New Disease Scary, but Not as Bad as Flu

Reuters via Yahoo ^ | Wednesday, April 2, 2003 | Maggie Fox

[InShanghai]

New Disease Scary, but Not as Bad as Flu -- Yet

WASHINGTON (Reuters) - It jumped from ducks to farmers in the densely populated southern provinces of China, spreading via jet to the whole world within a year and killing half a million people. SARS? No -- just ordinary influenza.

As world health officials scramble to identify and contain the outbreak of Severe Acute Respiratory Syndrome, they are drawing constant parallels with flu, a much more familiar -- and so far deadlier -- foe.

SARS has killed an estimated 78 people and made 2,151 ill, the World Health Organization (news - web sites) said in its latest update.

In contrast, influenza kills anywhere between 250,000 and 500,000 people every year around the world. In the United States, with a vaccine and modern medical care widely available, flu kills at least 36,000 people a year.

New strains regularly pop up, with varying degrees of lethality.

The "Spanish flu" pandemic of 1918 killed between 40 million and 50 million worldwide, most of them young, healthy adults. The "Asian flu" and "Hong Kong flu" pandemics of 1956-1957 and 1967-1968 killed a combined 4.5 million people.

The SARS outbreak is tiny in comparison, said Dr. Richard Duma, head of infectious diseases at the Halifax Medical Center in Daytona, Florida, and a member of the board of the National Foundation for Infectious Disease. "I think it is frightening a lot of people but I don't think it will produce the mortality that influenza will produce," Duma said.

In fact, when SARS cases were first reported in Guangdong early this year, experts assumed it was another outbreak of a deadly strain of influenza known as H5N1.

BIRD SLAUGHTER STEMMED OUTBREAK

In 1997, Hong Kong authorities slaughtered more than a million chickens and ducks to stem the epidemic of "bird flu" that came to be known by its genetic nickname of H5N1. It killed six people and infected 18.

Richard Webby, an influenza virus expert at St. Jude Children's Research Hospital in Memphis, noted that three members of a Hong Kong family who visited Fujian Province in southern China became infected with H5N1 early this year and two of them died.

They were the first known human cases since 1997.

U.S. and WHO experts knew of a larger outbreak of respiratory disease in China's Guangdong province at the time and assumed it was more H5N1, which alarmed them.

The new outbreak has since been identified as SARS, which may be caused by a different virus, known as a coronavirus.

But the parallels with influenza are obvious. Both are respiratory diseases, both are highly infectious and both, apparently, have jumped from animals to people.

And both were born in China. Influenza begins as an infection of birds, one that does not make its avian hosts ill. A slight mutation allows it to move into people, sometimes via pigs as an intermediate host.

Once a person recovers from influenza, he or she has immunity to that strain. But every year a new strain jumps from the flocks of chickens, ducks and geese raised in China, forcing vaccine makers to come up with a new formula.

Something similar may have happened with SARS, said Mike Osterholm, an infectious disease expert at the University of Minnesota who has for years been warning about such emerging infections.

"You have the world's largest population in China. You have the world's largest population of pigs in China, the world's largest population of aquatic birds. You have close contacts and you have a lot of different species where these agents are floating around, and you are going to see a jump from animals to people," Osterholm said in a telephone interview.

Only SARS looks worse than ordinary flu. It kills between 3.5 percent and 4 percent of known victims -- a rate higher than the 1918 influenza epidemic, the worst epidemic in recorded history, in which 3 percent of patients died.

In an average year, influenza kills fewer than 1 percent of patients, experts said.

"Four percent mortality -- that is a lot of people if you multiply it by a few million," Webby said.

[Katya]

Well, as long as we're talking cold and flu here and not ebola, geography may indeed play a roll in how severely one gets sick. I imagine antibodies along with disease resistence based on diet are different region to region.

[goldstategop]

The Zaire strain of Ebola has a 90% mortality rate. SARS is a piker compared to Ebola.

[R W Reactionairy]

"Why is it SO difficult for you hyperventaliting scardy-cats to realize that SARS has , indeed , been around for many months and has NOT speard all that much, and has NOT killed all that many people. Past pandemics, without the aid of planes, spread far faster and far wider than SARS has !"

From what I have read the truth is somewhere between the position you seem to be taking and the proposition that the sky is falling. My ealier post in this thread [#3] pointed out that some discharges were occuring.

Secondly, before you conclude that only a few people are dead because this has been around for months remember the PRC has under reported, engaged in news black outs and generally lied about what is going on inside the PRC. Until independently verified, assume that any reported data from that source is at best suspect.

Until this got to Hong Kong it was simply not in a population that was regularly jumping on aircraft and traveling around the world. As soon as these conditions obtained, [a little more than a month ago] the disease started to show up in other countries.

Distribution of cases is very odd and appears to indicate that certain people / or certain conditions result in a high likelihood of spreading the disease. This is true of all contagious diseases to some extent but in this case the clusters appear to be a big part of the story. The PRC doctor / professor who was the apparent source of the infection in Hong Kong. The patient in Hanoi who infected more than 50 percent of the health care workers who came in contact with him. The elderly lady and her son who appear to be the focus of the Toronto cluster of infection. The Amoy Gardens cluster which appears to be related to a couple of visits by one infected individual.

Additionaly, the number of infections seen in travelers who have merely spent a few days in Hong Kong [versus the million who live there] appears to be significant. It could also be the total number of contacts, but Hong Kong as a whole is jam packed with people so it seems to me that the epidemiologists have sometime to work with here. Some transmission has occurred on planes, but most appeared to have occurred in Hong Kong.

From all of this I do not think that it is prudent to reach conclusions about the potential for transmission. It is simply too early and until we know for certain it is reasonable to assume that there is a real risk.

In any event, this is a nasty bug and a something north of 10 percent of those hospitalized in Hong Kong have required artificial ventilation. If they had not gotten this level of care would some of these have survived? Probably but a lot would not have.

Panic? No. Dismiss as trivial? Hardly.

[CobaltBlue]

March 17, 167 cases.
March 23, 456 cases.
March 31, 1662 cases.

That's way more than doubling.

[CobaltBlue]

An engineer pointed out to me that since the death rate is lagging the infection rate, the death rate is actually higher than 4%. He suggested 7%-8%.

[CobaltBlue]

Hi Blam - you need N95 masks. Surgical masks only work if they are N95. You can also get N100 masks, which are better.

You can get them with an exhale valve, which is more comfortable, or without. Obviously a sick person shouldn't use one with an exhale valve.

You can get them at a paint supply store or a hardware store.

[CobaltBlue]

Last time I checked, two hospitals were closed in Toronto, due to quarantines, and health care workers at a third have just come down with SARS.

I think the internet gives us the ability to see this disease outbreak as never before. It's just as contagious as other diseases which turned into pandemics, and far more lethal.

[aristeides]

When I looked, in the early stages of the epidemic, it looked as if the numbers were doubling every four days or so.

[aristeides]

If the disease is only killing people aged 40 or more, the death rate among people of that age must be much higher than that.

[CobaltBlue]

Canada cumulative (breaks in dates are in the data set):

3/17/03 8
3/18/03 8
3/19/03 8
3/20/03 9
3/21/03 9
3/22/03 9
3/24/03 11
3/25/03 11
3/26/03 19
3/27/03 28
3/28/03 29
3/29/03 37
3/31/03 44
4/1/03 53
4/2/03 58

[An American In Dairyland]

"even inits early days, the Spanish Flu infected and killed far MORE people, world wide, than SARS has. Facts are our friends, dear; hysteria and erronious codswallop aren't."

One fact you overlooked is that medical knowledge, treatment, equipment, etc. is far more advanced today than it was in 1918. Much has changed in medicine in 85 years. This partially explains why SARS has been recognized quicker, and has been more contained than the Spanish Flu was.

Note that out of those hospitalized, very few patients have been released. Were we still working under 1918 conditions, these people would most likely have already died. Even with the advances of medicine, SARS has a 0.5% higher death rate than the Spanish Flu did.

If China ever really comes clean on their stats, we will have a better picture of how deadly SARS has really been.

[per loin]

Hospitalized Hong Kong SARS cases

Time		Number of cases		Percentage Increase				Number of current deaths as a percentage of case totals on previous days
Day	Date	New	Total	Day	Week	Recovered	Deaths	Today	Day ago	2 Days	3 Days	4 Days	5 Days	6 Days	Week
Wed	03/19		150
Thu	03/20	23	173	15.33%
Fri	03/21	30	203	17.34%
Sat	03/22	19	222	9.36%
Sun	03/23	25	247	11.26%
Mon	03/24	13	260	5.26%
Tue	03/25	26	286	10.00%
Wed	03/26	30	316	10.49%	110.67%
Thu	03/27	51	367	16.14%	112.14%
Fri	03/28	58	425	15.80%	109.36%
Sat	03/29	45	470	10.59%	111.71%		10	2.13%	2.35%	2.72%	3.16%	3.50%	3.85%	4.05%	4.50%
Sun	03/30	60	530	12.77%	114.57%		13	2.45%	2.77%	3.06%	3.54%	4.11%	4.55%	5.00%	5.26%
Mon	03/31	80	610	15.09%	134.62%		15	2.46%	2.83%	3.19%	3.53%	4.09%	4.75%	5.24%	5.77%
Tue	04/1	75	685	12.30%	139.51%		16	2.34%	2.62%	3.02%	3.40%	3.76%	4.36%	5.06%	5.59%
Wed	04/2	23	708	3.36%	124.05%	89	16	2.26%	2.34%	2.62%	3.02%	3.40%	3.76%	4.36%	5.06%
Thu	04/3	26	734	3.67%	100.00%	98	16	2.18%	2.26%	2.34%	2.62%	3.02%	3.40%	3.76%	4.36%
Averages				11.25%	117.40%			2.30%	2.53%	2.83%	3.21%	3.65%	4.11%	4.58%	5.09%

[aristeides]

Encouraging drop in the number of new cases yesterday. Could this thing be coming under control?

[Domestic Church]

"Why is it SO difficult for you hyperventaliting scardy-cats"

Maybe it's because my 10 year old nearly died last fall. She had atypical pneumonia.

[per loin]

It looks like that wild flurry of cases from Amoy Garden has subsided. I'd suspect that a slew of epidemiologists are crawling all over that apartment complex, while others scrutinize the med records of the one patient who they believe caused it. Perhaps his being on an immunosupressant drug had something to do with how infectious he was.

[InShanghai]

Thanks for adding the "Recovered" column. That could be good to track also.

Could this thing be coming under control?

Don't count your chickens before they hatch. I'm sure mainland China will be increasing numbers daily, although I think they already know who, what, where, when... Political damage control by stretching the numbers out over a period of time instead of stating it all at once. Heck, they may even look good by claiming they contained outbreaks in other cities.

Today I've received an e-mail from the consulate describing which hospitals to report to if any of my family get symptoms {:-(

SARS started in November 2002, in Guandong. If the infection rate is growing as fast as they say, then most of Guandong would have, or had, the disease by now. I'm suspicious that the numbers only reflect hospital/doctor reported cases and is missing an important factor. There must have been some infected people staying at home, and surviving the disease, in Guandong. That would mean it could present itself as a regular cold to healthy people. Therefore the number of infections would be much larger and the ratio of deaths to cases would decrease.

Last week my wife brought a cold home. Our whole family had it within two or three days. I think it's entirely possible that SARS could present itself differently, or not at all, to people whose immune systems may be better equipped. I had a terrible flu or cold a year or two ago accompanied by pneumonia. My wife and kids had it also... It just makes me wonder whether or not the WHO is trying to show it's worth. They are a part of the now defunct UN.

[B-Chan]

The Coronavirus: this is SARS

[InShanghai]

Virus-infected cells are inspected under a microscope
during a news conference at a Hong Kong hospital March 27,
2003. Scientists in Hong Kong said they had identified
a new strain of the coronavirus, which causes the common
cold, as the culprit of the killer pneumonia disease
which has left more than 50 people dead worldwide.
(Reuters - Handout)

[per loin]

It looks like they will be regularly publishing HK recovery figures, so they're a natural addition.

I agree with you about there likely being many more low level cases, both in Guangdong and in HK. I'm unsure how else the number of infections among tourists could be accounted for, as these folks are unlikely to have been hanging around the hospitals.

Did you notice the report that said coronavirus was not found among the patients in Guangdong?

[IvanT]

Where are the SARS survivors?

Up here in Canada, we've already had 20 completely recover -they're feeling better and will be released from quarantine in the appropriate amount of time. So it is beatable. They're administering a cocktail of drugs up here that seems to be working.