Semi-Daily Journal

Paul Ehrlich, the butterfly guy, wrote a book about human populations called "The Population Bomb" during the 1970s. One of his predictions was that an increase in the human population would lead to the emergence of new diseases that would spread around the world. A lot of his predictions are not far off the mark.

Most of the US is still adjusting to the West Nile Virus.

This thing sounds like big trouble. But the mortality rates and transmission rates are inconsistent from area to area. Even 2% or 3% mortality would be a big mess--the Asian markets have already taken note of this.

Maybe I can buy some face masks online before they become hard to find.

Now there's a true hero. Much more useful to mankind than any military hero.

A lot of his predictions are not far off the mark.

Except, of course, for the prediction that headlined the book and predicted the deaths of 65 million Americans in the 80's. I seem to also recall a bet he made and lost with Julian Simon on the price of metals.

(which is not to say that increased population density does not contribute to the spread of disease, just that Ehrlich being correct is similar to the old canard about the stopped clock...)

snsterling - if it's a virus then face masks are useless except as a portable tissue to catch sneezed droplets (ie it helps stop you giving it to other people if YOU have the disease - thats why people with colds wear them in Japan). Once the droplets evaporate airborne viruses are small enough to go straight through cloth or paper.

This gives me shivers, in part because it's one of those "there but for the grace of God" things. I've been in the clinic at the French Hospital in Hanoi.

Airborne infections have a way of migrating to war zones. I wonder how long it will take to reach Iraq. The 1918 typhus epidemic had a huge impact on the world - a far larger one than most people estimate - and WWI was one of the major transmission vectors. Millions of Americans have immune systems that are to some degree compromised - far more than in 1918 thanks to modern medicine - and public health facilities in the US are a disaster.

Not to be paranoid, but this could be very bad. Of course, it could also all blow over. I have no way of assessing the odds of either one.

Here in Toronto -- one of the world's larger Cantonese-speaking cities -- we have four dead, and a program of voluntary quarantine under way. Two hospitals have closed, and all hospitals and prisons have stopped visiting hours.

The medical authorities are over-reacting, which strikes me as exactly the right thing to do. One of the interesting things to find from TV is how many of the senior public health bosses are Asian -- which a.) proves the value of open immigration, and b.) must be reassuring for the Asian immigrants who seem to be most at risk so far in this potential epidemic.

I volunteer at a local Catholic hospital, but the non-Anglo clients there are mostly from the Philippines. (There's another Catholic hospital between here and the Vietnamese and Chinese parts of the city.) No panic, but some annoyance at the food bank getting more complicated. Some functions will probably have to be relocated this week.

Passengers on both incoming and outgoing aircraft are being inspected and surveyed to limit spread of the virus as much as possible. Latest theory is that there are about 100 cases around the city, disproportionately among front-line health-care workers.

The voluntary quarantines seem to be giving a lot of cops an excuse to take a lot of days off with pay.

I have been following this story very closely since it broke, and I am convinced that the SARS epidemic is growing out of control in both Hong Kong and China. I cannot see anything to stop the continued exponential growth in the number of new cases -- a number that doubles every one to two weeks.

The 4% fatality rate is bad enough, but it hides the virus' true deadliness. Something like 10-20% of SARS patients wind up in intensive care, many on respirators. Without good hospital facilities, most of them would die. In parts of the world where healthcare is sparse, the fatality rate will be huge. Even in the developed world, this bug has the potential to follow an exponential growth curve in which the number of sick people quickly outstrips the number of hospital beds.

I hope I am wrong about this, but I believe that SARS will be the biggest story of this decade.

From today's Minneapolis Star Tribune:

http://www.startribune.com/stories/484/3792785.html

Infant from Northwest flight monitored for mystery illness

The infant on the Northwest flight, which originated in Beijing and stopped in Tokyo before arriving in the Twin Cities, developed a fever and other respiratory problems mid-flight, said Northwest spokesman Jeff Smith.

The Centers for Disease Control and Prevention asked that the baby be taken to a hospital as soon as the plane landed. The baby was still being treated on Sunday at Hennepin County Medical Center in Minneapolis, officials said.

The infant, who had been adopted in China, tested positive in an initial screening for respiratory syncytial virus, or RSV, the most common cause of respiratory illnesses in children under age 1, said Buddy Ferguson, a state Health Department spokesman. He said he didn't know the baby's gender.

RSV "is a very likely explanation for the symptoms that were being seen in this infant," he said. "So we've lowered our level of concern."

But SARS has not been ruled out, he added. Health officials will continue to monitor the case, he said.

The 375 passengers on board were given cards to fill out so health officials could contact them if needed, Smith said.

Neither the baby's parents nor the people on the plane have reported symptoms since the flight, officials said. SARS typically has a two-to-seven day incubation period.

Ferguson said Minnesota has had three suspected cases of SARS that developed several weeks ago before health officials were looking for it.

In retrospect, health care providers think those patients might have had SARS because the symptoms they exhibited and because they had traveled to parts of Asia recently. But each patient is doing well today, Ferguson said. Also, there have been eight to 10 possible cases of SARS investigated in Minnesota -- nearly all of which have been ruled out, he said.

http://www.nytimes.com/2003/03/31/international/asia/31INFE.html

The World Health Organization, the Centers for Disease Control and Prevention and the Hong Kong Health Department have all said masks are mainly of value for health care workers, to help prevent the spread of illness by people who feel sick and to protect those in close contact with those who feel ill. Advocates of wider mask use contend that people who are starting to feel unwell, and are thus perhaps on the verge of infectiousness, are more likely to wear masks if they are less likely to be stigmatized in a community where healthy people are wearing masks too.

Hong Kong has had 530 cases so far among its seven million people, so healthy people with no close contacts with ill ones may not need to worry too much yet, unless the spread of the disease continues to accelerate....

"Millions of Americans have immune systems that are to some degree compromised - far more than in 1918 thanks to modern medicine - and public health facilities in the US are a disaster."

Rubbish, rubbish, rubbish....

Speaking of Iraq...

I doubt that Iraq would be one of the first places for the disease to spread. Note that all of the spread has been to North America, Europe, and Asia. As far as I can tell, no reports of South America, Africa, Middle-East - even India.

This is interesting to me because it highlights the pattern of globalization, in which certain countries have a great deal of contact, while others have much less.

Silicon Valley is rightfully worried about SARS. We have a great deal of manufacturing in Asia and regularly make trips to China, Singapore, Hong Kong, etc.

Of course, the real worry isn't globalization bringing the world closer together but China's unaccountable government. With no need to answer to the citizens that nation won't ever shape up and require basic health standards for agricultural operations. So China will have birds, swine, and humans living in close contact and new murderous flus will arise there again and again.

If that happened in the USA or Brasil or even to our enemies in Western Europe, the public health authorities would rush to change things and the people would support them enough through the sacrifices to get the job done.

Maybe next on the list shouldn't be Syria or Iran but Red China.

Of course, the real worry isn't globalization bringing the world closer together but China's unaccountable government. With no need to answer to the citizens that nation won't ever shape up and require basic health standards for agricultural operations. So China will have birds, swine, and humans living in close contact and new murderous flus will arise there again and again.

If that happened in the USA or Brasil or even to our enemies in Western Europe, the public health authorities would rush to change things and the people would support them enough through the sacrifices to get the job done.

Maybe next on the list shouldn't be Syria or Iran but Red China.

Hostile fellow.

I gather from the WHO website that Beijing has been very cooperative but that Guangdong less so.

http://www.who.int/csr/sarsarchive/2003_03_31/en/

That's too bad. It feels like there are regional administrative issues surrounding this, as Hong Kong and Beijing are both also part of China.

I also noticed that the affected areas page on the WHO site lists "China: Taiwan Province" as an affected area.

(I'll betcha there's some amount of politicking involved here.)

Compare Dr Urbani with George W "Personal Responsibility" Bush and operation Shift the Blame going on right now. Now ask which one is more likely to get high schools and airports named after him.
Man oh man, it numbs the soul.

I was in Hong Kong when SARS hit there a few weeks ago, and have been in Singapore more recently (and have to go back there at the end of the week). As best as I could tell -- and I don't have inside information -- Singapore is doing a good job of controlling things, at least for the moment. They have one hospital dedicated to SARS patients, and they are enforcing home quarantine on a large number of people; they have also stepped up health checks at Changi airport. Other than that, people are pretty much getting on with their lives; there is anxiety, certainly, but no sense of panic or anything like that.

Jay H is surely right, though, that the big risk is that the medical infrastructure will not be able to cope if the numbers get too large .

What? You mean you're not used to Ronald Reagan national airport yet? Get a grip, because soon BWI will be renamed G.W. Bush international...

Maybe Urbani will get some small municipal train station in southern China named after him. We'll see.

Dahl, would you care to explain either how people with AIDS, people taking immune suppressing drugs and the much larger part of the population that is over 60 years old do not have immune systems that are to some degree compromised, or how all of those things were present in 1918?

I know most everyone here is a big fan of SF (as am I), but Dr. Urbani's life and death reminds me of one of my favorite books, The Plague by Camus.

A story about living an admirable and heroic life, not a story about death.

JJJ - are you saying that Camus wrote science fiction, or are you implying that SF readers don't read other literature? :^)

I'm risking getting censored for going off-topic with this, but I've noticed a remarkably high percentage of the people here - well, of the leftish ones anyway - seem to be at least minimally literate in French, and that this generalisation seems to hold about to the same degree that people here tend to be SF junkies.

Also interesting to note. The Chinese government has not released information about the SARS virus to the China mainland. None of the general public in the north of China where I am at the moment have heard anything about it when I ask them, they haven't told them!

Also interesting to note. The Chinese government has not released information about the SARS virus to the China mainland. None of the general public in the north of China where I am at the moment have heard anything about it when I ask them, they haven't told them!

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