Much of the life-threatening lung damage in SARS victims appears to result from an overly aggressive counterattack by their own bodies, suggesting that virus-killing drugs alone may fail to stop the disease.
Researchers are testing drugs already on the shelf and creating new ones in an effort to find something that will destroy the virus and arrest the disease, which can wreck the lungs. However, many worry that the body's own attempt to fight off the virus is part of the problem, and a study released Thursday supports that concern.
Researchers examining victims' lungs found two sources of damage: the virus itself and the white blood cells summoned to fight it. This combination of offense and misguided defense plays a part in many infectious diseases, and the researchers said finding it so prominently in SARS supports the strategy of subduing patients' immune systems to help them get better.
In fact, some doctors treating SARS in Hong Kong and elsewhere already routinely give steroid drugs to patients to restrain their immune defenses and protect them from a flood of potentially harmful chemicals, called cytokines, aimed at the virus. However, this approach is controversial, and some question whether it could do more harm than good by dulling patients' virus-fighting edge.
The latest evidence, based on lung samples taken from six people who died of SARS, was released on the Internet on Thursday by the British journal Lancet. The study was conducted by Dr. John Nicholls and others at the University of Hong Kong.
No drugs are proven to kill the SARS virus inside the body. However, with nothing else to offer, some doctors have used a combination of ribavirin, which works against some other respiratory infections, and steroids.
Enthusiasm for ribavirin has waned, especially after lab tests found no sign it kills the virus. And some doctors said the latest study should not prompt further use of steroids, at least until there is evidence in animal studies that the approach improves recovery.
"With a few patients, you cannot make those kinds of recommendations," said Dr. Sherif Zaki, pathology chief at the US Centers for Disease Control and Prevention. "You are dealing with human life. You have to have evidence."
The debate also went on in this week's issue of The New England Journal of Medicine, which published five SARS reports released earlier on the Internet. Dr. Yuji Oba of the University of Missouri in Kansas City wrote a letter calling steroids potentially hazardous in SARS, while Drs. Nelson Lee and Joseph Sung of Chinese University of Hong Kong responded that the treatment has been given "to suppress the cytokine storm ... and, in fact, in many cases, it did."
The Lancet report showed evidence of extensive destruction triggered by blood cells called macrophages. These cells produce a variety of chemicals that fight infection but also trigger dangerous inflammation.
The doctors said some of the resulting lung damage is similar to what was seen in the bird flu outbreak, which killed several people in Hong Kong in 1997. They said this suggests that large amounts of inflammatory chemicals produced by macrophages in the air sacs of the lungs help explain why both diseases can be lethal.
"If this is true, it's possible one could intervene at the very early stages of SARS and use anti-inflammatory agents," such as steroids and other immune-suppressing drugs, said Dr. Zab Mosenifar, pulmonology chief at Cedars-Sinai Medical Center in Los Angeles.
In related news, a World Health Organization expert said yesterday that Beijing hospitals are failing to record some possible SARS cases, leading to possible underreporting of the size of the Chinese capital's outbreak.
His comments came as China announced its lowest nationwide daily increase in infections in weeks.
The Health Ministry reported four new SARS deaths and 39 new cases -- a fraction of the increase announced early in the Month when China was reporting more than 150 new cases a day.
Shanghai, the country's biggest city, reported its second death -- a 54-year-old man who wasn't hospitalized until he was gravely ill and had infected his wife.
Severe acute respiratory syndrome has killed 275 people in the country and infected 5,191.
ROLLER-COASTER RIDE: More than five earthquakes ranging from magnitude 4.4 to 5.5 on the Richter scale shook eastern Taiwan in rapid succession yesterday afternoon Back-to-back weather fronts are forecast to hit Taiwan this week, resulting in rain across the nation in the coming days, the Central Weather Administration said yesterday, as it also warned residents in mountainous regions to be wary of landslides and rockfalls. As the first front approached, sporadic rainfall began in central and northern parts of Taiwan yesterday, the agency said, adding that rain is forecast to intensify in those regions today, while brief showers would also affect other parts of the nation. A second weather system is forecast to arrive on Thursday, bringing additional rain to the whole nation until Sunday, it
CONDITIONAL: The PRC imposes secret requirements that the funding it provides cannot be spent in states with diplomatic relations with Taiwan, Emma Reilly said China has been bribing UN officials to obtain “special benefits” and to block funding from countries that have diplomatic ties with Taiwan, a former UN employee told the British House of Commons on Tuesday. At a House of Commons Foreign Affairs Committee hearing into “international relations within the multilateral system,” former Office of the UN High Commissioner for Human Rights (OHCHR) employee Emma Reilly said in a written statement that “Beijing paid bribes to the two successive Presidents of the [UN] General Assembly” during the two-year negotiation of the Sustainable Development Goals. Another way China exercises influence within the UN Secretariat is
LANDSLIDES POSSIBLE: The agency advised the public to avoid visiting mountainous regions due to more expected aftershocks and rainfall from a series of weather fronts A series of earthquakes over the past few days were likely aftershocks of the April 3 earthquake in Hualien County, with further aftershocks to be expected for up to a year, the Central Weather Administration (CWA) said yesterday. Based on the nation’s experience after the quake on Sept. 21, 1999, more aftershocks are possible over the next six months to a year, the agency said. A total of 103 earthquakes of magnitude 4 on the local magnitude scale or higher hit Hualien County from 5:08pm on Monday to 10:27am yesterday, with 27 of them exceeding magnitude 5. They included two, of magnitude
Taiwan’s first drag queen to compete on the internationally acclaimed RuPaul’s Drag Race, Nymphia Wind (妮妃雅), was on Friday crowned the “Next Drag Superstar.” Dressed in a sparkling banana dress, Nymphia Wind swept onto the stage for the final, and stole the show. “Taiwan this is for you,” she said right after show host RuPaul announced her as the winner. “To those who feel like they don’t belong, just remember to live fearlessly and to live their truth,” she said on stage. One of the frontrunners for the past 15 episodes, the 28-year-old breezed through to the final after weeks of showcasing her unique