Question:
G'day G'day Folks, It would seem there is even less reason to be complacent about SARS as the morbidity figures have been revised upwards. By way of comparison, most flu epidemics finish off about 1%, the worst closer to 5%. http://www.who.int/csr/sarsarchive/2003_05_07a/en/ No where in the world that I know of is the traffic so bad that it takes the lives of 15% of drivers and passengers in 10 or even 20 years lifetime. Let's hope complacency and foolish thinking doesn't allow SARS to become pandemic with a billion or so cases. -- Quentin Grady ^ ^ / New Zealand, #,#< [ / \ /\ "... and the blind dog was leading." http://homepages.paradise.net.nz/quentin
Answers:
Quentin Grady <quentin~paradise.net.nz wrote in news:s27tbvg7lcimqgolkg72ir91nj73elvu19~4ax.com: G'day G'day Folks, It would seem there is even less reason to be complacent about SARS as the morbidity figures have been revised upwards. By way of comparison, most flu epidemics finish off about 1%, the worst closer to 5%. http://www.who.int/csr/sarsarchive/2003_05_07a/en/ No where in the world that I know of is the traffic so bad that it takes the lives of 15% of drivers and passengers in 10 or even 20 years lifetime. I don't think that's really an apt comparison; 15% is a good estimate of the case-fatality rate for SARS, but *not* of the *population* mortality rate. The two don't come even close unless you're talking about a disease that nearly everybody gets at some point. The relevant figure for traffic would be the percentage of deaths among drivers and passengers *who are involved in traffic accidents*. If you don't take this into account, you can fall into what's called the broad-base fallacy. About 10 years ago on a slow news day, an American editorial writer observed that the number of deaths due to high-school football (the American, pads-and-helmets kind) injuries was substantially greater than the number of deaths from Formula 1 auto-racing injuries and concluded that Formula 1 racing was actually safer than high school football. What he failed to take into account was that there were about 350,000 high school football players and 200 Formula 1 racers at the time, and the actual rates were about 0.003% for football players and 0.5% for racers. When evaluating the safety of an activity, you aren't really concerned with the probability that a randomly-selected member of the population will die as a result of the activity, but rather with the probability that a *participant* will die. As mathematician John Allen Paulos pointed out in his book _Innumeracy_, very few people die of injuries from high-wire aerobatics between skyscrapers, yet that doesn't imply that the activity is safe. Let's hope complacency and foolish thinking doesn't allow SARS to become pandemic with a billion or so cases. I see that as extremely unlikely. If it was likely to happen, it already would have happened in China, where the disease began over six months ago and was treated with complacency and foolish thinking up until a few weeks ago. Yet the infection curves have been at worst linear in all places with outbreaks, and have usually turned sigmoid. Nosocomial transmission (infection of patients hospitalized for something else) has been a major factor in most of the outbreaks so far, but that was largely a matter of bad preparation and is unlikely to happen again (I'm quite convinced that the reason the US has had no SARS deaths is that there's been no nosocomial transmission). I suspect China is going to have a lot more cases: not as a pandemic, but rather as a series of geographically-separate epidemics where one region develops an epidemic just as the previous one peters out. The danger is that they could go around in a circle.
Answers:
This post not CC'd by email On Mon, 12 May 2003 07:03:24 +1200, Quentin Grady <quentin~paradise.net.nz wrote: It would seem there is even less reason to be complacent about SARS as the morbidity figures have been revised upwards. G'day G'day Folks, Here is something I'll leave the statisticians to ponder. http://www.biomedcentral.com/news/20030507/05 May 7, 2003 SARS death rate up to 43% Epidemiological study published today gives more accurate picture than previous WHO figures. By Robert Walgate SARS (Severe Acute Respiratory Syndrome) is a more dangerous disease than previously thought, epidemiologists conclude in a paper published today. But this is not attributed to the mutation rate of the causative agent — it's a consequence of simple epidemiological arithmetic and a misunderstanding of the low mortality figures published by the World Health Organization (WHO). The death rate from SARS in Hong Kong is 43% in those over 60 years old (35–52%, at 95% confidence), and 13% in the under 60s (10–17%, at 95% confidence). These are the key results of the first thorough epidemiological study of the SARS outbreak, published today (May 7, 2003) in The Lancet online, by Roy Anderson of Imperial College London, working with colleagues in London and Hong Kong. Mark Salter, WHO's coordinator for the clinical management of SARS, told The Scientist today that he thought "the mortality in the older age group seemed relatively appropriate, given that a lot of them have co-morbidity factors [other health problems besides SARS], but I'm a little bit surprised that the upper end for young people is as high as 17%." The WHO's estimates of 6–10% have been much lower but, somewhat misleadingly, have referred to different quantities. "We have to remember that the paper's figures are modelling projections," Salter said. "And the figures we've quoted are actual surveillance. What we've been saying is that there have been 5000 cases reported and 500 deaths, and the death rate is the ratio. But that's not an accurate rate. I'm sure that Professor Anderson and his team have looked at it more closely, at people who have actually passed through their disease, to discharge or death." In other words, Anderson and colleagues have analyzed the complete data to arrive at what we would commonly understand by a death rate: the chance that a person who contracts SARS will die. The WHO figures, by contrast, simply divide the number of deaths reported up to a certain moment, by the number of reported cases at the same moment. But these deaths must arise from cases included in the case numbers some 20 or more days earlier. And, because the outbreak is growing, at the time those cases were reported the number of cases was smaller than the number being reported now. So, the denominator in the WHO calculation has always been too large to give the "true" mortality rate. Only if the number of cases leveled off, so that there was a constant number of cases per day, and a constant number of deaths, would the WHO figures be expected to reach something like the figure calculated by Anderson and colleagues. Indeed, "We have always expected the mortality rate to rise," Salter said. Other significant conclusions of The Lancet paper are that the incubation period of the disease is six days (5–8 days, at 95% confidence), and that the initial exponential growth phase of the disease in Hong Kong is now over, with a daily case rate of under 20 by April 28, 2003. The control of the outbreak in Hong Kong is probably the result of public health policies, including: encouraging people to report to hospital rapidly after the onset of clinical symptoms; contact-tracing for confirmed and suspected cases; quarantining, monitoring, and restricting travel of contacts; and isolation and staff-protection methods in hospitals. Could death rates be even higher in areas of the world with less advanced health care? Not so far, Salter said. "The logical supposition would be that, in an area where there is inadequate medical service, you might see a higher death rate, particularly among those that have the more severe form of disease; but we're not seeing that at the present time." According to Salter, "The figures at the moment don't suggest there is an ongoing problem in the rural areas of Western China and other remote regions of China, but it's not something we can sit back and relax about." Links for this article C.A. Donnelly et al., "Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong," Lancet, 361, May 7, 2003. http://image.thelancet.com/extras/03art4453web.pdf Imperial College London http://www.ic.ac.uk/ WHO: Cumulative number of reported probable cases of Severe Acute Respiratory Syndrome (SARS) http://www.who.int/csr/sarscountry/2003_05_06/en/ -- Quentin Grady ^ ^ / New Zealand, #,#< [ / \ /\ "... and the blind dog was leading." http://homepages.paradise.net.nz/quentin
Answers:
Quentin Grady <quentin~paradise.net.nz wrote in message news:<s27tbvg7lcimqgolkg72ir91nj73elvu19~4ax.com... G'day G'day Folks, It would seem there is even less reason to be complacent about SARS as the morbidity figures have been revised upwards. By way of comparison, most flu epidemics finish off about 1%, the worst closer to 5%. http://www.who.int/csr/sarsarchive/2003_05_07a/en/ No where in the world that I know of is the traffic so bad that it takes the lives of 15% of drivers and passengers in 10 or even 20 years lifetime. Let's hope complacency and foolish thinking doesn't allow SARS to become pandemic with a billion or so cases. ======================================================= Sunday, May 11, 2003 at 17:50 JST GENEVA — Deaths from severe acute respiratory syndrome, or SARS, totaled 526 worldwide as of Saturday, up 12 from the previous day, the World Health Organization (WHO) said. http://www.japantoday.com/e/?content=news&cat=8&id=259437 ======================================================== Hello Quentin. I too hope we don't have a devastating infection rate. I think what frightens many folks is their fear of not being in control. They can't just get a shot and a cure at this point. But thats what most disease was like until the last century or less, I think, so in a way we are getting a taste of what our forebears lived with just three or four generations ago. 526 people have died of SARS worldwide in about 6 months. By way of comparison, here's the time it takes for that many African children to die of malaria: 4hr, 23min. (http://www.mercola.com/2003/may/10/malaria.htm) --Hua Kul
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This post not CC'd by email On 11 May 2003 22:19:18 GMT, Eric Bohlman <ebohlman~earthlink.net wrote: Quentin Grady <quentin~paradise.net.nz wrote in news:s27tbvg7lcimqgolkg72ir91nj73elvu19~4ax.com: G'day G'day Folks, It would seem there is even less reason to be complacent about SARS as the morbidity figures have been revised upwards. By way of comparison, most flu epidemics finish off about 1%, the worst closer to 5%. http://www.who.int/csr/sarsarchive/2003_05_07a/en/ No where in the world that I know of is the traffic so bad that it takes the lives of 15% of drivers and passengers in 10 or even 20 years lifetime. I don't think that's really an apt comparison; G'day G'day Eric, Well that is a good start. A common response to the SARS outbreak in Montreal has been to point out more people died in traffic accidents in the same time. Neither of us think such comparisons apt. 15% is a good estimate of the case-fatality rate for SARS, but *not* of the *population* mortality rate. The two don't come even close unless you're talking about a disease that nearly everybody gets at some point. We are talking about a disease that has been reported to mutate rapidly, more rapidly than say influenza. While I have not hassle with your reasoning that the rate of spread is currently low and even on the decline, I don't see any particular reason to think that this happy situation will necessarily continue. The relevant figure for traffic would be the percentage of deaths among drivers and passengers *who are involved in traffic accidents*. And the rate of traffic accidents in most countries is low. The rate of incidence where there are outbreaks of SARS as in some buildings doesn't appear to be low. If you don't take this into account, you can fall into what's called the broad-base fallacy. About 10 years ago on a slow news day, an American editorial writer observed that the number of deaths due to high-school football (the American, pads-and-helmets kind) injuries was substantially greater than the number of deaths from Formula 1 auto-racing injuries and concluded that Formula 1 racing was actually safer than high school football. What he failed to take into account was that there were about 350,000 high school football players and 200 Formula 1 racers at the time, and the actual rates were about 0.003% for football players and 0.5% for racers. Even on a bad day, 350,000 high school students aren't likely to get infected with Formula 1 racing. It seems with containment the same is true for SARS. Without containment I'm not so sure. When evaluating the safety of an activity, you aren't really concerned with the probability that a randomly-selected member of the population will die as a result of the activity, but rather with the probability that a *participant* will die. As mathematician John Allen Paulos pointed out in his book _Innumeracy_, very few people die of injuries from high-wire aerobatics between skyscrapers, yet that doesn't imply that the activity is safe. Let's hope complacency and foolish thinking doesn't allow SARS to become pandemic with a billion or so cases. I see that as extremely unlikely. If it was likely to happen, it already would have happened in China, where the disease began over six months ago and was treated with complacency and foolish thinking up until a few weeks ago. Yet the infection curves have been at worst linear in all places with outbreaks, and have usually turned sigmoid. Nosocomial transmission (infection of patients hospitalized for something else) has been a major factor in most of the outbreaks so far, but that was largely a matter of bad preparation and is unlikely to happen again (I'm quite convinced that the reason the US has had no SARS deaths is that there's been no nosocomial transmission). I think these arguments are very reasonable. I hope they are validated by future experience. Of course they hinge on SARS continuing to behave in a consistent way and that assumes none of the mutations are more contagious. I suspect China is going to have a lot more cases: not as a pandemic, but rather as a series of geographically-separate epidemics where one region develops an epidemic just as the previous one peters out. The danger is that they could go around in a circle. My only plea is for people not to be complacent. -- Quentin Grady ^ ^ / New Zealand, #,#< [ / \ /\ "... and the blind dog was leading." http://homepages.paradise.net.nz/quentin
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Gee, we are 100% in agreement on this Hua Kul wrote: Quentin Grady <quentin~paradise.net.nz wrote in message news:<s27tbvg7lcimqgolkg72ir91nj73elvu19~4ax.com... G'day G'day Folks, It would seem there is even less reason to be complacent about SARS as the morbidity figures have been revised upwards. By way of comparison, most flu epidemics finish off about 1%, the worst closer to 5%. http://www.who.int/csr/sarsarchive/2003_05_07a/en/ No where in the world that I know of is the traffic so bad that it takes the lives of 15% of drivers and passengers in 10 or even 20 years lifetime. Let's hope complacency and foolish thinking doesn't allow SARS to become pandemic with a billion or so cases. ======================================================= Sunday, May 11, 2003 at 17:50 JST GENEVA — Deaths from severe acute respiratory syndrome, or SARS, totaled 526 worldwide as of Saturday, up 12 from the previous day, the World Health Organization (WHO) said. http://www.japantoday.com/e/?content=news&cat=8&id=259437 ======================================================== Hello Quentin. I too hope we don't have a devastating infection rate. I think what frightens many folks is their fear of not being in control. They can't just get a shot and a cure at this point. But thats what most disease was like until the last century or less, I think, so in a way we are getting a taste of what our forebears lived with just three or four generations ago. 526 people have died of SARS worldwide in about 6 months. By way of comparison, here's the time it takes for that many African children to die of malaria: 4hr, 23min. (http://www.mercola.com/2003/may/10/malaria.htm) --Hua Kul
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Hate to tell you, but SARS does NOT mutate, all samples so far are genetically identical. It is quite stable for a corona virus AND, the rate of spread is quite low. The problem is that we don't know much about it - but are learning fast Quentin Grady wrote: This post not CC'd by email On 11 May 2003 22:19:18 GMT, Eric Bohlman <ebohlman~earthlink.net wrote: Quentin Grady <quentin~paradise.net.nz wrote in news:s27tbvg7lcimqgolkg72ir91nj73elvu19~4ax.com: G'day G'day Folks, It would seem there is even less reason to be complacent about SARS as the morbidity figures have been revised upwards. By way of comparison, most flu epidemics finish off about 1%, the worst closer to 5%. http://www.who.int/csr/sarsarchive/2003_05_07a/en/ No where in the world that I know of is the traffic so bad that it takes the lives of 15% of drivers and passengers in 10 or even 20 years lifetime. I don't think that's really an apt comparison; G'day G'day Eric, Well that is a good start. A common response to the SARS outbreak in Montreal has been to point out more people died in traffic accidents in the same time. Neither of us think such comparisons apt. 15% is a good estimate of the case-fatality rate for SARS, but *not* of the *population* mortality rate. The two don't come even close unless you're talking about a disease that nearly everybody gets at some point. We are talking about a disease that has been reported to mutate rapidly, more rapidly than say influenza. While I have not hassle with your reasoning that the rate of spread is currently low and even on the decline, I don't see any particular reason to think that this happy situation will necessarily continue. The relevant figure for traffic would be the percentage of deaths among drivers and passengers *who are involved in traffic accidents*. And the rate of traffic accidents in most countries is low. The rate of incidence where there are outbreaks of SARS as in some buildings doesn't appear to be low. If you don't take this into account, you can fall into what's called the broad-base fallacy. About 10 years ago on a slow news day, an American editorial writer observed that the number of deaths due to high-school football (the American, pads-and-helmets kind) injuries was substantially greater than the number of deaths from Formula 1 auto-racing injuries and concluded that Formula 1 racing was actually safer than high school football. What he failed to take into account was that there were about 350,000 high school football players and 200 Formula 1 racers at the time, and the actual rates were about 0.003% for football players and 0.5% for racers. Even on a bad day, 350,000 high school students aren't likely to get infected with Formula 1 racing. It seems with containment the same is true for SARS. Without containment I'm not so sure. When evaluating the safety of an activity, you aren't really concerned with the probability that a randomly-selected member of the population will die as a result of the activity, but rather with the probability that a *participant* will die. As mathematician John Allen Paulos pointed out in his book _Innumeracy_, very few people die of injuries from high-wire aerobatics between skyscrapers, yet that doesn't imply that the activity is safe. Let's hope complacency and foolish thinking doesn't allow SARS to become pandemic with a billion or so cases. I see that as extremely unlikely. If it was likely to happen, it already would have happened in China, where the disease began over six months ago and was treated with complacency and foolish thinking up until a few weeks ago. Yet the infection curves have been at worst linear in all places with outbreaks, and have usually turned sigmoid. Nosocomial transmission (infection of patients hospitalized for something else) has been a major factor in most of the outbreaks so far, but that was largely a matter of bad preparation and is unlikely to happen again (I'm quite convinced that the reason the US has had no SARS deaths is that there's been no nosocomial transmission). I think these arguments are very reasonable. I hope they are validated by future experience. Of course they hinge on SARS continuing to behave in a consistent way and that assumes none of the mutations are more contagious. I suspect China is going to have a lot more cases: not as a pandemic, but rather as a series of geographically-separate epidemics where one region develops an epidemic just as the previous one peters out. The danger is that they could go around in a circle. My only plea is for people not to be complacent.
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I get very pessimistic about SARS when I see the decision about control set by the business community. On the bright side it may take a few of us old fogeys off of the group and get some new blood. Of course it might reduce the cost of diabetes if my friend in the field is correct. The real problem is we have setup a quick transport system that will spread any new disease rapidly. They tell me this has been the concern of the health people for a longtime. Have to control overpopulation some way. Maybe better than war. I don't have much to lose. Guy On Sun, 11 May 2003 22:53:09 -0400, Ted Rosenberg <tedrosenberg~iname.com wrote: Hate to tell you, but SARS does NOT mutate, all samples so far are genetically identical. It is quite stable for a corona virus AND, the rate of spread is quite low. The problem is that we don't know much about it - but are learning fast Quentin Grady wrote: This post not CC'd by email On 11 May 2003 22:19:18 GMT, Eric Bohlman <ebohlman~earthlink.net wrote: Quentin Grady <quentin~paradise.net.nz wrote in news:s27tbvg7lcimqgolkg72ir91nj73elvu19~4ax.com: G'day G'day Folks, It would seem there is even less reason to be complacent about SARS as the morbidity figures have been revised upwards. By way of comparison, most flu epidemics finish off about 1%, the worst closer to 5%. http://www.who.int/csr/sarsarchive/2003_05_07a/en/ No where in the world that I know of is the traffic so bad that it takes the lives of 15% of drivers and passengers in 10 or even 20 years lifetime. I don't think that's really an apt comparison; G'day G'day Eric, Well that is a good start. A common response to the SARS outbreak in Montreal has been to point out more people died in traffic accidents in the same time. Neither of us think such comparisons apt. 15% is a good estimate of the case-fatality rate for SARS, but *not* of the *population* mortality rate. The two don't come even close unless you're talking about a disease that nearly everybody gets at some point. We are talking about a disease that has been reported to mutate rapidly, more rapidly than say influenza. While I have not hassle with your reasoning that the rate of spread is currently low and even on the decline, I don't see any particular reason to think that this happy situation will necessarily continue. The relevant figure for traffic would be the percentage of deaths among drivers and passengers *who are involved in traffic accidents*. And the rate of traffic accidents in most countries is low. The rate of incidence where there are outbreaks of SARS as in some buildings doesn't appear to be low. If you don't take this into account, you can fall into what's called the broad-base fallacy. About 10 years ago on a slow news day, an American editorial writer observed that the number of deaths due to high-school football (the American, pads-and-helmets kind) injuries was substantially greater than the number of deaths from Formula 1 auto-racing injuries and concluded that Formula 1 racing was actually safer than high school football. What he failed to take into account was that there were about 350,000 high school football players and 200 Formula 1 racers at the time, and the actual rates were about 0.003% for football players and 0.5% for racers. Even on a bad day, 350,000 high school students aren't likely to get infected with Formula 1 racing. It seems with containment the same is true for SARS. Without containment I'm not so sure. When evaluating the safety of an activity, you aren't really concerned with the probability that a randomly-selected member of the population will die as a result of the activity, but rather with the probability that a *participant* will die. As mathematician John Allen Paulos pointed out in his book _Innumeracy_, very few people die of injuries from high-wire aerobatics between skyscrapers, yet that doesn't imply that the activity is safe. Let's hope complacency and foolish thinking doesn't allow SARS to become pandemic with a billion or so cases. I see that as extremely unlikely. If it was likely to happen, it already would have happened in China, where the disease began over six months ago and was treated with complacency and foolish thinking up until a few weeks ago. Yet the infection curves have been at worst linear in all places with outbreaks, and have usually turned sigmoid. Nosocomial transmission (infection of patients hospitalized for something else) has been a major factor in most of the outbreaks so far, but that was largely a matter of bad preparation and is unlikely to happen again (I'm quite convinced that the reason the US has had no SARS deaths is that there's been no nosocomial transmission). I think these arguments are very reasonable. I hope they are validated by future experience. Of course they hinge on SARS continuing to behave in a consistent way and that assumes none of the mutations are more contagious. I suspect China is going to have a lot more cases: not as a pandemic, but rather as a series of geographically-separate epidemics where one region develops an epidemic just as the previous one peters out. The danger is that they could go around in a circle. My only plea is for people not to be complacent.
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This post not CC'd by email On Sun, 11 May 2003 22:53:09 -0400, Ted Rosenberg <tedrosenberg~iname.com wrote: Hate to tell you, but SARS does NOT mutate, all samples so far are genetically identical. It is quite stable for a corona virus G'day G'day Ted, I am delighted to hear that. Our television carried a number of stories implying that there were already mutations. Unfortunately retracting the story saying it is genetically stable is less news worthy. Do you know how the rapid mutation story got started? AND, the rate of spread is quite low. The problem is that we don't know much about it - but are learning fast Which is just as well. It takes quite a while to develop a vaccine. -- Quentin Grady ^ ^ / New Zealand, #,#< [ / \ /\ "... and the blind dog was leading." http://homepages.paradise.net.nz/quentin
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This post not CC'd by email On Sun, 11 May 2003 22:53:09 -0400, Ted Rosenberg <tedrosenberg~iname.com wrote: Hate to tell you, but SARS does NOT mutate, all samples so far are genetically identical. It is quite stable for a corona virus G'day G'day Ted, My reading of the following article is that two thirds of genome is stable with one third unstable. I just don't get the picture of samples being genetically identical, quite the contrary. Were these researchers mistaken? The good thing is we can discuss it. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++- ++++++++++ Chinese scientists have finished complete genomic sequencing of another isolate of a virus that is associated with severe acute respiratory syndrome (SARS). A collaborative effort by scientists at the Institute of Microbiology and Epidemiology, Chinese Academy of Military Medical Sciences and the Beijing Genomics Institute (BGI), Chinese Academy of Sciences resulted in a comprehensive paper published on Saturday on the Internet edition of the Chinese Science Bulletin. By comparing the complete sequence of the Isolate BJ01 they produced and those of four other isolates identified in the United States, Canada and Hong Kong, scientists are able to get closer to "the real killers" in the SARS-associated virus, said Yang Huanming, director of the BGI and one of the co-authors. The research conducted so far shows the SARS-associated virus is very new -- unlike all other known viruses. "The genome sequence of the SARS-associated virus provides essential information for scientists to identify pathogen(s) and interpret transmission and pathogenesis,'' Yang said. The work will also pave the way for scientists to develop diagnostic tools and drugs for SARS and work out preventive measures such as future vaccines, Yang said. He and his colleagues found the whole genome of SARS virus is composed of a stable protein -- RNA-dependent polymerase -- which accounts for two-thirds of the genome sequence and some variable proteins. Results of sequencing show that two of the variable proteins -- spike protein (S protein) and membrane protein (M protein) -- have a high mutation rate. "It is these two kinds of proteins that help the SARS virus enter human cells, and then cause trouble,'' said Yang. The comparative analysis indicates there are 31 substitutions among the variable proteins of the five complete genomes. Of the 31, nine can be found in two or three independent isolates of the SARS virus. "This shows that SARS virus has strong variability,'' said Yang. "This will make it very difficult to produce SARS vaccines." Phylogenetic studies show the genome of Isolate BJ01 is similar to one of the isolates identified in Hong Kong. However, another isolate identified in Hong Kong might be closer to that from Toronto. The Toronto patient, from whom the isolate was obtained, travelled from Hong Kong, Yang said. The isolate from the United States appears to be the farthest from all others. Yang and his colleagues have also compared the SARS virus with 17 kinds of coronaviruses from both human beings and animals. These include four isolates from human beings, four from birds, two from rodents, and seven from house animals or pets. "But there is no evidence yet that the SARS virus is linked with any of these viruses,'' he said. BGI is currently trying to produce complete sequences of 10 isolates of the SARS virus. The already completed genome sequence of Isolate BJ01 was obtained from the lung of a dead SARS patient in Beijing. These isolates of the SARS virus were all provided by the Chinese Academy of Military Medical Sciences. Yang said BGI has also completed draft sequences of another three isolates of the SARS virus from Beijing and an isolate of the SARS virus from Guangzhou. -- Quentin Grady ^ ^ / New Zealand, #,#< [ / \ /\ "... and the blind dog was leading." http://homepages.paradise.net.nz/quentin
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As my daughter lives in China, I follow the SARS stories VERY closely - Google news is excellent The latest it that the US army anti-biowarfare center is full blast on SARS - despite the fact that it is not considerd a biowarfare. The stuff actually spreads rather slowly, and the lack of mutability means 1) good news: It is easier to find a vaccine 2) Bad news: it will not take the usual path by mutationg into a less dangerous form. There have been zillions of wild rumors since the start, and you have to read the latest news to stay informed. Problem was everyone wanted NEWS, os each guess was publicised - NEXT week, when it turned out to be false, the NEXT rumor was on the way. Except for mainland Chna, whioch is mainly in a panic, everyone has had good results tracking vectors and isolating cases. Even in Bejing, new cases are down 50% in the last week. But, we are talking about 4,000 cases in a country of one BILLION residents!!! At the moment, you are in much greated danger of getting hit by a bus. Quentin Grady wrote: This post not CC'd by email On Sun, 11 May 2003 22:53:09 -0400, Ted Rosenberg <tedrosenberg~iname.com wrote: Hate to tell you, but SARS does NOT mutate, all samples so far are genetically identical. It is quite stable for a corona virus G'day G'day Ted, I am delighted to hear that. Our television carried a number of stories implying that there were already mutations. Unfortunately retracting the story saying it is genetically stable is less news worthy. Do you know how the rapid mutation story got started? AND, the rate of spread is quite low. The problem is that we don't know much about it - but are learning fast Which is just as well. It takes quite a while to develop a vaccine.
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You don't have to be an epidemiologist to see that the death rate is no where NEAR 43%, out of 3,304 cases which are closed, 478 died - as some of those were from cases which would otherwise be active, a rate in the 10 % +/- range is obvious YES, elderly with multiple problems have a high rate, and very very few young die. If I get it, I am in trouble. Also, death rate is falling as treatment improves. Quentin Grady wrote: This post not CC'd by email On Mon, 12 May 2003 07:03:24 +1200, Quentin Grady <quentin~paradise.net.nz wrote: It would seem there is even less reason to be complacent about SARS as the morbidity figures have been revised upwards. G'day G'day Folks, Here is something I'll leave the statisticians to ponder. http://www.biomedcentral.com/news/20030507/05 May 7, 2003 SARS death rate up to 43% Epidemiological study published today gives more accurate picture than previous WHO figures. By Robert Walgate SARS (Severe Acute Respiratory Syndrome) is a more dangerous disease than previously thought, epidemiologists conclude in a paper published today. But this is not attributed to the mutation rate of the causative agent — it's a consequence of simple epidemiological arithmetic and a misunderstanding of the low mortality figures published by the World Health Organization (WHO). The death rate from SARS in Hong Kong is 43% in those over 60 years old (35–52%, at 95% confidence), and 13% in the under 60s (10–17%, at 95% confidence). These are the key results of the first thorough epidemiological study of the SARS outbreak, published today (May 7, 2003) in The Lancet online, by Roy Anderson of Imperial College London, working with colleagues in London and Hong Kong. Mark Salter, WHO's coordinator for the clinical management of SARS, told The Scientist today that he thought "the mortality in the older age group seemed relatively appropriate, given that a lot of them have co-morbidity factors [other health problems besides SARS], but I'm a little bit surprised that the upper end for young people is as high as 17%." The WHO's estimates of 6–10% have been much lower but, somewhat misleadingly, have referred to different quantities. "We have to remember that the paper's figures are modelling projections," Salter said. "And the figures we've quoted are actual surveillance. What we've been saying is that there have been 5000 cases reported and 500 deaths, and the death rate is the ratio. But that's not an accurate rate. I'm sure that Professor Anderson and his team have looked at it more closely, at people who have actually passed through their disease, to discharge or death." In other words, Anderson and colleagues have analyzed the complete data to arrive at what we would commonly understand by a death rate: the chance that a person who contracts SARS will die. The WHO figures, by contrast, simply divide the number of deaths reported up to a certain moment, by the number of reported cases at the same moment. But these deaths must arise from cases included in the case numbers some 20 or more days earlier. And, because the outbreak is growing, at the time those cases were reported the number of cases was smaller than the number being reported now. So, the denominator in the WHO calculation has always been too large to give the "true" mortality rate. Only if the number of cases leveled off, so that there was a constant number of cases per day, and a constant number of deaths, would the WHO figures be expected to reach something like the figure calculated by Anderson and colleagues. Indeed, "We have always expected the mortality rate to rise," Salter said. Other significant conclusions of The Lancet paper are that the incubation period of the disease is six days (5–8 days, at 95% confidence), and that the initial exponential growth phase of the disease in Hong Kong is now over, with a daily case rate of under 20 by April 28, 2003. The control of the outbreak in Hong Kong is probably the result of public health policies, including: encouraging people to report to hospital rapidly after the onset of clinical symptoms; contact-tracing for confirmed and suspected cases; quarantining, monitoring, and restricting travel of contacts; and isolation and staff-protection methods in hospitals. Could death rates be even higher in areas of the world with less advanced health care? Not so far, Salter said. "The logical supposition would be that, in an area where there is inadequate medical service, you might see a higher death rate, particularly among those that have the more severe form of disease; but we're not seeing that at the present time." According to Salter, "The figures at the moment don't suggest there is an ongoing problem in the rural areas of Western China and other remote regions of China, but it's not something we can sit back and relax about." Links for this article C.A. Donnelly et al., "Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong," Lancet, 361, May 7, 2003. http://image.thelancet.com/extras/03art4453web.pdf Imperial College London http://www.ic.ac.uk/ WHO: Cumulative number of reported probable cases of Severe Acute Respiratory Syndrome (SARS) http://www.who.int/csr/sarscountry/2003_05_06/en/
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"Hua Kul" <gmp~adres.nl wrote in message news:3da4c6e5.0305112034.1c5b9a59~posting.google.com... Quentin Grady <quentin~paradise.net.nz wrote in message news:<s27tbvg7lcimqgolkg72ir91nj73elvu19~4ax.com... G'day G'day Folks, It would seem there is even less reason to be complacent about SARS as the morbidity figures have been revised upwards. By way of comparison, most flu epidemics finish off about 1%, the worst closer to 5%. http://www.who.int/csr/sarsarchive/2003_05_07a/en/ No where in the world that I know of is the traffic so bad that it takes the lives of 15% of drivers and passengers in 10 or even 20 years lifetime. Let's hope complacency and foolish thinking doesn't allow SARS to become pandemic with a billion or so cases. ======================================================= Sunday, May 11, 2003 at 17:50 JST GENEVA - Deaths from severe acute respiratory syndrome, or SARS, totaled 526 worldwide as of Saturday, up 12 from the previous day, the World Health Organization (WHO) said. http://www.japantoday.com/e/?content=news&cat=8&id=259437 ======================================================== Hello Quentin. I too hope we don't have a devastating infection rate. I think what frightens many folks is their fear of not being in control. They can't just get a shot and a cure at this point. But thats what most disease was like until the last century or less, I think, so in a way we are getting a taste of what our forebears lived with just three or four generations ago. 526 people have died of SARS worldwide in about 6 months. By way of comparison, here's the time it takes for that many African children to die of malaria: 4hr, 23min. (http://www.mercola.com/2003/may/10/malaria.htm) --Hua Kul Hi Hua. Thanks for posting the link. Perspective is everything. Marie, Caretaker Mom T2 Dx 3/2002 Lantus Novolin-R
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Awww, Guy, stop that! Are you depressed or sumpin'? You're my mentor, just like the other folks on here. You are very much needed. Bonita "Guy" <gswil~intertex.net wrote in message news:114ubvs8e7vsm5f0729epopqfl8njicp0j~4ax.com... I get very pessimistic about SARS when I see the decision about control set by the business community. On the bright side it may take a few of us old fogeys off of the group and get some new blood. Of course it might reduce the cost of diabetes if my friend in the field is correct. The real problem is we have setup a quick transport system that will spread any new disease rapidly. They tell me this has been the concern of the health people for a longtime. Have to control overpopulation some way. Maybe better than war. I don't have much to lose. Guy On Sun, 11 May 2003 22:53:09 -0400, Ted Rosenberg <tedrosenberg~iname.com wrote: Hate to tell you, but SARS does NOT mutate, all samples so far are genetically identical. It is quite stable for a corona virus AND, the rate of spread is quite low. The problem is that we don't know much about it - but are learning fast Quentin Grady wrote: This post not CC'd by email On 11 May 2003 22:19:18 GMT, Eric Bohlman <ebohlman~earthlink.net wrote: Quentin Grady <quentin~paradise.net.nz wrote in news:s27tbvg7lcimqgolkg72ir91nj73elvu19~4ax.com: G'day G'day Folks, It would seem there is even less reason to be complacent about SARS as the morbidity figures have been revised upwards. By way of comparison, most flu epidemics finish off about 1%, the worst closer to 5%. http://www.who.int/csr/sarsarchive/2003_05_07a/en/ No where in the world that I know of is the traffic so bad that it takes the lives of 15% of drivers and passengers in 10 or even 20 years lifetime. I don't think that's really an apt comparison; G'day G'day Eric, Well that is a good start. A common response to the SARS outbreak in Montreal has been to point out more people died in traffic accidents in the same time. Neither of us think such comparisons apt. 15% is a good estimate of the case-fatality rate for SARS, but *not* of the *population* mortality rate. The two don't come even close unless you're talking about a disease that nearly everybody gets at some point. We are talking about a disease that has been reported to mutate rapidly, more rapidly than say influenza. While I have not hassle with your reasoning that the rate of spread is currently low and even on the decline, I don't see any particular reason to think that this happy situation will necessarily continue. The relevant figure for traffic would be the percentage of deaths among drivers and passengers *who are involved in traffic accidents*. And the rate of traffic accidents in most countries is low. The rate of incidence where there are outbreaks of SARS as in some buildings doesn't appear to be low. If you don't take this into account, you can fall into what's called the broad-base fallacy. About 10 years ago on a slow news day, an American editorial writer observed that the number of deaths due to high-school football (the American, pads-and-helmets kind) injuries was substantially greater than the number of deaths from Formula 1 auto-racing injuries and concluded that Formula 1 racing was actually safer than high school football. What he failed to take into account was that there were about 350,000 high school football players and 200 Formula 1 racers at the time, and the actual rates were about 0.003% for football players and 0.5% for racers. Even on a bad day, 350,000 high school students aren't likely to get infected with Formula 1 racing. It seems with containment the same is true for SARS. Without containment I'm not so sure. When evaluating the safety of an activity, you aren't really concerned with the probability that a randomly-selected member of the population will die as a result of the activity, but rather with the probability that a *participant* will die. As mathematician John Allen Paulos pointed out in his book _Innumeracy_, very few people die of injuries from high-wire aerobatics between skyscrapers, yet that doesn't imply that the activity is safe. Let's hope complacency and foolish thinking doesn't allow SARS to become pandemic with a billion or so cases. I see that as extremely unlikely. If it was likely to happen, it already would have happened in China, where the disease began over six months ago and was treated with complacency and foolish thinking up until a few weeks ago. Yet the infection curves have been at worst linear in all places with outbreaks, and have usually turned sigmoid. Nosocomial transmission (infection of patients hospitalized for something else) has been a major factor in most of the outbreaks so far, but that was largely a matter of bad preparation and is unlikely to happen again (I'm quite convinced that the reason the US has had no SARS deaths is that there's been no nosocomial transmission). I think these arguments are very reasonable. I hope they are validated by future experience. Of course they hinge on SARS continuing to behave in a consistent way and that assumes none of the mutations are more contagious. I suspect China is going to have a lot more cases: not as a pandemic, but rather as a series of geographically-separate epidemics where one region develops an epidemic just as the previous one peters out. The danger is that they could go around in a circle. My only plea is for people not to be complacent.
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In article <3EBF23AD.3070405~iname.com, tedrosenberg~iname.com says... As my daughter lives in China, I follow the SARS stories VERY closely - Google news is excellent The latest it that the US army anti-biowarfare center is full blast on SARS - despite the fact that it is not considerd a biowarfare. The stuff actually spreads rather slowly, and the lack of mutability means 1) good news: It is easier to find a vaccine 2) Bad news: it will not take the usual path by mutationg into a less dangerous form. I thought they had already identified two separate strains of SARS. And that one of the reasons they are focusing so much attention on the Amor Gardens case was that the victims there were sicker than normal, and the worry was that it wasn't due to great exposure but rather a more virulent strain of the disease. There have been zillions of wild rumors since the start, and you have to read the latest news to stay informed. Problem was everyone wanted NEWS, os each guess was publicised - NEXT week, when it turned out to be false, the NEXT rumor was on the way. Except for mainland Chna, whioch is mainly in a panic, everyone has had good results tracking vectors and isolating cases. Even in Bejing, new cases are down 50% in the last week. But, we are talking about 4,000 cases in a country of one BILLION residents!!! At the moment, you are in much greated danger of getting hit by a bus. Ah. But I can see the bus coming and dodge it. I can't see a SARS virus. Also, I see the latest news reports suggest that as many as 10% of those who contract SARS suffer permanent lung damage... FW