Medical guidelines: The advice being given to hospitals and GPs on how to manage suspected cases of SARS in the Republic is out of date.
The advice was drawn up by the National Disease Surveillance Centre (NDSC) earlier this month but since then the director of the centre as well as several of its public health specialists have gone on strike, along with colleagues across the State, in protest over pay and working conditions.
As a result, the guidelines have not been updated since April 11th and they now conflict with the most up-to-date guidelines from the World Health Organisation (WHO) on the management of suspected SARS cases.
The most noticeable way in which they differ is in relation to whether or not all suspect SARS cases should be hospitalised.
WHO guidelines state all suspect cases should be hospitalised. NDSC guidelines state that a suspect case need only be hospitalised if they have had close contact with a probable SARS case. And they say if a suspect case is suspect only because they have had a history of travel to a SARS affected area, they need not be hospitalised and can be treated at home.
These guidelines were being followed when a Chinese woman, suspected of having the condition after arriving in Ireland from Guangdong province, was released from St Vincent's Hospital, Dublin, after being assessed in its accident and emergency unit last Friday.
She was told to return to her Dún Laoghaire hostel for the weekend and advised to wear a mask.
However, she is now back in hospital and her condition is continuing to be monitored, even though tests on her, according to the Eastern Regional Health Authority, proved negative for SARS. She and her sister are in Cherry Orchard Hospital in Ballyfermot.
Questions have been asked about why this is so, if the woman does not have SARS. Where are the guidelines in this respect?
WHO stress people should be monitored for a number of days given that the incubation period for the virus is 10 days and given that there is as yet no fast and accurate laboratory test for SARS.
Furthermore, they say: "A negative SARS virus test does not mean that the patient does not have SARS."
The reasons for negative test results in a patient with SARS include the following:
The patient is not infected with the SARS virus; the illness is caused by another infectious agent or non-infective cause.
Test results are incorrect. Current tests need to be further developed to improve sensitivity.
Specimens were not collected at a time when the virus or its genetic material was present. The virus and its genetic material may be present for a brief period only, depending on the type of specimen tested.
Specimens were collected early in the course of the illness and before antibodies had been produced.
Researchers in several countries are working towards developing tests for SARS. However, until those tests have been adequately field tested and shown to be reliable, SARS diagnosis remains dependant on the clinical findings of an atypical pneumonia not attributed to another cause and a history of exposure to a suspect or probable case of SARS.
Dr Mike Ryan, of the WHO, said yesterday the test that "is definitive is 21 days after the infection". The WHO guidelines are constantly updated as new information becomes available.
It is unclear when updated guidelines will be made available by the Department of Health's SARS expert group but it is understood this issue was discussed at the group's meeting yesterday.