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Pastimes : SARS - what next? -- Ignore unavailable to you. Want to Upgrade?

To: Maurice Winn who wrote (734)	9/9/2003 8:18:06 PM
From: Henry Niman	Respond to of 1070

The article below suggests that the media is starting to again believe lab results, even when generated in the summer. Below the lab data for Vancouver was cited as inconclusive and the positive lab data associated with cases that don't meet the WHO case definition were mentioned (but OC43 data were given a significant mention). Looks like the spin has a limit and lab data is starting to be confirmatory again. Maybe the ABS (Anything But SARS) epidemic is declining because of seasonal factors. Fall is approaching in the northern hemisphere and we will soon see if all of the positive lab data demonstrating the rapid spread of SARS CoV has any relevance to SARS. >===== Original Message From "Henry L Niman, PhD" <henry_niman@hms.harvard.edu> ===== Singapore confirms SARS case By Steve Sternberg, USA TODAY The SARS virus apparently has turned up in Singapore in a 27-year-old biologist, but authorities said Tuesday that the man's symptoms aren't typical of the disease that raced through Southeast Asia and Toronto in the spring. This is the second SARS scare in three months. An apparent outbreak of severe acute respiratory syndrome occurred in July in a suburban Vancouver nursing home, but test results were inconclusive. The Singaporean patient has twice tested positive for the SARS virus. He is a postdoctoral student researching West Nile virus in a laboratory at the National University of Singapore, according to the Ministry of Health.

To: Maurice Winn who wrote (734)	9/10/2003 10:12:45 PM
From: Henry Niman	Respond to of 1070

The article below expresses some of the frustration with WHO's position on outbreaks that do not meet its expectations of how SARS CoV infections should present as well as the failure to provide a scientifically valid explanation of SARS CoV activity detected by reputable labs. The case in Singapore offers a good opportunity for using molecular epidemiology to trace the origin of the infection. Sequencing of the virus will be most important. There are already 7 fully sequenced isolates from Singapore that are associated with the first outbreak. I am not sure if any of the clones handled on or about Aug 17 at the NEA are novel, but if they are, a comparison between the sequence of the virus handled then and the virus detected in the post-doc could be quite revealing. Singapore seems to be ready and willing to get to the true cause of the illness and not willing to settle for scientific nonsense such as OC43 detection as an explanation of an exact match with TWO SARS CoVs. Last week's Science article provides a broad spectrum of mutations that be analyzed with a relatively small amount of sequence data. Hopefully real data will come out of the investigation into the true origin of the SARS CoV detected in the post doc. I expect the Singapore investigation to be more thorough than the PR put out on the Vancouver outbreak. >===== Original Message From "Henry L Niman, PhD" <henry_niman@hms.harvard.edu> ===== straitstimes.asia1.com.sg SEPT 11, 2003 Better be forearmed: Treat the case as Sars By Andy Ho SENIOR CORRESPONDENT

To: Maurice Winn who wrote (734)	9/12/2003 12:24:05 PM
From: Henry Niman	Read Replies (1) \| Respond to of 1070

Don't ask don't tell is shifting into high gear. It's becoming increasingly obvious that some officials just don't want to know about SARS CoV and comments that the Singapore post-doc should not have been tested clearly show who is in the driver's seat. WHO said that SARS CoV doesn't exist in humans and as long as testing is limited, they can maintain the illusion a little longer. I believe that WHO has now seen the Winnipeg data and since there isn't an obvious scientific explanation for the SARS CoV sequences, WHO will just reduce testing. The spin goes on and on. >===== Original Message From "Henry L Niman, PhD" <henry_niman@hms.harvard.edu> ===== Canada to Limit SARS Testing Unless a New Outbreak Occurs Goal Is to Reduce Risks Of False-Positive Results Triggering Health Panic By ELENA CHERNEY Staff Reporter of THE WALL STREET JOURNAL TORONTO -- Canadian health officials, seeking to prevent imperfect laboratory tests from triggering a SARS panic, plan to restrict SARS testing on patients with respiratory symptoms unless there is another outbreak. A cluster of summer colds at a British Columbia nursing home attracted international attention last month when Canada's National Microbiology Laboratory found evidence of a coronavirus that it said bore striking similarities to the coronavirus that caused last spring's deadly outbreak of severe acute respiratory syndrome. Now, Canada's Ministry of Health is developing a policy that would steer Canadian scientists away from doing SARS tests on most patients. "We're living in a world where there is no SARS," said Arlene King, director of Health Canada's division for immunization and respiratory infections. A lab worker in Singapore is believed to have a mild case, possibly linked to exposure in the lab. Since tests continue to produce false-positive results even though the disease isn't circulating right now, public-health agencies around the world are seeking to avoid sparking hysteria, Dr. King said. "The public health, economic and social consequences of overcalling SARS are profound," Dr. King said. "Everyone is struggling with this issue." The Canadian protocol, which isn't yet final, would instruct labs to test for SARS only if physicians were puzzled by an unexplained cluster of severe illness, or, in an isolated case, if the patient showed the hallmark symptoms of the ailment, which causes an atypical pneumonia and had some connection to parts of China where the malady potentially could be re-emerging. The reaction in Asia to the isolated SARS case in Singapore illustrates the dangers of aggressive testing for the virus in individual cases with mild symptoms, World Health Organization spokesman Dick Thompson said. The case in Singapore, which is believed to be a "mild SARS coronavirus infection" is an "extremely isolated" case that hasn't spread, Mr. Thompson said. Yet it has sent shudders through Singapore's stock market and caused anxiety throughout the region.

To: Maurice Winn who wrote (734)	9/12/2003 2:03:36 PM
From: Henry Niman	Read Replies (1) \| Respond to of 1070

>>"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.