THIS ELUSIVE DISEASE

PUBLISHED : Wednesday, 07 May, 2003, 12:00am
UPDATED : Wednesday, 07 May, 2003, 12:00am

I commend the South China Morning Post for its timely report on May 1 about a five-year-old Hong Kong Nepalese boy, who died of a Sars-like illness a week earlier.


The doctor in charge of the boy's case asked the father for permission to change the wording of the death certificate because the illness was not caused by the new Sars coronavirus, but by an agent that could not be identified.


This incident has highlighted two important questions. The first concerns terminology - and the name Sars (severe acute respiratory syndrome), which has been given to this new and highly contagious disease.


So far, we know that Sars is a type of atypical pneumonia, caused by the new coronavirus, which may take some time to identify in the laboratory (in some cases, its presence cannot be confirmed).


Thus, in the early stage of a case of suspected Sars, with the symptoms of a very severe acute respiratory disease (which the boy did have), should the medical staff inform the patient or his or her family that the patient has 'suspected Sars' or 'suspected atypical pneumonia' (or simply 'atypical pneumonia')?


The exact classification of the disease could have scientific importance, but it could also lead to confusion. Could we just name this atypical pneumonia according to the causative pathogen(s), e.g. 'coronavirus atypical pneumonia'?


Perhaps we can leave it to the World Health Organisation (WHO) to reconsider the appropriateness of the name 'Sars' when we know more about the disease and the agents causing it.


The second question has more importance in public health and infectious-disease control.


It is known that the boy suffered from a Sars-like illness. The causative agent could not be identified and extensive tests had shown no sign of the Sars virus.


Given that the boy had a history of a weak immune system, the severity of the disease shown in him could be an isolated case. But as a precaution, let's think otherwise: could this be another very severe form of atypical pneumonia, caused by a completely new agent? If this is possible, we should try to identify it, its source, its possible route(s) of transmission and portals of entry into our body.


Also, I draw the attention of the Department of Health and the Hospital Authority to a mystery illness reported in the South China Morning Post in March. The mystery illness that included fever and dizziness had claimed at least 27 lives in Nepal within two months of it being detected ('Mystery bug kills 27', March 18).


I do not intend to imply that there is a connection between this illness and the Hong Kong boy's condition. Rather, it is because the fight against Sars has taught us that the saying 'prevention is better than cure' is no longer a cliche (especially when there is no known cure for the disease), and that timely and accurate information and speedy preventive measures are all significant.


Could the health authorities try to obtain more information about this illness from the Nepalese government? Or could the WHO enlighten us on this matter?


Lastly, I wish to express my deepest sympathy to Mr Lakandri (father of the five-year-old boy) and his family.


VICKY WONG


Tuen Mun


A SHAKY PROPOSITION


I refer to the letter headlined 'Join forces on Sars' (May 3). It says, 'From what I've heard, it seems to be highly possible that most of the latest deaths in Hong Kong were due to drug overdoses rather than the virus itself'.


The author failed to say where he/she heard this, nor give the least information or statistics supporting the possibility of an overdose being the main cause of death.


However, based on these unfounded propositions, the author proposed public inquiries, which Hong Kong must have had more than its fair share of and which cost public money.


I do not claim to know how many pills a Sars patient may take daily. Neither can I define 'overdose' in each specific Sars case. But I do know that it is naive to expect every patient of a life-threatening illness to fully recover despite all the dedication and expertise of doctors and nurses.


I am sure every step of the Sars treatment is taken with utmost meticulousness, not only because the death toll has the attention of the world but because we are charting new viruses.


Treating patients around the clock while immersing themselves in the 'hot zones', the least our medical workers need now is a whimsical suggestion from people who are eager to jump on the bandwagon or settle old scores.


At extraordinary moments, we need people who can make extraordinary judgments in a short time. We should bear in mind that in making these decisions, our medical staff must have balanced the pros and cons with the best knowledge they had about Sars.


When there is a health-care crisis, everyone on the street seems to become an expert, but we should not allow homespun knowledge and opinion to shove our medical workers into defensive treatments.


JONATHAN MAN


Kowloon


ENTREPRENEUR'S BURDEN


One of the measures the government implemented as a response to the Sars outbreak is a maximum $3,000 salaries tax reduction.


The most prominent group to benefit from this are civil servants, teachers and other employees who have a well-cemented job with a high fixed salary.


On the other hand, there are many sole proprietors who do not pay salaries tax but the15 per cent standard profits tax. Most of these entrepreneurs are probably suffering a significant loss.


My wife is a secondary school teacher, while I manage my small educational centre as a sole proprietor. She has a stable job and will benefit from this salaries tax refund. I will suffer a loss because the parents of some children do not allow their kids to come to my tutorial lessons.


I also pay tax but will not get any support from the government. This problem is just the tip of the iceberg. The progressive rates of salaries tax and the $108,000 basic allowance, which is available only to individuals who earn income chargeable to salaries tax, are examples of financial discrimination.


For example, an employee who earns $213,000 a year pays a maximum $7,350 salaries tax if no further allowance is available. A sole proprietor pays $31,950 from the same income.


And now the employee gets back $3,000. Very clever.


Instead of reducing salaries tax for those who do not really need it, why not spend the money to combat Sars?


ZOLTAN GREGOR


Mongkok


MORE SOAP


I refer to the letter on toilet facilities at Pokfulam Country Park ('No soap', April 28).


Measures have been taken to step up the cleaning of country parks in view of the increasing number of visitors.


Our staff have also been reminded to check the dispensers for liquid soap in toilets daily and refill them whenever necessary. Six special work teams have been formed to provide additional cleaning services in country parks on Saturdays, Sundays and public holidays.


Desludging of mobile toilets at some popular country parks has also been stepped up on weekends.


LEUNG CHI-FONG


for Director of Agriculture, Fisheries and Conservation