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Graphic Outbreak of severe acute respiratory syndrome in Hong Kong Special Administrative Region: case report

BMJ 2003; 326 doi: (Published 19 April 2003) Cite this as: BMJ 2003;326:850

Rapid Response:

SARS and Temperature

I read Dr KP Chan's article with interest.

I have some observations to add.
I have seen many case of URI coming in these few weeks.Though eventually
they did not end up in hospital, and they did not have positive XRay, they
did have features unusual , quite unlike the common URIs seen before.

The first cases were seen in early March.They made the patient very
ill,with high swinging fever.Many of them were quite healthy people
before,as I know them quite well for years for other complaints.
One private radiologist looking at CXR from this region told me that she
observed around 5-10 cases of very mild nonspecific pnueumonia. Though
these all eventually did not end up in hospital,she regarded the
occurrence as unusal,as she used to see only one or two of such films pre
year for her many years of practise.

These horde of cases lasted around two weeks, at early March. They
then disappeared,and were followed by another batch of URI with symptoms
of mild colic, and frequency of bowel motion,but not amounting to watery

These lasted around half to one week.

Then another batch of URI appeared with intense pain and coldness of
the forehead.There was also very strong foul smell of breath from deep
down the airways,somewhat like kerosine.Such patients felt that the breath
from deep inside is very cold. I had feel such breath, it was really very
cold.Such patients felt very much improvement by having hot water shower
over the forehead and chest. Some did it for continuously 30 plus minutes
and felt completely cured after that. Some of them said that it was better
than my antibiotics and analgesics.

These cases. though stormy, usually ended up only as bronchitis,and
lasted only one to two days.

There was then one night of intense thunderstorm.There was little
case after that night for a few days.

Then later that week,cases like the first batch of intense fever
reappeared. But they are milder and patients felt less ill.

During the last week,cases like those 'cold' cases reappeared. But
the coldness was milder. They seemed more resilient,and lasted more than
three days. Though milder,many of them ended eventually to mild
bronchiolitis to mild pneumonia,but no typical SARS XRC.Again they have
this cold air from inside,foul smell,and response to hot water shower.But
unlike the 'first'batch,hot shower relieved but could not 'cure' the
discomfort.It still lingered on after half a day of relieve.

I have not been able to do viral tests for everyone. But my patients
of these sort promised to come back later for reassesment their viral
My impression is that they may be two types ,coming in two batches. The
later batch seems milder than the first batch for both.One seems hot,while
the later 'cold' cases response to 'physical therapy'with hot water

Of course these may not be the corona virus.But they were what
presented to us recently,and quite unlike the URI we used to see.Are they
'relatives'or 'peers'?
I cannot tell until they have their viral studies back.
I just want to share these observations with other front line workers in
cases it may be of some hint in tackling SARS.

PS. My last response on SARS and the direction of east,I forget to
mention that Macao. She is so close to Hong Kong and China, with in fact
nonstop travellers between them. She also have a less powerful medical and
health setup. Yet their cases are nearly nil compare to HK. HK is again on
Macao's east.I heard that WHO is going to study this problem too,and hope
that their research worker also put this factor into their consideration.

Competing interests:  
None declared

Competing interests: No competing interests

17 April 2003
Y L Yip
Honorary Asst. Professor, Dept of Family Medicine, Faculty of Medicine, HKU
St Teresa's Hospital, Argyle Street ,Kowloon ,Hong Kong