SARS hits Orange County -- should we worry?

NATURAL PERSPECTIVES

We were sick last week, and we don’t mean our sense of humor. We both

came down with a cold-type virus that is making its way around town.

Vic came home from a meeting and reported that everyone there,

including him, was coughing. Friends say that many of their

co-workers have a sore throat, a cough and no voice. Some people are

jokingly speculating that we coughers have severe acute respiratory

syndrome -- the new worldwide virus know as SARS. But that’s pretty

unlikely.

As of Monday, only four people out of the nearly 3 million who

live in Orange County were suspected of having SARS, and they had

just returned from China. So far, all of the 148 suspected cases in

the U.S. are people who have traveled to one of the areas where SARS

is spreading locally such as China, Hong Kong, Singapore, Taiwan,

Vietnam or Canada.

SARS is now in 19 countries and on four continents. Some experts

believe that the virus spreads by direct contact and possibly even by

contacting surfaces that an infected person may have touched a short

time earlier. Modern transportation makes it possible for new

diseases such as SARS to spread globally in a short time. Given the

large amount of travel between Orange County and Asia, the spread of

SARS to our area was probably inevitable.

So far, SARS is still extremely rare. According to the World

Health Organization, there were 2,750 cases and 103 deaths worldwide.

Unfortunately, those numbers are climbing every day. A mere three

weeks earlier, there had been only 264 cases worldwide, with nine

deaths. Despite intense efforts to contain the disease, the number of

cases increased ten-fold in only three weeks.

Vic and I attended a meeting of the American Medical Writers Assn.

in Monterey in mid-March, where we presented a workshop on West Nile

fever and other health effects of global warming. There was plenty of

talk at the conference about SARS, which, like West Nile fever, is an

emerging disease.

Researchers believe that SARS is caused by a newly discovered

coronavirus, which is in a family of viruses that cause the common

cold. The big difference is that SARS is far more deadly than the

common cold. The mortality rate, roughly 3.7%, is slightly higher

than was seen with the influenza virus that caused a devastating

pandemic of 1918. SARS can be deadly, it’s spreading rapidly, and

there’s no treatment. That’s what has people worried.

After a week at our conference discussing scary topics such as the

emergence of SARS and other deadly infections, Vic and I were mildly

concerned when we both developed a cough a few days after the

conference. Some of the conference attendees were from Toronto, where

SARS is spreading locally. We had been in close contact with them

during the conference. To set our minds at ease, we logged onto the

Center for Disease Control and Prevention and World Health

Organization Web sites to learn more. Don’t worry, we definitely

don’t have SARS.

Although both SARS and flu are associated with a cough, achy

muscles, and respiratory symptoms, the main diagnostic clue is that

people with SARS have a temperature over 100.4 degrees. We ran a

low-grade fever, under 100 degrees, which is more typical for a

garden variety cold.

The other big difference is that there are signs of pneumonia with

SARS. Patients with SARS quickly progress to “respiratory compromise”

according to an article from China that was published recently in the

New England Journal of Medicine. There are diagnostic laboratory

findings as well. A Canadian study published in the same journal

reported that X-rays show fluid on the lungs in all SARS patients.

Basically, SARS patients have pneumonia with a high fever.

Currently, in order to make a diagnosis of SARS in the U.S.,

doctors ask patients about recent travel to places where SARS is

spreading locally. If a patient hasn’t been to one of those locations

or had close contact with someone who has, the doctor is unlikely to

make a diagnosis of SARS. Doctors may have to modify that diagnostic

criterion as SARS spreads more broadly.

Three diagnostic laboratory tests are now available, but all have

disadvantages. One test is valid only 20 days after the patient has

been infected, too late to identify patients at the beginning of an

outbreak. Another test is valid at 10 days, but it is a relatively

slow test that requires growing the virus in culture. The third test

is fairly rapid, but is unreliable and gives many false negatives,

which means that people who have SARS aren’t identified. Doctors

still have a long way to go before they will have good diagnostic

tools that can help identify victims at an early stage.

At press time, there have been no deaths from SARS in the U.S.

SARS is nothing to sneeze at, but in terms of total number of deaths,

far more people are dying of the effects of air pollution than from

SARS. Air pollution can weaken the respiratory and cardiovascular

systems and cause premature death. Perhaps instead of panicking about

SARS, we should be more concerned about the very real dangers that

are already here and work harder to clean up our air.

* VIC LEIPZIG and LOU MURRAY are Huntington Beach residents and

environmentalists. They can be reached at [email protected].