STILL UNKNOWN
A year after the first SARS case was reported, the medical world is still at a loss about the virus
FOSHAN, China
Early in November last year the deputy head of a local village came to this southern Chinese city looking for a doctor who could treat a raging fever, a worsening cough and increasing breathing difficulties.
Pang Zuoyou was the world's first known SARS case.
On November 16 the middle-aged man headed to the Foshan Number One People's Hospital where doctors treated him for pneumonia and released him after he recovered. He remains in good health today.
At the time, medical workers had no idea that Pang was infected with severe acute respiratory syndrome. It would be months before the villager from Zhangcha township near Foshan would be retrospectively diagnosed as the world's first documented SARS patient.
Four workers at the hospital were infected by him, but doctors are still baffled at how members of his family escaped the deadly disease and remain concerned the virus could spread to people who do not show symptoms but are nevertheless infectious.
"Within two weeks of the Foshan case, other outbreaks occurred in Heyuan city which is pretty far away from Foshan," Feng Shaoming, an official with the Guangdong provincial health bureau, recalled. "By January and February seven cities in Guangdong had recorded cases of this new type of atypical pneumonia."
There were no clear-cut links between the early first cases of a disease that spread globally from Guangdong in March to infect nearly 8,500 people in over 30 countries, killing more the 800. China was the worst hit, with almost 350 fatalities from over 5,300 infections.
"With SARS we were lucky," said Dr. Julie Hall, a contagious diseases expert with the WHO in Beijing who was sent to the Chinese capital to monitor the SARS situation. "We were lucky in terms of the virus itself, which didn't spread quickly and was not an air-borne disease. We were also lucky that we were on high alert and the global response was very good."
If SARS were an air-borne disease, instead of being spread in droplets of water emitted by talking, coughing, or sneezing, then the disease would have been much harder to control and would have spread much faster, Hall said.
Still, a great deal is left unknown about the mystery disease.
"We can't say 100 percent that there was no link between the earlier cases, but there is no evidence that these people interacted with each other," Feng said. "So there is a possibility that the disease emerged in different places at the same time and was not isolated to one person who went on to infect other people." This scenario could mean that the SARS virus is still out there, possibly among animals, and could be seasonal in nature and ready to reemerge at anytime, he said.
Not Conclusive
The evidence is not conclusive, but many suspect the coronavirus that causes SARS jumped the species barrier from animals to humans somewhere in southern China this time last year. A virus similar to the SARS coronavirus has been found in at least seven wild animals, many of which continue to be served in Cantonese restaurants in Guangdong province.
"One theory is that SARS jumped from an animal to one human being, another theory is that there were a number of jumps that happened around the same time," Hall said. "We really don't know what happened at the very beginning and it has been real hard to say. We are calling for more research in animal populations, how did it jump the species barrier?, where is the highest risk?, is it in eating animals?, probably not, in butchering them?, probably yes."
AFP
Divided by SARS
GENEVA
International health experts want to divide the world into three zones to detect a possible resurgence of the SARS virus, with southern China and Hong Kong at the center of the most severe testing regime for suspected cases.
The three-tier system, classifying areas by the degree of risk of a SARS infection, is designed to avoid overburdening hospitals and laboratories during the influenza season, the experts said after a meeting at WHO headquarters. The flu can trigger similar symptoms to SARS and health experts want to avoid testing every patient, except in the "zone of re-emergence" where the deadly disease is thought to have originated late last year.
In a second zone of "nodal areas," corresponding to other regions where the disease has been transmitted before, there should be no routine tests for atypical pneumonia-one of the first possible clinical signs of sars-unless a cluster of suspected cases is found.
In the third zone, the rest of the world where the virus was "not normally" seen, suspect patients will only be tested as a last resort, John Mackenzie of WHO said. "Our suggestion is that we should not be testing routinely people who have atypical pneumonia for SARS, unless there is a cluster of cases.
The experts also want to impose an international double testing regime, with a blood test required from a second laboratory to confirm the detection of SARS in a first laboratory test.
AFP
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