Newsstand - First SARS case in New Zealand

http://xtramsn.co.nz/news/0,,3882-2325325,00.html

First SARS Case In NZ Confirmed
29/04/2003 07:38 PM
IRN

The first confirmed case of SARS in New Zealand is to be reported to the World Health Organisation.

A Hawke's Bay woman's condition fits the international criteria for Severe Acute Respiratory Syndrome.

NZ has its first confirmed SARS case, a patient in the Hawkes Bay region.

But Public Health Director, Colin Tukuitonga, says the announcement should not cause alarm.

He says the way the case has been handled means the risk to other people is minimal.

The woman had been part of a tour to China.

Dr Tukuitonga says she knew enough about SARS to stay away from other people upon her return to New Zealand.

i don't see this in the worldwide list of probably sars, so either it will show up on the list tomorrow, or it is only possible sars, not probable.

Well, it didn't make any other headlines, so let's hope that it was all a mistake.

<font face="Verdana, Arial, Helvetica, sans-serif" size="2">Originally posted by Spider:
First SARS Case In NZ Confirmed
29/04/2003 07:38 PM
IRN

The first confirmed case of SARS in New Zealand is to be reported to the World Health Organisation. A Hawke's Bay woman's condition fits the international criteria for Severe Acute Respiratory Syndrome.</font>

Do you see how dangerous the media is without some ethical journalistic regulation. Can anyone see the contradiction in article from the first couple of lines?

"Confirmed" and "fits the criteria". Therefore it is not confirmed and either "suspected" or "probable" (In case you are wondering "probable" means the onset ot pnemonia whether atypical or typical). There also exists NO diagnostic test, so how can they be "confirmed"?

So the headline to SCARE is "confirmed". This screws up the economies to those who read it. We in BOS are having a serious problem with the media, however they are taking a bashing from viewers and an "ethics squad" these past days, therefore changing their rhetoric from "confirmed" to "suspected" and "probable".

It's good for near illegal media to tell the truth and serve public interest. But sometimes the line gets crossed at the wrong time for money (selling papers, advertisers, scaring readers to stay on, because there is really not much interesting news out there).

Someone give me Clark Kent!

<font face="Verdana, Arial, Helvetica, sans-serif" size="2">Originally posted by SHADO:
There also exists NO diagnostic test
</font>

If that were the case, how do you think doctors are classifying patients according to probable, suspected, etc? Random assignment? Educate yourself.

Did you know a diagnostic test exists to detect for SARS antibodies? It's not fullproof, and is under evaluation, but it is nevertheless a diagnostic laboratory test being used en masse. Did you know that doctors often take Xrays to check for pneumonia before classifying a case as probable SARS? It's not fullproof, but it is part of a diagnostic test, that works with some consistency when other factors are considered as well (fever over 100.4, contact with SARS victim or area, etc..)

http://www.cdc.gov/mmwr/preview/mmwrhtml/figures/m2d429a1b.gif

Anyway I still don't see New Zealand on the list of countries with probable SARS cases. So this guy was probably just suspect for now.

New Zealand just got its first listing today for a probable SARS case. I'm guessing the same person got bumped up from suspected to probable.

I heard from a NZ friend today that local radio stations were saying that the suspected SARS case turned out to be a false alarm. Has anyone else heard anything similar?

It's kind of strange. You look at the May 1 chart, nothing for NZ. Then you look at May 2, it shows 1 new case, and 1 recovery. So maybe the person got SARS and instantly recovered, or they screwed up tabulating it somehow?

http://www.who.int/csr/sarscountry/2003_05_02/en/

<font face="Verdana, Arial, Helvetica, sans-serif" size="2">Originally posted by benoit:
If that were the case, how do you think doctors are classifying patients according to probable, suspected, etc? Random assignment? Educate yourself. Did you know a diagnostic test exists to detect for SARS antibodies? It's not fullproof, and is under evaluation, but it is nevertheless a diagnostic laboratory test being used en masse.</font>

So your test case of a "diagnostic case" is recording those currently mentioned as today's results? Educate yourself away from the speculation and prove me wrong. The word is *prove* which you cannot do.

The only tests that are working are on the dead and samples of their tissue. Sorry to inform you of the facts, which is why your version of the events is leaving everyone without answers.

SHADO

does this prove you wrong? http://www.flyertalk.com/forum/smile.gif Notice they are talking about SARS diagnostic tests, the ones you said did not exist at all? Oh well. Now you know.

The Centers for Disease Control and Prevention has added laboratory criteria for evidence of infection with the SARS-associated coronavirus (SARS-CoV) to its interim surveillance case definition. CDC Director Dr. Julie L. Gerberding announced a new category, laboratory-confirmed, at a Senate committee hearing on SARS on Tuesday.

A total of 274 cases of SARS have been reported in the United States; 222 are suspect cases and 52 are probable. Of the 52 probable SARS cases reported as of April 29, 2003, 6 are laboratory-confirmed using the new laboratory criteria. Twelve cases are considered probable, but are not laboratory-confirmed, either because the laboratory tests are not sensitive enough to pick up the SARS virus or because the illness was not caused by SARS virus. Laboratory results are undetermined for the remaining 34 probable cases; for some, testing is in progress and for others suitable specimens are not available for testing.

Using the new laboratory criteria, a SARS case is laboratory-confirmed if one of the following is met:

* detection of antibody to SARS-CoV by indirect fluorescent antibody (IFA) or enzyme-linked immunosorbent assay (ELISA)
* isolation of SARS-CoV in tissue culture
* detection of SARS-CoV RNA by reverse transcriptase-polymerase chain reaction (RT-PCR), which must be confirmed by a second PCR test

I think Shado's point is that there exists no diagnostic test which maps 1:1 (or even close to that) with the so-called "SASR infected" population. The test in N America (reported by the Head of Microbiology in Toronto) only showed positive in 40% of cases where "SARS" hasd been diagnosed, and, moreover, showed positive in 15% of the general population.

The argument that the test wasn't sensitive enough to find the virus in the other 60% of cases doesn't wash because a more sensitive test would presumably find it in a much higher proportion of the general population as well. If this were the case then this virus is already endemic and there is no point in doing anything about it except getting on with our lifes.

[This message has been edited by christep (edited 05-03-2003).]

He explicitly said there was no diagnostic test, period. Read above.

The laboratory test you mentioned is not the only diagnostic test. There is also the primary diagnostic test involving radiologic evidence for pneumonia, which gives better accuracy than 40%, when combined with other parts of the test (fever, travel history evidence, etc..). This is the test that has been used as the basis for the "probable" classification recently. Just because it is not a "laboratory test", does not mean it is not a "diagnostic test". It is.

Also now they are newly doing PCR testing, not just antibody. So we will see how accurate the new lab tests are.

<font face="Verdana, Arial, Helvetica, sans-serif" size="2">Originally posted by benoit:
Also now they are newly doing PCR testing, not just antibody. So we will see how accurate the new lab tests are.</font>

This summarises the problem for me. You are defining the accuracy of the test by whether it gives you the answer you want. The answer you want seems to be to define as many SARS cases as possible.

How can you judge the accuracy of a test when you have no fixed definition of what it is you are testing for? You're in a circular logic.