View Full Version : SARS' Mythical Mortality Rate
docbear
Re: 4/23 SARS' Mythical Mortality Rate
« Reply #32 on: Apr 24th, 2003, 7:07am »
1) SARS Mortality – The “Official” figures”:
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The commonly reported “official” 3-5% SARS mortality rate is unbelievably low, according to those who work with SARS cases. _ Nonetheless, on April 23 _the Executive Director of Communicable Disease for the WHO (World Health Organisation), Dr. David Heymann said that SARS had, “a death rate now of about 5%.”
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For the past week, our SARS Updates have demonstrated that official estimates of SARS mortality are in error. _ The “official” method takes the number of deaths and divides it by the total number of reported cases. _ _There is also a “reverse official method” which estimates the SARS survival rate as the number of cases discharged, divided by the total number of cases. _ _
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_SARSWatch.org provides a number of Web Links about SARS mortality. _You can see a good graph of ‘rising’ SARS death rate as calculated by the “official method” at this web site. _
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The New York Times, April 22, ran a story titled, "Death Rate From Virus More Than Doubles". _It says the first reports of SARS' death rates, from WHO, were around 2%, and says the current rate is 5.6%. _
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The NY Times’ article sees the rising “official” death rate and worries that it is a sign the virus is mutating, becoming a more dangerous killer. _The article neglects the simple explanation for the 'rising' SARS mortality rate. _
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The reason the “official” death rate appears to be is rising is that such rates are based upon a flawed assumption. _The "official" method, in the early epidemic, had grossly underestimated the true case-fatality rate. _It assumes that no person, currently ill with SARS, will die -- obviously a ridiculous assumption. _This early underestimation, when the epidemic was very poorly controlled, was a small comfort, a pleasant fiction for the harried public health workers. _
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On April 21, Dr. Joseph Sun, a pathologist at the University of Hong Kong, said that there was a 5% mortality rate in Hong Kong. _This fit with earlier pronouncements by Hong Kong’s Minister of Health, Welfare and Food. _ By April 23, the “official” mortality rate in Hong Kong was up to 7.2% (105 deaths divided by 1458 total cases). _The Minister had to admit that the rate was not going to be 5%, and that the ‘official’ mortality rate calculation had not been correct. _
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If he had not backed away from the “official estimates, that Hong Kong executive would have to agree that the epidemic had become more deadly. _He knew this was not true, because the daily numbers of new cases had dropped in Hong Kong over the past ten days. _
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The problems with the “official” method are that it will underestimate the death rate when an epidemic is racing out of control, and it will show a rising rate as the number of new cases slows. _ Until the last person has died at the end of the epidemic, the “official” estimate will always be lower than the true case-fatality rate, a comfort to those in SARS-denial.
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In the US, on April 22, Dr. Julie Gerberding of the CDC (Centers for Disease Control and Prevention) noted this rising rate and understood it was an artefact. _She said that worldwide, " ...the postulated mortality rate right now is 5.9 percent. Thankfully, we have had no deaths in the U.S. up to this point in time. You may see the mortality rate go up as we go forward, but it is in part because the definition of SARS will become more precise as we begin to utilize laboratory tests or as some of the people initially included in the definition are ultimately found through virus testing or other kinds of antibody testing to have something else. So the denominators shrink, and the number of deaths may stay the same, so obviously the number will get larger." _
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Alternative models, detailed below, show that the actual case-fatality rate of SARS is between 8 and 20% as documented in our recent SARS Updates. _ The two methods we use are the “cohort” method, and a method recommended by Henry Niman. _
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2) SARS Mortality – Niman’s Method:
Wired Magazine reviews Niman's method of estimating the case-fatality rate. _April 19, Harvard scientist Dr. Henry Niman estimated that SARS has an 18% mortality rate. _A French scientist, Axel Ellrodt, estimated a 16% mortality rate, using Niman’s method. _Ellrodt’s figures can be seen in an Excel spreadsheet, at this Web site.
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Basically Niman looks only at SARS cases, for whom the result is clearly known. _He counts only the deaths and the discharged patients. _Niman estimates that the actual case-fatality rate is approximately equal to the number of deaths, divided by the number of cases with certain outcomes (the deaths are divided by the sum of the deaths plus the discharges). _
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3) SARS Mortality – The Cohort Method:
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The “Cohort Method”, like Niman’s, seeks to eliminate the group of patients with uncertain outcomes, but it does so in a slightly different way. _It looks at the date when the newly dead patients were first reported to have SARS. _Then it divides the number of cumulative deaths by the number of cumulative reported cases on the date that the newly dead patients entered the SARS count. _
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To use the cohort method, we must know the average duration of a SARS illness prior to death. _
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At a press briefing in Hong Kong, April 20, Dr. Ko Wing-man said that the duration of illness, for Hong Kong SARS patients that die, is “several weeks”. _He also indicated that it was about 3 –4 weeks, when discussing members of the Amoy Gardens cluster of SARS cases. _That cluster of more than 320 SARS cases peaked on March 24. _Three of those patients died April 19-20. _On April 22, Ms. Elizabeth Rolland of the Ontario Public Health office said that the average duration of a SARS illness, in Ontario, has been 14.5 days for patients that died and 15 days for those that lived. _To use the cohort model, we can choose to look back 14 days, 3 weeks or 4 weeks, depending upon the average duration of a SARS hospitalisation. _
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China gives a fair estimate of the case-fatality rate:
On the mortality issue, China has been more honest than the other affected countries. _On April 21, Chinese Executive Vice Minister of Health, Gao Qiang, said, _"Guangdong has developed some effective methods which can cure 80 percent of the patients." _[ 20% cannot be cured – docbear]
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Age is a factor, in the chance of dying from SARS:
The death rate for SARS varies with age, being most dangerous for the elderly. _Here is a nice table from the Straits Times. [ Hat-tip to 'musewerks']
MORTALITY RATE _
In Hong Kong for different age groups, as of April 15
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AGE GROUP
MORTALITY RATE
0-14
0
15-34
0.4
35-54
3.6
55-64
6.5
65-74
18.9
over 75
28.6
Source: HK Dept of Health
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These figures are based upon a very small group, not enough for a “statistically valid” sample of the “age-dependent case-fatality rates”, but they indicate the power of good mortality figures.
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Example: _The 3 methods of calculating case-fatality rates, with Canadian data: _
The following calculations are based upon the April 22 figures for Ontario:
57 probable SARS cases are discharged/at home. _13 probable SARS cases have died. _55 probable SARS cases are in hospital. _One is under investigation. _ _Total probable cases = 136 _
143 probable or suspected cases discharged/at home. _14 prob. or sus. cases have died. 101 prob. or sus. cases in hospital. Two under investigation. _ Total probable & suspected cases = 261
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1) "Official" model. _This model gives a minimum number. _The true case-fatality rate can be no lower than this. _
The case-fatality rate for those who probably have SARS is = 13/136 = 9.6%
The case-fatality rate for those who are suspected or probably have SARS is = 14/261 = 5.4%
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1-A) Reverse of the "official" model. _This model gives a maximum number for the case-fatality rate. _It can be no higher than this.
The case-survival rate for those with probable SARS is = 57/136 = 41.9% _ The maximum _limit to the case-fatality rate is 58.1% _
The case-survival rate for those with suspected or probable SARS is = 143/261 = 54.8%. _The maximum limit to the case-fatality rate is 45.2%
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2) Using Dr. Niman's model. _This model ignores those who are still in hospital. _It looks only at those whose outcomes are certain, i.e. the discharged or the dead.
For probable SARS cases, the case-fatality rate is 13 / (57+13) = 13 / 70 = 18.6%
For combined probable and suspected SARS cases, the case-fatality rate is 14 / (14+143) = 14 / 157 = _8.9%
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3) Using the cohort model. _This model ignores the recently diagnosed SARS patients. _It observes only the earlier SARS patients, up to the date when the recently deceased cases were first reported. _Today, we will use Ms. Rolland's figures of an average 14.5 days duration, for lethal SARS cases. _
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Here are the figures from 13 days ago, when the cohort would be completed and reported, April 9 _-- 94 total probable cases, 101 total suspect cases, 195 total current cases (includes 10 deaths and 49 discharges).
The cohort model says:
The case-fatality rate for those who probably have SARS is 13 / 94 = 13.8%
The case-fatality rate for those with probable or suspected SARS is 14 / 195 = 7.2%
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Summary:
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It is time to discard early "official" estimates that the mortality of Severe Acute Respiratory Syndrome (SARS) was 2-5%. _
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For those who probably have SARS, we know that the true case-fatality rate must be between 9.6% and 58.1%. _
The best current estimates say the SARS case-fatality rate is between 13.8% and 18.6%.
Rural China Struggling With SARS
Hospitals Unequipped To Handle Infections
New disclosures by the Chinese government have heightened the world community's sense of alarm over the spread of SARS. Enter the Gallery.
By John Pomfret
Washington Post Foreign Service
Friday, April 25, 2003; Page A17
QINGXU, China -- "If I get that disease, I'll just wait to die." The statement by Zhang Gang, a 32-year-old farmer in this impoverished rural county, was matter-of-fact. And probably true.
In a worrying development in the fight against severe acute respiratory syndrome, the disease has entered China's countryside, a part of this vast country that is unprepared and unequipped to fight it. According to Chinese reports, nowhere is the situation worse than in Qingxu, 270 miles southwest of Beijing, where dozens have caught the disease and several have died.
About 20 miles up the road in Taiyuan, the capital of Shanxi province, doctors estimate that there are about 300 cases and that 15 patients died last week at one hospital alone, although the provincial government acknowledged only 162 infections and seven deaths. In an indication that there could be far more cases than reported, a Chinese government spokesman was asked how many respirators were needed to deal with SARS in Shanxi. He said there were currently 80 but that hospitals could use another 453.
Life in this gritty mining town has been severely affected by SARS. "Temporarily shut due to extraordinary circumstances," read the sign on the door of a diner called The Spirits' Meeting Place. Such notices were all over town. There were no pedestrians. Schools were closed, as were discos, Internet bars and karaoke halls. Intercity buses were not stopping in Qingxu. "The place is dead," said Wang Baishan, a local truck driver.
The Chinese cabinet yesterday established a $2.56 billion fund to help poor farmers and urban residents pay for treatment, to help hospitals in China's poorer regions modernize to deal with the disease and to support SARS research.
But Zhang and others in Qingxu said they didn't think they would have access to that money if they became ill. "A peasant's life in China has never been worth anything," Zhang said. "I made $300 last year and I'm rich compared with some of my neighbors. But it costs $250 to go to the hospital. What happened to the money that was supposed to bring us out of poverty?" He was referring to millions of dollars in anti-poverty funds that many believe were stolen by local officials.
Officials are so worried about the disease spreading to poor parts of the country that they have begun to ban migrant workers from returning home. Shanghai and Beijing are among the cities that have taken that step. However, China's size and its population of 1.3 billion make such an effort impossible to enforce. Thousands of workers have already fled Beijing, possibly bringing SARS deeper into the countryside, and police at checkpoints on roads leaving the capital are not attempting to stop every vehicle.
"We really don't know what or who we're checking for," said one officer.
Authorities in Shanxi, and in other provinces, are also worried by another phenomenon. SARS patients and those suspected of having the virus are fleeing hospitals in the hinterlands because they have no faith in the medical system and want to die at home.
The China Youth Daily reported Wednesday that a relative of a SARS victim in Taiyuan, who had a fever and a dry cough, fled when an ambulance came to pick him up. "This is not the first time this has happened in Taiyuan," the report said.
One problem is that, for years, China's government has devoted few resources to health care in the interior. State subsidies for provincial hospitals have been slashed.
"If you do not have the resources to deal with SARS, I think we're going for a very big outbreak in China," Henk Bekedam, the World Health Organization's representative in China, told reporters in Beijing last week.
In a speech last week, Premier Wen Jiabao said the health care system was so inadequate that an epidemic could spread "before we know it" and "the consequences could be too dreadful to contemplate."
There are signs that people outside China's major cities do not understand the danger presented by SARS. The government has begun a campaign to distribute information about the virus, but the material apparently has not reached people in rural areas.
In Shandong province to the southeast of Beijing, for example, a reporter from the People's Daily newspaper visited several rural regions and reported that taxis and public buildings were not being disinfected as directed by a nationwide "urgent notice" issued by the Commerce Ministry.
Despite the cabinet's ruling that no patient with SARS should be refused treatment, China's provincial hospitals were still demanding a down payment before they would treat patients. At a hospital attached to the Inner Mongolian School of Medicine in Hohhot, the provincial capital of Inner Mongolia, seven people thought to have contracted SARS waited for seven hours in a common waiting room while they pleaded for treatment, according to Chinese news reports.
The patients were relatives and friends of someone who had died of SARS, the reports said. They were exhibiting symptoms of the disease -- a dry cough, fever and vertigo. The doctor decided they should be admitted, but none had the required $250 deposit. So they were transported to the emergency room, where they lay on stretchers and waited.
Asked by a reporter why the patients had not been treated, the head of the emergency ward, Wang Jianping, replied, "What can I treat them with?" When told that the cabinet had issued regulations mandating the treatment of all SARS patients, Wang replied, "This hospital has procedures for prescribing medicine."
Shanxi is one of the poorest of China's 31 provinces, regions and major cities. Its medical system is a shambles, according to a source who has worked with the government, especially its ability to deal with an epidemic.
Shanxi medical authorities also are troubled that only 20 of 157 acknowledged cases have been traced to a source of infection, according to a doctor in Taiyuan.
"That means that people are still out in public getting sick," the doctor said. "Our tracing system is too weak. We don't know how these people got ill."
SARS is believed to have arrived in Qingxu through Yue Shoubin, the Communist Party secretary of Mayu township. Yue had a reputation as a corrupt leader who demanded personal payoffs from villages under his control.
Local sources said Yue used money collected from Mayu township to go to Beijing in March for a medical procedure at the No. 301 Hospital of the People's Liberation Army, which was treating SARS patients. Yue was infected and returned to Qingxu.
In China, if a party secretary gets sick, local officials are expected to visit him in the hospital. So, Cui Yueren, the head of Qingxu's Chinese People's Consultative Congress, an advisory body to the Communist Party, led a delegation to visit Yue in a local hospital. Cui was infected and died in Taiyuan on April 5. Yue's wife, their driver and other local officials also were infected. Yue is still in the hospital.
In Mayu, local farmers say they did not know of any cases of peasants in the area having contracted SARS.
"It's just the leaders. We're breathing better air than they are," joked Wang Mei, 27, a farmer who stood holding her baby at the side of the road. "The party secretary deserved what he got. He took our money to go to Beijing to get medical treatment. Now he's infected all the other officials."
© 2003 The Washington Post Company
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April 26 2003
Everyone infected with SARS and anyone they have been in contact with must be found to contain the explosive epidemic, the World Health Organisation (WHO) warned today.
"We cannot afford to miss a single person," said WHO regional director Shigeru Omi at a meeting of East Asian health ministers and international experts on the Severe Acute Respiratory Syndrome (SARS) crisis.
The meeting in Malaysia's capital is a prelude to an emergency regional summit on Tuesday in Bangkok aimed at forging a united front against the disease which has left 281 dead out of more than 4,800 cases worldwide, mostly in East Asia.
"We are at a crossroads. What we decide today and at the heads of state meeting on Tuesday will determine the future course of this outbreak," Omi said.
"We must be absolutely relentless in our search for every possible SARS case. We must use every weapon at our disposal. The world is watching us."
The disease erupted in southern China in November but was recognised as a major health threat only last month.
In the six weeks since the WHO issued a global health alert on March 12, the disease has caused widespread panic and economic disruption in East Asia and severely affected countries as far as Canada.
Omi noted that although the number of SARS cases and deaths was not large in comparison with those caused by some other diseases, the epidemic poses an "unprecedented" threat, and has three special characteristics
"First this virus has already demonstrated its explosive power to cause sudden outbreaks in a large number of countries," he said.
"In some countries schools and offices are being closed, international travel has been dramatically reduced, tourism has almost disappeared and normal life has been seriously disrupted," he said.
The second characteristic is the particularly severe impact on health workers, who constitute the largest group of cases.
"This is a major concern since this means that our health systems are under threat, undermining our ability to fight the outbreak," he said.
And there is the urgency to track down all SARS cases.
"Although this is a public health problem that affects large groups of people, we have to reach each and every contact and suspected case if we are to stop the outbreak from spreading," Omi said.
Omi said there had been many encouraging developments in the six weeks since the WHO issued a global alert.
"However, despite our significant achievements, the epidemic is spreading to more countries every week and countries with SARS cases are experiencing great difficulty in containing the epidemic," he said.
- AFP
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"You have to consider the morbidity rate as well - in other words, how likely as a person in an environment where SARS is present (a pedestrian walking along/across the street) is it that you will catch the disease (be hit by a car).
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You can look at the overall impact by combining these two and looking at the overall death rate. In Hong Kong in 46 days 53 people below the age of 65 have died of SARS (of whom 14 were already chronically ill with something else). In the same period, using the 2000 death statistics on a prorata basis, 171 people under the age of 65 would be expected to die from accidental injury or poisoning.
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In other words, for people less than 65 in HK you are still more than three times as likely to die from accidental injury or poisoning as from SARS.
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For me this is a far more useful piece of information than whether the "mortality rate" is 6% or 10% or whatever."
"My own opinion is that this panic is irrational beyond words. The hysteria is absurd, as are the witch-doctor remedies people are racing to buy. It's a case study of panic and, in some cases, stupidity. I want to flee Beijing not because of SARS but because of this hysteria, which has made life here painfully difficult and nerve-wracking. OK. the movers come in 30 minutes and they'll be pissed if I'm sitting here blogging...."
cheesebeast
28-04-2003, 01:27
From http://www.independent.co.uk
I'm not sure I fully agree with this guy writing from the comfort of his London bedsit, as although there is more than an element of panic, it's a little unsettling to live in a place where you can't be sure that the next person who serves you may not pass on a 5-10% chance of dying, although Hobbes I am heartened to learn from one of your earlier articles that my age group has a much lower chance of dying in the unlucky/unlikely event that I will be infected.
It strikes me that the chance of it spreading to some unknown extent in parts of rural China is not insignificant?
It has seemed reasonably difficult to stop the spread of the virus in hospitals and areas where it has been known that peops are infected and one would assume that all possible precautions were taken in the hospitals.
That said I'm off to the discos of Wan Chai to see what the action's like out there, I'm sure the hookers are doing it tough.:p :p
Robert Baker: We are in the grip of an epidemic, but it is not Sars
Deadly conditions such as malaria, Aids and heart disease are being ignored while the world overreacts to the new virus
27 April 2003
Your best friend is an alcoholic heroin addict who has run up unpayable debts with the mafia. One cold wintry day he proposes going out. He says he is going to see Tony Soprano to demand some more money to score some smack. You launch into an uncontrollable, hysterical screaming fit about how he should be wearing a proper vest.
This is pretty much my assessment of the media coverage of the Sars epidemic to date. Could everybody not just calm down for one moment? The Government is failing to act and should be making Sars a notifiable disease like anthrax, say some papers. It's from outer space, says the expert from Sheffield with the suspiciously Viz-like name, Dr Milton Wainwright. Sars could be bigger than Aids and our only hope is to mount an immediate aggressive global response at the highest levels, says Dr Patrick Dixon, an expert in predicting global trends at the London Business School's Centre for Management Development. We're all doomed, says a Walmington-on-Sea based spokesman for the Home Guard.
Please excuse my apparent facetiousness in the face of a serious world health issue. It is, of course, true that some 290 people have died since this problem was identified and at least 4,800 have been infected. There has been a Chernobyl-like cover-up in China. The disease may be caught by casual contact. It has taken a hold in some Western cities. There is no cure or vaccine. But "the first global epidemic of the 21st century"? Hang on, we haven't finished with the old ones yet.
Let us take a cold look at some other figures that might put Sars into perspective. Since you began reading this article several people have died of malaria, probably children; 3,000 more will be dead by tomorrow. Nearly three million more people will have died of tuberculosis by the end of 2003; the progress of resistant disease is unstoppable. Forty million people have died of Aids.
Nor can we in the West be complacent. Ordinary influenza kills between 20,000 and 30,000 in the United States every year, and proportionately similar numbers in the UK. Our neighbours in eastern Europe are undergoing a catastrophic rise in HIV incidence. Hospital-acquired infection with antibiotic-resistant strains of common bacteria has reached epidemic levels in some UK hospitals. Blood-borne infection with resistant bacteria such as MRSA – methicillin-resistant staphylococcus aureus – has an almost identical proportional mortality to smallpox: about 30 per cent.
Doctors who are involved with management of these infections and wish to educate the public about them grow weary of beating the same old drum to the same old indifference from the press. None of this is news these days. Is anyone in Fleet Street interested in World TB Day any more? HIV's almost a non-story nowadays. May I remind you of the Sars figures in Britain to date? Six people have been identified as probable Sars cases. Six. Not 6,000, not 60. Six. None has died. In some countries, the incidence of HIV exceeds 30 per cent, and cases in London are increasing by 10 to 15 per cent per year.
You could reasonably argue that none of the figures for major infective killers, shocking as they are, has any influence on our response to Sars. This is a new disease, an entirely new virus that can be picked up in aeroplanes and affects affluent Westerners rather than penniless African children. Health workers such as doctors and nurses can be infected and some have died. Some say a handshake is enough, or touching a lift button. Nobody has natural immunity to this variety of coronavirus, which makes it a ready candidate for a widespread pandemic. It has a recognised mortality rate, now believed to be about one in 15. I could be wrong – we may be in for a new Black Death, although the evidence so far suggests not, and the agent may not even be as infectious as first thought.
But do we really gain anything by some of the overwrought headlines we have read in the last week? What possible virtue is there in panic? You can make a very short list of the people who benefit from this kind of knicker-twisting. Publicity-hungry "experts" from obscure institutions. Manufacturers of "protective" face masks. (Check out the ads for a respirator offering reliable protection against anthrax, biological agents, Sars and pollution: £9.99. Sorry, guys, but it probably doesn't work.) Journalists who have been kicking their heels since Iraq petered out so disappointingly, and editors with rather forlorn-looking empty front pages. Perhaps we need a constant sump for our free-floating anxiety. Saddam has inconveniently disappeared. What's next? Does anyone remember the thriving market in helmets when Skylab was about to crash to earth?
And have we learnt nothing from the recent past? An entire, proud industry was virtually destroyed in the name of CJD. The country was visited as though by a biblical plague, an already struggling rural economy was kicked in the teeth. I attended a lecture at the Royal College of Physicians at the height of the BSE crisis, given by one of the Government's most senior advisers on CJD, Professor Roy Anderson, who has also recently reported on Sars. He predicted deaths on a large scale from CJD. While I have every sympathy for the victims of this dreadful condition, and their relatives, and do not wish to minimise their suffering, the projected epidemic never came. We are, however in the middle of a separate epidemic – of heart disease caused by our diet, including beef. But that's not news.
Then there was foot and mouth. A complacent government failed to act and yet another plague was visited on our countryside. I wonder if this recent episode is fuelling our hysteria? Hard to know what lessons we can draw for Sars, as that crisis arose because there is no veterinary Health Protection Agency. There is no possibility of ring-vaccination against Sars. Perhaps someone will propose a contiguous cull.
The Government's Chief Medical Officer, Liam Donaldson, has got it right. We should be vigilant but calm. Clinicians up and down the country are alert to the condition – how could they fail to be? Making the disease notifiable is an irrelevant bureaucratic nicety under the circumstances. We have probably the best public health service (recently renamed the Health Protection Agency) in the world. Shouldn't we listen to it? In the words of another spokesman from Walmington-on-Sea: "Don't panic!"
Dr Robert Baker is a specialist in infectious diseases at King's College Hospital, London
28 April 2003 01:08
cheesebeast as my earlier postings might indicate i am more inclined in the direction of the article you posted. scarper made passing reference to it being "all hype" over 2 weeks ago and i am sure the panic is causing more damage than the disease itself.
in the vast majority of cases transmission has occurred from close proximity over longish periods of time ( metropole hotel, PoW hospital, amoy gardens, family groups ) rather than casual contact. further they seem to have it under control outside china. ( new cases in HK are declining nicely ). also it appears it is likely only transmittable whilst the carrier has a fever so hopefully those peops will not be out and about in the general public.
i view the only major risk as transmission from china come autumn, winter if they cannot contain it there.
http://www.whatagreatproduct.com/
further mutation is a serious concern - if it manages to toughen up to be more like a regular cold virus (same family) then we maybe in serious trouble. the panic could have saved a lot - who knows.
"The 1918 flu epidemic is different again. _Flu is very contagious indeed. _If SARS had been as contagious as flu we would be in serious trouble, but it's not. _In all this hysteria the salient point about contagion from the start is worth remembering - you can fly from Hong Kong to Toronto in a plane with a sars victim and in all probability not get infected. _Indeed at the start of the epidemic WHO traced 2000 people who'd been on flights with a known sars case and didn't find a single case.
Indications are that the disease is not seriously contagious before the victim becomes ill. _I point to the WHO tracing airline passengers at the beginning of the outbreak. _The first 2000 they traced they found not a single case of transmission. _Since then they have found the odd one, but you have to be sitting right next to the carrier and they have to be ill."
Example - say you have an infected lecturer go into a hall with 100 students for an hour. _With measles when he leaves all 100 students have been infected - that's *highly* infectious . _With flu it's a couple of dozen. _Smallpox and the lecturer needs to dance with the students to pass it on. _Sars you might get an infection or two, if your very unlucky, but you most probably won't. _At least one of the super-infectors seems to have been caused by a leaking nebulizer - you might as well go and inject people with the sars virus in those circumstances
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Evidence to back up this lack of infectivity comes from the airline flight tracing. _From the first 2000 traced there was no infections, and from all traced to date there's apparently 5.
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At this level of infectivity your exponential curve is very vunerable to changes in it's environment - which is what happend in HK etc.
From what I've heard or read so far, one shouldn't be too worried about catching SARS when flying. For example, the SARS patient who caused all the trouble at Amoy Garden flew to visit his brother in Taiwan. His brother also caught SARS and died a couple of days ago. The point is though if SARS could be spreaded through the airflow in a plane, a lot more people in that plane should have caught SARS and even died of it already. That's not been the case. So one shouldn't really be over concerned.
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Engineers familiar with airliner design said that many cabin ventilation systems are designed to eliminate small particles and impurities, including viruses. And their circulation pattern doesn't favor the spread of disease.
In many planes, filters can weed out particles as small as .3 microns, meaning all but the tiniest viruses are trapped before air moves back into the cabin. SARS droplets, according to Brandling-Bennett and other experts, are almost certainly too big to pass through.
David R. Space, a Boeing engineer working on industrywide cabin air quality standards, said Boeing planes typically circulate the air in a way that minimizes passengers' exposure to germs.
About 50 percent of the air is pulled in from the outside and ultimately exhausted, while the other half is recirculated.
The air comes in streams from nozzles above passenger seats that direct it left and right in a circular motion that hugs the fuselage - instead of running the length of the plane. The air flows out of the cabin through a filter under the floor.
"If someone is sick in row six, you don't spread the illness to row 15," Space said. "They're the same type of filters used in hospital operating rooms."
But others note research showing that filtration systems can contribute to the spread of disease if they break or they're poorly maintained.
John Moorehead, a chemical engineer and researcher with the Battelle Memorial Institute in Ohio, said he studied filters in a handful of Boeing 737 jets in 1999 and found they can become a source of contamination if they are not changed often enough.
In some cases, he said, yeast, fungus or bacteria growing on the intake side of the filter grew through to the other side after five to 15 months - allowing microbes to be blown into the cabin.
Likewise, a 2002 National Research Council study warned that the filters used to process cabin air "could be a source of microbes."
But it noted that "infectious agents that are transmitted from person to person generally grow poorly outside the human body, so contamination in an aircraft cabin is unlikely to be a source of them."
There is evidence that disease spreads more rapidly when filtration systems are turned off or aren't working properly.
One case mentioned in the American Journal of Epidemiology involved an Alaskan flight from Anchorage to Kodiak on which 54 passengers were stuck in the cabin for three hours after a mechanical problem crippled the ventilation system. Some 72 percent of the travelers contracted influenza within three days.
But overall, researchers say, it's the close quarters rather than any flaw in aircraft design that promotes the spread of SARS.
Concern is mounting over the continuing spread of the deadly Sars virus.
Some experts say it could have a similar impact to the 1918 flu epidemic that killed 50 million - or the current world HIV crisis.
However, the World Health Organization believes that, in many countries, including Hong Kong, the worst may already be over.
BBC News Online looks at the actual risks faced by people around the world - and how they could change if the virus carries on spreading.
Sars can still be brought under control - and perhaps even eradicated - says the World Health Organization.
On Monday, it announced that it felt the outbreak had peaked in every country in south east Asia except China.
They know this because the number of new cases is falling away - although, in Hong Kong in particular, many people are still dying from the illness.
In Vietnam, the WHO is even more confident of success - there have been no fresh cases reported in 20 days - indicating that the outbreak is under control.
The strategy of the WHO has been to clamp down hard on Sars, issuing its first global health alert for years, and later, its tough travel advice on Toronto
This is even though its impact of Sars has been miniscule in comparison with established diseases such as malaria and AIDS
This is because experts believe they have to attempt to take up a once-only opportunity to eradicate Sars completely in many areas before it becomes established - freeing mankind of that burden forever.
And the good news from the Far East suggests that strategy is having a positive effect.
Future worry
There are some scientists, however, who do not share that level of optimism.
They believe that the illness, should it become established in countries with poor health systems, could kill millions worldwide.
Even in countries with no Sars cases, these predictions are likely to fuel growing panic.
At moment, even in areas where Sars cases are in the hundreds, there is little to justify this - and experts say there is certainly no reason to panic in countries with only a handful of cases.
The risk to an individual is tiny - for example, in Toronto, a city of millions, there have just over 300 cases - and authorities are hopeful that the number of new cases is drying up.
Hard to catch
Scientists say that, at the moment, the illness is relatively hard to catch.
It appears to be far less "transmissable" than influenza, and in many cases has required repeated close contact with an infected person, perhaps in a medical setting or within a family group.
However, overall there is still relatively little known about Sars - scientists do not fully understand how the virus is passed from person to person, or at what point a Sars carrier becomes contagious.
It appears as though droplets released by a cough, and, in some cases, contact with contaminated sewage may be able to spread Sars.
Statements from the World Health Organization on Thursday were a mixture of upbeat prediction and more worrying news.
WHO spokesman Dick Thompson said that Sars cases were now being reported in western provinces of China - which he described as "low resource" areas.
Large numbers of people are said to be fleeing Beijing - perhaps unknowingly spreading Sars throughout the country.
However, the WHO spokesman said: "We are still confident that this is a disease which can be contained and eradicated."
Clamping down
Professor Peter Harvey, an infectious disease expert from the University of Birmingham, has just returned from a trip to Hong Kong and Southern China, said that efforts to eradicate the illness in Beijing and the southern province of Guangdong were bearing fruit.
However, he said that if Sars became established in rural areas, that would produce a far more difficult situation.
"Guangdong province has some of the best medical facilities in China.
"If the disease became endemic in rural areas with poor health provision, you could end up with a constant low-level problem - with outbreaks occurring again and again."
In my view, we are not going to get a global pandemic of Sars.
Professor Peter Harvey, University of Birmingham
And he said that the limited medical facilities in rural areas would increase the death rate.
This kind of endemic Sars in China would also increase the risk that Sars could eventually become established in other countries, such as India or in Africa.
He said: "It's possible that the health systems in these countries are in an even worse position to cope."
The WHO fears that smaller hospitals covering poorer, rural areas would be knocked out of action by even a handful of Sars cases.
The need to quarantine a hospital on which a large area depends not only means that Sars patients are threatened, but also patients needing treatment for a wide variety of other illnesses who need urgent access to hospital.
No doom
Dr Harvey, however, stopped well short of the apocalyptic vision offered by some scientists.
He said: "In my view, we are not going to get a global pandemic of Sars.
"I believe that it will behave a bit like Lassa Fever - with outbreaks every now and again that kill people. But Lassa fever never threatened to wipe out the world."
Comparisons with HIV are misjudged, he suggests.
"They are two completely different diseases - you just can't compare the two."
Future threat
However, there are warnings from scientists that the virus may outwit all efforts to contain it.
While Sars in its current form may not be as destructive as feared, other scientists do foresee situations in which it could become a more major threat.
Dr Adrian Mockett, who has studied coronavirus in animals, says that because this strain is relatively new to humans, genetic mutations which improve its ability to survive in our cells are possible.
He said: "You only get one chance to eradicate something like this - once it's established, you've got a real problem."
If future genetic mutations make Sars more transmissable, the WHO, and the world, would have a far bigger problem.
cheesebeast
29-04-2003, 11:48
When SARS first broke out in Guangdong last November, I paid no attention to it - it was far away, and if it ever got serious, I figured, the government would call in WHO and ask for help. Besides, new diseases break out in Guangdong every five minutes or so; avian flus, new strains of colds, and assorted other bugs seem to thrive there.
And then the fuss died down for a bit, and then suddenly it was March, and I was back in Harbin, and I was getting e-mails from the U.S. Consulate in Shenyang. At first, these were bland cautionary notices trickling in maybe once a week - "There's a weird strain of pneumonia going around in Guangdong, so, like, heads up" - and then gradually became more urgent - "Don't go to Guangdong if you don't have to." Then, around the middle of March, buried among the e-mails that all American citizens abroad got about being careful because of the terror alert and the war, were the local consulate's SARS messages, more frequent than before, and kind of panicked - "People are dying, and we don't know how many because the Chinese government is lying constantly, so be really careful." After another week, they had become hysterical missives that came in at the rate of 5 a day. "GET OUT OF CHINA," they said, followed by another one 10 minutes or so later, saying "NO, DUDE, SERIOUSLY, GET THE FUCK OUT OF CHINA! WE ARE NOT JOKING!"
Then came a much calmer e-mail saying that they had "authorized the departure, on a voluntary basis, of all non-essential personnel at the Embassy in Beijing and all consulates."* The e-mails stopped coming after that.
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None of the foreigners I know here in Harbin was particularly worried; mostly we made gallows-humour jokes about what an inconvenience it would be to catch atypical pneumonia and have scarred lungs for the rest of our lives*. Then it hit Beijing, and I got one final e-mail from the consulate in Shenyang (which is relatively near Harbin) saying that there were unconfirmed rumours of cases there. Then I heard from a friend in Changchun - a two-hour train ride away - that the word on the street there was that they'd just had their first SARS fatality.
Meanwhile, CCTV was easing our minds by insisting that they were cooperating fully with WHO, and that there were only 4 cases in Beijing, 1 in Shanghai, and 8 (if I recall) in Shenzhen, all of which were so amazingly under control that we really had nothing to worry our pretty little heads about. They aired a press conference given by the Minister of Health which went something like this:
CHINESE REPORTER: "First, I would like to congratulate the Ministry of Health on its remarkable success at controling and treating this outbreak without foreign aid."
MINISTER OF HEALTH: "Thank you."
CHINESE REPORTER: "And secondly, I would like to ask whether you anticipate anything unexpected [sic] in your continuing treatment of the disease."
MINISTER OF HEALTH: "Not at all. We are entirely confident in our ability to control this. Next question."
FOREIGN REPORTER: "You said at first that you are treating this disease, but then said that you had cured it. Is it a treatment or a cure? Also, if it is so effective, why has it not been mentioned by WHO? Are you addressing the symptoms, or the disease itself, and, more importantly, how?"
MINISTER OF HEALTH: "I would like to say that I think the most important factor in our successful control of this disease has been international cooperation. Next question."
And so on. My favourite line of any Chinese news program's SARS coverage was a Chinese "medical expert" saying, with an absolutely straight face, that "just because this disease is from Guangdong Province does not mean that it is necessarily a Chinese disease."
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But the amazing thing is that this seemed to work on Chinese people, in some kind of bizarre real-life Orwellian doublethink: It's under control. It has always been under control. It's from Guangdong. It's not Chinese. We have always been at war with Eastasia.
That is, it worked at first. Then last week, I overheard my co-workers talking in hushed voices about feiyan - "pneumonia." One of them later said to me that they had all cancelled their travel plans for the upcoming May Day holiday because they were afraid of catching SARS. Meanwhile, the radio station keeps reporting the same figures: 4 cases in Beijing. 1 in Shanghai. Other areas being watched, but appear to be fine.
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I like Shanghai Noodles, in the Nangang District on Revolutionarystrife Road, for a few reasons: first-off, they're 24-hours, and in a country where 99% of the population seems to go to sleep at 8 and wake up at 7, 24-hour joints must be supported. Second, because of its hours, it's frequented by cabbies, who are usually fun to eavesdrop on when they're talking shop. Third, no matter how sick I may get of noodles, theirs are always excellent, and their liangcai are to die for.
Last night, there was a prophet of doom at Shanghai Noodles. I was sitting there and not really paying attention when I heard someone angrily shout that in all of Harbin, there was no such bing. Distractedly, I wondered for a moment why someone was getting so worked up about pancakes, and how that could be, anyway, given the number of bakeries in Harbin's Nangang and Daoli districts alone. Then I realised that I'd misheard the tones: 'pancake' is third-tone bing, but he'd said fourth-tone bing. "Disease."
This went through my mind quickly enough that I was able to follow his companion's response from beginning to end:
"Bullshit there isn't any fucking pneumonia in Harbin. I'll tell you -- I'll tell you -- no, I'm not finished, so shut the fuck up -- I'll tell you, my wife's sister in Changchun said they've heard that 3 people are dead there. Word on the street is that someone died from it here today! I went to the one pharmacy on Strongwill Avenue and West 11th, and they didn't have any masks -- use your fucking head, man!"
"But on the radio they said --" began the other.
"4 cases in Beijing? 4 cases my ass! Think about how much people move around just here in Harbin, and then think about how much more they do it in Beijing. They say 4, they mean 40, 400, 4000."
I listened a while longer; it was more interesting, certainly, than the bulk of conversations I eavesdrop on when there's only me and two Chinese people in a restaurant - there are almost invariably long arguments over whether or not I'm a Soviet*. all predicated on the assumption that I don't understand them despite having just ordered dishes and chatted briefly with the waitress in fairly decent Chinese - but this seemed to be the high point of the conversation. They talked a bit more about the likelihood of an outbreak in Harbin, and what that would do to the cab economy; whether or not they'd wear masks, and whether or not Chinese medicine would be more successful than Western in curing SARS. (They agreed that it would not.) Then they stopped talking - their noodles came - and all I could hear for a few minutes was slurping and chewing.
Then, quietly, "Hey, think he's Soviet?"
I stood up, paid for my noodles, and left.
cheesebeast
29-04-2003, 11:49
The fact that almost all of the commercials on Chinese TV are for some kind of medicine or another would make one think that health was first and foremost on the People's consciousness, and yet the People spit, cough, and sneeze everywhere, with no regard whatsoever for where they are, what they may have, or who may be in their path. This minor irony did not pass through my head on Tuesday morning as I stumbled through the hallways of Harbin Medical University #2 Hospital. I was too busy mentally calculating spittle ballistics and snot trajectories, and trying not to breathe too much.
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I didn't feel great at all on Monday morning: I had a mild headache and sore throat, my neck muscles hurt, and I wanted nothing more than to ditch work and stay in bed. In this respect, it was almost exactly like any other Monday morning, and I put my body's aches and pains down to nothing more than a physical expression of my fear and loathing of Mondays, and the first-grade classes that came with them.
Anyway, I went in and taught my first morning class, Grade 1, Class 3. 1.3 is easily the best of the first-grade classes, and usually enough to cheer me up anough to face the rest of the day in its cheerful, hyperactive, bouncing, screaming entirety.
This Monday, though, it didn't. My head still hurt, and my throat still hurt, and my muscles still ached, and I still wanted just to die or better yet go back to bed. This got worse after Grade 4, Class 1, but 4.1 always ruined my mood. I went home after that - I had a free period, and then the lunch break after that, which was enough time for a decent nap.
The day went on - the after-lunch fifth-grade class, which was always the high point of the first half of my week, failed to make me feel better, and the next two first-grade classes made me feel even worse, and then suddenly, as my head was buried in my hands - a common occurrence with 1.1 - I noticed that my forehead felt really hot, and that, moving down from there, the lymph nodes along the side of my neck were distinctly swollen.
"Well, shit," I thought, and went back through my memory of the last 48 hours looking for a recollection of a dry, rasping cough at any point. Finding none, I concluded that I was probably fine, and went on with the rest of the day as normal.
Then I got home, collapsed on the bed, and slept, more or less solid, until 7 the next morning, when I woke up and found that I was drenched in sweat, and my forehead was burning hot, and I felt too weak to get out of bed.
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On the rare occasions that I call in sick to work, the conversation goes something like this:
"Hi, it's Brendan. I'm really sick today - I have a fever, and I really can't come to class. I'm terribly sorry about this."
"OK. I hope you feel better. Have a good rest."
On Monday, it went like this:
"Hi, Maggie. It's Brendan."
"Hi."
"I have a pretty high fever and a sore throat. I'm sorry, but I can barely stand up - I really can't teach today."
"A fever?"
"Yeah. I don't know how high, but it's definitely a fever."
"Are you coughing?"
"No - I'm pretty sure this isn't feidian*."
"You should go to the hospital."
"I really don't like going to hospitals here. If this isn't better by tomorrow, I'll go to the hospital, but if I can possibly avoid going, I will."
"Oh. OK. I hope you feel better."
"Thanks. I'm sorry I can't come in today."
"It doesn't matter. Have a good rest."
"Thanks. Bye."
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In order to get a Z-class visa for a period of longer than six months, you must get a physical.
So I got one back in the States, before I left for China. I had notarized papers certifying that I was free of 'mental disorder' (although anyone who has ever seen my room or even my notebook can certify that I am disordered), 'syphilis,' 'brucellosis' (by virtue of not being a cow), and many other illnesses.
And when I got to China, they told me I had to get another physical.
So this was my only experience at a Chinese hospital; my boss took me to a place in the Daoli district that was somehow affiliated with the People's Liberation Army, and I was poked and prodded and sampled and x-rayed. It did not give me a good impression of Chinese hospitals at all, at all.
The hallways were filthy, littered with spit and cigarette butts, carpeted in grime, populated by surgeons stealing smokes. The equipment was Neolithic in nature. The doctors' bedside manner could be charitable described as 'brisk,' and accurately described as 'hostile.' And all in all, it did not strike me in the least as a place to which I would be eager to return.
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Five minutes after I called Maggie to say I couldn't come in, I heard a knock on my door. It was Mr. Wang, the school's driver, fixit man, and general go-to guy. Since he spoke no English, he called me 'Bulaidan,' the butchered transliteration of "Brendan" which the school uses instead of my English name. I hate it, and so when I opened my apartment door, wrapped in a blanket and shivering, with my head aching and my throad constricted and barely able to stand, my mood was not improved by the failure to use my Chinese name, Ou Bo'en.
"Get dressed and come downstairs," he said. "We want to take you to the hospital to get you checked out. You're not coughing, right?"
And in my semi-delirious state, I decided that rather than objecting, or saying that I would rather dig my eyes out with a spoon than go to a Chinese hospital, I would indeed get dressed, go downstairs, and be checked out.
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The first thing I noticed when the car pulled up in front of the hospital was that the joint was jumping. Crowds of people were huddled around the entrance, and doctors sprinted into and out of the doorway in true TV-drama fashion.
The second thing I noticed was that about two thirds of the people were wearing masks.
(continued...)
The third thing I noticed was that there was an ambulance outside whose signs proclaimed it to be from Daqing, far to the north of Harbin, near the border with Russia. Daqing is a big, fairly modern city, from what I know of it, so I couldn't help but wonder why they would need to send people down to Harbin for medical care.
I didn't have much time to wonder, though, as Mr. Wang led me by the hand, through the doorway and into the hospital lobby.
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As I have remarked before, one of my least-favourite things about China is that every group activity involves a lot of people and a lot of pushing and shoving. I am not an aggressive person, and am small and weak besides, so I almost invariably end up with my face pressed into someone's armpit, or in similarly close quarters. This is unpleasant at the best of times, and at the worst of times - like when you've got a high fever and are having a hard time standing up, or when there is a fucking epidemic going on - it becomes intolerable.
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Mr. Wang led me through the crowd to a masked nurse* sitting at a desk in the corner. "This is my school's foreign teacher," he said. (I was playing mute, and looking around as if I could see the viral clouds emitted at every sneeze, every cough, every hack and ptui that came from the people around me.) "He has a fever."
"How high?" asked the nurse (this exchange would be repeated several more times throughout the visit, until it became a litany).
"I don't know," I said. "I don't have a thermometer."
"Oh, he speaks Chinese." (this to Mr. Wang).
"No," I said, "I don't speak a single word. I just learned these phrases phonetically and have no idea whatsoever of what I'm saying."
Fortunately, she was following the standard Chinese practise of ignoring the foreigner anyway, and making notes on a piece of paper while asking Mr. Wang about me.
"Is he coughing?"
"No, I'm not."
"No, he's not."
(She wrote down that I was not.)
"Does he have any other symptoms?"
"I have a headache, a sore throat, swollen lymph nodes, and muscle pains."
"His head hurts, and so does his neck."
(She wrote down that my head hurt, and so did my neck.)
At this point I gave up and let Mr. Wang do the talking.
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The nurse told us to go to the respiratory department, on the third floor; first, we had to shove through the crowd (someone coughed directly in my face, and someone else spat on the floor right behind me; I quickened my pace and nearly fell over) to pay for the checkup. This was done through a thick, bulletproof-looking Plexiglas window; Mr. Wang selected Option C, "Examination and Diagnosis," and paid the 28 kuai or whatever it was by sliding the money through the slot under the window, where it was picked up by the gloved hand of another masked nurse,* who gave him his change and a receipt, and directed us to the third floor.
My mind was not at its clearest, thanks to the fever, but what intelligence it had left in it was all bent on figuring out ways to avoid breathing or touching anything. Unlike about half of the people around me, I was not enjoying the imaginary health protection of a kouzhao - face mask - and the sweater I had stretched, ninja-style, over the bottom half of my face was not easing my mind. Nor did the elevator ride to the third floor, which took place, as elevator rides are wont to do, in a small, enclosed space, and which was, as everything in China is wont to be, crowded in the extreme. And our destination, the third-floor respiratory ward, removed any lingering illusions I might have had about a comfortable hospital visit.
The hallways were full - literally full, as in wall-to-wall-front-to-back-no-room - of people pushing and shoving their way towards desks where an overworked attendant gave them a number. The waiting rooms were chock full of people waiting anxiously to have their cough listened to, and only emptied out briefly as people left to get cigarettes. (The "no smoking" rule was, for a change, being enforced.)
"One doctor, one patient," read a sign on the wall, a rule which most people seemed to be observing. The problem was that the patient-doctor ratio was wildly imbalanced; I saw only three examining rooms, and easily two hundred patients, if not more. Mr. Wang managed, through some finagling or threatening or bribery, to get me a fairly low number from the nurse - #33; they were on #17 at the time - and left to get a cigarette or four. I nodded off; he woke me up when he came back and handed me a thick cotton face mask.
I knew perfectly well that the masks were almost as effective at warding off SARS as voodoo charms and keeping one's fingers crossed. But having spent the past half hour or so trying to breathe as little as possible, and jumping every time someone coughed or cleared his throat, the feeling of something over my mouth and nose was calming in a way I can't really describe. The soft cotton felt like the blanket little kids hide from monsters under - thin, but as safe and reassuring as a wall - and in a few moments I was asleep again. I slept until my number was called and Mr. Wang shook me awake, saying "they called you! It's time!"
So I shuffled into the examining room as quickly as I could and sat down in front of the nurse.
"Does he speak Chinese?" she asked Mr. Wang. "Very well," he said. And so, wonder of wonders, she talked to me instead of him.* We went through the same questions as before, with the nurse at the door - how high was my fever, did I have other symptoms, was I coughing, how long had I felt like this - and then she listened to my breathing, front and back, with a stethoscope, checked my throat, complimented me on my Chinese, wrote me out a slip of paper, and sent me to go get blood taken.
Like every other part of the hospital, the 'Blood Collection Room' was crowded and dirty. The waiting process here was much more free-form (i.e., competitive and vicious) than it had been for examinations; first you shoved you way through a waiting room, and then you leapfrogged people sitting in front of you so that you could get to the blood-collection window, which, like the payment windows downstairs, was thick, bank-style Plexiglas. (Perhaps it would be better called the "blood-deposit window.") There, you got stuck with a probably-clean-and-new needle, had a pen-cap's worth of blood extracted, were given a cotton wad to hold against your arm, and told to come back in 3 hours' time for results. I wasn't able to sleep in the waiting room here; the process was quick enough that people shuffled seats forward every 20 seconds or so, and the competition to move ahead was so cutthroat that a momentary blink might doom you to another 5 minutes' wait. So I stayed as alert as I could, and darted in front of as many people as I could - I have gotten good enough at this that I was only cut off twice - and had my blood taken. "Come back at 1:30," said the nurse through the window, and I assured her that I would. Then I shuffled out of the hospital with Mr. Wang; outside, another ambulance from Daqing had come.
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"I'll call you if the results from the blood test are anything abnormal," said Mr. Wang as the car pulled up outside my apartment building. "You don't have to go out at 1:30 - I'll do it."
I thanked him as profusely as I could, and staggered upstairs to my apartment, where I had leftovers of the spicy Sichuan food and restorative ginger soup that a friend had brought over for me the night before, when she heard I was sick. I microwaved and ate them, feeling a little better, then took a couple of cold/flu pills and, seeing that it was almost 1:30, lay down next to the phone to wait for any news that might come in.
I waited a half hour, nothing came, and finally, satisfied that I was certified SARS-free, I lay down and went to sleep.
Animals suffer in the war on Sars
Asia's Sars epidemic has been claiming non-human victims, as the Chinese authorities target domestic pets suspected of spreading the disease.
In Beijing, dogs and cats belonging to Sars patients are being rounded up and killed, officials said on Wednesday.
However other animals may be benefiting from the war on Sars, as China cracks down on the trade in endangered species.
Although veterinary experts have said there is no evidence Sars can be transmitted to humans from household animals, the authorities are taking no chances.
"Pets can spread diseases. People can take measures to prevent diseases being spread, but not pets," a Beijing police official told the French news agency AFP.
"If a family has Sars and they have pets, we will catch and kill the pets regardless of whether they show Sars symptoms."
Chinese citizens are required by law to pay a special tax if they want to own a pet, but in the past this law has been frequently ignored.
Now, however, the police have started to actively enforce it.
"If we find any stray dogs or cats, or if anyone make reports to the police about people illegally raising pets, we will send people out to catch the animals and deal with them," the official said.
Sometimes the pet owners themselves are eager to get rid of their animals.
A man in Beijing's Fengtai district threw his Pekinese dog from the sixth floor of his apartment block because he suspected it might have Sars, according to the Beijing Star Daily.
Animal markets raided
But Sars may be good news for China's endangered animals.
The nation is regularly criticised by animal protection groups for failing to stop the lucrative trade in rare species.
But now the authorities have launched a clampdown, because of concerns that smuggled animals could be carrying the deadly disease.
An official in the southern province of Guangdong said thousands of markets, restaurants and kitchens had been raided to check for protected animal species.
The Xinhua news agency said about 15,000 animal fairs and 70,000 hotels and restaurants had been raided.
Officials are reported to have confiscated more than 800,000 endangered animals and arrested 1,428 suspects.
Among the animals found were snakes, pangolins, anteaters, cranes, turtles and lizards.
While the link is far from proven, some experts believe Sars may have emerged in humans by jumping species from animals, perhaps from wild game.
Sars originated in Guangdong, where humans live close to farm animals, and endangered animal markets are a frequent sight.
Some of the world's most deadly pandemics are thought to have begun in southern China.
Story from BBC NEWS:
"In today's article about health officials meeting in Toronto to discuss SARS:
_
Low and some others have become convinced that the virus that causes SARS -- identified by the WHO as a new coronavirus -- is not nearly as infectious as the world's medical community initially believed and feared. _
_
The virus spreads extremely efficiently in certain settings, such as in hospitals, between patients and the health-care workers looking after them. It also spreads effectively in households, where close contact such as hugging and kissing makes for easy transmission of droplets laced with the virus. _
_
But shopping malls, subways and workplaces have not proven to be hospitable environments for the virus. Example: A SARS patient went to work at a Hewlett Packard plant in Markham while sick with the disease. His actions sent 197 colleagues into quarantine. But he only passed the disease onto one. _
_
"This thing doesn't have legs in the community," Low said flatly.
In Beijing, dogs and cats belonging to Sars patients are being rounded up and killed, officials said on Wednesday.
I went to see a stand-up comedian a couple of weeks ago. He said SARS was caused by the ghosts of chickens seeking revenge over their massacre after the outbreak of bird flu in HK. I cringe to think what the spirits of these innocent dogs and cats will conjure up for us!
The good news is that maybe the endangered animals will be off the menu? I just hope that the authorites dont kill the ones that they have " rescued" from the pots.
Its seems that they wasted little time in raiding the markets and restaraunts where endangered species were served up. Why didnt they do something before SARS?
cheesebeast
07-05-2003, 12:31
Hong Kong's SARS Death Rate Estimated
2 hours, 25 minutes ago Add Health - AP to My Yahoo!
By EMMA ROSS, AP Medical Writer
LONDON - The first major study of SARS (news - web sites) trends estimates that about 20 percent of the people hospitalized with the disease in Hong Kong are dying from it, and that more than half of those over 60 die.
The findings are similar to earlier, cruder estimates for Hong Kong, one of the areas hardest-hit by SARS. However, experts warn that the figures do not reflect the chances of an average person anywhere dying from a bout of SARS once it is contracted.
The average age of the SARS patients in the study — those hospitalized in Hong Kong — is 50, and disease experts generally agree that the virus is much more deadly in people over 60.
Nearly 200 of the more than 1,600 people believed to have the respiratory disease in Hong Kong have died.
Led by Roy Anderson, regarded as one of the world's leading infectious disease experts, the new research is the latest in a weekslong debate about the true death rate for SARS.
The rate has risen sharply from below 5 percent in the weeks that SARS was first spreading around the globe.
Worldwide, the World Health Organization (news - web sites), which is leading the effort to stop SARS' spread, says the death rate ranges from 6 percent to 10 percent, depending on location. The U.S. Centers for Disease Control and Prevention (news - web sites) puts the rate at 6.6 percent.
One WHO official noted that the death rate is lower in places where the outbreak has ended or is nearing an end. "We know that in a real situation where the outbreak has completed itself from beginning to end — in Hanoi, Vietnam — they had an 8 percent case fatality rate," said WHO spokesman Dick Thompson.
And in Canada, where patients have been older, the death rate is 15 percent, he said.
"What we do see is that in people under 40 the death rate is generally lower and in people over 60 the numbers are much higher," Thompson said.
The Lancet study, conducted by scientists at Imperial College in London, the University of Hong Kong and the Hong Kong health authorities, estimated that the death rate could be as high as 55 percent in people over the age of 60.
In younger people — those under 60 — the death rate could be as low as 6.8 percent, the study found.
"That's sadly still very high for a respiratory infection," said Anderson, a professor of infectious disease epidemiology at London's Imperial College. "In other common respiratory infections it is much less than 1 percent in the vulnerable elderly."
The former head of the U.S. Centers for Disease Control and Prevention said quibbling over the death rate "really doesn't matter one whit."
"It's a serious illness, whether it's 5 percent or 25 percent," said Dr. Jeffrey Koplan, now vice president of academic health affairs at Emory University in Atlanta. "It's much higher than a cold or influenza or most other infectious diseases that we commonly encounter."
Officials with the CDC and WHO would not comment immediately on the new research.
Calculating the death rate has been a sore point for the world's epidemiologists. Two methods dominate among scientists: The method used by the WHO and CDC is to divide the total number of deaths by the total number of SARS cases. The second approach involves dividing the deaths by the total of those recovered plus those who died.
Anderson said both those methods are deeply flawed and underestimate the death rate because they ignore the fate of people who are still ill.
His method involves sophisticated mathematical calculations to estimate how many of those who are ill will eventually die.
He acknowledged his method still has the drawback of not knowing how many people are infected with SARS but do not get sick enough for the infection to be noticed.
"This is the death rate based on those who have been admitted to hospital, and they tend to be the more severe end of the cases," Anderson said.
The Lancet study, based on 1,425 SARS cases in Hong Kong up to April 28, also found that the maximum incubation period — the time it takes between getting infected and becoming ill — may be as long as 14 days.
Quarantine measures have been based on a maximum incubation period of 10 days.
If the incubation period is truly longer than 10 days, people who are being quarantined because they have been in close contact with a SARS patient may not be in isolation long enough.
"The article does raise the caution that maybe we need to move the curve out a little bit by four days and that's well worth further study," Koplan said.
WHO said it is possible that the incubation period could be longer than 10 days because the U.N. agency calculates it starting from the last day a person was exposed to SARS.
cheesebeast
07-05-2003, 16:28
From the SCMP
THE FIGHTBACK AGAINST SARS
Serum cures Sars patients
The treatment, which has a 50pc success rate, is derived from other victims' blood
PATSY MOY
A serum drawn from the blood of recovered Sars victims has cured more than 10 patients who failed to respond to standard anti-viral treatment, doctors announced yesterday.
The findings from the Prince of Wales Hospital are based on the first batch of 20 patients who were given the serum.
The patients had initially received a combination of Ribavirin and steroids - the standard treatment adopted by the Hospital Authority to deal with severe acute respiratory syndrome (Sars) - but showed no progress.
More than half of the patients in the study have recovered and been discharged, according to Gregory Cheng, associate professor of the department of medicine and therapeutics at the Chinese University. The rest showed no significant improvement and remain in hospital.
The university has started using the serum as a "second-line" treatment on another batch of about 50 patients who have also failed to respond to Ribavirin and steroids.
Official data shows about one in 10 Sars patients do not respond to the standard anti-viral treatment.
Professor Cheng said patients who responded to the new serum had shown "dramatic improvement" one or two days after they were treated. The professor said the findings were encouraging and the new treatment had not shown any side-effects so far.
He said the serum would be more effective if used on patients in the second week of symptoms, which he categorised as the earlier stage of Sars.
However, Professor Cheng admitted that further research was needed to determine whether the serum should be extensively used as the standard second-line treatment for Sars in all public hospitals - or even to replace Ribavirin and steroids. That treatment carries serious side-effects, including possible damage to the liver, heart and blood. It can also cause deformities in unborn children.
"We need to tell the public that we are only at an experimental stage of using this serum for treating Sars. At this stage, we do not have enough data to claim that the serum is the best option above other alternative treatments, such as protease inhibitor," Professor Cheng said, referring to another second-line treatment.
"The serum is extracted from the blood of Sars patients who have recovered, so we need donors to maintain the supply.
"We also need to make sure their serum contains the antibody of the coronavirus [which is the main virus that causes Sars]. Also, not all the serum can be used, especially the serum from patients who have underlying diseases such as hepatitis," he explained.
Professor Cheng - who contracted the disease in March but has since recovered - was among the 50 or so serum donors.
He said the supply was "just enough" for the Prince of Wales Hospital and he hoped that other patients could donate their serum.
"But we still have the last resort - which is for my colleagues who have also come down with the virus to donate their serum," Professor Cheng said.
Serum is obtained from patients who have developed antibodies in their blood after recovering from Sars. Each patient can donate about 800ml of serum - enough to treat about five patients.
Separately, Liu Shao-haei, senior executive manager (Professional Services) of the Hospital Authority said the authority was open to alternative treatments for treating Sars.
May 9 2003
The global death toll from SARS passed 500 yesterday after China reported five more deaths from an illness the government is trying desperately to keep under control in the countryside.
The Health Ministry said 146 more people had been infected, taking the number of cases to 4,698, the bulk of the world's total, while deaths totalled 224.
Shanghai, China's commercial capital, reported its first death due to Severe Acute Respiratory Syndrome yesterday.
With no sign SARS is being controlled in the world's most populous nation, the government and the World Health Organisation fear the epidemic could spread rapidly through the vast hinterland, where health services are often poor.
The WHO extended its SARS-related travel warning yesterday to the city of Tianjin and the province of Inner Mongolia as well as to Taipei, capital of Taiwan.
The UN health agency had already warned people not to travel to Beijing, the Chinese provinces of Guangdong and Shanxi, and Hong Kong.
Chinese Premier Wen Jiabao has urged preventive measures be taken in areas where "basic rural medical facilities are weak".
Reflecting those concerns, four WHO health experts headed to the province of Hebei today to assess the ability of healthcare systems there to cope with a SARS outbreak. The WHO said the number of probable cases has risen sharply.
The province wraps around Beijing, which has the world's highest number of SARS cases and is home to a floating population of hundreds of thousands of migrant workers, many from Hebei.
The SARS virus surfaced in southern China late last year and has been spread around the world by air travellers. Worldwide, the death toll is 503 and more than 7,400 have been infected.
Reinforcing global concern, an international team of scientists said the death rate from SARS was higher than previously thought and could be as high as 55 per cent for people over 60.
They said the rate was about 13 per cent in those under that age. There was no evidence the virus had mutated into a deadlier form, despite earlier mortality estimates of 6-10 per cent.
Researchers and health officials in Hong Kong and Britain, who examined data from the first nine weeks of the outbreak of the virus in Hong Kong, also found the incubation period - the time from infection to displaying symptoms - averaged six days.
Their study was released online by The Lancet medical journal.
China said it has punished more than 120 officials in the past month for covering up the extent of the SARS outbreak or failing to prevent the spread of the flu-like virus, the Web site of Xinhua news agency said yesterday.
Officials in 15 provinces and major cities were sacked, suspended, warned or demoted for deserting their work, delaying reporting or covering up the number of infections and deaths.
In China's countryside, fear of SARS has led to some villages setting up roadblocks to keep away people from Beijing and at least four riots against quarantine centres have been reported in recent days. Thousands have been quarantined in China.
A police official said 64 people had been rounded up for rioting in the northern city of Chengde because they suspected a local clinic would be turned into a SARS hospital.
Hong Kong, the worst SARS-hit area outside of China proper, reported four more deaths and seven new cases.
"The number of new infections announced today is the lowest since records began," a health official told a news conference.
While SARS appeared to be under control in most places outside China, it has wreaked havoc on economies in the region.
Earlier in the week Singapore Prime Minister Goh Chok Tong said SARS would slow East Asia's economic growth by half to one per cent this year. A total of 27 people have died of SARS in Singapore.
US brokerage firm Merrill Lynch cut its ratings for Hong Kong's Cathay Pacific airline and Australia's Qantas Airways, saying share price falls had not yet reflected the full impact.
Taiwan said today SARS had probably spread into the community and the next five days would be crucial.
Reuters
The Health Ministry said 146 more people had been infected, taking the number of cases to 4,698, the bulk of the world's total, while deaths totalled 224.
if china doesnt contol this the rest of the worlds efforts may have been wasted!
SARS IS A SCAM. Throw away your mask.
Medical experts believe there are no more than a few dozen Sars-carriers left among the seven million people on the streets of Hong Kong.
The World Health Organization’s advisory against travel to the city is widely being seen as an unwarranted death sentence on Asia’s once-leading tourist destination.
It has been established that millions of children have for weeks been locked out of schools for a disease to which they have a natural immunity.
And tests have repeatedly confirmed that Sars is not the highly infectious disease it was feared to be.
The tiny number of victims of the disease make it clear that Sars is nothing at all like the global pandemic it is presented as. Diarrhea last year killed 1.9 million people, mostly children. In comparison, Sars has killed 465 individuals out of six billion.
But it is true that Sars has been a catastrophe for Hong Kong. Entire industries have been wrecked, thousands have been thrown out of work, and lives have been lost – not by the coronavirus, but by irrational hysteria.
Yet the virus has not been bad news for everyone in Hong Kong. Pharmacists and druggists have seen their businesses transformed. Cleaning companies have been hiring staff at high speed. Sales of Western and Chinese medicine have gone through the roof. Importers of surgical masks have increased production beyond their wildest dreams. Vendors of ionisers and other air-purification devices have seen massive sales booms. Business has soared for firms distributing protective work-wear. Language teachers report an increase in applications, as customer-hungry firms prepare to send sales teams overseas. And sellers of wireless computer equipment and broadband connections have seen a strong upswing in demand.
In one Hong Kong school, a parent repeatedly insisted that all staff and students wear masks at all times and change them at frequent intervals. It was later discovered that she was in the medical supplies business.
In the press, ad sales may have slumped, but editorial and circulation departments aren’t downbeat at all. Readership and circulation have risen, and journalists have been galvanized by the biggest story for years.
But for the ordinary, struggling, Hong Kong person on the street, with children to feed and a mortgage to pay, Sars has been a scam. While it is a terrible disease to the unfortunate people it has hit, danger to the Hong Kong population is minimal. Yet the damage done has been inestimable.
The Sars scam has been perpetrated semi-unconsciously by a host of sources – from the first woman in Shatin to wear a mask while out shopping, to panic-stricken parents swapping ill-considered emails, to a media which always emphasizes the negative, to business people who stand to profit directly from the hysteria.
The media have continuously focused on the negative numbers. It reported that there were 400, then 800, then 1,200, then 1,400 known Sars cases in Hong Kong. Today, reports say the figure is 1,637.
It is not true. At the time of writing, there are 500, and NOT ONE of those is out on the streets infecting people. The health authorities know exactly where each of them is – precisely which bed in which hospital
The number of new infections in Hong Kong is very small. And it is smaller still if you account for cross-family infections and infections of health workers. Medical experts calculate that the number of unlisted carriers still out there on the streets must also be tiny. In theory, it could be a single individual.
Any child with Hong Kong Form 5 level mathematics can tell you that for seven million people to wear masks on the street to protect themselves from a disease possibly carried by even a few dozen people is ludicrous
Enemy number one in the scam: The humble surgical mask. Alone, it has brought our tourism industry to its knees.
Yes, it is wise to wear a mask when you are working in a Sars hospital. But outside? Experts say no.
The masks first spread from working surgeons to non-doctor staff at the Prince of Wales Hospital in Shatin new town in the third week of March. Virtually every Hong Kong newspaper put photographs of hospital staff wearing masks on the front page that week.
The mask itself quickly became infectious. The habit spread to the population of the nearby urban centre. From Shatin, the mask habit spread to the rest of Hong Kong.
The international media picked up the story. Within weeks, virtually every illustrated newspaper, newsmagazine and international television news report in the world blasted out pictures of Hong Kong people wearing masks – not hundreds of thousands, but hundreds of millions of such images.
The bizarre vision of an entire city of masked people became the Hong Kong archetype. No tourist in his or her right mind would voluntarily visit such a city. This image, repeated on a daily basis in hundreds of thousands of news reports, tore the heart out of our travel sector.
And it was all unnecessary. Robert Breiman, chief medical officer of the W.H.O.’s Sars team in Guangdong, said masks were unnecessary for normal wear. When he stepped out of Guangdong hospital wards, he took his mask off. The Hong Kong scientist who found the coronavirus, Malik Peiris, recently appeared in a packed room without a mask, and explained that Sars was usually transmitted via the hands, often when someone touched a Sars patient and then rubbed their eyes. Dr. E.K. Yeoh, heading the battle against Sars for the Hong Kong government, is rarely seen with a mask.
The almost universal donning of masks was limited to Hong Kong – it has not been seen in Singapore, China, Toronto or Vietnam.
Masks took Hong Kong’s tourism industry to its knees, but the coup de grace came from the World Health Organization. Although much of the superlative work done by the W.H.O. has been deservedly applauded, the group’s knee-jerk reaction to Sars has been uncharacteristically ill-considered.
The organization released a negative travel advisory against Vietnam because five people died out of a population of 81 million. The organization maintains its advisory against Hong Kong because the city has a disease carried on the streets by maybe a few dozen people out of seven million. A similar advisory was placed on Singapore because it had a disease that killed 27 people out of four million.
Make no mistake, anyone who has followed the work of the organization will find these numbers bizarre. The W.H.O. has realized this for some weeks, and has been busy re-examining the numbers and revising its demands.
If such numbers are reason enough for negative travel advisories are issued, the W.H.O. should be restricting travel to every major city in the world.
Compare the statistics for other diseases. There are 200,000 cases of yellow fever a year, killing 30,000 people, with death rates in some areas hitting 50% of adult victims and 70% of child victims. The disease strikes mainly in South America and Africa. The W.H.O. does not advise people to avoid South America and Africa.
In the United States, deadly strains of influenza are sweeping through cities, killing 36,000 people a year. The W.H.O. does not advise people to avoid visiting the US. The number of people carrying Hepatitis C in China is counted in the millions. But that fact did not trigger a travel advisory against China. Bacterial meningitis hits 1.2 million people a year, killing 173,000 people, with most victims being in Africa. The W.H.O. does not advise people not to visit Africa.
When you compare the 173,000 deaths of bacterial meningitis with the five Sars deaths in Vietnam, you start to realize that we need to get things in proportion.
When expats in Hong Kong started telling me that they “were taking the kids back to New York because it’s safer there” then I knew that all perspective had been lost.
This is important. There is a significant chance that ultimately more deaths will be caused by the over-reaction to Sars than by Sars itself. Medical experts have long known that joblessness, poverty and economic downturns are directly reflected to the number of deaths in a society. We know that Sars has killed 465 people. The number of people the hysteria will kill can only be guessed at. As firms close down, an epidemic of economic hardship is only just beginning.
If there are seven Sars carriers left walking the streets of Hong Kong, there is literally a one-in-a-million chance of meeting one. Do the math.
Unless you are in a genuine high-risk situation, you know what to do.
For the sake of our children and the future of our community, take off your mask.
Nury Vittachi, Hong Kong 5th May 2003, (for the benefit of non-Hong-Kongers, Nury is a well known journalist who has worked for the South China Morning Post, The Far Eastern Economic Review and Asian Finance, plus other publications. In addition, he has written numerous splendid and amusing books over the years)
The World Health Organisation today issued a new warning against
non-essential travel to the entire Western hemisphere following renewed
concerns about the spread of Severe Loss of Perspective Syndrome (SLOPS).
Officials are warning travellers not to visit the UK, the US, almost all of
Western Europe, and Canada, following further outbreaks of the disease,
which has led to mass panic among the media, thousands of ecstatic children
being kept out of school by their credulous and moronic parents, and
increased profits for DIY stores as the idiot public rush to bulk-buy face
masks and boiler suits.
A WHO spokesman said, "You'd be much better off going to somewhere like
Thailand or China, because all you've got to worry about there is SARS, and
let's face it, you're about as likely to die from that as you are to get
kicked to death by a gang of zombie nuns."
The SARS virus has now claimed a staggering 500 lives in only six months,
which makes it considerably more deadly than, say, malaria, which only kills
around 3000 people every single day. Malaria, however, mainly effects only
darkies what speak foreign, whereas SARS has made at least one English
person feel a bit iffy for a couple of days, and is therefore considered
much more serious.
The spread of SLOPS has now reached pandemic proportions, with many
high-level politicians seemingly affected by the disease. The rapid spread
of SLOPS has been linked to the end of the war in Iraq and the need for
Western leaders to give the public something to worry about. Otherwise, they
might start asking uncomfortable questions about domestic issues, and that
simply would not do.
Licorice compound may put Sars on the run
AGENCE FRANCE-PRESSE in Paris
--------------------------------------------------------------------------------
Updated at 10.47am:
A major ingredient in licorice has proven remarkably successful at combatting the SARS virus in lab-dish tests, according to a German study reported on Saturday in the British weekly journal The Lancet.
Glycyrrhizin, a compound extracted from licorice roots which has been previously explored in anti-viral research, was highly effective at stopping the SARS virus from reproducing, the authors say. It easily beat out four standard compounds used to block virus or tumorous cell replication -- ribavirin, 6-azauridine, pyrazofurin and mycophenolic acid.
The research is only a preliminary study and much further work is needed, assessing safety as well as effectiveness, before anyone can call glycyrrhizin a cure for Severe Acute Respiratory Syndrome (Sars).
Even so, the findings are so positive that it should be taken seriously as a potential weapon in the fight against this disease, say the team, led by Jindrich Cinatl from Frankfurt University Medical School.
The experiment involved taking samples of the Sars virus from two patients with Sars who had been admitted to the university's medical centre.
The viruses were then used to infect Vero cells, a tissue culture of monkey kidney cells that are a standard item of lab equipment.
The dishes were exposed to each of the five compounds and examined 72 to 96 hours later to see how many infected cells had reproduced.
Ribavirin - a drug widely used against Sars, especially in Hong Kong, but which has had very disappointing results - did nothing to stop the virus sample from replicating, nor did mycophenolic acid. Pyrazofurin and 6-azauridine had low and modest effect respectively, but were outclassed by glycyrrhizin, which was more than five times more effective than those two compounds and at high concentrations completely blocked replication.
"Of all the compounds, glycyrrhizin was the most active in inhibiting replication of the Sars-associated virus. Our findings suggest that glycyrrhizin should be assessed for treatment of Sars," Dr Cinatl's team says. Glycyrrhizin gets its name from Glycyrrhiza glabra, the Latin sobriquet for the licorice plant, which homeopathic medicine has long claimed to be useful in tackling respiratory, urinary and digestive irritations and infections of the mouth and throat. Licorice is especially used in traditional Chinese medicine.
Glycyrrhizin has previously been used experimentally against hepatitis B and C virus and even against the Aids virus, where small-scale studies have suggested it boosts numbers of T-cells, a key component of the immune system. The extract is derived from licorice roots and takes the form of a yellow powder with a bittersweet taste. Why glycyrrhizin apparently works against Sars is unclear, the study says. It may induce the infected cell to produce nitrous oxide, thus blocking the molecular pathway that helps the virus to replicate.
Nitrous oxide has previously been established as an inhibitor of the Japanese encephalitis virus. Glycyrrhizin is a well-known molecule with relatively few side-effects even at high doses, unlike ribavirin, whose toxic effects include reductions in haemoglobin, the oxygen-carrying substance in the blood, the study says. Since emerging in China's southern Guangdong province last November, Sars has killed 750 people and infected more than 8,400 worldwide, according to figures from the World Health Organisation.
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