SARS, Sarin and WMDs

SARS, Sarin and WMDs

Dear Dr. Marc,


Dr. Marc answers readers’ questions every other week. To send a query, click here.

Dear Dr. Marc,

One of the employees in my tavern has gone on holiday to China for two months. A number of customers have asked me if I am going to allow her back to work when she returns. They are in quite a snit over SARS and have no interest in handling things reasonably. What should I tell them? How should I treat my returning employee? What should I tell my customers?

Seattle, WA

Dear Gustav,

Tell them that the risk of contracting SARS to the individual traveling to China is still quite low (much, much higher for malaria). Tell them that after ten days to two weeks after her return if she doesn’t have symptoms she is definitely not going to get anything. Tell them that the quarantines that they’ve read about to prevent the spread of SARS, especially in China, inadvertently make the disease proliferation seem a lot worse than it currently is. Unfortunately, the healthcare system in China leaves a lot to be desired. Many people don’t seek out medical care until they are practically dying, which means there is probably a milder form of SARS that no one is hearing about. I am not alone among physicians who believe that the mortality rate is actually far lower than is being reported because of those mild cases, which haven’t come to attention. SARS cases numbers in the thousands. Fear of SARS cases numbers in the millions, potentially billions.

Dear Dr. Marc,

Thanks for the sense you are putting into the SARS discussion as it relates to bioterrorism. I have noticed nothing in the media about how people who die of SARS have been treated. Perhaps they are taking over-the-counter meds that lower fever but allow the condition to worsen. I’m reminded of some grim humor at the time Legionnaires’ disease hit. One guy had such a persistent fever that it couldn’t be controlled. He survived, but all those with controlled fevers died. What do you think?

Waupaca, WI

Dear Larry,

I don’t think that lowering the fever with over-the-counter analgesics contributes to the problem. In most viral illnesses, SARS notwithstanding, lowering fever and keeping the patient well hydrated improves comfort and outcome. To be sure, fever is part of the body’s response to an invading organism, but it is the accompanying revved-up metabolism that helps the body fight off infection, rather than the fever itself.

Dear Dr. Marc,

Last year my 73-year-old mother, who was in excellent health and had no family member with a history of colon cancer, had a routine colonoscopy at the urging of her physician. She had a complication, which resulted in emergency surgery, a temporary colostomy and then a second surgery to reconnect the bowel. I have been a nurse for twenty-four years, so I understand that any medical procedure, even performed by the most skilled practitioner, has risks and possible side effects. I will be 50 this year, and so I am entering the age where a colostomy is recommended as a precautionary measure. What is your feeling about the risk/benefit of colostomy versus noninvasive stool tests for hidden (occult) blood? Do you routinely recommend them for your patients? Have you had a colostomy?

Seiad Valley, CA

Dear David,

I am not yet 50, but I have had one, and I feel colonoscopy is a well-tolerated procedure, especially when performed by a talented practitioner. I would encourage you to get such a recommendation, and I do advise this test as a routine screening for patients over 50. Stool tests are fairly insensitive, and definitely do not take the place of colonoscopys. Noninvasive CT scans–I get asked this question all the time–aren’t well enough studied yet to be used in lieu of colonoscopy, and since the prep is similar, and is to many the most uncomfortable part, I tend to steer clear of the rapid CT scan as an alternative.

Dear Dr. Marc,

I am a student from Singapore and I would like to know more about devices that are used in detecting poison gases such as sarin. I’m curious about their effectiveness and whether they are practical in my country, which is characterized by very high population density and high-rise buildings. I would also like to know what precautions Singapore should take given that we are a small country. How can we maximize our capabilities?


Dear Azhar,

There are devices to detect the presence of nerve gases, but these aren’t nearly as accurate as laboratory gas chromatography and spectroscopy. But the likelihood of sarin reaching you is quite low, so I don’t think the detectors are necessary on a countrywide basis at this point.

Dear Dr. Marc,

It seems that from your answers, we should be much more worried about automobile crashes than biological and chemical terrorism. Would you place such weapons under the category of WMDs alongside nuclear weapons?

Baltimore, MD

Dear Walter,

No I wouldn’t–which is why I consider WMD such a misleading term. Chem-bio, as they are also known, are weapons of great destructive potential, but not in the same range as nuclear. The suggestion that they are is part of the unfortunate rhetoric and propaganda that is meant to galvanize us.

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