Monday, 17 June 2013

Stuff from the literature: Don't judge a virus by its worst case [UPDATE].

This article, a Letter in the Journal of Clinical Virology (2013 Sep; 58(1):338-9) is one from our own keyboard. It is entitled Avian influenza A (H7N9) virus: Can it help us more objectively judge all respiratory viruses? Unfortunately it s behind a paywall, but I do not have the funds (they all go into the research) to pay for open access publication.

We try and make
the point that every respiratory virus can be found in severe, moderate, mild cases or even asymptomatic people - H7N9 in a young child earlier this year being an example - but no particular portion of a given virus's clinical severity spectrum should be used to define that virus.

The risk of future prejudgement is real. For example, not all influenza-like illness (ILI) is due to influenza viruses. Expecting it to be so leads to confusion and misunderstanding. But on the other hand, screening for every likely viral culprit in every patient during a pandemic is impractical - or at least, it creates a bottleneck that slows result reporting and infection control. At some stage we'll have better, faster higher-throughput tech to do this, but we're not there yet - so we have to pick and choose.
In the meantime, old labels like the "common cold" virus (human rhinoviruses and coronaviruses) have done little to help anyone really be aware of what a virus is capable of. You may argue they have slowed research into their other roles to the detriment of public health. I do. These labels will never be shaken off. Yet we now know that most asthma exacerbations are triggered by infection with one of these 200 or so little packets of mischief.
Apart from naming viruses to avoid geopolitical, and personal sensitivities, it is also important not to label viruses which at one time may be innocuous...and at another, deadly.

Viruses pack a lot of potential into a small shell-and do a great job of running us in circles.