When the severe acute respiratory syndrome (SARS) appeared in Guangdong Province three months ago, Taiwanese experts did not believe information that it could be cured by chlamydia or tetracycline. Because the contagion broke out in a cold and dry continental winter climate and in unhygienic poultry-feeding conditions, we know SARS is a mutant strain of some kind of winter virus, such as bird flu, paramyxovirus or coronavirus.
According to WHO statistics, 10 percent of those infected will develop serious symptoms. About one half of those will eventually need respiratory treatment and 4 percent will die. The remaining 90 percent will recover after a short period of less serious symptoms.
Globally, we see high proportions of medical personnel among the infected -- 33 percent of those infected in Guangdong, 50 percent in Hong Kong and 66 percent in Canada. Medical personnel also account for most of the SARS deaths.
Tests by the US Centers for Disease Control and Prevention (USCDC) show that SARS is caused by a mutant strain of coronavirus. Its genes differ from the regular coronavirus by 50 percent to 60 percent. It is possibly a new variety of bird flu, a critical pulmonary disease produced by a combination of human and animal coronavirus. The contagion is similar to the paramyxovirus in Respiratory Syncytial Virus (RSV), which affects infants and young children.
Taiwan's disease control is on a par with European and US standards, and much better than China's opacity or the chaos in Hong Kong. One important benchmark for SARS survival is the status of respiratory treatment and equipment rather than anti-viral medication efficiency. Disease control should emphasize protection at medical units and on aircraft. Wearing masks and washing one's hands remains essential.
In addition to a gradual discovery of the make-up of SARS, there have been a few more revelations.
First, SARS is a winter-season respiratory tract virus. If spread through aerosol droplets, there would have been more infections than seen during the last three months. The great concentration among medical personnel is further evidence of the high probability that it is spread through close contact.
Washing one's hands may be even more important than wearing a mask. Since coronavirus is sensitive to ethanol, medical personnel should use ethanol for disinfection. We'll have to wait for warmer weather to see if this mutant strain has preserved the coronavirus' characteristic of becoming less active at 37?C.
Second, past RSV treatment experience has shown the ribavirin antiviral medication to be ineffective. Preliminary comparison has also shown steroids to be ineffective. Appropriate use of respirators is the only way to save lives, which is one possible reason for lower death tolls in Taiwan and the US.
Third, of 40 people infected in the US, only one has required respiratory treatment, which shows their immune systems are resistant to the mutant strain. Improved nutritional intake and immunity and more exercise allows the liver to quickly synthesize immunity proteins (SP-A and SP-D) on the alveoli, leading to the quick recovery from SARS-induced acute or adult respiratory distress syndrome (ARDS).
All medical and disease prevention personnel on the front lines of this battle for disease control are worthy of our respect and admiration, including the Italian World Health Organization expert, Dr. Carlo Urbani, who succumbed to SARS on March 29.
Mayo Kuo is a doctor and an advisor to the Center for Disease Control.
Translated by Perry Svensson
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