Hong Kong's public hospitals will offer a holistic approach to help those patients who have recovered from SARS return to a normal life, the Secretary for Health, Welfare & Food Dr Yeoh Eng-kiong said today. Doctors will also be advised to adjust their treatment protocol for SARS, based on experience and evidence to date.

7 new cases, 20 more sent home

As at 1pm today, 7 new patients in public hospitals were confirmed to have SARS syndrome. A total of 1,035 patients - more than 62% of all confirmed cases - have recovered and been discharged from public hospitals. Of them, 20 were sent home today.

No new healthcare workers have come down with the disease.

Most of the 427 patients currently in hospital are responding positively to the new treatment protocol. Of them, 67, about 15%, are receiving treatment in intensive-care units.

Another 89 patients are recovering in convalescence, in preparation for discharge.

Two patients, both with chronic illnesses, died in the last day. They included a 79-year-old man who died at Tai Po Hospital, and a 73-year-old woman who died at Caritas Medical Centre.

This brings to 212 the number of SARS-related deaths.

Joining Dr Yeoh at a press briefing today were:

* Dr Leung Pak-yin, Deputy Director of Health;

* Dr Yu Wai-cho, Consultant in the Department of Medicine & Geriatrics, Princess Margaret Hospital;

* Dr Loretta Yam, Chief-of-service of the Department of Medicine, Pamela Youde Eastern Hospital;

* Prof Yuen Kwok-yung of the Department of Microbiology, University of Hong Kong; and

* Prof Joseph Sung of the Faculty of Medicine, Chinese University of Hong Kong.

Three phases identified

Research shows that the illness has three phases. The first is the viral replication phase, during which the virus multiplies within the body. The second is the immune hyperactive phase - when the immune system recognises the presence of the virus in the body, it goes into overdrive to fight it. This can also do damage.

The third phase is the pulmonary destruction phase. Both the virus and the immune system begin to damage the lungs. Only about 20% of patients enter this phase, and most of them are then treated in intensive-care units.

Recommended adjustment in treatment protocol

Based on these findings, and the response seen in SARS patients to date, the experts recommend an adjustment in the treatment protocol. Initially, when little was known about the cause of the illness, clinicians combined the antiviral drug Ribavirin with steroids. Many patients responded well to that.

Now that the three stages of the disease are known, instead of combining Ribavirin and steroids at the outset, it appears more appropriate to give the antivirus drug in the initial stage to suppress the replication. Another drug, the protease inhibitor Kaletra, also works well in stopping the virus from multiplying.

"We're giving them either singly or in combination to tackle the virus replication," Dr Yeoh said.

Steroids should be introduced during the second stage, to combat the hyperactive immune system and keep it from causing lung-tissue damage.

Patients who were given steroids earlier had to have higher doses, and they suffered more side effects.

Masks aim to lower mortality rate

Dr Yam noted that patients who do experience the third phase suffer damage to their lungs and almost always require assisted breathing, through intubation and a respirator. However, medical literature published so far suggests that using positive pressure masks is far more comfortable for the patient and it reduces the mortality rate.

Dr Yam demonstrated several of the masks for reporters at the briefing.

Holistic approach to convalescence

While many SARS patients have left the hospital, not all of them can quickly return to their normal routine. They may still have coughs, and if they want to exercise, they experience shortness of breath. Many who want to return to work find it hard to do so - and researchers aren't sure if the symptoms will subside.

To help former patients return to a normal life, the Hospital Authority will provide rehabilitation at Wong Tai Sin Hospital. They can learn exercises to help them breathe easier if their lungs have been damaged. Some patients need muscle-building exercises after spending many weeks in a hospital bed.

Patients' needs will be assessed, and individual programmes set up to help them fully recover. Some may suffer from post-disease psychological trauma, so the programmes will help address both the mind and body.