Thursday, April 03, 2003

SARS graph: cases vs. mortality

The longer the epidemic goes on, the better survival rates seem to get:

SARS: two interesting articles

From spiked:

Viral fears, by Stuart Derbyshire
The experience of a US-based researcher confronted by the over-reaction to SARS on a trip to South Korea

The SARS farce, by Mischa Moselle
Fear, not disease, has put Hong Kong in quarantine, says a HK resident.

SARS update

These are the latest WHO cumulative figures for countries with more than ten cases, plus the global total:

Here's a further list of responses to the SARS epidemic:

  • In Canada, two people who had been in contact with a SARS patient have refused to isolate themselves and may be forcibly quarantined. Health staff in Toronto have been told they can only work at one hospital for the time being, affecting staff who work part-time at a number of sites. (National Post)

  • The number of new cases in Guangdong, China seems to be falling. (The Age)

  • Indonesia has declared SARS to be a national threat, allowing the government both to monitor the condition and granting it draconian powers to deal with anyone who blocks efforts to deal with the disease. There are, as yet, no cases in Indonesia. (Channel News Asia)

  • Reports says there are six new cases in Malaysia, bringing the total to 65. (Malaysia is not listed in the WHO table) (Star Online)

  • Air travel levels have been hit by the war and SARS, but comparisons with last year are complicated by the late Easter holiday. (CNN)

  • Sales of masks have surged in the USA. (USA Today)

SARS: are we too late?

There is an interesting piece by Julie Gerberding, head of the US Centers for Disease Control and Prevention in the current New England Journal of Medicine. Firstly, she does a good job of illustrating how effective the global response to SARS has actually been. The virus responsible has almost certainly been identified, methods of containment have been introduced and treatments are being worked out. Considering that the novelty of the condition was only really made clear on 1 February, it is remarkable that awareness of the problem among medical practitioners is now high and that the disease is under control in all but two of the areas affected.

Unfortunately, she then proceeds to speculate gloomily about the possibility that a pandemic may ensue in any event. 'The emergence of SARS presents formidable global challenges. If we are extremely lucky, the epidemic will be curtailed, develop a seasonal pattern that will improve prospects for regional containment, or evolve more slowly than it has in this early stage. If the virus moves faster than our scientific, communications, and control capacities, we could be in for a long, difficult race. In either case, the race is on. The stakes are high. And the outcome cannot be predicted.'

While it is too early to claim victory, it is clear that we can deal with these problems very well. What is also clear is that the panic related to the disease will cause more harm than the disease itself.

Faster... but fast enough?, New England Journal of Medicine [pdf format]

Wednesday, April 02, 2003

Who is the most evil man in the world?

(first published on spiked)

That's the discussion started by Pentagon spokeswoman Victoria Clarke.

She claimed that Saddam Hussein was the worst ruler in history. 'The Iraqi people will be free of decades and decades and decades of torture and oppression, the likes of which I think the world has not ever seen before', she said.

This immediately provoked a 'defence' of such old-time great dictators as Adolf Hitler (up to six million Jews plus millions of others, especially in Russia). Or what about Jozef Stalin's 10 to 20million (depending on which political viewpoint you're reading) killed in purges, work camps, etc? Saddam's 5000 gassed Kurds and other abuses seem to pale by comparison.

The difference? Stalin was holding together the massive Soviet Union; Hitler was leading wars of aggression across Europe. Saddam runs a third world nation.

Still, perhaps he's the worst leader since Hitler and Stalin? Not according to US State department official Lorne Craner. When asked whether Iraq was the worst country for human rights at the moment, he replied, 'No, I think that honour probably goes to North Korea.'

The debate continues.

N Korea rights 'worse than Iraq', BBC News, 1 April 2003

DVT: now, it's criminal

The UK Independent reports today that manslaughter charges are being considered against airlines over DVT. 'Detectives from South Wales, and Devon and Cornwall constabularies are investigating three complaints from the families of passengers who died after long-haul flights. Eleven more cases are expected to be lodged with the police shortly,' says the paper.

This is ludicrous. About 1 in 2000 people suffer from DVT in the UK each year. It is more common in older people than younger people. Research has not demonstrated any specific link between air travel and DVT. There is some evidence to suggest that immobility is a risk factor, but the relative increase in risk is likely to be very small. The exercise regimes and circulation socks that seem to be becoming all the rage are totally unnecessary.

What will we have as a result of this? At a minimum, our journeys will be less convenient. Will there be enforced exercising on aeroplanes to avoid suggestions of liability for airlines? Perhaps, there will even be enforced stopovers on long-haul flights. Imagine having to spend 25-hours on a plane and then being obliged to have a seated aerobics class, or having to break your journey when you wanted to fly direct.

Even worse, what happens if these cases proceed and company directors are convicted? On what basis could they really have done anything about these deaths when the cause of the DVT is still unknown and where there can be no balance between risk and convenience?

I suspect that the authorities know all of this, yet seem unable to say 'no' to bereaved families. I don't think they are doing those families, or wider society, any service by pursuing these cases.

Airlines may face charges over DVT deaths, Independent, 2 April 2003
Deep-vein thrombosis, UK Department of Health

SARS update

These were the figures according to the BBC today:

China 1190 cases (46 deaths)
Hong Kong 685 (16)
Singapore 92 (4)
Vietnam 58 (4)
Canada 129 (6)

Taking Hong Kong as an example, that's 0.01 percent of the population who have had it or have it. Of these, less than three percent have died, presumably more vulnerable people. BBC News suggests that most people have recovered after a week. As a comparison, in 2001 there were 7,262 cases of tuberculosis in Hong Kong with 311 deaths. As such, TB is clearly a much more serious problem long-term. It is simply the novelty of SARS that gives it such attention.The bigger problem is the panic attached to it, particularly in Hong Kong, where people are wearing paper masks quite commonly (which are useless), avoiding the streets etc.

Here is a list of some of the other responses to SARS:

  • 100 families from an effected apartment block have been moved by the Hong Kong government to 'holiday camps'. (UK Independent)

  • The Thai government has forced foreigners from SARS-effected regions to wear face masks at all times or face a jail sentence. Thais returning home from these regions must stay at home for 14 days. (Go Asia Pacific News)

  • Concern over SARS has led to jammed emergency rooms at Vancouver General Hospital and Children's Hospital with what the Vancouver chief medical officer calls the 'worried well'. Air Canada has reduced its flights to Hong Kong from 14 per week to nine.(Vancouver Sun)

  • The Australian government is demanding that all flight crews check passengers for signs of illness before allowing disembarkation. (ABC News Online) It also advised its citizens not to travel to Canada and Asian countries hit by the virus, and to wear face masks while travelling. (Express India)

  • SARS is a threat to the New Zealand economy, although there are no cases there as yet. (New Zealand Herald)

  • Microchip manufacturer Intel has cancelled major events in Taipei and Beijing. (Forbes) Also cancelled are concerts by the Rolling Stones and Santana. (Yahoo! Music)

HK Department of Health tuberculosis figures
Travel warning over deadly bug, BBC News, 2 April 2003

Pseud's corner

Death by excess: consumption, its discontents and the morbid enjoyment of capitalism

According to Baudrillard (1998) waste - often considered a negative consequence of capitalistic production - is a necessary and integral concept within which modern capitalist societies recognise and identify themselves. It is through the production of excess - of waste - that capitalism knows it is capitalism. This paper is concerned with how discourses of waste, and excess are produced as markers of identity and subjectivity within oppositional cultures to global capitalistic processes. The paper is concerned in particular with dominant expressions of what might be termed an anti-consumption sensibility articulated via (in)formal groupings, collectivities and pressure groups. These groupings are frequently referred to in popular discourse as the anti-capitalist movement. A key discourse within this movement is pronounced polemic against what it considers the excessive and wastefully conspicuous character of contemporary consumption. This paper argues that this movement expresses an increasingly morbid character, organised principally around notions of waste and the death like character of ‘excessive’ consumption. These discourses appear increasingly religious in character - drawing upon Western Christian notions of temperance. Furthermore this paper argues that the morbid characterisation of capitalist consumption functions as a spectacular form of jouissance or enjoyment.

Thankfully, the author then takes the piss out of Arsenal manager, Arsene Wenger. Phew!

Monday, March 31, 2003

The cost of rail safety

BBC News reports today that the cost of running Britain's railways has doubled. 'Network Rail said spending on the railways in the next three years would be more than £6bn a year, compared with the £3bn originally expected.'

My friend's father (who shall remain nameless) is a railway engineering consultant with decades of experience. He is exasperated by the way in which safety measures are being implemented, out of all proportion to their benefit. Repairs that weren't previously regarded as necessary having to be done, work gangs working with excessive numbers of lookouts etc. Meanwhile, the actual function of the railway - getting people from A to B - crumbles.

Here's an interesting article about rail safety from Japan Railway and Transport Review [pdf format]. It makes the point that rail safety continues to improve in Britain, mainly due to removing 'slam door' trains from service and improving safety for the work gangs. However, the public's attention has been drawn to five major fatal accidents: Southall, Ladbroke Grove, Hatfield, Great Heck and Potters Bar. The author, Richard Hope, looks at what effect privatisation had on each accident.

For example, Southall could have been prevented if the Automatic Warning System (AWS) had been repaired. It wasn't working at one end of the train. When the driver tried to get the train turned around, no-one was in a position to take responsibility so he had to travel without a warning system. The lack of a unified management system means repairs didn't get supervised which caused the Hatfield derailment.

But there are other factors which are screwing things up: the closure of tracks after accidents is much longer, both for the initial investigations and, in the case of Hatfield, for follow-up inspections and repairs on other areas of track. Areas of track taken out of service for repairs are greater due to safety concerns, especially with inexperienced contract staff. This means much greater compensation has to be paid to train operators. The cost of Advanced Train Protection is rising - to implement the new system will cost £14million per life saved, as opposed to £3million originally envisaged. All of this is the product of a new and almost certainly unhelpful obsession with safety.

Rail repair bill doubles, BBC News, 31 March 2003

Wobblers and squabblers

While the action in the Gulf proceeds at a much slower pace than expected, the real fighting is the in-fighting.

In Britain, the self-appointed Wobbler-in-Chief is Robin Cook. The former foreign secretary wrote an article for the Sunday Mirror called 'Bring our lads home'. In it, he states, 'I just hope those who expected a quick victory are proved right. I have already had my fill of this bloody and unnecessary war. I want our troops home and I want them home before more of them are killed.' (1)

Cook's article certainly put noses out of joint among his erstwhile Cabinet colleagues. David Blunkett put the boot in during an interview with David Frost. 'Robin resigned with great dignity, putting his argument with great force. But it’s hard to retain that dignity or force if you advocate capitulation after just ten days...We have to back those who are in conflict in bringing down Saddam Hussein and we have to ask everyone to answer the question: "Who do you wish to win?"' (2)

Cook's response was as wobbly as his article. 'I am not in favour of abandoning the battlefield and that is not my position. There can be no question at this stage of letting Saddam off the hook,' he said. 'I wasn’t in favour of starting this war, but having started this war, it’s important to win it. The worst possible outcome will be one which left Saddam there.' (3) In other words, he would prefer it if the Iraqis would just do the decent thing and surrender now.

While Cook's article was unwelcome to the British government, most of his piece was actually spent blaming Donald Rumsfeld for the mess. Blaming Rumsfeld seems to be all the rage at the moment, especially in US government circles. The defense secretary spent the weekend fending off criticism of his battle plan: that it was over-optimistic about Iraqi support for an invasion; has become over-stretched on the road to Baghdad; and that war was started with insufficient troops.

Whether any of this is legitimate criticism is beside the point. What is remarkable is the way in which the squabbles within the US administration have been aired in public. The fact that there are differences of opinion in government is not new. But in the past, the attitude would have been 'not in front of the children'. Or more to the point, 'not in front of the enemy'.

For example, having been criticised for trying and failing to win a second UN resolution, the supporters of Colin Powell have been only too happy to exploit the current difficulties to score points against Rumsfeld, vice-president Dick Cheney and deputy defence secretary Paul Wolfowitz. The Washington Post quotes one former Republican appointee as looking at 'whether this president has learned something from this bum advice he has been getting.' (4)

Meanwhile, the current issue of the New Yorker suggests that Rumsfeld not only interfered with military planning but essentially threw out the existing basis of military strategy in favour of a new philosophy based on smaller forces using high-tech equipment. (5)

Rumsfeld has reacted to criticism of his interference by claiming he had no hand in military planning at all. 'It's been described as an excellent plan. I'd be delighted to take credit for it, but wouldn't be fair, because it's a product that is essentially General Franks's, but it is certainly the result of a lot of thought from a lot of very fine military planners.' Or, to put in another way, 'it's not my fault'. (6)

These squabbles have the potential to have military consequences. The one slim possibility for an Iraqi victory in this conflict is that the opposition give up and go home when the pressure gets too much. On any objective analysis, there should be no way that the Iraqis could beat the US and UK forces. But it is too soon to rule out the possibility of the 'coalition' beating themselves.

(1) Bring our lads home, Sunday Mirror, 30 March 2003
(2) Cook flayed as Blunkett asks: Who do you want to win?, Scotsman, 31 March 2003
(3) Cook flayed as Blunkett asks: Who do you want to win?, Scotsman, 31 March 2003
(4) , Washington Post, 31 March 2003
(5) Offense and defense, New Yorker, 31 March 2003
(6) Rumsfeld defends war planning, New York Times, 31 March 2003

Sunday, March 30, 2003

Militarily useless

Chemical and biological weapons will be of little threat to troops in the Gulf if they are properly prepared for their use, according to scientists at a briefing in London. Such weapons would be more effective against civilian targets in the West. But they are also difficult to produce and deliver effectively. Explosives are much more likely to be used by terrorists as they are cheaper and easier to produce and apply successfully.

Coalition troops face 'low' chemical risk, BBC News, 26 March 2003

Recycling can damage your health

At least, that appears to be the case according to a study in Scandanavia. There, waste is separated by householders. Organic waste is collected separately but only a fortnightly basis. The extended delay causes the waste to putrefy, releasing potentially hazardous aerosols which the refuse collectors breathe in. The study found that the workers suffered higher levels of lung inflammation in midweek as compared to Mondays, after a day of rest.

This doesn't exactly strike at the heart of recycling philosophy, but it is illustrates that 'natural' and 'biodegradable' are not necessarily risk-free.

Recycling 'risks binmen's lungs', BBC News, 29 March 2003

Thimersol and autism

The New York Times reports on an American review of evidence of the relationship between autism and mercury. It seems even in the US now, people are trying to find a connection between autism and vaccination. In Britain, the most popular (except in the medical profession) links measles to autism; in America, it is thimersol that is the centre of speculation.

And yet, an awful lot of effort is being spent trying to find some kind of a link when even the circumstantial evidence of a link is weak. This is the problem when science is lead by popular opinion rather than expertise. spiked columnist, Dr Michael Fitzpatrick, has been consistently critical of the panic around measles, mumps and rubella (MMR) vaccine.

Vaccines and Autism, Beyond the Fear Factors, New York Times, 25 March 2003

spiked-issue: MMR

A mess over vaccination

The New York Times reported the continuing scare over heart deaths amongst receipients of the smallpox vaccine (see my earlier posting about this). Not only have people with known heart disease been excluded from the program, but now those with three or more risk factors (e.g. smoking, high cholesterol, high blood pressure etc) have been excluded, too. None of which will ease concerns about the safety of the vaccination program. Yet, it still seems to be the case that the known fatalities are probably not linked to the vaccine but were cases of hidden heart disease.

The real twist is that it is a panic over a treatment which was itself a panic reaction to a highly unlikely smallpox attack.

Exclude More From Smallpox Vaccinations, U.S. Is Urged, New York Times, 29 March 2003

SARS: more infectious than first thought?

The New York Times reports today on a Hong Kong apartment block where one sufferer managed to infect 78 others, suggesting that the disease is considerably more infectious than first thought. '"The potential for infecting large numbers of people is very great", said the [Centers for Disease Control and Prevention] director, Dr. Julie L. Gerberding. "We may be in the very early stages of a much larger epidemic of a disease for which there is no specific treatment beyond standard supportive nursing and respiratory care"', Dr. Gerberding added. There was also the tragedy that the doctor who first identified the illness in Hanoi had now died from it.

However, I still think there is plenty of reason to believe that this is not such a big problem. Since health workers are now practicing barrier nursing on infected patients, there have been no further cases among hospital staff.

There have now been 1,550 cases with 54 deaths, according to the WHO.

U.S. Warning on Respiratory Disease, New York Times, 30 March 2003