Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Full information for containing the SARS?
- Edward Lai (19 April 2003)
-
sever acute respiratory syndrome in south asia
- muhammad fayyaz, 46000 pakistan (20 April 2003)
-
Global health alert
- Peter D.O. Davies (23 April 2003)
-
SARS and other ‘medical’ major incidents: lessons from the Furness Legionnaire’s outbreak
- Andrew F Smith, Cathy Wild, John Law (23 April 2003)
-
SARS Checklist
- Madhu Bardhan (24 April 2003)
-
sudden or severe?
- Philippe Beutels (24 April 2003)
-
Re: sever acute respiratory syndrome in south asia
- nimit shah (24 April 2003)
-
Implications for specific communities
- Jayapriya D Raj (25 April 2003)
|
|
|||
|
Edward Lai, Physiotherapist North District Hospital, Hong Kong
Send response to journal:
|
I strongly agreed with Maria Zambon that Coronavirus (HCoV) may be responsible for SARS, but human metapneumovirus (HMPV) may also be related. From the World Health Organization (WHO) update on 26 Mar., 2003, WHO experts in the network were considering the theory that SARS was caused by co-infection with two new viruses, HCoV & HMPV. They somehow need each other in order to cause severe disease in humans. Evidence is strongly pointing to a new virus, or possibly two new viruses, that have not previously been known to infect humans or cause severe disease. Other hypotheses included SARS was either caused by HMPV or HCoV. However, with the global attentions on HCoV, more and more evidences evoked for HCoV. In the WHO update on 16 Apr., 2003, WHO announced that a new pathogen, a member of the coronavirus (HCoV) family never before seen in humans, is the cause of Severe Acute Respiratory Syndrome (SARS). Is it jump to the conclusion too early to say HCoV are the only causative agent for the recent SARS outbreak ? From the recent paper from Hong Kong that published on the New England Journal of Medicine (NEJM) on 7 Apr., 2003 (Lee, N., etal, 2003). We can find that both HCoV and HMPV can be found in some of their 183 patients. And from the microbiological report from Hong Kong, HMPV had been cultured in 25 out of 53 samples of the patients in Prince of Wales Hospital (PWH) of Hong Kong on 25 Mar., 2003 (Fung H, 2003). Observed evidences show that both HCov and HMPV may be present in the SARS patient in Hong Kong. However both local and global attention are seemed to be focused on HCoV only. One incidence in PWH makes me feel worry is that one medical student who was previously discharged was re-admitted with the diagnosis of SARS on 26 Mar., 2003 (Fung, H 2003). Although I had directed this incidence to the doctor in-charge in the open forum of PWH on 15 Apr., 2003, the doctor replied that he did not know the resaon behind the re-admission incidence. The above incidence poses several questions: 1) Is it a relapse ? That means the virus is not fully controlled by recent therapy. 2) Is it a re-infection by the same virus? 3) is it a newly infection by another virus (HCoV or HMPV)? 4) Does the recent therapy can only control one virus, and the other virus causing the relapse ? I think the questions from this incidence are endless. However, one may observe that the above questions indicate the possibility of the both HCoV and HMPV are related to the cause of SARS pandemic in Hong Kong. I hope the recent attention on HCoV is not the "half" solution in containing the SARS pandemic. And I do hope Hong Kong as well as the world can free from SARS as soon as possible with more attentions on both viruses. Reference: Fung, H (2003): Situation report of PWH on 25 Mar., 2003. PWH,Hong Kong. Fung, H (2003): Situation report of PWH on 26 Mar., 2003. PWH,Hong Kong. Lee, N et al (2003): A major outbreak of SARS in Hong Kong. NEJM: 7 Apr., 2003. www.nejm.org. Competing interests: None declared |
|||
|
|
|||
|
muhammad fayyaz, medical student army medical college rawalpindi, 46000 pakistan
Send response to journal:
|
i am happy to say that still pakistan is free from this deadly syndrome that has played havoc in china and now the hong kong is on top in deaths with today morning news that the authorities in hong kong have found a cluster of 321 new cases in amoy garden estate(1). But it is very much unsatisfactory now when one confirmed case has been found in Goa,an indian state(2). Pakistan has a long border with india and also bad relations as well and the china is on other side .Pakistan is sandwiched between these two big states. Its a strong possiblity taht SARS may spread to pakistan or send to pakistan for any other means in the face of bab relations. In the background of great congestion of cities in most south asian cities once SARS established in this region it will become very much difficult to control.Still the organism is in dispute and no satisfactory treatment is available and investigative tools are only available at a few palces in the country. secondly its a great possiblity that it would have been a mixed infection . My hypothesis is that the infection with HMPV might have occured first that under the favourable envirmental facotrs activated rather facilitated virulence of another organism named now "SARS VIRUS" by WHO. And this virus then spread in the world so its great possibilty that it was a mixed infection to start with but with the passage of time the HMPV subsided or unable to grow in some specific undetermined envoirnmental conditions while SRAS adapted all advers envoirnmental conditions due to continous mutations. Now lets wait with patience that up to what conculsion we be able to reach at the end. 1.Unanswered questation:a critical point in the evoulaion of SARS update 34(who.INT) 2.Severe acute respiratory syndrome(SARS)-multi-country outbreak update 33(who.int) Competing interests: None declared |
|||
|
|
|||
|
Peter D.O. Davies, Consultant Physician, Secretary TB Alert. Cardiothoracic Centre, Liverpool L14 3PE
Send response to journal:
|
Your editorial states that Severe Acute Respiratory Syndrome (SARS) has prompted the WHO to issue its first global alert for over a decade. As I recall the last global alert, issued exactly 10 years and a month ago, was for tuberculosis (TB). With 2 million deaths a year and rising TB kills as many people every six hours as SARS has done since its first description. Yet there are still no new drugs or vaccines on the horizon. I hope the response to SARS will have better fortune. Competing interests: None declared |
|||
|
|
|||
|
Andrew F Smith, Consultant Anaesthetist Royal Lancaster Infirmary, LA1 4RP, UK, Cathy Wild, John Law
Send response to journal:
|
Zambon’s editorial1 reminds us of the challenge such outbreaks might pose for healthcare systems. We have been analysing the local organisational response to the Legionnaire’s disease outbreak in Barrow-in -Furness in summer 2002. Some features may be relevant to large-scale ‘medical’ incidents such as SARS (sudden acute respiratory syndrome), influenza epidemics and the effects of biological terrorism. First, recognition of the outbreak may be delayed, especially when symptoms are non-specific. Although Legionella was identified promptly, the lack of a single catastrophic trigger such as an explosion (as would be usual in a ‘typical’ major incident) and the initial difficulty predicting the scale of the outbreak led to some confusion as to quite whether, and when, a major incident should be declared. A further difference is the duration of the crisis, which necessitated careful manpower planning to protect staff from overwork. This would be more pronounced if staff themselves were incapacitated, as might well occur with SARS. Second, the low mortality rate was attributed partly to the widespread use of an early warning scoring system for the timely identification and intensive care referral of deteriorating patients2. We have still to explore whether this effect was due to the scoring system itself or the close involvement of ICU staff on general wards. Third, the hospital’s incident plan was simply not designed for this type of incident. Paradoxically, this seems to have been beneficial in that it allowed experienced clinical and managerial staff the freedom to improvise as events demanded. Further, despite the presence of a central incident room, our data suggest a loose organisational hierarchy with relatively ‘low status’ employees able to make decisions. These characteristics are evident in safety-critical ‘high reliability organisations’3 and the challenge for major incident planning is to prevent such vital human factors being stifled by protocol and prescription. 1 Zambon M Sudden acute respiratory syndrome revisited(editorial) BMJ 2003; 326: 831-2 (19 April) 2 Morgan RJM, Williams F, Wright MM An early warning scoring system for detecting developing critical illness. Clin Intens Care 1997; 8: 100 3 Roberts KH Some characteristics of one type of high reliability organisation Organization Science 1990; 1: 160-76 Andrew Smith Head of R&D
John Law Competing interests: None declared |
|||
|
|
|||
|
Madhu Bardhan, Consultant in Public Health Medicine Christchurch House, Coventry, CV1 2GQ
Send response to journal:
|
EDITOR,
I would like to share the SARS checklist below, which I have designed for busy general practitioners and hospital doctors. Colleagues inform me that they have found it useful. The checklist is based on WHO case definitions as well as the UK case definitions¹ updated on 10th April 2003. ¹ www.phls.co.uk/topics/SARS/case-definitions.htm
UPDATED DECISION MAKING LIST FOR SARS
Case Name ........................
Case Definition based on PHLS update 10th April 2003.
A Presenting after 1st Feb 2003 date ? A
B History of Sudden Onset High Fever ? B
>38 degrees C
C Cough ? C
or
Sore Throat ? C
or
Shortness of breath ? C
or
Dyspnoea ? C
D Travelled to an area in which there is ? D
more than limited local transmission
in 10 days before onset
E Close contact 10 days before onset:
Cared for SARS patient ? E
or
Lived with SARS patient ? E
or
Direct contact with respiratory ? E
secretion
or
Direct contact with body fluid ? E
F CXR = Pneumonia and no response to ? F
standard antimicrobial treatment or
Respiratory distress, sudden ? F
deterioration or fast progression
or
Death due to an unexplained ? F
respiratory illness, autopsy shows
signs of RDS of unidentifiable cause
and history of travel to SARS area
within 10 days prior to illness
Suspected LOW Case = A + B + one of C + D Suspected HIGH Case = A + B + one of C + one of E Probable Case = A + B + one of C + D + one of F Probable Case = A + B + one of C + one of E + one of F Please note:
ii) If the case warrants hospital admission, please discuss this with the consultant physician on call, so that precautions can be taken to prevent spread of infection in hospital. iii)Ideally transport to hospital should be organised with the ambulance service after ensuring at the time of booking, ambulance control is aware of the possibility of SARS so that precautions can be taken. iv) Information regarding SARS can be found on http://www.phls.org.uk/topics_az/SARS/menu.htm v) If you feel you have a case, suspect or probable please do not forget to inform Public Health, so that contact tracing can be arranged. Competing interests: None declared |
|||
|
|
|||
|
Philippe Beutels, Senior researcher National Centre for Immunisation Research, University of Sydney, Westmead 2145 NSW, Australia
Send response to journal:
|
In light of the current problem, I (and others I've spoken to) have a very trivial question. I read SARS to be the abbreviation of Severe Acute Respiratory Syndrome in most instances (including this week's editorial in the BMJ), and of Sudden Acute Respiratory Syndrome in others (including last week's obituary of Dr Urbani in the BMJ). As the abbreviation is starting to lead it's own life (like AIDS), it might be a good time to decide what it stands for. Competing interests: None declared |
|||
|
|
|||
|
nimit shah, senior house officer uk,lu40en
Send response to journal:
|
i fully appreciate the concern about the spread of virus to pakistan.as a medical student and a future doctor i would have appreciated if my colleague would have concentrated more on the role of government of pakistan taking action in preventing the spread to virus to pakistan rather making statement that virus could be send to pakistan because of bad wibes between the neighbouring countries.it is a serious health issue and we have to fight it globally without any discrimination or political issue.i would appreciate if these sorts of political statements are edited in future. Competing interests: None declared |
|||
|
|
|||
|
Jayapriya D Raj, SHO in Accident & Emergency West Cumberland Hospital, Hensingham, Whitehaven, Cumbria, CA28 8JG
Send response to journal:
|
Dear Editor, Thanks for keeping us readers on the cutting edge of current health issues. I was watching the BBC television programme yesterday about the impact of SARS on the chinese british community. It has been reported that there have been lesser customers and other visitors to their business establishments, due to the SARS situation in China. Is there any risk involved if adequate quarantine measures are being taken? Can the people be given information about the actual methods of spread of the virus responsible and avoid panic? It would help if the issue of impact of SARS on the multicultural society is addressed in one of your future publications. Thankyou. Competing interests: None declared |
|||