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medpundit |
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Saturday, April 05, 2003Elsewhere in the news, SARS has been added to the diseases worthy of quarantine, which means if need be, the government can force you stay in your house until you’re no longer sick. The list is nothing new. It’s been around for some time and includes such diseases as smallpox and cholera, but it’s the first time in a while that a new disease has been added to it. And, from the CDC press conference yesterday, we learn why the disease hasn’t been as fatal here: We are using a very broad, very nonspecific, but quite sensitive surveillance case definition here to pick up these 115 suspect cases. Now, having said that, though, why have we not seen one of these severely ill patients? I think we have been lucky, frankly. I mean, there is no better explanation at the moment, and we won't know until we get better information on risk factors, as they relate to exposure and individual susceptibility. Translation: luck. And there’s mounting evidence that the coronavirus is, indeed, the culprit - although it still isn’t certain: Evidence for this previously unrecognized Coronavirus has been found now in at least 10 laboratories, including the laboratories here at CDC. The preponderance of the evidence continues to mount and continues to favor an etiologic role or this previously unrecognized Coronavirus in the cause of SARS. So far, in looking at specimens from the suspect cases in the United States, we now have evidence of infection with this agent in a total of four people, and we are working with the state health departments in the states where these people reside, so that they are provided with the information and they, in turn, will provide the clinicians and the patients with the information. Now, let me give a little more detail on the extent of the laboratory evidence. We have cultured this Coronavirus from a total of four patients. We have electron microscopic evidence from two patients of this virus. We have PCR results--that is the Polymerase Chain Reaction, the amplification technique--where we find evidence of Coronaviral nucleic acid in 11 patients. Looking at the antibody tests, of which we have two--an IFA test and Allose test--there is evidence for infection in a total of five patients. And from the standpoint of histopathology, looking through the microscope at tissue from deceased patients, we have seen evidence of an entity that the pathologist call diffuse alveolar damage, which is the pathologic correlate for the clinical syndrome of Acute Respiratory Distress Syndrome, which has appeared in patients with severe forms of SARS. This last bit about the pathological changes in the lungs is a key difference between this infection and influenza. The influenza virus doesn’t, for the most part, directly attack the lungs. “Influenza-related deaths” are usually caused by complicating factors - the development of a pneumonia super-imposed on influenza, or hypoxia that makes a heart condition suddenly fatal. This virus, in contrast, seems to attack the lungs directly and damage them enough to cause a critical illness in a significant number of its victims. And, finally, is the CDC examining this outbreak for lessons in controlling and preventing a bioterrorist attack? This is a fire drill for a number of things. It is a fire drill for an unexpected, severe acute respiratory disease. The one of those that we know is going to occur one day is the next worldwide epidemic or pandemic of influenza. So those of you who have been interested in following influenza preparedness in the past ought to pay very close attention to this. This has many similarities to the way the next influenza pandemic might begin. Now, having said that, I am sorry, I have forgotten--well, let me,in terms of bioterrorism. Yes, I mean, we are operating through our Emergency Operations Center. That center was activated by Dr. Julie Gerberding, our director, back on March 14th, and it's been operating around the clock ever since. We're using that now. If we have a bioterrorism attack, we will be using that emergency operation center and doing many of the same things that we're doing now, operating through multidisciplinary, headquarters-based and field teams. So this a drill. We are building on our experience in dealing with anthrax, on the one hand, and also on our experience in dealing with West Nile encephalitis last summer as it swept across the country. And I would just remind everybody we're paying close attention to what's going on with West Nile Virus right now because, as things warm up, we're going to come back into West Nile transmission season before too long. Bioterrorism? What’s that to us when we have West Nile virus to worry about! posted by Sydney on 4/05/2003 08:47:00 AM 0 comments 0 Comments: |
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