Six Months to Act

The Wall Street Journal ^ | Friday, April 25, 2003 | By DONALD S. BURKE

[WaveThatFlag]

The most chilling moment of my medical career occurred in 1985, when I led a program to test incoming U.S. Army recruits for HIV, the virus that causes AIDS. At the time, little was known about the emerging HIV virus or AIDS. As I began to analyze blood samples from the first 600,000 recruits, I discovered that HIV had silently infected a large cross section of apparently healthy young adults. At that moment I realized that we were already losing the race to control the virus, and that the human species was destined to be afflicted with HIV as a fact of life -- and death -- for decades to come.

[cricket]

["Chance favors the prepared mind." For the moment, chance is on our side.]

. . .a small silver lining bump. . .

[HiTech RedNeck]

We thought the Patriot Act brought Big Brother. That will be nothing compared with the SARS Eradication Act (assuming there's no vaccine).

[Gorjus]

New [whatever] should be mass-produced and made freely available around the globe.

Why am I not surprised someone wants someone else to make something and then give it away freely? This is always, totally, absolutely flawed and undermines the entire analysis.

There ain't no such thing as a free lunch. The right answer is to address the costs honestly and decide how to pay for them. It may indeed be the right thing to do to pay from them collectively (charity donations, special tax, even tax breaks for the producers that offset the costs of production, transportation, distribution) rather than at point of use, but the costs still need to be addressed.

[CatoRenasci]

Exceptionally sound advice bump!

[CatoRenasci]

To control the outbreak of a disease like SARS, it is definitely worth it to the US, if necessary, to fund the worldwide distribution of vaccine or cures alone. Sure there will be a free rider problem, but the danger to our population and economy is sufficiently great that we cannot niggle about the cost. It is exactly the same situation as the War on Terror: we must win, and count the cost later.

[Gorjus]

To control the outbreak of a disease like SARS, it is definitely worth it to the US, if necessary, to fund the worldwide distribution of vaccine or cures alone.

I didn't say we shouldn't do anything about SARS (just the opposite, in fact). I said it was dishonest not to recognize that the costs are real, and not to deal with them. Would you still say it was worth it to protect Chinese citizens if the cost were a billion dollars per patient (and if that cost could have been spent in other ways that would be more effective in protecting Americans)?

There ain't no such thing as a free lunch!

Admit it. Deal with it. Make rational, effective, honest decisions. Anything else may do (and often has done) more harm than good.

[CatoRenasci]

Of course there's no free lunch -- I'm a longtime admirer of what Milton Freedman described as the "eight word theory of political economy"

1. Ain't No Free Lunch

2. Them what has, gets

which has always struck me as elegant as well as true. Others prefer the Heinlein incarnation from The Moon is a Harsh Mistress: "TANSTAAFL - there ain't no such thing as a free lunch" or the "golden rule" He who has the gold, rules..

While cost must undoubtedly taken into account, and rational decisions made about the most cost effective ways of dealing with epidemics, the thrust of your post was different. You implied that the solution was some combination of private and charitable action, not state action. While ordinary health care issues ought indeed be dealt with in that way, I think the SARS situation is different in kind: it is the sort of potential publich health crisis that requires state action. It was precisely to deal with things of this sort that the Surgeon General's position was created and the uniformed Public Health Service created, in the 19th century when epidemics were still common phenomena.

[Gorjus]

You implied that the solution was some combination of private and charitable action, not state action.

********

What I actually said was:

It may indeed be the right thing to do to pay from them collectively (charity donations, special tax, even tax breaks for the producers that offset the costs of production, transportation, distribution) . . .

Don't know how things are where you're from, but where I come from, taxes are a state action. If you've got some way to levy private taxes, please let us in on it!

[EternalHope]

Outstanding article!

I think he was too optimistic about still having a chance to eradicate SARS, at least without a good diagnostic test. Given the late start, lack of resources, and crowded conditions in many areas, I seriously doubt SARS can be put back in its box in China without such a test.

Sure hope he's right about SARS being seasonal. That could help keep this from exploding in China in the short-term, and give us time to develop a reliable, quick, and cost effective diagnostic test before next fall.

One of the problems with our current tests is that they do not work reliably early in the course of the disease. Hence we have difficulty knowing who really has SARS until the person has had the disease for quite a while.

[LonePalm]

Another big difference between SARS and HIV is that SARS doesn't have civil rights attached (yet).

Where would we be today with regard to HIV/AIDS if we had treated it from the beginning as a purely public health question the way we did Tuberculosis and Small Pox?

Garde la Foi, mes amis! Nous nous sommes les sauveurs de la République! Maintenant et Toujours!
(Keep the Faith, my friends! We are the saviors of the Republic! Now and Forever!)
LonePalm, le Républicain du verre cassé (The Broken Glass Republican)

[WaveThatFlag]

Well, the regular flu kills more people in this country than AIDS, and gets treated as a purely public health issue. How would you say we are coming along with a cure for the flu?

[forewarning]

The flu vaccines work pretty well.

Important article bump -- this is a bit like a war.

[WaveThatFlag]

Still no cure, though :(

[Future Useless Eater]

I was looking for references on humidity vs the spread of droplets and came across this...

There are hundreds of different forms of the influenza virus (and the common cold, for that matter). Some are more deadly than others. The global Spanish flu pandemic in 1918 killed 20 million people, around one per cent of the world’s population at the time. This was a particularly vicious strain of the influenza virus, in some areas over 80 per cent of the population succumbed to Spanish flu.

http://members.optusnet.com.au/printing_with_chemistry/Articles/Virus.html

I had never heard of that before. Can anyone confirm that in some 'hotspots' the 1918 Spanish flu had an 80% mortality?

[FairOpinion]

This is what I found at CDC:

1918: Spanish Flu
The Spanish Influenza pandemic is the catastrophe against which all modern pandemics are measured. It is estimated that approximately 20 to 40 percent of the worldwide population became ill and that over 20 million people died. Between September 1918 and April 1919, approximately 500,000 deaths from the flu occurred in the U.S. alone. Many people died from this very quickly. Some people who felt well in the morning became sick by noon, and were dead by nightfall. Those who did not succumb to the disease within the first few days often died of complications from the flu (such as pneumonia) caused by bacteria.

One of the most unusual aspects of the Spanish flu was its ability to kill young adults. The reasons for this remain uncertain. With the Spanish flu, mortality rates were high among healthy adults as well as the usual high-risk groups. The attack rate and mortality was highest among adults 20 to 50 years old. The severity of that virus has not been seen again.

http://www.cdc.gov/od/nvpo/pandemics/flu3.htm

[Future Useless Eater]

...another interesting paragraph from that same australian page...

Keeping the species apart

In late 1997, chickens in Hong Kong were discovered to have a deadly new type of flu. Humans had to eat an infected chicken to catch this lethal disease, whereas ordinary less virulent strains are airborne by coughs and sneezes. However, flu viruses have the ability to combine with each other if they meet in a host, a process called reassorting, and the resultant supervirus offers the worst of both worlds. Local Health Authorities made the bold decision to slaughter every chicken in Hong Kong, which was derided by many as a completely unnecessary and wasteful precaution. On the other hand, one informed estimate I’ve seen suggests that this action might potentially have saved 60 million or more human lives worldwide.

I see there is a lot more on this supervirus, and similar new virus'es...

Just do a GOOGLE search for... 'reassorting' and 'virus'

[Future Useless Eater]

I just realized how old this thread is, and I'm not sure how I stumbled onto this one. I will repost some of these questions elsewhere.

[Future Useless Eater]

Thanks FO, interesting link.

[Judith Anne]

Hmmmm....six months to act, that's April to October/Nov...I predict we'll all know more than we want to about SARS by then. I'm hoping it's not firsthand.