Post #92,822
3/29/03 1:05:30 PM
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They're only reporting index patients?
Oh, that's no good. Index patients (ie- exposed from outside as opposed to catching it here) is perhaps 3% to 5% of all reported cases in Toronto. So, if the ratio is app. the same, five reported cases equals probably about a hundred to a hundred and fifty actually extant... and since all index cases here have been immediately placed into isolation since the health unit in T.O. figured out what was going on, the rate of infection might be higher.
Fortunately, the situation in Vancouver from the initial patient is that they managed to keep it under control, with no new cases reported among hospital staff there. OTOH, fourteen people arriving from Hong Kong were immediately whisked off to isolation from Van's airport yesterday.
In an interview on CBC radio this morning, the chief nurse at Van's big hospital was saying "maybe we had better procedures in place, maybe the patient wasn't as infectious as the person in Toronto, or maybe we just got lucky: I don't know."
Confirmed cases are being put in negative pressure rooms, with staff wearing full protective gear up here. They (er, the health unit folks) don't really know how transmissable it is, but I think they may have seen some evidence that scared the shit out of them on Wed. night or early Thurs. morning because they suddenly went from a soothing "relax, everything's under control" to "we need to quarantine thousands" in less than 24 hours.
Today, there are big full page ads in the Globe and Mail from the health unit telling people what to look for and what to do. I imagine that the ads are in the Toronto Star too.
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Post #92,828
3/29/03 1:19:03 PM
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So *that* is what an index patient is?
I had been wondering...
As for the ratio between patients and index patients, that is like the ratio between a spark and the fire started. They are unconnected, and therefore there is no reason to believe that the two resemble each other in any way.
However if Bellevue is typical, rather than 5 reported cases in NYC, we probably have more like 30. Most of whom are at home, with family in the home, having pizza delivery guys coming home, etc.
Well, if I had thought that the public health system was not going to contain this before, I am positive now...
Suggested reading: [link|http://www.lauriegarrett.com/index_betrayal.html|http://www.lauriegar...dex_betrayal.html].
Cheers,
Ben
"good ideas and bad code build communities, the other three combinations do not"
- [link|http://archives.real-time.com/pipermail/cocoon-devel/2000-October/003023.html|Stefano Mazzocchi]
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Post #92,914
3/29/03 8:15:19 PM
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What is actually known?
We don't know that much about transmission, and there is some evidence that it may be somewhat easier than initially thought, but the death rate is currently being estimated slightly lower than before (3.5% vs 4%):
[link|http://www.cnn.com/2003/HEALTH/03/29/mystery.illness/index.html|http://www.cnn.com/2...llness/index.html]
[link|http://www.nytimes.com/2003/03/30/health/30INFE.html?ex=1049605200&en=515394677ffb382d&ei=5062&partner=GOOGLE|http://www.nytimes.c...62&partner=GOOGLE]
As for Toronto, what appears to have changed is that there is a public panic. They not only have to deal with the medical problem, but also the panic. If someone thinks that they might have it and you think that they don't, why not just tell them to isolate themselves? No real harm done, and they are out of your hair. A more detailed report describing how they were swamped:
[link|http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&cid=1035780018110&call_pageid=968332188492&col=968793972154|http://www.thestar.c...&col=968793972154]
And, speaking of panic, this is a very good time to re-read [link|http://www.vmyths.com/fas/fas1.cfm|http://www.vmyths.com/fas/fas1.cfm], all of it. It talks about a different kind of virus, but the phenomena that it talks about is universal. I also note that mere geographic proximity to an outbreak doesn't actually confer any actual expertise on the topic in question.
Yes, this disease is a serious public health threat. But when all is said and done, and the corpses are tallied, I am willing to bet that the panic over the disease will cost an order of magnitude more than the disease itself did - with little reduction in the actual long-term spread because of it.
Of course that bet is being made by a moderately informed person armed with no more than a broad general background, decent intelligence, and undue verbal facility. Insert appropriate levels of skepticism...
Cheers,
Ben
PS I actually am finally getting around to reading [link|http://www.lauriegarrett.com/index_betrayal.html|http://www.lauriegar...dex_betrayal.html] and I reiterate my recommendation to read it. It is a very good book that is extremely relevant to the current situation.
PPS If the name Laurie Garrett rings a bell, it is because she is the person who wrote the infamous description of what happened at the WEF...
"good ideas and bad code build communities, the other three combinations do not"
- [link|http://archives.real-time.com/pipermail/cocoon-devel/2000-October/003023.html|Stefano Mazzocchi]
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Post #92,928
3/29/03 9:20:32 PM
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Known SARS cases in T.O. tops 100
At least, so says CBC Newsworld tonight (as in, five minutes ago). The health unit folks say they expect to see more. Also, they've called in the police to start ensuring that quarantines are observed.
I suspect that the reason they went from "it's all OK" to "close hospitals and quarantine" is because they knew that the confirmed cases were about to rise dramatically. As Dr. Cunha put it in today's press conference "the major vectors now are health workers and people in close personal contact with them" which is to say health workers in the two hospitals that have been completely closed and their families.
I've been reading the Garrett stuff too. Very interesting reading, albeit all US history; obviously, the development of public health infrastructure followed a very different path in Canada.
I think it's the very large differences between the two that have led to the different approaches to dealing with SARS on the two sides of the border. It will be very interesting to see how it plays out... there's a paper in there, that's for sure.
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Post #92,934
3/29/03 9:51:08 PM
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Her book is not all US
As for SARS, an impending rise is a good reason to get more serious. As I said at first, with an untreatable disease either you succeed in confining it at the start, or you have to live with the consequences of failing. If current policy is not containing it, then it is better to go drastic early than to wait.
The more than 100 number is also confirmed at [link|http://www.globeandmail.com/servlet/story/RTGAM.20030329.umask0329/BNStory/National|http://www.globeandm.../BNStory/National].
Ben
"good ideas and bad code build communities, the other three combinations do not"
- [link|http://archives.real-time.com/pipermail/cocoon-devel/2000-October/003023.html|Stefano Mazzocchi]
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Post #92,939
3/29/03 10:23:39 PM
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Well, I'm only reading chapter 4
That's the one she has available online in PDF format, though there may be other parts that I've not found yet. Interesting reading, nonetheless; the recounting of early twentieth century public health advances in New York is fascinating. I'm more familiar with the efforts of the Europeans (Pasteur, Snow, etc) than I am with what happened in the US in the late nineteenth and early twentieth centuries.
As for SARS in T.O., I have to say I'm concerned. Considering that these folks are ones who should know how to minimise risk of infection from their patients, the possibilities for what's going to happen to their immediate families are chilling; they would simply not have been thinking about it most of the time, I'd imagine.
One thought that I had earlier this evening would be the consequences if it got into the homeless population in Toronto. That would be really bad, I think. That possibility underlines the importance of looking at indigency not only as an ethical problem (the suffering of the indigent) but also as a potential public health problem.
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