SARS
Severe Acute Respiratory Syndrome

All suggestions on the page are not to be taken as professional
medical observations by Steve Van Nattan. You should see you
doctor at once if you believe you have SARS.

APRIL 2003 AND THEREAFTER

SARS:
DEFEND YOURSELF AND FAMILY

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THE STORY

What is coming at us? It is a bit early to anticipate whether SARS will be a world class pandemic, or if it will pass over easily, but now is the time to get ready. This is because the things needed for survival will be scarce once the epidemic arrives in your nation, state, or province.

The following story has been lifted from http://www.globalchange.com/sars.htm without permission under the assumption that such an epidemic requires that we bypass some protocols of courtesy in publishing. I trust that you and the author of the material will understand.

DISCLAIMER: We do not agree with almost every other teaching of the source here. This article seems not to be infected with any of the author's theological and neo-globalist Post-Millennial views.

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

• On 2 April, 2,300 were already known to be infected with the SARS virus, an increase of 700 in 3 days, of which 75 had died. 95 cases were reported in total in Singapore with over 1000 in quarantine - just one of 15 nations with cases: Canada for example had 6 deaths and over 150 cases, with 1,200 officially reported cases in China and more than 700 in Hong Kong. Other affected countries included Taiwan, France, German, Italy, Republic of Ireland, Romania, Singapore, Switzerland, Thailand, United Kingdom, United States, Viet Nam.
• The first case of SARS infection was reported in Hanoi on 26 February: a man was admitted to hospital with symptoms of high fever, dry cough, myalgia (muscle soreness) and sore throat. Over the next four days he developed increasing breathing difficulties, severe thrombocytopenia (low platelet count which means his blood was not able to clot properly) and severe breathing difficulties requiring ventilator support. He died of SARS pneumonia. Today we face a serious global epidemic, and know the truth which is that SARS infection has been around for months, hidden away in China.
• By early April 2003, many countries were already deeply alarmed by cases in their hospitals of a highly infectious viral infection causing severe atypical pneumonia, striking suddenly, failing to respond to normal treatment and causing many sick people to die. The streets of Hong Kong were filled with people wearing surgical masks, or holding pieces of cotton over their faces
• Evidence was growing that suggested SARS virus not only spreads via face to face contact, or to people nearby, but can also jump rapidly from person to person, home to home in other ways - perhaps through contaminated objects being touched by hands which then touch the nose, or through air conditioning, or through common sewage or water supplies. The virus has been detected not only in respiratory droplets but also reportedly in faeces and in urine. Although it is not known if the virus is still capable of causing infection via these routes, it may help explain some clusters of SARS pneumonia in Hong Kong.
• Singapore closed all schools and threatened huge fines on anyone in contact with an SARS sufferer if they left their homes.
• A day later Hong Kong also told a million students and children to stay at home with new SARS outbreak rates running at around 65-80 a day. And almost all of these people needed urgent hospital admission, many in intensive care on life-support systems with full-blown SARS pneumonia.
• The US had seen 62 cases of SARS infection by March 31st with numbers rising rapidly. Almost all had become infected in other nations. Urgent steps were being taken to repatriate foreign office staff fropm embassies and government consulates in Hong Kong, and Guangzhou.

HONG KONG ALARM AT UNUSUAL SARS SPREAD IN TOWER BLOCKS

• Hong Kong took action to effectively imprison 230 people in an entire 35 story high-rise block of flats for 10 days, where there had been over 100 SARS cases - almost half identified in 48 hours. However no action was taken to contain residents of 3 other towers among the 19 in the area, where a further 120 cases had occurred. All the cases were traced back to four initial visits by someone with a kidney problem who entered one of the tower blocks after being treated in a hospital where there were many people with pneumonia.
• The SARS virus seemed to have jumped rapidly from one household to another, up and down floors in these tall towers. World Health Organization experts were shocked, as they were unable to see how each person infected had been in close physical contact with a known SARS virus carrier. These residents became dependent on deliveries of food and other supplies by government employees. However, when police officers in masks turned up to seal the building, they later found in door to door visits that over half the residents had fled. Frantic efforts followed to try and track down every missing person across the whole of Hong Kong - among a population of over 6 million. The military then decided to truck over 200 people to an isolated quarantine camp.
• Hong Kong health care teams were overwhelmed by the huge jump in cases, making it almost impossible to work out who infected who, how and in what order. Yet this information is vitally important in understanding how the virus spreads, and what kind of isolation measures are necessary.
• Contact tracing, follow up and strict isolation of all potentially exposed is very labour intensive and a highly specialist area. It is the only weapon we have currently against the SARS epidemic, but rapid spread in Hong Kong is making the job almost impossible for a small number of infectious disease experts.

GLOBAL IMPACT WIDENS OF SARS INFECTION

• Investor confidence has been hit across the region, together with tourism and business travel. Intel Corp shut part of its Hong Kong office and sent a third of its 250 Hong Kong workforce home after a team member became sick with SARS pneumonia. HSBC opened its backup trading floor at a different location in case its entire top trading team was suddenly placed in quarantine.
• Other nations were also proposing radical action to save lives and their health care systems from meltdown. A single SARS infection was enough to close an entire hospital - with rapid spread to health care workers and threats to other sick patients and family members.
• Many countries began delivering dire health warnings top travelers - for example Australia told citizens to avoid all travel to Canada and affected countries in the Far East.
• Travelers in Japan, China and Hong Kong began to see large numbers of local citizens covering their faces in public places with medical masks or makeshift 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). Ontario has a resident Chinese population of over 400,000 with frequent travelers to and from the Chinese mainland.
• Taiwan decreed SARS 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 SARS quarantine by the end of March and the government announced they were thinking of a ban on air travel to or from China. Taiwan media has savagely attacked Chinese leadership for what they say has been slow action, risking the health of the whole world by being secretive. Hong Kong authorities have also been criticized for slowness to act - perhaps out of deference to the authorities in China.

MEDICAL TEAMS HIT HARD BY SARS VIRUS

• Medical teams have been badly affected by SARS pneumonia: 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. Some of these health workers then unknowingly infected their own children, husbands, wives and friends. 8% of all medical staff at the Hong Kong Prince of Wales hospital fell sick with SARS in two weeks, with suggestions in local press that a significant number may have been infected despite infection control measures being taken. It is not clear whether some / all had just been using masks or whether they had been following the strict disciplines of full isolation and barrier nursing, which does seem to be very effective - see below. Doctors in clinics have been infected as well as family doctors (General Practitioners) working in the community.
• 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 pneumonia.
• Symptoms of SARS, which is believed to be spread through droplets by sneezing and coughing, are hard to diagnose as SARS infection because they include common health problems as high fever, chills, coughing, cold and breathing difficulties of various kinds - read on for more below on SARS symptom profile.
• Many people are recovering from SARS pneumonia, but only very slowly, after long treatment in hospital, including the need for support from mechanical respirators (life support systems / ventilators) in intensive care units. The demands on health care resources from a single case are immense. SARS infection produces a spectrum of very severe illness and longer term effects on health are unknown.

ORIGINS OF SARS VIRUS

• Because the SARS epidemic suddenly seemed to appear from nowhere just as the Iraq war began, some feared SARS infection was a biological warfare attack - a germ warfare virus released by Saddam. We know this is not the case since the spread of SARS began months earlier. However scientists do have the technology to produce viruses like SARS.
• Investigations by Hong Kong authorities suggest SARS infection 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 the SARS virus. 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.
• By the end of March WHO officials were working their way through patient records in Beijing where there were also growing numbers of cases, but had still not been permitted to make their first visit to Southern China which it is thought to be the global epicenter of the SARS epidemic, raising growing concerns about the real nature of the problem in Guangdong. Health care workers in the area had been forbidden to talk about what is happening. Stories are circulating in Taiwan that local journalists have also been instructed not to report what they are seeing.
• Judging by the experience of Hong Kong, and the slow reluctance of the Chinese authorities to allow observers into Guangdong, it was becoming hard to believe that the Chinese epidemic had been fully contained. Control depends on full cooperation by the whole population, reporting symptoms early, taking sensible precautions. But how can you control disease like SARS during an information blackout with strict censorship?
  

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, gut problems and other symptoms. Twenty years ago medical students were trained to diagnose virus infections by their typical symptoms and skin rashes, but today the range of low-grade viral infections is huge and rapidly growing. Few are formally diagnosed. Doctors just tell people they are suffering from a "self-limiting condition" which is another way of saying there's no treatment but it is unlikely to kill you. But that was before SARS.
• 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. Most viruses are species-specific but occasionally they cross over. We saw this in 1998 with a severe outbreak of bird flu in Hong Kong which killed several people and only halted after over 1.3 million chickens were slaughtered. Fortunately the virus did not seem to be able to spread very well between humans.
• 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.
• Most new viruses are either harmless or relatively uninfectious, or both. HIV is an example of a dangerous, relatively uninfectious virus that is a global menace because people can live for many years in an infectious state without realizing they are a potential risk to others..
• 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 urbanization 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. Genetic engineering may be a key weapon in vaccine development.
  

SARS SYMPTOMS, INCUBATION PERIOD, INFECTIVITY, TRANSMISSION, TREATMENT AND PREVENTION

• SARS stands for Severe Acute Respiratory Syndrome.
• SARS symptoms start with a fever of more than 38.5 centigrade or 100.4 degrees F, sometimes with shaking, headache, muscular stiffness, body aches, confusion, rash, diarrhea, loss of appetite and malaise (feeling generally unwell). Within a week, the patient develops a dry cough, and in many cases shortness of breath. In 10% to 20% of cases, patients require mechanical ventilation to breathe. Between 3% and 5% die from the disease. Symptoms of SARS start in most cases 2 to 7 days after exposure but sometimes it seems to take as long as 10-14 days.
• SARS diagnosis is by exclusion: there is no specific test at present which can be used in the early stages of infection, so physicians and health care teams work hard in every suspected case to rule out every other known cause of severe pneumonia. And then as a last resort they conclude this must be SARS. In the meantime, all with severe pneumonia anywhere in the world who have been potentially exposed must be regarded as possibly suffering from SARS until otherwise proven. That is why many with symptoms similar to SARS are at present often included for a while in SARS statistics, later being eliminated from the infection list as the real cause becomes clear. As infection continues, levels of specific antibodies always rise as the body starts to fight, and blood tests can then reveal the causative organism.
• Cause of SARS is thought to be a virus - or possibly more than one virus acting together. (See book chapter on what exactly is a virus? which explains why viruses are such a problem for human beings).
• 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 antigens rapidly in subtle ways to confuse the immune system. We call this process antigenic drift. That's why vaccines don't work against colds.
• SARS virus spread occurs probably through droplets created by coughing or sneezing, but may also 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. It may also spread through other routes - for example through fecal contamination or sewage - we don't yet know. We have no idea how long the SARS virus can survive on contaminated objects (called formites). We also have no idea how soon carriers become infectious. Assumptions are being made that people may become infectious a day or so before they develop symptoms, and also that those who do not develop symptoms after exposure do not develop active infection, and do not become silent carriers.
• Many reports have speculated that like other coronaviruses the virus is destroyed after 3 hours or so but there is no direct evidence for this. Hand-nose contamination is a very common way cold viruses spread - and the answer is frequent handwashing as well as avoiding hand - nose contact. Surfaces can be sterilized with diluted bleach or disinfectants.
• Sales of face masks have soared in Hong Kong and elsewhere, although there is little direct evidence that they will protect the health of the wearer when walking around outside. They may prevent infected droplets released by coughing or sneezing from landing on the skin around the nose or from being inhaled, however, individual virus particles are far too small to be filtered by such masks. It all depends whether free virus particles are causing infection, or far larger droplets of secretions which contain virus.
• Those in recent contact with people who have SARS, or with others who could be incubating SARS infection (themselves SARS contacts in the last 2 weeks), should quarantine themselves, keeping at home, away from others, in a well ventilated room, eating and drinking a normal diet and getting plenty of rest. Urgent medical advice should be sought, whether the person feels sick or well, about detailed procedures to be followed to protect the health of others while also enabling the person in quarantine to be properly looked after.
• 213 people appear to have been infected by SARS in one apartment complex alone in Hong Kong - all of which landed up in hospital - with a further 240 people from the same block in strict quarantine. The question is how and why did they all become infected? Of the 213, over 100 were in a single residential block. The greatest risk of transmission seems to have been to those living directly above or below others already infected, suggesting a new factor is involved other than normal person to person spread, such as infected body secretions entering common ventilation or plumbing systems of other flats. Huge efforts are being made to answer this question. The Amoy Garden complex is in the Kowloon district and has many 35 story residential blocks, housing a total of 15,000 people.
• The vital question is this: 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? 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 airborne 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, aprons, head covers and goggles seems to provide almost 100% SARS protection for nurses, doctors and other health care workers. Barrier nursing is a standard procedure 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 (containing of course only one person or only others proven to have SARS already) 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 14 days from contact to first symptoms, Chinese reports show - but seems to be usually less than a week. During the incubation period people may feel completely well, yet begin to be infectious.
• 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, a process called recombination.
• 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.
• In countries like Singapore there has been a rush to sign up for health insurance but people may be disappointed. Health insurance cover may exclude SARS in countries where SARS has become a notifiable infectious disease - check the terms of your policy.

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 mobilized 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 initially slow to reveal the extent of the problem to the World Health Organization, 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 of over a billion people, huge overcrowding, ignorance of the disease, difficulty in diagnosis, poorly developed health infrastructure, low access to radio and TV, high levels of illiteracy among the poor and the impossibility of quarantining hundreds of thousands of people. Only those who have traveled to India or live there can fully understand the vast scale of the challenge if India should see cases on its own soil. Quite simply, the battle to prevent a global pandemic could be lost almost overnight.

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 realized 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 - by injecting people with damaged virus particles, or by finding a variant which produces very mild illness, but is similar enough to provoke protective antibody responses.
• 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 a few weeks with very few deaths.
• Alternatively, a continued epidemic provokes global aggressive control efforts plus a research program 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 strict 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 inadequate facilities for monitoring and control. Health services and contact tracers come under severe strain, made worse by rumour and panic. Draconian measures, introduced by some countries to enable disease control, have the unfortunate effect of making many people with symptoms afraid to come forward, in case they lose their liberty, access to their own children and so on, forcing the infection to spread even faster underground. Many tens 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 a scenario would also have major impact on national economies, especially sectors such as travel and tourism.
• 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. Many experts in infectious diseases have been saying for a long time that it could only be a matter of time before history repeats itself.
• The influenza pandemic of 1918-1919 killed more people than the Great War, (known today as the first world war or WW1). Estimates vary but some believe as many as 2 billion people were infected of which 30 million died. It was 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. Many were struck down rapidly. For example one man started a ride on a street car feeling well and was dead a few blocks down the road.

Conclusion: the World Health Organization 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.

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