Huge dose of steroids may help cure SARS

Sari P. Setiogi, The Jakarta Post, Jakarta

A Hong Kong research scientist asserted here on Friday that large doses of steroids could help patients recover from Severe Acute Respiratory Syndrome (SARS).

With no clear answers to questions on the lifecycle of the coronavirus that causes it -- let alone its precise cure -- the steroid treatment offers hope to countries at risk for any new outbreak of the dangerous pneumonia-like ailment.

The steroid treatment has proven successful in Hong Kong, notably at Queen Elizabeth Hospital and Queen Mary Hospital where SARS patients were treated during the first outbreak early this year.

SARS burst onto the scene late in 2002 and quickly became the world's number one health concern, as it rapidly killed more than 800 people globally, mostly in China and several surrounding areas.

The idea of giving this treatment stemmed from the fact that the steroids are responsible for maintaining many vital bodily functions and that SARS weakens the victim's physical ability to naturally combat the spread within the body.

However, the steroid treatment was only given when the patient's condition deteriorated markedly, Kenneth W.T. Tsang, associate professor at the Respiratory and Critical Care Medicine of the Faculty of Medicine, University of Hong Kong, told The Jakarta Post on Friday.

"We did not give (patients) steroids or other treatment until their conditions deteriorated. We kept giving them antibiotics until they reached a really low point of deterioration because we could never be sure whether they were infected by SARS in the first place," said Tsang.

Tsang was the physician in charge at both of the aforementioned hospitals in Hong Kong during the SARS outbreak. He was in Jakarta to attend the International Meeting of Respiratory Care Indonesia 2003 (Respina) from Sept. 18 to Sept. 20.

There were cases where patients showed a slight improvement, but most patients showed signs of deterioration within the first seven to 10 days after the symptoms set in, said Tsang.

"We gave high doses of steroids to each patient for three to five days, because we have learned that when we gave the steroids for just one or two days, it (the disease) would recur with worsening effects than the initial attack."

Recurring attacks proved to be very hard to treat and required higher doses of steroids and immunoglobulin with no guarantee that they would recover, said Tsang.

However, the response to steroid treatment varied among patients, with results ranging from good to fair and poor.

"In fact, SARS is a very highly individualized disease, everyone responds differently in terms of severity, acuteness and how quickly the disease sets in and causes deterioration," he said.

About 60 to 70 percent of the patients recovered completely and are categorized as good responders.

"Patients with fair responses, about 10 percent to 20 percent, responded slowly. They eventually recovered, but not 100 percent and they did not feel completely well."

"There were also poor responders and these were the people who were likely to die. Probably about 10 percent to 20 percent of these cases will develop into Acute Respiratory Distress Syndrome (ARDS) when both lungs are white," said Tsang.

Asked whether race or gender was a factor, he said he was not sure.

"We can't predict the type of people who develop the worst diseases. What we know is that people who already have other diseases such as heart, kidney or cancer, are more likely to die. Older patients, over 60 years old, tend to have worse conditions than the younger ones."

From the psychological point of view, most SARS patients also suffered from depression due mostly to being isolated.

"So a lot of them were very distressed."

On the long term effects of steroids, Tsang admitted that many patients continued to feel distressed, could not concentrate and suffered from hair loss. However, he could not determine whether those conditions were attributed to the use of steroids.

"We still don't know whether SARS itself might cause that. We all feel distressed after several viro-illnesses, after an influenza attack."

"A small number of patients develop bone complications. We call it a vascular necrosis, a condition when the blood supply to the hip and knees is cut off because of the use of high doses of steroids. Fortunately we don't see many of these cases".

Tsang also said that the only way to avoid the complications from the use of steroids was by not using it at all. The only way to achieve that was to develop an effective antivirus drop, a drop that could cure the effects of the SARS virus, he added.

However, he doubted that it would happen in the foreseeable future.

"You cannot just drop in at the laboratory and say it works. You need to carry out lots of experimentation, to compare between a group who takes the drops and those who do not. An experiment of this type takes years to complete."

Research is still underway to find out whether the use of steroids on SARS patients is merely increasing the patient's natural resistance, or effectively killing the virus, or both.

"For sure, we found out that coronavirus does not live in a patient's body afterwards," said Tsang.

Mortality rate of SARS in several countries:

(1) Taiwan 27%

(2) Hong Kong SAR 17%

(3) Canada 17%

(4) Singapore 14%

(5) Vietnam 8%

(6) Mainland China 7%

Source: Kenneth W.T. Tsang