>>"He probably should never have been tested" because symptoms weren't severe enough, Mr. Thompson said.
The WHO's surveillance policy is geared to detecting clusters of severe, life-threatening illness. If SARS stages a comeback, "we'll probably miss the first case," Mr. Thompson said. "But the first cluster should be obvious."<<
When WHO talks about SARS, its hard to tell if the mean the epidemic or the virus. They have said SARS CoV doesn't exist in humans and a re-emergence would come from an animal reservoir.
However, the lab data says otherwise. The data for Surrey was pretty overwhelming that SARS CoV was present and was a cluster. However, WHO explained away the data with nonsense about OC43 and now they are recommending limiting testing.
Since they have trouble explaining away the Singapore case, they say that the patient should not have been tested. However, regardless of how the post doc contracted the infection, it is clear that the infection didn't meet the WHO case definition. It also seems that in most locations the patient would have been sent home and told to rest and drink plenty of liquids. The case did eventually resolve, but if sent home would there have been transmission? SARS CoV levels generally peak 10 days after symptoms. It seems that putting the patient in the hospital because he was positive for SARS CoV was a better idea than not testing for the virus and sending the patient home.
WHO is talking about missing the first case. It sounds like they may have already missed dozens if not hundreds of cases of SARS CoV infections. The examples above clearly show that not all patients who test positive for SARS CoV go on to develop pneumonia. However, the cases above were diagnosed in the summer, and most viral respiratory diseases have a strong seasonal component. Pneumonia associated with SARS CoV may in fact involve co-factors.
At this time there is no data indicating that the sequences detected in Surrey and Singapore were not from fully infectious SARS CoVs. Sequence data indicate at least 2 SARS CoV subtypes were in the Surrey patients. I suspect a third subtype was involved in Singapore. It seems that more testing should be done, not less, to see just how far and wide the virus has spread.
Reducing or eliminating testing is bad science and bad public health policy. The SARS CoV doesn't read WHO press releases and doesn't care about the hopes and dreams of government health officials. The virus has the ability to mutate and there is no reason to think that it doesn't cause a mild disease. WHO's policy of discouraging testing merely aids and abets a virus that seems to spread quite easily, as officials issue comments indicating that they are confused and perplexed about the obvious. |
