TUESDAY, Dec. 23, 2003 (HealthDayNews) -- Less than a year after the world first heard of SARS, researchers are reporting on the success of measures taken to control the first outbreak as well as treatments that might prove effective in future epidemics.
These reports, looking back and looking forward, appear in the Dec. 24/31 issue of the Journal of the American Medical Association.
The SARS story essentially began on Feb. 21 when a sick physician from Guangdong Province in China infected more than a dozen guests and visitors within 24 hours on the ninth floor of a Hong Kong hotel where he was staying. Those people then carried the virus to Hong Kong, Vietnam, Singapore and Canada. Soon, SARS -- or sudden acute respiratory syndrome -- was a household word and a threat across the globe.
Dr. Daniel R. Feikin, a medical epidemiologist with the U.S. Centers for Disease Control and Prevention, traveled to Beijing as a consultant for the World Health Organization last May, just as the SARS epidemic was beginning to wane. He is the senior author of one of the reports appearing in the journal.
Beijing had the largest SARS outbreak with 2,521 reported probable cases. At the epidemic's peak, in late April, more than 100 new patients were being hospitalized in the city every day. The last probable case appeared on May 29.
Feikin scoured official documents and spoke with Chinese public health officials to gauge what had worked and what hadn't. Although criticism was initially directed at the Chinese government for its failure to communicate during the early stages of the outbreak, Feikin and his colleagues conclude that measures taken later were largely successful in controlling the epidemic.
"I think you have to distinguish the early phase of the outbreak... with the later part of the outbreak when they [Chinese officials] declared it publicly and then tackled it aggressively," Feikin says. "It was successful. The last case they had was only six weeks after the peak day of hospitalization."
Among the more important measures taken, Feikin says, were the education of 60,000 health-care workers on how to manage SARS and how to use personal protective equipment, and the triaging of people with suspected SARS. Probable patients were first clustered together in one ward of a hospital and eventually confined to 16 hospitals that were dedicated to managing the outbreak. Quarantining high-risk individuals such as family members was also successful.
The World Health Organization estimates that 8,098 people worldwide became sick with SARS, and 774 died -- the vast majority in Asia.
Also in the new journal, researchers in Toronto provide encouraging preliminary information that a combination of corticosteroids and interferon can be effective in treating SARS.
"[Interferons are] first and foremost notable for their activity against inhibiting viruses," says Eleanor N. Fish, senior and corresponding author of the report and senior scientist and division head at Toronto General Research Institute. "From my perspective, this was a no-brainer. We had an acute viral infection and we needed to get rid of the virus."
Between April 11 and May 30, the height of Toronto's SARS outbreak, Fish organized a trial in which 13 patients with SARS were treated with corticosteroids alone while nine SARS patients were treated with corticosteroids plus interferon alfacon-1.
The researchers set up a dedicated SARS laboratory and purchased equipment to analyze specimens on the spot. "It literally happened over the weekend," Fish says.
While both treatment protocols had a similar effect on fever, other differences emerged. More than a third (38.5 percent) of the patients being treated with corticosteroids alone were transferred to the intensive care unit, 23.1 percent required intubation (a tracheal tube) and mechanical ventilation, and 7.7 percent died.
Of those receiving the tandem therapy, 33.3 percent were transferred to the intensive care unit, 11.1 percent required intubation and mechanical ventilation, and there were no deaths.
Perhaps most dramatic, people in the interferon alfacon-1 group got normal chest X-ray readings within four days, versus nine days for the other group, and got off supplemental oxygen faster -- 10 days versus 16 days.
"The results are very encouraging," says Fish, adding that Health Canada has approved this protocol should another outbreak occur.
"People should be reassured," Fish says. "There are emerging infectious diseases, there are global outbreaks, but I think interferon has the potential for a number of different viruses. It's not SARS-specific."
More information
For more on SARS, visit the U.S. Centers for Disease Control and Prevention or the World Health Organization.
