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21st century superbug



Panic: Severe Acute Respiratory Syndrome (SARS) is the 'killer bug' that has now affected 3947 people in 27 countries. Of these, 229 have died. There is no cure or vaccine for the disease, which appears to spread by close contact with an infected person. Many of the early victims were hospital workers, and many cases require ventilation to survive: both of which factors put a strain on health services. Death rates from the disease seem to be rising, leading to suggestions that a more virulent form of the disease may have developed. People have been advised not to visit Hong Kong, mainland China or Toronto, Canada. Sales of face masks have risen in many of the countries affected.

Don't panic: The number of reported cases remains a tiny fraction of the populations of the countries affected. Even in Hong Kong, the most disproportionately affected area, the 1434 reported cases represent just 0.02 percent of the people living there. As a comparison, in the year 2000 there were 7578 cases of tuberculosis in Hong Kong. So while SARS in Hong Kong is a significant new strain on health services, it not out of proportion to other, existing infections.

There is even less reason for general alarm elsewhere in the world. Eighty-seven percent of all cases have been in mainland China and Hong Kong, and many cases in other countries have been among travellers who contracted the disease while in China and Hong Kong. There is panic over the apparent rise in the number of cases: but these are cumulative figures, not new cases. Of the 3947 cases reported, 1935 patients have already recovered. Moreover, there has been a big leap in cases reported simply because China is now providing more accurate figures. An examination of the level of new cases reported each day by the World Health Organisation (WHO) shows that the number has been surprisingly static throughout April.

As for reports of an increasing death rate, or a 'virulent new strain', it is simply too early to come to any conclusions. For example, in contradiction to these gloomy suggestions, Taiwan has had 29 cases to date, but not a single death. It will be some time before the differences in outcomes can be explained.

What is clear is that SARS is a powerful demonstration of the ability of medical services to respond to novel disease. WHO is now convinced that the virus responsible has been identified, as have the likely modes of transmission. Treatment methods have been adapted to minimise the risk to hospital staff. While there is no cure, a reasonably successful form of care has been devised. The death rate appears to be quite low, although there is variation between countries. All this for a disease that was only identified as something new and important in February 2003.

SARS does, however, appear to have damaged economies. Travellers face quarantine procedures at airports, as do many private school children returning from the worst affected areas. Governments have taken draconian steps to deal with anyone who refuses to cooperate with containment measures. While the health risk of SARS appears largely under control, the consequences of the panic could run and run.

Read:
Pandemic of precaution,
by Stuart Derbyshire
Severe Acute Respiratory Syndrome,
World Health Organisation

http://www.spiked-online.co.uk/Articles/00000006DD33.htm

Article8 April 2003

Pandemic of precaution

by Stuart Derbyshire

As the highly contagious disease continues to spread, the impact is disrupting complex supply chains, communication and travel, and is forcing airline and banking industries to adjust their operations.

We are not talking about severe acute respiratory syndrome (SARS), the respiratory disease that began in China in November 2002. We are talking about fear, the disease that began to spread around the time of the end of the Cold War, was catalysed by the events of 11 September, and is currently focused on the SARS outbreak in Asia.

On 3 April, the World Health Organisation (WHO) was reporting 2340 infections worldwide and 81 deaths (1). That figure is bound to rise over the coming months, but consensus opinion is that the rate of infection is now slowing down, with Hong Kong reporting 23 new infections on 2 April and 26 on 3 April, compared to about 80 per day in the preceding days (2).

For the 81 people who have died, this outbreak has been an unmitigated tragedy, and my sympathies go to their families and loved ones. But looked at objectively, an infection rate of approximately 1 in 2-3million is nothing for the general population to be alarmed about. And even that figure misses the complexity of infection, which will obviously weigh more heavily upon the elderly, the very young, relatives of those infected and hospital workers in direct contact with patients.

For those of us who are not in these high-risk groups, the risk of infection is so slight as to be barely worth a thought. Thirty-six thousand people will die in the USA of influenza during this year, which is approximately 1 in 10,000. Who would close the office, cancel a holiday or travel halfway around the world to avoid the flu?

As I sit on a much busier aircraft returning to the USA, I wonder if my fellow travellers have considered the absurdity of their evasive actions. My flight originated in Seoul and will collect more passengers in Tokyo. At the time of writing, Japan has reported 14 suspected cases of SARS and South Korea none at all. The USA, on the other hand, has reported 85 definite cases and Canada more than 100 with 6 deaths (1). Toronto shopkeepers are selling out of facemasks and thermometers. But people travelling to the airport or to the shops are putting themselves at risk of a serious traffic accident that far exceeds the threat from SARS.

I cannot blame my fellow travellers, though, when their national leaders, heads of major corporations and international organisations are doling out messages of caution. Despite the falling numbers of cases, Hong Kong health authorities could not help but couch the good news within a warning that a new wave may be coming (1). Little wonder that on 1 April, Hong Kong residents mobbed stores for rice and water following an internet hoax claiming that the city was subject to international quarantine (2).

On 3 April, the WHO issued its first ever disease-related travel advisory against visiting the southern Chinese province of Guangdong and Hong Kong, unless unavoidable. In the wake of this warning, Japan's largest travel agency, JTB, said it would cancel package tours to Hong Kong and Guangdong for at least two weeks. Sony has told employees not to travel to either place and to limit any stay in Singapore and Vietnam. The bank UBS AG ordered employees returning to its European offices from trips to Asia to stay at home for 10 days before reporting to work, and Intel has cancelled two major conferences in Asia.

KLM airline has warned that SARS is hurting international travel more than the war in Iraq. The Business Travel Coalition, an advocacy group for business, released a survey on 1 April that found 27 percent of respondents banning travel to Asia and eight percent more considering a ban. The survey participants are estimated to spend $734,000 per day on air travel to Asia - but not at the moment.

The Swiss government has issued a ban to prevent 2500 traders from Southeast Asia from attending a jewellery and watch fair, and on 1 April the authorities in San Jose, California, quarantined a flight from Tokyo after two passengers and two crew members complained of SARS-like symptoms. After two hours of investigation it was decided they did not actually have symptoms consistent with SARS. Obviously it is a bad idea to sneeze or cough when you travel these days?.

The motive behind this defensive behaviour is the precautionary principle, the idea that 'you can never be too careful'. Except that, of course, you can be too careful. Everything is dangerous compared with wrapping yourself in a duvet and hiding under the bed wearing a crash hat. But nothing is possible from a position of hiding out. Life is a contact sport, and not playing means foregoing the possibility of winning. Furthermore, reining in experimentation carries the risk of not making life-enhancing breakthroughs.

Excessive caution can actually hamper an effective response - for example, by blinding investigators to the true mode of transmission of the virus. People are wearing masks because it has been assumed that the SARS virus is airborne, and yet workers wearing masks in hospitals have come down with SARS at an unexpectedly high rate. This was blamed on the super-infectivity of the virus, avoiding the more obvious possibility that people were being careless, and the less obvious possibility of a different transmission route such as contact with infected fluid (3).

And Hong Kong medical investigators examining an outbreak in the Amoy Gardens housing estate found that the disease travelled vertically down the building, perhaps following a leaky sewer system, rather than an airborne vector. It may turn out that the advice to wear masks is a pointless distraction from the better option of washing hands.

The focus on coronavirus as the main suspected cause of SARS might also be a rush to judgement (4). The coronavirus is part of a group that causes the common cold and therefore fits with the perception of a highly infectious airborne disease. It is certainly possible that coronavirus is the culprit, but it is early in the search and the data is not convincing in any direction. Rather than assume the worst it would be better to keep an open mind on the hidden mechanisms at work.

Lest I be misunderstood, I am not suggesting that people should rush to Amoy Gardens and start licking the walls. Commonsense precautions are not a problem - what is problematic is the zealous expectation of personal tragedy and human disaster in the face of a trivial threat. While previous generations shrugged off capricious acts of nature and got on with life, today we hunker down and hide in anticipation of further calamity.

Stuart Derbyshire is assistant professor at the University of Pittsburgh Medical Centre, Department of Anaethesiology, and is a contributor to Animal Experimentation: Good or Bad?, Hodder & Stoughton, 2002. Buy this book from Amazon (UK)

Note: Stuart got back to Pittsburgh on Friday afternoon. He was not quarantined despite a slight cough.

Read on:

The SARS farce, by Mischa Moselle

(1) See Asian Wall Street Journal, 4 April 2003; International Herald Tribune, 2 April 2003; International Herald Tribune, 3 April 2003

(2) International Herald Tribune, 2 April 2003; International Herald Tribune, 3 April 2003

(3) Financial Times, 1 April 2003

(4) Asian Wall Street Journal, 4 April 2003

Reprinted from : http://www.spiked-online.com/Articles/00000006DD33.htm
Article8 April 2003

Pandemic of precaution

by Stuart Derbyshire

As the highly contagious disease continues to spread, the impact is disrupting complex supply chains, communication and travel, and is forcing airline and banking industries to adjust their operations.

We are not talking about severe acute respiratory syndrome (SARS), the respiratory disease that began in China in November 2002. We are talking about fear, the disease that began to spread around the time of the end of the Cold War, was catalysed by the events of 11 September, and is currently focused on the SARS outbreak in Asia.

On 3 April, the World Health Organisation (WHO) was reporting 2340 infections worldwide and 81 deaths (1). That figure is bound to rise over the coming months, but consensus opinion is that the rate of infection is now slowing down, with Hong Kong reporting 23 new infections on 2 April and 26 on 3 April, compared to about 80 per day in the preceding days (2).

For the 81 people who have died, this outbreak has been an unmitigated tragedy, and my sympathies go to their families and loved ones. But looked at objectively, an infection rate of approximately 1 in 2-3million is nothing for the general population to be alarmed about. And even that figure misses the complexity of infection, which will obviously weigh more heavily upon the elderly, the very young, relatives of those infected and hospital workers in direct contact with patients.

For those of us who are not in these high-risk groups, the risk of infection is so slight as to be barely worth a thought. Thirty-six thousand people will die in the USA of influenza during this year, which is approximately 1 in 10,000. Who would close the office, cancel a holiday or travel halfway around the world to avoid the flu?

As I sit on a much busier aircraft returning to the USA, I wonder if my fellow travellers have considered the absurdity of their evasive actions. My flight originated in Seoul and will collect more passengers in Tokyo. At the time of writing, Japan has reported 14 suspected cases of SARS and South Korea none at all. The USA, on the other hand, has reported 85 definite cases and Canada more than 100 with 6 deaths (1). Toronto shopkeepers are selling out of facemasks and thermometers. But people travelling to the airport or to the shops are putting themselves at risk of a serious traffic accident that far exceeds the threat from SARS.

I cannot blame my fellow travellers, though, when their national leaders, heads of major corporations and international organisations are doling out messages of caution. Despite the falling numbers of cases, Hong Kong health authorities could not help but couch the good news within a warning that a new wave may be coming (1). Little wonder that on 1 April, Hong Kong residents mobbed stores for rice and water following an internet hoax claiming that the city was subject to international quarantine (2).

On 3 April, the WHO issued its first ever disease-related travel advisory against visiting the southern Chinese province of Guangdong and Hong Kong, unless unavoidable. In the wake of this warning, Japan's largest travel agency, JTB, said it would cancel package tours to Hong Kong and Guangdong for at least two weeks. Sony has told employees not to travel to either place and to limit any stay in Singapore and Vietnam. The bank UBS AG ordered employees returning to its European offices from trips to Asia to stay at home for 10 days before reporting to work, and Intel has cancelled two major conferences in Asia.

KLM airline has warned that SARS is hurting international travel more than the war in Iraq. The Business Travel Coalition, an advocacy group for business, released a survey on 1 April that found 27 percent of respondents banning travel to Asia and eight percent more considering a ban. The survey participants are estimated to spend $734,000 per day on air travel to Asia - but not at the moment.

The Swiss government has issued a ban to prevent 2500 traders from Southeast Asia from attending a jewellery and watch fair, and on 1 April the authorities in San Jose, California, quarantined a flight from Tokyo after two passengers and two crew members complained of SARS-like symptoms. After two hours of investigation it was decided they did not actually have symptoms consistent with SARS. Obviously it is a bad idea to sneeze or cough when you travel these days?.

The motive behind this defensive behaviour is the precautionary principle, the idea that 'you can never be too careful'. Except that, of course, you can be too careful. Everything is dangerous compared with wrapping yourself in a duvet and hiding under the bed wearing a crash hat. But nothing is possible from a position of hiding out. Life is a contact sport, and not playing means foregoing the possibility of winning. Furthermore, reining in experimentation carries the risk of not making life-enhancing breakthroughs.

Excessive caution can actually hamper an effective response - for example, by blinding investigators to the true mode of transmission of the virus. People are wearing masks because it has been assumed that the SARS virus is airborne, and yet workers wearing masks in hospitals have come down with SARS at an unexpectedly high rate. This was blamed on the super-infectivity of the virus, avoiding the more obvious possibility that people were being careless, and the less obvious possibility of a different transmission route such as contact with infected fluid (3).

And Hong Kong medical investigators examining an outbreak in the Amoy Gardens housing estate found that the disease travelled vertically down the building, perhaps following a leaky sewer system, rather than an airborne vector. It may turn out that the advice to wear masks is a pointless distraction from the better option of washing hands.

The focus on coronavirus as the main suspected cause of SARS might also be a rush to judgement (4). The coronavirus is part of a group that causes the common cold and therefore fits with the perception of a highly infectious airborne disease. It is certainly possible that coronavirus is the culprit, but it is early in the search and the data is not convincing in any direction. Rather than assume the worst it would be better to keep an open mind on the hidden mechanisms at work.

Lest I be misunderstood, I am not suggesting that people should rush to Amoy Gardens and start licking the walls. Commonsense precautions are not a problem - what is problematic is the zealous expectation of personal tragedy and human disaster in the face of a trivial threat. While previous generations shrugged off capricious acts of nature and got on with life, today we hunker down and hide in anticipation of further calamity.

Stuart Derbyshire is assistant professor at the University of Pittsburgh Medical Centre, Department of Anaethesiology, and is a contributor to Animal Experimentation: Good or Bad?, Hodder & Stoughton, 2002. Buy this book from Amazon (UK)

Note: Stuart got back to Pittsburgh on Friday afternoon. He was not quarantined despite a slight cough.

Read on:

The SARS farce, by Mischa Moselle

(1) See Asian Wall Street Journal, 4 April 2003; International Herald Tribune, 2 April 2003; International Herald Tribune, 3 April 2003

(2) International Herald Tribune, 2 April 2003; International Herald Tribune, 3 April 2003

(3) Financial Times, 1 April 2003

(4) Asian Wall Street Journal, 4 April 2003

Reprinted from : http://www.spiked-online.com/Articles/00000006DD33.htm