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   SARS: More Panic than Peril?


SARS: More Panic than Peril?

by Chris Holmes, M.D.

Media reports have us believing that a new plague of biblical proportions is stalking the land. Travel is severely curtailed, the worried well inundate ERs and clinics for the slightest cough and fever, and a few have taken to wearing surgical masks in malls and theaters. Chinese restaurants fret over loss of business even though the disease is not foodborne. And the Mayor of Toronto has watched his city's tourist traffic dry up like a Manitoba prairie in summer. Government officials are talking about developing a vaccine against SARS.

Is the epidemic really that out of control, or just the media reports of it? Here's what we know: The vast majority of the 4,500 or so cases are from China and other parts of SE Asia. The mortality rate is around 5%. But because China is opaque to information, we know little else. When did the outbreak really begin and what tests were used to confirm the diagnosis? How many cases were other, misdiagnosed common viral illnesses? What is the rate of hospitalization and the average length of stay? How many patients required ventilatory support? What population groups are at highest risk: the elderly and those with pre-existing disease, or healthy young adults?

In the U.S., around 250 cases have been reported to the WHO. But only 45 of these have had positive laboratory confirmation, and only 40 or so (16%) have had an illness characteristic of SARS. Ninety-five percent of the cases are travel-related. The US case fatality rate is 0. That's zero. Nada.

SARS has been compared to influenza, another viral respiratory disease. Is that a fair comparison? In 1918, influenza caused 20-40 million deaths. Now that was an epidemic! It still accounts for a half million U.S. cases every winter, with 20,000 deaths, mostly in the elderly and those with cardiac, respiratory or immune diseases. Seventy million doses of flu vaccine are given to those at high risk and to workers to prevent sick absence. Because of variations in influenza strains--called antigenic drift--new vaccines must be formulated every year. But despite the high cost and mortality rate from influenza, there is little press coverage of it; most people just shrug and go about their business.

If there is little comparison between SARS and influenza, what is it that has us so fretful? Is it that SARS is a new virus, is that what raises the hair on the back of our necks? Does this presage some germ apocalypse? It does not. Change, variation, and mutation are common in biology; they are the stuff of evolution. Our fear may stem from the same astonishment as 9/11, which proved we are not safe behind our two ocean barriers, or those anthrax cases, which demonstrated our vulnerability to disease from the mail. SARS has again shown our impotence to control our environment.

Though highly contagiousness, SARS cannot be equated with influenza. After all, you cannot get a death rate less than zero. And spending hundreds of millions of dollars on a vaccine or new anti-viral drugs for a disease with no mortality seems imprudent. Standard public health measures, meticulously carried out, are a far better bang for our buck: a refined case definition to prevent over-diagnosis; identification and targeting of high risk groups; hospitalization and isolation for those who are ill; case contact identification and self-imposed isolation for those merely exposed; improved diagnostic tests for rapid identification; and reasonable precautions for travel to areas with known cases (mostly, stay away from hospitals with SARS patients). Vietnam claims to have eradicated the disease with just these basic measures.

The sky is not falling. The grim reaper has not been let loose. This is not bubonic plague or anthrax. What we need are more cool heads, fewer hyperactive news reports.

Chris Holmes, M.D., M.S.P.H., has written his first novel, The Medusa Strain, which attempts to make the threat of bioterrorism understandable to the layperson. His next book is a non-fiction analysis, Spores, Plagues, and History: The Story of Anthrax; both books are published by Durban House, and the latter will be available in September, 2003. Holmes, a retired Captain in the US Marines, has been studying the history of medicine for over 35 years.

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This story was published on May 13, 2003.
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