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?
GUSTAV HELLTHALER JR.
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?
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.