Friday, April 25, 2003

21st century superbug

I wrote this for publication on spiked on 24 April 2003.

Severe Acute Respiratory Syndrome (SARS) is the 'killer bug' that has now affected 3947 people in 27 countries. Of these, 229 have died. There is no cure or vaccine for the disease, which appears to spread by close contact with an infected person. Many of the early victims were hospital workers, and many cases require ventilation to survive: both of which factors put a strain on health services. Death rates from the disease seem to be rising, leading to suggestions that a more virulent form of the disease may have developed. People have been advised not to visit Hong Kong, mainland China or Toronto, Canada. Sales of face masks have risen in many of the countries affected.

The number of reported cases remains a tiny fraction of the populations of the countries affected. Even in Hong Kong, the most disproportionately affected area, the 1434 reported cases represent just 0.02 percent of the people living there. As a comparison, in the year 2000 there were 7578 cases of tuberculosis in Hong Kong. So while SARS in Hong Kong is a significant new strain on health services, it not out of proportion to other, existing infections.

There is even less reason for general alarm elsewhere in the world. Eighty-seven percent of all cases have been in mainland China and Hong Kong, and many cases in other countries have been among travellers who contracted the disease while in China and Hong Kong. There is panic over the apparent rise in the number of cases: but these are cumulative figures, not new cases. Of the 3947 cases reported, 1935 patients have already recovered. Moreover, there has been a big leap in cases reported simply because China is now providing more accurate figures. An examination of the level of new cases reported each day by the World Health Organisation (WHO) shows that the number has been surprisingly static throughout April.

As for reports of an increasing death rate, or a 'virulent new strain', it is simply too early to come to any conclusions. For example, in contradiction to these gloomy suggestions, Taiwan has had 29 cases to date, but not a single death. It will be some time before the differences in outcomes can be explained.

What is clear is that SARS is a powerful demonstration of the ability of medical services to respond to novel disease. WHO is now convinced that the virus responsible has been identified, as have the likely modes of transmission. Treatment methods have been adapted to minimise the risk to hospital staff. While there is no cure, a reasonably successful form of care has been devised. The death rate appears to be quite low, although there is variation between countries. All this for a disease that was only identified as something new and important in February 2003.

SARS does, however, appear to have damaged economies. Travellers face quarantine procedures at airports, as do many private school children returning from the worst affected areas. Governments have taken draconian steps to deal with anyone who refuses to cooperate with containment measures. While the health risk of SARS appears largely under control, the consequences of the panic could run and run.

Don't panic

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