25-04-2003 16:11									#31
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I think botched socialized medicine has something to do with it

	25-04-2003 17:48									#32
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The current worlwide mortality rate is 5.9% which has jumped from 4% as more numbers from the Chinese have come in.

A couple of interesting points.

SARS in Canada has pretty much only killed the elderly (the youngest was 43 but most patients are 60-70). So in Canada the pathogenesis is similar to a virulent pneumonia.

There may be more or less virulent strains within the SARS outbreak. In Singapore, the first infectee gave it to her immediate family and friends, almost all of whom died. In contrast none of the american SARS patients have died.

Given the Canadian experience as well, its interesting to postulate that the severity of SARS is not due to the strain variation in the coronavirus itself but may be due to variations in the carriage of other opportunistic organisms.

	25-04-2003 17:53									#33
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quote: Originally posted by Starchild SARS is related to the common cold in the fact that they both belong to the same family of virii called coronaviruses. Whether SARS displays the extreme mutability of it's cousin is something still to be seen.

Both the Canadian and CDC sequences (derived from different outbreaks) agree to within a few bp out of 25K bp. So the evidence to date does not suggests hypermutation.

	25-04-2003 17:59									#34
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The virus was designed for minimum fatality among the Chinese.

	25-04-2003 18:01									#35
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quote: Originally posted by DaShi The virus was designed for minimum fatality among the Chinese.

Guess they screwed up badly then

But seriously, I doubt that this is a bioweapon running loose.

	25-04-2003 18:31									#36
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In Canada the severity of the disease is related to the series of events causing one infected person to infect a large number of other patients with weakened immune systems.

Actually, it's a bit perplexing why this is getting so much attention, it's just a kind of pneumonia, which, like all pneumonias, can be dangerous for old folks in hospital.

The only worrying note is that one of my comrades is going back to work in the most at risk group...toronto health care workers (Sunnybrook).

	25-04-2003 18:43									#37
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quote: Originally posted by Seeker Actually, it's a bit perplexing why this is getting so much attention, it's just a kind of pneumonia, which, like all pneumonias, can be dangerous for old folks in hospital.

The media needs the headlines. The whole thing in Toronto has been seriously overblown by W.H.O.; we're talking about, what, 300 cases in a city of over 2.5 million? A whopping 16 deaths? You can get 10x that many people dying of cancer or heart disease every day in this country, and on bad days, probably that many from traffic accidents too. And, as you've said, pneumonia or the flu can be as bad for seniors as this thing seems to be.

Whoop-de-friggin-doo, says I. If it ever does reach pandemic status, then start clogging the airways with it. Until then, I wish the media would just shut the hell up about it, all they're accomplishing by focusing on it is fear-mongering.

	25-04-2003 21:57									#38
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quote: Originally posted by optimus2861 The media needs the headlines. The whole thing in Toronto has been seriously overblown by W.H.O.; we're talking about, what, 300 cases in a city of over 2.5 million? A whopping 16 deaths? You can get 10x that many people dying of cancer or heart disease every day in this country, and on bad days, probably that many from traffic accidents too. And, as you've said, pneumonia or the flu can be as bad for seniors as this thing seems to be. Whoop-de-friggin-doo, says I. If it ever does reach pandemic status, then start clogging the airways with it. Until then, I wish the media would just shut the hell up about it, all they're accomplishing by focusing on it is fear-mongering.

A DL from a Chinese government official perhaps?

The facts so far are: that this disease is highly communicable (possibly airborne), has a mortality rate similar to the 1918 swine flu (which killed 20M people worldwide), and like that epidemic can kill previously healthy people. Sticking your head up your ass (as the chinese did) and waiting for it to be a pandemic before anything is done isnt gonna work. Because of modern air travel this is a pandemic already. Now that we recognize the problem to some extent, the only question is whether we will contain the spread better than the 1918 pandemic. Hopefully we will.

	25-04-2003 22:17									#39
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I think my opinion on this is somewhere in between SpencerH and optimus2861. Public health officials have to consider the worst case scenario which would be something like the 1918 flu epidemic. We may have gotten lucky this year with SARS cases hitting near the end of flu/cold season. Next year could be worse.

But WHO may have overreacted issuing that travel advisory on Toronto. I don't know if it is the warmer weather or what but I haven't heard of many new cases in the last few days there. More people will die from many other things this year including West Nile.

I am no doctor but I think if the virus mutates it will become less deadly not more. The idea from a virus's standpoint is to replicate yourself as often as possible. That doesn't work so well if you are killing your host.

	25-04-2003 22:21									#40
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Now West Nile IS something I'm worried about.

Canada has a **** of a lot of mosquitoes, a malaria like disease could be really bad, especially since we'd be defenceless against it.

They say that even the NWT are experiencing some West Nile.

	25-04-2003 23:27									#41
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no offense, but i find a lot of media coverage about infectious diseases far too overblown..

west nile? west nile only harms those with weakened immune systems: hiv+, elderly, children... not your average 20-30 year old human.

'course, the way the media broadcast it, you'd've thunk it was the worst thing ever since the bubonic plague.

same with this sars thing.

and starchild, even if canada's really british, i'm sure the majority of you were infected with the virus d'quebecois... (izzat how you do it? ) meaning that your immune systems are probably weaker than say, the regular units of the iraqi army.

	26-04-2003 00:57									#42
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quote: Originally posted by SpencerH A DL from a Chinese government official perhaps?

I resent that.

quote: The facts so far are: that this disease is highly communicable (possibly airborne),

If it were airborne, it would probably already be a pandemic (and I find your definition of 4,400 cases & 263 deaths worldwide as "already a pandemic" laughable, to be blunt). If it were airborne, you'd think Toronto would have diagnosed one new case in the past 19 days (they haven't). The fact is, scientists don't yet know how communicable it is.

quote: Sticking your head up your ass (as the chinese did) and waiting for it to be a pandemic before anything is done isnt gonna work.

I'm saying the media should tone it down and quit fear-mongering. The health organizations have generally done a good job, though I think the travel advisory against Toronto was overkill.

It's right to be cautious. But to portray this as a parallel to 1918 is just blatant alarmism at this point.

	26-04-2003 01:06									#43
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It because they're weak!

	26-04-2003 01:30									#44
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quote: Originally posted by optimus2861 I'm saying the media should tone it down and quit fear-mongering. The health organizations have generally done a good job, though I think the travel advisory against Toronto was overkill.

The UK media is treating the whole deal with a bit of bemusement. All the UK correspondents that I've seen on location in Beijing, Hong Kong, Singapore and Toronto have not been wearing healthmasks like all the locals, and have been visiting all the hotspots in a very nonchalant manner.

The report at Heathrow had all the tourists coming back from China saying "What's all the fuss about?", and all those being told that their trips to China have been cancelled/postponed are being shown as disappointed and irritated.

Quite unusual for our media to not hype it up.

	26-04-2003 02:29									#45
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quote: Originally posted by optimus2861 I resent that.

so?

quote: If it were airborne, it would probably already be a pandemic (and I find your definition of 4,400 cases & 263 deaths worldwide as "already a pandemic" laughable, to be blunt).

Its not my fault you dont know the definition of pandemic. I suggest you look it up.

quote: If it were airborne, you'd think Toronto would have diagnosed one new case in the past 19 days (they haven't). The fact is, scientists don't yet know how communicable it is.

Thats right, scientists, like me, who work on the pathogenesis of infectious disease, dont know whether it's airborne. But guess what? There is evidence for more than droplet spread. For example, one of the first reported Hong Kong cases was a nurse with protective clothing including a mask working 6 ft from a SARS patient. She's dead. Airborne spread would explain why it hasnt been contained by health care workers using droplet protection measures and why the new recommended infection protection measures published by the CDC include those for airborne transmission ie negative pressure rooms and respirators.

quote: I'm saying the media should tone it down and quit fear-mongering. The health organizations have generally done a good job, though I think the travel advisory against Toronto was overkill.

Travellers to Toronto have now spread SARS to the Phillipines and possibly to Australia. I would say that travellers to Toronto should be made aware of that.

quote: It's right to be cautious. But to portray this as a parallel to 1918 is just blatant alarmism at this point.

Please feel free to cite your expertise in the field of infectious disease. There are a number of important parallels between the current pandemic and that which occurred in 1918. When this hit the news a few short weeks ago it was troubling but it looked like it was contained to a small number of cases in HK and that the authorities were doing the right thing ie quarantine. Since then, some of the truth has come out. The Chinese sat on their hands and given the fact that it is present in the far north (Beijing) and south (HK) as well as reports of multiple deaths in Shanghai, it has probably spread across China where it is the begining of their flu/cold season (RedFred).

Hopefully I am being an alarmist, but colleagues of mine who smiled at me two weeks ago are changing their tune. Its not like there is any treatment for SARS. All we can do is make people aware of the risk and try to reduce the rate of transmission. Personally, I think its a lost cause. Unlike other emerging diseases that cause flash epidemics but havent spread worldwide I think SARS will be around for a long time. I'm gearing up to run diagnostics in my lab now.

	26-04-2003 04:43									#46
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quote: Originally posted by SpencerH so?

So, rather than rebutting my points, you chose to attack me -- a classic ad hominem. I'm glad you provided some more info this time.

quote: Its not my fault you dont know the definition of pandemic. I suggest you look it up.

Pandemic: adjective
1) (of a disease) affecting persons over a wide geographical area; extensively epidemic.
2) a pandemic disease (isn't that circular?)

Wide geographical area could be granted, but "extensively epidemic"?

Epidemic: adjective
1) (esp. of a disease) attacking or affecting many persons simultaneously in a community or area.
noun
2) a widespread occurrence of a disease
3) a rapid development, spread, or growth of something, esp. something unpleasant

So I guess it depends on what you consider "many persons", "widespread", or "rapid". 4,000 people worldwide in a couple of months -- and outside of China & Toronto, no concentration of more than a couple hundred -- doesn't qualify as "many" or particulary "rapid" to me, in a world of 6 billion. YMMV.

Contrast with 1918, here's just one example: the first case of Spanish influenza hit the state of Georgia on Oct. 1, 1918. The next day, 138 soldiers at Camp Gordon had it. By the 5th, Camp Hancock had 3000 cases, and 52 deaths. That's a pandemic, if you ask me. SARS hasn't come close to that level of threat yet, and God willing, it won't.

quote: the new recommended infection protection measures published by the CDC include those for airborne transmission ie negative pressure rooms and respirators.

Fine, doesn't hurt to play it safe.

quote: Travellers to Toronto have now spread SARS to the Phillipines and possibly to Australia. I would say that travellers to Toronto should be made aware of that.

Fine, but why the advisory to avoid travel to Toronto? We're talking 1:10,000 people who are only suspected of having it. You've got better odds of being hit by a bus.

quote: Please feel free to cite your expertise in the field of infectious disease.

Ah, yes, the "I know better than you do" argument. Shove that. I'm stating my opinion that this is not a pandemic -- and I think I've shown that the definition isn't black-and-white -- and that the news media have been overreacting. I don't need qualifications to say that.

quote: Personally, I think its a lost cause.

Pessimist .

quote: Unlike other emerging diseases that cause flash epidemics but havent spread worldwide I think SARS will be around for a long time.

Let's hope you're wrong, then.

quote: I'm gearing up to run diagnostics in my lab now.

Good luck! Seriously, I mean it.

	26-04-2003 05:19									#47
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Spencer, to a smaller degree I know how it feels. A couple of weeks ago I made a thread asking why airline travel to infected parts of asia hasn't been shut down. I got laughed at pretty good. Now, though they haven't had the guts to say screw the economy, shut down the air traffic, China has shut down an entire city!

It may prove that a strong centralized government is more able to deal with such emergencies.

Also, questions if you don't mind. It's been reported that Vietnam may be in the process of defeating SARS. Less new cases than cases being released from the hospitals. First, is it true do you know? Second, how did they do it and could we do the same?

	26-04-2003 06:40									#48
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quote: Originally posted by Urban Ranger I think it should be number of dead over total number of cases.

You might be right. What I wrote was from a letter to the Post editor from a doctor. He argued that the total number of cases of infected people should not be included in the calculation because if they haven't died or recovered then the outcome is not known. He said the calculation should be based on cases where the outcome is known.

Maybe he is wrong, but it seems to make sense.

	26-04-2003 06:45									#49
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quote: Originally posted by optimus2861 Fine, but why the advisory to avoid travel to Toronto? We're talking 1:10,000 people who are only suspected of having it. You've got better odds of being hit by a bus.

SpencerH is probably right when he mentioned the link with the person getting the disease in the Phillippines after being in Canada.

Toronto Star columnist Thomas Walkom wrote:

"Since the end of March, the World Health Organization has urged Canada to medically screen passengers flying out of Pearson international airport.

"But federal Health Minister Anne McLellan balked. Too cumbersome. Too costly. Too inconvenient.

...

"Ottawa, however, did not seem to care. The United Nations' World Health Organization, which is charged with preventing the international spread of infectious disease, did.

"A key reason for the WHO travel advisory, officials explained this week, was that Canada appears to have exported the disease. In particular, a SARS case in the Philippines has been linked to an infected health care worker who arrived from Toronto.

"In effect, the U.N. body has quarantined Toronto because our own federal government was unwilling to take the proper measures itself."

http://www.thestar.com/NASApp/cs/Co...path=Columnists

	26-04-2003 06:56									#50
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quote: Originally posted by Q Cubed no offense, but i find a lot of media coverage about infectious diseases far too overblown..

Don't blame the messanger.

Officials in Hong Kong have spread panic by making outrageous statements.

Tung Chee-hwa, the "mayor" of Hong Kong, went around telling people that the virus is "highly contagious" when there is no proof that it is (contagious yes, highly contagious, not likely). He was also moaning about how the virus would have medium- and long-term impacts on the economy, blah blah, blah. How the hell does he know and why is he destroying public confidence.

Then there's Mel "Who are You" Lastman with his indepth knowledge. Here's part of an interview reported by Australia Broadcasting Corporation:

MAL (sic, should be Mel) LASTMAN: What I'm doing right here, right now, is sending out a message to this CDC group, whoever the hell they are.

REPORTERS: The WHO.

MAL LASTMAN: Who?

REPORTERS: The WHO.

MAL LASTMAN: The WHO. Sorry.

Well who's the CDC?

REPORTERS: The Centre for Disease Control.

MAL LASTMAN: Okay, the WHO.


And then he goes on CNN and according to the Star:

"In his five-minute interview with Aaron Brown on Thursday night, the flustered mayor said one million people a year take Toronto transit - it's actually about one million daily - and had no clue how many people in the city were in quarantine or had SARS symptoms.

"Lastman also erroneously stated that 500 Toronto residents had travelled to the Philippines and been put into quarantine upon their return, and reiterated something he'd been saying for days - that, as mayor of the country's largest city, he'd never heard of the high-profile World Health Organization. "

	26-04-2003 07:10									#51
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That news conference was on MSNBC. Actually he *****ed and whined. I was not impressed. What a baby! He was incredulous.

	26-04-2003 07:12									#52
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quote: Originally posted by Lancer It may prove that a strong centralized government is more able to deal with such emergencies.

Its why I thought the Chinese had things under control when they quarantined that apartment complex and posted soldiers to guard it. Its exactly whats needed in these cases and something we couldnt do.

quote: Also, questions if you don't mind. It's been reported that Vietnam may be in the process of defeating SARS. Less new cases than cases being released from the hospitals. First, is it true do you know? Second, how did they do it and could we do the same?

I dunno if its 'true' but the CDC has said the same thing.

Possible reasons as to why:

1) The Vietnamese strain is less transmissible
2) Vietnamese are less likely to be infected
3) The Vietnamese didnt have their heads up their asses, have a good relationship with WHO physicians and therefore listened to Dr. Urbani when he said "something smells fishey here" (or words to that effect) and took immediate action.

A less inflammatory version from the CDC

"WHO country staff attribute Viet Nam’s success in combating SARS to the quick manner in which the country initially reacted. “After Carlo identified the disease, we were able to influence the hospital to take the right infection control measures very quickly,” said Pascale Brudon, the WHO representative in Viet Nam.

The commitment of the Vietnamese government came soon thereafter, including high-level support for a WHO coordinated response in Hanoi. “The first priority was to contain the disease and monitor each case,” said Brudon. International collaboration to combat SARS came quickly via the Japanese government and Médecins Sans Frontières, who both worked under the umbrella of the WHO initiative in Viet Nam.

Viet Nam was fortunate in that the country had only a single index case, who spent less than 3 days in Hanoi prior to hospitalization. This short time in the community effectively limited opportunities to transmit the SARS virus to a contained hospital environment."

Its certainly positive news if Vietnam has contained it. China could still do so but it will require measures akin to closing the country for a month with everyone staying home in infected cities for part of that time. If that happens we may beat this quickly. If it doesnt happen we will potentially have 1 billion chinese as a neverending global source.

EDIT: after re-reading my post to make sure in wasnt in urdu or something strange I noticed (again) the last paragraph in that CDC pub. Canada only had one index case so did HK. Transmission in HK (and Singapore) was possible after a very very very short exposure so the three days in Hanoi explanation doesnt hold water either. With that in mind it may be that the Vietnamese index case was not a 'hyper-transmitter' (whatever that is) wheras the Toronto and HK index cases were.

	26-04-2003 07:24									#53
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I live in Toronto, close to the city centre. I use the subway regularly to get to U of T which is in the heart of downtown.

So far I have seen a grand total of three people wearing masks in public and two of those were two weeks ago. The idea that we are all walking around in masks is ridiculous. I've also walked past all the downtown hospitals. They have notices on the doors and you can't go in, but apart from that there is no problem.

I don't know anyone who has SARS. I don't know anyone who has been near anyone with SARS. I don't even know anyone who knows anyone who has been quarantined, let alone anyone who has SARS. It got out in the hospital system before anyone knew what it was. Now it appears to be well on the way to being contained.

Most of the 7000 odd people who were quarantined are now out of quarantine. Most of these people live in Scarborough, which is well out of the city centre. There have been only a couple of new infections over the past few days; the infection rate peaked a couple of weeks back. The authorities can trace all the cases back to the initial infection so it isn't as if people are randomly being infected.

The desperately funny thing is that the real hoo-haa has just started right as it looks like things are winding down here.

	26-04-2003 07:34									#54
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Thanks Spencer, very interesting posts btw.

I hope this thing mutates out of existance. Could it be that the longer SARS is in human beings the less nasty it gets?

	26-04-2003 15:55									#55
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quote: Originally posted by Lancer Now, though they haven't had the guts to say screw the economy, shut down the air traffic, China has shut down an entire city!

Which city is that?

quote: Originally posted by Lancer Also, questions if you don't mind. It's been reported that Vietnam may be in the process of defeating SARS. Less new cases than cases being released from the hospitals. First, is it true do you know? Second, how did they do it and could we do the same?

It has been speculated that hot weather inhibits the virus. That's why you don't see a lot of cases in tropical countries including Vietnam and Singapore.

	26-04-2003 15:56									#56
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quote: Originally posted by Big Crunch The UK media is treating the whole deal with a bit of bemusement. All the UK correspondents that I've seen on location in Beijing, Hong Kong, Singapore and Toronto have not been wearing healthmasks like all the locals, and have been visiting all the hotspots in a very nonchalant manner. The report at Heathrow had all the tourists coming back from China saying "What's all the fuss about?", and all those being told that their trips to China have been cancelled/postponed are being shown as disappointed and irritated.

Oh really? That's amusing.

	26-04-2003 15:58									#57
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quote: Originally posted by Tingkai Tung Chee-hwa, the "mayor" of Hong Kong, went around telling people that the virus is "highly contagious" when there is no proof that it is (contagious yes, highly contagious, not likely). He was also moaning about how the virus would have medium- and long-term impacts on the economy, blah blah, blah. How the hell does he know and why is he destroying public confidence.

I know, I wish he would just shut up and stop telling us his speculations. He should ask himself this question, "Is my opinion helpful to the overall happiness of the people?"

If the answer is no, he needs to clam up.

	26-04-2003 16:01									#58
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Ahh, he can keep talking as long as his next words are: I resign.

	26-04-2003 16:05									#59
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The only problem is, if he resigns, we might get somebody worse

	26-04-2003 17:52									#60
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quote: Originally posted by Lancer Thanks Spencer, very interesting posts btw. I hope this thing mutates out of existance. Could it be that the longer SARS is in human beings the less nasty it gets?

Possibly, though this is usually more notable in retroviruses as far as I know. A significant amount of the human genome is old integrated retroviruses, which might have had similar effects as HIV now millions of years ago.

A virus that travels easily is less likely to do adapt I should think, as its own lifecycle is not threatened by its host dying.