Intended for healthcare professionals


Severe acute respiratory syndrome revisited

BMJ 2003; 326 doi: (Published 19 April 2003) Cite this as: BMJ 2003;326:831

Full information for containing the SARS?

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.

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.

Competing interests:  
None declared

Competing interests: No competing interests

19 April 2003
Edward Lai
North District Hospital, Hong Kong