SARS update – validation of coronavirus hypothesis
Scientists say SARS virus identified
They also said they had developed a diagnostic test that will allow doctors to tell within eight hours whether someone has the disease, according to Reuters.
The microbiologists from the University of Hong Kong said a new strain from the family of coronaviruses, which are the second-leading cause of colds in humans, was to blame.
Now the search for treatment continues. As the number of known cases increases, we will better understand the epidemiology. Having a diagnostic test will allow us to understand transmission. We should start to better gauge risk. This remains a frightening to me. A common cold virus becoming a serious pathogen will challenge our health care delivery system.
Moynihan
This blog will remain 99% medicine. However, I must comment on Daniel Patrick Moynihan.
I generally vote Republican. My political philosophy is best described as Libertarian domestically and neo-conservative internationally. (see Robert Prather to better understand this – Neocons Vs. Paleocons.
Regardless of ones political inclinations, Daniel Patrick Moynihan should represent the ideal in politics. He based his stands on principle and intelligence. Even when one disagreed with him, one had to reconsider ones own position, because he was so damn smart. Read this outstanding tribute from George Will – A Beautiful Mind. Oh, but that we could have the Congress full of his like!
Daily SARS update
China Raises Tally of Cases and Deaths in Mystery Illness
Officials in Guangdong Province, the center of China’s epidemic, reported an estimated 792 cases and 31 deaths as of the end of February, a rise from the 305 cases and five deaths they had previously reported.
The new tallies mean that China now probably has had more cases and deaths than any other country, although the latest estimates have not been officially approved by China’s Ministry of Health or reviewed by international health officials. About 500 cases have been reported elsewhere in the world.
The new figures are being released just days after a World Health Organization team arrived in China to help investigate this country’s epidemic of the mystery pneumonia, which goes by the name SARS, for severe acute respiratory syndrome.
For months, Chinese officials tried to hide the problem, health experts said, and in recent weeks world health officials have applied increasing pressure on China to improve its cooperation and statistical reporting on the disease.
While all other countries that have experienced cases of the new pneumonia, including Vietnam, Singapore and Canada, send daily updates of cases and deaths to the World Health Organization, China has been consistently unwilling or unable to provide such information.
Even today’s newly revised estimates, which officials of the World Health Organization praised as a “great step forward,” cover only cases through the end of February and provide no information about cases in the past four weeks. The previous tallies covered only cases reported up to Feb. 10.
“We want to keep the spotlight on folks here and to encourage them to be part of the solution,” said Dr. Rob Breiman, of the International Center of Diarrheal Disease Research Bangladesh, who is a member of the W.H.O. team currently in China. “We want to use the incredible amount of information they have collected here to help solve the problem.”
Meanwhile, I can find no new news on the virology. I am still intrigued by the two virus hypothesis (see yesterday’s rant and a similar Medpundit rant today).
On the containment front today’s Wall Street Journal Online (subscription required) has an article on the Singapore response to SARS. While some might consider them draconian, one can easily argue that such measures are needed to control a potential disaster.
Singapore, on the other hand, has been both transparent and proactive in fighting the spread of SARS. Although there have only been 69 cases and one fatality in the city state, much fewer than Hong Kong, it has taken several decisive steps. The government closed all schools and designated the Tan Tock Seng Hospital to handle all cases and closed it to other admissions. It has also forcibly quarantined 841 people who had exposure to the victims; those under a quarantine order can’t leave their apartments for 10 days under penalty of a $2,832 fine.
Hong Kong appears to now be emulating this approach. HK orders mystery virus quarantine.
Finally, at least one editorial recognizes that the US public health system has acted aggressively and appropriately in anticipation of a possible outbreak in the US. SARS and public health preparedness
The SARS outbreak has shown how much public health preparedness has changed for the better since the anthrax attacks of 2001. However, many improvements should be made. The next disease to emerge could be aimed at the United States, and might not be natural in origin.
Insurance companies do stupid things
Alice, the author of Feet First, frequently provides insightful comments here. She wrote one such comment yesterday, and I noticed she had a blog. So I clicked and found this story – Now I’m Really Mad. Please read the entire story – this excerpt will only give a slight taste of the entire meal.
I called up Medco to make my case for continuing to maintain the patient on 300 mg. During my conversation with the pharmacist, I told them how ridiculous I thought this was and that I had never seen such a request before. “Is it really worth it to do this?” I asked. “How much money can they possibly be saving?”
The pharmacist stated that he didn’t know, but that the company must be saving a significant amount of money or they wouldn’t have begun this protocol.
Later that day, to satisfy my curiosity, I called the pharmacy downstairs from me and asked for a price quote on a month’s supply of ranitidine, both for 150 mg and for 300 mg.
Thirty 150 mg tablets cost $13.
Thirty 300 mg tablets cost $15.
Let’s do the math here, folks. That’s two dollars a month.
The rant goes on and one quickly shares her frustration. I have added her blog to my medical blog list (she writes both about medicine, as well as anything else she cares to consider). Nice work Alice!!!
Not enough time
This blog has several recurring themes. One concerns paying generalists enough money to allow them to provide excellent care. This issue has more complexity than one might first assume. Some would argue that generalists make a good living – why are they complaining? When I talk to practicing generalists, they bemoan the time that they can designate to each patient. Financial considerations drive visit volume. Financial considerations continue to decrease the supply of new generalists. Thus, we have generalists retiring and retreading; we have a decreasing supply; and is yesterday’s rant on Medicare suggest, we have increasing demand for services. We also should do more at each visit – improving medical care options require more time. A specific example is preventive care. Prevention is like motherhood and apple pie, everyone is in favor of prevention. Why do we do such a mediocre job? Time!!!! Not Enough Time for Primary Prevention
For an average-size practice, performing all the recommended preventive services would take about 7.4 hours per day, according to a report in the current issue of Research and Practice, dated February.
“Currently recommended preventive services for the US population require an unreasonable amount of physician time,” write Kimberly S. H. Yarnall, MD, and colleagues from the Duke University Medical Center in Durham, North Carolina. “The magnitude of the problem is likely to increase as new genetic tests become available.”
Using published and estimated times needed to provide services recommended by the U.S. Preventive Services Task Force (USPSTF), the authors determined that it would take 1,773 hours per physician per year, or 7.4 hours per working day, to provide these services at the recommended frequency to a population of 2,500 patients.
Changing the age distribution of the patient population would not significantly change the time requirement, which was 0.61 hour per year per child and 0.66 hour per year per adult. Performing only services with A recommendations from the USPSTF would take approximately two hours per day, or about 25% of patient care time.
We all really no this (the we being physicians). This study confirms this important concept. We must continue to push this point. One advantage of retainer medicine is the time it allows one to practice ’state-of-the-art’ care. Such care does cost more than we currently pay. Explain why it is not worth the extra money.
