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SARS much more deadly than first estimated.
April 25, 2003 5:39 PM   Subscribe

SARS much more deadly than first estimated. Analysis of the latest statistics on the global SARS epidemic reveals that at least 10 per cent of people who contract the new virus will die of the disease. The low death rates of about four per cent cited until now by the World Health Organizatio n and others are the result of a statistical difficulty, well known to epidemiologists, that hampers the early analysis of new disease outbreaks. [...] A better current estimate of the deadliness of SARS may be the number of deaths as a proportion of resolved cases. Those numbers for Hong Kong, Canada and Singapore are 15.8, 18.3 and 13.7 per cent.
posted by Bletch (68 comments total)

 
What a splendid new gift China has given the world. But of course, we musn't say anything that might upset them.
posted by homunculus at 6:00 PM on April 25, 2003


SARS attacks!
posted by SpaceCadet at 6:05 PM on April 25, 2003


I gather that about 15% of patients require ventilation. Which is all well and good if you have ventilation equipment. If you don't, well, that death statistic might be raised a little bit.
posted by kablam at 6:07 PM on April 25, 2003


oh no! we better start panicking now!
posted by fnord_prefect at 6:08 PM on April 25, 2003


ah!
posted by Espoo2 at 6:13 PM on April 25, 2003


I'm not an epidemiologist, but it still seems to me like it's too early to give a confident mortality estimate since there are still many news SARS patients under reliable observation who have neither recovered nor died. Thus these percentages seem likely to be lower than to the true mortality figure. Time to panic? Possibly if you're in Guangdong or Singapore or Delhi [BMJ], though it's apparently still somewhat contained in Canada, where there have been 300 cases so far [BMJ].
posted by Bletch at 6:19 PM on April 25, 2003


A SARS Reality Check, just in case anyone's been excessively worried.Ï8´
posted by Bletch at 6:26 PM on April 25, 2003


That's still a far lower death rate than the US death rate for *treated* pneumonia.

SARS is certainly a public health concern, but it's hardly the "new plague" media hysteria suggests.
posted by Sidhedevil at 6:36 PM on April 25, 2003


Homunculus, that was a wonderful example of trolling, thank you for showing us how it's done.
posted by phyrewerx at 6:55 PM on April 25, 2003


Really? I thought it was pretty tame. I think there is a strong case that by trying to cover it up since November, the Chinese government helped create a global problem, and that the US is giving them a free pass on their poor human rights record, of which the SARS secrecy is an example. I apologize if I was a troll, but read the articles I linked and see if you agree.
posted by homunculus at 7:16 PM on April 25, 2003


Sometimes it seems like they should filter the elderly out of these statistics. They have a much higher rate of death after contracting virtually anything, than a 25 year old does.
posted by smackfu at 7:22 PM on April 25, 2003


Well, I loaded up yahoo news to see that the headlines for the business, World, Sports, Technology, and Health sections were all about SARS... now it turns out this was a completely valid amount of media coverage.
posted by Wingy at 7:36 PM on April 25, 2003


270 dead, huh?

Meanwhile, thousands of people a day are dying of Malaria, including more than 3000 children daily in sub-Saharan Africa alone.
posted by stavrosthewonderchicken at 7:42 PM on April 25, 2003


I see your argument Homunculus, and I do not doubt that the recent relaxation in criticizing China's human right's records may be a step towards a very uncertain and muddy path.

However, I find it hard to blame China fully for the cover-up. I remember listening to a WHO Health official on a Toronto radio station (oh the irony) during the first week Hong Kong was visited by the CDC and the WHO. The official was quoted as saying, at that time, Hong Kong and the rest of east asia was still safe for tourism, and the severity of the SARS outbreak is nothing compared to the avian flu Hong Kong endured a few years back. Of course, one can argue that if they knew what China knew then, they may have begun to issue travel warnings sooner and hopefully could have contained the spread sooner. However, it is also possible that even if they have the Chinese statistics, they may still have taken a more relaxed approach for the fear of stirring panic in the Asian economy.

Either way, I think the recent efforts by the Chinese government is a step in the right direction... for whatever the reason.
posted by phyrewerx at 7:46 PM on April 25, 2003


Stavros is right. SARS is just the flavor of the month.
posted by konolia at 7:48 PM on April 25, 2003


On the plus side, for better or worse, within a week or two, we'll have a much better grasp of things.
This thread will have long since scrolled, so if someone posts a new one, don't trash it for being a duplicate.
posted by kablam at 7:53 PM on April 25, 2003


Definitely not my flavor, baby.
posted by LexRockhard at 7:54 PM on April 25, 2003


Not that other diseases like Pneumonia, etc. aren't awful too, but I think there are some definite characteristics that make SARS worse from a societal standpoint:

1. It's very contagious, and therefore difficult to stop.
2. It doesn't kill too fast. This is why Ebola never spreads much. It kills of it's own carriers too quickly.
3. Unlike many other diseases, the initial symptoms aren't that obvious. So, it's harder to find SARS victims before they've acted as carriers.
4. There's no real cure. There are treatments, but of doubtful effectiveness.

Perhaps worst, though, is that we simply don't know much about it, and it's difficult to fight what you don't know. With this mortality rate, it looks like we could have a real problem on our hands.
posted by unreason at 7:54 PM on April 25, 2003


With this mortality rate, it looks like we could have a real problem on our hands

What Stavros said. Real problems = Tuberculosis (and not even the emerging antibiotic resistant forms, just the regular kind), malaria, and that huge contributor to infant mortality, diarrhea. These kill hundreds of thousands more annually than SARS ever will. You want a public health crisis? How about access to fresh water, which is only a luxury in many parts of the world?
(I don't mean to slag you personally, unreason, I'm just really fed up with SARS hysteria at the moment.)
posted by jokeefe at 8:18 PM on April 25, 2003


Bletch: A SARS Reality Check, just in case anyone's been excessively worried.Ï8´

stavros:270 dead, huh? Meanwhile, thousands of people a day are dying of Malaria


Here is the cumulative case report.

I dont buy these arguments that we shouldnt be worried because more people die from slipping in a bathtub. That is a misleading and dangerous comparison.

The onset of any disease will be small by definition. The critical factors are not sheer numbers but rather method, opportunity and results of infection. The WHO has been monitoring all of these factors.

Unlike traffic accidents, this disease is highly contagious and has an optimal incubation period. Unlike malaria or many other diseases, it also depends only on human vectors for transmission. The flu-like symptoms make it harder to diagnose and thus more likely it will slip by.

Unlike the flu, our health agencies do not have a coordinated program to contain this. We understand the flu. And with coordinated planning we have been able to, if not defeat it, at least monitor it and keep it contained with vaccines.

What i have seen so far is worrying. (on preview: sorry jokeefe, i feel the opposite to be true. We cannot afford apathy right now)
posted by vacapinta at 8:24 PM on April 25, 2003


I don't mean to slag you personally, unreason, I'm just really fed up with SARS hysteria at the moment

No offense taken, news reporters are quite annoying :)

I'm not saying that other diseases and health problems aren't really bad, I'm just saying that SARS looks like it's going to be really nasty. Tuberculosis is pretty bad; I was tested positive for it and had to look into treatment, etc. It's bad, and it's a health problem. But we know a lot about it, we've got surefire tests that work quite well, and we've got workable treatments. The problem isn't so much the water or the Tuberculosis, but the root of those problems, namely poverty. Poverty is a real problem, but things can be done to help. What worries me is that with SARS it doesn't really seem like there's much that's doable. Even worse, if a sound treatment is developed, many of the countries it will be entrenched in are poor (there we go again) and will be unable to afford the medicine.
posted by unreason at 8:30 PM on April 25, 2003


Good point, vacapinta, but careful analysis and level-headed discourse are not (ever) the order of the day, at least with regard to the media.

I'm not arguing that we shouldn't be worried - my point, such as it was, was to express some mild disgust with media priorities.

That said, BBC World is my only source of TV news in English, and they were talking about malaria yesterday (in between hammering the SARS fear home, again and again and again...)

Tim Bishop's SARSwatch.org might be of interest here.
posted by stavrosthewonderchicken at 8:30 PM on April 25, 2003


Having been in mainland China (Nanjing) for the past year and in a stage of siege mentality for the past several weeks, I'm getting really freakin' sick of looking at snide comments on the Internet from people in the West saying, "Oh, what's the big worry? Coming down with SARS is like coming down with a cold. Hey, more people die from toenail cancer in Angola each year than from SARS."

Perhaps the number of cases doesn't impress you, the media-saturated cynics. Hey, even I was once like that as well. "Oh, sure, if I were to for some reason die this year, it's more llikely be from some cab driver hitting me while I crossed the street than from SARS."

But the general panic is even getting to me. All it's been for the past couple of weeks is wave after wave of rumors. Did you hear that so-and-so school is shutting down and sending their students home? Did you hear that passengers on all the buses that get into so-and-so city are being detained in hotels for a period of 10 days? Did you hear that there was someone with SARS symptoms on a train from Beijing and that they quarantined the entire train?

I'm trying to ride it out, but who knows. There are new developments out here every day, almost all worse than previously thought unimaginable.
posted by alidarbac at 8:43 PM on April 25, 2003


The belittling of the threat from SARS has a lot of parallels with global warming "skepticism." 270 people dead from SARS. Global temperatures only up a degree or two. Sounds pretty minor, huh? Well, the scientists who study these kind of things don't generally think so.

At least the right's state of denial about climate change makes some kind of political sense. They want to hold on to their Ford Excursions. I don't understand what the rationale behind SARS denial is. By denial, I don't mean reasoned efforts to argue why it will eventually be contained, I mean deriding any concern about it as out-of-proportion hysteria.
posted by transona5 at 8:44 PM on April 25, 2003


[vacapinta, I was just about to post that link]
Does anyone know how is the mortality rate measured?
If we use deaths/infected = 274/4649 = 5.8%
If we use deaths/(recovered+deaths) = 274/(274+2206) = 11%

It seems the later method is used by NewScientist, but an estimate of 8% could have been obtained since April 10. Indeed, 8% is less than 11%, but 8% is greater than 4% reported at that time.
What is wrong in this picture?
posted by MzB at 8:56 PM on April 25, 2003


If you look at this post, which I made back on Jan 1st 2003, it estimates that the worlds population has grown by over 23 million human beings, in less than 4 months.

I don't think the human race needs to worry about going extinct any time soon.
posted by Beholder at 9:30 PM on April 25, 2003


The media saturation (of this, and pretty much every other major storey) seems to have two effects - those who say "it's all hype" and tune out, disregrarde and devalue all reports, and those who get swept along in the tide, "we're all going to die!". No doubt the truth lies, as it normally does, some where down the middle road. But, I didn't really mean to get off onto a dime-store media analysis....

Yes, Pneumonia, TB, malaria and all these other infection diseases /are/ bigger threats right now but right now SARS is new. While cases are being measured in the hundreds we have a chance, quite possibly our only chance to stop SARS from joining the ranks of these other deseases. I think this alone warrents the attention that SARS is getting.

What if the delay between the detection of HIV and the hysteria of AIDS had been measured in months instead of years? What if instead of a slow burn of scientific papers and medical conferences it was in the news every night? That sort of media attention would have been hyperbole concidering what we knew/thought we knew/didn't know about AIDS in the early '80s but would it have made a difference to the epidemic that followed?
posted by adamt at 9:45 PM on April 25, 2003


Beholder: You may be right, but the steady growth in worldwide pandemics in the last 50 year makes me wonder about a "Gaian immune system" response. AIDS, Tuberculosis, SARS, even Lyme Disease: outside my door, It seems to be getting deadlier. Imagination?

And then there is the "Methane Burp" problem...
posted by troutfishing at 9:57 PM on April 25, 2003


270 dead, huh?

Meanwhile, thousands of people a day are dying of Malaria, including more than 3000 children daily in sub-Saharan Africa alone.


geez, was that meant to sound so cruel? did you say something glib like that when the world trade center was destroyed? every death that could have been prevented is important.
posted by kv at 10:00 PM on April 25, 2003


So if all the old people die of SARS, will we be left with a teenage wasteland?

(sorry.)
posted by kaibutsu at 10:07 PM on April 25, 2003


It doesn't matter how many cases there are, it only matters that the number of cases continues to rise.
posted by stbalbach at 10:09 PM on April 25, 2003


every death that could have been prevented is important.

And everyone is a unique freaking snowflake, I know.

did you say something glib like that when the world trade center was destroyed?

Yeah, I just loved watching those people die, because I'm a monster. Nice troll there, kv. I explained the point I was trying to make once already in this thread, but clearly not monsyllabically enough for you to get the gist. Let me try it again : media hysteria over 270 deaths - as valuable and wonderful as each and every single one of those beautiful souls might have been - in the face of resounding media silence over a quadrupling of malaria cases in Africa in the last few years leading to another dead child every 30 fucking seconds...this disgusts me.

Do us all the courtesy of at least skimming what has gone before before you offer us your saccharine platitudes, mmkay, kv?
posted by stavrosthewonderchicken at 10:48 PM on April 25, 2003


The media "frenzy" isn't about 270 deaths. It's about the warnings of very knowledgeable doctors and epidemiologists whose research has led them to believe that this disease could be a major new threat, a threat that might have a better chance of being contained if people wake up right now to how potentially serious it could be and avoid engaging in activities that might spread it.
posted by transona5 at 10:53 PM on April 25, 2003


270 dead, huh? Meanwhile, thousands of people a day are dying of Malaria, including more than 3000 children daily in sub-Saharan Africa alone.... I'm not arguing that we shouldn't be worried - my point, such as it was, was to express some mild disgust with media priorities.

I don't mean to personalize this against stavros, but there's so much that's wrong with this statement.

First, this is not a media-created crisis. This is a broad-based public health crisis, and every major agency involved is jumping into urgent response mode, including the WHO and CDC. SARS may have killed few to date, but its potential is surely catastrophic: it is highly contagious, we don't know exactly how, and it tends to infect medical workers who treat patients -- including an important disease researcher from Europe -- and its advent can close an entire hospital and send thousands into quarantine. The point, of course, is to halt its spread now before it becomes one of those mature diseases we have to deal with on a recurring basis.

Second, allow people to choose their concerns. Malaria is not a first-world disease; it isn't going to come jumping around Illinois. Yet SARS has spread to Toronto, a city very near the US, and very like many American cities. Clearly this has spurred people to think of this as not a far-away threat but something that could potentially affect them personally. That tends to pique one's interest.

Third, the numbers alone don't tell the story. Certainly if every newspaper every day filled its first five pages with coverage of the "heart disease crisis", thereby giving it its due by comparison, nobody would buy newspapers. Similarly if newspapers chose their stories by what they thought their readers should be concerned over rather than with what they, as customers, are concerned about. Readers tend to think that kind of agenda-setting is patronizing.

Fourth, just as more funding can't automatically cure AIDS (to cite the agenda-driven joke), so too more media attention in the first world is hardly going to have a significant immediate effect on an endemic third-world disease such as malaria, which is a public health problem requiring enormous local effort and, probably, borad-based social changes before it can become truly controlled. Malaria eradication was tried a few generations ago, and has roundly failed; malaria control is understood today to be a reasonable approach. But it requires many complicated things to work together: modern sanitation systems, mosquito habitat elimination, modern health care facilities and alert systems, and ultimately those will require significant dents in poverty. Even SARS-adjusted media attention isn't going to get those goals accomplished any time soon.

Fifth, and this is a very important point, if China had a free press SARS might not have become a crisis for anyone else: we might be talking about 27 deaths worldwide instead. But because China, for all the progress it has made in becoming a mature state with responsive institutions, has failed its own people, the world now faces a real problem. China's health care system is not responsive and transparent, but hierarchical and opaque in the extreme. With a free press treating SARS with the level of interest it clearly deserved, China might have halted the spread of SARS before it reached any other country. Instead, five months of officially-endorsed media silence, combined with institutional turgidity and ass-covering mentality, has left us with a Chinese population that is only becoming aware of SARS after it has already spread to many cities and killed many people. If only the Chinese media had been free to overreact back in November.

stavros, clearly you are now apparently entitled to be incensed because your words were overinterpreted, but you have completely derailed this thread. If you have bright ideas about malaria, please post your own thread, or you might as well pop into every single thread on MeFi and say "Why are you spending time playing Flash games? Why are you talking about Madonna? There are kids dying in Africa!" It's a trite point: there are always more important things to spend our time and money on, but that hardly means we must stop talking about everything else.
posted by dhartung at 11:11 PM on April 25, 2003


Malaria is not a first-world disease; it isn't going to come jumping around Illinois.

Yes. And not because people in Illinois shouldn't care about suffering elsewhere, but because they can actually do something with SARS knowledge - like, say, not visit someone with SARS overseas and come back home, as the first SARS case in my county did.
posted by transona5 at 11:18 PM on April 25, 2003


270 dead, huh?

Meanwhile, thousands of people a day are dying of Malaria, including more than 3000 children daily in sub-Saharan Africa alone.


Not in Canada or the US. I say that not to be snide or cruel, but malaria just isn't something for most people here to worry about. SARS is. I'm not saying that's fair or that it justifies how we spend medical dollars, stavros, but it does explain why one has a much higher profile.

Sometimes it seems like they should filter the elderly out of these statistics. They have a much higher rate of death after contracting virtually anything, than a 25 year old does.

Yeah, advertisers don't care what TV programs they watch, so that argument makes sense, I guess, smackfu. It just leaves for room for the 18-to-35 people who really matter.

If you look at this post, which I made back on Jan 1st 2003, it estimates that the worlds population has grown by over 23 million human beings, in less than 4 months.

I don't think the human race needs to worry about going extinct any time soon.


Beholder: So all those clean air laws, auto safety laws, FDA meat inspections, etc. are a waste too? Why save lives when you can just make more people?
posted by pmurray63 at 11:33 PM on April 25, 2003


Thanks for explaining the situation so well, dhartung.
posted by homunculus at 11:42 PM on April 25, 2003


Dittoes to dhartung.

The concern has less to do with the number killed so far, but with the fact that it is highly contageous, and there is a high possibility for asymptomatic transmission or mildly symptomatic transmission vectors. This makes containment very problematic. Basically the same epidemeology that made the 1918 Influenza the deadliest outbreak in history with a mortality rate of 4%.
posted by KirkJobSluder at 12:04 AM on April 26, 2003


you might as well pop into every single thread on MeFi and say "Why are you spending time playing Flash games? Why are you talking about Madonna? There are kids dying in Africa!" It's a trite point: there are always more important things to spend our time and money on, but that hardly means we must stop talking about everything else.

dhartung, I am not, nor have I, said anything like 'what's the point of talking about this here?' Thanks for putting words, once again, into my mouth, as you seem so inclined to do. I encourage people to talk about whatever the hell they want (yourself included) here, and more power to them.

Choose your own concerns, certainly. Be aware of whatever you choose to be aware of, do whatever you will and can to make the world better. I don't really care. But please don't accuse me of being trite (or equally, of being glib about something like the deaths on 9/11) merely because I disagree about the degree to which a 'crisis' may or may not be media-created.
posted by stavrosthewonderchicken at 12:21 AM on April 26, 2003


This is a broad-based public health crisis, and every major agency involved is jumping into urgent response mode, including the WHO and CDC

In a lot of people's estimation the WHO has waning legitimacy because it's affiliated with the UN (which many don't put any faith in) and is seen as a political body more than a medical body. It's not at all far fetched to feel that the WHOs advisory against Toronto was simply a way of taking the focus off of China. If you know anything about how the WHO operates you'll know that this type of advisory is totally and utterly unprecedented. Before SARS, WHO relied on member countries to issue their own advisories, which WHO would then distribute. So to many it's all very suspect.

As for the CDC, they have spoken out against the WHOs advisory against Toronto and issued their own which simply states that if visiting you should wash your hands a lot and not visit hospitals or homes where people have been quarantined. The CDC has stated publicly several times over the last week that the harshness of the WHOs advisory is patentedly unfair and that Toronto has done an exemplary job of dealing with SARS.

This makes containment very problematic.

And yet no one has randomly caught SARS in T.O. Each and every confirmed case and death has been tied to the original infector, what they call "the index case".

I'd take the time to find links to all this information but I suspect that most people love it when they think the sky is falling and it will be wasted time on my part. I've got better things to do, such as partying it up in my fair city; it's the weekend after all and there's no place I'd rather be than T.O.

And if I may snark further for a moment.... If unreasoned SARS fear keeps the state of Michigan from overrunning Toronto this summer as it does every blessed frelling year then hooray for SARS! I will never get used to how aggravating those people are as tourists.
posted by zarah at 12:24 AM on April 26, 2003


I love the calm, reasoned explanation about why we should be panicking. With respect to the above posters, it's going to take a lot more than that to convince me that worrying about SARS is a good use of my time.
posted by Hildago at 12:55 AM on April 26, 2003


I'm never wrong.
posted by shoos at 1:35 AM on April 26, 2003


crap. wrong thread.
posted by shoos at 1:46 AM on April 26, 2003


stavros the condescending jerk.
posted by kv at 2:19 AM on April 26, 2003


Well, that's that cleared up, then.
posted by stavrosthewonderchicken at 3:28 AM on April 26, 2003


The problem with these statistics is they ignore cases that may have never been diagnosed. It may well be that some people get this disease and are barely affected by it. If that's true, and these people shrug it off as a 24 hour bug or a cold, then the death statistics are hopelessly skewed. In short, it's far too early to make definite statements; I find it significant and interesting that this disease seems to be very slow to spread to new places. I don't believe this is because health authorities have managed to bottle it up - I think there's factors that cause SARS to spread under certain specialized circumstances. If this was a runaway epidemic, we should have seen a lot more cases of it by now.
posted by pyramid termite at 5:59 AM on April 26, 2003


jokeefe and stavros:

At one point in our history, only one human being on the planet was infected with the HIV virus.
posted by syzygy at 6:02 AM on April 26, 2003


God you people are idiots.

"ooh, only 274 people, who cares!?" But a month ago, it was 20 people. Next month it could be 2,000 people, then 20k, and so on. If everyone in the world caught this, there would be over a billion dead.

Only about 4k people have been infected. Obviously that number is going to grow, and by a lot. SARS is way more contagious then things like Pneumonia, AIDS and the like.
posted by delmoi at 6:53 AM on April 26, 2003


I agree with what you're saying, syzygy, as I was upthread, when I said : "I'm not arguing that we shouldn't be worried - my point, such as it was, was to express some mild disgust with media priorities."

Argh. Am I speaking Swahili all of a sudden?!
posted by stavrosthewonderchicken at 6:58 AM on April 26, 2003


Whew! Thank goodness I'm not an idiot in addition to being a condescending jerk!
posted by stavrosthewonderchicken at 6:59 AM on April 26, 2003


Colour me freaked out by SARS. What worries me the most is that it's mutating rapidly. So if you're in the 90% of people who catch SARS and survive, then your wrecked lungs will still have to deal with the next mutation. I think this is as serious as diseases get. Imagine if common colds had a 10% fatality rate. I've had a lot of colds in my life.
posted by seanyboy at 7:25 AM on April 26, 2003


I really am beginning to wonder if SARS skeptics are just not following the news very closely. That feeling increased significantly after reading this thread.

The 1918 influenza epidemic killed what, 2.5% of infected? A disease doesn't have to have a high mortality rate to be a gigantic problem, not if it's extremely contagious. SARS kills at least twice that number. The mortality rates are suspect, but are far more likely to increase than to decrease. Since we've been counting the number of dead divided by the number of infected, without correcting for the incubation period, WHO estimates are skewed extremely low. So if SARS was as contagious as the Spanish Flu, it would be a huger disaster. Fortunately, it's not that easy to catch, but only barely. Nurses have been getting SARS even when wearing N-95 masks and gloves and protective gowns and eye shields. SARS can last on objects for up to 24 hours, and doctors suspect hands of being the main method of transmission. That means if someone with SARS coughs, but covers their mouth with their hand, before paying for something with a credit card, then you can get SARS from being the next person in the store to use their pen. I don't believe that's actually happened, but an elevator-button transmission definitely happened. It's also somewhat airborne, since there have been cases in planes where people three rows and the aisle apart were infected. What this means is that it's not hysteria when hospitals have to be sealed and disinfected, or trains....it's common sense.

SARS is one, inordinately long strand of RNA. Long strands are correllated highly with mutations. Single-stranded data are correllated highly with mutations. Who knows how long it took for SARS to mutate enough to jump to humans? All we know for sure is that it would take less time for it to mutate just enough to be as deadly as the feline coronavirus which kills all infected. Worrying that the virus will mutate in such a way would be hysteria. However, between SARS' mortality rate, its infection rate, and its predilection for mutations mean the disease deserves recognition as a serious problem for humanity.

We'll be set when we have a vaccine, assuming the virus changes slowly enough for us to be able to catch up, influenza-style. But that won't be for months. Before then, a lot more people are going to die.
posted by jbrjake at 8:13 AM on April 26, 2003


I was at my pulmonologist's office yesterday for my normal six-month checkup. Even though there has been a confirmed SARS case in the area, they aren't taking any precautions. Because of course, what could they do? Everyone who goes there has one or more symptoms of the illness.

Being hard-of-breathing sucks. Asthma rates are on a precipitous rise in the US and around the world. Fifteen million adults have asthma, 6.3 million children in the US alone. Just thinking about it makes my chest tighten up. I remember when it was considered just a childhood disease (during my own childhood, for example). I personally am just waiting for the fallout when SARS hits that compromised population after being spread through the "doctor's office" vector and then the "elementary school" vector. Excuse me while I break out my inhalor.
posted by elgoose at 8:23 AM on April 26, 2003


Damn it! We can't win - either the world gets wiped out by SARS, or the media has suckered us again.
posted by SpaceCadet at 8:31 AM on April 26, 2003


It should be noted that comparing SARS to other diseases ignores the obvious: that just because you have one doesn't mean you are immune to the other.
For example, when SARS hits central Africa, with its horrifically high HIV and AIDS rates, its (SARS) death rate could well be over 80%. It may have similar lethality to those millions already weakened by malaria, tuberculosis, or just malnutrition.
The biggest limiting factor will be space, that is, population density, taking into account migration routes, and only lastly health prevention and treatment.
I will also add that although massive resources are in place to combat influenza, it remains the #1 biological threat to the world and the US. The Swine Flu proved that in the right circumstances, nobody can produce and distribute vaccine faster then the disease progression.
posted by kablam at 8:40 AM on April 26, 2003


The point is not that SARS isn't contagious, or dangerous, it's that all you can do to prevent it is limit your contact to people you know have been exposed. Worrying about it all day long is not going to help anybody. Television news programs that tell you the same statistics every 15 minutes are just frightening you, and you are allowing yourself to be frightened.

If SARS could be prevented by eating more carrots or something, it would be a good thing for everybody to be talking about eating carrots all the time. But if SARS is more contagious than the common cold, and there is quite literally no way to reduce the risk of catching it if you are exposed to it, all this discussion is just panic-mongering.
posted by Hildago at 12:32 PM on April 26, 2003


Scientific hints about the origin of SARS also provide painful political lessons in how a disease that has spread worldwide could have been prevented.
posted by homunculus at 1:57 PM on April 26, 2003


Wow. My mother-in-law, a three-pack-a-day smoker since the Johnson Administration, now has asthma and frequently is short of breath (although she and my wife insist she doesn't have emphysema). I'm worried about what could happen if she's exposed to SARS; she had pneumonia three years ago and spent two weeks in the hospital.
posted by alumshubby at 3:26 PM on April 26, 2003


Pyramid termite expounds: "If this was a runaway epidemic, we should have seen a lot more cases of it by now."

Ahem.

I don't know how much you know about exponential growth, but here's a case study: five weeks ago new SARS patients were appearing at the rate of 1 per day worldwide. 2.5 weeks ago 10 per day were diagnosed worldwide. Today 100 new cases of SARS are being diagnosed each day. If this continues, then by mid May there will be 1000 new cases per day, and so forth.

Comparing SARS to pneumonia or malaria is simply stupid because both these diseases have reached a stable state. the reason for concern is for the potential of unchecked growth.

The Flu of 1918-19, which has been brought up so much in discussions of SARS, had a growth vector nearly twice that of SARS, and even then it took 18 months to run its course.

This is the worst new disease since AIDS, when looked at from the standpoints of contagion and fatality rates. Hanta Virus and Ebola, both highly dangerous, don't have the potential that SARS does to reach pandemic state.

Once SARS blooms exist in more than 10 US cities, travel advisories will lose all effectiveness, and it's a foregone conclusion that it will spread unchecked, and if you think the fatality rate is acceptable, then you should see what happens when there simply aren't enough respirators to go around. how many do you think each hospital has, just lying in wait?

The best course of action is to hold it in check through advisories and quarantine, in hopes that we'll have a vaccine within 12 months.

9/11 had a fatality rate of 0.04% in New York City. Using the modest fatality figure of 4%, only one in 100 New Yorkers would have to catch SARS to beat that death toll, and that's just one city.
posted by kfury at 4:58 PM on April 26, 2003


First-world countries are organized enough to stop the spread of the disease. Singapore is a good example they pretty much have it under control for now (see homunculus NYT link above) the USA could do the same. The problem is 2nd and 3rd world countrys it could go unchecked. Typically those governments don't have the resources and it falls to the local populace to take care of each other and they won't act untill there is a full-blown problem by which time it could reach pandemic proportions.
posted by stbalbach at 6:41 PM on April 26, 2003


stbalbach: I, and the CDC disagree. Back during the Ford years, the Swine Flu was believed to be the next killer flu and the federal government went full tilt to try to produce and distribute the vaccine needed. It could not. Estimated fatalities anywhere from 150,000 to in the millions. Fortunately, the disease mutated to a less harmful strain before it arrived in the US.
This was in the days when flu had the unique characteristic of travelling around the globe from east to west. This too has changed. Now, new, potent influenzas are being incubated in Alaska, then brought down the west coast of the US, cutting our response time down to nothing.

As the Chinese are now learning, quarantining a major metropolitan area is next to impossible.

Our biggest advantage is low population density, a good health care system and overall healthy population. But given worst case scenarios, we can still have a lot of fatalities.
posted by kablam at 9:06 PM on April 26, 2003


Captain Trips! Captain Trips! Now the question is whether to pack my bags and move to Boulder or to Las Vegas?
posted by KidnapCounty at 10:00 PM on April 26, 2003


I just want to make a point about the flu, since that is a disease that is being compared to SARS and causes many, many deaths each year.

First, comparing a newly discovered disease like SARS to an disease such as the flu is somewhat futile. We don't know what SARS is going to do or how any possible treatments of the disease are going to evolve.

Very importantly, there are aspects of the flu virus that keep it from being more of a concern that it already is. Firstly, it is a seasonal disease, it dies out every year. This keeps any major flu outbreaks contained at least to a degree.

Secondly, there are vaccines for the flu (this can be a controversial area I know) and there are treatments at this point in time.

Something that we don't know is always going to be more frightening that something we do know. This is human nature.

I dislike the sensationalism of the popular press as much as anyone. However there is an analogy here I think with the treatment of patients who are, rightly or wrongly, labelled as histrionic. They are more likely than other patients to have real and serious diseases over-looked by their health provider.

Similarly, we shouldn't allow the sometimes sensationalist treatments of serious topics by the popular press blind us to the realities of news stories, anymore than we should allow ourselves to be foolishly led or influenced by them.
posted by lucien at 3:20 AM on April 27, 2003


lucien: that is the normal progress for *typical* flu. The atypical flues, the "killer" flues, don't fit that pattern. For example, the Spanish Flu lasted for 18 months straight. Its primary victim were males 18-35 years old. Not the usual "old, young, and infirm."
And, as far as vaccines are concerned, most are created in chicken eggs, which is why "avian" flues, that kill chicken embryos, are much more difficult to develop vaccine for. Hong Kong has, in the last few years had at least two 100% preventative chicken kills, and a partial kill or two.

Last but not least is the production/distribution problem.
Cranking out huge numbers of perishable vaccinations, then distributing them *and* getting the word out that they are available is astoundingly hard. Even in the last flu season, production/distribution difficulties delayed vaccine getting out, and then it only made it to high risk groups, at first. (And consider that it takes a while for the vaccine to provide protection, once it's in you.)

Personally, I drove across town to be there for some of the first "general public" available shots in my area.
posted by kablam at 8:00 AM on April 27, 2003


No one knows enough about the coronavirus that causes SARS to be able to state anything with absolute certainty.

Science is on the case. The answers will take time.

This is what we do in Hong Kong—follow the best available advice of the moment:

• Wash your hands frequently. (I did before, but I have definitely increased how often I do this.)

• Keep your hands away from your face. (I was a bad one for rubbing my eyes. No longer.)

• Stay away from people who have been infected. (And oh yeah, if you're sick, do everyone a damned favour and take the day off work, huh?)

• Wear a mask to control the spray of your own coughs and sneezes, and in case someone else coughs on you. (I wear my mask on trains and buses—close quarters—but out on the street I don't.)

• Disinfect the surfaces of the things you touch at home when you first arrive: handles, switches, taps. (An easy habit to acquire. We don't even have to think about it anymore. Even if there were no new virus, it's not a bad idea.)

• Disinfect the floor. (I've been doing this ever since I moved to Hong Kong. Old hat.)

• Wash the clothes you wore immediately when you get home. (Again, not hard to do.)

It is quite difficult to contract this virus if you don't get near it, or don't give it a chance to survive if it's in your presence.
posted by bwg at 9:48 AM on April 27, 2003


bwg: looks as though SARS will be a powerful selective pressure for the obsessive-compulsive disorder gene...
posted by Bletch at 12:29 PM on April 27, 2003


Last chance to eradicate SARS?
posted by homunculus at 1:39 PM on April 27, 2003


Bletch: Indeed.
posted by bwg at 7:56 PM on April 27, 2003


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