Avian Flu Diary: Anniversary

Showing posts with label Anniversary. Show all posts

Wednesday, March 06, 2013

Branswell: Remembering SARS

SARS Spread April 2003 – Credit WHO

# 6986

The `must read’ of the day from from the inimitable Helen Branswell of the Canadian Press, who takes us back to the first real epidemic threat of the 21st century: SARS.

At this point, I’ll simply step aside and invite you to read:

SARS: Memories of global health crisis still fresh in the minds of the players

Helen Branswell,

Wednesday, March 06, 2013 2:10 PMTORONTO - It's a thing you notice about the people who came through the SARS crisis of 2003. Survivors, responders — they remember the outbreak in exquisite detail.

Read it on Global News: Global News | SARS: Memories of global health crisis still fresh in the minds of the players

Sunday, February 24, 2013

SARS And Remembrance

Credit World Health Organization – May 2003

# 6964

This third week of February, the 21st day to be exact, is the 10th anniversary of the arrival of SARS (Severe Acute Respiratory Syndrome) to Hong Kong. While the virus had been percolating stealthily across rural China since the previous November, this was its first known border crossing.

The virus arrived via a 64-year-old Chinese physician from neighboring Guangdong Province who had recently treated atypical pneumonia cases at Zhongshan hospital.

Asymptomatic when he began his journey, by the time he checked into a 9th floor room of the Metropole Hotel, he was beginning to show signs of illness. Exactly how the virus was transmitted to a dozen guests or more staying at that four-star hotel may never be known.

Perhaps he coughed while standing in a crowded elevator, or contaminated door handles or the pen at the register when he signed in at the lobby. It was speculated he might have even vomited in the hallway.

In October of 2003, WHO issued a consensus document on the epidemiology of SARS that included:

– The implications of the Metropole Hotel outbreak are not yet fully understood.

Intensive investigations of circumstances surrounding the late-February outbreak in the Metropole Hotel, Hong Kong, which seeded the international spread of SARS, have not yet answered all questions. During this incident, the virus was transmitted to at least 16 guests and visitors, all linked to the 9th floor of the hotel. The results of environmental sampling on the carpet outside room 911, where the index case resided, and elevator areas show a hot zone (possibly vomitus or respiratory secretions). Samples were PCR positive for the virus 3 months after the index case spent a single night at the hotel. Although tests demonstrated the presence of SARS coronavirus RNA and not viable virus, this finding may have implications for the persistence of the virus in the environment.

The Metropole Hotel outbreak is recognized as a “superspreading event”. However, the index case did not have an unusually high viral load when tested on days 9 and 11 of illness.

By whatever means, Dr. Liu Jianlun – who died in a Hong Kong hospital two days later – became known as as the first international `super spreader’ of the disease.

The results of his fateful visit to Hong Kong are recounted below in the WHO document Severe acute respiratory syndrome (SARS): Status of the outbreak and lessons for the immediate future.

Days later, guests and visitors to the hotel’s ninth floor had seeded outbreaks of cases in the hospital systems of Hong Kong, Viet Nam, and Singapore.

Simultaneously, the disease began spreading around the world along international air travel routes as guests at the hotel flew home to Toronto and elsewhere, and as other medical doctors who had treated the earliest cases in Viet Nam and Singapore travelled internationally for medical or other reasons.

This still unidentified virus quickly began to show up in Vietnam, Singapore, and even Toronto – and hospital workers – unaware that a new, virulent and highly infectious pneumonia virus was before them, were exposed and infected.

By March 12th, after reviewing the situation in Hanoi, Hong Kong, and Beijing, WHO issues a global alert about cases of atypical pneumonia warning that Cases Of Severe Respiratory Illness May Spread To Hospital Staff.

Two days later (March 14th), three cases appeared in Singapore, brought in most likely by a flight attendant who had also stayed at the Metropole hotel in Hong Kong.

The next day, the World Health Organization issues emergency travel advisory as it became apparent that whatever this virus was, it was spreading rapidly.

This syndrome, SARS, is now a worldwide health threat,” said Dr. Gro Harlem Brundtland, Director General of the World Health Organization. “The world needs to work together to find its cause, cure the sick, and stop its spread.”

While the virus was definitely on the move, eventually making it to more than 30 countries, no city was harder hit than was Hong Kong.

Between March 11th and June 6th, a total of 1750 cases were identified, and of those, 286 died.

In time, the virus was identified, and contained (see Hong Kong’s Coronavirus Response), with quarantine being the most effective weapon in the public health department’s arsenal.

But not before nearly 8,000 were infected worldwide, and nearly 800 died.

Bad . . . but not as bad as it might have been. In many ways we were lucky that time.

Unlike with influenza, patients were not infectious until they displayed overt symptoms, making the identification and isolation of cases possible.

Last month, In EID Journal: A Brief History Of Quarantine, we looked at the long, successful history of this most basic of public health interventions, and how it was utilized during the SARS outbreak. I wrote:

During the 2003 SARS epidemic, Isolation was used in the United States for patients who were ill, but since transmission of the virus was very limited here, quarantine was not recommended for those exposed (cite).

In other countries, where transmission risks were greater, quarantines were used – quite successfully – in order to contain the virus.

Singapore was one of the first countries to mandate quarantines when more than 800 family members of SARS patients were ordered to stay in their homes.

Hong Kong sealed part of the Amoy Gardens Apartment complex after scores of cases erupted there, and later moved all remaining residents to two holiday camps where they were quarantined.

And Toronto, Canada closed schools and quarantined thousands in their bid to contain the virus (see The SARS Experience In Ontario, Canada).

The graph below shows two distinct phases of disease transmission in Canada, both apparently dampened by the implementation of quarantines.

While the aggressiveness of quarantine measures taken in Toronto have been criticized by some (see Severe acute respiratory syndrome: Did quarantine help?), many experts have stated that quarantining those exposed (usually in their own homes) helped to halt the epidemic.

The full story of the SARS outbreak is both long, and fascinating, and I heartily recommend both Karl Taro Greenfeld’s The China Syndrome: The True Story of the 21st Century's First Great Epidemic and David Quammen’s excellent book Spillover: Animal Infections and the Next Human Pandemic.

The remembrance of this crisis has no doubt helped to amplify the concerns of the public - and health officials - in Asia, and around the world over the recent emergence of another coronavirus in the Middle East.

This novel coronavirus (NCoV) is not SARS, and so far it has failed to demonstrate an ability to spread as easily as did SARS.

Nevertheless, this week - along with a lot of media stories recalling the the 2003 SARS epidemic, we are seeing a number of cautionary statements from doctors and researchers regarding this NCoV.

Vigilance urged over new coronavirus

Concerted efforts in enhancing surveillance and control measures for novel coronavirus

Not because they are convinced that this newest coronavirus presents an immediate or inevitable public health threat. But because the remarkable success in containing the 2003 SARS epidemic demonstrated the value of a swift, and coordinated, global public health response.

The future of NCoV is highly uncertain right now. It could continue to threaten - or it could easily fizzle – finding itself unable to adapt well enough to humans to thrive.

These are, as they say, early days.

But if NCoV does fade away, it might very well be due to the unsung efforts of local, regional, and global health officials and researchers (at the WHO, ECDC, CDC, CHP, HPA, etc) who are currently seeking to better understand this virus, and contain its spread.

The old saying is true, `When public health works, nothing happens’.

Friday, August 24, 2012

Remembering Andrew: 20 Years Ago Today

# 6514

Infrared image of Andrew over Dade county

0900 UTC August 24, 1992. (566K GIF)

Today marks the 20th anniversary of Hurricane Andrew, which struck Homestead Florida with CAT 5 force on August 24th, 1992.

I was living aboard my 36 foot sailboat on the west coast of Florida at the time, making hurried plans of what I would do if this monster storm turned in my direction.

As it turned out, I was spared Andrew’s wrath, only to be clobbered 7 months later by the 1993 `storm of the century’.

So today, as we watch an increasingly active Atlantic Basin and the threat posed by a much weaker Isaac heading for the Gulf of Mexico, a remembrance of that disaster 20 years ago.

Here is how Ed Rappaport, of the National Hurricane Center (updated 10 December 1993) described the storm.

Andrew was a small and ferocious Cape Verde hurricane that wrought unprecedented economic devastation along a path through the northwestern Bahamas, the southern Florida peninsula, and south-central Louisiana. Damage in the United States is estimated to be near 25 billion, making Andrew the most expensive natural disaster in U.S. history¹.

The tropical cyclone struck southern Dade County, Florida, especially hard, with violent winds and storm surges characteristic of a category 4 hurricane (see addendum on upgrade to category 5) on the Saffir/Simpson Hurricane Scale, and with a central pressure (922 mb) that is the third lowest this century for a hurricane at landfall in the United States.

In Dade County alone, the forces of Andrew resulted in 15 deaths and up to one-quarter million people left temporarily homeless. An additional 25 lives were lost in Dade County from the indirect effects of Andrew2. The direct loss of life seems remarkably low considering the destruction caused by this hurricane.

Since this writing, of course, we've seen even greater destruction and loss of life caused by Hurricane Katrina in 2005.

Whether it is an earthquake, a flood, a hurricane, or a pandemic . . .those who are prepared in advance will find their survival, and even their comfort, greatly enhanced during an emergency.

If you aren't convinced on the importance of being prepared for the unexpected, just click on the pictures below.

They are hard to argue with.

STORM IMAGES (Credit NOAA)

(click to enlarge, but warning: Some are very large)

The last radar image taken from NHC before the WSR-57 radar was blown off the roof, 0835 UTC August 24, 1992. (120K JPEG)

ANDREW'S DAMAGE

The roof sign says it all! (555K GIF)

Lakes by the Bay (751K GIF)

Naranja Lakes (524K GIF)

Naranja Lakes (520K GIF)

Homestead Fl. (530K GIF)

Homestead Fl. (434K GIF)

Devastating hurricanes like Andrew may only come around infrequently, but they do happen. And as Florida’s SERT reminds us;

It only takes one.

Meanwhile, the latest forecasts from the NHC on T.S. Isaac are increasingly encouraging for the west coast of Florida, but less so for the upper-middle Gulf coast.

As the 5am Discussion this morning states:

IT IS IMPORTANT NOT TO FOCUS ON THE EXACT TRACK DUE TO UNCERTAINTIES IN THE INITIAL LOCATION AND THE TRACK FORECAST...AND THE FACT THAT ISAAC HAS A LARGE AREA OF TROPICAL STORM FORCE WINDS ASSOCIATED WITH IT.

Much will depend on how well the storm hangs together as it passes over Haiti and then Cuba, and how quickly it coalesces once over the warm waters of the Gulf of Mexico.

Computer models become more reliable once a storm reaches, and maintains, hurricane strength.

In any event, all interests along the Gulf Coast, from Texas to Florida, need to keep an eye on this storm over the weekend.

Sunday, April 24, 2011

24 Months Later

# 5516

Two years this week, novel H1N1 swine flu erupted out of Mexico and in short order spread around the world.

On April 21st of 2009 I was driving from Florida to Missouri and just pulling into Springfield when my good buddy Sharon Sanders of FluTrackers called me to let me know that two unusual cases of Swine Flu had been detected in San Diego.

Seventy-two whirlwind hours later (Apr 24th), I returned from my ill-timed hiatus and began blogging on what would become the first pandemic of the 21st century.

At the time, we knew very little about the virus. Early reports out of Mexico suggested it might be severe, but too little data was available during those early days to make that assessment.

Although the picture would become clearer over time, and Swine flu was proven to be less deadly than initially feared, those first few days illustrate just how thick the `fog of war’ can be during an emerging crisis.

This morning I thought it would be useful to look back to where we were 2 years ago today, and to remember how little we really knew about the crisis that lay ahead.

What follows are some excerpts from the first blog I wrote upon returning from my trip to Missouri.

Afterward, I’ll return with some comments.

Friday, April 24, 2009

Trial Run Or The Real Thing?

# 3028

In my ill-timed absence news stories about a newly emerging `swine’ flu virus have been breaking in rapid succession – particularly over the past 48 hours.

While it is too soon to know just how serious this virus will end up being, there can be no doubt that many public health scientists are watching these developments with concern.

This story is, after all, unfolding much in the way that an outbreak of a novel pandemic virus might be expected to play out.

But that doesn’t mean a pandemic has begun, or that this virus will spark the next pandemic.

So, before everyone heads down to the bunker, it should be noted that there is a lot about what is going on we don’t fully understand yet.

Sure, this outbreak could have `legs’, and this virus could go on to have a major impact . . . . but it could also recede back from whence it came.

Right now, it is impossible to know what will happen.

The Swine Flu outbreak at Ft. Dix in 1976 vanished as mysteriously as it first appeared (see A Case of Deja Flu) , and the short-lived `lethal flu mutation’ (see Sometimes . . . Out Of The Blue) in England and Wales in 1951 died out in a matter of weeks.

SARS, which appeared in 2003, died out more or less of its own accord as well.

We honestly have very little idea why sometimes a virus persists, and sometimes it simply fades away.

And of course, even while this new `swine flu’ rears its ugly head, the H5N1 bird flu virus continues to percolate in places in Indonesia, Egypt, Vietnam and presumably China.

No matter what this virus ends up doing, that threat hasn’t diminished.

So regardless of what happens with this virus, we should be looking at this incident as a valuable learning tool. A reminder that – almost overnight – a new pandemic virus can leap onto the scene.

Good enough reason to review your personal and business pandemic and disaster plans, to make sure you have the emergency supplies you and your family would need to deal with a crisis.

This is also an excellent time to talk to your friends, family, and neighbors about the need to be prepared.

Maybe we get lucky.

Maybe this virus peters out, or never becomes the killer flu that we’ve feared from other viruses.

I hope so.

But if it does fade away, I hope we are wise enough use this as a wakeup call.

To accept it as a not-so-gentle reminder that we are vulnerable to pandemics, and other disasters, and that being prepared is our best defense against whatever comes next.

In the end, novel H1N1 had `legs’, although its severity was far less than it might have been.

The next time, we may not be so lucky.

Too many people have already forgotten the lessons of the pandemic of 2009. They’ve moved on to other concerns, and pandemic preparedness has been – if not forgotten – at least put on the back burner.

It is as if the world has decided that we’ve `had our pandemic’, and that it may be another 40 years before we see another.

And besides . . . “Swine flu wasn’t so bad . . .”

And while that may end up being true, in the span of 20 years -between 1957 and 1977 - we saw several million people die from the H2N2 and H3N2 influenza pandemics, and the surprising (and deadly) return of the H1N1 virus after a 2 decade absence.

Proving that pandemics and emerging viruses don’t run on any predictable schedule.