaggerated statement.

In their effort to avoid the pitfalls of saying what they think they know, they typically rely on carefully worded announcements that can be backed up by documented facts or statements by other authorities.

Reporters are generally ignorant of the medical system and with all the mixed messages we are getting from authorities coupled with bad reporting I don't think any of us have any way to know what is really going on with SARS.

Consider the following:

1. There is not a reliable test to diagnose the disease,
2. The route of transmission is not understood,
3. We do not have an understandable definition of the disease,
4. There is no known treatment,
5. The window of transmission is unknown,
6. Medical privacy seriously restricts release of information,
7. Panic could crash the markets and ruin the government,
etc.

When you consider all the things that we don't know, you almost have to raise the question, is it a real disease? I wondered the same thing about HIV until I saw people around me get sick and die.

I have a paranoid friend who flew to California in February. Upon his return, he had a very bad cold and heard on television that someone on an airplane had SARS.

He put one and one together and concluded that he had a mild case of sars. He has since had another two or three colds, each one seemingly worse. He believes that SARS is cyclical disease, we will all become infected, get over it, and then get sick again. Interesting theory and at this point, who can refute it?

[Judith Anne]

Nobody, and don't kiss him. ;-D

[Bluewave]

I'll keep the kissing between me and wife, but if his theory is correct, she may not be safe. She had a cold last week.

I'm going on a trip and will be away from the computer for a while. Hopefully you will have SARS under control by the time I get back.

[DeaconBenjamin]

When SARS first raised its ugly head, I told my wife that I thought Severe and Acute sounded redundant. She educated me on their difference in medical terminology.

[Judith Anne]

ROFL! No promises!

[hellinahandcart]

I understand that there are terms in many professions that have completely different meanings than the same word in common usage. For instance, as a painter, when I refer to "values" in one of my paintings, I am not talking about my core beliefs, but about light and dark.

But it's easier on everyone if, when talking to a non-artist about the painting, I simply say "light and dark", so they automatically know what the hell I'm talking about.

[DeaconBenjamin]

We are assured that it is not -- judge for yourself:

'Relapse' patients had other problems: HK

HONGKONG -- A dozen former Sars patients here who were initially thought to have suffered relapses actually had other medical problems, health officials said.

The Hongkong Hospital Authority caused international alarm last Wednesday when it said that 12 patients who seemed to have recovered from Sars had been readmitted to hospitals after apparently relapsing.

But Dr Liu Shao Haei, a senior manager of the authority, said on Sunday that while some of the patients had developed fevers or other symptoms of illness after their initial discharge from a hospital, not one turned out to be sick again with Sars.

Eight of them had since been discharged for a second time.

'One was discharged, but was then readmitted with discomfort but it wasn't a relapse... It could just have been one of the stages of the illness and the patient returned for further observation,' explained Dr Liu.

'Another patient presented some generalised discomfort...but the investigations' results came back negative and she was discharged,' he said.

In one case, a woman had developed leg swelling from deep-vein thrombosis apparently caused by her prolonged bed rest during her treatment for Sars, Dr Liu said.

'There are, of course, cases where they develop fever and they reported the symptoms to the clinical teams during their home stay, and the clinical teams to be cautious asked them to come back for further investigations.

'The chest X-ray and blood tests were clear and they have been discharged,' he added.

'They are all confirmed as not related to any relapse of Sars conditions.'

Mr Dick Thompson, a spokesman for the World Health Organisation (WHO), welcomed the re-evaluation of the cases here that were initially diagnosed as relapses.

'It sounds like there's lots of good news,' he said.

The WHO was scheduled to hold an international video conference yesterday to examine if the 12 Sars patients in Hongkong might have suffered relapses after they appeared to recover.

Dr David Heymann, head of the communicable diseases section at WHO, had noted that the reported relapses might be due to steroid therapy used in Hongkong which was tapered off too rapidly, 'but we're not yet certain'.

Hongkong said yesterday it had reached a crucial stage in the fight against Sars after reporting just eight new cases, keeping figures in single digits for a second day, and said it would talk to the WHO about lifting a travel advisory.

Three more Sars patients died in the territory, bringing Hongkong's toll to 187, and Health Director Margaret Chan said it was too soon to claim victory.

She urged the public to maintain good personal and environmental hygiene.

'This is perhaps the most critical period, and if we relax on these measures all the hard work we'd put in place in the previous two months might go waste,' she told a news conference.

http://www.straitstimes.com/sars/story/0,4395,188113,00.html?

[per loin]

[arthurus]

This year's "flue"around here lasts up to a couple of months and the people who have had it have experienced several days of the high fever that does not respond well to aspirin and the like. hey go through periods of difficulty breathing that does not seem to be as with pneumonia. They cough incessantly without coughing up anything. They go through periods of aching all over. My wife has had this as have a number of other teachers in her school and all of the children in her class. It seems to be the same progression that has been described for SARS but no one has died from it and no one has been admitted to the hospital with it. There have been 2 "suspect" cases of SARS in the local area (travelers to Asia) that got no further mention after the first notice.

Purely in speculation I wonder if SARS is, perhaps, much more widespread than is advertised. Those who die from it, and this is difficult to discern because of the nonissuance of information, seem to be almost all ethnic Chinese or health care workers who are massively exposed. Different groups react differently to some diseases. For instance, Chinese are much more at risk for the exotic forms of Hepatitis that are transferred to people of other ethnicities only by fluid transfers, like AIDS.

[jacquej]

That is a very interesting observation, arthurus. My daughtere teaches in a city high school, and mentioned to me this winter that several students had been severely afffected by the flu, and that one had died, which I thought very strange at the time, because teenagers usually do not die from the flu.

But, then, I thought, perhaps there were complicating factors, an underlying medical problem, etc... and went on.

There has been speculation that SARS is more widespread. We will not know until further testing is done on those not showing serious symptoms, I guess.