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Is SARS a precursor to pandemic?
The Star.com ^ | May 26, 2003 | Raywat Deonandan

Posted on 05/26/2003 4:33:48 AM PDT by Judith Anne

When a relative finally succumbed to cancer a few weeks ago in a Toronto hospital, her parents and children were unable to be with her at the end, because of visitation restrictions enacted in response to SARS.

Disarray brought on by the epidemic also caused the staff of another hospital to store a friend's terminally ill and bedridden father in the morgue while he awaited transportation to his home.

Similar stories abound of families and patients enduring indignity, separation or heartbreak as hospitals struggled to establish appropriate procedures in the wake of an unforeseen public health emergency.

Despite such unfortunate occurrences, Toronto is being applauded in international public health circles for having acted swiftly and effectively to contain the epidemic.

Inconveniences were many, but infections and deaths were relatively few.

An epidemiologic modelling exercise performed by scientists at the Los Alamos National Laboratory in New Mexico predicted a potential outbreak of 200,000 victims in the Toronto area.

Instead, due to the vigilance of Toronto health workers, SARS will likely have infected only a few hundred people in the region.

With a death rate of around 6 per cent, this translates to 12,000 lives having been saved by effective epidemic containment practices.

While this is certainly a cause for a degree of self-congratulation, another perspective needs to be considered — that the SARS outbreak is merely a trial run for a truly lethal epidemic, one that is sure to visit us in coming years.

Epidemiologists are fond of citing the global influenza pandemic of 1918 as a virulent terror that is certain to return.

Indeed, many experts believe that outbreak, characterized by a high kill rate that affected mostly young, fit people, was largely responsible for stopping World War I, having removed so many young men from the battlefield.

That outbreak killed 20 million to 40 million people worldwide.

Every year, seasonal influenza kills 500 to 1,500 people in Canada, mostly among the elderly or those with compromised immune systems. Every few decades, however, a mutation creates a particularly virulent form of the disease, and a lethal pandemic results.

In this century, global flu pandemics have occurred in 1918, 1957 and 1968. According to this pattern, another is likely to be upon us in five to 10 years. In such an event, if a vaccine were not available, according to a model devised by the U.S. Centers for Disease Control and Prevention, Canada would see 9,000 to 51,000 deaths.

Even with a vaccine developed in time, production and distribution limitations might still cause nationwide bed shortages and urban quarantine conditions.

The public's distaste for vaccination is also an issue. A 1993 Health Canada study found that only 13.8 per cent of Canadians chose to receive the flu vaccine in the 1990-91 season, despite its proven ability to prevent or lessen the disease's transmission.

The major reason given by those avoiding vaccination was a fear of side effects. Such popular misconceptions regarding adversities posed by vaccination will surely hinder attempts to quickly rein in the effects of a sudden, lethal pandemic.

To be fair, it should be noted that in 1976, more people in North America developed bad reactions from the swine flu vaccine than actually contracted the disease.

Epidemics like the SARS outbreak are rare, but will likely increase in frequency. Globalization has resulted in closer ties between the farthest points on the globe, and improved air travel has greatly facilitated the transportation of disease vectors between those points.

Population pressures, particularly in Africa and Asia, are forcing human settlements to become more intimately involved with previously isolated ecosystems, and to compel closer associations between people and livestock.

This provides more opportunities for zoonoses — diseases transferred from animal to human domains. Ebola, hanta virus and a host of flu-like bugs have all resulted from such conditions. More new diseases are inevitable.

Toronto has weathered a small outbreak of a relatively non-lethal disease, but at significant financial and emotional cost.

A true pandemic will quickly overcome extant resources. Any given city will not be able to draw additional resources from provincial or federal sources, since all areas will be affected simultaneously.

Canada has had a structured federal influenza pandemic response plan since at least 1988, but our public health is threatened by more diseases than just the flu.

We should learn from the SARS experience and develop appropriate responses for larger medical emergencies, much like the emerging U.S. bioterrorism response plans.

Any such plan necessarily begins with education: The more we know, the more willing we will be to tolerate the incursions on our dignities and freedoms that an outbreak emergency will probably entail.

--------------------------------------------------------------------------------

Dr. Raywat Deonandan is a Canadian epidemiologist working in Washington, DC.


TOPICS: Canada; Culture/Society; Foreign Affairs
KEYWORDS: pandemic; sars; spanishflu
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FYI
1 posted on 05/26/2003 4:33:48 AM PDT by Judith Anne
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To: aristeides; blam; riri; Dog Gone; TaxRelief; CathyRyan; InShanghai; Prince Charles; FL_engineer; ...
It will be important to see how far the latest breakout goes before drawing a lot of conclusions...this doctor talks as though it's over...
2 posted on 05/26/2003 4:37:09 AM PDT by Judith Anne
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To: Judith Anne
We're all going to die!!
3 posted on 05/26/2003 4:37:38 AM PDT by doom n gloom
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To: doom n gloom; Admin Moderator
Good morning newbie. What are you doing here?
4 posted on 05/26/2003 4:39:49 AM PDT by Judith Anne
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To: Judith Anne
Heh! I just couldn't resist since the thread seemed so apropos to my new moniker.. Sorry for trying to make a joke!
5 posted on 05/26/2003 4:44:25 AM PDT by doom n gloom
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To: Judith Anne
On a more serious note, it's yet quite unclear (as you seek to imply) that SARS is anywhere close to having run its course. Whereas SARS appears at least somewhat less virulent than influenza, its mortality rate is in fact substantially higher than was that of the Spanish Flu. By all accounts, SARS entered widespread transmission well toward the end of the 02-03 cold/flu season.

It yet remains to be seen how easily contained it will prove (the recent outbreak in Toronto is not promising) or how extensive its impact once it runs a full cold season course. Moreover, it's an open question how devastating SARS may prove once it enters African or South Asian or even Latino populations that are both much more open than the East Asian outbreak regions and have far inferior medical services.

I'm not predicting anything in particular, just suggesting that no one really knows...yet.
6 posted on 05/26/2003 4:51:11 AM PDT by doom n gloom
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To: doom n gloom
I certainly do not seek to imply that the outbreak is anywhere near over. I am greatly concerned that the US will see several serious outbreaks this fall.

You might want to check out some of the SARS threads, to learn more about my position on SARS.
7 posted on 05/26/2003 5:02:31 AM PDT by Judith Anne
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To: Judith Anne
A true pandemic will quickly overcome extant resources. Any given city will not be able to draw additional resources from provincial or federal sources, since all areas will be affected simultaneously.

What an astute observation. Respirators (ventilators) will be in EXTREME demand. Food for thought.

8 posted on 05/26/2003 5:05:21 AM PDT by MeneMeneTekelUpharsin (El que rie ultimo, rie mejor.)
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To: MeneMeneTekelUpharsin
I read somewhere on these threads that Tommy Thompson ordered 3000 new respirators/ventilators for distribution around the US "soon." Frankly, I wonder if that will be enough.
9 posted on 05/26/2003 5:09:55 AM PDT by Judith Anne
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To: Judith Anne
No - I meant that you seek to imply that SARS has not run its course (contrary to the article's implication); I misplaced the parenthetical. We aren't getting off to a promising start - let's start over! Hi, Judith, I'm doom'n'gloom & I'm new around here.. Nice to meet ya! ;)
10 posted on 05/26/2003 5:28:03 AM PDT by doom n gloom
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To: Judith Anne
With a death rate of around 6 per cent, this translates to 12,000 lives having been saved by effective epidemic containment practices.

I note the good doctor has mistated the death rate from SARS.

11 posted on 05/26/2003 5:31:17 AM PDT by harpseal (Stay well - Stay safe - Stay armed - Yorktown)
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To: doom n gloom
Hiya, d&g. Welcome aboard. ;-D
12 posted on 05/26/2003 5:31:48 AM PDT by Judith Anne
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To: Judith Anne
I read somewhere on these threads that Tommy Thompson ordered 3000 new respirators/ventilators for distribution around the US "soon." Frankly, I wonder if that will be enough.

Difficult to tell. Asia needs hundreds more already, particularly in China. If it begins to spread here, the demand will be outrageous. As a nurse, you know that 10-12% of SARS patients require mechanical support to breath. In spite of the sorrow of this disease, wise individuals take lemons and make lemonaide. Or, like the Chinese character for crisis...must be formed by using the character for opportunity. Perhaps we understand each other better now.

13 posted on 05/26/2003 5:32:24 AM PDT by MeneMeneTekelUpharsin (El que rie ultimo, rie mejor.)
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To: harpseal
Exactly, and so far, those lives may still be at risk...
14 posted on 05/26/2003 5:33:08 AM PDT by Judith Anne
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To: MeneMeneTekelUpharsin
Actually, I thought the figure was 20% needing mechanical support...but I could be wrong...
15 posted on 05/26/2003 5:34:43 AM PDT by Judith Anne
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To: Judith Anne
Disarray brought on by the epidemic also caused the staff of another hospital to store a friend's terminally ill and bedridden father in the morgue while he awaited transportation to his home.

Disarray?....sounds french How did "Dissaray" cause the staff to store a living human being..terminally ill and bedridden in "the morgue"...

Socialized medicine having lead to the hiring of complete -callous -incompetants maybe...

Hillary care strikes again

16 posted on 05/26/2003 6:03:22 AM PDT by joesnuffy (Moderate Islam Is For Dilettantes)
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To: joesnuffy
I know what you mean. That is so bizarre...if Toronto is so well-equipped and so on top of this "outbreak" then where did all that "disarray" come from? /sarc
17 posted on 05/26/2003 6:07:33 AM PDT by Judith Anne
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To: Judith Anne
bump
18 posted on 05/26/2003 6:24:53 AM PDT by Judith Anne
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To: Judith Anne; Mother Abigail; CathyRyan; per loin; Dog Gone; Petronski; InShanghai; Ma Li; ...
This reads as though it was written before the reemergence of SARS in Toronto.
19 posted on 05/26/2003 6:54:22 AM PDT by aristeides
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To: aristeides
Now that you mention it, it does...
20 posted on 05/26/2003 6:59:25 AM PDT by Judith Anne (Tagline! You're itline!)
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