Ask the doc with first-hand SARS experience

[KarlGauss]

What are the odds that some clueless MD out there is going to send a sample to the lab where I work, thinking it’s some other, more common respiratory virus, thus killing me?

Well I assume that you take precautions for all samples, and that you, in turn, assume that everything that comes your way is potentially infectious. So, I’d say the existence of SARS doesn’t change anything for you

*I’m an asthmatic and I have to travel internationally. I do take precautions, but if I get SARS on top of my asthma, is that pretty much an automatic death sentence? It might sound stupid, but I’ve been terrified of this. *

The people most likely to do poorly with SARS are/have:

• age over 60
• diabetic
• kidney problems
• chronic obstructive lung disease (COPD)
• chronic heart problems

In truth, I’d worry about anyone with asthma who got SARS, assuming that someone whose lungs were already unhealthy would be less able to tolerate the lung complications of SARS. Still, I am not aware of any evidence to back this up and note that COPD is not the same as asthma.

Here is something I haven’t been able to glean from the media reporting on SARS. Most people recover, some people die. What makes most people recover? Early detection and treatment? General better health (i.e. age, nutrition, etc)? Or is it a crap shoot, where some people just pick up a particularly bad case of SARS?

Please see above. The death risk (in Toronto, at least) among young, otherwise healthy people is 1/300. Most people who did poorly (death, mechancial ventilation) were over age 60, had diabetes, or other chronic medical condition. We suspect that people with cancer, AIDS, and the like would also do poorly, but, again, I have no data on this.

There is also a strong belief here that the severity of your disease depends, in part, on how much SARS virus got into you in the first place. So, if you had intensive and protracted contamination (eg. from a spouse coughing on you for two days), you probably will have a rough course. On the other hand, it seems that those who had minimal exposure (eg. a doctor who transiently had a break in precaution such as her mask falling off) do quite well if they get SARS. Most of the SARS-infected doctors and nurses at my hospital have done very well.

Is SARS contageous through spit? I ask because in China most people use chopsticks and eat from common dishes (eg, use your chopsticks to pick up food from the family plate to your rice bowl, eat, pick up more food with saliva laden chopsticks, repeat).

Almost certainly. This is scary. We think that many cases of hospital-acquired SARS have come from people touching their mouths or face with contaminated hands. Spit would do just fine to spread it too.

It also appears that droplets/rubbing eyes is a virulent form of transfer. Would you agree?

Yes, although it may be that by rubbing our eyes we get in our hands, and our hands then touch our lips. Regardless, eye precautions and barriers are important.

[Qadgop_the_Mercotan]

Thanks, KarlGauss!! More via email later! You da SARS man! Meanwhile I’m being overwhelmed by inmates with Hep C today. Like any other day here.

QtM

[Cisco]

#1. I thought I heard a few weeks ago that they had already come up with a definite cure and we didn’t have anything to worry about. I admit to being incredibly far out of the news loop, especially with things I consider overhyped (SARS, Lacey Peterson, Etc.), but what happened to that? Did I hear wrong, or did the cure just not work? Will there be a cure in the future?

#2. What did you think of the song I wrote for you in the other thread? I didn’t realize until after I posted it that you might think I was trying to make light of your situation. That was not my intent and I hope you didn’t take it the wrong way :).

[CRorex]

*Originally posted by Smeghead *
**What are the odds that some clueless MD out there is going to send a sample to the lab where I work, thinking it’s some other, more common respiratory virus, thus killing me? **

Well since you are dealing with clinical samples shouldn’t you be in 2+ gear? Mask, Gown, Gloves and good sterile technique you should be fine.

Realistically it’s less of a danger than working around HIV-2 in a lab setting.

As a side note:

I couldn’t stop laughing imagining MDs and RNs being told one morning to put on portable containment suits to treat patients.

It’s not so much a problem with manual dexterity, it’s worse than being double gloved but it’s the fact that you’re in a sealed enviroment about 1 inch larger than you are… so you literally being to fill the suit with your sweat from the second you put it on.

That and I really don’t think general hospitals have the room in a patient ward to set up decon showers and prep areas. Nevermind trying to get to a patient in a hurry when you have 20-30 min to suit up to go in and the 45 min it takes to decon and shower.

And it’s pointless getting into full isolation gear when the building you’re in doesn’t have enviromentally isolated sections.

[ShibbOleth]

First, KarlGauss, thanks for your efforts in this. It’s cool to know that there are real heroes out there.

*Originally posted by KarlGauss *

I agree with much of this. Still there are lots of cases where the health care workers first got symptoms and then got screened (and mostly after direct SARS patient contact). From speaking to too many of my friends who have been affected, I’d say the consensus is that you know when you’ve got it. Bad myalgias. A real sick feeling. Fevers. And the blood work is impressive. Lymphopenia ( <0.5), high CK’s (300 range), and serious LDH rise (often >1000). These can occur even if the pulmonary manifestations are minimal or absent.
**

Second, can you explain a bit of the above paragraph to us lay folk?

Third, you mentioned about exposure possibly influencing severity of the illness. Could that mean I could catch a mild case, but someone else could get a more severe case from me, by prolonged extreme exposure?

Finally, what is the average recovery time and the variation from the average? How do you “know” when someone is okay to go out into the public again?

[Smeghead]

*Originally posted by KarlGauss *
**What are the odds that some clueless MD out there is going to send a sample to the lab where I work, thinking it’s some other, more common respiratory virus, thus killing me?

Well I assume that you take precautions for all samples, and that you, in turn, assume that everything that comes your way is potentially infectious. So, I’d say the existence of SARS doesn’t change anything for you
**

Yeah, I was half-joking. I, of course, am perfect in my technique. The problem is, the Infectious Disease lab is on the other side of the bench from my lab. And I don’t trust those weasles at ALL!

[KarlGauss]

I thought I heard a few weeks ago that they had already come up with a definite cure and we didn’t have anything to worry about. Did I hear wrong, or did the cure just not work? Will there be a cure in the future?

No, no cure. Although, in another thread about SARS someone used the term.

The truth is that there is NO proven effective therapy. Treatment consists of supportive care (IV’s, oxygen, etc.) but nothing specifically against the SARS virus. We had been using a drug called Ribavirin until earlier this week. The consensus now, though, is that it added little or nothing yet caused lots of serious side effects.

I’m not a virologist and shouldn’t really speculate about the potential for a cure in the future. But, I’m not optimistic. We’ve never been particularly good at curing viral diseases, and seldom, if ever, can we do it in a “slam dunk” manner.

I’m also not holding my breath for a vaccine. The virus believed to cause SARS, the coronavirus, mutates rapidly. That means the effectivenss of a vaccine may likely decline rapidly too.

*What did you think of the song I wrote for you in the other thread? *
I did like it. Would it be wrong to have the kids in my daughter’s school sing it in their “gala” night next week?

I agree with much of this. Still there are lots of cases where the health care workers first got symptoms and then got screened (and mostly after direct SARS patient contact). From speaking to too many of my friends who have been affected, I’d say the consensus is that you know when you’ve got it. Bad myalgias. A real sick feeling. Fevers. And the blood work is impressive. Lymphopenia ( <0.5), high CK’s (300 range), and serious LDH rise (often >1000). These can occur even if the pulmonary manifestations are minimal or absent.

*can you explain a bit of the above paragraph to us lay folk? *

Surely. My point was that many health care workers who were diagnosed as having SARS really did have the disease and it wasn’t the case that hypervigilance was causing us to detect mild or subclinical SARS which would have ordinarily been missed.

They had symptoms of severe muscle aches (myalgias) and fever. Blood tests showed that certain subsets of their white blood cells were abnormally low (lymphopenia), and that there was something cooking in their muscles (CK is an enzyme released into the bloodstream when muscle is being damaged). LDH is another enzyme which was elevated in the blood of the SARS patients. It comes from any damaged tissue, including liver cells, red blood cells, lung cells, muscle cells, and heart cells. All of these symptoms sometimes occurred even when the lungs were not, apparently, involved by SARS.

you mentioned about exposure possibly influencing severity of the illness. Could that mean I could catch a mild case, but someone else could get a more severe case from me, by prolonged extreme exposure?

I wouldn’t say that, since you’re gonna have to be exposing yourself to yourself a lot more than you could be exposing yourself to someone else. But the converse is true. If you have bad SARS, but only shed a “few” viruses to someone, they may only get a mild case.

Finally, what is the average recovery time and the variation from the average? How do you “know” when someone is okay to go out into the public again?

These are important questions with little data to guide us. Most people have completed the course of their disease in about two weeks. The average person is sickest between days 5 and 11 of his illness. There are clearly outliers, though. We have cases of people who become critically ill only two to three weeks into their course. Some people have lingered in the ICU for many weeks already.

Different centres are using different criteria to declare when victims can be let out of isolation. In Hong Kong, the docs wait 17 days after the last fever. We wait 13 (3 in hospital, and 10 at home). The virus hangs around for 4 weeks or more, though. Still, AFAIK, no one has ever transmitted it after they’ve been without a fever for a week or so.

[Flamsterette_X]

Should I be worried about meeting my sister at the airport on Sunday night, when she’s just come from Mississauga? (and had the flu last week, plus had her best friend recently come out of quarantine?)

Originally, I wasn’t going to wiorry much… but then I read something in the paper today about how we should all take precautions when meeting someone from a major SARS centre. (which Mississauga / the Toronto area is)

F_X

[mrsface]

Just want to say thanks for this thread KarlGauss - cleared up a lot of questions for me

BTW, shouldn’t it be in General Questions though? This is hardly “mundane pointless stuff”

[smam]

Is it pronounced sars or zars? I am sure these newsreaders are just being pretentious.

[Honey]

Good thread.

I went to Boston for the weekend 2 weeks ago. We spent quite a bit of time in Chinatown, eating etc.

Since I got home I’ve had a low-grade fever and a bronchitis type cough. At times breathing is a little difficult. Is this just a run-of-the-mill bug or could I have SARS?

[China_Guy]

Honey, SARS is color blind.

[KarlGauss]

*Should I be worried about meeting my sister at the airport on Sunday night, when she’s just come from Mississauga? (and had the flu last week, plus had her best friend recently come out of quarantine?)

Originally, I wasn’t going to wiorry much… but then I read something in the paper today about how we should all take precautions when meeting someone from a major SARS centre. (which Mississauga / the Toronto area is)*

If a person has finished his/her quarantine, there is no risk.

In terms of your sister, I can’t (and really shouldn’t) give specific advice. In any case, the answer would possibly depend on just what “the flu” meant, and whether she, herself, had exposure to SARS.

*Just want to say thanks for this thread KarlGauss - cleared up a lot of questions for me

BTW, shouldn’t it be in General Questions though? This is hardly “mundane pointless stuff”*

Thanks for the positive feedback!

Maybe a moderator could move this thread if he/she thinks it still worthwhile. Then again, most of the action seems to have died down.

Is it pronounced sars or zars? I am sure these newsreaders are just being pretentious.

Definitely it’s pronounced “sars”. I could be sarscastic and ask if they are being sarious to pronounce it zars, or just bizars.

*I went to Boston for the weekend 2 weeks ago. We spent quite a bit of time in Chinatown, eating etc.

Since I got home I’ve had a low-grade fever and a bronchitis type cough. At times breathing is a little difficult. Is this just a run-of-the-mill bug or could I have SARS?*

The incubation time for SARS is no more than 10 days. If a person hasn’t been exposed to SARS for > 10 days, and then gets a fever, it isn’t SARS.

[Honey]

*Originally posted by China Guy *
**Honey, SARS is color blind. **

Oh my Goodness, I’m sorry. I never meant to offend, I swear.

[Zyada]

KarlGauss, how are you doing? I just read about a Toronto doctor who has died, and I was hoping it wasn’t you.