**********************************************************
Following is a question by the Hon Emily Lau and a written reply by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong, in the Legislative Council today (May 21):
Question :
Currently, the Hospital Authority ("HA") mainly uses Ribavirin and steroids to treat patients of Severe Acute Respiratory Syndrome ("SARS"). However, the World Health Organisation and the local medical profession have pointed out that the two drugs have serious side effects on the patients, including weakened immunity and damage to hearts and kidneys. The HA also uses the sera of recovered SARS patients for treatment. In this connection, will the Executive Authorities inform this Council:
(a) of the countries or places which adopt the same methods as those adopted in Hong Kong to treat SARS patients and the mortality rates of their SARS patients, as well as the countries or places adopting different treatment methods, the details of such methods and the mortality rates of their SAR patients;
(b) whether they have conducted a study of the side effects on the SARS patients who have taken Ribavirin and steroids, and of the number of patients who have died of complications developed as a result of the side effects of the drugs; and
(c) whether they know if the HA will consider making other treatment options (such as Chinese therapies and medication, alternative therapies, naturopathy and homeopathy) available to SARS patients or their relatives; if it will not, of the reasons for that?
Reply :
(a) Severe Acute Respiratory Syndrome (SARS) is a new respiratory illness caused by a coronavirus never before seen in humans. At this stage, much remains unknown about SARS. There is no internationally agreed definitive treatment for coronavirus related SARS. The Centers for Disease Control and Prevention in Atlanta of the United States recommends that SARS patients receive the same treatment that would be used for any patient with serious community-acquired atypical pneumonia. We understand this is also the practice in many other countries/places with SARS patients. In Hong Kong, patients with SARS are treated at the initial stage of the illness, as is the practice in the USA and many other countries/places, with antibiotics for presumptively known bacterial agents of community-acquired atypical pneumonia. For patients with unsatisfactory response to antibiotics, they are treated with ribavirin and/or protease inhibitor, with or without steroid, and/or any other treatments, on the advice of a panel of experts, comprising clinicians of the Hospital Authority (HA) and leading academics from both the University of Hong Kong and the Chinese University of Hong Kong, which is based on both laboratory and clinical experience. The attending physicians will decide on what treatment method to use on specific patients taking into account the known side effects and contra-indications of the drugs, the patient's physical conditions and response to treatment, as well as cohort variations of patients. The drugs used, the timing of prescription and dosage for patients therefore vary among attending physicians and hospitals in all parts of the world, including Hong Kong.
According to the World Health Organisation, the case fatality rate of SARS can be influenced by the profile of patients (including age and the presence of underlying diseases), and the route of exposure to and the amount of the virus. Bearing in mind that at this stage the diagnosis of SARS is based on a host of clinical factors rather than a specific accurate diagnostic test, there may be variations in the classification of cases as SARS by different countries and places. In the absence of detailed information on the diagnostic practice, the classification system and patient risk factors contributing to case fatality of other countries and places, it is not meaningful to compare mortality rates in different countries and places.
(b) HA has formed a SARS Collaborative Group comprising representatives from all hospitals and specialties involved in the management of SARS to understand more about the natural course of this new disease and study the factors that will influence outcome of treatment of the disease.
(c) Advisory groups comprising clinicians of HA and academics are evaluating the efficacy of alternative treatment options for SARS on the basis of evidence. One of the alternative treatment options being examined by HA is the use of Chinese Medicine. In this connection, HA has recently invited two experts on Chinese Medicine from the Guangdong Provincial Hospital of Chinese Medicine to come to Hong Kong to exchange views with local clinicians on the management of SARS patients in public hospitals using an integrated Chinese and Western medicine approach.
End/Wednesday, May 21, 2003
NNNN
