Probe into cocktail death link
Michael Ng and Cannix Yau

Secretary for Health, Welfare and Food Yeoh Eng-kiong said yesterday medical
experts were now examining whether the drug cocktail of ribavirin and
steroids was responsible for some of the coronavirus pneumonia deaths in Hong

``Experts are now continuing to look at the drug treatment protocol to see
whether modifications should be made and whether we should modify doses for
patients ... We certainly do not wish to cause more harm than good,´´ Yeoh

However, he insisted the drug mixture was still the best available treatment
for Severe Acute Respiratory Syndrome (SARS) at the moment. Global health
officials have said there is no clinically proven cure for SARS.

The probe was ordered after the Chinese University conducted autopsies on
seven people who died of the killer disease, and found that, apart from
severe lung damage, other organs like the heart and kidneys were also
affected. It was not known whether these people had chronic illnesses.

Medical experts are now studying whether the side effects from the current
treatment had caused the failure of the patients´ organs, or whether it
triggered their deaths. They are also studying which type of patients are
likely to suffer from more serious side effects.

In their analysis using the treatment records of 138 SARS patients at Prince
of Wales Hospital, experts found 18 of them had also suffered from a
bacterial infection as the steroids had depressed their immune systems. These
18 patients are still under intensive care.

Chairman of the Chinese University´s department of medicine and therapeutics,
Joseph Sung, said some patients simply did not respond to the steroids
treatment. He warned that an increase in the dosage would only have an
adverse effect on them.

``There is an upper limit in the use of steroids. If a patient receives more
than his or her upper limit, the side effects will be greater than the
healing effects,´´ Sung said, adding the hospital had begun using a
rheumatoid arthritis drug on patients who did not respond to steroids and was
studying the response. ``If these patients do not respond well to other forms
of treatment, we don´t know what else we can do for them. I don´t know what
other drug we can use to relieve their symptoms,´´ he said.

Manager of the pharmacy department at Queen Mary Hospital, William Chui, said
most of the deaths were the result of severe lung damage, but he did not rule
out the possibility of side effects from the anti-viral drug treatment.
``Most of the deaths were caused by lung damage, but some of the reports now
indicate that other body organs were also damaged. We are not sure whether
the damage was caused by the virus or side effects from the drug,´´ he said.
Chiu said the hospital had begun using other drugs to adjust patients´ immune

However, Yeoh said the mixture of ribavirin and steroids was still the best,
and medical experts in Guangzhou and Singapore were also using the formula.
``It does not mean the treatment is effective for all patients. Patients, on
the whole, respond well to this treatment protocol. But there are individual
patients who do not,´´ he said. ``Of course, with any drug treatment, there
are always side effects. As I have explained, the side effects can occur at a
high rate and tend to be more severe with sick and elderly patients.´´