SARS Challenges Met With New Technology

Clinical labs gain important insights about dealing with new infectious disease

CEO SUMMARY: When SARS began to spread around the globe, the United States was fortunate to escape the type of outbreak which still dogs Hong Kong and Toronto. Had SARS cases appeared in the U.S. a week earlier, the first affected cities would have experienced widespread concern, reduced tourism and economic activity, as well as severe disruption of normal hospital and laboratory activities.

HOSPITALS AND LABORATORIES in the United States should consider themselves lucky. By the time the first SARS patients began to show up in U.S. hospitals, the healthcare system was on the alert.

As a result, few healthcare workers in U.S. hospitals were infected and the normal operation of hospitals continued. It was the exact opposite in Toronto. As described by THE DARK REPORT here and here, in recent weeks hospitals throughout Greater Toronto ceased all elective surgery and non-urgent care as part of the effort to control SARS.

Imagine A Similar Scenario

Move 100 miles from Toronto across the Canadian border to Detroit. Imagine the impact on healthcare if Detroit’s hospitals were banned from doing normal surgeries and non-urgent care for at least two weeks. The financial consequences would be disastrous, not to mention the sizeable backlog of patient care that would result.

The laboratory profession is paying close attention to the battle against SARS. SARS follows on the heels of 9/11 (a shutdown of the air transport system for several days, interrupting blood supplies and reagent deliveries to labs) and the anthrax terror attacks (putting emergency departments [ED] and hospital labs on alert that any patient appearing in the ED may be sick with some of the nastiest bugs known to mankind).

Laboratories survived both those challenges with a high degree of proficiency. So far, SARS can be considered a similar success story. To date, it has demonstrated that healthcare officials across the globe can collaborate to share information and work effectively to limit the spread of the disease.

Not widely reported is the exceptional cooperation that took place among research laboratories and public health laboratories worldwide. Without regard to protecting potential patent claims, researchers and investigators shared findings.

For the laboratory profession, the technology used to identify the SARS virus and connect it with an existing family of viruses demonstrates how swiftly genetic-based technology is transforming laboratory practices. It was Joseph DeRisi, Assistant Professor of Biochemistry and Biophysics at the University of California at San Francisco, who first identified the SARS virus as being a probable member of the coronavirus family, reporting that fact to the Centers for Disease Control and Prevention (CDC) on March 23.

Virus Hunting Microarray

Two years ago, DeRisi created a microarray chip to help virus hunters. His microarray contains a “huge library of genetic sequences of all known human and animal viruses that have ever been sequenced, and which possesses the capability of detecting previously unknown viruses as well.” To better use this microarray, DeRisi and his partner in the project, David Wang, a postdoctoral student at Massachusetts Institute of Technology (MIT), created a software program to help evaluate the microarray.

After receiving SARS samples from the CDC, DeRisi used a laser microscope to compare the SARS genetic samples against his microarray, which contains the genetic sequence of 1,000 different viruses. In just a few minutes, he had established the relationship between SARS and other viruses in the coronavirus family.

Because most microarray projects have targeted human genes, DeRisi’s successful identification of an unknown virus using microarray technology has attracted lots of attention. It is a powerful demonstration of how genetic knowledge will revolutionize healthcare.

Laboratory medicine is making another important contribution in the fight against SARS. Using a variety of new technologies, efforts are underway to create at least three different types of diagnostic tests for SARS. They are expected to be available within a few weeks. Two of the assays will test for antibodies. The other will detect the presence of viral DNA in blood.

SARS Is Unusual Event

In other developments, physicians from Hong Kong’s Prince of Wales Hospital authored a report published in the online edition of the Journal of New England Medicine about an enzyme test that may help predict which SARS patients are most likely to die of the disease. According to the report, high levels of the enzyme lactate dehydrogenase indicate lung damage and may be an important clue to why some SARS patients die while others recover.

As a contagious new disease, SARS must be considered an unusual and important event. In speaking with laboratory administrators and pathologists in Toronto, THE DARK REPORT constantly heard statements such as “In my healthcare career, I’ve never seen anything like this.”

Attracted Lots Of Attention

At a minimum, the SARS lessons learned by laboratories in Toronto will change certain aspects of hospital laboratory management, particularly in the relationship between the infection control team and microbiology. There will also be informed changes made in how regional laboratory networks are operated.

Probably the most far-reaching impact of SARS was identified by Donald Low, M.D., Microbiologist In Chief at Toronto General Hospital. He observed that “what Hepatitis B and HIV did for body-fluid precautions, we hope this [SARS] will do for respiratory precautions.”

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