This chapter also includes a description of an alternative diagnostic platform—the mass spectroscopic identification of microbial nucleic acid signatures—that can be adapted to detect the SARS coronavirus. Using technology originally designed for the environmental surveillance of biowarfare agents, this platform could potentially identify the SARS virus directly from a patient sample, obviating the need for time-consuming viral culture. This method is designed to distinguish between SARS and other coronaviruses, and perhaps even between genetic variants of the SARS virus; however, direct comparisons of sensitivity between this and other SARS detection systems using patient samples have yet to be conducted.
Several workshop participants expressed concern about the limited capacity in health care systems—particularly related to workforce and facilities shortages—that present a significant barrier to preparations for SARS and other threats to public health. It was suggested at the workshop by Jerome Schentag that this situation might be mitigated in some degree through the use of flexible approaches to isolating SARS patients. One such approach, discussed in this chapter, is a mobile technology that destroys viral particles and droplets in the air. These mobile units, by isolating individual patients being transported to and within hospitals, potentially could be used to protect staff during high-risk procedures such as intubation or bronchoscopy, to decontaminate larger areas such as hospital waiting rooms or airplanes, and to create air exchange systems for isolation facilities or areas within hospitals. Importantly however, it was noted during the workshop that the technologies described here must be thoroughly evaluated to determine their suitability for containing SARS in a variety of clinical settings before they are recommended for use.
Research has proceeded rapidly to develop antiviral drugs and vaccines to combat SARS. Previous antiviral discovery efforts by researchers at Pfizer on the human rhinovirus protease 3C—a functional, genetic, and structural analog to a key SARS coronavirus protease that has therefore been named “3C-like” (3CL)—are recounted in this chapter. This knowledge has aided in a search for 3CL protease inhibitors, a project undertaken by Pfizer in collaboration with scientists at the National Institute of Allergy and Infectious Diseases and the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID). Several candidate inhibitors have been selected by bioassay and are currently being evaluated for clinical development, while others are being sought through alternative strategies such as structure-based design and combinatorial chemistry. A vaccine for SARS—even if steered along a highly streamlined route to development—might still postdate a return of SARS, perhaps by several years. Nevertheless, because the medical need for developing such a vaccine and/or effective antiviral drugs is perceived to be acute, several pharmaceutical and biotechnology companies have taken up this challenge.