URGENT HEALTH WARNING

Eugen Leitl eugen@leitl.org
Tue, 18 Mar 2003 01:31:26 +0100 (CET)


I don't think this is serious, but just in case you're at risk because you
believe you're in first contact group or this is going pandemic (not 
bloody likely).

The rest of you can slumber on.

---------- Forwarded message ----------
Date: Mon, 17 Mar 2003 18:49:16 EST
From: [a friend]
To: cryonet@cryonet.org
Subject: URGENT HEALTH WARNING

I am communicating with you only because I believe this is a matter of life 
or death.

This is a warning of a possible near term pandemic which may be highly lethal 
and result in serious disruption of civil order and normal daily life. As 
most of you probably know from news reports there has been an unusual 
communicable form of "pneumonia" which does not respond to any treatment 
currently available including antivirals and antibiotics. 

What you may not know is that the media is severely (in my opinion) 
underreporting the gravity of the situation in general, and the severity of 
this illness in particular. I first became aware of this problem about 6 
months ago when reports came out of China that a new flu had emerged and the 
local population was "overreacting" according to the Chinese government. One 
of my Internet medical colleagues in China advised me that the disease was 
quite serious, virulently communicable (had failed containment using standard 
Universal Precautions and cloth and disposable surgical masks). I was also 
told that heath care workers were heavily affected and that draconian 
containment measures were being used in the province where the disease began. 
I was also told that it was *rumored* that the area where the epidemic began 
was in proximity to military installations involved in defensive 
nuclear-chemical-biological (NBC) research. Shortly afterward, he died, 
possibly of the new illness. His last message indicated that all attempts he 
knew of (i.e., civilian) to isolate the etiologic agent responsible for the 
disease in China had failed. In short, it did not appear to be an influenza, 
although the province where it originated is in the heart of the world 
influenza generation zone (which, BTW, is in China).

On 15 March, the World Health Organization (WHO) issued an alert and gave the 
illness a name: SARS, or Severe Acute Respiratory Syndrome. My contacts in 
other areas of epidemiology and medicine have informed me that the CDC has 
also so far failed completely to characterize the etiologic agent for SARS.

Many of you will also note that I relocated to a remote, isolated area in 
September of this year. Some of you may have wondered why. Now, you know part 
of the reason and Dave Pizer's comment about my post being "almost scary" can 
be put into perspective. As a sidebar, unfortunately, I currently work at a 
facility that services travelers and tourists, so, unless my timing is 
flawless in the face of a US epidemic of SARS, all my precautions may have 
been futile. 

Several things are clear:

1) SARS patients who require hospitalization do not seem to improve and those 
who become ventilator dependent remain so. It is not known how many people 
recover from the illness who do not reach hospital, but in well nourished 
urban populations it appears that the mortality rate may be as high 10%-20%.

2) SARS is *extremely* infectious; those physicians treating it in Hong Kong 
report that it is about as infectious as influenza. So that you can 
understand the gravity of this statement this would mean that SARS is more 
infectious than Ebola or the other hemorrhagic fevers and would require the 
highest level of biosafety containment for handling in the laboratory. *For 
practical purposes it means that complete civilian protection can best be 
achieved by complete isolation until the epidemic is over. * Masks 
(respiratory) and conjunctival protection (eye shields) coupled with gloves 
will probably provide a significant degree of protection against casual 
exposure. A principal purpose of the gloves is to remind you not to touch 
your face. However, these methods of protection will likely fail if contact 
with infected person(s) is prolonged in indoor or contained spaces (homes, 
vehicles, aircraft, etc.).

3) SARS is likely to spread rapidly and public health officials are likely to 
react too slowly to contain it. Only draconian measures would allow any 
significant degree of protection and these measures are likely to be so 
severe that normal commerce and travel would be severely or completely 
disrupted. SARS may well behave much like the 1918 Flu. For an excellent and 
comprehensive review of this pandemic I highly recommend Gina Kolata's FLU: 
THE GREAT INFLUENZA PANDEMIC OF 1918 AND THE SEARCH OF THE AGENT THAT CAUSED 
IT (ISBN: 0374157065
Publisher: Farrar, Straus & Giroux, LLC). Used copies are available from 
bookfinder.com for as little as $1.00 (US). The 1918 Flu killed more people 
than W.W.I. Estimates for deaths in the US are as high as 18 million.

4) I suggest that if you have not done so already, you stockpile emergency 
food, water, and minimal protective equipment for you and your loved ones. It 
is impossible to be comprehensive here, but other measures such as having 
bleach and dispensing equipment available for disinfection of surfaces should 
you have to care for someone infected with SARS should also be undertaken 
Many websites for disaster and NBC preparedness exist, and many of these sell 
supplies which may be useful. Frankly, these are supplies you should *all* 
have in any event as a routine part of preparedness for life. *Anyone 
seriously concerned about their survival should have these kinds of 
preparations in place. * Survival Unlimited.com is one such website. There 
are many others.

5) The elderly and immunocompromised appear to be particularly hard hit by 
SARS and appear to constitute a disproportinate number of those who've died.

6) I emphasize that media coverage is not accurately reflecting the severity 
of the disease or the extent of SARS in China, although the media is 
beginning to report that SARS "is of concern to healthcare agencies."

7) Those involved in healthcare, cryonics care, and those who deal with 
tourists (freeway related businesses, tourist centers, and hotels/motels) are 
IMHO likely to be at very high risk of exposure to the initial wave of 
infection with SARS should it become epidemic in the United States and 
Europe. A disproportinate number of sentinel provincial Chinese cases were in 
hoteliers and shopkeepers at trade hubs. If you are involved in such a 
business it would probably be wise to cease operation (where possible) at 
such time as the first cases are reported in your country or region of your 
country.

Healthcare and cryonics workers should acquire active full-head HEPA 
protection for all staff and impermeable full-body protective suits. In the 
case of cryonics personnel, Standby staff who deal with the patient while 
alive will be at very high risk. Volunteers for these high risk positions 
should be sought at the earliest opportunity and training to minimize the 
risk of SARS transmission (using influenza as a model) should begin at once.

Cryonics organization should also, in my opinion, modify handling and 
operative procedures to deal with this illness. The external surfaces of all 
patients who arrive should be scrubbed with detergent and 2% sodium 
hypochlorite.

Finally, impending war is likely to provide a fertile opportunity for rapid 
spread of SARS since it mandates movement of manpower and material across 
multiple borders even the presence of disease, concentrates people in 
barracks and shelters, and results in immunocompromise from stress (even in 
healthy and well nourished soldiers and civilians) from increased 
glucocorticoid secretion. War is the handmaiden of epidemic disease and in 
this case the timing could not be worse in my opinion.

Thank you for your consideration of this message. The communication from Tom 
Buckley, as posted to the Critical Care Medicine Forum (CCM-L), is reproduced 
below.

Mike Darwin


The implications of SARS for the cryonics community are overwhelming. 

I will close this message with a communication from Tom Buckley, an 
Intensivist in Hong Kong. Tom's is a superb physician and Intensivist and his 
communication below should give you snap shot of what is happening in a 
major, highly sophisticated medical center in Hong Kong.

Dear All,

I have not read all of the below because we seem to be close too or are the
centre of this form of atypical pneumonia.

So just a brief summary of our experience.

Male arrives on the medical ward having been admitted thru A & E. Other
patients and STAFF start to develop symptoms - fever, headache, dry cough.

Unresponsive to various combinations of cefotaxime, chlarithromycin,
levofloxacin, doxyclycline and Tamiflu.  All microbiology is NEGATIVE (after
one week).

Physicians have started patients on ribovarin and steroids.

As of yesterday there were 64 patients with "atypical pneumonia" in the
hospital - a large number of whom are staff.

Patient visitors, medical consultation staff, medical students visiting
patients have all developed symptoms and to a large degree CXR signs.

While most of our cases revolve around the patient admitted to the medical
ward we have admitted (to ICU) another patient from another hospital with
atypical pneumonia.

In ICU we have twelve patients admitted so far

Five are ventilated. Seven breathing spontaneously but very oxygen
dependent.

My impressions
CXR reveal progressive bilateral infiltrates starting at the bases.
Patients invariably have a low WCC and maybe thrombocytopenic.
Patients invariably have an elevated CPK.  No ECG changes and Troponin T
negative.  Post mortem on an Indonesian maid (not in our hospital) showed
evidence of ARDS and myocarditis.

So far 2-3 of our older patients with chronic disease have deteriorated
fastest.  Medical staff - younger and fitter have faired better.  Their
radiological findings have deteriorated in all but one case.

We receive 2-3 admissions per day.  So far no-one has shown any improvement.
Once intubated however they remain relatively static but very oxygen and
PEEP dependent.  Those ventilated have solid lungs.  Interestingly one
patient developed a pneumothorax on the medical ward and after chest drain
and re-expansion his pneumonia involves only the side without a chest drain.
Another patient (ventilated) has developed surgical emphysema.

ICU is now closed for all but atypical pneumonias.  All our other "clean
cases" have been transferred to other ICUs.  All elective surgery is being
cancelled and wards are being closed and evacuated. Al ambulances are being
diverted.  

We are taking strictest possible isolation procedures available to us
including hand washing, gloves, gowns, N95 masks and visors.

Masks are worn throughout the hospital.
Staff are not going home to children.


Please take the warning below seriously.  My impression is that even with
minimal contact with an infected person people have been becoming ill.

Staff morale in ICU is high but If ICU staff start developing symptoms then
this is a big problem as we have instituted isolation procedures earliest.

Other hospitals in Hong Kong are admitting sporadic cases.

I am off to a noon update.

Any suggestions will be gratefully received.



Tom Buckley
Consultant Intensivist
Department of Anaesthesia and Intensive Care,
Prince of Wales Hospital
Shatin, 
Hong Kong