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SARS CoV Symptoms in Fatal Taiwan Cluster

Recombinomics Commentary
May 25, 2005

>>  The Chinese-language China Times reported that a businessman who had recently returned from China was suspected to have died from Severe Acute Respiratory Syndrome and one of his sons had since been hospitalised with similar symptoms.

"We officially deny the reports. We have many people travelling between Taiwan and China every day and some of them came back with fever," Chou Chih-hao, Department of Health spokesman, said by telephone.

The department of health said the man, who died on Saturday, had probably succumbed to pneumonia and that while his son was also likely suffering from the illness, his condition had already improved.

"But no-one had tested positive for SARS and we think the chances of re-emergence of SARS are extremely small," Chou said. <<

More information on SARS testing would be useful.  Although the official commentary indicated no one had tested positive for SARS, there was no mention of anyone testing negative for SARS.  Moreover, there was no etiological agent described for the pneumonia, which was common in fatal SARS cases.

The death of the father and survival of his son is consistent with case fatality data for SARS in 2003.  The case fatality rate was markedly higher for older patients, or those with underlying medical conditions, than younger patients.

The case fatality rate for SARS in 2003 was high, and the reported cases in 2004 were fewer and milder.  The sequence data for 2004 isolates indicated the coronavirus had recombined into a milder form.  Thses isolates were from humans, civets, and other animals, showing that SARS CoV was still circulating in Guangdong, but as a milder form.

Like bird flu, coronaviruses recombine frequently.  The newly discovered isolates, NL63 and HKU-1 like viruses are coronavirus class  1 and class 2 recombinants, and include SARS CoV sequences as well as sequences from other coronaviruses. 

Additional evolution and recombination in SARS CoV is likely, as is re-emergence as a deadly human pathogen.

Taiwan's record on SARS CoV is less than ideal.  In 2003 there were two waves of outbreaks.  The second wave was more deadly and widespread and traced back to recombinants from Amoy Gardens.  The case fatality rate in Taiwan was very high.  In many cases patients were cremated before samples could be collected for confirmatory tests. 

Taiwan created a new category for these patients, who were said to have had SARS-like disease.  However, analysis of the data showed that the case fatality rate for the SARS-like patients was actually higher than the case fatality rate for the SARS confirmed cases.

There have been rumors of 2005 SARS cases in China and Hong Kong.  The denials in Taiwan, without more data on the number of SARS tests on the father, son, and China contacts, will do little to quell the rumors.

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