Why the hysteria over SARS

Factual Questions
1

Here’s my question: isn’t the world reaction to SARS **way **out of proportion to the threat, and perhaps mostly indicative of gloabl angst about other things: war, terrorism, etc.?

Okay, now IANAEpidemiologist, and I’m the first to admit that I haven’t studied this issue seriously, beyond catching a few newscasts here and there (mostly NPR and CNN). So I could be mistaken.

Here are a few of the facts about SARS I’ve learned (and if I’m wrong about any of them, please feel free to correct me):

  • It presents symptoms similar to flu and pneumonia.
  • It is fatal in about 1-3% of cases.
  • Until very recently (last week?) no reliable test to identify it existed. Therefore, the number of actual cases (and fatalities) may be significantly overstated.
  • No treatment or cure is available yet.
  • A few hundred people in China have died, a few dozen in Hong Kong, Vietnam, and a handful in a few other world cities.

The world reaction: Tourists have practically stopped going to Hong Kong and China, hotels, restaurants, and other public areas in those areas are empty, and people are wearing surgical masks when they go outdoors, as are some people in other world cities. The economies of the region could be affected for years to come because of this outbreak.

But is this number of fatalities really all that scary? In China, the world’s most populous country, I’d wager that a few hundred people die of hiccups every few months. Among the millions of Hong Kong residents don’t a couple dozen die of plain old pneumonia every week?

The risk of contracting SARS, much less dying of it, seems really low to be creating this level of panic. I mean, it’s not like it’s Ebola, which has a fatality rate of 90% or so.

So isn’t this all a serious over-reaction to the situation? A media-created frenzy? A boogeyman that happened to hit the news just as the war was ending, when the world’s pent up anxiety and tension had no where else to go?

Or am I wrong, and should I toss out all my duct tape to make room for a stock of surgical masks?

2

Here’s the WHO SARS section. BTW there are treatments for the disease.

3

A lot of it is media induced. If you compare statistics like traffic related fatalities, regular pnumonia fatalities, etc up against SARS, then it doesn’t seem to be such a big deal.

Toronto is worrisome in that it’s a first world country, and not some humid and extremely densely populated city where everyone takes mass transit and housing is shall we say not up to building code.

China is worrisome in that SARS is likely to wipe out 5% of the countryside. The cities may be largely untouched, but the countryside is in for tens of millions dying. Ditto for India if it takes root there. That will make for some serious human suffering not to mention nasty headlines for 12-18 months.

I live in a city that is largely untouched, but the knock on effects of SARS is everywhere. US embassy staff in China now will only travel by private vehicle. Thanks guys for showing your mettle and leading by example.

When my daughter ran a fever 10 days ago in Shanghai, you can bet what ran through my mind.

4

Oh ya, you’ll be less panicked if you read the www.cdc.gov website and the WHO website linked by Urban Ranger instead of listening to CNN.

Every newscast I see there’s some talking head spewing off about how there is a slight chance this thing might be airborne or some other BS, which translates into big screaming headlines

5

Underlying the overhype from the media is one concern that always worries public health officials whenever a “new” infectious respiratory disease appears: Is this the next 1917?

I am of the opinion that China’s mismanagement of the situation may have contributed to the hysteria.

6

Because it’s a new disease. We don’t know how it will behave. That’s kind of scary. Personally, I think people are more worried about it than is warranted, but you never know. New fatal diseases don’t pop up all that often, so it’s newsworthy.

7

I’ve given reasons as to why we’re concerned about SARS in Hong Kong in this thread:

http://boards.straightdope.com/sdmb/showthread.php?s=&threadid=178444

8

W.H.O knew of the SARS outbreak since Nov 2002, so why the big deal now? What about all the other diseases like T.B, Malaria, Cholera, which kill more people and the media don’t tell you that. And yet, people still travel to countries where these diseases are prevalant.:rolleyes:

9

Because we know so little about it, because unlike other forms of pnuemonia, this atypical one (in HK especially) is killing many typically young people (between the ages of 35-50), because SARS has the ability to travel and travel fast.

But I’ll admit one thing though, people here do seem to be predisposed to panic, but yet we do need to be concerned.

10

The thing I read about yesterday, in BBC news, was that they’re already seeing strain mutations. Which of course one would expect in a virus. But imagine (for pessimists like me) the worst case scenario. This thing is a very close relative of the common cold. Imagine that the most efficient mutations survive, that is, the mutations which most effectively allow the virus to transmit from host to host. How many colds do you catch a year? 1, 2, more? What if you caught SARS a few times a year? And it was sufficiently nasty to knock you off of your feet for a few weeks or kill you each time?

Doesn’t sound particularly pleasant, does it?
[/paranoia]

11

In Toronto several montsh ago, the Norwalk virus had very bad effects. Shutting down emergency rooms, etc. Everyone business I know was affected to some degree (we had 3 employees off sick in an office of 40). The idea that SARS could spread as widley but be fatal is worrisome.

That being said, the media here is doing it’s best to actually educate without getting sensational. So in Toronto we’re a little hypervigilant, but not hysterical. We’re all diligently washing our hands (most businesses have a lot of extra soap) and people are being diligent.

CNN on the other hand quoted a doctor saying “it’s slightly more infectious than Ebola.”

Now, while that little factoid might be true, it’s not particularly helpful to the general population of North America (whose knowledge of Ebola comes mostly from movies like Dustin Hoffman’s Outbreak – in which the U.S. government decide to control the disease by nuking a town). Comparing SARS to Ebola frightens far more than it informs. That’s when you’re getting “hysterical” media coverage – when they aim for drama rather than information.

12

I would disagree with this statement. Until now, I never heard anybody giving a fatality rate.
I assume you did the maths by comparing the number of cases with the number of deaths. But since most people have been recently infected and are undergoing treatment, you can’t know how many of them will die. For instance let say there has been 100 cases and 5 five people died. At first glance, it could mean that the disease is fatazl only in 5% of case. But if actually, amongst the 100 persons, 90 are being treated, 5 have died and 5 have recovered, the death rate could as well be 50% (I don’t mean that in this particular case the death rate is that high, it’s just an example).

If you want a more accurate number, it would be better to compare the number of recoveries with the number of deaths. For instance, if 400 have recovered and 100 died from the disease, then the fatality rate could be closer to 20% (100 out of 500) than to your 1-3%. Though it wouldn’t be accurate, either, since recovery could be long for people who don’t die from the disease, and in this case, doing the maths this way would overestimate the lethality rate, as long as you didn’t have time enough to base your maths on a large enough sample of people who got the disease quite a long time ago (enough time to have all either recovered or died).

Also, currently there aren’t that much people ill. They receive good medical care. But if the disease becomes widespread, will the hospitals be able to give the best treatments to thousands, dozens of thousands, or hundred of thousands people? If they are unable to, then the letality rate could rise to a very high level (you could also consider that a lot of medical professionals could catch the disease themselves).

And in the previous paragraph, I was only refering to develloped countries. In third world countries which can’t provide a minimal level of medical care, even currently, what will happen? Most of the people won’t receive any treatment at all. And what is the letality rate for people who don’t receive medical care? Of course, it’s unknow. But since ill people have extremely serious respiratory problems, I would expect it to be very high…25%? 50%? 75%? I sure don’t know. So, if the disease spread to Africa, India, etc…the death toll could be enormous.

Also, even if the death rate is actually low, say, your 3%, how many disease which are easily transmitted (contrarily to say, AIDS) do you know which have such a lethality rate? Not many people die from catching a common cold.
Which raise the next point : how easily transmitted is the disease? If it’s as easy to catch it than the aforementionned common cold, it could mean that a very large part of the population will eventually catch it over the years. Even 3% of the population of develloped countries, and a way, way higher percentage of the population of develloping countries would mean an enormous death toll.
Finally, it is said that the virus can mutate very easily. Then, some “brands” (I don’t know the correct english word) of the virus could spread more easily, or could be more lethal. Finally, it would also mean that you couldn’t find a vacine which would protect you with certainty, and that having caught the disease once wouldn’t mean you couldn’t catch it another time (like with the flu : you can perfectly catch the flu several times in your life since it’s not always the same virus which is running around (and your body only know how to fight the agents it has already been exposed to).

So, to sum up, yes, I do think that you’re underestimating the risk, and that this disease could kill really a lot of people if it isn’t contained.

13

[ul][li]It’s easily transmitted.[]Transmission mechanism not yet known.[]Currently incurable.[]5% fatality rate (though possibly much higher).[]Can simultaneously infect large, contiguous groups of people (cf. Amoy Gardens in HK).Mutating readily.[/ul]Pretty damn scary to me.[/li]
[aside] Just got our third suspected case in Ireland (two others proved negative): a woman who just came back from Guangdong with “SARS-like symptoms” and the [expletive deleted] hospital sent her back to the hostel where she was staying. They’ve sealed off the hostel and are now desperately trying to trace everyone who was in the hostel, and anyone else she may have come into contact with. :smack:

14

Actually a significant number of people do die every year from catching a cold. It’s mostly elderly people, or people who are ill already.
I dunno if anyone has mentioned this already, but aren’t those masks completely ineffective? Surely a virus is small than the holes in the mask?

15

The big scare came after the Block E apartment in China, where leaking sewage blew into fans, making it appear to not only airborne, but highly virulant, with an over 80% infection rate in that one building.

They are fairly certain now that it’s only transferred via body fluids, which is much less cause for concern. The incubation period and slow onset to full blown symptonology are still cause for concern, since that will pretty much gaurantee that it will be nearly impossible to control or eradicate.

16

What the government here in HK is doing is urging just those who have been in direct contact with any SARS patients to wear masks at all times.

As for masks being ineffective, I guess it will depend on which ones you use. There are ones such as the N95 mask which are pretty restrictive, in the sense that people who have breathing difficulties or asthma shouldn’t wear them.

Most of the people in the streets are wearing 2 or 3-ply paper masks, which can be bought rather cheaply at any shop around the corner.

The effectiveness of masks really depends on how well the person can restrict themselves from touching the masks, how the masks are disposed of. Masks really don’t need to be worn by everyone, just as long as we all keep our personal hygiene standards pretty high, ie washing hands with liquid soap every now and again.

17

Disclaimer: IANAD/N, but I do work with patients in a medical center, and was trained in infectious disease protocols here.

Masks would be ineffective if the virus were airborne, which it does not appear to be. SARS appears to be spread by droplets, which would for the most part be contained/blocked by a mask. Protocol for working around patients with droplet-borne diseases (like tuberculosis) includes wearing a mask, though I believe they are better than the ones that I’ve seen most people wearing in pictures from China/Hong Kong, and may even involve a special ventilator-like system attached in certain circumstances. (I’ve never actually had to wear one, though I was fitted for a special mask in case I do work with patients with TB, etc.)

So in other words, the mask could be helpful at avoiding droplets by people who might sneeze/cough very near you, though I would suspect most people there would be very alert about not coughing right on someone else. It would also probably help someone with the disease not transmit to someone else. However, other hygenic measures would also have to be followed very strictly, or else the mask-wearing would be completely worthless.

Worry about SARS has spread even to Chinatowns of various US cities - a report on the news yesterday said that businesses in Chicago’s Chinatown are suffering greatly from lack of customers, even though there are currently zero cases of SARS within Chicago itself, versus several in the suburbs.

18

With all due respect, please provide a factual answer in General Questions instead of a WAG. Take a look at the WHO website SARS page

Jimm, the transmission method is known via droplets and body waste. Amoy Gardens in Hong Kong has been traced to leaky sewage pipes and spread through droplets.

19

So, has anyone forbidden Toronto residents to travel if they’re not infected, and don’t think they’ve been exposed? My husband and I are planning to visit Ottawa next weekend for someone’s college graduation. Do people think we should stay home?

20

Lissla, a handful of cruise companies have forbidden Torontois (I always thought the French word sounded better than Torontonian). I would not restrict your travel unless you have a fever greater than 38 degrees or feel really crappy. This is a medical opinion, FWIW.

SARS is scary because they can’t test for it, don’t know the optimum treatment and because it seems to be both quite contagious and has a pretty high fatality rate. The media has probably been blowing it out of proportion, I would agree. But I’d rather see Public Health use a stick too big than too small given the dangers, for the same reasons the British Government should have leapt on Mad Cow Disease earlier… easier to deal with a small problem than a big one.