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SARS

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Pandemics and Politics

29 April 2009

Pandemics and Politics

 By Gwynne Dyer

At the time of writing, almost a week after we all learned that a lethal new strain of influenza had appeared in Mexico, every single death attributed to swine flu has been Mexican, and all but one of those deaths happened in Mexico itself. (The one exception was a Mexican toddler visiting Texas with his family.)

The media work themselves into a frenzy about how this may be a pandemic that kills tens or hundreds of millions of people around the world. Even with a prescription, you can no longer buy Tamiflu or Relenza, the leading antivirals that could lessen the impact of swine flu: in most countries, governments requisitioned the entire available supply last weekend. And yet air travel between Mexico and the rest of the world continues unhindered.

Our elders and betters assure us that a travel ban would not help.

The World Health Organisation’s assistant director-general, Keiji Fukuda, tells us that trying to contain the virus by enforcing travel restrictions “is not a feasible option.” Besides, he says, “the virus has already spread to several other countries.” Texas governor Rick Perry says that closing the US border with Mexico, crossed by tens of thousands each day, would be “a little premature.”

Am I alone in experiencing a desire to strangle these people? To begin with, Rick, you either close the US border now, or you don’t bother.

Closing it a week from now would be completely pointless. If human-to-human transmission of the virus has not already taken root in the United States, it will certainly have done so once another few hundred thousand people have crossed the border.

Obviously, people from other countries who are currently holidaying in Mexico (overwhelmingly Americans and Canadians) must be allowed to come home, but would it be unreasonable to monitor their health for a week or so in case they are carrying the virus? Indeed, shouldn’t we stop further holiday-makers from travelling to Mexico and ask Mexicans to stay home for a while? It would cause inconvenience, yes, but large numbers of lives are at stake here.

It may be too late to stop the spread of the virus by banning non-emergency travel to and from Mexico, but nobody knows that for sure.

The virus has already appeared in a dozen other countries, but at this point almost all the victims are still people who were recently in Mexico.

If the flow of further people from Mexico dwindled rapidly as the remaining tourists and business travellers came home, there would still be a chance of containing the virus.

If this “swine flu” really is like the “Spanish influenza” virus that killed tens of millions of healthy young adults in 1918-19, then we should be doing everything possible to hold it at bay. And even if the virus is bound to get out of Mexico in the end, it’s worth winning some time before it does.

It is spring across the northern hemisphere, where most of the world’s people live, and flu typically goes into retreat in the spring and summer. Even if it comes back in the northern autumn — and pandemic flu often comes in several waves some months apart, becoming more virulent in the later waves — by then we might have a vaccine ready. The process of designing and mass-producing the vaccine takes four to six months, which is exactly what immediate and severe restrictions on travel to Mexico now might win us.

So why do government bureaucrats everywhere, together with the international civil servants of the World Health Organisation, assure us in massed chorus that travel bans are futile? Because they work for governments whose economies could be severely damaged by those bans.

Governments do accept a certain responsibility for protecting the lives of their citizens, but even in the developed world, where resources are not scarce, they interpret that responsibility quite differently.

Britain and France have stock-piled antiviral medicines like Tamiflu for 50 percent of their citizens (and Britain is now going to over 80 percent).

Japan, Australia and New Zealand are all over 40 percent, but the United States only has 25 percent cover and Canada a mere 17 percent.

The biggest difference, however, is between the vague, general responsibility that governments feel for the lives of their citizens and the acute, real-time responsibility they feel for the health of their economies. They are inundated daily by demands from commercial and industrial organisations to keep the borders open and commerce flowing.

They are NOT inundated by demands by powerful citizen organisations to impose travel bans and save lives.

So they yield to the greater pressure, as governments generally do.

At the extreme, they conspire to hide the disease altogether, as China did with SARS (and Mexico may have done for some time with swine flu). And they lie routinely about the usefulness of stopping travel from infected countries, because to do so would gum up international commerce and damage economies.

The less reflective ones may not even realise any more that they are lying, because within WHO and the various national governments it has become an article of faith that you can’t contain pandemics once they move beyond the first few villages. But that is quite obviously bullshit.

Bullshit that could kill your kids.

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NOTE: YOU MAY WISH TO SUBSTITUTE “nonsense” FOR “bullshit” (TWICE) IN THE LAST PARAGRAPH.

To shorten to 725 words, omit paragraphs 2 and 5. (“The media…unhindered”; and “Obviously…here”)

SARS

17 April 2003

SARS and China: Get It Right Next Time

By Gwynne Dyer

The virus that causes Severe Acute Respiratory Syndrome (SARS) was identified on 15 April in a ten-country collaboration between 13 laboratories as a corona virus related to those that cause the common cold. “Now we can move away from methods like isolation and quarantine and move aggressively towards modern intervention strategies including specific treatments and eventually vaccination,” said David Heymann, executive director of the World Health Organisation’s communicable diseases programmes.

That’s the optimistic view. In Canada, where most of the SARS cases outside Asia have occurred, the tone is more cautious. “The problem in China is out of control so this is a virus that’s not going away. We’ve got this forever,” said Dr. Donald Low, chief microbiologist at Toronto’s Mount Sinai Hospital. But if quarantine measures continued to restrict the disease’s spread, he hoped, there would be time to develop a vaccine, or at least better therapeutic measures and diagnostic tests, before it spread too widely.

Almost on the same day, however, news broke that around five hundred members of a religious group in Toronto had been exposed to SARS and had continued to move around the city in the course of their normal lives for a week afterwards, raising the risk that the city is about to tip over into ‘community spread’. That happens when the diffusion has become so wide, and the difficulty of tracing all the contacts of each infected person so great, that individual quarantine ceases to be effective and it may be necessary to consider quarantining the whole community.

The worst of the four scenarios developed by scientists advising the SARS team in Toronto and leaked last week to the ‘Globe and Mail’ envisaged an epidemic spread of SARS in the city in which “the health-care system would be overwhelmed. Case fatality rates could rise due to inability to provide optimal care. Considerable societal disruption could occur and maintaining even essential services could become problematic.” That is the extreme case, of course, but it is not inconceivable.

The SARS virus is actually deadlier than the ‘Spanish influenza’ virus that caused the great pandemic of 1918, which infected between 20 and 40 percent of the world’s population and killed 20 million people in four months. SARS kills 4 percent of its victims compared to 2.5 percent for the Spanish ‘flu. The difference is in the speed with which it spreads: when the Spanish flu struck with full force in the autumn of 1918, tens of thousands died in just the first few weeks — and the young and healthy died just as fast as the old and those suffering from chronic health problems.

SARS, on the other hand, has probably killed fewer than 200 people in three months, and most of the victims have been over 65. The only worrisome thing is that the Spanish flu began with a mild version that travelled around the world in the spring of 1918, and then came back a few months later in a far more virulent form to ravage the planet — at which point public health care did collapse in many places and families had to look after their own as best they could. “I don’t think we know where on the path we are (with SARS),” said Dr. Edwin Kilbourne, professor emeritus at New York Medical College and one of the world’s leading experts on the 1918 pandemic.

The speed with which the medical world can identify new diseases and generate new vaccines is far greater than in 1918, but so is the speed with which new diseases can travel around the globe, thanks to cheap air travel. Since the main way for viruses to mutate into new and lethal strains is by hopping back and forth between people and their domestic animals, the urgent lesson to be learned from this episode is that China must clean up its act.

South China, where many rural people live under the same roof as their animals but also travel widely in the world, is a leading source of new viruses. The SARS virus first appeared there, in Guangdong province, in mid-November, but the Chinese government suppressed the news. It only came to the world’s notice when Dr. Stephen Cunnion, president of International Consultants in Health Inc, of Silver Springs, Maryland, which is currently installing modern labs in China, posted a query about the rumoured epidemic in Guangdong on an infectious diseases website in mid-February. By then, 305 people had been infected and five had already died.

“If (Beijing) would have acknowledged this early, and we could have seen the virus as it occurred in south China, we probably could have isolated it before it got out of hand,” said Dr. Cunnion. “But they completely hid it. They hide everything. You can’t even find out how many people die from earthquakes.”

The cover-up continues even down to the present: Alan Schnur, head of WHO’s office in Beijing, visited military hospitals in Beijing this week after Jiang Yangyon, a former surgeon at one of the hospitals, accused Health Minister Zhang Wenkang of systematically understating the number of those infected in China. Schnur concluded that Beijing probably has “between 100 and 200” cases of SARS, not the 37 officially declared.

This has got to stop. No considerations of Chinese pride or pecial political circumstances can excuse this kind of behaviour, which exposes the whole world to risk. Pressure should be brought on the Chinese government to guarantee that next time, everybody in the world hears about a new disease at the same time. How much pressure? As much as necessary.

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To shorten to 725 words, omit paragraphs 3, 9 and 10. (“Almost…community”; and “If…declared”)