X-Message-Number: 21440 Date: Fri, 21 Mar 2003 13:34:25 -0500 (EST) From: Charles Platt <> Subject: SARS update Today (Friday March 21st) marks the end of the first week in which the World Health Organization has tabulated worldwide cases of Severe Acute Respiratory Syndrome (SARS, the virus that originated in China and has spread from Hong Kong). The bad news is that email dispatches from a doctor in the most severely affected ICU in Hong Kong report that the "second wave" of cases has begun, as family members of previously infected people are now seeking help. The relatively good news is that so far, the increase in reported cases from March 17 through March 21 has been linear. Globally, the daily cumulative numbers of cases reported by WHO have been 167, 219, 264, 306, and 350. The step from each number to the next is more-or-less constant. Thus this is not a geometric progression, presumably because efforts at containment have been partially (but not wholly) successful. In Hong Kong the numbers have been 95, 123, 150, 173, 203. Again this is an approximately linear progression. Tim Freeman has already commented that since the first probable cases of SARS were in mainland China several months ago, my nightmare scenario (in which I postulated cases tripling every 5 days) is implausible. True, but the USA (for example) would not be able or willing to apply the more draconian measures which I assume the Chinese might have used promptly and effectively in their regime. We simply don't know what they did to contain the initial outbreak. We do know that one doctor emerged despite the containment effort and infected many people before he died, thus starting the current wave of cases. Another reader of CryoNet asks various "what-if" questions. Unfortunately I don't think anyone has the answers. Personally I live in a remote area where we do not have a municipal water supply, and well drilling is impractical. Therefore we have a 2500 gallon water tank which is replenished by deliveries. Coincidentally (not for survivalist reasons) I just installed a 1000-gallon tank in addition. The total supply would be sufficient for two people for six months if it were used frugally. But is this really an advantage? If SARS spreads widely, I can't see that it will disappear completely within six months. Thus the survivalists who eventually come down from their mountain retreats will still be vulnerable, unless of course a vaccine is developed within that period. The CDC web site presented a transcript of answers to questions from journalists two days ago. Unfortunately, journalists generally are so clueless (I speak as a former journalist) they didn't ask some of the obvious questions. For instance, I cannot find any reliable information on the incubation period (five days average?), the likelihood that new cases become infectious during the incubation period, the number of patients who have been able to return home after hospitalization (this information is so incredibly basic), the age distribution of people who are severely affected (one case was reported of a healthy 23-year-old in Hong Kong who is still on a ventilator), or the effectiveness of antiviral drugs. We do know that the primary ICU in Hong Kong has switched to N100 masks to protect their medical staff, and these seem to be effective. Alcor has ordered a modest supply of these same masks in addition to our N95 masks. I did not see the point of ordering a large number of N100s (which are $11 each), because I am unsure that we will be able to deal with SARS cases for reasons described in my previous dispatch on this topic. If anyone has better sources of information, please contact me. Currently I am relying on a critical-care medicine email discussion list, Associated Press and Reuters dispatches, CDC, and WHO. The last two of these sources can be found at: http://www.cdc.gov/ncidod/sars/ http://www.who.int/csr/sarscountry/en/ --Charles Platt Alcor Foundation Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=21440