# Is SARS a case of mass hysteria? How can we tell either way? **URL:** \ **Category:** Great Debates\ **Created:** [May 11, 2003, 7:48pm UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538 "2003-05-11T19:48:57Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![capacitor](https://avatars.discourse-cdn.com/v4/letter/c/e47774/32.png) [@capacitor](https://boards.straightdope.com/u/capacitor)\ **Post date:** [May 13, 2003, 4:48am UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/21 "2003-05-13T04:48:28Z")
Remember the yearly warnings about some exotic flu going out, like from Hong Kong? We didn’t get such a warning this year. Until now. ---
**Author:** ![OliverH](https://avatars.discourse-cdn.com/v4/letter/o/278dde/32.png) [@OliverH](https://boards.straightdope.com/u/OliverH)\ **Post date:** [May 13, 2003, 7:52am UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/22 "2003-05-13T07:52:06Z")
> [@](#): > > \*Originally posted by spoke- \* > \*\*Those percentages are new to me (but still not in the 20% range). > > Also, the number of cases reported strikes me as vanishingly small, given the size of human populations in the affected areas. Why have there not been huge waves of SARS victims? Is it that the response has been effective? Or is it simply that the disease is not as virulent as feared? \*\* It seems a post of mine was somehow lost. According to the German Robert Koch institute (similar to the CDC), the death rate varies greatly with age. They cite the WHO with a death rate of 0% below age 25 and a rate of **50%** at age 65 and higher. The 4% death rate you probably heard about from the WHO is NOT for _known_ cases of SARS, but rather for _probable_ cases of SARS, i.e. it includes such cases presumed to be SARS in the absence of solid evidence either way, and as such, probably a lot of flu cases. > [@](#): > > The global case-fatality rate for probable SARS is 4%. [http://www.who.int/csr/sars/epi2003\_04\_11/en/](http://www.who.int/csr/sars/epi2003_04_11/en/) The number of cases has hardly been vanishingly small. You need to keep in mind that only specific regions of China are hit, not the entire country. Take a look at [http://www.who.int/csr/sarscountry/2003\_05\_12/en/](http://www.who.int/csr/sarscountry/2003_05_12/en/) for the latest breakdown, and keep in mind that a lot of paranoia has already set in. 1683 in the Hong Kong SAR alone is certainly not a small number (with over 200 deaths), especially given that there are probably plenty of unreported cases. Keep in mind that, as cited, the severity of the disease depends a lot on age, and quite likely a lot of physical stamina, and its support by outside measures. As such, areas in which the number of cases can easily be observed and cared for by health systems are far more likely to have a low death rate than areas in which administrations are struggling to handle the situation and hospitals are overfilled. As for the infection rates, just yesterday, I saw a report on TV about several families becoming infected somewhere in an apartment building in Asia in a very interesting pattern that allowed the conclusion that SARS can be transmitted via feces: It had been observed that families had become infected not in a horizontal but vertical pattern in the house. (Airborne transmission is usually horizontal, since you likely see the people on your floor more often than above or below) As it turned out, the main wastewater lines were on the outside of the building, and usually ended in the kitchens of the apartments. They were pretty badly corroded. As it turned out, a person who had recently been in a hospital hit by SARS had visited a friend in the house, and used the toilet there. Through the wastewater line, all families below the friends’ apartment were exposed to the virus. ---
**Author:** ![Abe](https://avatars.discourse-cdn.com/v4/letter/a/f1d935/32.png) [@Abe](https://boards.straightdope.com/u/Abe)\ **Post date:** [May 13, 2003, 7:56am UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/23 "2003-05-13T07:56:10Z")
I’m not a doctor, but I’ve been keeping an eye out on this disease since it was first detected. Obviously – I live in the city SARS slammed first. > [@](#): > > \*Originally posted by spoke- \* > Those percentages are new to me (but still not in the 20% range). **Spoke** , have you been keeping up with developments on the disease? The higher end of the fatality range refers (of course) to the elderly, it doesn’t mean that SARS kills 20% of those it infects by any means – among other segments of the population the fatality rate is lower (and in those under 19 years the disease is thought to have little comparative impact). You refer to the 4% fatality figure, but that estimate is very much out of date. If you simply crunch the numbers in the WHO table I provided earlier, you get a current global fatality rate of 7.4% (not that it would be a good final indicator, but just to show that the 4% figure is out the window by practically any standards). I still think 5-20% is a fairly reasonable estimate of SARS fatality rates, and may even be a bit on the low side. Wired has an article discussing some of the issues involved in estimating the death rate: [Docs Wrangle Over SARS Death Rate](http://www.wired.com/news/medtech/0,1286,58552,00.html) . I’ll come back to this article later. You want scary statistics? Check out the study released on Hong Kong by the Imperial College Of Science, Technology And Medicine and published in Lancet. I haven’t had a chance to read the original, but here is a story on it (dated from just last week): > [@](#): > > \*From [http://www.sciencedaily.com/releases/2003/05/030507080703.htm](http://www.sciencedaily.com/releases/2003/05/030507080703.htm) \* > An international team of researchers has estimated that the fatality rate for SARS is considerably higher than some early estimates. > > According to a paper published online today in The Lancet, which examines data from the first nine weeks of Hong Kong’s epidemic, the case fatality rate, among those admitted to hospital, in patients 60 years of age and older is estimated to be far higher ( **43.3%** , 95% confidence interval 35.2 to 52.4%) than those below 60 ( **13.2%** , 95% confidence interval 9.8 to 16.8%). > > Similar estimates were obtained using a second statistical estimation method: **55.0%** (95% confidence interval 45.3 to 64.7%) for those aged 60 or older and **6.8%** (95% confidence interval (95% confidence interval 4.0 to 9.6%) in those below 60. My emphases. Or have a look at this report based on a study of the WHO: > [@](#): > > \*From [http://www.cidrap.umn.edu/cidrap/content/hot/sars/news/may0703sars.html](http://www.cidrap.umn.edu/cidrap/content/hot/sars/news/may0703sars.html) \* > May 7, 2003 (CIDRAP News) – The World Health Organization (WHO) today estimated the overall fatality rate for SARS (severe acute respiratory syndrome) patients at 14% to 15%, significantly higher than previous estimates. The agency estimated the rate for people older than 64 years to be more than 50%. > > The revised WHO estimates, based on data from four countries, came on the heels of a Lancet article in which researchers studied case records from Hong Kong and calculated a case-fatality ratio as high as 55% for patients aged 60 and older. > > In the early stages of the SARS epidemic, health officials estimated the mortality rate at less than 4%. More recently, officials have cited rates in the 6% to 7% range. Today’s SARS figures from the WHO—6,903 cumulative cases and 495 deaths—point to a case-fatality ratio of 7.2%. But WHO officials note that this calculation underestimates the rate, since some currently ill patients will die of the disease. > > The WHO based its estimates on an analysis of the latest data from Canada, China, Hong Kong, Singapore, and Vietnam. “On the basis of more detailed and complete data, and more reliable methods, WHO now estimates that the case fatality ratio of SARS ranges from 0% to 50%, depending on the age group affected, with an overall estimate of case fatality of 14% to 15%,” the agency’s announcement said. > > The fatality ratio is less than 1% for people younger than 25, 6% for those aged 25 to 44, 15% for those aged 45 to 64, and more than 50% for people 65 or older, officials said. Similar stories on the study at [http://www.cbc.ca/stories/2003/05/07/sars\_study030507](http://www.cbc.ca/stories/2003/05/07/sars_study030507) (for the Canadians) [http://usinfo.state.gov/topical/global/sars/03050802.htm](http://usinfo.state.gov/topical/global/sars/03050802.htm) (from the US Dept. of State, this also contains the text of the WHO press release) While SARS may not be a world-killer that will cut us all down in a Stephen King scenario, the problem is _by no means_ a trivial one even if we consider the milder indicators. Anyone who insists on thinking SARS is a case of mass hysteria is almost certainly uninformed. Not to say the _reaction_ to the disease is frequently hysterical, but that is another matter. > [@](#): > > _Originally posted by spoke_ > Also, the number of cases reported strikes me as vanishingly small, given the size of human populations in the affected areas. Why have there not been huge waves of SARS victims? Is it that the response has been effective? Or is it simply that the disease is not as virulent as feared? From the WHO Web site, Update 53 (12 May 2003): > [@](#): > > \*From [http://www.who.int/csr/sarsarchive/2003\_05\_12/en/](http://www.who.int/csr/sarsarchive/2003_05_12/en/) \* > Singapore has greatly increased its containment measures aimed at halting further transmission of SARS. A special effort has been made to raise the standards of infection control at Tan Tock Seng Hospital, which was converted into the country’s specialized hospital for managing SARS patients. > > Singapore has also introduced strict screening measures for all outbound air passengers. Selected incoming passengers from areas with recent local transmission of SARS are also screened. Nineteen thermal infrared scanners are in place at the airport, on loan from the military. The machines are capable of detecting a fever within a 0.2°C degree range of accuracy. > > \ > > WHO commended Hong Kong officials for their level of transparency in reporting on the SARS situation in the territory, a degree of cooperation that would be valuable from all countries. > > Hong Kong has introduced a rigorous contact tracing procedure. All close contacts of known SARS cases are quarantined at home. In addition, their Hong Kong Identity Card numbers are passed to the Immigration Department to ensure that these individuals cannot leave the territory. Response to the disease has indeed been effective thanks to the measures taken by the various authorities. Hong Kong in particular pulled off a great turnaround, considering that when the disease struck the territory practically nothing was known about SARS, there was no treatment to speak of, and health care workers seemed to be particularly vulnerable. The Chief Executive looked set to do his usual thumb-twirling routine, but all in all the authorities moved quickly and efficiently (the Head of the Hospital Authority was killed by SARS fairly early on, this alarming development could have further stiffened resolve). > [@](#): > > > [@](#): > > > > \*Originally posted by SuaSponte \* > > This is a null factor, as this is true of all diseases. Even the extreme mortality rates for Ebola necessarily only count those who were actually diagnosed with Ebola. > > _originally posted by Spoke_ > Not the same. Far fewer cases of ebola would go undiagnosed. (Hard to miss those ebola symptoms.) On the other hand, a mild case of SARS (how’s that for an oxymoron?) might easily be mistaken for a flu or a severe cold. Therefore, SARS is much more likely to go undiagnosed. There could have been (and could still be) thousands upon thousands of undiagnosed cases and we’d never know it. No, I’m afraid **Sua** is right on the money. Firstly, while it’s possible that there may be thousands of cases unreported at present that is indeed a non factor, an unknown. Is there evidence to suggest “thousands upon thousands of undiagnosed cases”? No, and until such evidence arises, the data have to be treated conscientiously. As Sua said, take these figures as useful comparative indicators. Mortality and infection rates aren’t calculated based on guesses of what we don’t know, but on the data available to us. Secondly, when and if we resolve the unknown factors of the SARS epidemic, the mortality rate could well turn out to be _higher than estimated_ (see my comments on undiagnosed cases later). Wired explained the concept pretty well, even though the article is fairly old (21 April): > [@](#): > > \*From [http://www.wired.com/news/medtech/0,1286,58552,00.html](http://www.wired.com/news/medtech/0,1286,58552,00.html) \* > An accurate fatality rate is impossible to determine at this point in the epidemic, experts say. The actual death rate will depend on how many people who are now sick die, and how many people suspected of having the disease turn out to have just a bad case of the flu. > > Some researchers believe the 4 percent figure is too low because it is not being accurately measured. The CDC is calculating the death rate by dividing the number of deaths by the number of probable cases. > > But because the number of probable cases includes some people whose outcome is not yet determined, some say the denominator in the CDC’s equation is too large. And of course, it’s possible the fatality rate is in fact lower – but, again, we’re dealing here with reported cases, which is what calculations are correctly based on, not guesses. If you want to discuss the undiagnosed cases, well I estimate that their number will not be particularly high. In case you haven’t been keeping up with the areas where SARS hit hard, this has become a full scale war on disease. Entire building complexes have been quarantined in an attempt to control the spread of the virus (in Beijing, tens of thousands of people under quarantine). Any employees who are suspected of having SARS-like symptoms (and this includes the flu) are ordered not to come to work and to go see a doctor. Temperature checks are frequently made outside of airports as well as in them – some apartment buildings have introduced mandatory temperature checks and registration (complete with ID card number details) for visitors. Hygiene campaigns are de riguer, hand-shaking is discouraged, information is available through web sites, hot lines, etc, and so forth. Additionally, with a mortality rate that is by no means trivial, persons who suspect symptoms are more likely to hie themselves over to medical care than they would be in case of a fairly harmless disease like the flu. Finally, the evidence up until now suggests that if you develop second and third phase SARS, it’s not going to be a picnic. Severe Acute Respiratory Syndrome isn’t just a pretty name, it also describes the disease, which has been found to operate in three phases and **is** rather severe: **1)** viral replication phase, when the virus multiplies in the patient’s body **2)** immune hyperactive phase, in which the immune system detects the virus and goes into overdrive to attempt to fight it off, sometimes attacking human tissue and resulting in damage **3)** pulmonary destruction phase, reached by 20% of patients and requiring treatment in intensive-care units (intubation and respirator). At this phase both the virus and the immune system attack lung tissue in earnest: death a distinct possibility, and in case of survival patients usually have to deal with permanent lung damage. [quote] _Originally posted by sivispacem_ Most of the deaths are coming in China and Southeast Asia, Eastern medecine is very, very good at somethings - but treating respiratory illness is certainly not one of them. Their health care is way behind in that department, and very few people have access to what health care there is, hence the high death rates. [quote] You may be under the impression that “Eastern medicine” is the primary practice in hospitals in the Orient, and by that I assume you mean traditional Chinese (and other) medicine. Hospitals, even those in mainland China, usually practice medicine in ways rather similar to Western medicine, with a rigorous and scientific approach to the problems at hand (and, sometimes, a pinch of the traditional philosophy). If things were left up to traditional medicine entirely, with its high volume of utter nonsense, things would be looking rather dim (dried penis, anyone?) In highly developed places like Hong Kong and Singapore, the standard of medical care is good (these are ultra-modern cities). Yet in Hong Kong, where good medical care is available to almost everyone, SARS still exacted a heavy toll. In mainland China, if we are to believe the figures reported (I would estimate the real fatality figures are at least double those reported thus far by China) the death rate is surprisingly low, yet it’s safe to say medical capability in China is not greater than in Hong Kong, quite the opposite. If SARS sweeps across rural China or makes strong headway into India, this will be a disaster medically and economically speaking. In that case, as you say, the health care systems will be severely overloaded very quickly. But most SARS cases in the region have been reported in cities, where better medical care is available and government supervision is the rule. Perhaps that offsets the effects of high population density… ---
**Author:** ![SuaSponte](https://avatars.discourse-cdn.com/v4/letter/s/67e7ee/32.png) [@SuaSponte](https://boards.straightdope.com/u/SuaSponte)\ **Post date:** [May 13, 2003, 2:26pm UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/24 "2003-05-13T14:26:35Z")
> [@](#): > > \*Originally posted by spoke- \* > \*\*Not the same. Far fewer cases of ebola would go undiagnosed. (Hard to miss those ebola symptoms.) On the other hand, a mild case of SARS (how’s that for an oxymoron?) might easily be mistaken for a flu or a severe cold. Therefore, SARS is much more likely to go undiagnosed. There could have been (and could still be) thousands upon thousands of undiagnosed cases and we’d never know it. \*\* Um, actually, mild Ebola symptoms mimic that of a flu or severe cold. Sua ---
**Author:** ![Spoke](https://avatars.discourse-cdn.com/v4/letter/s/a88e57/32.png) [@Spoke](https://boards.straightdope.com/u/Spoke)\ **Post date:** [May 13, 2003, 6:49pm UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/25 "2003-05-13T18:49:48Z")
> [@](#): > > 1683 in the Hong Kong SAR alone is certainly not a small number (with over 200 deaths), especially given that there are probably plenty of unreported cases. Hong Kong has a population of 6,800,000. 1683 victims represents 0.025% of the population. 200 deaths represent something like 0.003% of the population. I’d call those numbers vanishingly small, when viewed in that perspective. Certainly it has quite a way to go to catch up with the Black Death, which killed a third of Europe. The fact that the numbers are so low suggests to me either that the disease is not as contageous as feared or that there are many, many milder cases going unreported. (I’m more inclined to go with the second proposition, as it would explain the low death rate among US cases. The majority of people probably get the milder version experienced by most of those returning travelers.) Is SARS a disease to be taken seriously? Yes. In absolute numbers (as opposed to percentages) it could kill a lot of people. Is it the next Plague? Sure doesn’t look like it. The hand-waving and panic are way out of proportion to the harm this virus is doing. But hey, panic sells papers. ---
**Author:** ![Abe](https://avatars.discourse-cdn.com/v4/letter/a/f1d935/32.png) [@Abe](https://boards.straightdope.com/u/Abe)\ **Post date:** [May 14, 2003, 6:28am UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/26 "2003-05-14T06:28:38Z")
Vanishingly small? Compared to the Black Death? Those are not very meaningful comments. Mortality statistics for the Black Deaths are sketchy, for obvious reasons. We must remember that the plagues (bubonic, pneumonic, and septicemic, all commonly lumped in the term black death or plague) took _years_ to spread and wreak their havoc among very unhygienic populations who didn’t have a hope in hell of good medical care. In the case of SARS we’ve seen the disease spread very quickly in the initial days and weeks before being brought under control rather efficiently in a number of places (apart from China). The epidemic is not even half a year old yet. The comparison to the Black Death is silly because of the substantial differences in context between famous historical plagues and the modern situation. The comparison may be silly, but there is no reason to dismiss the worrying severity of SARS. I remember an estimate that the mortality rate for the pneumonic plague if treated by today’s medical standards would only be 5-10%, a number less threatening than that of current SARS mortality estimates. If untreated, pneumonic plague is usually fatal within 24 hours (approaching 100% mortality rate), so in that sense it is rather worse than SARS. The bubonic plague, on the other hand, has a mortality rate of about 60% if untreated. Only the pneunomic variant of the plague is spread by respiratory droplets (as SARS is), whereas other forms rely on intermediary transmission by fleas (usually from rodents) in order to transmit from person to person. Therefore historical context becomes all-important – remove the filth, the rats, and the parasites, and you have a markedly decreased chance of a plague being, well, a plague. In fact, an outbreak of plague **today** would probably not be as serious as the SARS epidemic is currently. Firstly, plague is bacterial, and it is generally much easier for medical science to combat a bacterium than a virus. Secondly, the general context is to our advantage – standards of hygiene and medical care today far, far outstrip even those of the wealthiest nobles when the Black Death held sway over the lands. Thirdly, pest control. Fourth, we have adequate sewage systems that siphon our waste away safely (or almost safely). Indications suggest SARS spreads not just via respiratory droplets but also through excretions, and I hesitate to think of the impact SARS would have had on the populations that historically proved so vulnerable to the Black Death, and who did not have adequate sewage systems (to say the least!). I’m guessing SARS would have qualified as a killer plague back then, given its infectiousness, vectors, and the environmental advantages for the virus. So much depends on context. So, no, SARS is not _today_ what the plagues were _in the past_, but do not be fooled – it is not a difference in disease virulence/infectiousness that safeguards us from the fate of the victims of the historical Black Deaths. Rather, it’s our science, hygiene, and containment strategies that afford us much improved chances. > [@](#): > > _Originally posted by spoke_ > The fact that the numbers are so low suggests to me either that the disease is not as contageous as feared or that there are many, many milder cases going unreported. Effective containment. I mentioned it in my earlier post and provided the appropriate link to WHO. But here’s a more recent and elaborate version of that answer: > [@](#): > > - from [WHO Update 54 - Outbreaks in the initial “hot zones” indicate that SARS can be contained](http://www.who.int/csr/sars/archive/2003_05_13/en/) \* > > In the absence of a vaccine, the most effective way to control a new disease such as SAS is to break the chain of transmission from infected to healthy persons. \ > > For SARS, three activities – case detection, patient isolation, and contact tracing – can reduce the number of people exposed to each infectious case and eventually break the chain of transmission. > > Case detection aims to identify SARS cases as soon after onset of illness as possible. Once cases are identified, the next step is to ensure their prompt isolation, in a properly equipped facility, and management according to strict procedures of infection control. The third activity – the detective work – involves the identification of all close contacts of each case and assurance of their careful follow-up, including daily health checks and possible voluntary home isolation. > > Together, these activities limit the daily number of contacts possible for each potentially infectious case. They also work to shorten the amount of time that lapses between onset of illness and isolation of the patient, thus reducing opportunities for the virus to spread to others. > > The effectiveness of these measures is reflected in an important indicator of disease transmission – the so-called “effective reproduction number”. This is the average number of new cases generated by each new case. > > If each new SARS patient infects more than one additional person, then the number of new cases will increase with time. If each new SARS patient infects one further person, then the number of new cases will remain static. However, if each new SARS patient infects, on average, less than one further person, then the number of new cases will fall and the outbreak will die out. and from a bit later on in the same update: > [@](#): > > - from [WHO Update 54 - Outbreaks in the initial “hot zones” indicate that SARS can be contained](http://www.who.int/csr/sars/archive/2003_05_13/en/) \* > > Nonetheless, as SARS has clearly demonstrated, a single case admitted to an unprepared hospital can ignite a new outbreak. While trends are moving in an encouraging direction in many areas, even greater focus on control measures is needed if SARS is to be contained globally. WHO experiences with outbreaks of Ebola haemorrhagic fever have repeatedly shown that the initial stages of containment are the most dangerous time to start lowering the level of control. I think effective containment is a better answer today to your question than speculations about the nature of the virus or of the disease it causes. > [@](#): > > Is SARS a disease to be taken seriously? Yes. In absolute numbers (as opposed to percentages) it could kill a lot of people. Is it the next Plague? Sure doesn’t look like it. The hand-waving and panic are way out of proportion to the harm this virus is doing. But hey, panic sells papers. It really depends on the papers one considers, but this virus IS dangerous AND harmful, not just to public health but to the economy as well. Your breakdown of Hong Kong deaths over population is not entirely relevant. Firstly, we don’t know how many subjects in addition to the confirmed SARS cases were exposed to virus hosts directly or indirectly, but it **certainly** was not the entire territory of Hong Kong. Secondly, this is a brand new virus that has very recently jumped species. It’s a virus that was not around before, and it had to start work on its infection curve from the very bottom, probably from one single infected human case and up (at least that seemed to be the case in Hong Kong). Fortunately the disease was identified in the early stages of the outbreak and contained quickly (ex-China), being nipped in the bud as it were. Allow SARS to run rampant in a given population, and you are guaranteed rather more depressing results in a longer term. ---
**Author:** ![OliverH](https://avatars.discourse-cdn.com/v4/letter/o/278dde/32.png) [@OliverH](https://boards.straightdope.com/u/OliverH)\ **Post date:** [May 14, 2003, 1:11pm UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/27 "2003-05-14T13:11:07Z")
> [@](#): > > \*Originally posted by spoke- \* > \*\*Hong Kong has a population of 6,800,000. > > 1683 victims represents 0.025% of the population. > > 200 deaths represent something like 0.003% of the population. > > I’d call those numbers vanishingly small, when viewed in that perspective. Certainly it has quite a way to go to catch up with the Black Death, which killed a third of Europe. > > The fact that the numbers are so low suggests to me either that the disease is not as contageous as feared or that there are many, many milder cases going unreported. (I’m more inclined to go with the second proposition, as it would explain the low death rate among US cases. The majority of people probably get the milder version experienced by most of those returning travelers.) > > Is SARS a disease to be taken seriously? Yes. In absolute numbers (as opposed to percentages) it could kill a lot of people. Is it the next Plague? Sure doesn’t look like it. The hand-waving and panic are way out of proportion to the harm this virus is doing. But hey, panic sells papers. \*\* Sorry, man, but the only one hand-waving here is you. It takes quite some guts to make such comments without any background in epidemiology. Comparing SARS with the Black Death is a statement that really invalidates your entire line of posts as mere ranting for ranting’s sake. Maybe you should go and check up on when the Black Death happened, and what the state of medical research was at the time. ---
**Author:** ![China\_Guy](https://avatars.discourse-cdn.com/v4/letter/c/779978/32.png) [@China\_Guy](https://boards.straightdope.com/u/China_Guy)\ **Post date:** [May 14, 2003, 2:22pm UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/28 "2003-05-14T14:22:05Z")
i’ve yet to see any reputable medical source such as CDC or WHO talk about people having a “mild” form of SARS and not knowing it. I did have a colleague who panicked and got his family out of Hong Kong claiming that his son had a “mild” form of SARS. I had colleagues who passed through HK in March and went home with a cold and jet lag who claimed they “must have had a mild form of SARS.” ---
**Author:** ![Spoke](https://avatars.discourse-cdn.com/v4/letter/s/a88e57/32.png) [@Spoke](https://boards.straightdope.com/u/Spoke)\ **Post date:** [May 14, 2003, 6:01pm UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/29 "2003-05-14T18:01:51Z")
In a city the size of Hong Kong, I find it difficult to swallow the idea that the (relatively) tiny number of victims is due entirely to effective medical response to the epidemic. Even with the best response, someone slips through the cracks, and if SARS were as contageous and as uniformly deadly as we are led to believe, we’d be seeing a much longer casualty list. Much as I admire and appreciate the efforts of the medical community to contain the outbreak, I don’t think they are capable of miracles, and I think some other factor must be present to explain the small numbers. As I said before, I think the most likely X factor is the existence of a milder form of SARS which is mostly undetected. Why no fatalities in the US yet? Why have US cases been (for the most part) notably mild (at least in comparison to the experience elsewhere)? Could it be that US citizens returning from Asia are being so closely screened that even victims of the hypothetical “mild” version of the disease are being identified? The idea bears investigation, I should think. But, again, panic sells papers, and (not incidentally) also sells research grants and CDC/WHO budgets. ---
**Author:** ![Abe](https://avatars.discourse-cdn.com/v4/letter/a/f1d935/32.png) [@Abe](https://boards.straightdope.com/u/Abe)\ **Post date:** [May 15, 2003, 3:47am UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/30 "2003-05-15T03:47:16Z")
> [@](#): > > \*Originally posted by spoke- \* > In a city the size of Hong Kong, I find it difficult to swallow the idea that the (relatively) tiny number of victims is due entirely to > effective medical response to the epidemic. Even with the best > response, someone slips through the cracks, and if SARS were as > contageous and as uniformly deadly as we are led to believe, we’d be seeing a much longer casualty list. It seems to me you have your own highly particular ideas about SARS. For example, no one is claiming that SARS is especially contagious. It’s not a super-spreader, nor does anyone in the know claim it is. Why do you keep pulling up this trampled and beaten straw man? > [@](#): > > Much as I admire and appreciate the efforts of the medical > community to contain the outbreak, I don’t think they are capable of miracles, and I think some other factor must be present to explain the small numbers. You’re repeating this assertion again but I still don’t see relevant support for it. > [@](#): > > As I said before, I think the most likely X factor is the > existence of a milder form of SARS which is mostly undetected. It’s possible, but that’s speculation. > [@](#): > > Why no fatalities in the US yet? Why have US cases been (for the most part) notably mild (at least in comparison to the experience elsewhere)? Could it be that US citizens returning from Asia are being so closely screened that even victims of the hypothetical “mild” version of the disease are being identified? The idea bears investigation, I should think. A few possible reasons pulled completely at random because I have no time for more research: 1. By time of first cases in US, much valuable information on the disease had already been uncovered (not the case for Canada, which was hit earlier) 2. Superior medical resources and skills 3. Early identification of cases – chances of a good recovery improve if SARS is detected early in patients (i.e. first phase) 4. Maybe some of the probable cases recorded in the US were in fact cases of influenza or similar illnesses and so forth. We don’t have to reach desperately towards unknowns in order to provide a reasonable answer to your question. > [@](#): > > But, again, panic sells papers, and (not incidentally) also > sells research grants and CDC/WHO budgets. As I said before it depends what papers you’re looking at; I didn’t find the media _I_ consult unduly alarmist, but certainly not every medium has been diligent and scientific in their reporting – it’s a question of identifying reliable sources of information and setting aside the crap. As for CDC/WHO budgets and grants, that is a ridiculous statement being based as it is entirely on your conjecture. Conjecture that does not seem well informed. Besides, it’s not like CDC and WHO are going to run out of dangerous diseases to concern themselves with… nor are they in a position to fake public data just to win grants. Science relies on peer-based analysis, not on wild claims. Perhaps you can point out how in your opinion the CDC and/or the WHO have been spreading panic in any way whatsoever? ---
**Author:** ![Sam\_Stone](https://avatars.discourse-cdn.com/v4/letter/s/ecccb3/32.png) [@Sam\_Stone](https://boards.straightdope.com/u/Sam_Stone)\ **Post date:** [May 15, 2003, 7:24am UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/31 "2003-05-15T07:24:55Z")
> [@](#): > > Why no fatalities in the US yet? Why have US cases been (for the most part) notably mild (at least in comparison to the experience elsewhere)? Could it be that US citizens returning from Asia are being so closely screened that even victims of the hypothetical “mild” version of the disease are being identified? The idea bears investigation, I should think. A big factor is the age of the afflicted population. SARS seems to be especially dangerous in the elderly - one statistic I saw showed a 55% mortality rate among people over 65. In Canada, I believe the afflicted population was relatively old. Same with some of the major breakouts in Hong Kong and Taiwan. Perhaps the afflicted in the U.S. are younger than average? ---
**Author:** ![Spoke](https://avatars.discourse-cdn.com/v4/letter/s/a88e57/32.png) [@Spoke](https://boards.straightdope.com/u/Spoke)\ **Post date:** [May 15, 2003, 12:43pm UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/32 "2003-05-15T12:43:14Z")
**Sam** wrote: > [@](#): > > Perhaps the afflicted in the U.S. are younger than average? Don’t think so. The two cases I know of in Atlanta were definitely AARP-eligible. **Abe** wrote: > [@](#): > > You’re repeating this assertion [that there should logically be more victims] again but I still don’t see relevant support for it. Common sense, man. If you’ve got a virulent virus loose in a teeming city like Hong Kong, you would expect more casualties. I admire the efforts of the health officials there, but they’re not miracle workers. Some other factor must be in play to keep the numbers down. Yes, this is hypothetical. Speculation, if you will, but it is based on common sense. **Abe** wrote: > [@](#): > > For example, no one is claiming that SARS is especially contagious. Well, earlier, you wrote: > [@](#): > > Indications suggest SARS spreads not just via respiratory droplets but also through excretions, and I hesitate to think of the impact SARS would have had on the populations that historically proved so vulnerable to the Black Death… Sure sounds like you are promoting the contageous aspects of the disease. Look, if SARS is spread by air then you would expect a much higher infection rate in a city like Hong Kong. Quarantine is great, but it takes time to identify and quarantine victims, and in the meanwhile, they are out coughing on and handling the same doorknobs as friends, family, co-workers and neighbors. Common sense suggests an X-factor which is limiting the outbreak. ---
**Author:** ![Super\_Gnat](https://avatars.discourse-cdn.com/v4/letter/s/e274bd/32.png) [@Super\_Gnat](https://boards.straightdope.com/u/Super_Gnat)\ **Post date:** [May 15, 2003, 12:55pm UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/33 "2003-05-15T12:55:16Z")
**spoke-** , from what I understand, they aren’t waiting to identify and quarantine victims. They’re taking everyone who has the sniffles and putting their block on lockdown. ---
**Author:** ![China\_Guy](https://avatars.discourse-cdn.com/v4/letter/c/779978/32.png) [@China\_Guy](https://boards.straightdope.com/u/China_Guy)\ **Post date:** [May 16, 2003, 2:32am UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/34 "2003-05-16T02:32:07Z")
> [@](#): > > \*\*\*Originally posted by spoke- \*Look, if SARS is spread by air then you would expect a much higher infection rate in a city like Hong Kong. Quarantine is great, but it takes time to identify and quarantine victims, and in the meanwhile, they are out coughing on and handling the same doorknobs as friends, family, co-workers and neighbors. > > Common sense suggests an X-factor which is limiting the outbreak. \*\* SARS has been identified as a corona-virus (spelling?), and has been proven to not be spread as an air borne contagion. It is spread through droplets like a common cold and body waste (like some forms of hepatitus). Read the WHO site, you pretty much have to be in close contained contact to catch SARS. As in a hospital. Either CDC or WHO investigated the Toronto outbreak and indentified improper use of preventative equipment like gloves, masks, eyecovers, etc as the main vector of transmission within the hospitals. As I wrote much earlier, SARS appears to be quite contageous only in close quarters like sick infectuous people in hospitals. Washing hands frequently and getting in the habit of not rubbing your eyes, nose or mouth should significantly reduce the risk from casual contact ala elevator buttons. I can’t speak for Hong Kong, but I can for Shanghai which has only a handful of cases. I speak daily with a large number of multinational corporations operating in China as well as with various contacts in the expat community and the local community via my family and colleagues, there is not one case of SARS confirmed among the people I am in contact with. There was one high profile confirmed case of SARS at Motorola in Beijing, and they shut that entire building down for 2 weeks. In Shanghai, railroad passengers go through a thermal scanner. If one person on the train has a fever, the entire train population goes into quarantine. This happened in nearby Nanjing. If one person on a plane has a fever, the entire train population goes into quarantine. I personally watched buses from outside the Shagnhai border pull into check stations, and all passengers line up for temperature checks. If you enter my residence building or office building as a visitor, you get a temperature check. Companies with big factories like the automakers require special top level approval - and that basically means the top management team. If you go to a 5 star hotel, your temperature is taken on entry. If I want to travel in China I have to get approval from the country manager. If I travel to a SARS advisory area, then I have to self quarantine for 2 weeks in Shanghai, with myself personally and company liable if I have SARS and spread it. These are just some of the steps going on in Shanghai. A pre-school had a suspected case, and the health authorities basically quarantined a few hundred little kids and their teachers until the suspected case was cleared. Superspark is correct. Having erred by not recognizing the problem early on, China has perhaps over reacted on the other side. Remember the rights of society are paramount in China (and have been since time immemorial) rather than rights of the individual. Argue those merits all you want, but what that means is quarantines are taking place immediately with authorities heads on the chopping block to be over zealous rather than under zealous. I’m sure you’ve all seen that China has passed a new law that punishes deliberate spread of SARS by various penalties including the death penalty. Is this hysteria? Dunno. Given China’s 50-200 million transient population, lack of computerization in the countryside, and a health care system that is third world, not sure what else one can do except quarantine like hell. One doesn’t want to see 20% of the Chinese countryside get wiped out over the next 12 months. ---
**Author:** ![Abe](https://avatars.discourse-cdn.com/v4/letter/a/f1d935/32.png) [@Abe](https://boards.straightdope.com/u/Abe)\ **Post date:** [May 16, 2003, 7:22am UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/35 "2003-05-16T07:22:54Z")
> [@](#): > > \*Originally posted by spoke- \* > Common sense, man. If you’ve got a virulent virus loose in a teeming city like Hong Kong, you would expect more casualties. I admire the efforts of the health officials there, but they’re not miracle workers. Some other factor must be in play to keep the numbers down. Yes, this is hypothetical. Speculation, if you will, but it is based on common sense. More repetition without support. This may be common sense to _you_, but it’s not such to anyone who has read up on this issue and is aware of the actual factors involved, factors that render your “common sense” quite superfluous in this particular case. > [@](#): > > **Abe** wrote: > > > [@](#): > > > > For example, no one is claiming that SARS is especially contagious. > > Well, earlier, you wrote: > > > [@](#): > > > > Indications suggest SARS spreads not just via respiratory droplets but also through excretions, and I hesitate to think of the impact SARS would have had on the populations that historically proved so vulnerable to the Black Death… > > Sure sounds like you are promoting the contageous aspects of the disease. Not at all, I am promoting a realistic view of this epidemic free of uninformed claims, unfounded suspicions, and unnecessary speculations. I have not made the claim, direct or indirect, that SARS is especially contagious (by the way, you keep mispelling that word). Stating that scientists believe the virus is spread through faeces in addition to respiratory droplets is not the same thing as saying that SARS is in any way “especially contagious”. This is why some reading on the subject may help you form a more educated opinion on SARS to replace any misconceptions you may have picked up. You could even start with the links to information already provided in this thread, which it seems you have not taken the time to explore. Note that SARS is by no means the only or even one of a few diseases that can spread through contact with faeces. Indeed, it is highly likely that bird droppings were ultimately responsible for the development of human influenza, since flu is thought to have an avian origin. Many of our winged friends enjoy viral coexistence with and can be asymptomatic to flu, happily carrying it and shedding it through their faeces all their lives, thereby spreading it to all sorts of terrain and mammals (and, eventually, to humans when the virus mutates sufficiently to jump the species barriers, for example through pigs as intermediary). Spread through faecal matter is by no means unusual for many diseases. I brought it up because you made a reference and comparison to historical plagues in Europe, and I pointed out how much more quickly SARS would be likely to spread in an environment where (among other things I discussed) infected human waste was not carried away safely by a system of sewers. > [@](#): > > Look, if SARS is spread by air then you would expect a much higher infection rate in a city like Hong Kong. Simply put (yet again) no. SARS is spread via contact with body excretions in general, not via the air. Were it spread in the air we would have an airborne version of SARS, which would be a deeply troubling problem indeed, far more serious that SARS is currently because then it _would_ get around much, much more. > [@](#): > > Quarantine is great, but it takes time to identify and quarantine victims, and in the meanwhile, they are out coughing on and handling the same doorknobs as friends, family, co-workers and neighbors. And that is why doorknobs, friends, family, co-workers and neighbors are all taken into consideration and scrutinized very closely as soon as possible every time a SARS case is identified. You clearly haven’t read the cites posted in this thread, which is highly annoying for anyone repeating the answers you’re not listening to. Evidence already provided in this discussion explains how SARS is being contained. Here is the exact same information posted earlier, but with added emphasis for maximum clarity: > [@](#): > > - From [WHO Update 54 - Outbreaks in the initial “hot zones” indicate that SARS can be contained](http://www.who.int/csr/sars/archive/2003_05_13/en/) \* > > In the absence of a vaccine, **the most effective way to _control_ a new disease such as SAS is to break the chain of transmission from infected to healthy persons**. \ > > For SARS, three activities – case detection, patient isolation, and **contact tracing** – _can reduce the number of people exposed to each infectious case and eventually break the chain of transmission_. > > Case detection aims to identify SARS cases as soon after onset of illness as possible. Once cases are identified, the next step is to ensure their prompt isolation, in a properly equipped facility, and management according to strict procedures of infection control. **The third activity – the detective work – involves the identification of _all close contacts of each case and assurance of their careful follow-up, including daily health checks and possible voluntary home isolation_**. [Added note: case contacts are not always quarantined _voluntarily_ by any means! It depends on the country in question] > > Together, **these activities _limit_ the daily number of contacts possible for each potentially infectious case**. They also work to shorten the amount of time that lapses between onset of illness and isolation of the patient, thus **reducing opportunities for the virus to spread to others**. > > **The effectiveness of these measures is reflected in an important indicator of disease transmission** – the so-called “effective reproduction number”. This is the average number of new cases generated by each new case. > > If each new SARS patient infects more than one additional person, then the number of new cases will increase with time. If each new SARS patient infects one further person, then the number of new cases will remain static. However, **if each new SARS patient infects, on average, less than one further person, then the number of new cases will fall and the outbreak will die out**. That is the simple common sense involved here from day one. The whole point of infectious disease containment measures is to try _stop the disease from infecting others_. No “miracles” are needed to explain the current success in places like Hong Kong; simple, sound, tested containment procedures will do the trick, which is what _they’re designed to achieve_. Also see **China Guy** ’s useful perspective on how things are in Shanghai – that should give you an idea of the resources mobilized to deal with this problem. Clearly in Hong Kong the authorities were not quite as draconian as the mainlanders, but they were very thorough nonetheless, and in fact they won praise from WHO for their handling of the SARS outbreak. Efforts don’t stop at simply tracing a disease in a number of cases – cleanup and hygiene are also part of the campaign against SARS. In Hong Kong practically every building, residential or business or public, has adopted temporary measures to stop the chain of transmission. Door handles, door bells/intercoms, lifts, etc., are cleaned several times a day (frequently every hour) precisely because it’s possible that someone with SARS may have sprayed droplets all over them. Surgical masks became widespread shortly after the disease was identified, meaning that infected people have a harder time spreading the virus to others (while of limited use to protect _from_ the virus, masks stops respiratory droplets from spraying out in their usual fashion). Corridors, passages, and building estates in general are hosed down and disinfected regularly. TV and newspaper ads encourage everyone to wash their hands frequently, avoid touching eyes/nose/mouth, maintain good hygiene, and cease the revolting habit of spitting in public (if SARS can finally stop the spitting, that alone will be worth the cost in dollars of the disease). And so on, and so on. > [@](#): > > Common sense suggests an X-factor which is limiting the outbreak. I hope you can see why common sense has nothing to do with your present claims of an x-factor. We don’t have to deny the possibility, but to speculate the presence of an x-factor where none is indicated, suggested, or needed is sloppy and may even give rise to complacence; there’s been downplay of the seriousness of SARS, and this is every bit as serious as the other end of the spectrum, the unduly alarmist approach. ---
**Author:** ![Abe](https://avatars.discourse-cdn.com/v4/letter/a/f1d935/32.png) [@Abe](https://boards.straightdope.com/u/Abe)\ **Post date:** [May 16, 2003, 7:31am UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/36 "2003-05-16T07:31:02Z")
> [@](#): > > \*Originally posted by spoke- \* > Common sense, man. If you’ve got a virulent virus loose in a teeming city like Hong Kong, you would expect more casualties. I admire the efforts of the health officials there, but they’re not miracle workers. Some other factor must be in play to keep the numbers down. Yes, this is hypothetical. Speculation, if you will, but it is based on common sense. More repetition without support. This may be common sense to _you_, but it’s not such to anyone who has read up on this issue and is aware of the actual factors involved, factors that render your “common sense” quite superfluous in this particular case. > [@](#): > > **Abe** wrote: > > > [@](#): > > > > For example, no one is claiming that SARS is especially contagious. > > Well, earlier, you wrote: > > > [@](#): > > > > Indications suggest SARS spreads not just via respiratory droplets but also through excretions, and I hesitate to think of the impact SARS would have had on the populations that historically proved so vulnerable to the Black Death… > > Sure sounds like you are promoting the contageous aspects of the disease. Not at all, I am promoting a realistic view of this epidemic free of uninformed claims, unfounded suspicions, and unnecessary speculations. I have not made the claim, direct or indirect, that SARS is especially contagious (by the way, you keep mispelling that word). Stating that scientists believe the virus is spread through faeces in addition to respiratory droplets is not the same thing as saying that SARS is in any way “especially contagious”. This is why some reading on the subject may help you form a more educated opinion on SARS to replace any misconceptions you may have picked up. You could even start with the links to information already provided in this thread, which it seems you have not taken the time to explore. Note that SARS is by no means the only or even one of a few diseases that can spread through contact with faeces. Indeed, it is highly likely that bird droppings were ultimately responsible for the development of human influenza, since flu is thought to have an avian origin. Many of our winged friends enjoy viral coexistence with and can be asymptomatic to flu, happily carrying it and shedding it through their faeces all their lives, thereby spreading it to all sorts of terrain and mammals (and, eventually, to humans when the virus mutates sufficiently to jump the species barriers, for example through pigs as intermediary). Spread through faecal matter is by no means unusual for many diseases. I brought it up because you made a reference and comparison to historical plagues in Europe, and I pointed out how much more quickly SARS would be likely to spread in an environment where (among other things I discussed) infected human waste was not carried away safely by a system of sewers. > [@](#): > > Look, if SARS is spread by air then you would expect a much higher infection rate in a city like Hong Kong. Simply put (yet again) no. SARS is spread via contact with body excretions in general, not via the air. Were it spread in the air we would have an airborne version of SARS, which would be a deeply troubling problem indeed, far more serious that SARS is currently because then it _would_ get around much, much more. > [@](#): > > Quarantine is great, but it takes time to identify and quarantine victims, and in the meanwhile, they are out coughing on and handling the same doorknobs as friends, family, co-workers and neighbors. And that is why doorknobs, friends, family, co-workers and neighbors are all taken into consideration and scrutinized very closely as soon as possible every time a SARS case is identified. You clearly haven’t read the cites posted in this thread, which is highly annoying for anyone repeating the answers you’re not listening to. Evidence already provided in this discussion explains how SARS is being contained. Here is the exact same information posted earlier, but with added emphasis for maximum clarity: > [@](#): > > - From [WHO Update 54 - Outbreaks in the initial “hot zones” indicate that SARS can be contained](http://www.who.int/csr/sars/archive/2003_05_13/en/) \* > > In the absence of a vaccine, **the most effective way to _control_ a new disease such as SAS is to break the chain of transmission from infected to healthy persons**. \ > > For SARS, three activities – case detection, patient isolation, and **contact tracing** – _can reduce the number of people exposed to each infectious case and eventually break the chain of transmission_. > > Case detection aims to identify SARS cases as soon after onset of illness as possible. Once cases are identified, the next step is to ensure their prompt isolation, in a properly equipped facility, and management according to strict procedures of infection control. **The third activity – the detective work – involves the identification of _all close contacts of each case and assurance of their careful follow-up, including daily health checks and possible voluntary home isolation_**. [Added note: case contacts are not always quarantined _voluntarily_ by any means! It depends on the country in question] > > Together, **these activities _limit_ the daily number of contacts possible for each potentially infectious case**. They also work to shorten the amount of time that lapses between onset of illness and isolation of the patient, thus **reducing opportunities for the virus to spread to others**. > > **The effectiveness of these measures is reflected in an important indicator of disease transmission** – the so-called “effective reproduction number”. This is the average number of new cases generated by each new case. > > If each new SARS patient infects more than one additional person, then the number of new cases will increase with time. If each new SARS patient infects one further person, then the number of new cases will remain static. However, **if each new SARS patient infects, on average, less than one further person, then the number of new cases will fall and the outbreak will die out**. That is the simple common sense involved here from day one. The whole point of infectious disease containment measures is to try _stop the disease from infecting others_. No “miracles” are needed to explain the current success in places like Hong Kong; simple, sound, tested containment procedures will do the trick, which is what _they’re designed to achieve_. Also see **China Guy** ’s useful perspective on how things are in Shanghai – that should give you an idea of the resources mobilized to deal with this problem. Clearly in Hong Kong the authorities were not quite as draconian as the mainlanders, but they were very thorough nonetheless, and in fact they won praise from WHO for their handling of the SARS outbreak. Efforts don’t stop at simply tracing a disease in a number of cases – cleanup and hygiene are also part of the campaign against SARS. In Hong Kong practically every building, residential or business or public, has adopted temporary measures to stop the chain of transmission. Door handles, door bells/intercoms, lifts, etc., are cleaned several times a day (frequently every hour) precisely because it’s possible that someone with SARS may have sprayed droplets all over them. Surgical masks became widespread shortly after the disease was identified, meaning that infected people have a harder time spreading the virus to others (while of limited use to protect _from_ the virus, masks stops respiratory droplets from spraying out in their usual fashion). Corridors, passages, and building estates in general are hosed down and disinfected regularly. TV and newspaper ads encourage everyone to wash their hands frequently, avoid touching eyes/nose/mouth, maintain good hygiene, and cease the revolting habit of spitting in public (if SARS can finally stop the spitting, that alone will be worth the cost in dollars of the disease). And so on, and so on. > [@](#): > > Common sense suggests an X-factor which is limiting the outbreak. I hope you can see why common sense has nothing to do with your present claims of an x-factor. We don’t have to deny the possibility, but to speculate the presence of an x-factor where none is indicated, suggested, or needed is sloppy and may even give rise to complacence; there’s been downplay of the seriousness of SARS, and this is every bit as serious as the other end of the spectrum, the unduly alarmist approach. ---
**Author:** ![OliverH](https://avatars.discourse-cdn.com/v4/letter/o/278dde/32.png) [@OliverH](https://boards.straightdope.com/u/OliverH)\ **Post date:** [May 16, 2003, 3:21pm UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/37 "2003-05-16T15:21:05Z")
> [@](#): > > \*Originally posted by spoke- \* > \*\*In a city the size of Hong Kong, I find it difficult to swallow the idea that the (relatively) tiny number of victims is due entirely to effective medical response to the epidemic. Even with the best response, someone slips through the cracks, and if SARS were as contageous and as uniformly deadly as we are led to believe, we’d be seeing a much longer casualty list. > > Much as I admire and appreciate the efforts of the medical community to contain the outbreak, I don’t think they are capable of miracles, and I think some other factor must be present to explain the small numbers. > > As I said before, I think the most likely X factor is the existence of a milder form of SARS which is mostly undetected. > > Why no fatalities in the US yet? Why have US cases been (for the most part) notably mild (at least in comparison to the experience elsewhere)? Could it be that US citizens returning from Asia are being so closely screened that even victims of the hypothetical “mild” version of the disease are being identified? The idea bears investigation, I should think. > > But, again, panic sells papers, and (not incidentally) also sells research grants and CDC/WHO budgets. \*\* Huh? WHO budget is on scales where shot term panic has precious little impact. There is no miracle at work here at all, but merely greater physical stamina of some. As was pointed out to you, the mortality rate is low with young people. People zipping around the world are unlikely to be above the age of 65, where mortality is highest. As such, that many people exposed to it don’t die is not unusual at all, but a case of demographics. ---
**Author:** ![Lamia](https://avatars.discourse-cdn.com/v4/letter/l/8e7dd6/32.png) [@Lamia](https://boards.straightdope.com/u/Lamia)\ **Post date:** [May 16, 2003, 11:44pm UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/38 "2003-05-16T23:44:28Z")
Update: After perusing the latest CDC report, the administration at my school decided this morning to allow Mrs. Li to attend her daughter’s graduation. She’ll be here tomorrow. ---
**Author:** ![China\_Guy](https://avatars.discourse-cdn.com/v4/letter/c/779978/32.png) [@China\_Guy](https://boards.straightdope.com/u/China_Guy)\ **Post date:** [May 17, 2003, 6:06am UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/39 "2003-05-17T06:06:44Z")
Good news Lamia. Hope she has a great time and the admin apologizes for being complete fuckwits. ---
**Author:** ![TheRealJohnPeat](https://avatars.discourse-cdn.com/v4/letter/t/4bbf92/32.png) [@TheRealJohnPeat](https://boards.straightdope.com/u/TheRealJohnPeat)\ **Post date:** [May 17, 2003, 1:17pm UTC](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538/40 "2003-05-17T13:17:56Z")
- WARNING: Layman has a theory 🙂 \* Firstly, it occurs to me that, from time to time, the people who ‘fight disease’ need a bit of publicity - to get a boost in funding and attention if nothing else. Now - whenever something like SARS crops up (or more particularly the fact a government has hidden the extend of it) , the opportunity is too good to miss surely? That said - the outbreak of a totally resistant strain of Plague didn’t ‘set the alarms ringing’ the way this has - despite the fact a more widespread outbreak would be FAR more deadly… Note: I’m not saying SARS isn’t a serious threat - I’m just saying we’d get the media coverage whether it was or wasn’t… The “real” threat of something like this isn’t really the death-toll tho - it’s the ‘collapse of society’ which could well happen long before the death-toll gets into any serious figures. If people start to panic it doesn’t take long before all manner of unpleasantness starts - from widespread job absenteeism through hoarding upto looting - societies which are armed start brandishing guns at people they don’t like the look-of and so on and so on. All I’m suggesting is that a virus/bacterial outbreak doesn’t have to have a high fatality rate to cause enormous problems - the ability to fight it can easily be ovrewhelmed by people’s ignorance of the facts, let alone the infection itself… But then you knew that I guess… - Layman out \* TTFN JP [Previous page](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538.md?page=1) [Next page](https://boards.straightdope.com/t/is-sars-a-case-of-mass-hysteria-how-can-we-tell-either-way/174538.md?page=3)