Sars death rate 'higher'

BBC,com ^ | April 26, 2003

[Sweet_Sunflower29]

The death rate for Sars could be significantly higher than previously thought, according to an British expert's study into the pneumonia-like virus. The research by Professor Roy Anderson, due to be published in a medical journal next week, is expected to say the virus could kill between 8% and 15% - or one in seven - of those infected.

The World Health Organization (WHO) had predicted a death rate of 5% to 6% and said the virus could be beaten if countries worked together to stop it spreading.

A WHO spokesman said Professor Anderson was a top class professional and his findings were probably accurate.

Latest figures show Sars has infected an estimated 4,649 people in 26 countries around the world. So far more than 274 people have died, with most sufferers making a full recovery.

Higher death rates

Professor Anderson, of Imperial College, London, who is one of the world's leading authorities on infectious diseases, told the BBC: "If one looks carefully at the WHO figures on mortality and recovery rates, it is running, unfortunately, at 10%."

The new research was based on the study of the 1,400 or so cases in Hong Kong.

It appears to be contained, certainly in developed countries, by very good containment and monitoring practices

Professor Roy Anderson

Sars death toll rises Panic 'pleases terrorists' Prof Anderson analysed the spread of Sars in Hong Kong, where 121 people have died so far.

He calculated that between 8% and 15% of those who contracted Sars would die.

His research also found Sars remained infectious much longer than other viruses.

But Prof Anderson told the BBC that media speculation about Sars had exaggerated the problem facing the world.

He said the higher mortality rate was not the most important issue as so many other health factors could influence a patients' death.

Prof Anderson said: "If this was a highly transmissible agent that was spreading like wildfire then of course there would be huge cause for concern, but it is not.

"It appears to be contained, certainly in developed countries, by very good containment and monitoring practices.

"The concerns lie in the large populous regions of the world: China, India, Indonesia, where the disease reporting systems are limited and it is much less clear to work out what is going on there.

"This just reminds us that we are a globally mixing community and what happens in one corner influences us all."

Working together

On Saturday, Dick Thompson, a spokesman for the WHO's communicable disease section, said: "We have not seen the report so we could not comment except to say that this is a top class professional and any figure he commits himself to is likely to be as close as possible to accurate."

KNOWN DEATH TOLL China: 122 Hong Kong: 121 Singapore: 20 Canada: 19 Vietnam: 5 Thailand: 2 Malaysia: 2 Philippines: 2 Source: WHO/ local health authorities

WHO executive director of communicable diseases, David Heymann, said on Friday he believed the disease could be stopped if everyone worked together.

"What is important is for all countries to participate and to help prevent it getting in a place where it would be very difficult to stop it," said Dr Heymann.

Of the 26 countries that had seen Sars cases, 23 have contained it well, according to the WHO.

Officials have also taken comfort that it has not spread as easily as other viruses, such as influenza.

There have been six probable cases of the virus in the UK, but no deaths.

A group of school children from Cheshire returned home early from a cultural exchange visit to Beijing on Saturday.

Two members of staff and 21 youngsters from Knutsford High School in Knutsford, had been due to return from their cultural exchange visit to Beijing on Sunday but came home a day early.

[Sweet_Sunflower29]

IIRC, the last I checked, the SARS death rate in Canada was about 20%. I wonder what the determining factor(s) regarding mortality could be?

[TaxRelief]

Looking at the Hong Kong data only is irresponsible and also just plain bad math on the part of these "researchers".

1.) The earliest cases have had higher death rates and the earlier cases were in Hong Kong. All patients infected prior to any identification of the disease would have to be excluded to improve the outcome of the calculations.

2.) Hong Kong is still on a learning curve concerning nosocomial infection (spread of disease among health workers)

3.) Hong Kong has socialized medicine.

4.) The death rate will naturally increase as suspect cases are ruled not SARS.

5.) There has been no testing of people with mild colds or no symptoms to find out if the disease also manifests itself in milder forms.

[Nov3]

The death rate may be much higher if we look at the valid assumption that many diagnosed with SARS are suffering from other milder viruses.

When the use of an accurate SARS test determines its actual death rate separating the real cases from the rest I will believe the calcs.

As I am sure everyone knows they are working hard on a test to diagnose SARS and they don't have it yet.

[KeyWest]

The Canadian death rate was so high because they never identified it when they should have, so those misdiagnosed were allowed to return home and died at home, after spreading it to family members and friends. And the first death was also mis diagnosed as a heart attack, even though he was being treated with antibiotics.
One was on a gurney in emergency in a hospital for something like 10 hours - one of the benefits of socialized medicine- and spread it to many in the hospital. In all, Canada has done about as good a job on SARS as China. Canada, BTW is the system that the dems would like us to emulate.

It should be noted that Canada had all the alerts about SARS but did not recognize it even though all the symptoms were there as well as travel from the orient. The Doctor's never asked. Compare that to the response from our non-universal health care system. One person had the sniffles and we quarantined an airplane.

[The Duke]

The sobering fact about SARS is that, if one has an average-sized family, there is a *real* possibility that a family member will be lost if this virus finds its way home.

[Sweet_Sunflower29]

As I am sure everyone knows they are working hard on a test to diagnose SARS and they don't have it yet.

Well, unless I've missed something-

April 14, 2003--German Firm Distributes First Sars Test Worldwide

[Sweet_Sunflower29]

...if one has an average-sized family, there is a *real* possibility that a family member will be lost if this virus finds its way home.

Now there are specifics which hadn't crossed my mind.

Damn sobering thought.

[Lucas1]

Quote "One was on a gurney in emergency in a hospital for something like 10 hours - one of the benefits of socialized medicine- and spread it to many in the hospital. In
all, Canada has done about as good a job on SARS as China."

Ummm actually things are pretty much contained right now...only a couple of new cases over the last two weeks. Toronto is right on the edge of containment. They have done a good job with the hand they were dealt.

[Lucas1]

Quote "Compare that to the response from our non-universal health care system. One person had the sniffles and we quarantined an airplane."

Ummm yeah...after weeks and weeks of this being on the news...and AFTER the fact that fear has set in. Same thing would happen now in Canada. Your comment is really not saying much at all.

[Grut]

There has been no testing of people with mild colds or no symptoms to find out if the disease also manifests itself in milder forms.

A very good point. My feeling is that if the virus is as easily transmitted as it seems to be, there ought to be many more cases... and maybe there are, but mild ones.

[Nov3]

You possibly have. In the same article. German microbiologist Bernhard Fleischer, head of the BNI, said late last month that his institute had probably identified the virus causing SARS.

Scientists believe it is caused by a new coronavirus, a relative of one of the many viruses that cause the common cold. SARS is marked by a high fever, dry cough and other flu-like symptoms but can progress to pneumonia.

They sound real sure about it. I hope they have the right virus in that huge family.

The WHO and CDC use guidelines to diagnose this virus so far. These guidelines are very broad. How many times have you had a 100.4 fever, dry cough and body aches and pains? How many people in China and Hong Kong have the same symptoms? How many have actually been tested using this test? In Hong Kong? In mainland China?

How many of the so called recovered people had this test? Remember it came out Apr 14 and the death rate has steadily risen since then.

There are several heartening reports of several researchers Identifying the same virus over the past 4 or 5 days. When and if there is agreement I will believe in the "test". Till then I think the actual death rate is at best conjecture.

[Nov3]

When and if there is agreement I will believe in the "test". Till then I think the actual death rate is at best conjecture.

And when it is used on a large enough sample group who have had time for the disease to run its course.

The death rate is higher than they are seeing now. I would bet my bottom dollar.

[Dog Gone]

Another person in Toronto died today, bringing their total up to 20.

[Nov3]

What is their total number of infections? I can't find the data on the WHO site.

[KeyWest]

Ummm actually things are pretty much contained right now...only a couple of new cases over the last two weeks. Toronto is right on the edge of containment. They have done a good job with the hand they were dealt.

They did not identify it correctly, They did not contain it properly. They had more deaths because of the initial screwup. Do a search on Styne and he has an excellent condemnation of Toronto and Canada in general and their handling of SARS.

[LocalYokel]

Note for history buffs:

The 1918 Influenza Pandemic (aka Spanish Flu) killed 25 to 40 million worldwide and had a death rate of only 2%

[discostu]

Also worth noting that the primary point of infection in Canada was an emergency room. Logic tells us that people already in an emergency probably aren't healthy to start with, then you give them a mystery disease, this will artificially increase the death rate.

And finally the most important part (at least if you're contemplating whether or not this is an end of the world Biblical type plague) isn't the death rate, it's how contagious the disease is. So far it doesn't look like SARS transmits too well. Diseases that don't transmit well don't pose very much threat even if everybody who gets it dies.

[TaxRelief]

So far it doesn't look like SARS transmits too well. Diseases that don't transmit well don't pose very much threat even if everybody who gets it dies.

Case in point would be Ebola.

[Nov3]

What is the WHO saying in this document? It reads one way but communicates another. It says we do not have an accurate test. They are worried that the test may miss some people and that is the problem. They are not about to say there may be false positives. Either way the definitive test has not come out, been used on a significant population through the entire course of the disease to determine actual death rates.

Quote:

In the absence of a reliable diagnostic test, national authorities are strongly advised to continue to base decisions concerning what constitutes both a suspect and a probable case of SARS on the present clinical and epidemiological case definition, and not to rely on the results of diagnostic tests. WHO advises that all suspect and probable SARS cases be placed in isolation and managed according to strict procedures of infection control.

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.printable version

Severe Acute Respiratory Syndrome (SARS) - Multi-country outbreak Update 39

25 April 2003

Disease Outbreak Reported

Optimism in Viet Nam, caution urged when using diagnostic tests

Viet Nam may soon become the first country to contain SARS
No new cases of SARS have been detected in Viet Nam for 17 days in a row, despite a high level of awareness and good surveillance. Although numerous rumours have been reported, all have been investigated by WHO and government officials, and all suspect cases have been determined to have other causes.

The most recent probable case was detected on 8 April, bringing the cumulative total in Viet Nam to 63 cases. Detection of that case initially brought disappointment, as it occurred after no new cases had been reported over an 8-day period. Since the outbreak was first recognized in Hanoi in late February, 5 deaths have occurred. As of today, five patients remain hospitalized.

Viet Nam was the second country to experience a SARS outbreak. The first was China, where an outbreak began in Guangdong Province in mid-November of last year.

If no new cases are detected by 30 April (a date which marks the end of two incubation periods), Viet Nam could become the first country to be taken off the list of SARS-affected countries. This achievement would also make Viet Nam the first country to successfully contain its SARS outbreak.

SARS was first identified by Dr Carlo Urbani, a WHO infectious disease specialist. Dr Urbani alerted the world to SARS when cases of an unusual and severe respiratory disease began appearing among health staff treating a Chinese-American businessman at the French Hospital in Hanoi. The patient, a 48-year-old resident of Hong Kong, was admitted to hospital on 26 February with fever and respiratory symptoms. His recent travel history included trips to Guangdong Province, Shanghai, and Macao SAR. By 20 March, at least 22 staff at the Hanoi hospital were ill with influenza-like symptoms. Twenty had signs of pneumonia, and two were in serious condition.

The Chinese-American businessman died of SARS in Hong Kong on 13 March. Dr Urbani died of SARS in Thailand on 29 March.

WHO country staff attribute Viet Nam’s success in combating SARS to the quick manner in which the country initially reacted. “After Carlo identified the disease, we were able to influence the hospital to take the right infection control measures very quickly,” said Pascale Brudon, the WHO representative in Viet Nam.

The commitment of the Vietnamese government came soon thereafter, including high-level support for a WHO coordinated response in Hanoi. “The first priority was to contain the disease and monitor each case,” said Brudon. International collaboration to combat SARS came quickly via the Japanese government and Médecins Sans Frontières, who both worked under the umbrella of the WHO initiative in Viet Nam.

Viet Nam was fortunate in that the country had only a single index case, who spent less than 3 days in Hanoi prior to hospitalization. This short time in the community effectively limited opportunities to transmit the SARS virus to a contained hospital environment.

Viet Nam’s northern Quang Ninh province recently began barring Chinese tourists at its overland border with China in an effort to prevent importation of SARS. This move comes ahead of any decision by the Vietnamese national government to seal its border with China indefinitely, as has been recommended by the country’s ministry of health.

Caution urged in the use of diagnostic tests
WHO is currently working with four major laboratories to develop a clinically validated diagnostic test for SARS. Standard test reagents are being established to assess the quality of the test and ensure its reliability. When the test has been developed and clinically validated, it can be used reliably to confirm cases of SARS. However, test development and validation are expected to take at least another two weeks.

In the meantime, laboratories in a growing number of countries have developed SARS diagnostic tests, often based on information made available at the WHO web site. It is extremely important for national authorities and medical and hospital staff to understand the limitations of currently available tests. Their use as the basis for treatment decisions may give a false sense of security that can allow persons carrying the SARS virus, and therefore capable of infecting others, to escape detection.

PCR tests can detect genetic material of the SARS virus in various specimens, including blood, stool, respiratory secretions, and tissue samples. Primers, which are the key pieces for a PCR test, have been made publicly available on the WHO web site by laboratories in the WHO network. The primers have since been used by many countries around the world.

These currently available PCR tests are very specific but lack sensitivity. This means that negative test results cannot be relied on as proof that a patient is not infected with the SARS virus.

In the absence of a reliable diagnostic test, national authorities are strongly advised to continue to base decisions concerning what constitutes both a suspect and a probable case of SARS on the present clinical and epidemiological case definition, and not to rely on the results of diagnostic tests. WHO advises that all suspect and probable SARS cases be placed in isolation and managed according to strict procedures of infection control.

All other currently available diagnostic tests also have important limitations. The ELISA (enzyme-linked immunosorbant assay) test detects antibodies in the serum of SARS patients reliably, but only as from about day 21 after the onset of clinical signs and symptoms. Immunofluorescence assay tests detect antibodies in serum of SARS patients, but only after about day 10 following the onset of clinical signs and symptoms. Moreover, the test is demanding. Reliable results depend on the use of fixed SARS virus, an immunofluorescence microscope, and an experienced microscopist.

Virus in specimens from SARS patients can also be detected by infecting cell cultures and growing the virus. Once isolated, the virus must be identified as the SARS virus with further tests. Cell culture, which is the only method of demonstrating the existence of a live virus, is a very demanding and time-consuming test.

Update on cases and countries

As of today, a cumulative total of 4649 cases with 274 deaths have been reported from 26 countries. This represents an additional 210 cases and 11 deaths when compared with yesterday. The new deaths were reported in China (5) and Hong Kong SAR (6).

In China, the Ministry of Health has today informed WHO of 180 newly reported probable cases. The breakdown by location is Beijing (103), Inner Mongolia (23), Guangdong (15), Tianjin (13), Hebei (12), Shanxi (11), and one case each in Henan, Guangxi, and Sichuan. These latest figures bring the cumulative number of probable cases reported in China to 2601. Among health workers, a total of 38 new probable cases were reported from Beijing (17), Tianjin (9), Hebei (5), Inner Mongolia (5), Shanxi (1), and Guangdong (1).

Beijing reported 3 deaths, Shanxi 1, and Guangdong 1, bringing the cumulative number of deaths in China to 115. The fact that cases continue to occur in health workers underscores the need for better infection control in hospitals. In Beijing, WHO is still awaiting data giving dates of onset and the location of cases in order to fully assess the situation.

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[discostu]

Yep the rate of spread is much more important than the death rate.