Health Ministry: SARS plan flexible

The real test of the Health Ministry’s response to Severe Acute Respiratory Syndrome (SARS) will be when the plan is executed and where necessary changes will be made.

“We will need to look at the response on the field, and try and put things in place to anticipate a situation. We have to be flexible,” Ag Principal Medical Officer, Epidemiology Dr Ian Popplewell said in a telephone interview last week. To date, SARS has killed 180 people and infected 3,461 others. Last Saturday alone 12 people died in Hong Kong, the largest number of deaths in a single day. Popplewell chaired a meeting last Wednesday to go through the entire response plan and the different levels of preparedness, with Ministry of Health and RHA officials, Accident and Emergency, Infection Control and National Surveillance Unit staff. Officials from the Airports Authority and Port Authority were also in attendance.

Popplewell said the “drug of choice” for early treatment of SARS is Panadol. Aspirin can cause a drop in platelet count. What is used after depends largely on the condition of the patient. As there is no rapid test to diagnose SARS, Popplewell said testing will be based on a process of elimination of all other probable causes of illness—pneumonia and atypical pneumonia. Medical and travel history will also be taken into consideration in diagnosis. The Health Ministry’s plan is targeting arriving passengers, so emphasis is on ports of entry. 

Persons arriving at Piarco International Airport will be expected to complete Health Declaration Forms (HDF) while Port Health Officers (PHO) in the course of doing their health status reports will be vigilant for workers and travellers arriving via sea. Due to the large travel population on cruise ships, Popplewell said PHOs will require a great deal of assistance from doctors on board in completing the HDFs. He said the plan at present is flexible, and recommendations for changes can be made. “It is simply a plan in the event of anything happening.” Samples of probable SARS cases will be sent to the US Centres for Disease Control as there is yet no test available locally or anywhere else in the world for SARS.

Dr Eldonna Boisson of the Caribbean Epidemiology Centre (CAREC) said global labs are working towards developing a diagnostic test which could be disseminated. She said they have been working on three tests simultaneously. Two of them took too long (10-20 days) to give a positive indication for SARS. While the third test gave many “false negative” results. Doctors and scientists have been relying on clinical symptoms and travel history to differentiate SARS cases from other diseases. “Differential diagnosis” (testing for other diseases like Leptospirosis, Influenza) is also being used to distinguish SARS. “All the cases around the world are probable cases,” Boisson said. She said to date no samples have been sent to CAREC.

The main symptoms of SARS are: high fever (38 degrees Celsius), one or more respiratory symptoms including a cough, shortness of breath, difficulty breathing; close contact with a person diagnosed with SARS (close contact means having cared for, having lived with or having had direct contact with respiratory secretions and body fluids of a person with SARS); and recent history of travel to areas reporting cases of SARS.