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NEWS EXTRA: Scott Gottlieb WHO is worried that China is under-reporting SARS BMJ 2003; 326: 1110-a [Full text]

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SARS Epidemic Figure is True in China

Clayman Zhang   (24 May 2003)

Serpins in SARS, that is the difference between China and Europe.

Friedrich Flachsbart   (27 May 2003)

SARS outbreak almost over-A great releif.

Dr.J. Pramanik, M.Shresths,Sunil Sharma,Tanu Pramanik,Rajesh Nepal.   (1 June 2003)

SARS Epidemic Figure is True in China 24 May 2003
Clayman Zhang, MD & PhD North China Coal Medical College Send response to journal: Re: SARS Epidemic Figure is True in China	Dear Dr Scott: I can't agree the main point in your paper. I work in Tangshan City and am a Epidemiologist responsible for SARS epidemic analysis and prediction. Every morning, I must pool the data from collected from about 80 epidemic tracing team, and data from every hospital responsible for receiving fevered suspect patients. There is a effective monitoring system for SARS in our city. SARS in China is not the SARS in USA and UK.Because there lack the PCR or serum method., we largely depend on X-ray,WBC,lymphosite counting and self-reporting syndroms. Epidemic clues is one of the important criteria,too. By the above criteria. more people with classic atypical pnomonia are being suspected with SARS.We compare the "Atypical Pneumonia" in this spring and last spring. in Tangshan, there were about 300 AP in the last two spring, but there are not more than 100 this spring. Could you explain these figures? Competing interests:   None declared
Serpins in SARS, that is the difference between China and Europe. 27 May 2003
Friedrich Flachsbart, General medicine 37085 Göttingen Send response to journal: Re: Serpins in SARS, that is the difference between China and Europe.	Dear Sir, To understand very simple facts of everyday life it is sometimes necessary to go deep into pure science. The fact common cold has to be interpreted by the biochemical theory of SERPINS. Common cold viruses like picorna, corona and influenza use serine proteases as invasive factors. Coinfection by streptococci and staphylococci is aggravated by serine proteases as invasive factors. The inhibition of invasion is done by serine proteases inhibition. Nature invented these inhibitors on large scale more than 650 million years ago. We call them SERPINS, SERin Proteases INhibitors. Serpins are the defense shield against serine proteases. Serpins are the first line of defense, they are the innate immunity response against invasive viruses, microbes and even tumor cells. Serpins are the basis of coagulation, inflammation, sepsis. Serpins are the first response and the last response. If adaptive immunity is evaded and subverted, serpins are doing their job. Sometimes the collateral damage is high in these situations. The thrombotic responses become dangerous in itself. In these moments low dose anticoagulation is necessary. People in cold regions, adapted to common cold, do have a different thrombotic response. People in hot regions are adapted to malaria, they do have sickle cell anaemia and thalasaemia as different response. So we understand, why SARS in China is different from SARS in Europe. These interactions should intensively be looked upon. (The only BMJ paper on SERPINS is one about invasion of cancer cells: H. J. Nielsen et al. : Association between plasma concentrations of plasminogen activator inhibitor-1 and survival in patients with colorectal cancer. BMJ 316(7134):829) Sincerely Yours Friedrich Flachsbart Competing interests:   None declared
SARS outbreak almost over-A great releif. 1 June 2003
Dr.J. Pramanik, Visiting Professor & Academic Co-ordinator, Xinxiang Medical College,Xinxiang City,Henan,P.R.China., M.Shresths,Sunil Sharma,Tanu Pramanik,Rajesh Nepal. Send response to journal: Re: SARS outbreak almost over-A great releif.	SARS outbreak almost over-A great relief. - a short report from China, Nepal & India. J.Pramanik1, M.Shrestha2, Sunil Sharma3,Tanu Pramanik4,Rajesh Nepal.5 Visiting Professor & Academic Co-ordinator, Xinxiang Medical College, P.R.China.1 Visiting faculty ( Public health ) XXMC, P.R.China. 2 Project Director, XXMC, P.R. China. 3 Medical Sociologist, India. 4 Medical Student,XXMC,P.R.China.5 ABSTRACT Among Asian countries, major victim of severe acute respiratory syndrome (SARS) epidemic is P.R.China. Neighbouring countries like Nepal and India, have been reported to be relatively safe till date. Moreover, recent increase of SARS cases in Canada, is a cause of deep concern. The Central Government of China is making strides to contain this dreaded disease with rigorous strategies all over the country under the World Health Organization’s guidelines. Difficulty in explaining the possible links between cases in Beijing, raised criticism. Stringent actions have been taken against Government officials neglecting duties to control spread of SARS. Visiting faculties in Xinxiang Medical College, Henan Province, P.R. China, are appreciating the Chinese Government’s determination and sincere approach to control SARS at an early date. WHO recommended case control tactics to fight SARS, have been reported to be successful . It is a matter of great relief that SARS is coming to an end. ----------------------------------------------------------- Background: SARS outbreak is a global disaster. This epidemic was initially reported from Chongdong in China, Hanoi in Vietnam, Toronto in Canada. WHO alerted whole world about this killer disease in time and prescribed stringent strategies to control its spread. Since past three months rigorous case control measures have been activated all over the world, sacrificing international business transactions, tourism, academic movements, sports etc. International air travels came down to bare minimum. P.R.China is the major victim of this overall tragedy. The Chinese Government is trying maximum to contain this dreaded disease soon. Their health workers and medical professionals are constantly exposed to the high risk of contracting this disease from their patients. However, the case control strategies prescribed by WHO ,are working effectively . The majority of the SARS outbreak around the world are reported to be almost over. Experience in P.R.China mainland:- There are total 31 provinces in P.R. China, out of which 24 are free from SARS till date. Strict case control strategies have been followed in all th provinces including rural areas Since past three weeks, not a single suspected case was found in Henan province. Vigorous community awareness programmes, regular body temperature recording in road side camps, closing down fast food corners on the street sides, spraying disinfectants on the vehicle at all the main traffic points, voluntary health check up camps etc , are continuing with public co-operations. A super-specialty hospital, First teaching hospital in Wei hui near Xinxiang city has been designated for treatment of all SARS cases. Special supervisions and health care have been taken on foreign faculties and foreign medical students here in Xinxiang Medical College. We are receiving regular information about recent developments regarding SARS cases in China Central Television channel-9. Beijing Municipality Government authority is regularly discussing about SARS cases, death reports, case control measures etc in press conferences. Experience from Nepal:- Medical professionals and health care personnel are kept on alert since past three months. Till date no diagnosed case reported in Nepal. Royal airlines flights from Kathmandu to Sanghai, China have been cancelled as a preventive strategy. The last flight was on 25th May’03. Till now Thai airline flights are flying from Sanghai to Kathmandu via Bankok under strict case control measures at different transit airports. Experience from India:- Since past three months total three suspected cases have reported. No death report has been recorded till date .Central Medical Minister alerted all health care community to take necessary preventive care all over the country.Strict preventive screening are done in all the airports. Discussion:- Mr.Mike Ryan, is working as WHO’s coordinator of the global effort to stop the spread of SARS virus. On 17th may’03, he expressed great hope that the measures prescribed to control the spread of SARS, is working and the majority of the SARS outbreak all around the world are coming to an end. He agreed that difficult struggles remain in China mainland, but the epidemic there, although large, is no more complex than the rest of the world, and Chinese Government is making great strides as well.1 Mr. Peter Cordinley, WHO’s spokesman expressed deep concern regarding the unexplained links among the majority of the SARS cases in Beijing during past few months. Several other reports reflected similar worries during past two weeks . 2,3 Concluding remarks: It is an undeclared war going on all over the world. There is relapse of the SARS epidemic in Canada. It is important to trace the unexplained links there as well for future reference and precautionary strategies. However, our experiences in China mainland are not disappointing like others. Most of us are confident that the stringent steps taken by the Chinese Government under WHO guideline will definitely be successful.4 These days any negligence of the heath care officials , has been notified to be a punishable offence.5 We are very much hopeful that this sub-continent will be free from SARS and normal public life will be resumed soon. ----------------------------------------------------------- References:-. 1.WHO say SARS outbreak coming to an end. Yahoo news-17th May’03. .2.China is still not open enough about SARS,Says WHO. -Jane Parry:BMJ 2003;326:1055(17th May’03) 3. WHO is worried that China is under reporting SARS. -Jane Parry BMJ 2003;326:1110 (24th May’03) 4.WHO Scientists say Tactics to fight SARS are working- -N. York times-17th May’03. 5.Central China’s Henan Province punishes 800 officials and others over SARS- Health-AFP news Beijing(24th May’03) --------------------------------------------------------------------- --------------------------------------- Competing interests:   None declared