Caught Unawares

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Caught Unawares

• The risk of being unprepared
• to listen

Joan Deppa, Ph.D., Associate professor S.I.
Newhouse School of Public Communications Syracuse
University, Syracuse NY 13244-2100 Jadeppa_at_syr.edu
July 13, 2005 Upstate NY SRA Symposium The
Syracuse Technology Garden
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Crises
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Common themes

• Warnings and/or early signs of risk
• Delay and/or denial by authorities
• Actions by ordinary people, some heroic

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SARS first pandemic of 21st c.

• Spread to 29 countries
• Caused about 8,000 cases
• Led to 774 deaths
• Most cases and all deaths were adults
• 50 of victims were infected in hospitals
• 21 of victims were healthcare workers

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Guangzhou, China

• November 23, 2002
• WHO officials receive clues that an unusual
  respiratory disease is emerging in Guangdong
  province. Dr. Klaus Stohr, head of the WHO
  influenza team, later recalls how a health
  official from the province spoke about a highly
  infectious respiratory disease that was causing
  deaths and making health care workers sick as
  well.
• Canadian Broadcasting Corp.

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GPHIN translates a headline

• The Global Public Health Intelligence Network
  (GPHIN), developed by Health Canada in
  collaboration with WHO, is a secure
  Internet-based multilingual early-warning tool
  that continuously searches global media sources
  such as news wires and web sites to identify
  information about disease outbreaks and other
  events of potential international public health
  concern. GPHIN is one of the most important
  sources of informal information related to
  outbreaks. More than 60 of the initial outbreak
  reports come from unofficial informal sources,
  including sources other than the electronic
  media, which require verification.

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GPHIN translates a headline

• The link provided led to this Website.

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(Later, the CBC will translate)
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Guangzhou, China

• January 3, 2003
• The daily newspaper for Heyuan City reports that
  two people had been diagnosed with atypical
  pneumonia on December 15.
• It says people in the city have begun to crazily
  purchase antibiotics because of rumors about the
  spreading of an unknown virus.
• The reporter checks with the citys Center for
  Disease Control and is reassured that there is no
  unknown virus .

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Guangzhou, China

• January 5, 2003
• Two days later a reporter for the New Express in
  Guangzhou follows up by interviewing Dr. Yilong
  Wu, head of the No. 3 hospital of Zongshan
  University, who says that atypical pneumonia is
  not infectious.

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Toronto Vancouver, Canada

• January 2003
• Chinese-language newspapers in Canada carry
  stories about the strange respiratory disease in
  China.
• Pharmacists in Vancouver report customers buying
  surgical masks to send to family members
  overseas.

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Toronto Vancouver, Canada

• January 2003
• Toronto's Sing Tao newspaper asks What's to
  stop that epidemic from coming to Canada on a
  plane?

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Guangzhou, China

• Unpublished WHO data a second wave of disease
  with amplified transmission to health workers
  began occurring during the first 10 days of
  February
• David Heymann
• World Health Organization

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ProMED-mail A free, early alert, global
electronic surveillance system for the detection
and communication of outbreaks.

• Date 10 Feb 2003
• From Stephen O. Cunnion, MD, PhD, MPH
  International Consultants in Health, Inc. Member
  ASTMH, ISTM
• This morning I received this e-mail and then
  searched your archives and found nothing that
  pertained to it. Does anyone know anything about
  this problem? Have you heard of an epidemic in
  Guangzhou?
• An acquaintance of mine from a teacher's chat
  room lives there and reports that the hospitals
  there have been closed and people are dying.
• Two other people contacted ProMED that same day
  with similar news. Six subsequent e-mail posts
  detailed the Guangdong Province, China,
  pneumonia outbreak.

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Guangzhou, China

• THE AP (and others) REPORT
• Travelers wearing masks wait outside a train
  station in Guangzhou, southern China, Tuesday,
  Feb. 11, 2003 after a virus outbreak. An
  unidentified pneumonia virus has killed five
  people and left hundreds hospitalized in southern
  China while rumors of a surging death toll
  prompted frightened residents to stock up on
  antibiotics. (AP Photo/Vincent Yu)

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Guangzhou, China

• NEW CHINA NEWS AGENCY
  
  
• Guangzhou, 11 February
• The municipal people's government of Guangzhou
  says an outbreak of atypical pneumonia in the
  city in southern China is now under control.
• Monitored by the BBC

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Guangzhou to Hong Kong

• Feb. 15, 2003 A man, known as patient A, from
  Guangdong province develops symptoms of SARS. He
  travels to Hong Kong to visit family.
• Feb. 21, 2003 Patient A checks into a hotel. He
  infects 12 other people in the same hotel.
  Investigators say these patients in turn spread
  the illness to others in Hong Kong, Vietnam,
  Singapore, Ireland, Germany and Canada.
• Feb. 22 Patient A is hospitalized in Hong Kong.
  He dies the next day. Four hospital workers and
  two of his family members become ill. One family
  member dies.
• NPR

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Hong Kong to Canada

• March 5, 2003 A 78-year-old woman who had
  traveled to Hong Kong in February dies in
  Toronto.
• Initially, her death is blamed on cardiac arrest.
• NPR

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Toronto, Canada

• March 7, 2003
• The womans son, Chi Kwai Tse, 44, arrives at
  Scarborough Grace Hospital emergency room with
  severe symptoms. Doctors are stumped.
• Nurse Agnes Wong remembers something she read in
  a Chinese paper. "I read another story about a
  young family in Hong Kong. They took a trip back
  to Mainland China and then the father got sick,
  the daughter got sick and then eventually at the
  end of the trip two family members died. So that
  is really sad and very unusual. That stayed with
  me."
• Canadian Broadcasting Corp.

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Toronto, Canada

• Agnes Wong wonders if this case was caused by the
  same agent. She calls the night nurse at
  Scarborough Hospital and asks her to check
  whether anyone in the family had traveled to Hong
  Kong or China.
• When the night nurse calls back, she says the
  patients mother had traveled to Hong Kong and
  come back ill.
• So I told them to notify the physician. It's
  just somehow I made the connection, maybe it's a
  nursing instinct. Maybe it's sixth sense.
• Canadian Broadcasting Corp.

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(No Transcript)
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Toronto, Canada

• Health Update
• SARS Severe Acute Respiratory Syndrome
• On March 14, 2003, the Ontario Ministry of Health
  and Long-Term Care alerted health care providers
  about four cases of atypical pneumonia resulting
  in two deaths within a single family in Toronto.
  These cases provided an epidemiological link to
  Severe Acute Respiratory Syndrome (SARS) in
  Ontario..

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(No Transcript)
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GPHIN II, November 17,2004

• Ted Turner and Sam Nunn through the Nuclear
  Threat Initiative finance expansion of the
  program
• The Atlanta Journal-Constitution reports
• The new network will search for reports of
  diseases and other health hazards in six
  languages --- English, French, Russian, Arabic,
  Spanish and Chinese --- instead of just English
  and French as it did before. And it will do it
  around the clock, alerting health officials to
  unusual health-related events from Mongolia to
  Madagascar.

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China in denial over foot and mouth cull Attempt
to hide slaughter echoes response to bird flu and
Sars

• By Jonathan Watts in Dabailou village
• Tuesday May 24, 2005 Guardian
• In the idyllic setting of the Beijing countryside
  a short drive north of the Great Wall, a secret
  slaughter is taking place.
• Hundreds, possibly thousands, of cows have been
  killed in Dabailou village since the start of the
  month in a frantic attempt to stem one of China's
  worst foot and mouth disease scares.But instead
  of warning the nation's farmers and turning the
  village into a quarantine area, the authorities
  have mounted a botched attempt to cover up the
  news.

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Flu in wild birds sparks fears of mutating
virusExperts pressure China for samples that
can be analysed. Nature 435, (2 June 2005)

• The deaths in China of more than 1,000 migratory
  birds from the flu strain H5N1 has left experts
  struggling to square the outbreak with their
  knowledge of the virus. At the same time, rumours
  are beginning to circulate that humans in the
  region have also fallen victim to the disease ?
  although official sources have so far denied this.

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Flu in wild birds sparks fears of mutating
virusExperts pressure China for samples that
can be analysed. Nature 435, (2 June 2005)

• The H5N1 strain has killed at least 53 people in
  Asia since late 2003, and is seen as one of the
  prime candidates for sparking a human pandemic.
  Migratory birds can act as carriers of flu, but
  their role in spreading highly dangerous strains
  such as H5N1 remains a matter for debate.
• Until the latest outbreak, only a handful of
  migratory birds were known to have died from
  H5N1. This led some experts to suggest that the
  migrants are asymptomatic carriers of the virus,
  causing the occasional outbreak among poultry
  populations along their migration routes.

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Crises