Medical Alert

March 15, 2003 9:09 PM

CDC posts medical alert for atypical pneumonia. There is travel alert for those traveling from Asian countries around and in China. It seems that this type of pnenumonia has been found in North America. Symptoms include fever and hard-of-breathing. More articles about the disease here.
posted by azileretsis (29 comments total)

This kind of stuff scares the poop out of me.
posted by geekhorde at 9:38 PM on March 15, 2003

I've been tracking this story all day. It was first being reported as a variant of Hong Kong chicken flu a couple of weeks ago. It is scary.
posted by y2karl at 9:48 PM on March 15, 2003

On the other hand:

The flu-like virus – which results in severe acute respiratory syndrome (SARS) – has infected scores of people in Hong Kong, Vietnam and Singapore and killed eight people since it was first detected in China in February.

Let's not get too hysterical just yet.
posted by y2karl at 9:52 PM on March 15, 2003

y2karl, you madman that's almost .00000013% of the planet's population! Where can I get some flu-free water? I have money, guns, and women to trade!
posted by skallas at 10:07 PM on March 15, 2003

How come every scary disease has to have flu symptoms? Why can't they come up with their own symptoms so as not to freak the cold and flu infected sections of the population? Just wondering.
posted by catfood at 10:25 PM on March 15, 2003

Well, sorry catfood. Apparently the human body thinks thinks like coughing, runny nose, and fever are universal defenses against disease.

Sure, it would be nice if there were unique symptoms like maybe colorful unique rashes, but it hasn't happened yet.
posted by ilsa at 10:29 PM on March 15, 2003

I have money, guns, and women to trade!

Ooh, you're like quonsar, clavdivs and madamejujujive all in one.
posted by y2karl at 10:52 PM on March 15, 2003

Since I am supposed to be going from the US to Hong Kong next week, I can't help but be worried about these stories; and in fact, relatives and friends have already started begging me not to go.

On the other hand, as y2karl says--infecting "scores of people" in a city of 7 million does not constitute a high infection rate. There's probably more chance of my being injured in a terrorist attack than in catching this disease during a week-long visit to Hong Kong. (Though this is not quite a comforting observation, since, unfortunately, terrorist attacks do not seem quite as unlikely as they once did).
posted by Rebis at 10:52 PM on March 15, 2003

That surgical mask ala Michael Jackson meme is going to be catching.
posted by y2karl at 10:59 PM on March 15, 2003

gee, karl, do you think those flimsy little masks do any good? I think we may need this. Or this one is a bit more stylish.

Seriously, these increasingly aggressive diseases are getting rather scary. Are these diseases occurring more frequently, or is this just the media's shark scare hype for 2003?
posted by madamjujujive at 11:53 PM on March 15, 2003

Worry is warranted. As someone who works as a physician in a walk-in clinic in one of the most heavily trafficked spots in the US for international tourists, I've increased my level of vigilence. The symptoms, though, look like a number of just really bad lung diseases that would end up at the hospital if not the ICU anyhow.

That said, is this really scarier than the 1918 flu epidemic or an outbreak of Legionairre's disease. I think that the WHO is being a little alarmist particularly as it applies to US medical hygene. Perhaps for other nations that don't exercise universal precautions, the risk may be higher.
posted by shagoth at 12:21 AM on March 16, 2003

I was just IMing an hour or so ago with a close friend of mine who is now in thailand, just came from vietnam and is on her way to hong kong - a grand tour of the hotspots. And she is arriving back in the US on monday. When I informed her of the news, it was the first time she had heard it - asking others at the backpacker internet cafe it seems nobody knew what she was talking about.

I agree that worry is warranted if only because the stakes are so high. Then again, I'll admit to being a bit of a germ-o-phobe who is frightened by the idea of the common handshake.

catfood: The flu-like symptoms are mostly a combination of tried and true tactics that the body has developed to fight most infections. The elevation in temperature, for example, will kill of many pathogens and for that reason many will still recommend that a fever should not be artificially lowered unless it is beyond say 102.
posted by vacapinta at 12:46 AM on March 16, 2003

One of the reasons for elevated concern is that they haven't yet been able to isolate whether it's viral or bacterial. This means they can't nail down the method of transmission and can't adequately assess the risk of casual contact. It gives pause that dozens of medical professionals who had contact with patients in Asia have become symptomatic.

They're hoping to avoid a situation here where somebody walks into a hospital and debilitates, or just quarantines, a good chunk of their staff. People are on edge and there's been a lot of talk about anthrax and smallpox lately, but clearly this isn't nearly that serious quite yet. And usually, there's a strong inverse relationship between how easily a disease spreads, and how dangerous it is.
posted by dhartung at 3:10 AM on March 16, 2003

shagoth,

ISTR that the "Spanish flu" of 1918 was actually a virulent strain of pneumonia also. Wonder if it's back?

That being said, so far it's worthy of genuine concern but not panic and terror. Keep yer head level. Remember to wash your hands frequently; that's always a good practice when there's any kind of respiratory or rhinovirus floatin' around.
posted by alumshubby at 5:28 AM on March 16, 2003

What's up with those Hong Kong chickens this is not the first time.
posted by stbalbach at 6:42 AM on March 16, 2003

"Spanish flu" was a variant of the Influenza A virus with the unusual knack of killing healthy young adults. 'Flu still kills many people each year, probably by making them more susceptible to bacterial pneumonias, which is why 'flu vaccine is given to those at risk of chest disease and the elderly.
The Hong Kong strain of 'flu from chickens doesn't seem to spread very well between people - all of the cases were in direct contact with chickens. This is a separate thing from the atypical pneumonia that CDC has issued the warning about, so, with luck, we shouldn't be looking at an epidemic.
In the UK at present we have a lot of cases of Influenza B, but not much 'Flu A activity.
posted by tabbycat at 7:38 AM on March 16, 2003

My first reaction to this story: is this infectious agent au naturel?
posted by Fupped Duck at 7:39 AM on March 16, 2003

y2karl, you madman that's almost .00000013% of the planet's population! Where can I get some flu-free water? I have money, guns, and women to trade!

It is big news in the Chinese community here in Toronto. It turns out one of the people who has contracted the disease is a family friend of mine. She's a doctor and I think she saw some patients who were infected.

She's been in the hospital for a week now running a fever of 104 degrees and on 5 different anti-biotics. This is a woman in her late 30's who is extremely healthy.

The scary part isn't the number of people affected but the fact that the WHO has no idea how to try and cure this strain of pneumonia. Young, healthy people are getting extremely ill. It doesn't just strike the very young and the very elderly hard.

Anyway, please pray for my friend.
posted by PWA_BadBoy at 9:40 AM on March 16, 2003

While browsing around the web looking for a list of known influenza mutations, I've found this you may find it interesting:


Do Not Give Aspirin To a Child or Teenager Who Has the Flu
Never give aspirin to children or teenagers who have flu-like symptoms – and particularly fever – without first speaking to your doctor. Giving aspirin to children and teenagers who have influenza can cause a rare but serious illness called Reye syndrome. Children or teenagers with the flu should get plenty of rest, drink lots of liquids, and take medicines that contain no aspirin to relieve symptoms

The source is more then respectable, it's CDC
posted by elpapacito at 12:49 PM on March 16, 2003

Hopefully, elpapacito, the majority of parents know about Reye syndrome. It's a pretty basic thing, most pre-natal education programs should cover it prominently, and one of the reasons there are so many aspirin-substitutes such as Children's Tylenol. Reye is rare, but devastating. (It's also something we don't fully understand, beyond vague links to aspirin use.)

Fupped: There is no reason to suspect terrorism. First, as a biological agent, this one isn't very effective; it's spreading randomly apparently from person to person. It would take a long time to have a serious effect. Also, it's likely to affect people indiscriminately, which is the basic problem with a bioweapon. Second, as a flu-like virus, it's originating where a lot of flu-like viruses originate, and although the etiology appears different, it's probably some variant of something else out there. Flu viruses are always mutating to spread and survive; every year there's an enormous global effort to tweak the vaccines which anticipate the family that the common viruses will come from. Every once in a while, there's an outlier, a strain which is more virulent or deadly than usual. Essentially, while we have ongoing programs to contain illness outbreaks, we also have to keep in mind that the viruses and bacteria themselves are pursuing biological imperatives and never give up; and we can't diagnose and prevent them until they appear and present symptomatic patients to the medical community.
posted by dhartung at 2:03 PM on March 16, 2003

These alerts are not that uncommon, it's not as alarmist as people are thinking I don't think. Their audience, clinicians etc, don't see them as alarmist, it's just information they need.

catfood said something about so many diseases having flu-like symptoms, and that being a problem, made me think of something fun/sci-fi. We could engineer patches of skin that would color-change to represent foreign proteins found in the body. Our bodies already present foreign proteins to our immune system in a specific way, *all* we would have to do it make a new organ to present that information as some sort of unique 2D way. get to work! ;) maybe they would look like rorschach tests.

"Oh, you have the vagina-strain of the flu..."
posted by rhyax at 7:30 PM on March 16, 2003

rhyax: Apparently some clinicians see them as pretty scary indeed. Also:

We now have 80 cases of atypical pneumonia in this hospital (64 yesterday) and over 50% are either Health Care Workers or Medical students.

I'm not an epidemiologist or anything close to it, but going from 16 to 80 cases in one hospital in one day, esp. considering the number of undiagnosed cases that are probably out there (as has been said, the symptoms are shared by anyone with a cold — myself, at the moment, for one) seems like a pretty steep curve to me.
posted by IshmaelGraves at 9:24 PM on March 16, 2003

"The deadly pneumonia-like illness that was the subject of a World Health Organization warning on Saturday originated in southern China in November and peaked a month ago, according to a report the Chinese government provided to WHO officials."
posted by homunculus at 10:35 PM on March 16, 2003

rhyax: what IshmaelGraves said. Clinicians may not be 'alarmist', but they are intensely interested and worried. Emed-L, an emergency medicine listserver, has been buzzing about it for the last couple days.

This bug is a big deal, for a several of reasons:

1. It appears to be highly transmissible from person to person by airborne droplets, unlike HIV, Ebola or anthrax, for example. This means that coughs and sneezes can infect everyone near a patient. Ordinary handwashing, use of gloves, and hospital sterility measures will not prevent infection. The extremely high infection rate in health care workers, and family members of patients (the cases in Toronto) reflect this. Tom Buckley's letter from Hong Kong sounds like a dispatch from a war zone: nothing but SARS patients in the ICU, all elective surgeries cancelled, the hospital is turning away ambulances.

2. It has already jumped the Pacific to North America.

3. It appears to have a high fatality rate, even in young, otherwise healthy people.

4. I found this quote from the NYT article especially disturbing:

Although some victims remain stable and others seem to get better for two to three days, they eventually relapse, developing acute respiratory distress. Some need to have a tube inserted in their windpipe to help them breathe.

Among the survivors, "no one has gotten well yet," Dr. Heymann said in an interview.

No patient has yet fully recovered. The natural history of this disease is still unknown.

It's most likely to be a virus that has randomly mutated and increased its virulence. This happens. I've always been fascinated by the English Sweats, probably a similar random mutation causing increased virulence in a virus, that then killed all its potential hosts, and vanished. (Shakespeare mentions it.)

SARS is probably not the English Sweats, the symptoms and course of the disease are different, from what we hear so far, but it may be an example of the same phenomenon.
posted by Slithy_Tove at 12:10 AM on March 17, 2003

Our friend Laurie Garrett weighs in with an update.
posted by beagle at 5:51 AM on March 17, 2003

"On Saturday, China provided WHO with the first detailed information about an outbreak that began in November in Guangdong Province. China has yet to provide patient samples to outside authorities for analysis."

So first they suppressed the news and they still haven't decided to help other countries in their investigations. It sounds like China's penchant for secrecy is part of the problem.
posted by homunculus at 10:30 AM on March 17, 2003

There are actually paterns of pandemic and one was predicted to happen around now. Apparently, it's 5 years late. (I can't source it on the web, this was a research project in a high school that I recently encountered, help?) Hong Kong had prevented it by killing pretty much all the chickens on premise... a poultry holocaust one might say... and as mentioned above by homunculus, because this originiated in China (and not necessarily in China's defense, but after you've been a communist country for 3/4 of a century and isolated yourself from the rest of the world except for financial gain, you do quirky things in the international limelight), it was not reported until cases in HK were discovered.

[off topic]
There will also be the-worst-earthquake-ever predicted to happen in Vancouver. Why didn't they teach this stuff to us in geography/biology class?
[/off topic]
posted by margaretlam at 8:26 PM on March 17, 2003

WHO SARS homepage.

Daily update of cases and deaths by country.

Not many deaths so far (although 2 of 8 in the Toronto cluster died), but we're still very early in the course of this outbreak. The number of deaths will surely rise, but how high is unknown. And as homunculus noted, the number of deaths from the (apparently) original outbreak China is unknown.
posted by Slithy_Tove at 8:29 PM on March 17, 2003

(From a copy to emed-l, I can't find a good link to the ccm-l archives.)

Two more e-mails from Tom Buckley in the middle of the Hong Kong outbreak.

This is both good news and bad news. The good news is that there does not seem to be a wave of new, secondary cases. The outbreak, whatever it is, may have been contained successfully.

It's also good news that at least a couple patients seem to be improving, and that no one in Hong Kong has died (except for the man transferred from Vietnam).

The bad news is:

1. Apparently the Guangzhou outbreak had 30% mortality rate. (!!!) This may reflect the difference in medical care between Hong Kong and inland China. Or not. It's similar to the mortality rate in the tiny cluster in Toronto.

2. The mass media are saying that the disease is not spread by casual contact, because there have been no cases in individuals on airplanes or in airports who were presumably exposed to the sick travelers (e.g., the original Toronto case). Buckley's experience seems to suggest otherwise.
posted by Slithy_Tove at 10:04 PM on March 17, 2003