Posted on 04/14/2003 5:48:24 PM PDT by politicalpal
The SARS Hoopla By Carol Devine-Molin April 14, 2003
This entire SARS scare is reminiscent of the plagues and pestilences noted in the Bible's book of Revelation. In almost apocalyptic terms, the worldwide news media is ablaze with stories that SARS (Severe Acute Respiratory Syndrome) is poised to become a pandemic that will ravage the world. And, truly, everyone is abuzz with talk of SARS. Is this just the outcome of media sensationalism or an accurate reflection of reality? Is SARS among the worst illnesses out there? Or, are other disease outbreaks creating even greater problems for society? Let's step back and take the larger view.
The 1999-2000 influenza season was among the most dreadful in recent years, culminating in approximately 60,000 flu deaths, with many linked to pneumonia complications. According to the CDC, at the heart of the 1999-2000 influenza was a strain of the virulent A (H3N2) Sydney-like virus, which had been prevalent throughout the late 1990s. My neighbor, who is a nurse, later advised me that the elderly were "dropping like flies" in the nursing homes throughout the region (NYC and surrounding suburbs) during that particular winter.
Ah, I remember it well! I was one of the unfortunate who suffered a significant bout of the flu in early February 2000 that knocked me out of commission for about ten days, and continued to sicken me for the entire month. I've never been that ill in my adult life - For three days, I coughed my head off and endured the debilitating chills and fever that are the ubiquitous symptoms of influenza. Mind you, I had the flu in prior times, but nothing that ever approached this severity.
But the worst part was my breathing difficulties and the concomitant sleep deprivation brought about by extreme physical discomfort and a constant dry cough. It just felt that my lungs were filled with an insidious paste. By night three I said to myself "Well, is this where I begin to actively hallucinate or do I just die?" My chest was throbbing--It was too painful to even breathe, let alone cough. And, yes, I was kicking myself for not getting that flu vaccination. Just when I thought I couldn't take it anymore, some needed relief set in. During the middle of the third night, I was able to sleep for two hours straight. And when I awoke, I was almost euphoric - I had endured the most ghastly symptoms and I was on the road to recovery. Yes, of course I was praying throughout this personal calamity and I said to myself as I rallied, "Praise be to God"!
Family members had offered to travel down from upstate New York to assist me, but I would have none of it. I wouldn't dare expose them to this real-life nightmare, and I just stayed holed-up in my Westchester condo for more than a week. My family tells me that in the midst of everything, I was doing my best Capt. Kirk staccato imitation over the phone, as I exhorted them: "Must-get-flu-shot!", "Must-not-get-flu!" Moreover, I always try to look on the bright side, and thought, "Hey, I ought to lose at least ten pounds from all of this", and I certainly did.
Now why would I evoke the memory of such an awful episode? I'm just underscoring that seasonal influenza has been a substantive problem for years and our nation has managed to deal with it. And I have no doubt that we'll properly address this new-found SARS disease as it develops. To date, there have been an estimated 3000 SARS cases worldwide resulting in over 120 deaths, located in seventeen nations and on three continents. It doesn't sound like that many cases, but SARS has the capacity to spread rapidly. Canada (especially Toronto), China, Hong Kong, Singapore, Taiwan and Vietnam are considered hotbeds of SARS activity. And it goes without saying that Toronto is right across the US border and presents notable concerns.
Therefore, if, (and this is the really big "if") SARS cannot be adequately contained and becomes rampant, we must adequately prepare ourselves. The World Health Organization indicates that the development of proper diagnostic testing, a suitable vaccination, and effective medications for SARS are staunchly underway. It may take years, but we have to begin now. And President Bush has already signed an executive order permitting the quarantine of SARS infected individuals and those possibly exposed to the illness. In Canada, authorities are reportedly keeping people under house quarantine with electronic monitoring devices.
Where did SARS come from? SARS is a pneumonia-like illness that emerged from the "viral stew" in the countryside of Guangdong province in China, where people, pigs and poultry live in close proximity under filthy conditions. Sounds lovely, doesn't it? Reportedly, this region generates unusual viral outbreaks triggered by mutant strains of human and animal viruses. To reiterate, SARS is not an ersatz, biologically engineered virus that's a product of germ warfare, as had been previously speculated upon, but a naturally occurring phenomenon. Recent discoveries suggest that SARS is caused by a newly emergent form of the coronavirus. But there's more -- Apparently, this SARS virus is unusual since it's combined with bacterial pathogens. That said, bacterial Chlamydia has been found in the lungs of some SARS patients in China. Very Interesting!
SARS symptoms are largely akin to those of influenza including coughing, sore throat, muscle aches, fever, and chills. However, SARS is more closely associated with respiratory problems, shortness of breath, and atypical pneumonia in about 25% of the cases, culminating in a death rate of 3-5%. Any type of pneumonia, whether SARS related or not, involves inflammation and fluid within the lungs resulting from bacterial, viral, fungal, or parasitic infections. SARS is currently being treated with a cocktail of antiviral (oseltamivir, ribavirin) and antibiotic medications, sometimes in conjunction with steroids. SARS is thought to be primarily transmitted by airborne "droplet transmissions" that can also contaminate objects. However, the spread of this illness is also linked to cockroaches, especially in highly populated urban centers such as Hong Kong.
In conclusion, here are some hopeful remarks, regarding the status of SARS research, from the speech of Dr. Mark Salter at the World Health Organization's April 11th news conference:
*"At the present moment in time, 17 laboratories around the world from 9 countries are involved in dealing with, identifying, and developing tests for the diagnosis of the causative agent of SARS".
*"And when we have definitive evidence to suggest that the coronavirus is the primary causative agent, the next step that everyone will be anticipating is the development of a vaccine. Discussions are currently ongoing within the laboratories as to how this can be taken forward."
*"The aim of the collaborating group over the coming weeks will be to bring this information together in a systematic form so that we can actually rule out those therapies that are ineffective and push forward with those therapies that are roving to be effective".
It supports exactly what you're suggesting.
A. Statistical variances owing to 'catching it in time'
B. It varies from year to year - and whether it was a 'group' diagnoses or sporadic cases (see A. above) ...
Note that "nosocomial" used below is an adjective meaning: "originating in hospital"
example: a nosocomial disease
[ETYMOLOGY: 19th Century: New Latin nosocomialis, via Late Latin from Greek, from nosokomos one that tends the sick, from nosos (see noso-) + komein to tend])
Sustained Transmission of Nosocomial Legionnaires Disease -- Arizona and OhioMore: http://www.cdc.gov/mmwr/preview/mmwrhtml/00047639.htmIn 1996, two hospitals reported sustained transmission of nosocomial Legionnaires disease (LD). The hot water distribution systems in each hospital were implicated as the sources of infection. This report summarizes investigations in these two hospitals by hospital personnel, state and local health officials, and CDC and efforts to control transmission. Arizona, 1987-1996
In 1996, eight cases of nosocomial LD were diagnosed among cardiac and bone marrow transplant patients at hospital X. Possible nosocomial LD was first reported at hospital X in 1979, but no source had been identified. Intensified surveillance for nosocomial LD was initiated after the first three case-patients were identified in 1996.
A case of definite nosocomial LD in a hospital X patient was defined as respiratory illness with a new infiltrate on chest roentgenogram occurring after greater than or equal to 10 days of continuous hospitalization for a nonpneumonia illness and laboratory confirmation of legionellae infection by at least one of the following: 1) isolation of legionellae from tissue or respiratory secretions, 2) detection of Legionella pneumophila serogroup 1 (Lp-1) antigens in urine by radioimmunoassay or enzyme immunoassay, or 3) a fourfold rise in Legionella serogroup-specific antibody titer to greater than or equal to 128 between acute- and convalescent-phase serum specimens. Possible nosocomial LD was defined as onset of respiratory symptoms of LD after 2-9 days of continuous hospitalization (the incubation period for LD is usually 2-10 days).
and:
Legionnaires Disease Associated with a Whirlpool Spa Display -- Virginia, September- October, 1996From: http://www.cdc.gov/mmwr/preview/mmwrhtml/00047291.htmContaminated whirlpool spas have been reported as a source of legionellosis. This report describes the preliminary findings of an ongoing investigation by the Virginia Department of Health (VDH) and CDC of a recent outbreak of Legionnaires disease in Virginia, which implicated a whirlpool spa display at a retail store as the source of infection.
On October 15, 1996, a district health department in southwestern Virginia contacted the Office of Epidemiology, VDH, about a hospital (hospital A) report that 15 patients had been admitted during October 12-13 with unexplained pneumonia. On October 21, another hospital (hospital B), located approximately 15 miles from hospital A, reported its pneumonia census to be higher than expected for the first 2 weeks of October. On October 23, the district health department was informed about three area residents with legionellosis (with Legionella pneumophila serogroup 1 {Lp1} antigen detected in urine); one was a patient at hospital A, and two were patients at hospitals outside the jurisdiction of the health department.
Unusual huh?
It's not 4%. You get 4% when you divide the number of deaths by the number of cases. The number of cases includes those who got better, those who died, AND THOSE WHO ARE STILL SICK and who may get better or die. If you go by final disposition ( deaths / (deaths + got_better) ), the worldwide avg death rate is closer to 9%
The deaths-vs-recoveries ratio is lowest in China ( 64 vs 1088 ). In Hong Kong it's 47 vs 229 (for a death rate of 17%), and in Canada it's 13 vs 27 ( 33%). I'm suspicious of the China figures.
Opportunistic fits right in there - weakening a patient with a 'primary' disease opens up the patient for other contagion currently 'repressed' and residing at lower-population levels ...
I have a bad feeling there much more to this virus than meets the eye.
Walt Disney And Airlines Admit SARS Virus Is Crippling Business
We used to think that we could eventually fully understand medicine and health issues, but it now appears that won't ever be true. New illnesses with new causes will continue to arise.
This SARS thing is fascinating, simply because it demonstrates what we don't know. Why are some people "super-infectors"? Is the virus unstable and mutating into less deadly forms in secondary and tertiary infections? What role do bacteria play into the mix?
How the heck did it get into humans in the first place? Will it burn out like Ebola? Or is it likely to become an even more deadly illness than the Spanish Flu?
None of those questions have reliable answers tonight, and while the total number of people infected worldwide are miniscule, it all comes down to the question of whether we can stop it, or at least contain it, before it has the chance to kill millions.
It's already had an economic impact far beyond its mortality numbers. Cathay Airlines is in severe trouble. The economic fallout on Hong Kong is growing, and it's not an insignificant part of the global economy.
Perhaps the hype is far worse than the actual impact of the illness will be. But maybe not. It's the uncertainty that's killing us more than the illness tonight.
Yup. You know they must be 'puckering' about now.
Cayenne Pepper - it works on soft tissues in the throat (at least for me!) ...
I made the discovery while experimenting with Beef Bouillon cubes while my throat was showing slight signs of a problem - I added several taps of Cayenne Pepper to a cup and MAN! Like 'Drano' for the throat!
My doctor had clued me into the possibility of various 'cultures' growing in the relatively 'cool' area of the throat - and I think (based on just under ten years experience now) I've found a way to keep that area 'cleared out' ...
Legionnaires' Disease Associated With Potting Soil --- California, Oregon, and Washington, May--June 2000From: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4934a1.htmSince Legionnaires' Disease (LD) was first reported in 1976, outbreaks have been associated with airborne transmission of Legionella bacteria through cooling towers, showers, and other aerosolizing devices (1). However, most LD cases are sporadic, and the source and mode of infection in many cases are unknown. Infections with one species, Legionella longbeachae, have been associated with gardening and use of potting soil in Australia and Japan (2,3).
This report summarizes the findings of LD investigations in California, Oregon, and Washington, that suggest that transmission from potting soil has occurred for the first time in the United States, and that active surveillance and case finding are warranted to explore this association.
On June 13, 2000, CDC was alerted by a county health official in Washington of L. longbeachae infection in a 46-year-old woman who had been hospitalized with pneumonia. The patient reported that she had been potting plants during the 10 days before her symptoms began in May. An isolate from the patient's sputum was sent to CDC for species confirmation, and two samples of potting soil and one of compost from the original packages obtained from the patient's residence were sent for analysis. L. longbeachae was isolated from one potting soil sample. The compost contained other Legionella species but not longbeachae.
In May, two L. longbeachae isolates had been received at CDC from bronchial wash samples taken from both a 77-year-old Oregon woman and a 45-year-old California man who were both diagnosed with legionellosis. The California patient died and his house was cleaned before an investigation could be undertaken. State and local health officials determined that the Oregon patient had been potting plants using commercial potting soil mixtures and had been working in a home garden during the 10 days before her symptoms began in April. Two potting soil samples taken from her residence were tested for Legionella at CDC; one was positive for L. longbeachae. Isolates of L. longbeachae from the patients and soils will be compared using amplified fragment length polymorphism typing.
Relatively recent too ...
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