BLACKHERBALS.COM

The Truth about SARS
Severe Acute Respiratory Syndrome - Symptoms and Survival

Reminder of 1918-1919 flu disaster which killed 30 million people

http://www.globalchange.com/sars.htm

• By the end of March 2003, many countries were deeply alarmed by reports of a rapidly spreading viral atypical pneumonia with a very high death rate.
• On 31 March 2003 1,500 were already known to be infected with the SARS virus, and 1,500 were in quarantine on Singapore alone - just one of 15 nations with cases: Canada, China, Hong Kong, Taiwan, France, German, Italy, Republic of Ireland, Romania, Singapore, Switzerland, Thailand, United Kingdom, United States, Viet Nam.
• Singapore closed all schools and threatened huge fines on anyone in contact with an SARS sufferer if they left their homes, Hong Kong also told a million students and children to stay at home with new infections running at around 60 a day.
• The US had seen 62 cases by March 31st with numbers rising rapidly. Almost all had become infected in other nations.
• Other nations were also proposing radical action to save lives and their health care systems from meltdown. A single SARS case was enough to close an entire hospital - with rapid spread to health care workers and threats to other sick patients and family members.
• Medical teams badly affected by SARS: Hong Kong Chief Medical Officer described his horror as seeing over 60 doctors and nurses struck down with SARS symptoms of fever, cough and atypical pneumonia, decimating the ability of his hospitals to cope, and creating terrible fear. The Italian doctor who identified the SARS virus himself died: Dr Carlo Urbani, a 46-year-old Italian and expert on infectious diseases, identified Severe Acute Respiratory Syndrome in an American businessman admitted to hospital in Vietnam in February with severe atypical pneunonia..
• Symptoms of SARS, which is believed to be spread through droplets by sneezing and coughing, are hard to diagnose as SARS because they include cush common health problems as high fever, chills, coughing, cold and breathing difficulties of various kinds.
• Travellers in Japan, China and Hong King began to see large numbers of local citizens covering their faces in public places with medical masks or make-shift pieces of cotton.
• Ontario, Canada declared a provincial SARS emergency allowing legal action to remove personal freedoms for those affected if necessary to prevent spread (compulsory quarantine).
• Taiwan decreed the syndrome an "infectious disease" subject to quarantine laws and banned visits by civil servants to affected areas, including mainland China, Hong Kong and Vietnam. Over 500 were in strict quarantine by the end of March and the government announced they were thinking of a ban on air travel to or fom China.

ORIGINS OF SARS VIRUS

• Investigations by Hong Kong authorities suggest SARS was brought into that territory in February 2003 by a semi-retired professor of medicine from Guangdong Province. Three cases of strange "atypical" pneumonia reported in November 2002 point to the Foshan area of Guangdong as the likely geographic origin of SARS. Other SARS cases followed but there were no reports permitted in the Chinese press, despite (as we later learned officially) growing numbers of deaths. By late March the Guangong Province admitted they had seen almost 800 SARS cases with 34 deaths.
• The Chinese government only disclosed official figures of infections and deaths at the end of March, after deaths were reported throughout the world caused by a rapidly spreading atypical viral pneumonia, all trailing back it seemed into China. This crucial delay has meant that China itself is now likely to face a far more severe SARS epidemic, and made spread much more likely elsewhere. The SARS epidemic is acutely embarrassing to all countries with cases on their own soil, and particularly to the Chinese who are deeply sensitive to losing face, appearing weak or blameworthy to the rest of the world.
  

SARS BACKGROUND - WHY WE ARE VULNERABLE TO MUTANT VIRUSES

• Since 1987 I have been predicting the great vulnerability of our world to new mutant viruses. The SARS virus currently causing such global concerns is just one of a large number of totally new agents emerging each year, the vast majority of which are relatively harmless causing combinations of aches, pains, fevers, rashes and gut problems. Southern China is a place where new viruses often emerge, sometimes jumping from animals to humans. Viruses have the capacity to recombine with new genetic material as they spread.
• Last year we saw a new virus emerge called H5, also in Hong Kong. It killed 50% of those infected but fortunately proved difficult to catch. However, another of these recent mutant viruses is of course HIV, which already has spread to 1% of the entire world's 15-55 year olds, with almost 100% death rates from AIDS. Another, a hundred years ago, killed 30 million people - see below.
• With 6 billion people alive today, a small risk of viral mutation every time a single person is infected with any existing viral type, dense urbanisation in many countries, dramatic growth in international travel, and the lack of an antiviral equivalent to penicillin, conditions have been perfectly set for some time for just such outbreaks as SARS. We should therefore expect more to follow - less or more dangerous than SAR.
• All this underlines the urgent need to develop effective antiviral medication. It is shocking that 60 years after the discovery of penicillin we still do not have a single antiviral that is as effective as the earliest antibiotics. When we do, we will have a cure for common cold, flu, polio, smallpox, viral meningitis and viral pneumonia - amongst many other conditions.
  

SARS FACTS AND STATISTICS

• SARS stands for Severe Acute Respiratory Syndrome.
• Cause of SARS is thought to be a virus (or possibly more than one virus acting together). Officials of WHO and the U.S. Centers for Disease Control say SARS may be caused by a new form of coronavirus, one of a few viruses that can cause the common cold. But some researchers also found signs of another germ family, the paramyxovirus. If it is a coronavirus, it may make vaccine development more difficult since coronaviruses are notorious for changing their outer surface rapidly in subtle ways to confuse the immune system. That's why vaccines don't work against colds.
• SARS virus spread occurs probably through droplets created by coughing or sneezing, but may also possibly spread through hand to nose contact, if hands become contaminated with virus - for example through picking up or touching an object such as a pen, or an elevator button, and then touching the nose. Hand contamination is a common way cold viruses spread - and the answer is frequent handwashing as well as avoiding hand / nose contact. Surfaces can be sterilised with diluted bleach or disinfectants.
• 76 people appear to have been infected by SARS in one apartment complex alone in Hong Kong and several people on airline flights.
• The vital question is how close do you have to be to someone with SARS virus infection, and for how long, in order to be at significant risk of SARS infection? We don't know, just as we know very little about the level of exposure required in normal day to day situations to catch flu or a common cold.
• Most experts believe that SARS virus is caught mainly by inhaling an aerosol spray of fine particles comprised of body secretions, released through someone nearby coughing or sneezing. Such aerosols tend to fall to the ground and so, it is hoped, long distance airbourne spread is highly unlikely - for example through an air conditioning system in hotels, apartments or aircraft. Huge efforts are being made to work out how every person with SARS became infected: from whom and in what way but the situation is still very unclear.
• Some people with SARS are far more infectious than others for reasons we don't understand. For example one person infected 56 health care workers in a Vietnam hospital.
• Barrier nursing using gloves, masks, gowns and goggles seems to provide almost 100% SARS protection for nurses, doctors and other health care workers. Barrier nursing is a standard proceedure for many conditions and most hospitals in the world should be able to protect their health care workers from occupational SARS infection this way. Ideally rooms should be well ventilated with negative pressure systems so that air is drawn into the room as the door is opened, and stale air is constantly expelled outside the building.
• SARS has been called flumonia because it spreads like flu and kills like pneumonia.
• SARS incubation period may be as long as 10 days from contact to first symptoms.
• SARS death rates seem to be around 4% of those infected - but may be far higher in the elderly, in those with weak immune systems, and in those with other respiratory conditions.
• SARS deaths occur when lung tissue swells so that breathing becomes impossible.
• SARS experimental treatments include the use of high dose steroids and antiviral medication using Ribavirin.
• SARS recovery rates seem to be higher in the young and those without other illnesses.
• SARS is probably a spontaneous viral mutation from other viruses infecting animals and humans.
• We will never know how many people were infected with SARS in early 2003 since finding out would involve testing very large numbers of people for antibodies - those who at best may not have known they had an infection at all (mild cases) and those who at worst died with deaths blamed on other causes.

KEY SARS FACT TO WATCH: DOUBLING TIME

• Key fact to watch: doubling time, or the time for the number of new cases to double in a given country. With HIV the doubling time rarely exceeded 12 months and has usually, even in higher risk populations, been between 12 and 24 months. The doubling time of SARS appears to be days.
• But the good news is that SARS can be rapidly controlled, if all proper measures are followed and the illness is tracked early. For example by March 31st Vietnam was seeing virtually no new cases.
• Doubling times produce alarming statistics. If the DT is a week, then 1 person can result in 1,000 other infections in 10 weeks, and a million in 20 weeks. If the doubling time is 3 weeks, you reach the same numbers in just over a year. But the biggest impact is what then happens over the following few months. One million cases becomes 2, 4 8, 16 or 32 million in just a very short time.
• So far we seem to have gone in 4 months from 1 case (maybe more) to around 1,000. that indicates a doubling time of around 2 weeks or less.
• Doubling times always lengthen eventually, as the numbers of people who have already survived infection starts to rise. Every viral epidemic therefore tends to go through a phase of quiet spread (small numbers infected), explosive spread (where larger numbers of infected people are doubling rapidly) and gradual decline.
• The 1918-1919 terrible flu epidemic which killed tens of millions probably infected well over 400 million people before it ceased.
• Ordinary influenza mutates into a different shape roughly once a year and kills 500,000 each time it sweeps around the world, 26,000 people in the US alone - mainly older people and those with other respiratory problems such as chronic bronchitis or asthma.

THE POTENTIAL FOR CATASTROPHE IF ACTION FAILS NOW

• So then, SARS has the potential to produce a global plague within a few months unless radical action is taken by governments now
• A single SARS-virus infected individual can spark a fresh outbreak, and since people are highly infectious before the diagnosis is obvious, and since the early symptoms (cough and fever) are similar to many other conditions, it is hard to track spread.
• Global travel has never made it harder to stop spread of illnesses such as colds and flu - which appear to spread like SARS. So SARS could spread far faster and wider than the 1918-1919 flu epidemic.
• Containing SARS means tight control, and most importantly excellent national communication, with well understood health campaigns so that the whole population is mobilised rapidly. This may be particularly difficult in developing countries such as China or India.
• A particular concern is that SARS appears to have first struck significant numbers of people in Southern China. The government was intitially slow to reveal the extent of the problem to the World Health Organisation, and some experts doubt whether the true situation is now being described - even if it is fully known.
• If SARS hits a densely populated city like Calcutta or Bombay it will be extremely difficult to contain with a highly mobile population, huge overcrowding, ignorance of the disease, difficulty in diagnosis and the impossibility of quarantining hundreds of thousands of people.

THE FUTURE OF SARS EPIDEMIC

• What should we expect of SARS in the future? Hopefully the virus will turn out less dangerous than currently feared. We may find that SARS has been in the population for far longer than realised with a lower mortality than current death rates would suggest. Aggressive public health measures may succeed in preventing SARS from spreading into populations where there are few public health resources. We will soon have much more data on the virus, and the ability to collect serum from those who have recovered that may help save lives. We may be able to develop a vaccine quite rapidly.
• A key challenge with SARS is the fear governments have of spreading panic, not only among their own people, but also among tourists and investors. However, the epidemic has the potential to become a real threat to global health and if allowed to spread much further, may become a wild-fire impossible to put out.

BEST AND WORST CASE SCENARIOS - Reality likely to fall between

• Best case scenario: SARS turns out to be less infectious than feared and public health measures contain spread. SARS disappears altogether after few weeks with very few deaths.
• Alternatively, a continued epidemic provokes global aggressive control efforts plus a research programme to develop a vaccine, plus development of treatments using protective antibodies from survivors. Wealthy nations provide assistance to poorer nations in control measures without provoking "anti-imperialist" reactions. New cases are followed with rigorous contract tracing and quarantine measures. Intense local outbreaks are contained in limited areas by strongly enforced travel restrictions. Numbers of infections peak and then fall over the remainder of 2003.
• Worst case scenario: SARS spreads unchecked into many of the poorest nations with innadequate facilities for monitoring and control. Hundreds of thousands become infected, resulting in a global pandemic similar to spread of flu each year (which as we have seen itself kills 500,000 people annually), infecting perhaps 2-10% of the global population and resulting in up to 30 million deaths as well as paralysis of health care systems with health care professionals becoming casualties in large numbers and others too scared to turn up to work.
• Such viral plagues have happened before: for example just under 100 years ago with a virulent flu epidemic which killed many millions of people before mutating once again and disappearing.
• The influenza pandemic of 1918-1919 killed more people than the Great War, known today as the first world war or WW1, between 20 and 40 million people. The most devastating epidemic in recorded world history. More people died of flu in a single year than in four-years of the Black Death Bubonic Plague from 1347 to 1351. Known as "Spanish Flu" or "La Grippe" the influenza of 1918-1919 was a global disaster.

Conclusion: the World Health Organisation is correct to take this SARS epidemic very seriously indeed. Outcome will depend on global efforts by every government and every health agency, working together.

Latest World Health Organistion Update on SARS

* Dr Patrick Dixon is a physician with experience in HIV / AIDS and has been tracking the dangers of lethal virus infections for over 15 years.