Faculty Bibliography

Another participant, Dr. Sylvie van der Werf, a scientist at the Pasteur Institute in Paris who has tested specimens from SARS patients in Vietnam, said that scientists could be expected to develop molecular techniques based on the genetic maps of the SARS virus that would make research to develop blood and other tests easier and safer. Many molecular methods do not require use of the actual virus, which is dangerous and requires nearly the highest level of safety precautions. Scientists still do not know much about the SARS virus. They know that it can be found in sputum, tears, feces, blood and urine. But they do not know whether the form of the virus they now detect can cause disease if it is spread from these materials. About 10 percent of SARS patients develop diarrhea, suggesting that people can become infected by swallowing contaminated food and water, even through sewage. Dr. [Albert Osterhaus] reported that his team inoculated four macaque monkeys with the coronavirus isolated from SARS patients and then noted the appearance of the signs and symptoms of human SARS, like lethargy, a skin rash and severe difficulty breathing. The lungs and tissues of two monkeys euthanized on the fifth and eighth days after onset of symptoms had the same type of damage seen in patients who died of SARS, Dr. Osterhaus said. Blood tests showed that the other two monkeys had SARS

Monkeys experimentally infected with a new coronavirus have developed an illness similar to the mysterious human respiratory disease, SARS, and it is now 99 percent certain that the coronavirus causes the disease, a World Health Organization official said here on Tuesday. Preliminary findings show that the monkeys developed an illness resembling SARS after the coronavirus was put in their nostrils. Some monkeys developed pneumonia and examination of their lungs under a microscope showed that the coronavirus caused a pattern of lung damage similar to that in affected humans. Such findings include the formation of giant cells in the lungs. [David L. Heymann], in addressing U.N. delegates and staff members on Tuesday, expressed hope that new tests aimed at the coronavirus would eventually help contain SARS

While there are anecdotal case studies of individuals behind some outbreaks, there is little concentrated research in the field. 'There hasn't been enough time, thinking and probing' to hazard more than a guess as to why superspreaders are responsible for so much of the spread of SARS, said Dr. Donald Henderson, the epidemiologist who led the global eradication of smallpox. Several SARS patients have infected more than 30 people, according to the World Health Organization. The biggest reported superspreader is an airport worker admitted to Prince of Wales Hospital in Hong Kong in early March. He infected 112 people, including every doctor and nurse who treated him. Secondary infections are thought to be part of the rapid spread of AIDS in Africa. The virus spreads much more rapidly in populations where untreated genital sores are common. Gaetan Dugas, the flight attendant blamed for much of the early spread of AIDS in North America and dubbed Patient Zero in Randy Shilts's book 'And the Band Played On,' would be considered a superspreader like Typhoid Mary because he deliberately infected others

UNITED NATIONS - Monkeys experimentally infected with a new coronavirus have developed an illness similar to SARS, the mysterious human respiratory disease, and it is now almost certain the coronavirus causes the disease, a World Health Organization official said yesterday. Preliminary findings show the monkeys developed an illness resembling SARS after the coronavirus was put in their nostrils. Some monkeys developed pneumonia and examination of their lungs under a microscope showed the coronavirus caused a pattern of lung damage similar to that in affected humans. Such findings include the formation of syncytia, or giant cells, in the lungs. Even if the animal experiments show the coronavirus can infect humans and animals, researchers must still show the coronavirus is the cause of SARS and not another respiratory infection that is occurring by coincidence or as a co-infection with another microbe

Dr. David L. Heymann, executive director in charge of communicable diseases for W.H.O., said the agency ''is 99 percent sure'' that SARS is caused by the new coronavirus based on the monkey experiments in the Netherlands. Experiments on animals are necessary because the lack of an effective treatment for SARS and the relatively high death rate make it unethical to conduct such experiments on humans. The monkey experiments are essential in fulfilling the steps known as Koch's postulates that are needed to establish proof that a virus or other microbe causes a disease. Applying the postulates to SARS, scientists must determine whether injecting the coronavirus into animals causes similar symptoms to those that humans experience. A formal announcement that the likely cause of SARS has been found could come as early as Wednesday. The Chinese government's decision to allow the W.H.O. team to visit military hospitals ''is a welcome indication of China's willingness to come to terms with the SARS outbreak on the mainland,'' the organization stated. On Monday, China's president, Hu Jintao, said on state television that he was ''very worried'' about SARS

The gene maps were computer generated from viruses isolated from SARS cases in Canada and Asia. The maps detail the genetic sequencing of the nucleic acids, or nucleotides, in the virus. The maps generated by scientists at the Centers for Disease Control and Prevention and in Vancouver showed only ''a trivial'' difference in 15 among the 29,727 nucleotides in the coronavirus, Dr. [Julie L. Gerberding] said. Known members of the coronavirus family typically contain from 29,000 to 31,000 nucleotides. Samples of the coronavirus used to generate the gene maps came from patients with SARS, and health officials say a new type of coronavirus remains the leading suspect of the respiratory ailment that has spread around the world. But to prove that this particular coronavirus causes SARS, scientists need also to see if animals that are infected with the virus become ill with the same disease. Officials of the Centers for Disease Control have said that they have isolated the new coronavirus from four suspected SARS cases in this country. Laboratories in the W.H.O. network have also isolated the coronavirus from SARS patients elsewhere. But the scientists have not reported the systematic studies of several laboratories testing the same samples using the same techniques. That will require testing thousands of specimens from SARS patients and healthy individuals for purposes of scientific comparison to prove that the coronavirus causes SARS

Several SARS patients have infected more than 30 people, according to the World Health Organization. The biggest reported superspreader is a 26-year-old airport worker admitted to Prince of Wales Hospital in Hong Kong in early March. He infected 112 people, including every doctor and nurse who treated him. Referring to a well-known study of a cold outbreak at the Eagle Heights Apartments in Madison, Wis., and to an early theory that the outbreak of more than 300 SARS cases in the Amoy Gardens apartment complex in Hong Kong was spread by cockroaches, he said: ''Don't blame the cockroaches. In Wisconsin, it wasn't the cockroaches, it was the kids.'' Whoever put SARS in the Amoy Gardens sewage pipes -- and one regular visitor was a dialysis patient at the Prince of Wales Hospital while the airport worker was on the nebulizer -- would be a superspreader, with the help of rusty pipes

While there are anecdotal case studies of individuals behind some outbreaks, there is little concentrated research in the field. 'There hasn't been enough time, thinking and probing' to hazard more than a guess as to why superspreaders are responsible for so much of the spread of SARS, said Dr. Donald A. Henderson, the epidemiologist who led the global eradication of smallpox. Referring to a well-known study of a cold outbreak at the Eagle Heights Apartments in Madison, Wis., and to an early theory that the outbreak of more than 300 SARS cases in the Amoy Gardens apartment complex in Hong Kong was spread by cockroaches, he said: 'Don't blame the cockroaches. In Wisconsin, it wasn't the cockroaches, it was the kids.' Whoever put SARS in the Amoy Gardens sewage pipes -- and one regular visitor was a dialysis patient at the Prince of Wales Hospital while the airport worker was on the nebulizer -- would be a superspreader, helped by rusty pipes

A longtime patient of mine who suffers from severe asthma came to my office two weeks ago gasping for air. I knew as soon as I put a stethoscope to her hissing chest that I was going to have to admit her to the hospital for several days of intravenous steroids. The doctor in the New York University emergency room suggested -- strangely, I thought -- that I give her oral steroids first. I told him I disagreed. In such a severe case, intravenous delivery was by far the most effective way of calming an inflamed set of spastic lungs. But when I went to see the patient later that day, I found she had received the oral version, and, what was worse, she was still wheezing badly. The nurse explained to me that there was a shortage of methylprednisolone, the IV steroid I had ordered, because of the war in Iraq. Clearly, I needed to find out the extent of the problem. I contacted Dennis Karagannis, associate director in charge of supplies for NYU Medical Center's pharmacy. He explained that many intravenous and emergency medications were already in short supply because the FDA had stepped up regulation of their manufacture two years ago to ensure purity and consistency. At the same time, the market had changed, further contributing to the shortage. Many of the same products had become generic, making them cheaper in any form. A 125 mg vial of the IV steroid, which had sold for $6 a vial 10 years ago, was now only $2 a vial. The increased pressure on this shrinking supply suddenly worsened several months ago as the military began stockpiling medications for the upcoming war, Karagannis said. 'The companies ship right to the government,' he explained. 'We have to wait for the next production load. Right now several supplies are on back order or allocation, where you only receive your current monthly usage.' It turns out that steroids, lidocaine (a pain medication), morphine, atropine (a nerve blocker), dextrose (a sugar solution), sodium bicarbonate and some injectable antibiotics are among the drugs now in short supply

Students who have been exposed to SARS and who do not have fever, cough, sneezing or other respiratory symptoms should be allowed to attend school, but should be vigilant for onset of symptoms of SARS, the federal health agency said. The reason for not excluding such students from school is that, so far, SARS has not been transmitted from affected individuals to other people through casual contact in schools or public gatherings in the United States