Study offers first picture of effects of SARS

I've had tourists from big cities, Chicago, LA, etc., tell me the same thing about our rural hospitals. One of the ones I work at is rated in the top 100 US hospitals with an under 100 patient capacity. The other one should be, in my opinion. ;-D Both have helopads, of course. Doesn't everyone?

I agree about these threads, jacquej. We've ALL worked very hard to be responsible and to give out accurate information, to correctly assess the information we have, and to speculate from reliable facts. Kudos to all posters and to Free Republic for providing the most up-to-date and accurate SARS information available anywhere on the internet. In a number of cases, FR has been ahead of the news curve in evaluating SARS...

A huge benefit to the country is that there are a core of informed posters and readers who will have the latest accurate facts on SARS if needed. We all know where the hotspots currently are...In some cases, the breadth of knowledge shown in FR comments is more than impressive.

This might be off topic, but I thought it was an interesting article from Wired... long tho!

Behind the Six Degrees of SARS By Kristen Philipkoski
Story location: http://www.wired.com/news/medtech/0,1286,58985,00.html

02:00 AM May. 28, 2003 PT

The concept that each person on the planet is just six handshakes removed from every other person has frightening implications when it comes to a highly communicable disease like SARS.

Yet the "small world" effect, also known as the "six degrees of separation" phenomenon, may also help explain how severe acute respiratory syndrome has spread so rapidly around the globe, some researchers believe. The disease has infected 8,221 people and killed 735 worldwide, according to the World Health Organization.

Physicists, psychologists and mathematicians who study network effects, the scientific field that the six-degrees-of-separation notion has engendered, are busy creating mathematical models that attempt to explain the quick spread of SARS.

"We're modeling interactions within households, between households, in schools, shopping malls and other public areas," said Lauren Ancel Meyers, an assistant professor of integrative biology at the University of Texas at Austin.

Meyers and her colleague, Babak Pourbohloul, director of the division of mathematical modeling at the British Columbia Centre for Disease Control, will use these models to predict which strategies will work best to control the spread of SARS.

The two researchers are working closely with Canadian public health workers on the project. After a brief respite from new cases, Toronto recently reported eight unique cases of the disease, which can cause death from symptoms of pneumonia, re-instituting a travel advisory from the Centers for Disease Control and Prevention in the United States.

"We would like to do something very useful for them," Meyers said. "We're working with a whole team of Canadian scientists who are developing vaccines and trying to characterize (and control) the virus."

They also intend to develop software that would allow public health workers to predict the effectiveness of various methods for stopping the spread of the disease, such as face masks or quarantines.

Mathematicians have long used equations to examine the spread of epidemics, and to help public health officials control them. A recent paper in Science applied these methods to SARS.

In the Science article, the researchers assume that most people -- excluding those who come in contact with so-called superspreaders, have about the same chance of developing SARS. Superspreaders, researchers believe, have the ability to infect more people than most patients.

Network science, on the other hand, assumes that each person's social habits can increase or lessen his or her chances of getting infected. For example, one might be much more likely to come into contact with someone with SARS by traveling on a plane to Taiwan, a country that has recently seen a high rate of SARS infections.

"You take account of the fact that you don't have contact with everyone, but rather certain people," said Mark Newman, a professor of physics and complex systems at the University of Michigan, who pioneered the application of network effects to epidemics. "Then you can make predictions about how the disease would spread or about how you could deploy vaccine programs or treatment programs to try to prevent its spreading."

The study of network effects grew out of a 1967 experiment conducted by the Yale psychologist Stanley Milgram.

Milgram instructed 300 randomly selected people around the country to send important packages to recipients they did not know.

The "senders" were given clues about the recipients, such as their general geographic locations and occupations. Based on those clues, the senders were instructed to forward the packages to someone else they thought might be "closer" to the intended recipients. This process was repeated until the letters finally reached the correct people.

Milgram published a paper in Psychology Today that said that the letters that made it to their intended destinations passed through an average of about six sets of hands. The six-degrees-of-separation school of thought was born.

The phrase "six degrees of separation" was made famous by playwright John Guare, who wrote a play of the same name (later made into a film) about a young black man who scams an upscale New York couple into believing he's Sidney Poitier's son and a classmate of their children. He does the same to other members of the upscale Upper East Side community, and since they are all connected, they discover the scam.

Film buffs came up with a parlor game that challenges players to connect other actors to Kevin Bacon by six degrees.

The concept also influenced science. In 1996, Duncan Watts applied the idea to his doctorate research on the mating chirps of crickets.

Watts wanted to understand how large groups of crickets synchronized their chirps. He realized they do this not by listening to the whole group but to their close neighbors. Gradually, a chain reaction occurs as each cricket synchronizes its chirping with a nearby cricket and so on down the line. The phenomenon, he concluded, is another example of the six-degrees effect in action.

When he and his advisor at Cornell, Steve Strogatz, published a paper on the phenomenon in Nature, it caused a stir. Researchers in various disciplines -- from business to computing to epidemiology -- wondered if network effects might apply to them as well.

Watts eventually wrote two books on network effects, Small Worlds in 1999, and in February he published Six Degrees: The Science of a Connected Age.

Others have written on the role of network effects in the spread of epidemics, including Albert-Laszlo Barabasi, a professor of physics at the University of Notre Dame and author of Linked.

"The small-world property is bad news for all viruses: it means that if the virus is not contained, and very virulent, it could, in principle, reach every single person on earth," said Barabasi. "I do not need to know an individual to pass the virus to him. It is enough to be close to him."

Despite the flurry of interest in network effects, the six-degrees-of-separation theory itself came into question in 2001. A researcher named Judith Kleinfeld, a professor of psychology at the University of Alaska at Fairbanks, dug up the Yale data and found that only 29 percent of the packages Milgram sent actually made it to their recipients, and some that did make it required more than six intermediaries.

Kleinfeld couldn't find any evidence that the world, or even the country, is connected by six degrees. Other studies, like Watt's, she argues, use variations on Milgram's original study. They were more likely to achieve a network effect, she said, because they took place in smaller communities, such as high-rise apartment buildings, a specific urban area or a college campus.

But researchers say the size of the group doesn't matter. For the network researcher, what's important is the ability to define the essential characteristics of the network itself.

In Meyers' study, that would include the people with whom SARS patients and their caregivers come in contact. Using that information, Meyers can create a model for predicting the effectiveness of proposed strategies for fighting the disease.

"Despite questions surrounding the original (Milgram) experiment," Meyers said, "there is no doubt that network models of various biological, sociological and technological systems can offer great insights."

The stress of knowing that you have an acute,life-threatening disease, coupled with the physical demands the body has just experienced, must be intense. However, is it not premature to apply the "post traumatic stress disorder" diagnosis ? These folks would naturally still be emotionally distraught.

There have been numerous studies concerning the hypochondriac effects of preliminary diagnoses of physical and mental conditions. The end result is that "victims" need an inner strength of character to overcome the potentially negative effects stemming from the tendency of the medical profession to "push" them into a labeled condition.

I found this just a few minutes ago, and thought it was interesting. Shall we speculate how he got it?

SARS case raises questions
Husband gets disease after visiting wife in hospital

Lisa Queen, Staff Writer
May 29, 2003

Fred Fifield did everything North York General Hospital advised when visiting his wife, Shirley, who underwent double knee surgery earlier this month.

But, somehow, the 71-year-old previously healthy man contracted Severe Acute Respiratory Syndrome anyway.

And that has left his Aurora daughter suspicious health authorities have downplayed the danger of catching the deadly respiratory disease when visiting a hospital.

"I think people should be aware. It just makes you think they're not telling how easily you can get this disease," said Judy Epworth, now at home under quarantine.

"What scares me is how did he get it and how easily it can be caught."

Weak and on a respirator, Mr Fifield is listed in stable condition at North York General, now the focus of Toronto's renewed SARS outbreak.

Dr. Murray McQuigge, York Region's public health physician consultant, said Mr. Fifield's case is a further example the disease is confined to health-care settings, rather than a threat in the general community.

"Basically, what we're saying is this is a hospital disease. It has been from the start and it continues to be. It doesn't do well in the community," he said.

"We're very optimistic this is anything but out of control. It's dismaying that we did (get new cases but) ... far from being out of control, this is better than our wildest dreams of a month ago."

Dr. McQuigge would not comment specifically on Mr. Fifield's case until he has seen a review of the man's file.

Ms Epworth said her father contracted SARS through unknown means while visiting his wife, who had double knee surgery May 9 at North York General.

She said both her parents, residents of Parry Sound, wore masks and continuously used antiseptic cleaners to wash their hands while in hospital, which included a pre-operation visit May 8.

On May 14, Mrs. Fifield was transferred to St. John's Rehabilitation Centre, which also had SARS cases in the past week. Her husband never visited her at St. John's.

Mrs. Fifield has not displayed any symptoms of the disease.

On May 18, 10 days after his first visit to North York General, Mr. Fifield began feeling unwell.

"He had a fever and he was not feeling good at that point. He felt chesty," said Ms Epworth, who along with her brother, sister and sister-in-law are quarantined at their homes in Aurora, Barrie and Mount Forest because they visited their mother at North York General and St. John's.

On May 20, Mr. Fifield saw his family doctor in Parry Sound, who diagnosed him with a virus and sent him home.

Last Saturday, his children advised him to call the hospital in Parry Sound and seek further medical assistance when he complained about his worsening health.

He was instructed to come to the hospital and was then airlifted to North York General.

Ms Epworth said her family is angry North York General scheduled her mother's elective surgery when the hospital was apparently not SARS-free.

"They assured us SARS was under control. My father was there four times when my mom was in hospital and took every precaution the hospital offered. How did he get this, by pushing an elevator button? I don't know," she said.

"Needless to say, we're angry. We were assured at the hospital everything was under control. A perfectly healthy man goes to sit with his wife for elective surgery and comes down with SARS."

Meanwhile, she wonders if there was political pressure on health authorities to prematurely declare the outbreak over because of the economic toll SARS was taking on the Greater Toronto Area.

Meanwhile, Ms Epworth said neither she nor her husband and three children, who aren't under home quarantine, have exhibited any symptoms of SARS.

But she admits being anxious because her father stayed at her home while visiting her mother in North York General.

"If my dad caught it, why couldn't I?" said Ms Epworth, whose quarantine ends Saturday.

She is one of almost 3,000 York residents now under quarantine at home due to SARS.

There are seven suspected cases of the disease in the region, four of whom are health-care workers.

One patient is being treated in York Central Hospital and another is being care for at Southlake Regional Health Centre.

The other five are being treated in Toronto hospitals.

From the article:

Dr. Murray McQuigge, York Region's public health physician consultant, said Mr. Fifield's case is a further example the disease is confined to health-care settings, rather than a threat in the general community.

"Basically, what we're saying is this is a hospital disease. It has been from the start and it continues to be. It doesn't do well in the community," he said.

"We're very optimistic this is anything but out of control. It's dismaying that we did (get new cases but) ... far from being out of control, this is better than our wildest dreams of a month ago."

Lying weasel, imho.

A huge benefit to the country is that there are a core of informed posters and readers who will have the latest accurate facts on SARS if needed. We all know where the hotspots currently are...In some cases, the breadth of knowledge shown in FR comments is more than impressive.

Where the health care system failed in one aspect was managing risk. They were operating and proceeding from several false assumptions, and now this has come back to bite them.

I'm amazed. I'm a livestock producer and it seems like in many ways, the way we handle our livestock in regards to disease some Scrapie (a TSE), Johne's (Mycobacterium avium subsp paratuberculosis (MAP), etc., on a day to day basis - evaluation, treatment/control, etc is also about managing risk. With more studies on determining any link between the etiologic agent (MAP) responsible for Johne's in ruminants a significant cause of disease in humans, we manage that risk using a variety of methods, and I am only a producer. I am dissapointed that in the case of SARS, there appears to be inadequate oversight and risk management in the Toronto health care system and all systems that interface with the aforementioned.

The American Library Association (ALA) has a conference in Toronto next month. The Library staff where I am assigned to has discussed whether they will go. But what is good is that they will keep the college informed on their decision, etc.

A question - has the CDC issued any sort of travel advisory, etc for travel to Toronto, Province of Ontario, etc?

"Basically, what we're saying is this is a hospital disease. It has been from the start and it continues to be. It doesn't do well in the community," he said.

I am so sick of seeing this ridiculous statement, I could scream. If this were true, the best way to end SARS would be to keep patients out of the hospital. Stay in the community.

I know what you mean. It's irresponsible and disgusting.

There needs to be an open intercom system in these SARS rooms. If voice contact is ingoing it might help alleviate some of the isolation stress.

(Remembering a harrowing three day long induced labor in a room without windows.)

Will you move here, where I live, please?

Sorry, Hub is happy here for the past 14 years. We aren't going anywhere.

But thanks. ;-D

I agree, and both hospitals where I work have such systems. I suspect a lot of hospitals do; likely the majority, but I don't know...

Isolation is so difficult for patients, families, and nurses...and families tend to get lax, over an amazingly short period of time...so do physicians, in my experience.

Probably contracted through the eyes if contracted in hospital. No mention of them wearing eye protection.

A good comment...

Question: How would you change the Canadian system? (Tall order, I know, but I'm just asking...)

It seems to me that a distinct advantage we have in dealing with a contemplated SARS outbreak is the relatively long ( 6 days ) incubation of the virus as compared to influenza ( about 2 days ).

Rapid identification of contacts, and rigorous quarantine can quickly contain an outbreak, once a primary case is identified, a process that is just not feasible when dealing with influenza cases. Of course, such a process is only possible where competent public health authorities are in place.

So I guess I am a little more optimistic than some on this thread that should a worldwide pandemic of SARS eventuate this fall, we are better situated than most to contain widespread infection than those poor third world souls whose only public health system is a wing and a prayer.

I share your concern about the toll any epidemic will take on smaller hospitals, especially if every patient in a facility with respiratory symptoms or a fever has to be treated as a potential SARS case. There aren't enough N 95 masks in all of Christendom to meet the demand if this happens.

Congratulations on the way you handled DoughtyOne, and congratulations to DoughtyOne on having the sense to see the truth.

Many misinformed people have come on these threads with closed minds and nothing to contribute except insults. Sometimes they go away after learning a bit, but rarely do they own up to their mistakes.

As you know, the typical uninformed SARS "debunker" is fond of saying SARS is "just the flu". It's a small point relative to the overall thread, but it looks like you slipped a decimal point.

You said: Ordinary flu has around 1% mortality rate for all patients. The actual number is 0.1%. That makes SARS 150 times more deadly, with much more damage for the survivors.

Source: The CDC estimates 35,000 people die from flu every year, and between 30 million and 50 million people catch it.

Variants of influenza type "A" are the killer. The CDC statistics I read did not break it out separately, but it would certainly be higher than the mortality rate for "all flu" combined.

Listen, I am thinking here, which is always risky for me! (I can think my way into ridiculousness, ya know) So, take it all as just an effort to keep the aging brain cells forming new connections...

Toronto has done a good job with this, compared to Cascadia (The Vancouver/Wasington State Metro Areas, sorta), as the quarantining in Toronto has been agressive. Now, we suspect it isn't long enough, but I do not think it is fair to single out Canada for criticism for the following reason.

We have no idea what is happening here in the States. The ridiculous statement by the Health Dept. official yesterday from Wheeling, West Virginia is an indication of that, supporting my suspicion that US is using the same crazy obfuscating "definition" weaseling as other parts of the world.

For example, defining as "probable" only after a case has recovered. Death, of course is due to some other cause, understand? According to that WVHO, the "probable" case in critical care there probably didn't have SARS, although he fit all the criteria as we know it.

It is my fear that the US is in for a much tougher time with SARS than Canada for the follwing reason. Canada will automatically pay unemployment benefits for anyone quarantined with SARS, from what I have read elsewhere, (but I need you Canadians to confirm that.)

That won't happen here in the US, making quarantine compliance much more difficult. We have far too many people living from paycheck to paycheck who will resist sensible quarantine, if we ever figure out what that is!!!!

We have a non-compliant population in the states. We are a nation of "doing it my way" and do not conform to cultural norms as many other societies do... That can work for us in many ways, but in certain situations, can be a real problem. Shutting down schools and quarantining students at home to stop the transmission of SARS would be an example. Too many families here are single parent, or double-working parent families.

Other odd thoughts. The cross border gambling! Anyone know how many people travel across the Niagara Falls border everyday to go to the Casino there? How many Torontonians go there to gamble. The Falls, and the Niagara region, including Niagara-on-the Lake?

Think about it!!! Let's realize that all the cases in Toronto came from one index patient who had traveled in from Asia. All it takes is one.

About the summer break we are all hoping for... I wonder about this. I know that influenza is supposed to die down in the summer months, but what about coronavirus? Will it do the same thing as the influenza virus? Those of you more familiar with the statistics on "summer colds" or how the common cold behaves in the summer time might be helpful here.

Odd thoughts about "fashion" and handwashing? I know from handling raw poultry on a daily basis to feed my dogs a raw diet how important it is to wash my hands after handling such. Before I switched to raw feeding, I enjoyed keeping my nails a bit on the long side, but realized that the undernail area on my fingers was hard to really clean, so now I clip them right off with nail clippers every couple of days.

How many health workers in hospitals/doctors offices are wearing longer nails, false nails etc... you think the US could demand an end to wearing these nails, and require all to clip nails to the quick? How about the demand that this be done for workers in pharmacies, supermarkets, fastfood restaurants, shopping malls, health food chains?

Well, I better let my fingers and brain rest a bit. Don't want to wear anything out, including your eyeballs.

Thanks for your thoughtful comments. Much appreciated.

I could't recall the exact mortality percentage for regular flu, and I actually thought I erred on the low side instead of the high side. Thanks for the correction, and (as usual ;-D) your other informative comments.