SARS - Blown out of fucking proportion

The BBQ Pit
41

I’m reasonably certain it’s not that kind of virus…

We just got an email this morning from our HR goobs saying…

“As of 10 April, the total number of reported in Canada is 97 (57 cases less than in the U.S.), of which 23% have already recovered… We will issue official travel advisories based upon recommendations of the WHO and the CDC. As such, we make no recommendation against travel to Canada at this time.”

Umm… if there are fewer cases of SARS in Canada than in the US, doesn’t this mean that it’s a GOOD idea to go to Canada?

42

Canada has a much lower population, thus their rate of infection is higher, so that’s an argument to stay in the U.S.

43

There is something to be said about over hyping of the disease however a cavalier attitude is just as bad. As what happened when a fellow decided he was well enough to go to workand is now in trouble. The quarentine is a good idea in that if it works the disease is contained and hpefully that prevents future cases.

44

Actually, that’s not the case - the CDC is using a different and much more inclusive criteria for including cases on the ‘suspected’ list. From the latest ProMED update.

You can read the CDC criteria here:
CDC SARS case definition

The USA really only has five almost-certainly-SARS cases - the rest range from suspicious to probable. So far we’ve had no confirmed SARS deaths (Canada is up to 11 or 12, I believe) and no evidence of ‘community transmission’, although the CDC’s criteria for that is different, too - they aren’t counting cases passed on to health care workers and household members as ‘community transmission’, since they say such transmission is expected.

Really, Canada has a much more serious problem than we have in the USA - or, at least, of which we’re aware. The CDC’s broad category of ‘suspected case’ (which they used from the very beginning) may be what has kept SARS in check here so far. Not that Canada did anything wrong that I know of - I think they were just unlucky in the circumstances of their original outbreak.

BTW, Kuwait has now reported a suspected case, and Singapore has nailed their ‘supercarrier’ (or one of them, at least). Vietnam is still looking great, but China and HK seem to jump by 10 or more cases every time there is an update.

You know, everyone can get pretty darn accurate information about SARS over at the International Society for Infectious Diseases ProMED mailing list site. They post every announcement from WHO, CDC, HealthCare Canada, and other official organizations, e-mail messages from on-site or otherwise involved health care professionals, and the more reliable news stories. And they have archives - in this case going all of the way back to the first mention of a serious pneumonia epidemic in China on February 10. For some reason I can’t link directly to that page, so do this if you’d like to read it: Go to above ProMED link. Click on “Search Archives” in the lefthand menu. Scroll down to the last section in the righthand column titled “Archive Number”. Enter 20030210.0357 and click “Search”.

45

Let me just point out that the fatality rate in the US from SARS is 0.00%. Big difference between 3rd world health care and the US. Also mortality rate in Asia is almost exclusively over 40 years old, and generally elderly people with other health complications.

46

To heck with you guys, I’m duct taping my head!

47

::sigh::

When there is a fatal, contagious disease with an unknown vector, the appropriate reaction is overreaction. It’s insurance.

Looked at from a probability standpoint, most money spent on insurance is utterly wasted. The odds are that you are not going to be in a fatal car accident, be sued for negligence, need catastrophic care, etc.

But you purchase insurance anyway, because the harm you will incur if you do suffer one of the above instances and you don’t have insurance is immense.

Same here. Many of the steps being taken, the reporting and the warnings will probably, in the long run, turn out to have been unnecessary. But given the downside, they are appropriate, even if the downside is very unlikely.

Sua

48

Hey, is anyone else dreaming about an old black woman playing a guitar in a cabin in Nebraska?

49

While I somewhat agree with you regarding insurance, I have to disagree. True, we buy insurance to protect us from a low probability of something happening. But the amount of insurance purchased does not cause “harm”. In other words, someone doesn’t buy every type of insurance out there to the fullest extent or they would be unable to survive - since they would be broke.

The news should give us information but they are spewing out rumor after hypothsis to the point of making people paranoid and hysterical.

So where do you draw the line between giving out information which might be useful (or might not) versus going overboard and creating hysterics? In my opinion, the media has way crossed the line - so far they can’t even see it anymore.

50

No, but I have had a sudden urge to book a flight to Las Vegas.

51

Sorry, the above was in response to gobear

52

Odd definition of “harm.” Purchasing insurance certainly does cause harm - the purchaser is unable to spend the money spent on insurance on other things they desire, or to save the money in order to prepare for a rainy day.

Adding up the money I personally spent on insurance over the years, had I not so spent it, I would have a better car and probably sufficient funds for a down payment on a house. Every payment anyone makes on insurance reduces that person’s standard of living. Everyone is “harmed” by paying for insurance.

Even if your definition of “harm” was correct and continuing the insurance analogy, the affected governments, etc., have not bought every type of insurance out there to the fullest extent. True “fullest extent insurance” against SARS would include a complete quarantine of all affected cities and towns, complete cutoff of all forms of transportation. Hell, you want to be hyperbolic, “fullest extent insurance” against SARS would involve sterilization of all life in the affected areas - a nuke would do the trick well.

Sua

53

Yes, purchasing insurance can cause harm. Maybe I didn’t spell it out but the media is whipping people into a frenzy. I’ve seen people cancel trips since they don’t want to be on an airplane. I have coworkers that no longer take the subway since they don’t want to be that close to others. I’ve seen people NOT come to work since a coworker recently rode on a plane. I’ve seen people alter their lifestyles in not so good ways since they are scared of SARS.

This is due solely to the facts…um…rumors and crap spread by the media. These are, in my opinion, irrational behavior changes. Using your insurance comparison, I liken this to people buying insurance in levels and types not necessary and at costs at or beyond their means since they HAVE to have it. Sure, I could get a $2 million whole life policy. It would be nice for my family when I die but I’m not going to spend about $2,000 a month for it (which is about what it would cost).

So while some (and maybe most) insurance is not “harmful”, people can go overboard and actually put themselves in a position where the insurance levels cost too much and they are harmed.

54

I also live in Toronto and, although I respect this particular disease for what it can do, I don’t care to listen to the media report every case, every death, and all the interesting rumors it can dig up.

I actually have a higher chance of getting SARS than most people in that my SO’s brother works at Scarborough General (this hospital has not been closed due to the out break) as a nurse. He has to wear a surgical mask while working. If this virus isn’t airborne but rather transmitted by fluids there’s a small chance of him bringing it back (ok, so it’s a freakishly small chance).

Oh well, most news sources are still yapping about the war so I’ve stopped watching TV completely. Too much talk about POWs, Iraq and talking heads makes me want to puke.

55

I work in a major Toronto teaching hospital. We have more SARS cases than anywhere else in Canada. One of my jobs is coordinating (and participating in) SARS care.

The amount of arrogance and complacency posted in this thread (by a few) is astounding.

Some seem to imply that a 96% “cure” rate is wonderful, and what’s all the worry about. They omit the fact that in addition to the 4% death rate, there’s another 4%(?) who require prolonged mechanical ventilation. God knows what permanent long troubles there gonna have. And how about the 10 to 15%(?) who require prolonged hospitalization?

Some have compared SARS to good old influenza. OK. The death rate from SARS is much higher than that from the influenza variants we’ve seen in recent years. We have a vaccine for influenza. Not only do we not have a vaccine for SARS, but its putative agent, coronavirus, mutates so rapidly that making an effective vaccine will likely be elusive.

Others announce that it’s mostly just the old and immunocompromised who are at risk for the worst outcomes. But they seem to ignore the fact that “mostly” doesn’t mean “only”. In the last month, I’ve seen 40 and 50 year-olds crash - repeatedly. These were healthy people in their prime.

Some seem to think the low threshold for quarantine is an over-reaction. Ask the 44 year-old guy we admitted a few days ago, the guy who’s now tubed in the ICU, ask him what he thinks. All he did was sit in a funeral home with someone who had SARS but didn’t know it. There was NO intimate or even close exposure. Ask the group of GP’s we’re treating. Ask them if they would have preferred to assume that every person with fever and shortness of breath should be assumed to have SARS.

And, every person reading this should be very, very grateful that we are “over-reacting”. If we blow this, and the virus spreads, it could well be a disaster. If nothing else, health care as you know it will change. Radically. Masks, gowns, gloves, for everyone. Routine outpatient visits highly restricted, or even prohibited, at first, and then done under extreme caution only when you feel confident enough that your screening procedures are secure. (We’ve cancelled ALL elective surgery in the city for almost three weeks now, essentially eliminated hospital visitors, and reduced outpatient visits almost to zero. Morale is falling, efficiency is dropping, and cases are backing up.)

You do not want this to affect your city.

56

KarlGauss, I’ll try this again since the hamsters ate my first attempt. Since you are in the thick of things, I hope maybe you and/or your hospital has an informed opinion on a few things. Understood that answers will not be 100%, but generally speaking:

First, is this a droplet spread disease much like the common cold? Given the pattern of infection is there any reasonable belief that this is air born?

Second, why Toronto instead of Hongcouver?

Third, why so many deaths in Canada? According to WHO, Hong Kong has 1190 cases and 47 deaths, Singapore 158 cases and 12 deaths, US has 74 and zero deaths, canada has 100 cases and 13 deaths. That’s a 13% death rate versus a global average of 3-4%. also, the two hardest hit places of HK and Singapore are hot humid clients with extremely high population densities, massive apartment blocks, shoddy construction (at least in the case of HK), and a very high proportion of the population that commutes by subway/mass transit. Any thoughts?

Your view on the mass media coverage?

57

Hi there. Let me try and give you my take on this, understanding that no one is certain about any of this.

  1. Most people “in the know” consider this to be a droplet spread illness. However, the anomalous cluster in the Hong Kong apartment building suggests that, at least in some cases, other modes of transmission may be possible.

The main reason for the droplet theory, I believe, is that if this were airborne, we’d see faster and more widespread infection.

  1. This one is easier to answer. It’s just bad luck. The three original cases here were exposed to the index case in Hong Kong when they visited there and, it seems, at least two of these people are so-called “super-spreaders”. Unless I am mistaken, every case in Toronto has been traced back to them. It is tremendously reassuring that, to my knowledge, there have been no sporadic cases.

It is true that many of those now affected had no exposure to the first trio. They did, however, have exposure to others who had been exposed/infected to/by them.

  1. I think your numbers are off a bit. We’ve had something like 13 deaths out of 287 cases (see here). Just under a 5 percent fatality rate. I estimate that at least the same pecentage are on ventilators.

The degree of media coverage here is to be expected and, actually, has been pretty good. Initially, there was a lot of BS, but lately I think it’s been responsible and accurate. Remember, our hospitals are paralysed. It is like a war-zone.

I would be curious to know what the media coverage is like in, say, Chicago or Sydney.

Hope this is of some interest!

58

Thanks.

From a local perspective as someone who has lived in HK for 6 years. It is no wonder if SARS is spread by urine or feces (likely says the WHO and akin to hepatitus A) that the vertical transmission in some apartment blocks took place. HK generally has some pretty shoddy block housing with exposed sewer pipes and associated leakage. I’m pretty confident that the vector of transmission there will be identified. The HK government may try to cover that up because if true, it means that the initial quarantine order was absolutely the wrong thing to do (24 hours later they took all the residents out to an isolation unit in the new territories).

I’d like your take on the “super-spreaders” as according to the WHO there is no such thing:

hmmm, the WHO website still has the Canadian infected at 100, but your numbers seem much more in line with everywhere else.

59

I (and I know I’m not alone) still subscribe to the super-spreader concept (although there’s more to the spread of SARS than just a few super-spreaders).

One way of looking at it is that there are some people who, for whatever reason, have greater viral loads and/or greater viral ‘shedding’. By definition they would be putting out large numbers of viruses (or I suppose modest numbers of a more virulent virus). They may, or may not, have some specific immune susceptibility or vulnerability.

Others put less weight on super-spreaders and would point out that anyone who’s spewing out viruses will appear to be a super-spreader if they have intense or protracted close contact with others. They simply have more opportunity, more chances, to spread the virus.

Note that the website I linked to above is from Health Canada, so the figures are as good it gets.

Are we not being too civil for the pit? Will we be allowed back?

60

Maybe they’re close talkers.