SARS (Severe Acute Respiratory Syndrome)

The number of the prevalence and deaths has settled down gradually in the world and even in Beijing in China. And WHO announced "The SARS epidemic has been stamped outin July 5.", but next prevalence in winter should be cautious.
The SARS, Severe Acute Respiratory Syndrome which is spread from HongKong, GuangDong and Hanoi Vietnam is reporting recently. Many countries have been taking measures to meet this serious situation, and Japanese Government finally started to take measures to cope with SARS according to the reports from WHO (Cumulative Number of Reported Probable SARS cases) and CDC. But they are just putting up posters at the airport and stations etc, and urging people not to go these endemic areas. In spite of various measures of many countries especially in Asia, the number of both the infected people and the deaths has been increasing every day. Recently Chinese Government revised the number of the infection including death after the criticism that China may have lied the number of the infection.
Five cases including suspected cases was reported in Japanin 2003, but 3 of these cases were excluded by examination and following by April 22 (they were bronchitis), but all cases were not SARS cases. Japanese Government does not announce the detail, but it is important to show detail information to people from epidemiological point of view and disease prevention. Japanese Government (Ministry of Health, Labour and Welfare) may think it the best way to hide complex information to protect or control ignorant people from a disaster, and it is almost same as the policy to the AIDS problem in Japan (Japanese Government and some doctors hid the possibility about the AIDS infection through the blood products and they permitted the company to use them).

1. The outline of SARS
In Japan, Ebola haemorrhagic fever, Lassa fever and the plague etc are classified to the class 1 infectious disease by Japanese law for the infectious diseases, and SARS has been classified to the class 1 infectious disease, too. The CDC, Atlanta Georgia USA, expressed that new SARS virus, which belongs to the coronavirus group, is the cause of SARS being prevalent in Asian countries. The size of coronavirus is 80-150 nm and it has the process like solar corona on its surface, so it is called coronavirus. The coronavirus is widely seen in the natural world and it causes common cold and respiratory diseases to human beings and animals. One third of the cause of general common cold is this coronavirus. (photo: an electron microscope image)

2. Symptoms
The first symptom of SARS virus infection is fever of 38 and a patient shows the symptoms similar to the influenza such as headache, general maliase and muscle pain etc. The patient will complain of cough (dry cough rather than wet cough) and dyspnea within 2 -7 days. The incubation period is 7 - 10 days, so we should be cautious for at least a week after the contact to an infected person. The aged people and the infants have to pay much attention not to contact the SARS patients and not to go to the area where SARS is prevalent, and it is same as the influenza infection. Generally, no finding is recognized in Chest X-ray film at the beginning, and soon (within 2 - 7 days) the consolidation in the chest X-ray film is seen by rapid progress. By CT (Computed Tomography), uniform consolidation like ground-glass appearance is seen, but this finding is not specific to SARS.

Image : Chest X-ray film from Prince of Wales Hospital in HongKong ( http://www.droid.cuhk.edu.hk/ )

The coronavirus is known as a cause of common cold, and it sometimes causes acute enteritis. In Japan, the outbreak of acute enteritis by coronavirus were recognized in Mie Prefecture in Feb 1997 - May 1998. The symptoms were abdominal pain, fever and severe watery diarrhea, and no severe symptom of nausea and vomiting then.

3. The route of Infection
The droplet infection by cough and snezing of an infected person nearby like influenza is thought to be the main route of infection. On the other hand, contagion through door knobs, stationeries and public transportation etc is strongly suspected as an important route of infection (similar to other viral infection such as Rota and Adenovirus etc). By some reports, there is a tendency that persons who had been working near the patients (family and nursing staff etc) and who had no precautionary measures such as masks have been infected.

4. Therapy
There is no effective drug nor measure yet. Therefore, you should take precautionary measures such as taking a mask and washing hands etc, and of course the best way is not to go to the prevalent area. Recently, there is an information though it is uncertain that a kind of medicine used for treatment to hepatitis-C with the interferon(IFN) injection may be effective, because it is an antiviral agent. But it is not approved yet in Japan.

5. Cumulative Number of Reported Probable SARS Cases
WHO shows up-to-date cumulative number of reported probable SARS cases with various information in web site. Please check them.

6. Report in Japan (National Institute of Infectious Diseases)
Forty cases were suspected but 39 cases were already denied by the national committee in April 21 and another case is now improving. There were 16 probale cases in April 19 but 14 cases were already excluded by the committee, and other 2 cases have been improving now. But there is no definite evidence to neglect these 2 cases from SARS, so they are now under observation. There is no certain SARS case in Japan at the present, and WHO showed 1 probable case in June 25. But no case is shown in WHO web site about cumulative number of reported probable SARS cases now.

This is my personal opinion but we cannot trust Japanese government because they often betrayed people. Japanese bureaucrats always think everything not for people but for themselveseven about the national policy.

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