SARS, A Deadly New Disease

On another thread, there is a post questioning whether SARS is actually a new and serious disease and describing the reporting about it as "Hype". Let's set the record straight here. SARS is a new and serious disease that has a death rate many times that of the common flu. The death rate of SARS has been reported recently as being somewhere in the 5 to 7 percent range. The most recent figures posted today from reliable sources put the number of dead at 500 and the number of people infected with SARS at 7,000. My impression is that these figures are cumulative. How does the death rate compare with flu? The number of people killed by flu in the U.S. is estimated at about 36,000. Seems high, but the number of people who get flu each year is in the range of 28 to 56 million in the U.S. So the death rate is something in the vicinity of 0.1 percent, compared to the SARS death rate of at least 5 to 7 percent. A few minutes ago, my son said that newest figures on the overall SARS death rate were 15%. He also said that the death rate for those over age 60 is 50 percent. I have not personally seen these high figures reported but even if we accept the lower figures of 5 to 7 percent, it is clear that this disease is far more serious than common flu and could kill millions around the world. Is the news reporting hype? Not by a long shot.

 

This is a timeline of the disease:


Nov. 16, 2002 -- The first case of an atypical pneumonia is reported in the Guangdong province in southern China.


Feb. 26, 2003 -- First cases of unusual pneumonia reported in Hanoi, Vietnam.


Feb 28, 2003 -- World Health Organization officer Carlo Urbani, MD, examines an American businessman with an unknown form of pneumonia in a French hospital in Hanoi, Vietnam.


March 10, 2003 -- Urbani reports an unusual outbreak of the illness, which he calls sudden acute respiratory syndrome or SARS, to the main office of the WHO. He notes that the disease has infected an unusually high number of healthcare workers (22) at the hospital.


March 11, 2003 -- A similar outbreak of a mysterious respiratory disease is reported among healthcare workers in Hong Kong.


March 12, 2003 -- WHO issues a global alert about a new infectious disease of unknown origin in both Vietnam and Hong Kong.


March 15, 2003 -- WHO issues a heightened global health alert about the mysterious pneumonia with a case definition of SARS as after cases in Singapore and Canada are also identified. The alert includes a rare emergency travel advisory to international travelers, healthcare professionals and health authorities.


CDC issues a travel advisory stating that persons considering travel to the affected areas in Asia (Hong Kong, Singapore, Vietnam and China).


March 17, 2003 -- An international network of 11 leading laboratories is established to determine the cause of SARS and develop potential treatments.


CDC holds its first briefing on SARS and says the first 14 suspected SARS cases are being investigated in the U.S.


March 24, 2003 -- CDC officials present the first evidence that a new strain of a virus most frequently associated with upper respiratory infections and the common cold in humans called the coronavirus might be likely cause of SARS.


March 29, 2003 -- Carlo Urbani, who identified the first cases of SARS, dies as a result of the disease. Researchers later suggest naming the agent that causes the disease after the infectious disease expert.


April 2, 2003 -- WHO issues its first travel warning recommending that all non-essential travel to Hong Kong and Guangdong province be postponed.

April 3, 2003 -- WHO-sponsored team of international infectious disease experts arrives in Guangdong province to investigate the outbreak


April 4, 2003 -- President George W. Bush adds SARS to the list of quarantinable diseases, which gives the CDC the authority to isolate persons who might have been exposed to the disease.


April 9, 2003 -- WHO investigative team gives initial report on Guangdong outbreak. The team found evidence of "super spreaders" who were capable of infecting as many of 100 persons.


April 12, 2003 -- Canadian researchers announce they have completed the first successful sequencing of the genome of the coronavirus believed to cause SARS.


April 14, 2003 -- CDC officials annouce their laboratories have sequenced a nearly identical strain of the SARS-related coronavirus. The CDC version includes an additional 15 nucleotides, which provides the important beginning of the sequence.


April 16, 2003 -- A new form of a coronavirus never before seen in humans is confirmed as the cause of SARS according to Koch's postulates, which are four specific conditions that must be met for a pathogen to be confirmed as a causal agent of disease.


April 22, 2003 -- The CDC issues a health alert for travelers to Toronto, which is the epicenter of the Canadian outbreak of SARS. CDC director Julie Gerberding says the health alert alone is not a reason for potential travelers to avoid travel to the U.S. neighbor to the north, but it's part of the agency's effort to give travelers practical information to protect themselves from the global threat of SARS.


April 23, 2003 -- The World Health Organization adds Toronto, Beijing, and the Shanxi province of China to the list of regions travelers should avoid to reduce the risk of becoming infected with SARS and taking the deadly disease back home with them. WHO officials say the travel advisory will remain in effect for at least the next three weeks.


April 28, 2003 -- WHO removes Vietnam from list of SARS affected areas, making it the first country to contain SARS successfully. WHO also lifts travel advisory to Hanoi, Vietnam.


April 29, 2003 -- The WHO lifts its warning against nonessential travel to Toronto, Canada, citing local measures to stop the spread of SARS. The affected area had not reported new cases in the preceding 20 days.


May 6, 2003 - The CDC lifts its travel advisory for Singapore because no new cases of SARS had been reported in 20 days.

 

The following is an exact quote from the web site of the Centers for Disease Control. It mentions 20 thousand rather than 36 thousand deaths. I don't remember where I got 36, but perhaps that was for a different year. Anyway, whichever is used, the death rate will be far less than one percent, in the range of 0.1 percent.

"Influenza viruses are divided into three types, designated A, B, and C. Influenza types A and B are responsible for epidemics that occur almost every winter, and are associated with increased rates for hospitalization and death. Epidemics of influenza occur during the winter months nearly every year and are responsible for an average of approximately 20,000 deaths per year in the United States. (Influenza type C usually causes either a very mild respiratory illness or no symptoms at all, and it does not cause epidemics.)"

 

The following is also from the CDC web site and confirms the figures that I gave earlier today, from which I calculated the death rate of 0.1 percent.

"Most people who get influenza will recover in one to two weeks, but some people will develop life-threatening complications (such as pneumonia) as a result of the flu. Millions of people in the United States — about 10% to 20% of U.S. residents — will get influenza each year. An average of about 36,000 people per year in the United States die from influenza, and 114,000 per year have to be admitted to the hospital as a result of influenza. Anyone can get the flu (even healthy people), and serious problems from influenza can happen at any age. People age 65 years and older, people of any age with chronic medical conditions, and very young children are more likely to get complications from influenza. Pneumonia, bronchitis, and sinus and ear infections are three examples of complications from flu."

 

It seems that the latest news is that the death rate from SARS is even higher than I calculated earlier today. My son told me that this morning, but I didn't want to post it until I had read it myself from a news source. I just now found this on a CNN web site:

"These developments came a day after WHO revealed that the case fatality rate for SARS was 15 percent, nearly four times as much as an earlier estimate of 4 percent.

The mortality rate fluctuates depending on country and age, with the U.N. health agency saying SARS is particularly dangerous for the elderly. More than half of those older than 65 die from the disease, according to WHO mortality rate estimates."

 

The news of the upward revision in the death rate is now being reported widely. This is a report from USA Today:


WHO: SARS death rate about 15%
LONDON (AP) — The overall death rate from SARS worldwide is about 15% — double previous estimates — according to the first in-depth global analysis by the World Health Organization.

Officials at the U.N. health agency said Thursday the calculation indicates the disease is more dangerous, particularly in the elderly, than experts had thought. More than half of SARS patients over 65 are dying.

In addition, a study to be published Friday suggests the SARS virus is surprisingly stable and not mutating significantly — a finding that could indicate the virus may have been in humans for a while.

Until now, WHO had estimated the death rate to be between 6% and 10%. The new estimate was based on more complete and detailed data from China, Canada, Hong Kong, Singapore and Vietnam.

A study earlier this week estimated the death rate in Hong Kong to be about 20% overall, but about 50% in patients over 60.

"The global estimate we had previously was always clearly an underestimate," said Mike Ryan, who is coordinating SARS response at the World Health Organization.

"We always had a figure in our heads that was a range, but now we see that it's toward the upper end of that range. We didn't have a proper estimate and this is now much more accurate," he said.

Severe acute respiratory syndrome has made more than 7,000 people around the world ill and killed more than 500.

Until now, WHO has been making a crude calculation of the death rate by dividing the number of deaths by the number of SARS cases. Using that method, the death rate would be 7.1%, which underestimates the true death rate because it assumes everyone still hospitalized will survive.

Another method is to add up the number of people who have died and those who have recovered and divide the deaths into that total. However, that overestimates the death rate because deaths show up more quickly than recoveries and it ignores people who are hospitalized, Ryan said.

The new figure was reached by estimating what proportion of those hospitalized will recover and what proportion will die. It also takes into account the length of time patients have survived — looking at the risk of dying in the first week of illness, the risk in the second week, and so on.

However, the figure is still only an estimate. The final death rate will be known only when the epidemic is over. Also, the estimate is for those diagnosed with SARS, not necessarily everyone infected with the SARS virus. Including such people would lower the death rate.

As suspected, the analysis indicated the chances of dying from SARS greatly depend on age and, linked to that, on the existence of other illnesses, Ryan added.

The death rate is below 1% for people aged 24 or younger, rising to 6% for those 25 to 44, 15% in those aged 45 to 64 and more than 50% for those over 65, WHO estimates.

"You really have to take into account the age groups because that will determine the outcome," Ryan said. "Some countries, like Canada, appear to have a high case fatality. In fact, that's more determined by the fact that their patient group was older.

"In Vietnam, their fatality rate was 8%. That's probably determined less by the quality of care but more by the fact that the majority of those cases were in young, healthy adults," he said.

By contrast, WHO said the death rate was 14% in Singapore and 15% in Hong Kong. The agency did not give a rate for China or Canada.

WHO experts said there is no evidence the SARS virus is becoming more lethal.

In a new study published Friday, meanwhile, scientists found few mutations among 14 SARS virus samples, indicating the genetic makeup has remained remarkably stable.

In the first major analysis of mutations of the SARS virus, posted on The Lancet medical journal's Web site, scientists from Singapore's Genome Institute identified genetic differences that reveal two geographically distinct strains of the virus — signatures that could help in tracing where an individual's SARS strain originated.

The apparent stability of the virus is a double-edged sword, experts say. It does not seem to be mutating into a more virulent form, as feared. But it is also not becoming more benign.

"This virus is seeming quite constant as it is passing through people. Although there are some changes, there are not a whole lot," said Earl Brown, professor of virology at the University of Ottawa in Canada, who was not involved with the study.

If the virus remains stable, any vaccine created is likely to stay useful, Brown said. He said the findings also suggest the SARS virus may have been in humans longer than thought.

"Generally you'd see a virus mutate more when it first comes into a new situation," Brown said. "I'd be concerned that maybe it's been in humans longer than we think and it's already made its little changes and has settled down to a happy lifestyle."

End material embargoed for release at 7:01 p.m. ET.

Recent fears that about 12 people in Hong Kong had relapsed after being sent home from the hospital have turned out to be unfounded, said David Heymann, the agency's communicable diseases chief.

"SARS has not reoccurred in any of these patients. These patients have been readmitted to hospital, but with diseases other than SARS," he said.

The World Health Organization said it was still optimistic it could prevent SARS from taking root in communities, even in China, where the number of reported cases continues to rise.

 

It seems that the officials in Singapore are taking a quite different line that that idiot Steve Ransom. This is from a Singapore newspaper:

IF ANOTHER week goes by without any new Sars cases, Singapore would be officially free of the disease.

According to the World Health Organisation's (WHO) definition, a country is Sars-free if it has no new cases for 20 days.

But even if there are no new Sars cases by May 18, it may be too soon to break out the champagne.

Sars combat unit chief, Senior Minister of State Khaw Boon Wan, yesterday urged Singaporeans not to be complacent and think that the fight was over.

Mr Khaw said: 'Let us get the perspective right. I've been reading reports that say if you cross the finishing point, May 18, without any new cases, we have finished the fight.

'Rubbish, those are very dangerous thoughts. This is a prolonged war. If we cross May 18 without any new cases, it is worth celebrating. But it is just the first of many, many milestones we have to cross.'

On April 28, Vietnam became the first country to have contained the virus, according to WHO.

There have been no cases reported here after April 27. The last case, reported on Monday, was a 74-year-old woman who began having a fever on April 22.

There remain 22 Sars patients and nine suspect cases warded here, according to a Health Ministry statement yesterday.

Mr Khaw was at Alexandra Hospital yesterday to test its new hospital movement tracking system.

During the past week, visitors to the hospital's accident and emergency department have been given a radio frequency identification device. The credit-card-sized pass enables a sensor in the ceiling to track and record their movement in and out of the department.

Speaking to reporters after the trial, Mr Khaw said the technology was useful as it would make contact tracing faster and easier.

He added: 'Sars is not over, it is only over when there are no more countries on the WHO's list of affected regions. And that may take months, years. So till then, better assume the worst.

'If we let our guard down, we could go back to March 1, the whole clock could be reset to Day 1. It's as scary and as serious as that.'

So Singaporeans might have to wait a little longer before they can visit their loved ones in hospitals.

Mr Khaw hinted that the no-visitor rule, imposed on April 29 at all six public hospitals here, could be extended beyond this month.

The Government would be compelled to do this because of the strain on hospital staff, he said.

'As employees of an institution, they have a responsibility to themselves and colleagues. With visitors, they will have an added responsibility - to protect the visitors. That is a big burden, a lot of hard work and will put tremendous psychological stress on them.'

Even if the rule is eventually relaxed, he would still want to restrict the number of visitors going into the wards, he said.

 

Singapore and Vietnam have shown that the virus can be contained if the right measures are taken. But it takes vigorous enforcement to do that.

Helen, I think this incident shows that extreme care should be taken in examining a person's credentials before believing what they write. Steve Ransom's article, if it is believed widely, could result in the deaths of millions of people. He is obviously an idiot who does not know what he is talking about, either on the subject of AIDS or on SARS. All indications are that SARS is a new and deadly disease with the potential to kill millions of people if it is misunderstood.

 

From CNN:

MANILA, Philippines (CNN) -- If the SARS epidemic is not under control by September, Asian economies could lose between $12 billion and $28 billion as tourism and investments decline in the region, according to a new report released Friday.

The Asian Development Bank, based in Manila, studied the impact of the Severe Acute Respiratory Syndrome on seven East Asian and Southeast Asian countries, including the regions of Hong Kong and Taiwan.

Hong Kong would suffer the greatest drop in annual gross domestic product, by far, according to the ADB's report.

If the spread of SARS is not controlled by the third quarter of 2003, GDP growth in China would drop 0.2 percentage points to 7 percent, and in Hong Kong it could fall 4 percentage points into negative territory, the report states.

"Unemployment will rise as a result of weakening demand, " said Ifaz Ali, ADB's chief economist. "Of particular concern is the fact that SARS will not only induce hardship for many, but also intensify the poverty faced by the most vulnerable groups in society."

If the illness continues to spread into the end of June, the report says GDP growth could decline 5.3 percent for China (including Hong Kong and Taiwan) and Korea, and 3.4. percent for Southeast Asia -- Indonesia, Malaysia, Philippines, Singapore, and Thailand.

On a positive note, the report says there is a possibility that the economies will receive a boost after the disease is brought under control because people living in the affected areas will immediately