Unlocking SARS

1
Unlocking SARS

• What is Severe Acute Respiratory Syndrome and
  why should I be aware of it?

2
SARS background

• SARS first appeared in China in February of this
  year.
• On about March 15th, 2003, the World Health
  Organization issued a Worldwide Disease Alert
• This Alert is unprecedented in my life time. I
  have never seen a worldwide disease alert.

3
SARS background

• SARS has spread in China to at least 5 of its 10
  provinces
• SARS has spread to Hong Kong, Singapore,
  Thailand, Korea, Vietnam and was spread to
  Canada, the US, Europe, and is now showing up in
  Brazil, Pakistan, and is now infecting people in
  about 20 different nations.

4
SARS background

• The mortality rate the proportion of people
  that die when infected is about 4
• To put this in perspective, the great Spanish Flu
  Epidemic of 1918 had a mortality rate of 2.5
• In the Spanish Flu Epidemic of 1918 between 20
  and 40 million people died worldwide.

5
SARS background

• There is a reason why there is a Worldwide
  Disease Alert
• There are currently (April 16, 2003) about 3,500
  people that have been infected worldwide and
  about 180 people have died.
• This does not seem to be a big problem at all to
  us at this time most people are unconcerned.

6
SARS epidemiology

• Mathematical models of SARS growth in the
  population suggests that in a very short time,
  some 3 or 4 months, there could be many 10s, if
  not 100s, of thousands of people infected if the
  disease continues to infect people as it has for
  the last month.
• It is not unreasonable to expect between 5k to 6k
  worldwide infected by the end of April, 2003.

7
SARS epidemiology

• So far, of the approximate 200 people infected in
  the US, no one has died from SARS. But
• In Hong Kong, SARS is now killing young persons,
  e.g., 25 to 50 years old who were apparently
  healthy before they were infected.
• There is no cure for SARS at this point.

8
SARS epidemiology

• SARS is caused by a coronavirus
• Members of the coronavirus family that are
  relatives of SARS include bovine coronavirus,
  murine hepatitis virus, avian bronchitis virus,
  porcine diarrhea virus.
• SARS is not any of these and is a brand-new
  virus.
• There is no vaccine for SARS

9
SARS epidemiology

• The viruses related to SARS suggest that it will
  be very difficult, in not impossible, to create a
  vaccine for the disease.
• Viruses related to SARS show that they are
  capable of reinfecting an animal that has
  previously survived an infection there does not
  seem to be development of natural immunity to the
  virus.

10
SARS Epidemiology

• Currently nations are employing quarantine
  procedures to isolate the sick from the not-sick.
• There are many reports that medical staff
  treating patients with SARS become infected
  themselves. Several hundred medical staff are
  infected with SARS in Hong Kong.

11
SARS epidemiology

• Quarantine procedures have been instituted in
  Toronto, Canada to deter disease spread including
  the closing of 2 different hospitals and several
  health clinics.
• Singapore closed its schools to all K-12 students
  for 15 days and, just yesterday, opened them
  again with concern that they may need to close
  them again.

12
SARS epidemiology

• In the US, California, New York, Washington,
  Florida, and, Illinois have the highest number of
  SARS-infected persons. There are more than 30
  now in California.
• SARS is, as I said, a coronavirus. It is very
  similar to the viruses that typically cause the
  common cold but this is far more challenging.

13
SARS epidemiology

• There are no vaccines for colds despite years of
  interest there are no preventatives for colds
  there are only palliative treatments for colds.
• For SARS, some Chinese hospitals have used
  ribavirin and steroids to help people get through
  the disease.

14
SARS epidemiology

• Lets assume 100 people are infected by SARS
• 80 of those hundred will survive the infection
  just fine and have only a really-bad cold
• 20 of those infected will go on to have really
  serious breathing problems and may require
  hospitalization and ventilator treatment
• 4 of those 20 will die
• The 20 will be in the hospital for gt 10 days

15
SARS Epidemiology

• What are the symptoms?
• A fever of 100.5 degrees
• A persistent dry cough
• Malaise and body aches
• Serious shortness of breath
• SARS is, as you probably know, highly contagious
  (but it is not as contagious as a flu
  (orthomyxovirus) virus)

16
SARS epidemiology

• The SARS coronavirus can survive outside the body
  on a dry surface for at least 3 to 4 hours.
• The main vectors of infection appear to be
  water-droplets sprayed out when an infected
  person sneezes or if the fomite falls on surfaces
  that people touch.
• It can be spread by any body fluid contact

17
SARS epidemiology

• It is likely that the SARS coronavirus can be
  airborne but not quite so infective as an
  influenza virus (which is also airborne
  transmission).
• There are many researchers working on ways to
  stop the disease right now including both the
  World Health Organization and the Centers for
  Disease Control in Atlanta, Georgia.

18
SARS epidemiology

• Will these scientists be successful in stopping
  this disease?
• It is hard to say so far, the disease appears
  to be spreading in an exponential fashion the
  numbers infected are really going up quickly.
• Quarantine procedures have slowed the epidemic
  but have not stopped its growth

19
SARS epidemiology

• Regular reports from infected nations are
  published on number of infected persons in each
  nation on a daily basis by the World Health
  Organization.
• Daily reports on the number of infected in the US
  are published by the CDC in Atlanta and both are
  available daily on the web.

20
SARS epidemiology

• Is this an epidemic?
• You are witnessing the beginning of an epidemic
  an outbreak of a new disease
• Numbers are growing no cure, no very effective
  treatments no vaccines
• Luckily, the US has had no deaths yet Americans
  have died but were in China
• Canada has had 13-15 deaths
• We are in the very early stages of an epidemic

21
SARS epidemiology

• Will SARS become a pandemic?
• A pandemic is a global epidemic
• It is highly likely that it will become a global
  pandemic
• There are reports of SARS outbreak in Africa,
  Bangladesh, and other places in the 3rd world
• These countries do not have the sophisticated
  health care system that exists in the US and,
  once established, it will spread quickly

22
SARS epidemiology

• What was the virus again?

23
SARS virus under electronmicroscope
24
SARS virus

• What is the DNA code for the SARS virus?
• About 27,000 nucleotides long
• Adenine, Cytosine,Guanine, and Thymine
• CDC sequenced the virus on 4/14/03

25
SARS virus

• You can view the sequence of DNA of the virus at
• http//www.cdc.gov/ncidod/sars/pdf/nucleoseq.pdf
• And the phylogeny is here http//www.cdc.gov/ncid
  od/sars/pdf/proteinanalysis.pdf

26
SARS virus

• You can learn to do multiple sequences
  alignments on this or any other virus and learn
  what viruses SARS is related to if you like.

27
Where will SARS go?

• SARS cases will continue growing for the next
  months
• IF quarantine procedures work and IF nations act
  responsibly to prevent disease THEN it may be ok
  and well only see some 10k to 30k cases
  worldwide and only a few thousand deaths.

28
Where will SARS go?

• IF quarantine is not successful and IF nations
  and peoples do not act responsibly, we may have a
  1918-Spanish-Flu-like pandemic in the world. It
  is too early to know what will happen but it is
  soon enough to alert YOU to this possibility.
• You can protect yourself

29
How you can protect yourself

• You should wash your hands frequently.
• You should avoid going to areas that are SARS
  zones.
• You should avoid being around anyone that is
  infected with SARS.
• You should eat right, sleep right, and have
  generally good health and exercise.
• Dont worry just yet

30
How you can protect yourself

• Get yourself educated about SARS, its spread, the
  number of infected persons worldwide, what
  nations are infected, and follow the medical
  literature.
• Current literature on SARS is available here
  http//www.ncbi.nlm.nih.gov/entrez/query.fcgi?dbP
  ubMed

31
What if SARS shows up here?

• The college administration has been alerted to
  the fact that SARS is an emerging disease and is
  contagious.
• The CDC has issued policy statements for schools
  and universities to employ should SARS infect
  anyone at a school/university
• There is currently only a very-tiny risk to you
  personally next to ZERO

32
What if SARS shows up here?

• Should the next 4 months show the rapid growth of
  numbers infected as are predicted by a
  mathematical model, SARS will show up sooner or
  later.
• Remember that 80 of those infected recover
  completely and are just fine.
• Only 4 of those infected die.
• Time will tell in the next 6 months.

33
What might happen?

• It is hard to say either
• SARS will become a major pandemic rivaling the
  Spanish-flu epidemic of 1918 in magnitude, or,
• SARS will be a nuisance like mumps and measles
  used to be where some died, or,
• SARS will mutate into a mild form and will be
  just another cold virus
• NO ONE knows right now.

34
Why am I interested in this?

• Ive written a couple of books on viruses and
  have taught myself virology as a hobby.
• Im able to do multiple sequence alignments and
  BLASTS and other virus-hunter procedures
• As a psychologist and statistician, theres
  growing interest in the virology of mental
  illness and epidemiology in the field.

35
Questions about SARS or viruses?

• If you have any questions about SARS, the virus,
  its epidemiology, its mortality, its
  construction, relatives, its transmission, or DNA
  code, Ive read everything I can get my hands on
  about SARS for the last month.

36
Questions about SARS or viruses?

• The mathematical model for April SARS growth is
  here
• http//www.bhc.edu/eastcampus/leeb/aids/images/SAR
  SexpApril2003.pdf
• Thank you for listening.