HANOI
Out of any crisis there emerge heroes-those who put their own personal safety, often with fatal consequences, on the line to help others. For the tight-knit United Nations community in Vietnam, Carlo Urbani, the Italian doctor whose warnings drew the world's attention to SARS, fits into that category. Urbani was the WHO's top infectious disease specialist in Vietnam and an uncannily good diagnostician.
When the French Hospital in Hanoi called the WHO on February 28 for advice on a Chinese-American businessman who had fallen ill with suspected atypical pneumonia, he was the first on the scene. But his close contact with SARS patients over the next 10 days was to prove fatal. On March 29, he died of the disease he was trying to prevent from spreading.
Urbani's foresight and insistence were crucial to Vietnam's efforts to contain the disease, said Pascale Brudon, WHO representative to Vietnam, and a close colleague. "Carlo saw the potential of the infectivity of this disease and on March 5 said we must inform the government, so we did," Brudon said. Over the next two days, Urbani explained to health officials the need to isolate patients, insisted on bringing top levels of government into the loop, and succeeded in getting the WHO to bring in a team of disease control experts. On April 28, Vietnam became the first country to have brought the outbreak under control.
"Had it not been for his recognition that the outbreak of the virus was something out of the ordinary, many more would have fallen victim to SARS," said UN Secretary General Kofi Annan. "It was the cruelest of ironies that he lost his own life to SARS while seeking to safeguard others from the disease."
Since his death, tributes have flocked in from around the world for Urbani. Among the most moving was that from veteran BBC broadcaster Alistair Cooke in his weekly Letter from America. "We know him as Dr. Urbani, but it would seem proper and inevitable that future generations will come to know him as Saint Carlo. For if ever a saint was alive and practising in my time, Dr. Urbani was it," he said.
Researchers at the US CDC have proposed that the first strain of SARS associated coronavirus they have isolated be named the Urbani strain.
On May 8, Vietnam conferred on Urbani the presidential "Order of Friendship" and the "Medal for People's Health." Ben Rowse,
AFP
The Patience to Remind Patients
On a lay forum on severe acute respiratory syndrome (SARS) held April 10 by the Medical City Center for Patient Education, infectious disease expert Mediadora Saniel quoted what Edward Kass had said of Legionnaire's disease in the late 1970s: "The terror of the unknown is seldom better displayed than by the response of a population to the appearance of an epidemic, particularly when the epidemic strikes without apparent cause."
Together with Saniel, WHO representative Jean-Marc Olivé, Health secretary Manuel Dayrit, and The Medical City medical director Alfredo Bengzon warned against welcoming SARS with hysteria.
Yet just a few days later when SARS lent itself to a Filipino face-overseas worker Adela Catalon of Alcala, Pangasinan-hysteria was exactly what happened. There were newspaper reports of neighbors practically considering the Catalons outcasts, or even neighboring communities thinking just getting to Alcala would make them ill. This only confirmed what our health experts have been saying all along: that panic is the worst adverse event any disease could bring.
Doctors play a big role in stemming the problem of hysteria as well as preventing its opposite, complacency and sloppiness. And so what Saniel said in April-a combination of the practical and commonsensical-continues to apply unto now.
"We are not helpless," she said, adding that patients need to think of a few things first before scaring themselves and others. "There may be no cure, but we can certainly contain this virus." Using the WHO guidelines, she said patients should not worry too much about SARS if they have not had any close contact with a known SARS patient, or traveled to a SARS-affected country, or had high-grade fever (above 38 degrees Celsius, "hindi pwedeng sinat [lang]," she emphasized) even after 14 days of possible contact with a SARS patient.
Now what if a person has had close contact with a SARS patient? Saniel said that if that person is asymptomatic, the WHO and the DoH recommend voluntary home confinement at for the entire length of the incubation period of the SARS coronavirus (about 14 days). It would be prudent for someone with direct SARS contact to inform the DoH hotline when high-grade fever sets in anytime during the incubation period. Close contact with a patient involves having lived with a SARS suspect, being a caregiver to a SARS suspect, and having direct contact with the patient's secretions.
Saniel also responded to critics who had said that the absence of negative pressure rooms in the SARS quarantine areas would be a big problem-she said that more than high-end technology, things as basic as proper hand washing and aseptic techniques are of primary importance. "Transmission is halted or dramatically reduced by strict isolation and barrier nursing techniques. A lot of this is common sense," she emphasized.
Lastly, she advised doctors: "Information is your ally. Stay informed, and keep the public informed."
Jin Paul de Guzman
Double-Edged Sword
PARIS
The most complete genetic study to date of the SARS virus has revealed an agent that appears to undergo almost negligible mutation, a phenomenon described as "a double-edged sword" for the doctors battling to eradicate it.
Scientists in Singapore compared the genetic ID of samples of SARS virus taken in throat swabs from local patients with the genome of samples found in other countries. The most important areas of the genomes were identical, something that is remarkable in so-called RNA viruses, which includes SARS and other members of the coronavirus family.
Usually, RNA viruses mutate very quickly, changing a letter or so in their genetic code every time they replicate. This evolution is part of the virus' drive to survive, perhaps finding ways of evading the defense mechanisms of its host or of transferring to a new and more profitable host.
The research, published by The Lancet, was carried out by a team led by Edison Liu from Singapore's Genome Institute.
In a commentary, molecular biologists Earl Brown and Jason Tetro from the University of Ottawa, Canada, said that Liu's evidence pointed to "a remarkable genetic conservation" of the virus since the outbreak was first documented in February.
"This finding may be a double-edged sword," they warned. It shows that the virus is well adapted to lodging in the human host-in other words, there is the risk that it is here to stay. The virus is not under significant threat from the immune system and so has no need to mutate to a different form, hopefully a more benign one. Mutation such as this is what causes flu epidemics to die out.
On the other hand, its relative stability should make it easier to target it with a vaccine, they said. Viruses that mutate quickly are in effect a moving target, because vaccines work by teaching antibodies and killer blood cells the face of a familiar enemy.
"It's both good and bad news," Brown said. "The bad news is that we may get more of the same. The good news is that at least we think we have a clear target and with time, we may be able to have a vaccine." Brown added a caveat. Vaccines to combat animal versions of the coronavirus have had only limited success. "We're not sure why this is. It could be that the virus changes shape in response to the vaccine and ducks the immune system."
Brown said SARS' genetic stability placed it in a new class from the two other classes of coronavirus. "There are now three types of corona. This is a new flavor," he said.
AFP
