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SARS Much More Deadly Than First Estimated
New Scientist ^ | 4-25-2003 | Debora MacKenzie

Posted on 04/25/2003 3:08:17 PM PDT by blam

SARS much more deadly than first estimated

13:43 25 April 03

NewScientist.com news service

Analysis of the latest statistics on the global SARS epidemic reveals that at least 10 per cent of people who contract the new virus will die of the disease.

The low death rates of about four per cent cited until now by the World Health Organization and others are the result of a statistical difficulty, well known to epidemiologists, that hampers the early analysis of new disease outbreaks. This difficulty is the reason for the apparent rise in death rate - not a change in the SARS virus.

A fatality rate of over 10 per cent puts SARS on a par with some other RNA viruses. Yellow fever and Japanese encephalitis, spread by tropical mosquitoes, between them kill more than 10,000 people a year, even though both have vaccines. Lassa fever kills about 70,000 a year in West Africa, but people mainly catch it from a local mouse.

Because these infections need animal vectors that only exist regionally, none has ever gone global. But the SARS vector - humans - is everywhere.

Draconian measures

The emergence of the true deadliness of SARS comes as further draconian measures are implemented by health authorities around the world.

The latest is the quarantining of 4000 people and the complete isolation of two hospitals in Beijing. China, where the virus emerged, has about half the world's known SARS cases, which have now risen to total 274 deaths and over 4800 infections.

The standard figure used to gauge the deadliness of any disease is the "case fatality rate" (CFR). This is the number of deaths divided by the number of cases of the disease.

Early in the SARS epidemic, the CFR was about four per cent. But the CFR calculated from statistics released on Thursday and Friday for Hong Kong, Canada and Singapore are now 7.6, 10.7 and 9.9 per cent respectively. These three places are the worst hit after the Chinese mainland.

The global CFR has risen steadily since the start of the epidemic but this is to be expected, say epidemiologists contacted by New Scientist. Early in an epidemic, a significant proportion of the total number of cases have neither recovered nor died. Some will eventually die and so move from the denominator to the numerator of the CFR, raising its value. The CFR moves towards the true value as time passes, unless the number of new cases explodes.

Better estimate

With many cases still unresolved, a better current estimate of the deadliness of SARS may be the number of deaths as a proportion of resolved cases. Those numbers for Hong Kong, Canada and Singapore are 15.8, 18.3 and 13.7 per cent. But these too could be misleading if, for example, it takes longer to recover from a disease than to die from it.

In China, this death rate is only 8.8 per cent. But statistics there are widely mistrusted, after Chinese authorities withheld nearly all information until recently. The Chinese statistics may also include cases of pneumonia due to bacterial infections, a widespread problem there, and which are cured with antibiotics.

One way to resolve the uncertainty over the death rate, say epidemiologists, would be to take a "cohort" of cases that start at the same time, and follow them until all have resolved. Several groups, including Roy Anderson and colleagues at Imperial College in London, plan to publish detailed epidemiological analyses shortly.

Uncertainty may dog the exact calculation, but it now seems clear that in the absence of a cure or a vaccine, SARS could eventually kill millions. The best hope is a vaccine. At a high-level meeting last week in Washington DC, every major vaccine company reported that it had begun a research programme.

Debora MacKenzie


TOPICS: News/Current Events
KEYWORDS: deadlier; estimated; fatalityrate; first; rate; royanderson; sars
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1 posted on 04/25/2003 3:08:17 PM PDT by blam
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To: blam
Great article.

We've known about the statistical problem for quite a while on FreeRepublic. Nice to see the news media catching up.

However, someone needs to remind the reporter that more people have died from ___________ (fill in clever comparison here) than SARS has killed in billions of years.

Otherwise, his comment, "..it now seems clear that in the absence of a cure or a vaccine, SARS could eventually kill millions," will definitely draw fire on FreeRepublic.
2 posted on 04/25/2003 3:18:12 PM PDT by EternalHope (Boycott everything French forever.)
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To: blam
Summary: FR has again been ahead of other media in finding and correcting errors of analysis.

If only the noise level weren't so high....

3 posted on 04/25/2003 3:22:22 PM PDT by forewarning
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To: blam
Analysis of the latest statistics on the global SARS epidemic reveals that at least 10 per cent of people who contract the new virus will die of the disease.

Definetly a case of 'predicting the future based on past' - allowable within limits, but, the 'system' now as some 'controlling feedback' whose goal is to limit the progress of this contagion and NOT let it spread at a pace determined by incubation period, rate of infection of new hosts, et cetra.

4 posted on 04/25/2003 3:23:51 PM PDT by _Jim (Guangdong doctor linked to SARS: http://www.biomedcentral.com/news/20030320/09/)
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To: per loin; riri; CathyRyan; aristeides; Judith Anne; Ma Li; ex-Texan
ping.
5 posted on 04/25/2003 3:24:16 PM PDT by blam
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To: Mother Abigail; Dog Gone; Petronski; riri; EternalHope; Domestic Church; grizzfan
Ping.
6 posted on 04/25/2003 3:29:58 PM PDT by aristeides
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To: All
Test to Detect SARS Virus Inconsistent.
7 posted on 04/25/2003 3:31:59 PM PDT by aristeides
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To: All
Bush briefed on SARS outbreak .
8 posted on 04/25/2003 3:33:32 PM PDT by aristeides
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To: All
SARS Panic Growing: Beijing closes off a major hospital.
9 posted on 04/25/2003 3:35:25 PM PDT by aristeides
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To: blam
will there ever be any stats we can trust on this disease? I doubt it.. I think this is just the "epidemic" du jour.
10 posted on 04/25/2003 3:37:11 PM PDT by goodieD
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To: All; backhoe; flutters
Sars inflicts heavy political toll on China.
11 posted on 04/25/2003 3:37:50 PM PDT by aristeides
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To: aristeides
"In the United States, the CDC has reported 247 cases of SARS, of which 39 are probable cases. Of those 39 cases, 37 occurred in travelers to parts of the world where the SARS transmission is occurring, one occurred in a healthcare worker, and one was a household contact.

The three states reporting the most cases so far are California with 49 total, of which 35 are suspected cases and 14 are probable cases; New York with 28 total cases, of which 23 are suspected cases and five are probable cases; and Washington state with 23 total cases, of which 22 are suspected cases and one is a probable case.

12 posted on 04/25/2003 3:39:59 PM PDT by blam
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To: Thud
fyi
13 posted on 04/25/2003 3:42:16 PM PDT by Dark Wing
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To: blam; All
Did SARS mutate from duck, pig feces? China's old-world farming practices possible culprit.
14 posted on 04/25/2003 3:43:47 PM PDT by aristeides
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To: blam
My suspicion is that older people are more likely to die of SARS, but the article is silent on the age distribution of victims.
15 posted on 04/25/2003 3:45:44 PM PDT by E. Pluribus Unum (Drug prohibition laws help support terrorism.)
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To: InShanghai; Ma Li; All
SARS pictures from China.
16 posted on 04/25/2003 3:47:31 PM PDT by aristeides
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To: E. Pluribus Unum
Big White Guy's blog in Hong Kong had an age table based on the Hong Kong figures a few days ago: the death rate went up uniformly with increasing age, from 0% for children under 15 to something like 30% for people over 70 or so.
17 posted on 04/25/2003 3:50:17 PM PDT by aristeides
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To: blam
Has everyone that has SARS been hospitalized or only the very sick. Is it possible that there are many who suffered through it at home ?
18 posted on 04/25/2003 3:54:13 PM PDT by tubebender (?)
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To: blam
We don't know what we are dealing with, because the time frame is too short, the reportage too variable and the samples are too small.
19 posted on 04/25/2003 3:55:40 PM PDT by PayrollOffice
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To: tubebender
"Has everyone that has SARS been hospitalized or only the very sick. Is it possible that there are many who suffered through it at home ?"

Yes. IMO, every possibility is still on the table.

20 posted on 04/25/2003 3:57:41 PM PDT by blam
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To: tubebender
Has everyone that has SARS been hospitalized or only the very sick. Is it possible that there are many who suffered through it at home ?

The converse is also a possibility, i.e., cases with the symptoms of SARS *but* caused by other viral agents ...

21 posted on 04/25/2003 4:03:39 PM PDT by _Jim (Guangdong doctor linked to SARS: http://www.biomedcentral.com/news/20030320/09/)
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To: blam
Well, how the heck is the rest of the world going to blame this in the U.S. in general, and George Bush in particular?
22 posted on 04/25/2003 4:07:57 PM PDT by Plutarch
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To: EternalHope
... a statistical difficulty, well known to epidemiologists,...

This difficulty was known to the professionals though.

23 posted on 04/25/2003 4:14:05 PM PDT by Doctor Stochastic (Vegetabilisch = chaotisch is der Charakter der Modernen. - Friedrich Schlegel)
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To: EternalHope
than SARS has killed in billions of years.

SARS hasn't been around for "Billions of years" as far as we know. Maybe only a few years, maybe less than one. Give SARS time, it might turn out to be nothing at all, or the 21st century equivalent of the Black Death, or at least the Spanish Flu. We shall see I guess.

24 posted on 04/25/2003 4:14:28 PM PDT by El Gato
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To: aristeides
Thanks for the link to the blog. What I bring back from it is the following:

"All public transportation vehecales and public places must be disinfected everyday. Planes, trains, long distance buses, cargos, metro, buses, taxies and all other kind of publich transportation viacles and stations, ports, dorms in building sites, schools, Internet cafes, bars, Karaoks, theaters, shopping malls, and other public places must be disinfected everyday and stick the disinfection mark with the date of the disinfection. Failure to keep compliant with the requires will be shutdown immediately."

25 posted on 04/25/2003 4:17:55 PM PDT by PayrollOffice
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To: blam
Listen to this
26 posted on 04/25/2003 4:18:48 PM PDT by TexasRepublic
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To: blam
Fortunately, it would be a relatively peaceful way to die in the US. A ventilator and enough drugs to snow you out of this life.
27 posted on 04/25/2003 4:18:56 PM PDT by Glenn (Look on the sunny side of death.)
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To: goodieD
Remember there are lies, damn lies and statistics. There are stats on anything you can truly trust. As for SARS there just isn't enough data currently. The Philipines death rate is 50%, of course 2 people got it and 1 died. Give it another month, by that point all the current cases will have run their course and we'll know whether or not this is an epidemic (my vote is not) and there should be enough useful data to make something up with.
28 posted on 04/25/2003 4:22:50 PM PDT by discostu (A cow don't make ham)
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To: blam
at least 10 per cent of people who contract the new virus will die of the disease

And the WHO said that we had better just learn to live with it!

29 posted on 04/25/2003 4:26:55 PM PDT by my_pointy_head_is_sharp
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To: TexasRepublic
I do not know if I should laugh or not?
30 posted on 04/25/2003 4:27:36 PM PDT by CathyRyan
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To: blam
In the first place, a 4% death rate for a highly contagious disease is quite high. A death rate of 10 or 15% is extremely high.

In the second place, we will never get reliable statistics out of China. The leadership probably doesn't have them, and if they do, they will never reveal them.

A British doctor today said that Sars may not be highly contagious or fast spreading. We'd better hope so, because it's the first good news we've heard since Sars appeared on the radar scope.

News reports have said that older people have a higher mortality rate, as you would expect. But plenty of young healthy victims have died, too, so no one can expect to be free from danger, IMHO.
31 posted on 04/25/2003 4:58:50 PM PDT by Cicero (Marcus Tullius)
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To: goodieD
Ditto! The reports suggest we should worry but for some reason I just don't care about SARS and I'm not afraid of it. The disease Du jour indeed!
32 posted on 04/25/2003 5:00:24 PM PDT by TalBlack
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To: _Jim
The converse is also a possibility, i.e., cases with the symptoms of SARS *but* caused by other viral agents ...

I have been trying to put that thought out of my mind for a couple of weeks now. I was kind of hoping it was a foolish thought.

33 posted on 04/25/2003 5:02:53 PM PDT by Nov3
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To: blam
Lassa fever kills about 70,000 a year in West Africa, but people mainly catch it from a local mouse.

Well, catch that mouse then!

34 posted on 04/25/2003 5:04:26 PM PDT by Kevin Curry
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To: Kevin Curry
They do catch them. It's the eating them that causes the problem
35 posted on 04/25/2003 5:11:12 PM PDT by CathyRyan
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To: CathyRyan
It's a terribly lethal disease and those who catch it should be forcibly quarantined until it is over!

Let's not fool around here; we have an opportunity to prevent a melt-down of modern civiization.

36 posted on 04/25/2003 6:08:03 PM PDT by Dec31,1999 (Thank You)
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To: blam
Thanks for posting these articles.
37 posted on 04/25/2003 6:12:04 PM PDT by TheLion
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To: blam
Bump
38 posted on 04/25/2003 6:13:03 PM PDT by TheLion
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To: E. Pluribus Unum
Quote "My suspicion is that older people are more likely to die of SARS,"

Well of course :) That is always the case with any disease.

Healthy young people have died here in Toronto...as well as everywhere else that is dealing with this disease. Of course NOBODY has died in the USA ;) If you believe the Government...cough cough
39 posted on 04/25/2003 6:13:57 PM PDT by Lucas1
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To: Lucas1
Gives a whole new meaning to the concept of free trade, i.e., SARS-laden products.

From your Commie "friends."

40 posted on 04/25/2003 6:18:35 PM PDT by Dec31,1999 (Thank You)
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To: Dec31,1999
civiization.

civilization, of course..

41 posted on 04/25/2003 6:21:06 PM PDT by Dec31,1999 (Thank You)
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To: blam
McGlaughlin Group just quoted 18% death rates in Hong Kong and Canada, 13% in Singapore and 50% in rural China (estimated). So which is right? I guess we'll only know when they finally start counting the bodies in an accurate manner.
42 posted on 04/25/2003 6:26:25 PM PDT by Beck_isright ("We created underarm deodorant, and the French turned that down too."-Mitch Daniels, Budget Director)
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To: Beck_isright
If I remember my college statistics properly, we can conclude that your chances of getting SARS are greatly increased if you are Chinese.........
43 posted on 04/25/2003 6:52:43 PM PDT by POGIFFMOO (illegitimi non carborundum)
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To: E. Pluribus Unum
I'm an older person and I agree with you.

People my age are more susceptible to most diseases and we accept it.

I find SARS frightening and worry about my children and grandchildren,not about myself.

I remember my mother talking about the flu epidemic in 1917-18 and contageous diseases scare the heck out of me.
44 posted on 04/25/2003 6:58:31 PM PDT by Mears
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To: El Gato
Re: My "Billions of years" comment... I hoped my point was obvious, so I left the sarcasm tag off. Guess not.
45 posted on 04/25/2003 7:50:52 PM PDT by EternalHope (Boycott everything French forever.)
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To: blam
What we are witnessing now may be just the tip of an iceberg.

Virologists expect to see another mutated strain of SARS when it jumps on a HIV/AIDS victim which is a hundred times deadlier than SARS alone. They have found that SARS and AIDS can be genetically combined due to similarity of their RNA. This will make the present SARS virus just “kid stuff”.

It can happen anytime now, as there are no lack of HIV positive persons out there.
46 posted on 04/25/2003 8:14:04 PM PDT by FreepForever (China is the hub of all evil)
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To: Beck_isright
"So which is right? I guess we'll only know when they finally start counting the bodies in an accurate manner."

I expect the higher numbers to be closer to the truth. 10% or higher.

47 posted on 04/25/2003 8:20:39 PM PDT by blam
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To: tubebender
After the incubation of 2 to 11 days, the lung tissues will be destroyed in a matter of hours. It is impossible to stay at home as the patient respirator machine to assist breathing. Staying home is sure death.
48 posted on 04/25/2003 8:21:19 PM PDT by FreepForever (China is the hub of all evil)
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To: aristeides
Big White Guy's blog in Hong Kong had an age table based on the Hong Kong figures a few days ago: the death rate went up uniformly with increasing age, from 0% for children under 15 to something like 30% for people over 70 or so.>

This whole SARS thing is being blown WAY out of proportion.

There are 6,000,000,000+ human beings on the planet.

The world's record for longevity is ~120 years.

6,000,000,000 / 120 = 50,000,000 people dying every year, at least.

So far there have been ~500 SARS deaths.

500 / 50,000,000 = 0.001% of the deaths expected this year are due to SARS.

Give me a break.

49 posted on 04/25/2003 8:33:15 PM PDT by E. Pluribus Unum (Drug prohibition laws help support terrorism.)
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To: E. Pluribus Unum
Which law is it, that says there can never be another worldwide epidemic like the 1918 flu, or for that matter, HIV?
50 posted on 04/25/2003 8:37:12 PM PDT by Judith Anne
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