Normally if a cancer cell line is injected into a mouse the cancer cells grow. Some scientists at Wake Forest University discovered a mouse that was immune to injected cancer and have bred it and produced many generations of cancer-proof mice.
A cancer-proof mouse, which can survive being injected with any number of cancer cells, has been discovered by US scientists. The discovery of the resistant mouse could pave the way for future gene or drug therapies if the mechanism by which it fights cancer can be understood
This is amazing for a few different reasons. First, it is amazing that it is possible at all. An immune system that can kill such a large variety of types of cancer which does not appear to cause auto-immune disorders is not something I would have expected to be possible. Cancer cells look too much like normal cells and most cancers (perhaps virally caused cancers are an exception) are probably expressing only genes that naturally are expressed in human cells. So where does the specificity come from that lets an immune system knock out a large variety of cancers? Just figuring it out will reveal very useful knowledge.
What is also amazing about it is that the mutation happened and someone noticed. It is hard to say what the odds are for the occurrence of a mutant that would have the resistance to cancer.until it is discovered how the mechanism works and how many mutations had to happen for a mouse to have cancer resistance. Still, it seems amazing to me.
Here are more details.
WINSTON-SALEM, N.C. – Scientists at the Comprehensive Cancer Center of Wake Forest University have developed a colony of mice that successfully fight off virulent transplanted cancers.
"The mice are healthy, cancer-free and have a normal life span," the 10-member team reported in the Proceedings of the National Academy of Sciences online edition to be published the week of April 28.
The transplantation of the cancer cells in these special mice provokes a massive infiltration of white blood cells that destroy the cancer, said Zheng Cui, M.D., Ph.D., associate professor of pathology at Wake Forest University Baptist Medical Center and the lead scientist
"The destruction of cancer cells by these leukocytes is rapid and specific without apparent damage to normal cells," Cui said. "These observations suggest a previously unrecognized mechanism by which the body can fight off cancer."
The discovery of a genetic protection from cancer in mice "may have potential for better therapy or prevention of cancer in people," the team said. It also could help explain why some people are protected against cancer despite prolonged and intense exposure to carcinogens..
The discovery also could help solve another mystery. For years, scientists have been searching for the mechanism that permits spontaneous regression of human cancers without treatment. Cui said these cases are well-documented, but occur rarely. The new mouse colony gives the team the opportunity to study the mechanism in an animal model.
Cui and his colleagues began the mouse colony almost by serendipity. As part of ongoing cancer studies, they were injecting a virulent type of cancer cell that forms highly aggressive cancers in all strains of laboratory mice and rats. When injected into the abdomen, the tumor grows exponentially, causing the abdomen to fill with fluid within two weeks. The cancer can then progress by metastasizing into the liver, kidney, pancreas, lung, stomach and intestine.
But, said Cui, one male mouse unexpectedly remained free of the cancer despite repeated injections. The Wake Forest team was able to show this was genetic and to develop a colony from that single mouse. The colony, now about 700 mice, remains exclusively at Wake Forest. Meantime, the original mouse "remained healthy, cancer-free and eventually died of old age after a normal lifespan."
When the cancer-resistant mice were bred with normal partners, the researchers found that about half of their offspring were resistant to cancer cells, indicating that this genetic protection is dominant and is likely due to a change in one gene. The resistance continued in future generations.
Depending on the age of the mouse, some had complete resistance -- the cancer never got started -- while others displayed spontaneous regression -- the cancer started developing over a period of a couple of weeks, but then it rapidly disappeared in less than 24 hours.
"The mice became healthy and immediately resumed normal activities including mating," Cui said. They tested them again with another injection of the cancer cells. He said that once the mice developed the protection, they never again developed the cancer.
The researchers said the mouse model "represents a unique opportunity to examine cancer/host interactions."
Cui said the new mouse model also may help in solving another medical mystery -- why cancer becomes more common when people age. The usual explanation is that mutations accumulate in the body, leading to precancerous conditions that eventually become cancer.
But, he said, the mouse model suggests that the body's natural protection -- which scientists call host resistance -- declines with age.
Note that this result suggests another reason why the aging of the immune system is a significant problem. Luckily, it will probably be easier to develop rejuvenating cell therapy treatments for the immune system (also see this post) than for many other systems of the body.
How would a mutation that is found in a laboratory mouse strain be usable to create an anti-cancer therapy for humans? Well, the human and mouse genomes have both been sequenced and they have corresponding sections that can be lined up for 90% of their regions. Once the mutation location(s) responsible for this are found in mice then it is likely there will be a corresponding regions in the human genome. It may be possible to introduce equivalent mutations into the DNA of human leucocyte stem cell lines using gene therapy and then inject those stem cells into humans suffering from cancer. Then the cells would multiply and turn into immune cells that fight cancer. Many parts of the transfer of blood stem cells between humans is routinely done as part of leukemia treatments and for other disease treatments..
This mutation (or set of mutations - the capability may the result of a combination of mutations) is likely to have previously occurred in the wild. The fact that the mutation does not normally occur in wild type mice or naturally in other mammalian species suggests that either protection against cancer was not selected for by evolution because other things were killing mammals first or that the mutation has some cost in terms of reproductive fitness. It will be interesting to see how that shakes out.
Even if the mutation turns out to have some downsides it might still be useful as part of a therapeutic treatment. After all, when the downside of not getting treated is death then the side-effects (whatever they might be) of a revved up immune system may be worth it. Also, it might even be possible to add the mutation in a way that can be turned on and off. Attach the relevant gene to a regulatory region that can be switched on and off by a drug. Then even if there was a side-effect to this capability in the immune system it could be activated only long enough to wipe out a cancer.
Another thing that is great about this discovery is that it provides a model to figure out. Here's an immune system that can wipe out a large assortment of cancers. How? The detective work that will be done to figure that out will yield information that is useful by itself. It is even possible that the discovery of the knowledge of how these mice attack cancer will point the way to how to train an immune system to fight cancer with a method less drastic than gene therapy. Perhaps a vaccine could be developed that would train a human immune system to do the same.
Mice fed every other day had their rate of aging decreased in ways analogous to a calorie restriction diet.
Eating double portions one day and nothing the next delivers the same health benefits to mice as seen in animals whose lifespan has been extended by restricting their calorie intake.
Eat every other day and live longer. The rats fed every other day experienced lower blood glucose and blood insulin just as happens when on calorie restriction diets. But the rats fed every other day had normal body weight.
This might be doable with the development of an appetite suppression drug. One could take it before going to bed and then not eat the next day. Then wake up the following day and pig out.
Update: Mark Mattson, the NIH National Institute of Aging scientist who conducted the study, says skipping meals is probably beneficial.
Nevertheless, Mattson said, "I would be very confident in saying that healthy adults don't need three full meals a day and would be better off skipping one or two. When you go without food, there are benefits. Your cells become more efficient. I haven't eaten breakfast for 20 years."
Mattson said a study is being planned to test the effect of fasting on people. The plan is to compare the health of a group of people fed the normal three meals a day with a similar group, eating the same diet and amount of food, but consuming it within four hours and then fasting for 20 hours before eating again.
Here is the original press release from the NIH/National Institute On Aging on Meal Skipping Helps Rodents Resist Diabetes, Brain Damage.
A new mouse study suggests fasting every other day can help fend off diabetes and protect brain neurons as well as or better than either vigorous exercise or caloric restriction. The findings also suggest that reduced meal frequency can produce these beneficial effects even if the animals gorged when they did eat, according the investigators at the National Institute on Aging (NIA).
"The implication of the new findings on the beneficial effects of regular fasting in laboratory animals is that their health may actually improve if the frequency of their meals is reduced," says Mark Mattson, Ph.D., chief of the NIA's Laboratory of Neurosciences. "However, this finding, while intriguing, will need to be explored further. Clearly, more research is needed before we can determine the full impact that meal-skipping may have on health."
In the study*, published in the Proceedings of the National Academy of Sciences Online Early Edition the week of April 28, 2003, Dr. Mattson and his colleagues found mice that were fasted every other day but were allowed to eat unlimited amounts on intervening days had lower blood glucose and insulin levels than either a control group, which was allowed to feed freely, or a calorically restricted group, which was fed 30 percent fewer calories daily than the control group. Despite fasting, the meal-skipping mice tended to gorge when provided food so they did not eat fewer calories than the control group. This finding in mice suggests that meal-skipping improves glucose metabolism and may provide protection against diabetes, Dr. Mattson says.
In the same study, mice on these three diets were given a neurotoxin called kainate, which damages nerve cells in a brain region called the hippocampus that is critical for learning and memory. (In humans, nerve cells in the hippocampus are destroyed by Alzheimer's disease). Dr. Mattson's team found that nerve cells of the meal-skipping mice were more resistant to neurotoxin injury or death than nerve cells of the mice on either of the other diets.
Previous studies by Dr. Mattson and his colleagues suggested that nerve cells in the brains of rodents on a meal-skipping diet are more resistant to dysfunction and death in experimental models of stroke and other neurological disorders including Parkinson's, Alzheimer's and Huntington's diseases. Dr. Mattson also has found that meal-skipping diets can stimulate brain cells in mice to produce a protein called brain-derived neurotrophic factor (BDNF) that promotes the survival and growth of nerve cells.
Dr. Mattson and his colleagues are currently studying the effects of meal-skipping on the cardiovascular system in laboratory rats. The findings of this study, which compares the resting blood pressures and heart rates of rats that were fasted every other day for six months with rats allowed to eat unlimited amounts of food daily, should be available soon.
The NIA leads the Federal effort supporting and conducting biomedical, clinical, social, and behavioral research on aging. This effort includes research into the causes and treatment of Alzheimer's disease, Parkinson's disease, stroke and other neurodegenerative disorders associated with age. Press releases, fact sheets, and other materials about aging and aging research can be viewed at the NIA's general information Web site, www.nia.nih.gov.
*RM Anson, Z Guo, R de Cabo, T Iyun, M Rios, A Hagepanos, DK Ingram, MA Lane, MP Mattson, "Intermittent fasting dissociates beneficial effects of dietary restriction on glucose metabolism and neuronal resistance to injury from caloric intake," Proceedings of the National Academy of Sciences Online Early Edition the week of April 28, 2003 http://www.pnas.org/cgi/doi/10.1073/pnas.1035720100
It would be surprising to see pharmaceutical companies try to develop drugs that either stimulate the production of BDNF or that mimic the effects of BDNF.
A widespread lack of trust in their government is causing many Chinese people who suspect they are sick to avoid contact with doctors and hospitals.
"The government has said the people are panicking because they don't understand SARS, but that's wrong," said Kang, the social scientist. "They are panicking because they don't know who to rely on. The migrant workers in Beijing are afraid that if they are quarantined they won't get treated, just left there to get sick and die. Their flight is actually a rational response."
The previous report is more important than the fact that the WHO reports that SARS is declining in many of its major sites of infection.
BEIJING -As the World Health Organization announced that SARS had peaked and is declining in Hong Kong, Singapore and Canada, Chinese officials continue to withhold information crucial to combating the spread of the deadly virus, the U.N. agency's chief representative in Beijing charged Monday.
While some stock markets are rallying in reaction to WHO statements that SARS has peaked in many locations and a lot of people are breathing sighs of relief that perhaps the worst is behind us these optimistic reactions seem premature. SARS is being controlled in highly industrialized countries and also in Vietnam. But it is spreading deeper into China and there are worrying signs that it is getting a hold in India. With a 10th SARS case reported India has been reporting at least one SARS case a day for the last 4 to 5 days.
Medical experts warned that health authorities needed to do more to tackle the disease as SARS had entered the "local transmission" phase in which Indians who had returned to the country carrying the virus were now infecting fellow citizens.
If SARS becomes well established in rural India and rural China then there is no way it is going to be eradicated in the foreseeable future. There will then be a continuing risk that it will spread to still other less developed countries. An increasing portion of the world will come to be seen as made up of high risk destinations to visit. This will cut economic growth in those areas and in the world as a whole.
Individual Westerners who do not travel to regions which have SARS infection are going to continue to be at very low risk of getting the disease. In any locale where SARS shows up in the West the Western governments will conduct fairly aggressive programs to hospitalize sufferers and quarantine those who have been exposed (my guess is that other Western governments are learnng from Toronto to move quickly). The skilled personnel, supplies, and infrastructure are available to stop a local outbreak from getting out of control. Realistically a typical Westerner or resident of other industrialized countries such as Japan will be at greater risk of death from a car accident.
However, the economic impact of SARS is going to be great for the West in part because risk avoidance behaviors in the infected regions and among those who might otherwise travel to the infected regions will be so great. China is going to shut down its stock markets for at least a week. The economic effects of SARS are extending far beyond the infected countries and the global economy is slowing.
There are two big unknowns at this point:
Obviously, the answer to the first question greatly affects the size of the needed economic restructuring. But there are already many signs that computer and communications technologies are being used to reduce the economic impact of SARS. For instance, home banking use is surging in Hong Kong. Also, Video conferencing is enjoying a boom. Teleconferencing, telecommuting, email, mail order shopping, and other means of reducing one's exposure to other people are all helping to reduce the impact of SARS on the world economy.
The researchers discovered the two distinct patterns of disease. The five teenage patients had symptoms similar to SARS in adults - muscle pains, malaise, chill and rigour. However, the younger children had mainly coughs and runny noses with no muscle pains or chills.
And there is another more ironic proof of the seriousness of the situation — It is dusk here right now, and it is a clear, blue, glorious evening. The quality of this sky you do not see except when someone is in town that the government wants to impress, such as the International Olympic Committee, and the government shuts down the main thoroughfares and any industry that is going to pollute.
Tissue engineers who recently demonstrated penis replacement in animals have now added a vital missing component - nerve cells.
"The nerve cells are very important - they are responsible for all the sensory function," says Anthony Atala, at Boston Children's Hospital. "In order to do complete [penile] replacements we need to make sure all of the parts are there, including the nerves."
Keep in mind FuturePundit's rule for biotechnology: any biotechnology developed for repair will eventually be used for enhancement. There will be a big demand for this.
Biotechnology offers other promising future improvements. A couple of years ago a report was made on growth of breast tissue. The days of silicone implants are numbered.
Preimplantation Genetic Diagnosis (PGD) is done to embryos in vitro to identify embryos which are free of specific genetic disorders. In Vitro Fertilization (IVF) followed by PGD was first performed in 1989 and is now widely available. In Sydney Australia 74 babies have been born who were the result of PGD screening.
A special investigation by The Daily Telegraph today reveals she is one of 74 babies born in Sydney since the genetic screening program began in the late 1990s.
The particular clinic featured in this article, Sydney IVF can currently screen for 37 different genetically caused disorders.
Dr Kylie De Bore, from Sydney IVF, said the service was now available to rural families who previously had to come to Sydney for it. "We can screen for 37 disorders, because families have come to us with that many diseases," she said. "It is not restricted to those."
As the cost of DNA testing declines it seems likely that many people will elect to have tests done on themselves and their mates before conceiving children. There are already many genetic diseases such as Thalassemia, Tay Sachs, Cystic Fibrosis, and Retinitis Pigmentosa which could be avoided thru use of PGD. As the list of known genetic disorders and methods to test for them grow the value of PGD will increase.
Most genetic variations that cause differences in offspring are not diseases. Genetic variations affect eye color, hair color, height, body build, proneness to depression, proneness to obesity, intelligence, personality, and a great many other characteristics about which most people have preferences. We all have characteristics that we have gotten from one of our pairs of chromosomes. When someone reproduces there is currently no way to control which of each pair of chromosomes gets passed along. If, say, someone knew that for their genetic complement only one of a particular pair of chromosomes coded for higher intelligence or a happier disposition one can easily imagine that person would elect to use PGD to make sure that their offspring received the chromosome that coded for the desired feature.
Most people do not have the genetic variations for the big genetic disorders. But everyone who has children has a set of preferences about what they want those children to be like. Therefore it stands to reason that the real big future increase in demand for PGD will come when it can be used to exert some degree of control over the passing along of genetic variations that are not genetic disorders. PGD will therefore become much more popular once the effects of a much larger number of genetic variations become known and testable.
The biggest problem with PGD that will limit its usefulness is that for every trait to be selected for at the same time the number of embryos goes up by a factor of 2 or 3 or 4 (depending on whether it is a dominant or recessive trait and whether each parent has 0, 1, or 2 copies of the desired genetic variation). The number of needed embryos quickly becomes too large for too many different traits.
Scientists hope to improve the technology to the point where it can screen for one, maybe even two, positive 'traits' - for example blue eyes and height. That would still rule out the ideas of the genetic visionaries like Stock, who think PGD could be the first step to 'designer babies' and the re-engineering of mankind, by allowing parents to select among their embryos for all sorts of desirable (to the parents) qualities. The reasons this cannot work are not technical so much as statistical, to do with the way genes are passed on through sex. To screen for two traits you need at least 16 embryos, for three, 64 embryos and so on. Since the maximum number of embryos an IVF procedure produces are typically between 16 and 20, you can do the sums.
What is needed is either the ability to select individual chromosomes by separating them out and choosing which ones to recombine or the ability to do gene surgery to chromosomes to introduce desired genetic variations into an embryo. The gene surgery style of gene therapy is the technique that will ultimately obsolesce the need to generate a large number of embryos with IVF in order to get one that has the desired characteristics. The ability to change the genetic sequences in chromosomes will allow a single IVF embryo to be reshaped to have any desired genetic variations.
Air flights are not a huge source of risk for SARS infections. Aircraft use high-efficiency particulate air (HEPA) filters and take all bacteria and viruses out of the air at a very fast rate. Airplanes have better air filtering than commercial buildings.
Plane air is completely replaced with air from outside the aircraft 20 to 30 times every hour. This compares favourably against one to three times an hour in a typical building and five to seven times in a hospital operating theatre.
Granted, one could be seated on an aircraft right next to someone who has Severe Acute Respiratory Syndrome (SARS) and that person could cough on you. But consider the odds. The vast majority of those who have SARS are on the ground at any given time. Most do not fly from one place to another before being diagnosed and hospitalized. Few SARS cases to date have been traced back to exposures that happened on aircraft.
The biggest single kind of location for passing SARS on has been in hospitals. But most hospitals do not have SARS cases and so hospitals outside of areas which have a high level of SARS cases do not pose a risk as a source of SARS infections either.
The biggest danger from air flight comes from flying to a place that has a lot of SARS cases. Well, anyone who is worried about catching SARS should avoid visiting those (primarily East Asian) locations. The biggest danger to the rest of the world for SARS comes from the fact that people can fly from SARS-infected areas while still at early undiagnosed stages of infection. The greater danger from infected air passengers comes from the possibility that they will pass SARS along while staying for days at their destinations.
Public health experts are becoming increasingly pessimistic about the prospects for stopping the spread of SARS.
With infections now confirmed in two-thirds of China's provinces and mounting daily, ''hope dwindles'' for wiping out the disease, WHO virologist Wolfgang Preiser said from Shanghai. Even in ''Singapore and Hong Kong, very rich places, they still have problems. We are worried about the spread to poor provinces, maybe countries such as India and Bangladesh,'' where ''we don't think they have the capacity to stem the tide once it's introduced.''
''It may have happened already,'' he said.
Within the past day 3 new cases of SARS have been identified in India.
The Health Ministry has confirmed three more cases of SARS in India, which takes the total number in the country to seven. Of the three freshly confirmed cases, one is being treated in Kasturba Hospital, Mumbai, the second in Apollo Hospital, Kolkata and the third in Naidu Hospital, Pune.
If it was my decision to make I'd order the cessation of all commercial passenger flights between East Asia and the countries of the Indian subcontinent and Africa. Those countries do not have the capacity to contain SARS. They are too poor and most of their populations have little or no access to modern health care facilities.
Poor countries in the Indian subcontinent such India are unwilling to take sufficiently drastic steps to stop SARS in advance of a major SARS outbreak in their region. This is foolish. They lack the infrastructure needed to control SARS. As a result, the industrialized countries will have to adopt very rigorous measures at borders and ports of entry to detect SARS carriers because SARS is going to become endemic in much of the world. Thermal imaging and testing for SARS in all arriving and departing passengers will have to become routine at all ports of entry.
Reliable, accurate, and cheap DNA-based Real-Time Polymerase Chain Reaction (RT-PCR) SARS tests are the greatest hope the industrialized countries have for controlling SARS in a way that minimizes the economic impact. An ideal test would be able to use sputum so that a nurse would not be needed to draw blood. To allow testing of large volumes of business travellers an ideal testing device would need to be automated and have a high thru-put rate.
If all SARS carriers could be identified among international travellers even before they boarded aircraft to fly to a SARS-free country then regular business and holiday travel between SARS-free countries could proceed as normal. Also, anyone willing to risk going to an area where SARS is present would not need to be quarantined on return. Patterns of business meetings could be shifted to allow people from SARS-infected areas to travel to SARS-free areas to facilitate customer-supplier meetings. Then people in low risk areas would not have to travel to high risk areas to do business with the high risk areas.
If Taiwan could develop large-scale DNA-based SARS testing systems and use them to make Taiwan SARS-free then Taiwan could gain an advantage by making Taiwan as a place where mainland Chinese businessmen could travel to meet with businessmen from other parts of the world to do deals. Everyone coming to Taiwan could be tested before and on arrival for SARS virus. That way SARS carriers could be kept out. Business could be done in a safe environment fairly close to China. This would reduce the economic disruption that SARS is causing.
There are countries that are willing to take drastic steps. For instance, in order to keep out new cases of SARS Vietnam may close the 800-mile border it has with China.
Vietnam's northern Quang Ninh province, home of the Halong Bay tourist attraction, began barring Chinese tourists at its land border gates and waterways. Hanoi's health ministry has recommended the country seal all its borders with China indefinitely.
Countries that lack the capacity to fight SARS should be willing to close their borders to visitors from countries which have SARS cases.
The New York Times has an excellent long article that traces the spread of SARS. While China made huge mistakes in its handling of the crisis Singapore shines as a textbook example of how to aggressively quarantine and isolate potential SARS carriers.
But even in a small country, placing thousands on quarantine has been a strain. Last Monday, after a case of SARS was discovered in a vendor at Singapore's largest vegetable market, the Ministry of Health ordered all 2,400 food sellers to report for quarantine, up from a total of 467 quarantined before. Since 80 percent of the country's vegetables pass through the Pasir Panjang Market, restaurants were bracing for a shortage of greens.
Hong Kong has done a much worse job than Singapore in protecting health care workers.
In Singapore, with its aggressive system of identifying and isolating SARS patients, no health care worker has been infected for over three weeks. But in Hong Kong, 2 to 10 doctors and nurses are falling ill each day, in part, health officials there say, because doctors are still not identifying them as SARS victims early enough and are admitting them to ordinary wards.
Only recently -- weeks, if not months, after SARS hit -- have officials in China and Canada begun cordoning off entire buildings containing infected patients. Physicians such as Abraham Verghese say that slow response permitted the deadly virus to infect many others in their own countries and beyond. "The lesson of Hong Kong, China and, to some degree, Singapore is if you don't aggressively isolate, this thing can get out of hand," said Verghese, director of the Center for Medical Humanities and Ethics at the University of Texas Health Sciences Center at San Antonio.
Its apparent incubation period of two to 10 days is long enough for infected people who are asymptomatic to travel "from one city in the world to any other city having an international airport".
SARS is most likely a coronavirus. Other known coronaviruses can survive on surfaces for 24 to 48 hours.
Research done decades ago showed that the type of coronaviruses that cause many colds can remain viable on surfaces for 24 to 48 hours, depending on air temperature and humidity.
How long do coronaviruses survive in the environment?
In general, enveloped viruses such as coronaviruses do not last a long time in the environment. In earlier studies, a different coronavirus was shown to survive for up to 3 hours on surfaces. At this time, it is uncertain how long the newly discovered coronavirus associated with SARS can survive in the environment. In one preliminary study, researchers in Hong Kong found that both dried and liquid samples of the new coronavirus survived as long as 24 hours in the environment. Additional studies are under way to examine this important question.
People who live in areas where SARS is present should wash their hands frequently, avoid touching their faces or other parts of their bodies with their hands, and minimize the number of surfaces they touch in public areas. There are lots of ways to reduce one's need to touch surfaces. Do not use hand rails. Keep your hands on your lap when sitting in a public place. Use a stick or other object to press elevator buttons. Become more aware of where you are going and what you will have to touch in order to get there.
Update: If SARS does make it to the less developed countries the number of peope killed could be enormous.
With many cases still unresolved, a better current estimate of the deadliness of SARS may be the number of deaths as a proportion of resolved cases. Those numbers for Hong Kong, Canada and Singapore are 15.8, 18.3 and 13.7 per cent. But these too could be misleading if, for example, it takes longer to recover from a disease than to die from it.
There are other indications that the SARS death rate may be higher than expected. Mortality among infected SARS patients might end up being in the range of 8% to 15% of infected patients. Keep in mind that the death rate varies as a function of age and the death rate is higher in the elderly. Still, overall it is lookiing like the death rate from SARS is going to turn out to be at least 10%.
"If one looks carefully at the WHO figures on mortality and recovery rates, it is running, unfortunately, at 10 per cent," Professor Roy Anderson of Imperial College said.
Update II: Chinese infectious disease experts see a coming third bigger wave of SARS infections in China.
Bi and other experts have said that Beijing officials did not take adequate measures last week to stop Beijing's huge migrant labor population from returning home, and thereby possibly spreading the disease across China.
"The government held meetings for hours with no decision and meanwhile, everybody left town," Bi said. "Beijing is the second peak of the disease. The third one, in the countryside, will be much, much higher."
My fear about the coming third wave is that it will spread SARS into areas adjacent to China. Granted, most land borders of China are in pretty sparsely populated and harsh environments. But SARS could spread across Central Asia and eventually into more densely populated Asian countries.
Two more cases of Severe Acute Respiratory Syndrome (Sars) have been reported in India, taking the total number of people infected with the pneumonia-like virus there to nine.
SARS cases seem to be popping up in India daily. This is not good. All it would take is for one of these cases to be a "super-infecter" (also called "super-carriers", "super-spreaders" or "hyper-infecters" in some reports) for the disease to start spreading rapidly there.
Keep in mind that SARS cases in India are orders of magnitude more significant than SARS cases in more developed countries because India is far less able to control the spread of a disease. Places like Canada, the United States, Taiwan, and Singapore have the ability to identify cases, isolate them, trace those who might have been exposed, and generally take the steps that will eventually put a halt to the chain of spread. But if SARS makes it into areas where there are large numbers of poor people and primitive health care the disease will become a greater threat to the entire world. Pay especial attention to reports of SARS cases in the Indian subcontinent and Africa. The battle to prevent a global SARS pandemic will be won or lost in the poorest countries.
Growing fear of Severe Acute Respiratory Syndrome (SARS - also called atypical pneumonia in the Chinese media) has caused 1 million people to flee Beijing for other parts of China.
There was a continued exodus from Beijing today as thousands of people attempted to flee the epidemic and return to their home towns all over China. At the Beijing airport, travelers wearing face masks boarded planes out of the city. Local journalists estimated that almost 1 million people, about 10 percent of the population, had already left the capital.
This is an astounding figure. When is the last time that so many people took such drastic action in such a short period of time in response to a natural biological threat? Imagine how people would respond today to an even bigger infection threat. SARS does not spread as easily as influenza. Some day a new influenza strain that is more lethal than the typical influenza strains will arise. It could cause panic around the world.
The rush to flee Beijing has been fueled by the fear that the government would declare martial law and close off the city from the rest of China. The government has had to announce that it would not impose martial law but it is unlikely that the Beijing public believes it.
This is guaranteed to spread SARS further and faster. Infected people riding on airplanes, trains, and buses will pass the disease along to other passengers. They will also pass it on to people they have contact with at their destinations.
The treatment of those suspected of being exposed to SARS in Beijing is considered to be so harsh that people may be hiding their SARS symptoms from the authorities.
Sars suspects are being victimised in Beijing, where thousands have now been put in compulsory quarantine, a World Health Organisation specialist, Dr Wolfgang Preiser, said yesterday.
"If you make it hell for them, they go into hiding," Dr Preiser, a German virologist, told reporters in Shanghai.
While some might cheer the prospects of the Chinese government coming under intense criticism from its own population for the government's handling of SARS keep in mind that a revolution in China would by itself kill millions and that the chaos of a revolution would cause SARS to spread even faster.
Supermarkets reported a roaring trade in staples such as rice and cooking oil as rumors swirled the city would be isolated, while many other shops simply closed up as scared residents stayed at home.
At least this is a rational response. To reduce the risk of exposure in a high infection area it makes sense to buy a lot of food at a time and shop less often. It also makes sense to shop during the off-hours to reduce the number of people one is exposed to. If there was a big outbreak it would make sense to have open air markets so that the air would be dispersed quickly.
There is lots of bad news about Severe Acute Respiratory Syndrome (SARS). SARS is continuing to spread and to establish itself in more locales. The death rate has risen. It appears to mutate rapidly. There appears to be a more lethal strain that also infects the intestines and SARS is causing kidney failure in some patients. Tens of thousands of people (if not more) are fleeing Beijing and in the process helping to accelerate the spread of SARS to more parts of China. Effective drug therapies and vaccines are both distant prospects.
Different SARS coronavirus isolates have been sequenced and compared and many DNA sequence differences have been found.
The mutations were seen in all five of the viruses' known functional genes, with most of them occurring in the gene that carries the instructions for the distinctive spikes that jut from the outside of the virus, according to Siqi Liu, associate director at the Beijing Genomics Institute, part of the Chinese Academy of Sciences.
Those mutations on the outer coating are important because they can create new strains of the virus that are immunologically distinct. A person who has already been infected by SARS and recovered from it would be at risk of reinfection if exposed to a different strain of SARS that had undergone a lot of mutations in genes that code for outer layer proteins. Also, rapid mutation that generates immunologically different strains makes the job of development of vaccines more difficult and makes the period of protection from a vaccine version shorter.
"The ability of the virus to mutate has been a real problem in poultry vaccines. "The virus has the ability to change quite quickly - a vaccine might be suitable for a while, but not forever."
As I've previously posted, vaccine development time for SARS is measured in years. Well, this news that SARS is mutating rapidly will most likely lengthen the amount of time it will take to develop a vaccine. This is not good.
Rapid mutation can lead to more virulent strains. A more deadly SARS strain that attacks the intestinal tract may have already arisen.
The Amoy Gardens patients are three times as likely to suffer early diarrhoea, twice as likely to need intensive care and less likely to respond to a cocktail of anti-viral drugs and steroids. Even medical staff who caught the infection from Amoy Gardens patients are more seriously ill, Yuen said.
Tom Buckley, the head of the intensive care unit at Hong Kong's Princess Margaret Hospital, said organ failure was also now becoming more common.
"Initially patients were presenting with just respiratory failure," Dr Buckley said. "Now we're seeing renal failure and other organ failure."
Statistics in Hong Kong show that the death rate among people younger than 55 is 3.6 percent. For patients between 65 and 75, it is 18.9 percent. For those older than 75, the death rate is 28.6 percent.
The death rate from SARS in Hong Kong has increased to 7.2 per cent of reported cases - up from about 5 per cent earlier in the crisis - and officials fear it may go higher.
There are a number of possible reasons why the death rate is increasing. It could be that many of the initially infected tended to be healthy business travellers and health care workers. Now SARS is spreading from them to their families including older folks who are more at risk of dying from infections. Or the virus could be becoming more deadly as it mutates. Or some people may have been sick for weeks before finally succumbing. The real explanation may turn out to be a combination of factors.
CHINA: Beijing closed schools for two weeks and sent 1.7 million pupils home yesterday as the country struggled to contain a Sars outbreak thought to have originated in its south.
The 1,200 bed Beijing University People's Hospital was sealed off because of SARS today and police were posted to stop people going in or out, hospital staff said.
BEIJING, April 23 -- Thousands of people mobbed Beijing's West railroad terminal today in desperate attempts to flee the city as the capital reported another triple-digit increase in the numbers of people infected with SARS and nine more deaths.
But the relative safety of many of the provinces could prove shortlived if the infection is spread by the railway system.
If the infection is spread by the railway system? Why wouldn't it be spread that way? The infection is already being spread to many provinces of China. Surely some of that spread is happening via rail travel. But cars, airplanes, and other means of transportation are surely contributing as well.
When people start trying to get rail tickets for any place they can get a ticket for then real panic has set in.
Laden with burlap bags and potato sacks, they boarded trains for whichever destination they could get a ticket as the death toll jumped by 25 per cent in the Chinese capital.
Think about it. People are fleeing in panic from the capital of the world's most populated country. Most of the country has health care facilities that are primitive compared to Beijing's. People are spreading out to those more primitive places. My guess is that SARS will achieve pandemic status in China. The Chinese government's honesty (or lack thereof) in reporting SARS cases is becoming irrelevant as SARS spreads into the poorest areas of China. We will not know how many people in China have SARS because most of the future Chinese sufferers will be in areas too primitive for them to be seen by qualified medical professionals.
At least the people fleeing Beijing are trying to avoid enclosed areas where the risk of breathing airborne virus particles is greater.
A sea of faces in white cotton masks scanned coveted train tickets, waiting for hours outside in the chilly air rather than linger in crowded, enclosed waiting rooms.
BEIJING/TORONTO (Reuters) - Saying SARS was still spreading out of control, the World Health Organization tightened travel advisories on Wednesday, adding Beijing and Toronto to the list, while authorities in Beijing started quarantines.
Canada has responded angrily after the World Heath Organization (WHO) listed Toronto with Beijing and China's Shanxi province as places travellers should avoid because of the danger of Sars.
The Canadian government is being parochial. Steps to stop the spread of SARS need to be taken before it becomes an even bigger threat. The WHO should have gone much farther and told people to avoid China entirely. Plus, it should have asked that people in infected areas not travel from those areas.
China's government waited too long before acting. The spread of SARS to the poorer provinces of China makes it unlikely that the Chinese government will succeed now in stomping out SARS entirely. That, in turn, increases the odds that SARS will spread from China to even less developed countries. If SARS becomes established in India or, even worse, in Africa then it seems likely to achieve pandemic status.
The problem is that the more places SARS becomes established the greater the chance that on any given day there will be someone bringing SARS into areas where it hasn't become established. Plus, the greater the panic becomes the more people will flee infected areas and infected countries and carry SARS with them in the process.
The economic costs of trying to prevent the spread of SARS need to be weighed against the economic costs of what happens when it becomes established. In countries where SARS has taken root the economic costs of people becoming afraid to travel, go to jobs, meetings, and to go shopping in markets is becoming enormous. The Western industrialized countries need to work hard to prevent SARS from becoming big enough to start changing the behavior of a substantial portion of the population of each country. The economic costs would become staggering if SARS did come to be viewed as a threat to the population of the Western nations.
Countries should reduce the issuance of visas for people from infected areas. Some countries already are doing so. Saudi Arabia has stopped issuing visas to visitors from several East Asian countries. So has Israel. Belize has banned visitors from several countries including Canada. Singapore, Hong Kong, Tokyo-Narita, Beijing and other cities with international airports are installing thermal imaging systems to scan passengers for fevers. These are certainly steps in the right direction. More international airports should institute thermal imaging screening and other methods of screening incoming passengers. Unfortunately, it is the countries that are least able to afford to handle a SARS outbreak that will also be least able to afford extensive screening measures at their international airports.
Fast DNA-based SARS tests are essential for stopping the spread of SARS. As soon as fast DNA-based SARS tests become reliable the industrialized countries should use the tests extensively. At the very minimum, all suspected SARS cases and all their contacts should be tested and tested again. However, even more extensive testing regimes could be imagined. For instance, all people coming from infected areas could be tested or, for even more protection, all people coming into a country from any origin could be tested.
Infected areas that are relatively affluent and capable of carrying out fairly sophisticated measures to control SARS ought to consider testing their entire populations. For instance, Singapore's economic losses from SARS are so large and the benefits of being SARS-free are so large that once cheap and fast SARS tests become available city-state of Singapore ought to consider testing its entire population. Also, if a DNA-based test is not reliable within the first day or two of infection Singapore could consider putting people into quarantine for a day or two upon entrance into Singapore in order to test them again before letting them out into their general population. One way to make such a system workable would be to set aside hotels to use for quarantine and then to make each hotel receive only people who arrive on the same day with a rotating list of hotels looping thru the quarantine cycle.
The Eurasian land mass faces a more difficult task to contain SARS than do places that are geographically isolated with smaller populations. Countries like Taiwan, Australia, or New Zealand ought to be able to totally stamp out SARS and keep it out once fast DNA tests are available. But if SARS becomes established in Central Asia it will be able to jump across borders of impoverished countries and maintain its presence far more easily.
If SARS becomes established in countries that are significant sources of illegal immigrants then attempts to control SARS spread at borders of industrialized countries will become considerably more difficult. A SARS epidemic in Mexico would make SARS control in the United States much more difficult while a SARS epidemic in the Middle East or Africa would pose similar problems for Europe.
Update: The more industrialized countries ought to start taking more drastic measures now to help the poorer countries detect SARS sufferers entering their countries. For instance, an effort by the United States to help Mexico and Central American and Caribbean countries to screen international visitors for SARS infection (e.g. by training airport workers, providing thermal imaging machines, and eventually supplying help in testing passengers) will help the to prevent the spread of SARS into the United States. Either that or the United States had better be prepared to deploy troops on a massive scale to keep out illegal aliens coming up from Mexico potentially carrying SARS. That troop deployment may become necessary anyhow. SARS could be spreading in Mexico right now without our even being aware of it.
If the Asian Times staff are right China is already doing triage to decide in what parts of its country it will try the hardest to control SARS. The Chinese government may have already resigned itself to the wide spread of SARS into poor interior provinces and may be focusing its attention on Shanghai and other key trading and commerce cities. The industrialized countries need to start planning how they are going to keep a world SARS pandemic from reaching into their populations and disrupting the industrialized economies.
Update II: Time Magazine has an excellent article that confirms the widely suspected continued cover-up of SARS cases in Shanghai.
A doctor at the Shanghai Contagious Diseases Hospital told TIME that there are more than 30 suspected cases have been admitted to their hospital's facilities, nearly double the official suspected caseload for the whole city.
Basically, local authorities in China still are hiding the truth about SARS. Plus, in the poorer sections of China where SARS is spreading the local authorities will not even have the ability to know for themselves how many SARS sufferers there are. It sure looks like SARS is going to continue to spread thru China and therefore its chances of spreading to other parts of the world are probably increasing. The industrialized countries need to start scaling up to try to halt the spread of SARS into regions ill-equipped to handle it.
Once cheap fast SARS tests become available one great way to slow the spread of SARS would be to require the testing of all passengers on flights everywhere in the world. Also, all people crossing borders by other means should be tested as well.
The research by Professor Roy Anderson, due to be published in a medical journal next week, is expected to say the virus could kill between 8% and 15% - or one in seven - of those infected.
Keep in mind that SARS has a much higher death rate in the elderly. If you are young your own odds of dying from SAR woul be lower than this latest estimate and if you are old your odds would be much higher.
Lawrence Livermore National Laboratory (LLNL) is working on a PDA that can detect nuclear materials.
The device, known as RadNet, is designed to make calls, surf the Web, act as a Personal Digital Assistant, pinpoint locations with Global Positioning System technology and sniff out nuclear materials with a cutting-edge sensor. It is one of several national security projects being worked on at Lawrence Livermore National Laboratory.
The detector may eventually be built into a large assortment of vehicles and it could report detected radiation and a GPS-determined position automatically.
Livermore's Simon Labov, director of the lab's new radiation detection center, sees RadNet phones in the hands of police, firefighters and U.S. Customs agents. One day, though, Labov imagines the gizmos will be built into taxis, rental cars and trucks.
“In effect, all of the phones operating at any time are part of one large detector that is spread out throughout an entire geographic area,” Labov explained.
The deployed detectors would all report back to a central database where patterns of radiation changes could be detected and tracked.
With continuous monitoring and data collection, the system can look for patterns of radioactivity in a given area and detect changes that indicate a hazardous condition, he added.
A system of this sort wouldn't require human carriers to be looking at radiation detectors continuously. A microprocessor could automatically continuously read the radiation sensor in each device and it could automatically call in any reading it encountered that was above some threshold level.
Any type of sensor that can be paired with a microprocessor to look for anomalous sensor readings could be deployed in a similar fashion. A variety of chemical and biological agent detectors will surely be developed that can operate for long periods of time without the need to resupply reagents. Then mobile networks of automated biological and chemical terrorism detectors will be deployed along with the nuclear materials detectors.
But there are ways that chemical detectors could be used for more conventional law enforcement purposes. Consider how dogs can detect the smell of a person and track that smell. DNA samples are now widely collected from criminals. If some aspects of a person's scent are stable thru a period of years then it is not hard to imagine that some day scrapings of skin and sweat will be taken from each felon to be analysed to build a chemical signature of that person's scent. Then when chemical sensing technology becomes sufficiently advanced sensors that can detect specific chemical scent signatures could be deployed to continuously analyse the air in public areas. Wanted criminals could be identified by their scent as they pass a public detector. One could easily imagine banks allowing the deployment of such detectors so that the chemical signatures of bank robbers could be recorded along with video recordings.
The Bush Administration is pushing to change federal law to allow permanent retention of DNA samples from those arrested but not necessarily convicted of crimes.
Adding profiles from thousands of adult arrestees and juvenile offenders would greatly expand the DNA system's worth by increasing the number of potential matches, administration officials say. Justice Department officials have discussed potential changes in federal DNA law with key members of Congress and are pushing for legislation this year.
The American Civil Liberties Union (ACLU) is objecting to this proposal. The arguments here are interesting because this is not just an issue of being able to match a person's DNA with DNA that is found to be in some way connected with the commission of a crime. Another issue is that eventually many characteristics of a person will be discovered from analysis of a DNA sample. If genetic variations that cause particular personality types are discovered then a person's DNA could be analysed to see if it has genetic variations that are linked to particular personality and behavioral characteristics.
Governments have many conceivable uses of information about genetically determined characteristics. For instance, if there are genetic variations linked to how well someone can perform as a particular type of soldier then the military might want to look at the DNA profiles of all juvenile offenders (whether they were arrested for drunk driving or assault or just running away from home) to identify promising recruits for special forces. Also, if there are genetic variations that are more or less associated with loyalty and betrayal then intelligence agencies might want to look for recruits who are least likely to betray their country.
Some youthful offenders never commit another crime and some future career criminals are first caught committing a crime that is not particularly serious. Yet if there are genetic variations that make a person more prone to commit crime then someone identified from a first arrest (even if the charges are dropped) as having a DNA profile that matches a career criminal could then be pegged for future surveillance. Prosecutors could conceivably even push for long prison terms for first offenders if their DNA profile matches that of repeat offenders.
Widespread collection of DNA samples can potentially speed the rate of advance of understanding of the human genome. If it becomes legal to do so then as the cost of DNA sequencing falls the DNA samples collected from criminal suspects could be compared on a massive scale in order to discover which genetic variations correlate with which types of behavior. This would greatly help in the identification of genetic variations that contribute to intelligence, personality, and other human characteristics. If basic biometric data is collected (height, eye and hair color, weight, and assorted other measurable characteristics) then additional links between genetics and phenotypic characteristics could be discovered more easily.
The battle over DNA sample collection is just the first round. There will be many more rounds of political battle over what analyses should be allowed to be done to DNA samples in government hands. But the biggest question of all will be over what will be the allowable governmental uses for each DNA analysis.
Governments will not be the only users of DNA analysis results. Insurance companies and other businesses of course could find many applications for such data. However, personal uses of DNA analyses promise to be interesting as well and probably unstoppable.
Police will get powers to obtain and retain the fingerprints and DNA profiles of innocent individuals under proposed laws announced yesterday. A privacy expert with law firm Masons says this means that DNA profiles from nearly half the male population will eventually be contained in the police DNA database – and unless a pending House of Lords decision overrules lower courts, this practice will not breach human rights legislation.
The article on the British proposal brings up an interesting issue: criminals could get DNA samples from innocent people and then deposit such samples at the scenes of crime. This will become easier to do with time as equipment for growing human cells in culture becomes more widely available, cheaper, and easier to operate.
Scientists at Baylor College of Medicine have developed a gene therapy that causes liver cells to convert into insulin producing beta cells which normally are found only in Islets of Langerham in the Pancreas.
HOUSTON (April 21, 2003) – A gene therapy developed by researchers at Baylor College of Medicine has apparently cured diabetes in mice by inducing cells in the liver to become beta cells that produce insulin and three other hormones.
"It's a proof of principle," said Dr. Lawrence Chan, professor of medicine and molecular and cellular biology as well as chief of the division of diabetes, endocrinology and metabolism at the College. "The exciting part of it is that mice with diabetes are 'cured.' "
In the research, which is described in a report in Nature Medicine's online edition today, Chan and his colleagues used the NeuroD gene, a transcription factor that induces the liver to produce cells that make insulin and the three hormones associated with the pancreas' endocrine system.
The gene was attached to a so-called "gutless" adenovirus from which all toxic genes had been removed. This viral vector is a very efficient way to introduce genes into liver cells. Alone, NeuroD partially corrected the disease in the diabetic mice. Combined with a beta cell growth factor called Btc, the gene therapy complete cured the mice's diabetes for at least four months.
An added benefit is that the cells in the liver also produce glucagon, somostatin and pancreatic polypeptide, which may play a role in controlling insulin production and release.
"Until now it has not been possible to induce the formation of islets by any gene therapy approach," said Chan.
It does not mean that the treatment can be used in people immediately.
"It's farther from people than I would like," he said. He knows of no stumbling blocks to its effectiveness in people.
The main stumbling block is the vector or virus used to take the gene into the cells. Chan and his colleagues used the safest viral vector available today, but he expects even safer ones to be available within the decade.
"We want to use the safest vector possible," he said.
The treatment has advantages over transplant of islet cells, the insulin producers in the pancreas, because it avoids the lifelong use of powerful immunosuppressive drugs and eliminates the need to find a compatible donor.
Chan credits one of his postdoctoral students, Dr. Hideto Kojima, with much of the work in developing this protocol.
A UPI article about this report says this treatment does not permanently cure diabetes.
However, this "cure" is temporary and would require repeated injections, researchers point out. Also, just because this worked very well in mice does not guarantee such effects in people. "Unfortunately, it will probably take years," before such a treatment would be available to diabetes patients, Chan said. "Like any other gene therapy, the major concern is safety. People are quite different than mice.
The UPI article is the only article on this story that makes this claim that treatment does not last indefinitely. It seems odd. If cells are induced to differentiate into a different cell type I'd expect the new cell type state to be stable. Also, this treatment has already worked for 4 months in these mice. How long does it take for the treatment to wear off? It is possible that the NeuroD genes added to cells gradually break down and when they stop being expressed then all the downstream effects they cause in the cells stop happening.
Even if the injections had to be periodically repeated they'd still be an enormous boon for sufferers of Type I diabetes. Not only would diabetics be freed from daily injections, blood tests, and carefully regimented diets but they'd also live longer and healthier lives.
In the longer run gene therapies will improve to allow genes to be added to cells in ways that cause those genes to stay around permanently. Ways will be developed to deliver stable plasmids into cells and those stable plasmids will carry the desired genes.
My guess is that within 10 to 15 years type I diabetes will be a curable disease. If the genes used in this latest work have the same effect on human liver cells then the biggest remaining obstacle will be the development of better gene therapy vectors to deliver genes safely into cells. That's a topic that is seeing a great deal of work and it seems reasonable to expect better and safer gene therapy delivery methods will be developed within several years.
Some day in the future diabetics will be able to look at the color of their eye contact lenses in the mirror in order to detect their blood sugar level.
PITTSBURGH, April 14 – Millions of people suffering from diabetes mellitus may be spared the ordeal of pricking their fingers several times a day to test blood sugar levels, thanks to a breakthrough by University of Pittsburgh researchers who have developed a non-invasive method to measure the glucose level in bodily fluids.
Researchers Sanford A. Asher, Ph.D., professor of chemistry in the faculty and College of Arts and Sciences, and David Finegold, M.D., professor of pediatrics in the School of Medicine, created a thin plastic sensor that changes color based on the concentrations of glucose.
The sensor material, which would be worn like a contact lens, was described in a paper published in the online version of Analytical Chemistry on April 11. The paper is scheduled to be published in the print version of Analytical Chemistry, a publication of the American Chemical Society, on May 1.
"There has been a increasing demand for continuous, non-invasive glucose monitoring due to the increasing number of people diagnosed with diabetes mellitus and the recognition that the long-term outcome of these patients can be dramatically improved by careful glucose monitoring and control," said Dr. Asher.
"The current method of testing glucose in diabetes patients-by drawing blood from a finger prick-is uncomfortable and is dependent on patient skill and compliance for regular testing," said Dr. Finegold.
The researchers plan to embed the sensing material into contact lenses worn in the patients' eyes. Patients will determine their glucose levels by looking into a mirror-similar to women's makeup compact mirrors, but with a color chart to indicate glucose concentrations-to compare the color of the sensing material with the chart.
The sensor will change from red, which indicates dangerously low glucose concentrations, to violet, which will indicate dangerously high glucose concentrations. When the glucose level is normal, the sensor will be green. The researchers are still determining the number of detectable gradations, but expect that it may be as high as the finger stick meters currently provide.
The University of Pittsburgh, which owns this patented technology, has licensed this technology to a new startup company that will engineer the material and commercialize it. The researchers believe the product is at least a year from being tested in humans. The researchers expect that their technology would be able to be incorporated into currently available commercial contact lenses, which would be replaced weekly.
This seems like a pretty cool idea. While it is reasonable to expect that cell therapy or gene therapy will provide a cure for diabetes in 10 or 15 years the concept has other potential applications for measuring other body biochemical levels. Imagine a sensor keyed to measuring the severity of some other biochemical problem that could provide an indicator for when to take other drugs. Heck, sensors could be designed to measure the level of a specific drug and if one is taking that drug one could also wear a contact lens designed to detect it. Then one could glance in a mirror to see a color that indicates that one needs to take another pill.
A group of Japanese materials science researchers at Toyota Central Research and Development Laboratories in Nagakute, Japan have used computers to search thru large numbers of combinations of elements to discover alloys with qualities that exceed that of all known alloys.
While any other metal bends or breaks when experiencing forces well below theorized strength limits because of defects in their crystal structure, these new metals approach their ideal strength limits.
"You could not find this alloy just by mixing things and testing. It's just too many combinations -- millions of combinations," Shiflet said.
They have discovered titanium alloys which expand very little over a large temperature range and have other valuable qualities.
The alloys are strong yet unusually elastic, so they can deform more than other alloys and still return to their original shape. Engineers can also readily mold or bend the materials at room temperature into various shapes, a property called superplasticity.
The most interesting thing about this work is that it shows how the pace of material science research is going to accelerate. The ability to use computers in place of lab experiments is made possible by the continuing increase in speed of computers. Computers are getting fast enough to allow complex physical processes to be simulated. This allows the computer modelling of experiments. This ability to simulate physical experiments has the potential to accelerate many fields of science by orders of magnitude.
The fear of Severe Acute Respiratory Syndrome is causing an increasingly panicked response in Beijing China.
At Bank of China branches, there were no lines. The traffic at Western Station, the city's main rail terminal, has dropped 75 percent, to 80,000 passengers a day.
More than half of universities in Beijing said they would close indefinitely as the highly infectious disease spreads there.
It is important to remember that the coronavirus that is the probable cause of SARS is nowhere near as easily spread as influenza. Yet, as previous history demonstrates (most notably the 1918 Spanish Flu), very deadly influenza strains can infect the human population. Given that SARS can cause this degree of fear and panic and economic disruption then just imagine the effects on human behavior of an especially deadly influenza epidemic. Countries would close their borders. Cities around the world would become ghost towns. Natural biological phenomena still have the capacity to cause huge changes in the behavior of literally billions of people.
What I'd like to see come out of the SARS epidemic is a wider appreciation of the need to develop better capabilities to respond to natural disease outbreaks in the human population. Much of what needs to be done to prepare for natural disease outbreaks is also is helpful for handling bioterrorism attacks. Better monitoring systems are needed for both natural and man-made disease outbreak scenarios. Faster methods of identification and isolation and characterization of pathogens and faster methods for developing and manufacturing vaccines are all helpful for both types of scenarios. Advances in biotechnology are needed to speed up all the steps of response to a new disease.
Another area that needs to be looked at is how to allow people to carry out more of the normal activities of business and commerce with less exposure to other humans. What simple cheap things can be developed to allow people to move around and do things without coming into as much contact with surfaces other humans have touched or air that other humans have coughed particles into.
I can imagine all sorts of simple and cheap ways to reduce exposures. For instance, how about short sticks to use to press elevator buttons? Or how about more foot operated devices such as restroom soap squirters and water faucet operators so that people don't have to touch surfaces that other people touched?
Another important area that needs work is the development of better facial masks. This is an area that cries out for nanotechnological developments to create material that will filter air more efficiently and last longer. Masks should not become less efficient as they build up moisture from a person's exhalations of breath. Masks should be able to take more particles out of the air with less resistance so that breathing with them is easier.
Airline passengers arriving in Singapore from certain Sars-stricken areas are now being scanned for the disease by a military-grade thermal imaging camera, which will detect any increase in temperature, officials said.
One of the units is currently in use and another eight will be installed by the end of the week, Ong told The Associated Press.
Those who show up on the camera screen as “hot bodies,” or with a temperature greater than 37.5 C (99.5 F), will be pulled aside to have their temperature taken by a nurse, said government spokeswoman Evelyn Ong.
Singapore will also deploy thermal imagers to its border checkpoints with Malayasia. Other countries are following Singapore's lead as has been the case throughout the SARS crisis. Hong Kong's airport is also being equipped with thermal imaging to scan passengers.
In Singapore and Hong Kong, airports are being equipped with thermal imaging systems that can pinpoint feverish passengers
Thermal imaging is just one of the technologies being deployed in novel ways to fight the spread of SARS. The Ontario Province of Canada may join Singapore in placing electronic tracking bracelets on people exposed to SARS in order to monitor compliance with quarantine restrictions.
Dr. Young acknowledged the province is giving some consideration to putting electronic bracelets on people reluctant to stay in quarantine, as has been done in Singapore. "We're thinking about that and looking at that," he said. "There may be some legal issues involved."
Thermal imaging and electronic quarantine enforcement are just two of the ways that modern technology is changing how disease outbreaks are fought. The potentially most powerful tool in the modern epidemic fighting arsenal is DNA detection technology placed on DNA chips using low cost mass production. There are promising signs on that front.
Based on the discovered genetic sequence, the BNI has established a real-time PCR (Polymerase Chain Reaction) diagnostic test from which results can be obtained within two hours. From that test, artus developed a ready-to-use system (RealArtTM HPA-Coronavirus RT PCR Reagents) produced under GMP conditions (Good Manufacturing Practice). It will be available from artus and its subsidiaries in the USA and Malaysia from Monday, April 14th, on. Thomas Laue, project manager at artus says: "By providing this assay quickly, we hope to contribute to the standardization of SARS diagnostic worldwide. The early and rapid detection of the virus will be our small share in controlling this epidemic plague." The PCR assay directly detects parts of the new Corona virus in throat swabs, sputum and faecal samples. The RealArtTM HPA-Coronavirus RT PCR Reagents assay delivers results very quickly. The real-time PCR technique improves specificity, allows interpretation of results during the test and provides data about the quantity of the viruses in the sample material. Classical tests like antibody assays in blood allow detection of an infection normally much later, i.e. ten to twenty days after infection. The prompt results of the RealArtTM HPA-Coronavirus RT PCR Reagents assay allows immediate countermeasures by fast diagnosis, e.g. of travellers. By this, the rapid spread of the disease can be prevented.
Hot on the heels of the Artus announcement Singapore's Genome Institute has announced a 3 hour SARS coronavirus detection assay.
The state-run Genome Institute of Singapore said its new test would take three hours and may be sensitive enough to detect the virus in its early stages before a person develops Sars symptoms such as high fever and a dry cough.
How might the SARS outbreak be ended? Picture cheap, fast, and easy-to-use SARS virus detection tests that can detect SARS at a very early stage of infection. Such a test could be employed far more widely than quarantines. Everyone flying from an area where SARS has spread could be tested either before they get on the airplane or shortly after arrival at their destination airport and not released until their test shows a negative result. The same practice could be used at high risk ground border crossings as well. Plus, anyone found by either conventional thermometers or thermal imaging to be running a temperature could be tested and held until the result of the test is known.
If SARS testing could be made incredibly cheap then a more radical approach will become possible: test everyone for SARS. One could just test everyone in countries where SARS is spreading. Or one could, in the extreme, test the whole planet's population. If the testing was done in a relatively short period of time in a geographic area before non-tested people could pass along the virus to tested people then the disease could be eradicated from the human population in the area tested. Then in that area all people who entered could be tested.
Massive testing as a method to control the spread of a disease is easier to do for areas that are geographically isolated. For instance, it would be far easier to do this for Australia or Hawaii than it would be for a country on the Eurasian landmass. It would also be easier to do for areas that, for whatever reason, have little in the way of cross-border traffic.
The speed, cost, and ease of use of a test are not the only elements needed to make massive testing a feasible way to stop a dangerous disease outbreak. Another crucial element is the speed with which the test can be developed in the first place. SARS does not spread as rapidly as influenza and so it has not reached epidemic status in many locations. But the approximately 2 months that it has taken to develop fast tests for SARS (China knew about SARS 5 months ago but kept it secret and so the Western scientists have had only 2 months to identify the cause of the disease and to make tests for it) would be too long of a time for, say, a new and highly deadly influenza strain. However, it seems reasonable to expect that advances in nanopore technology, microfluidics, and other areas of biotechnology and nanotechnology will gradually shrink the amount of time it takes to identify a new pathogen and to sequence it. Once it is sequenced the creation of a new test for it can be done very rapidly.
What we are seeing in the response to the SARS outbreak is the development of elements of the future high tech public health disease fighting arsenal. Automated systems to detect disease and track human movement will only become cheaper and more powerful. Also, many other areas of relevant technology will surely see improvement. The current generation of facial masks will almost certainly be supplanted by greatly improved materials manufactured using nanotechology. The ability to protect a person from exposure will advance in a large variety of other ways including more advanced air filtration systems (again designed using nanotechnology), fancy personal instruments for monitoring individual health, and detection systems for airborne pathogens located in crowded public places. We may some day witness public health officials dispatched rather like police and emergency workers to quarantine an area and its occupants because a detector in some restaurant, airport, or hotel has signalled the presence of a dangerous pathogen.
Ultimately, just as technological advances have accelerated the rate at which diseases can spread other technological advances promise to entirely stop future epidemics at their very start. We may some day live in a future in which natural disease pandemics no longer happen.
You can read more about SARS from a more biological and public health perspective in my FuturePundit Natural Dangers Archive. For economic impacts see the ParaPundit Political Economics Archive. For what the response to SARS says about open versus closed societies see the ParaPundit Open Versus Closed Societies Archive.
Technology review has an interesting article on the work of Japanese researchers to convert natural gas into a solid form to make it easier to transport from small remote fields that would otherwise be too expensive to operate.
Japanese researchers Hajime Kanda and Yasuhara Nakajima at Mitsui Engineering and Shipbuilding in Tokyo think they’ve found a solution with the aid of hydrates, solid crystals in which natural gas—composed chiefly of methane—is caged inside of water molecules.
If the article is correct then currently most of the natural gas in the world is not exploitable because the fields are too small and can't justify the cost of building pipelines to transport the natural gas from them to market. If these Japanese researchers succeed then natural gas could become a much larger percentage of total fossil fuel use.
It is worth having a look at world natural gas reserves. The world total known reserves of oil is 1212.811 billion barrels and for natural gas it is 5,501.424 trillion cubic feet. Saudi Arabia has the biggest oil reserves at 261.800 billion barrels or about 21% of world oil reserves. But Russia has 1680 trillion cubic feet of natural gas or over 30% of world natural gas. Russia has only 60 billion barrels of oil reserves while Saudi Arabia has only 224.7 trillion cubic feet of natural gas.
What we really need to know is how to compare natural gas reserves and oil reserves for energy content. Some handy tables of energy conversion units provide the needed data. 1 cubic foot of natural gas has 0.00102 million btus of energy whereas 1 barrel of oil contains 5.46 million btus. Therefore 5352.94 cubic feet of natural gas have as much energy as 1 barrel of oil. Armed with these conversion factors let's see how do Russia and Saudi Arabia compare.
If these calculations are correct then Russia has more energy than Saudi Arabia and the world has almost as much energy in the form of natural gas energy as it has in the form of oil. While the Middle East has 56% of the world's oil it has only 36% of the world's natural gas. Any technological development that makes it easier to store and transport natural gas will have a large impact on energy markets. Of the fossil fuel energy producers Russia will benefit the most and the world's demand for energy from the Middle East will be reduced.
Carogero Caruso, Professor of Biopathology and Biomedicine at the University of Palermo in Italy, has found a link between high levels of anti-inflammatory cytokine InterLeukin-10 (IL-10) and longevity.
Professor Caruso, whose research is published in this month's Journal of Medical Genetics, said: "Longevity is definitely more easily controlled by those who can counter inflammatory disease."
Long term low grade inflammation has has been linked to the development of a large assortment of degenerative and chronic illnesses. Anti-inflammatory drugs have been found to decrease the incidence of heart disease, cancer (both breast cancer and colon cancer), and other illnesses. Therefore it is not too surprising to find that people who live longer have more anti-inflammatory IL-10 and less inflammation promoting hormone TNFa.
To investigate this further, the research team examined the frequency of genes coding for IL-10 and TNFa in 72 men and 102 women, all of whom had reached the age of 100. Similar DNA testing was also carried out in 115 men and 112 women aged between 22 and 60.
The results showed that significantly more centenarian men expressed genes encoding for high levels of the anti-inflammatory IL-10 than did younger men, although there were no differences in the levels of the pro-inflammatory TNFa among the various age groups.
And significantly more centenarian men expressed genes for the combination of high IL-10 and low TNFa production than did their younger peers. There were no differences in levels of the cytokines, either separately or in combination, among the women.
This latest work builds on previous work by Caruso's group showing that there is a genotypic variation that increases IL-10 production and is associated with longevity.
The presence of -1082GG genotype, suggested to be associated with high IL-10 production, significantly increases the possibility to reach the extreme limit of human lifespan in men. Together with previous data on other polymorphic loci (Tyrosine Hydroxylase, mitochondrial DNA, IL-6, haemochromatosis, IFN-), this finding points out that gender is a major variable in the genetics of longevity, suggesting that men and women follow different strategies to reach longevity. Concerning the biological significance of this association, we have not searched for functional proves that IL-10 is involved. Thus, we should conclude that our data only suggest that a marker on 1q32 genomic region may be involved in successful ageing in man. However, recent data on IL-6 and IFN- genes suggest that longevity is negatively associated with genotypes coding for a pro-inflammatory profile. Thus, it is intriguing that the possession of -1082G genotype, suggested to be associated with IL-10 high production, is significantly increased in centenarians.
This latest result is another example of how inflammation response affects longevity. Yet another example is the recently discovered link between Parkinson's Disease and COX-2 enzyme levels. Many of the newer non-steroidal anti-inflammatory drugs (NSAIDs), such as Celebrex and Vioxx, work by blocking just the COX-2 enzyme while the older generation NSAIDs inhibit both COX-1 and COX-2 enzymes. It is possible that COX-2 inhibitors may delay the development of Parkinson's Disease. More generally, expect to see a continued stream of reports on the results of studies that investigate how anti-inflammatory hormones and drugs slow or prevent a number of diseases of old age.
As the number of SARS cases in China continues to increase and as SARS shows up in additional parts of China the Chinese leadership has begun to publically acknowledge the seriousness the problem.
"Since the discovery of the SARS cases, I feel very worried. I feel anxious for the masses," Chinese President Hu Jintao said today.
It was his first public comment on SARS and, in an unusual step, the national evening news broadcast his own voice instead of having an announcer read his comments.
``Much progress has been made in combating the disease, with the epidemic brought under control in some areas, but the overall situation remains grave,'' Mr Wen was quoted as telling a national conference.
These statements are being reported by the Xinhua News Agency and major Chinese newspapers. The Chinese population is still being told that the spread of SARS is being controlled. The official message is still that the government has a handle on the situation. But the problem has gotten large enough and so visible internationally that the Chinese leaders have had to come closer to admitting to their own people the full extent of the problem. It is likely that SARS cases known in Chinese hospitals are still going unreported to the World Health Organization. But it is becoming too hard to cover it up.
Previous official statements that China had SARS under control were scaring away foreign visitors who didn't trust the excessively optimistic picture the Chinese authorities were painting.
Foreign diplomats said the main reason for China's slightly more transparent line on Sars appeared to be a realisation that the previous blithe assurances were scaring more potential foreign visitors than they were reassuring. Mr Wen was now trying a different tack to limit damage to the country's economy.
The official acknowledgement of the scope of the problem may signal that the Chinese authorities are going to try harder to fight the spread of the disease. These comments from top leaders were accompanied by the announcement that China will begin screening rail and aircraft passengers for symptoms of SARS and quarantine suspected SARS cases.
The problem is that China has already lost its best opportunity to control the SARS epidemic before it reached pandemic status. China's best chance was to contain SARS where it started at an early stage. One obvious reason to try to stop a disease at its earliest stage of spread is that the smaller an area it exists in and the fewer infected by it the easier it will be to contain it. But the other less obvious reason is that SARS originated in the Chinese province best equipped medically to contain an epidemic.
Due to its proximity to Hong Kong the Guangdong province of China, the origin of the initial SARS infections, has industrialized much more rapidly than the rest of China. Therefore Guangdong is more affluent and this greater affluence has translated into greater wealth flowing into health care facilities in the province with more hospitals equipped with modern medical equipment, test labs, and drugs. The wealthier hospitals and clinics of Guangdong province have a greater capacity to handle SARS than is the case for the rest of China. Public health experts are quite aware of this situation. In their preliminary report of April 9, 2003 the World Health Organization team in China made note that as SARS spreads from Guangdong into the rest of China it is spreading into areas far less able to handle the disease.
However, the team found an urgent need to improve surveillance in the countryside to head off new outbreaks in rural areas. The team was further concerned by an increase in sporadic cases, which could not be linked to a particular transmission chain, as such cases raised questions about the adequacy of contact tracing. In addition, the report noted many remaining concerns about the ability of other provinces, where health systems are not as strong as the one in Guangdong, to respond promptly and effectively to the challenge of SARS. In Beijing, for example, only a minority of hospitals make daily reports of SARS cases. Contact tracing is another problem in Beijing and does not appear to be carried out systematically. Failure to perform careful contact tracing will allow the disease to spread. The team observed that many of China’s poorer provinces may not have adequate resources, facilities, and equipment to cope with outbreaks of SARS, and underscored that Guangdong’s capacity was exceptional among China’s provinces. In Guangdong, the SARS outbreak placed an enormous strain on the health care system. The Guangdong Infectious Disease Hospital (Guangzhou No. 8 People’s Hospital) had 150 of its 400 beds occupied by SARS patients daily during the second week of February. The team noted that the response of the health care system has been exemplary, and commended the dedication and bravery of doctors, nurses, and others working in clinics and hospitals.
Even wealthier Guangdong's handling of SARS is far from perfect. Poor people infected with SARS are being turned away from Guangdong area hospitals.
The man, who was also exhibiting symptoms of SARS, owed the hospital $250, said Chen's daughter, Chen Lili, who was visiting her father at the time. "They made him pack up and go," she said. "Who knows what happened to him? He had no money and he was sick."
These patients are sent home where they can spread the disease to family members and thereby continue the spread of SARS.
"We're very concerned about what may be happening out in the provinces," Henk Bekedan, director of the W.H.O. office here, said in an interview today.
The April 14, 2003 SARS update from the World Health Organization reporting new SARS cases in the Chinese northern province of Shanxi and in Inner Mongolia. This spread from the south to the very north suggests SARS is probably spreading throughout China.
China has today reported 109 new probable cases of SARS and 6 deaths, bringing the cumulative total to 1418 cases and 64 deaths. The largest number of cases occurred in Shanxi Province, where 47 new cases were reported. In addition, two provinces reported SARS cases for the first time – 10 in Inner Mongolia and 3 in Fujian. The reports indicate that the nationwide surveillance system, recently introduced by Chinese authorities, is working to detect and report cases. However, questions remain about the capacity of some provinces to cope with the challenge of SARS.
Today, officials in Shanxi said the province's local Center for Disease Control was instructed only last week to deal with SARS on an urgent basis. Only three hospitals in the province, all in the capital, Taiyuan, are able to handle SARS patients, officials said.
After 4 people travelling from Inner Mongolia showed up in the country of Mongolia to the north of China the Mongolian authorities responded by cutting off air and rail links to Inner Mongolian capital Hohhot.
The government said in a statement it had cut air and rail links to Hohhot for 14 days after four people with symptoms of the disease arrived from the capital of China's Inner Mongolia region, where three people have died of SARS.
Does anyone think there is the slightest chance that Mongolia and Inner Mongolia have the capacity to deal with SARS? This disease looks set to spread throughout the poorest parts of Asia. Now it is time to start looking for reports of SARS in Central Asia. Russia ought to start checking all rail and air passengers coming into Russia from China and Mongolia and ought to start checking those headed westward. But given how far SARS has already spread in China it seems only a matter of time before the disease spreads westward across China and into Tajikistan, Uzbekistan, and other countries in that region.
In spite of all this do you still feel optimistic that the spread of SARS can be halted? Well, South Africa wants rich Chinese tourists so much that it continues to encourage them to visit South African and it will not even screen them as they enter the country for signs of SARS.
Beijing - South Africa wooed Chinese tourists on Monday, saying they will not be barred from the country or subject to screening despite the spread of the deadly severe acute respiratory syndrome, or SARS, virus.
Picture SARS getting established in Africa spreading thru large populations of HIV sufferers with weakened immune systems. The lackadaisical South African government attitude toward SARS is grossly irresponsible.
The April 14, 2003 SARS update from the World Health Organization shows Hong Kong and China have 80 percent of all known SARS cases to date.
As of today, a cumulative total of 3169 cases of SARS, with 144 deaths, have been reported to WHO from 21 countries. This represents an increase of 213 cases and 25 deaths since the last update on Saturday. Indonesia, the Philippines, and Sweden report their first probable cases (1 in each country) today. Japan, which had previously reported four probable cases, was removed from the list as these cases were determined to have other causes. China, with 1418 cases and 64 deaths, remains the most seriously affected area. Hong Kong SAR, with 1190 cases and 47 deaths, is the second most seriously affected area. Three of the deaths in Hong Kong over the weekend occurred in persons under the age of 50, marking a departure from a previously pattern in which SARS caused deaths primarily in the elderly or in persons with pre-existing disease.
My guess is that China's SARS spread will accelerate while Hong Kong might be able to get it under control. The events in China may presage what will eventually happen in India, Africa, and other impoverished locales. If it gains a foothold outside of China in a poor country then SARS is very likely to become a pandemic.
One thing that Chinese health authorities ought to consider doing is to identify all people who have been exposed to and recovered from SARS. Then recruit those people to become health care workers to take care of SARS patients. Many of those who were infected with SARS in the first place were health care workers. So they already possess the needed skills. But the other recovered SARS patients could be trained in simple medical skills and work under the supervision of more skilled people who could tell them what to do.
A German biotech company has released the first SARS test which is based on the assumption that SARS is caused by a coronavirus.
The full coronavirus sequence will allow the development of faster, more accurate tests for SARS, using specific viral DNA fragments to prime PCR reactions. Early sequencing by the Bernhard Nocht Institute in Hamburg, Germany, has already helped the German firm Artus to produce a test that goes on sale on Monday.
The test can detect the virus from throat swabs, sputum or feces and produces results in two hours, say its makers, who specialize in disease test kits. They said classical tests for antibodies typically took 10 to 20 days after infection.
A HAMBURG BIOTECH company will release a real time PCR (polymerase chain reaction) diagnostic test on Monday which, it is claimed, can diagnose SARS (severe acute respiratory syndrom) in two hours.
What is good about a PCR-based DNA test is that it can detect a SARS infection at a far earlier stage than an antibody-based test. Therefore this Artus test is very good news.
A cheap fast SARS virus DNA detection test has the potential to at least keep SARS from becoming a big presence in the industrialized countries. The SARS virus might achieve pandemic status worldwide and yet the industrialized countries could mount a vigorous long term defense using testing to keep SARS from becoming established in the industrialized countries. Testing could be done to all people entering industrialized countries thru legal ports of entry to identify people who need to be sent into quarantine. People could be held in customs until their tests were completed. Also, anyone showing SARS symptoms or exposed to someone with SARS could be quickly tested. However, illegal immigrants would still serve as carriers of SARS into industrialized countries. Also, there would still be false negative test results among those at the earliest stages of infection. Plus, all tests have error rates. Still, widespread testing could limit the presence of SARS in the industrialized countries until a vaccine becomes available.
Daniel MT Fessler, an anthropologist at UCLA, argues that hormones decrease interest in food in human women and a large variety of other animal species during the period of ovulation.
During this ovulatory period, a California anthropologist now finds, women naturally and unwittingly eat some 5 to 25 percent less than at other times.
The purpose of the decrease in appetite is to cause femals to spend less time searching for and consuming food in order to free up more time for mating.
Women's bodies must be telling them to give less attention to food and more attention to sex during the time each month when they could become pregnant.
Fessler speculates that the mechanism of action is that higher blood estrogen potentiates the effect of the hormone cholecystokinin. Cholecystokinin is believed to play a role in inducing satiety and is released by the small intestine after meals.
You can read the abstract of the paper from The Quarterly Review of Biology.
Evolutionary psychology grew out of sociobiology and, like its predecessor, is based on the assumption that human behavior has been importantly shaped by natural and sexual selection. However, evolutionary psychology differs from sociobiology in a number of fundamental ways. While sociobiology is content to treat the mind as a black box, evolutionary psychology asserts that because behavior is a product of mind, in order to shape behavior selective forces must have shaped the mind. Moreover, because selective forces are highly specific, the mind ought to consist of multiple independent systems, each a response to a particular selective force. Lastly, because foraging in small groups probably constituted the principal adaptation throughout most of hominid evolution, selection will have operated to maximize fitness within this social and physical context.
Human minds are thus seen as a package of proclivities and capacities, each of which served a specific function in our foraging past.
Fessler has additional information about his areas of research on his UCLA web site.
The British government's explicit legalization of human embryonic stem cell (hESC) research has led American scientists to move to Britain to do hESC research. However, Britain's membership in the European Union may now cause a cessation of all human embryonic stem cell research in Britain as the EU Parliament has voted tough restrictions on the use of stem cells taken from human embryos including a ban on all cloning for reproductive or therapeutic purposes.
Ignoring pleas from EU scientists who argue that the research may produce cures for diseases such as Parkinson's and diabetes, MEPs voted to halt the creation and use of human embryos for stem cell research in all circumstances.
Curiously, in a Europe which is widely portrayed as secular and post-religious the MEPs (Members of European Parliament) from the southern Catholic states voted heavily for a large set of amendments that restrict stem cell research.
I do not profess to fully understand how decision-making power is distributed between the European Commission, European Parliament, and member states. The European Parliament is (at least according to accounts that I've read) only supposed to take up issues which the European Commission has assigned to it (the EU, it must be remembered, is not very democratic by American standards). Therefore, at least in theory, the European Commission could argue that the amendments added to this regulatory bill go beyond the assigned subject of safety and get into ethical issues which the European Parliament is not supposed to address. The European Commission is already hinting that the European Parliament has gone too far.
A spokesperson for the Commission said that while the Commission is not taking a position regarding the Parliament vote, it is clear that the ethical dimension which the MEPs have added is not the original angle of the directive. 'This [directive] has nothing to do with stems cells [...] the whole issue has been hijacked [but] this decision is not final.'
The decision by the European Union's assembly still requires approval from each of the 15 EU member states to become law.
In the short term it seems likely that this bill will be blocked from becoming law by either the Euopean Commission or by a few of the northern European states. Therefore the status quo for stem cell research regulation in the various EU states will continue.
In Germany, for example, the extraction of stem cells from an embryo is illegal, although it is legal to import stem cells from abroad. In Britain, stem cell research is subject to a licensing procedure. But some European countries have no regulations at all, while in others, there is a complete ban.
In the longer term proposals to modify current EU decision-making mechanisms to allow more decisions to be made by majority vote may well lead to the banning of human embryonic stem cell research in the EU. Also, the expansion of the EU eastward will change the balance of belief on ethical issues related to biotechnology. Though it is hard to say how the Eastern European nations will come down on this issue on balance. Plus, there is the possible further expansion to include the very large population of Turkey which again may change the balance of opinion in Europe on bioethics questions.
Regardless of what finally makes it into law as a result of the current deliberations just the threat of such legislation will have a chilling effect on biotech company funding of human embryonic stem cell work in Europe.
"The increasingly skeptical climate is scaring European biotech companies and research centers away," EU Research Commissioner Philippe Busquin warned last month.
Australian biotech companies working with human embryonic stem cells might end up being the biggest beneficiaries over the uncertainty of the future of human embryonic stem cell work in Europe.
Satyabhama Mahapatra, using sperm from her husband Krishnachandra Mahapatra and an egg donated by her niece set a new record for oldest woman to give birth.
Agarwal said Mahapatra had undergone in vitro fertilisation (IVF) treatment at a clinic in Raipur city in the central Chhattisgarh state
She was able to make it only to the sixth month of pregnancy and then the baby was delivered via Caesarean section. Her 26 year old niece Veenarani Mahapatra donated the egg used in the IVF procedure.
But the couple insisted on going ahead with the pregnancy using an embryo from Satyabhama's 26-year-old niece.
While her age still needs to be established she and her husband looked quite old to the doctor who tried to talk them out of trying.
Medical experts are to examine Mrs Mahapatra to try to prove that she is as old as she says. Like many rural Indians, she has no birth certificate, but maintains that she was born in early 1938.
The previous record holder was 63 years old.
Mrs. Rosanna Dalla Corte (ITALY) born in 1931 gave birth to a baby boy on July 18, 1994 when she was 63 years old.
Some day artificial wombs will completely lift the age limit for reproduction. Also, advances in technologies for cloning and for growing replacement organs will eliminate the need to use donor eggs. The ability to grow and implant replacement organs will even allow an old woman to update her reproductive organs to a youthfulness that will allow them to naturally conceive and carry a fetus to term without any need of IVF or even of Caesarean section delivery.
Lots of new strains of influenza first show up in China. The reason is that tens of millions of humans live in close contact with a large variety of farm animals in conditions which encourage viruses to jump between species.
Dongxing is just one example of how Guangdong's 80 million people live close to the animals, poultry and fish they eat. At another piggery close to Mrs Yang's, a farmer keeps young chickens next to his pigs. All the piggeries empty their waste into the ponds where shrimp and grass-carp are raised for the table.
In other places, battery chickens are kept above the pig pens, feeding their waste into the pigs' food troughs. The close proximity and cross pollution adds to the risk of animal viruses infecting humans, either directly or via pigs
Of course it would be great if Chinese farming practices were changed in ways that would reduce the chances of viruses jumping between species. But the farmers who engage in the dangerous livestock raising practices are poor and do not have a lot of alternatives. As China industrializes one can expect conditions to improve as agriculture industrializes, becomes more capital intensive and less labor intensive. With fewer people down on the farm fewer people will come into contact with pigs, ducks, chickens, and other farm animals.
Given that China is such a threat as an origin of new pathogen strains and of pathogen species that jump between mammalian species it would also be great if the Chinese government was really eager to pursue proper public health policies for controlling epidemic disease outbreaks. However, as I explained in my ParaPundit blog posting Repressive Governments Make Fight Against SARS More Difficult the Chinese government, being a repressive regime that has lots of motives to cover up the truth, has plenty of reasons to mishandle an epidemic disease outbreak.
In spite of my previous readings and writings on why the Chinese government does what it does I was still floored to read that the Chinese government is currently trying to encourage domestic tourism as a way to assure international travellers that China is a safe destination.
Despite the risk of spreading the disease across this country, the government thinks that a successful May 1st holiday will help convince international travelers that China is safe, Chinese officials said.
Hong Kong is less an open society than it used to be but it is sufficiently open that scientists there are openly discussing the possibility that SARS will not be stopped.
Samson Wong, a microbiologist from Hong Kong University, said that Sars might infect 80 per cent of the population within two years and eventually everyone could be infected. A Health Department spokeswoman said that the possibility could not be ruled out but declined further comment.
What is making infectious disease experts less optimistic that SARS will be contained is the inability to trace some SARS cases to person-to-person contacts. This has led scientists to speculate that SARS may in some cases be spreading by cockroaches, sewage, contaminated surfaces such as door knobs, and by other means.
But in recent days, epidemiologists have been unable to trace a number of SARS outbreaks in hotels, hospitals and apartment complexes in Hong Kong, Singapore and China to such person-to-person spread.
In the face of such scientific uncertainty the Chinese government continues to be irresponsible in its handling of the SARS outbreak. It may become necessary for more governments to follow the example of Malaysia and start restricting travellers from Hong Kong and China.
Very few SARS cases have been reported in India so far. However, if SARS becomes established in India it will be very hard to stop.
"Our health system is very inadequate and it will be extremely tough to control the disease if it arrives," Anil Bansal, president of the Delhi Medical Association, told Reuters.
The very limited health case system in India makes the news about SARS coming from India very important. Therefore every suspected SARS case in India is watched very closely.
Not all suspected SARS cases in India have turned out to be SARS. For instance, Maria, the first suspected SARS case in New Dehli, may have a different kind of infection.
"She has been provisionally detected of having acute pharyngotonsilitis,’’ said Dr R.N. Salhan, the hospital medical superintendent.
Also, a 23 year old American woman suspected of having SARS in Bombay turned out to have a less dangerous illness. However there are at least two other suspected SARS cases in India including a 48 year old Indian national recently arrived via Singapore.
A 48-year-old software worker was admitted to hospital in Hyderabad on Tuesday after he arrived from Australia via Singapore with high fever, a cough and cold -- symptoms of the virus that has killed more than 100 people worldwide.
Surely the government of India can afford to quarantine and treat a few thousand sufferers. India is making efforts to be prepared to do so.
Facilities have been created for treatment of SARS cases in isolation in the Central Government hospitals as also in other Infectious Disease Hospitals. Health care facilities at International Airports and Ports have been strengthened by deploying additional doctors and evolving a standard operating protocol.
But the problem for India is that there are hundreds of millions of poor people who have little or no access to medical doctors and medical tests. If a single SARS sufferer reaches India and if that sufferer happens to be very infectious the results could be disastrous.
A single SARS sufferer is all it would take to rapidly cause a large SARS outbreak in a primitive country. "Hyper-infectors" (a.k.a. "super-carriers") of SARS may have been responsible for the big SARS outbreak in the Toronto Canada area.
Canada's SARS outbreak has been fuelled by three "hyperinfectors" who each passed on the disease to 20 or more other people -- a phenomenon never before seen with a virus, experts said yesterday
It is noteworthy that all three of the hyper-infectors in Canada died. Could it be that the more severe form of the disease is more infectious? Perhaps the people who have the severe form cough more and therefore generate more airborne particles which contain active virus.
Individuals who are inordinately infectious have been seen with certain types of bacteria, but not viruses, said Dr. Low.
Africa has the same vulnerability to SARS that India has. Therefore SARS cases in Africa are incredibly important to watch for. A Pretoria South African man who travelled from Hong Kong to South Africa on March 27 is hospitalized and suspected of being a SARS case.
A 62-year-old South African man is being treated at a Pretoria hospital as a "probable SARS" case, according to officials.
One factor that is doing a lot to reduce the chances of SARS spread is the great reduction in air travel. Given India's greater vulnerability to SARS Air India's 60% reduction in flights between Hong Kong and Bombay (Mumbai) is good news.
It further curtailed its services to Hong Kong, and will now operate only two flights a week (on Mondays and Fridays) as against the scheduled five flights a week.
While voluntary decisions to not travel are playing a role in efforts to reduce the risk of further spread of SARS government decisions can block off means of spread by more dramatic means. In order to reduce its risk of getting SARS cases from China the government of Malaysia is no longer granting tourist visas at its diplomatic facilities in China.
Malaysia has taken the draconian step of banning all tourists from mainland China to try to stop the spread of the deadly Sars virus.
India and Africa have greater need to take such a dramatic action than Malaysia does. If tourist travel was cut off other types of travel could still be allowed but under much more stringent rules. In the extreme, countries could allow passengers to travel from other countries but then force them into quarantine for 7 to 14 days upon arrival. This would provide a way for people who plan longer term changes in residence to still move around to take different jobs.
Update: On April 17, 2003 a confirmed case of SARS was found in Goa India.
Goa's chief minister, Manohar Parrikar said that a 32-year-old marine engineer had tested positive for the virus and was being treated at the Goa Medical College. The man is said to have arrived in Goa earlier this month after travelling in Singapore.
The worry has to be that this fellow may have already passed on SARS to other people after he returned to India. SARS may now be on the loose in India. If that is the case the odds of containing it there are low. If SARS becomes pandemic in less developed countries the effect on the world economy would be to cause world recession.
CALCUTTA, April 26 (Reuters) - A 42-year-old Indian man has tested positive for SARS, authorities said on Saturday, the country's sixth case of the virus that has killed at least 289 people and infected about 5,000 worldwide.
The search for the cause of Severe Acute Respiratory Syndrome (SARS) has been greatly sped up by the use of DNA microarray gene chip technology. UCSF Assistant Professor Joseph DeRisi built a gene microarray containing all known completely sequenced viruses and used it to classify a pathogen isolated from SARS patients as a coronavirus.
DeRisi placed his computer's cursor over one lit dot and it read "bovine coronavirus." Another dot outputted "avian coronavirus." By the time he got to the turkey and human coronavirus dots, he knew he was dealing with something the world's scientists had never seen before.
If it had been a known virus — say the human coronavirus, a cause of the common cold — then only human coronavirus dots would have lit up.
DeRisi discovered that SARS is genetically most similar to a virus that infects birds.
Its genetic sequences so far seem to have the most in common with Avian Infectious Bronchitis Virus, according to preliminary molecular data obtained by Joseph DeRisi at the University of California at San Francisco and circulated among virologists.
Working with MIT post-doc David Wang and one other colleague (whose name I haven't been able to locate) DeRisi built a DNA gene microarray chip with the DNA of 12,000 different viruses. This allowed DeRisi to classify the suspected pathogen within 24 hours of the time he received a sample from scientists at the CDC. Let's put that in perspective. It took months to identify the pathogen that caused Legionnaire's Disease back in the 1970s. While DeRisi's assay was only one step of the process of isolation (it had already been tentatively identified as a coronavirus by viewing it with an electron microscope) it was a step that enormously accelerated the overall process.
DeRisi's development of a robot to place DNA samples onto the DNA gene microarray chip was helped along by advances made to do silicon semiconductor chip manufacture.
In fact, the robots that "pick and place" each sample from a small reservoir onto its spot on the slide are descendants of the machines used to build electronic chips.
This demonstrates a recurring FuturePundit theme: advances in electronic technologies are accelerating the rate of advance of biotechnologies.
The role that DeRisi and his colleagues played in identifying a coronavirus as a suspected cause of SARS came to the attention of the national media when CDC Director Dr. Julie Gerberding mentioned the work in a March 24, 2003 press conference.
But in addition, we're collaborating with academic partners. Earlier this week, we sent DNA out to a laboratory at the University of California, San Francisco, so that they could do the absolute state-of-the-art probe for virus genes and help us identify the cause.
Dr. DeRisi has made a more general contribution to the acceleration of the use of gene array technology. He built and released to the world the design of a robot that automates the process of putting DNA samples into gene arrays.
The technology behind the hope works by hybridization, the affinity for complimentary strands of DNA (cDNA) to form double helix structures. More than 40,000 unique DNA samples can be printed on glass slides in pre-determined locations.
DeRisi designed a robot that, at top speed, prints 14,400 elements per minute. These slides are then used to assay fluorescently labeled cDNA from tumors or organisms, like malaria, which are then stored on computers. Comparing these profiles can reveal the unique molecular signature carried by each type of cancer and give clues as to the original defect.
Despite the central role he played in revolutionizing genomics, it was DeRisi's populist approach to science that made him the buzz among academic and industry scientists. DeRisi never pursued a patent for the robot, instead he posted instructions on how to make it on the Internet.
"Joe could be a very rich man if he kept things to himself," says David Wang, a postdoctoral fellow in DeRisi's lab.
What we still need are advances that will accelerate the rate at which vaccines can be developed. Vaccine development time for a disease like SARS is still measured in years. West Nile virus, for which vaccine development was begun in 1999, killed 277 Americans last year while leaving many others with central nervous system damage. Yet a vaccine for West Nile virus will begin undergoing preliminary testing on humans in June 2003, it is still three to five years away from general availability.
There's still a way that an infectious pathogen which is passed human-to-human like SARS can be defended against using biotechnology: be able to quickly and cheaply identify who is infected so that the infected people can be isolated. This can break the chain of infection and prevent a disease from developing into a pandemic. Without a test to identify exactly who is infected all people who have contact with an infected person must be put into quarantine regardless of whether they really are infected. Singapore has used this aggressive standard technique for epidemic control with considerable success. However, because an infected person can come into contact with a great many people who do not themselves become infected public health authorities are reluctant to quarantine them all. A test to identify people who are infected could make quarantine regimes far more acceptable and effective.
What is needed is a test that can identify infected people at a fairly early stage of the infection. Most of the SARS tests currently under development can not detect the infection at an early enough stage.
The development of a diagnostic test, which is being pursued around the clock by the WHO collaborating network of 11 laboratories, has proved more problematic than hoped. Three diagnostic tests are now available and all have limitations as tools for bringing the SARS outbreak quickly under control.
The ELISA detects antibodies reliably but only from about day 20 after the onset of clinical symptoms. It therefore cannot be used to detect cases at an early stage before they have a chance to spread the infection to others. The second test, an immunofluorescence assay (IFA), detects antibodies reliably as of day 10 of infection, but is a demanding and comparatively slow test that requires the growth of virus in cell culture. The presently available PCR molecular test for detection of SARS virus genetic material is useful in the early stages of infection but produces many false-negatives, meaning that many persons who actually carry the virus may not be detected – creating a dangerous sense of false security for a virus that is known to spread easily in close person-to-person contact.
What is needed is an advance in biotechnology that will provide a test for SARS with high sensitivity at a very early stage of infection.
(thanks to Hylton Jolliffe for the first link)
Researchers at the Pacific Northwest National Laboratory are developing miniaturized high output fuel cells for military applications.
“Our miniaturized fuel processor incorporates several chemical processes and operations in one device,” said Evan Jones, PNNL principal investigator. The fuel processor system contains two vaporizers, a heat exchanger, a catalytic combustor and a steam reformer, all within a compact package no larger than a dime.
When ready for final deployment, the military envisions many useful applications for this emerging miniaturized energy-generating technology. According to Terry Doherty, director of PNNL’s Department of Defense programs, soldiers could power personal, lightweight cooling systems while wearing protective suits and gear, prolonging their own comfort and efficiency during a reconnaissance.
“Vital personal communications devices could function for extended periods without the added weight of bulky, inefficient batteries,” Doherty said. He added that miniature sensors powered by the same technology could be scattered before advancing troops to monitor ground vibrations or detect dangerous toxic agents and relay this information electronically to soldiers. This technology broadens the possibilities for using self-sustaining items such as mobile devices in remote or difficult-to-access locations.
While methanol has proved to be the most effective fuel source, other liquid fuels such as butane, jet fuel — also known as JP-8 — or even diesel may be used. And, because the hydrogen power source is only produced as needed, there is no need to store or carry the volatile gas, reducing risk and creating a lighter load.
Testing has revealed that performance from the reformer and fuel cell prototype is impressive. “This system can produce an equivalent power (20 mW) to batteries, but at one-third the weight,” Jones said. Similar micro fuel cell systems with greater power output (50 W) currently under development are providing power equal to that of batteries weighing 10 times as much. Researchers suggest that with additional system efficiencies and improvements, even greater performance may be achievable. Development will now focus on creating a deployable system suitable for military use or industrial application.
High electric power output lightweight mini fuel cells would have many civilian applications as well. For example, workers in hot desert oil fields could wear cooling suits with lightweight backpack fuel cells that would allow them to work for longer periods outdoors. A former Bechtel worker who worked in Saudi Arabia once told me how they would work outside for a half hour and then come into a cooled mobile home for a half hour of recovery. This cycle of half hour on and half hour off was how they worked all day in Saudi Arabian oil fields where temperatures could approach 120 Fahrenheit or even hotter.
Construction workers in any really hot environments would find cooler suits incredibly useful as productivity enhancers. Also, if the energy of a fuel cell can be used to cool it certainly can be used to warm a suit as well. Therefore, oil field workers in extreme cold environments could wear heater suits powered by mini fuel cells.
One problem with the use of fossil fuel powered fuel cells is that they produce carbon dioxide and possibly other pollutants whose build-up indoors could be a health problem. But in outdoor applications that gaseous build-up wouldn't be a problem.
Portable fuel cells would have a lot of great uses in hiking and camping trips. They could provide heat for stoves, electricity to power light fixtures, and electricity for communications, computers, and other applications in remote locations.
Experts in public health and infectious disease are beginning to say that they believe SARS is more likely to spread to pandemic levels than to be contained.
"Most people are hesitant to say it will just go away," said Dr. Ruth Berkelman, head of Emory University's Center for Public Health Preparedness and Research. "Too many people are infected to think we won't see it for a long time to come."
In an editorial in The New England Journal of Medicine US CDC Director Dr. Julie Gerberding thinks it would require extreme luck for SARS to be controlled.
"If we are extremely lucky, the epidemic will be curtailed, develop a seasonal pattern that will improve prospects for regional containment, or evolve more slowly than it has at this early stage," Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention, wrote in an article this week.
"If the virus moves faster than our scientific, communications and control capacities, we could be in for a long, difficult race."
Note that her extreme luck scenario is for SARS to be controlled, not eliminated.
Dr. Donald Low (who is currently in isolation having himself been exposed to SARS) thinks SARS will become pandemic (i.e. widely spread).
"Unfortunately, it's an epidemic now that will become a pandemic," predicted Donald Low, chief microbiologist at Toronto's Mount Sinai Hospital.
Dr. David Heymann of the World Health Organization thinks we won't know whether we can contain SARS until we have a reliable test for infection.
"I think we've got to keep going at this speed until we get that diagnostic kit in use and figure out what's going on," Heymann said. "Then we'll know if we've lost or not."
One reason for the increased pessimism is the growing belief that some SARS sufferers are high infectious "super spreaders".
The four-member team is most interested in "the phenomenon of 'super spreaders' -- people who seem to spread their disease to a lot of other people," said the WHO team leader, Dr. Robert Breiman.
It is possible that co-infection with another pathogen makes a person into a "super spreader".
"It raises the question of, if you have one pathogen and you get hit with, say, coronavirus . . . are you more likely to transmit? Do you become what we call a 'super spreader?' " Breiman said.
Chinese scientists see evidence in some SARS sufferers of a rare airborne chlamydia bacteria that may be turning people into super spreaders.
Dr Robert Breiman, also of the WHO, said he feared people who already had chlamydia might be vulnerable to the flu-like bug and become highly contagious "super-spreaders".
Governments are moving to increase their quarantine powers. George W. Bush has signed an executive order giving public health officials the legal power to quarantine SARS victims. The Australian government has also moved to grant public health authorities power to force people into quarantine and even to close borders.
It seems likely at this point that decreased travel levels, use of facial surgical masks, and other responses to SARS will be longer lasting and spread to more locales. The economic cost of SARS then seems likely to increase substantially. If containment turns out to be impossible other defenses become more important.
Vaccines would be the ideal next line of defense but the very earliest we could expect help from a vaccine is a year from now. Since SARS is most likely a virus and anti-viral drugs are very difficult to develop the prospects on that front are not hopeful either. The best potential treatment is gamma globulin taken from the blood of people who have recovered from SARS. That may lower the fatality rate of SARS though likely only in industrialized countries and among elites in less developed countries. SARS could become pandemic in less developed countries and travel from those countries to industrialized countries could continually reintroduce it into the countries whose public health infrastructures allow them to stop its spread. Think of a series of fire alarms continually going off all across the industrialized countries as small outbreaks cause a series of small scale quarantines. That might turn out to be our future until a SARS vaccine is developed.
Another possible avenue of treatment is to find a way to suppress the most deadly symptom of SARS: the accumulation of fluids in the lungs which caused SARS to initially be called atypical pneumonia. The key to prevention of the fatal accumulation of fluids may be to find a way to suppress the production or sensing of the natural inflammation signalling compounds called cytokines. It is too early to tell whether steroids (which also suppress immune response) can suppress cytokines enough without suppressing the immune system too much.
With containment looking less likely, the availability of vaccines too distant in the future, and the development of drug regimens that prevent fatal consequences still in doubt the best response to SARS may turn out to be widespread changes in lifestyles and work habits to decrease the chances of spread. The widespread wearing of surgical masks as now seen publically in Hong Kong may spread to other areas where SARS takes hold. Health checks on airline passengers and the wearing of surgical masks on air flights might also become commonplace. The air filtration systems in many commercial and residential buildings may be quickly upgraded to prevent airborne virus spread.
Here's where the effect of SARS may become counter-intuitive: Because it kills only 3 or 4 percent of its victims a widespread public reaction that seeks to reduce the risk of exposure will have the added benefit of reducing the spread of influenza. This could lead to a net reduction in total deaths caused by infectious diseases because estimates of the yearly death toll in the United States from influenza run from 20,000 to 36,000 on average. The yearly death toll estimated as due to influenza in Canada runs from 1,500 to 4,500. Other industrialized countries have similar yearly death tolls from influenza proportionate to their populations. However, since influenza is more likely to kill the elderly the numbers also vary depending on the age distribution of the population and on the rate of yearly immunization. Also, death from influenza does not take as many total years of life away as a disease that strikes people down at a younger age. Still, if the populations of industrialized societies take drastic measures to reduce their risk of getting SARS one likely side effect should be a reduction of the death toll from influenza and possibly from other infectious diseases as well. Even those who are not at risk of dying from influenza will enjoy the benefit of being sick less often and employers will suffer lower amounts of lost work days and reduced productivity days due to sickness.
Update: A doctor in Hong Kong says Westerners fleeing Hong Kong are helping to spread the SARS virus more widely.
Dr David Stirling, told The Telegraph that families trying to escape the outbreak of the incurable illness - which has killed 80 people worldwide - were now the most likely reason for the spread of Severe Acute Respiratory Syndrome.
Update II: Time Magazine has an excellent article that compares the approaches used by Singapore and Hong Kong to respond to the outbreak of SARS. The far more aggressive measures pursued by Singapore resulted in the control of the outbreak.
When new cases were discovered, a team of 100 "contact tracers" tracked down not only patients' immediate families, friends and neighbors but also their office colleagues and favorite food hawkers, and placed them in quarantine, too. Anyone suspected of having SARS is transported to the hospital in an ambulance.
Singapore's far more aggressive approach toward identifying patient contacts and quarantining them has led to a decline in the number of new SARS cases in Singapore. It still may be possible to contain SARS if that aggressive approach is applied in other areas of SARS outbreak.
Update III: SARS may have gotten spread thru the Amoy Garden apartment complex in Hong Kong via cockroaches. If this turns out to be true then it will make SARS harder to contain.
WHO deputy director Alan Hampson, said the disease could be like AIDS with treatments taking years to develop. "It would take years to develop an anti-viral drug," he said. "The earliest you can expect a vaccine is in a small number of years."
Reinhard Kurth, the head of the German government's Robert Koch Institute, was not exactly encouraging on Friday night. A vaccine for Sars could be developed, he said – but it would take three to five years.
US National Institutes of Health NIAID director Anthony Fauci offers the best case timeline for SARS vaccine development of at least a year.
If it turns out that some other virus is at work, those researchers will have to start again, cautioned Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease. Even under the best-case scenario, he said, a vaccine is at least a year away.
Clearly, for the foreseeable future the only real option for the halt of the spread of SARS is to identify and isolate its victims quickly and to minimize the chances of exposure in locations where SARS is known to be present.
If you think SARS is bad just keep in mind that it does not spread as easily as influenza does. If SARS was caused by influenza tens of thousands would already be dead.
"If SARS were an influenza pandemic," says Melbourne University professor of virology, Ian Gust, "and the mortality rate was similar to what it is now (about 3.5per cent), we would have tens of thousands of people dead, rather than less than 100." And that is not because the virus would be any more potent, but because it would be much more contagious.
An extremely virulent form of influenza, the kind that only comes once every several decades, could end up infecting almost half of the population of industrialized countries. With a fatality rate similar to that of SARS it could easily kill one percent of the total population. The 1918-1918 so-called Spanish flu (which really didn't originate in Spain) With a world population at the time of 1.8 billion and with a low end estimate of the number killed by Spanish flu as 20 million the low end of the percentage of the population killed by the Spanish flu was at least 1 percent.
Although the history of flu epidemics is non-mathematical, in this case, as Voltaire might say, the superfluous is very necessary. In 1918, when the world population was 1.8 billion, an influenza epidemic incapacitated 1 billion and killed 20 million, all within the space of 8 weeks.
With a world population of 6.3 billion and a current annual growth rate of 1.16 percent a flu pandemic comparable to the 1918 Spanish Flu would kill somewhere in the range of 60 to 150 million people. This would be approximately equal to about one to two years of world population growth at current growth rates.
The most intense, to date, occurred in the last year of World War 1: the so-called "Spanish Lady" or "Spanish Flu" pandemic of 1918-19 which infected one billion people, half the world’s population at that time, and killed between forty and fifty million. This makes it the most devastating disease of man known, surpassing even the bubonic plague of the fourteenth century, smallpox in the sixteenth century and the human immunodeficiency virus/AIDS pandemic that is happening now.
Given the fatality rate of SARS infections we are lucky that SARS is not as easily spread as influenza. Still, there is reason to be concerned about the spread of SARS because there are cases of SARS which do not fit the more optimistic model of a requirement of close contact for SARS to spread.
Five of the 24 cases of Sars (Severe Acute Respiratory Syndrome) in the southern Chinese city of Foshan examined so far by a newly-arrived World Health Organization (WHO) team were caught despite the patient having no obvious contact with an infected person.
The biggest defense we have against a highly deadly influenza pandemic is the speed with which influenza vaccines can be developed against threatening new influenza strain.
(MEMPHIS, TENN.--April 2, 2003) Scientists at St. Jude Children's Research Hospital announced today the development of a vaccine against H5N1, a new lethal influenza virus that triggered the World Health Organization (WHO) to declare a pandemic alert in February 2003.
The virus appeared in birds in Hong Kong late last year and subsequently killed one of two infected people with rapidly progressive pneumonia in the past month. St. Jude developed the vaccine in only four weeks from the time it received the H5N1 sample from colleagues in Hong Kong.
The announcement comes at a time when a second, as-yet-unidentified virus, has taken several lives around the world. The unknown virus, which causes severe acute respiratory syndrome (SARS), appears to have originated at the same time and in the same place as the new "flu."
The development of the initial ("seed") batch of H5N1 vaccine is significant because humans do not have a natural immunity to the virus, according to Robert Webster, Ph.D., a member of the Department of Infectious Diseases at St. Jude. Rather, humans appear to become infected through contact with chickens and other birds. In the past the virus killed only the chickens it infected. But the new variant of H5N1 also killed many kinds of wild birds, which is unusual.
Even if a new vaccine could be developed rapidly to counter a killer influenza outbreak the problem today is that there would not be enough production capacity to make influenza vaccine for everyone. However, as demonstrated in US Health and Human Services Cabinet Secretary Tommy Thompson's March 27, 2003 testimony to the US Congress House Committee on Energy and Commerce & House Select Committee on Homeland Security the United States government is funding research to develop vaccine production technologies that are more easily scalable than current vaccine production techniques.
For example, the President's budget foresaw and prepared for an influenza outbreak. It proposes to spend $100 million to ensure the nation has an adequate supply of influenza vaccine in the event of a pandemic. Due to the constant changes in the circulating influenza strains, we cannot stockpile influenza vaccine, and the current manufacturing methods might not meet the Nation's needs in the event of a pandemic.
Funds will be used for activities to ensure a year-round influenza vaccine production capacity and the development and implementation of rapidly expandable production technologies. We will work closely with industry to accomplish these goals.
More scalable vaccine production techniques also have obvious anti-bioterrorism applications. Therefore the development of better vaccine production capabilities have been given an added spur by the rising awareness of the threat of bioterrorism.
Three months after SARS first appeared in China but almost a month before it started causing deaths in Hong Kong a Loudon County Virginia woman recently returned from Guangdong province China came down with what appears to have been the first American case of SARS (Severe Acute Respiratory Syndrome). On February 17 2003 after showing up in the emergency ward of Loudoun Hospital Center she was placed in a sealed room and the health care workers who treated her work protective gear in order to avoid infection.
In the emergency room, she had a high fever and a cough and was having trouble breathing. She and a relative mentioned that she had been in Guangdong and that a flu seemed to be going around there. A triage nurse put the woman in a sealed room that had a dedicated ventilation system to prevent her from passing along the infection.
The details of how she was handled read like a textbook approach for how to handle an unknown and potentially dangerous infectious illness. The Loudoun Hospital Center folks had the assets needed and made the right call.
The Washington Post has a good report laying out the events inside the Chinese government as it covered up the outbreak of SARS.
The outbreak of the illness is a revealing case study in how China's authoritarian government, which seeks to maintain a monopoly on power and control information, concealed vital data about a life-threatening disease from the Chinese people, according to doctors, health officials and journalists familiar with the events.
China is the place where the holding back of information on epidemic outbreaks promises to be most threatening to the world as a whole. Because of the millions of people (tens of millions? hundreds of millions?) in Southern China who live in close proximity with pigs, ducks, and other fowl China is like a big experiment for the mixing of DNA across different virus strains that normally infect different species. In the case of SARS it is likely that a human coronavirus coinfected a cell (probably in a human) at the same time a coronavirus from another species did as well. Genes were exchanged and the result was a coronavirus that is more lethal to humans. This also happens with influenza viruses. The most lethal influenza viruses are either viruses that jumped over from other species or which exchanged DNA with viruses from other species.
Because China has such ideal conditions for gene swapping between virus strains from different species it is more likely than any place on Earth to be the source of the next killer virus whose lethality would rank up there with the 1918-1919 Influenza pandemic that killed 20 to 40 million people. The authoritarian impulses of the Chinese authorities to control and hush up bad news, as they have done with the SARS pathogen, put the rest of the world at much greater risk to every new disease that first shows up in China. This impulse on the part of the Chinese government deserves to be widely and loudly criticised. The rest of the world needs to make it clear to China that this kind of "hush it up" reaction to disease outbreaks will not be tolerated because it creates an unacceptable risk to the health of all of humanity.
While the Chinese government prevented Chinese newspapers from reporting on SARS Dan Gillmor reports that text messaging using mobile phones helped spread the knowledge that SARS was a threat.
I found the Dan Gillmor link in a SARS link collection by Ian Mckenzie.
Update: Health care workers in Beijing are reporting 50 cases of SARS in spite of the fact that the last report from China to the WHO reported only 12 in Beijing. China is still being slow about admitting the extent of its SARS cases.
The additional cases have not been reported to the World Health Organization, even though Chinese health officials promised to begin daily reporting of such statistics this week.
Update II: The Globe and Mail has an excellent story on how the Chinese government tried to keep secret the spread of SARS.
But information was not shared with other health departments in this province of 80 million people. Instead, the Heyuan paper printed this statement on Jan. 3 from the local health bureau: "No epidemic disease is being spread in Heyuan. . . . Symptoms like cough and fever appear due to relatively colder weather." That was apparently the first report on SARS in the Chinese media.
Update III: In a move that is extremely rare for China the director of the Chinese CDC apologized for the Chinese government's handing of SARS.
"Today, we apologize to everyone," said Li Liming, director of the Chinese Center for Disease Control. "Our medical departments and our mass media suffered poor coordination," he said. "We weren't able to muster our forces in helping to provide everyone with scientific publicity and allowing the masses to get hold of this sort of knowledge."
While this apology has been broadcast in Hong Kong it is not clear whether people in mainland China heard it.
Li's statement was not immediately reported by Chinese media. It was not known whether his remarks were authorized by senior officials or whether Li, highly regarded in his field, had taken the unusual step of articulating the widespread view on his own. Other officials who have released unauthorized material about SARS have lost their jobs
In an encouraging sign that the Chinese leaders have perhaps learned that they can't go keeping major disease outbreaks secret the Chinese Deputy Prime Minister made noises about being a lot more open the next time around.
Deputy Prime Minister Wu Yi called for "the immediate establishment of a national medical emergency mechanism, with emphasis placed on a public health information and an early warning reporting mechanism".
There are 100 suspected cases of SARS (Severe Acute Respiratory Syndrome) in the United States with no deaths reported so far. By contrast, as of April 3, 2003 the World Health Organization has reported a cumulative total of 2270 SARS cases and 79 deaths.
Chinese authorities had previously reported a cumulative total of 1153 cases and 40 deaths in Guangdong Province from 16 November, when the outbreak began, to the end of March, making this province the area most seriously affected by SARS to date.
As of today, a cumulative total of 2270 SARS cases and 79 deaths have been reported from 16 countries. This represents an increase of 47 cases and 1 death (in Hong Kong) compared with yesterday.
Why the different death rates? Is the lower US death rate a reason to be complacent? Probably not. One reason is that US Centers for Disease Control and Prevention uses a different set of rules for identifying suspect SARS cases.
The majority of U.S. residents with SARS have recovered or stabilized clinically without specific antiviral therapy. The U.S. case-fatality proportion is lower than that reported in some other countries (3). Possible explanations for this include differing case definitions among countries or differences in the sensitivity of surveillance, leading to identification in the United States of patients with less severe or early manifestations of infection or of a larger proportion of patients with other respiratory illnesses. Until confirmatory laboratory testing is available, the case definition will include clinical criteria more likely to identify potentially infectious persons. Various therapies, including antiviral agents (e.g., oseltamivir or ribavirin) and corticosteroids, have been administered to SARS patients, but the efficacy of these therapies has not been determined.
Director of the CDC Dr. Julie Gerberding provides additional background on US CDC versus WHO SARS classification rules.
But with respect to your second question, why are the case patients in the United States having relatively mild illness, this is a conscious decision on our part to include anybody with fever and a respiratory symptom who had traveled to an affected area. The cases that WHO is including from countries on its list--at least most of the cases that are formally appearing on the WHO list--are only people who have the severe form of SARS, with the pneumonia. And so we are casting a broader net in this country because we want to be vigilant about identifying anyone who could possibly be infectious, and isolating them if they're sick, and advising their contacts how they can protect themselves. So not surprisingly, we do not have as many patients with pneumonia. In fact, I think we have altogether--I'll have to get back to you on the exact number, but less than 50 percent of our case patients have had pneumonia. And one of our case patients has required ventilation. But most of that is the artifact of the way in which we are conducting our evaluation and our epidemiologic assessment. Actually, about 20 of the case patients have been diagnosed with pneumonia.
Once an accurate test for SARS infection becomes available (and it looks like scientists are fairly certain that a coronavirus is the cause) then methods of classifying SARS victims can become more uniform. Dr. James Hughes of the CDC reports on progress in the development of SARS tests:
DR. JAMES HUGHES: In terms of the serologic testing, realize that 10 days ago we didn't have any antibody test to detect evidence of infection with this previously unrecognized corona virus. As a result of a lot of hard work that's been done here over the past 10 days, we now have two that look promising. One is an indirect fluorescent antibody test, and the other is an Eliza. More work needs to be done to validate these tests. I would remind you that these are tests that are not approved for routine use for patient diagnosis yet--not surprisingly, since they've just been developed. So we have to interpret results using these tests with caution. Having said that, they look promising in that they appear to perform well in suspect cases, particularly a subset of those that are relatively more severe. We have looked for evidence of this antibody in roughly 400 sera collected recently from people in this country without any suggestive evidence of SARS, and they're negative in all of those people.
If the indirect antibody test measures immune response to the virus (not sure, does anyone know?) it could be very useful for identifying recovered victims who no longer have the SARS virus in their bodies. This would be incredibly helpful because people whose immune systems have fought off the SARS virus could be used as blood donors to extract gamma globulin immune system molecules from their blood. The gamma globulin can be used to treat the most severe cases of SARS.
Whether SARS is eventually controlled continues to strike me as being heavily dependent on whether it reaches less developed places where the public health infrastructure is nearly non-existent. Let it get loose in India and it seems like it would become impossible to control.
A forthcoming New Scientist article reports the greatest fear of SARS (Severe Acute Respiratory Syndrome) researchers is the possibility of asymptomatic "silent carriers" may make SARS uncontainable
But if people can harbour and transmit the virus while while remaining healthy, or showing few symptoms, it will be much harder. "If there are silent carriers, it will be virtually impossible to contain," warns Osterhaus. This issue is now the focus of research, says Heymann. A lab test for SARS would give a huge boost to surveillance and containment efforts.
If the disease reaches India or some other country where few people have access to an organized healthcare infrastructure then the disease is going to be extremely difficult to contain anyhow. We could quickly reach a point where many countries stop allowing travel from countries where the disease is spreading unchecked.
Lucien Abenhaim, who as director-general for health is France's equivalent of surgeon-general, noted however "we know now that there are minor forms of the illness," meaning that people can be infected but have only minimal symptoms.
Hopefully the silent carrier fear will not pan out. But even if it doesn't it is by no means assured that SARS can be contained at this point.
SARS demonstrates the value of speedier methods to isolate and characterize pathogens. Technologies under development to make nanodots and other nanotech sensor approaches for biological material promise someday to speed up the development of defenses against new infectious agents by orders of magnitude. Advances in biotech are already evident in the response to SARS. It took many months to identify and characterize the cause of Legionnaire's Disease back in the 1970s. The pace of the advance in the SARS investigation has been much more rapid. The scientists working on the cause of SARS have already focused their attention on a coronavirus after an initial suspicion that a paramyxovirus might be the cause. Now scientists are reporting that SARS might have been come about from the mixing of DNA from coronaviruses from different mammalian species.
Canadian scientists racing to find the cause of SARS say it appears to be a mutant strain of coronavirus with bits of human, cow and mouse virus scrambled into its genetic code.
The likely way this happened was that a single animal or human was infected by human and animal coronavirus strains at the same time. Different kinds of coronavirues in the same cell swapped genes to create a new and more virulent hybrid. Separately, other scientists have shown that cross-species mixing of coronaviruses can create new and more infectious forms of virus.
Now, in a simple overnight experiment, researchers transformed a coronavirus that is lethal to cats into one that infects mouse cells by replacing a single gene1.
The genetic code of the coronavirus that is suspected of causing SARS is expected to be approximately 30,000 DNA base pairs in length. Scientists are working with isolates of the SARS coronavirus to sequence it. Once it has been refined into a pure enough form to be DNA sequenced the current equipment for DNA sequencing could read its code within a single day. However, sequencing is normally done several times to check for errors and so this process can take a week or two. Where we are still lagging in speed is in the ability to then develop a vaccine or drug that can counteract the effect of SARS. The best prospect for development of an anti-SARS treatment in the short term is in the isolation of gamma globulin from the blood of those who have recovered from the disease.
Although no drugs have proved useful in treating the viral infection, Dr. Leung Ping-chung of Prince of Wales Hospital said Monday that doctors used gamma globulin from recovered patients to treat 20 severely affected victims
The success of the gamma globulin treatment raises the prospects of being able to reduce SARS deaths in industrialized countries should SARS reach pandemic levels.
The rate of scientific progress in investigation of the cause of SARS might be fast enough to stop the spread of the disease because tests may be developed to speed its detection. Though that the containment of SARS is by no means assured. Even if we manage to dodge the bullet this time there is no reason for complacency. If an influenza (which is probably more easily transmissible) of equal or greater lethality was to pop up then the odds of containing it with current technology and current public health practices would be much lower. Therefore even in the industrialized countries humanity remains quite vulnerable to new and more lethal forms of natural pathogens.
The New Scientist has a worthwhile SARS theme page with all their SARS articles.
Update: You can find all of the FuturePundit SARS posts in the Natural Dangers category archive. Also, you'll find my coverage of the economic impacts of SARS on my ParaPundit blog in the Political Economics category archive
Update II: To clarify: Note that in the event of an outbreak of SARS into wider populations that while gamma globulin may be able to save many lives in industrialized countries SARS would exact a far higher toll in less developed countries. Also, as is being demonstrated in East Asia right now the economic consequences of a SARS pandemic would be enormous. I've been posting a lot on SARS because its like we are out there on the edge of a precipice and it is not yet clear whether we are going to take the plunge.
Reacting to the spread of the new infectious disease Severe Acute Respiratory Syndrome (SARS) the World Health Organization has advised against travel to Hong Kong and Guangdong province of China.
Wednesday, 2 April, 08:30 Palais des Nations
World Health Organization
Dr David Heymann, Executive Director, Communicable Diseases
Dr Guenael Rodier, Director, Communicable Disease Surveillance and Response
Mr Dick Thompson, Communications Officer
Mr Dick Thompson
This will be an abbreviated press briefing. You will have an opportunity to ask a few questions, but not many. The reason is that they are getting on a flight to attend Carlo Urbani's funeral in Italy.
Statement from Dr David Heymann
Good morning. Thank you for coming this morning. We have two different types of information to offer to you this morning. The first is that China is now a full partner with WHO. The teams have been asked to immediately go to Guangdong. Guangdong has reported the number of cases that have occurred during the month of March, which is 361 cases and 9 deaths, which mean that the epidemic is still going on in Guangdong, and they have promised that later today they will provide all of the information that they have obtained from their national disease surveillance system looking for SARS. So we are very pleased to announce that China is now a full partner with other international partners, in fact with the rest of the world, in collaborating on stopping this epidemic and in finding out the various aspects that we need to find out.
The second [type of information] is that since control measures have begun in Hong Kong, which began on 15 March, just after we made our announcement, and in other parts of the world, control measures have been successful in stopping the disease. For example, in Viet Nam the disease has been stopped we believe. In Singapore and Toronto, activities are going on and they are having good success.
I would like to focus now on Hong Kong, however, where since 15 March there have been 9 people, travellers, tourists or businessmen, from Beijing, from Taiwan, and from Singapore, who have returned home from Hong Kong infected with SARS. In addition in Hong Kong, they have found that transmission does not seem to be only by close contact from person to person. It appears that there is something in the environment that is transferring virus, which is serving as a vehicle to transfer the virus from one person to another. We do not believe this is the air. We believe that it is something else in the environment and we have talked about that in past press conferences. It is possibly an object that people are touching and getting infected from, where there has been a SARS patient who has coughed, or possibly a sewage system or a water system or some type of environmental vehicle that takes the virus from a sick person to others. So we see clusters of cases where there is one case, for example, living in an apartment building, where other people in that apartment building have been infected.
So for these two reasons, because of the fact that we do not completely understand the means of transmission in Hong Kong, and because since the 15 March tourists and businessmen have returned from Hong Kong to their countries with infection, we have decided to make a recommendation that people who are planning travel to both Hong Kong and Guangdong, which as you know is adjacent to Hong Kong, consider postponing their travel until another time. We will be working daily with the Hong Kong authorities, and we have daily conference calls with them and now we will begin also with Guangdong authorities, to determine if there are any reasons that we can stop that recommendation. In other words, the recommendation will be reevaluated every day and we will make a decision every day whether or not that needs to be changed. So now what we have is from all sites where there is a SARS outbreak that is causing chains of transmission, we have requested that tourists or travellers understand about the disease, that airports screen passengers who are returning to their countries from these sites, and now, in addition, we are telling travellers who are planning to go to Hong Kong and Guangdong that they consider postponing their travel. So what we have is a system in place now which will, we hope, stop the spread from the sites where SARS is occurring internationally and at the same time help passengers, tourists or businessmen who are planning to go to Hong Kong or Guangdong decide better whether or not they should go. We are recommending that they reconsider their travel plans and postpone if possible their travel to Hong Kong or Guangdong.
It is noteworthy that SARS has not been contained in China. The Chinese claimed they had it under control. Instead it has been spreading. China appears to finally be cooperating with the WHO. But the Chinese authorities have been quite irresponsible up to this point. The disease first showed up in Guangdong province China in November 2002. If the world's infectious disease experts had been notified at that time we'd be about 5 months further along in the learning curve about this disease and containment measures to stop international spread would have been begun much sooner and with much greater success.
Some countries are taking more drastic action. If travelling from Hong Kong to Thailand you will be placed in quarantine when you reach Thailand.
Q. Yes, Dr Heymann, can you explain a little bit about the process prior to issuing this advice? While it probably makes sense from the health perspective, it will have economic, social, political impact in the region. I’m wondering if you have consent from authorities in Guangdong, Hong Kong, or China?
A. Dr David Heymann: We’ve spoken first of all with IATA, which is the International Air Transport Association, and they have understood this and they have given their agreement that this is the recommendation which should be made at this point. We’ve discussed with the various different countries in the region, with our regional office and through our regional office, and we find that in those countries there are already much more strict recommendations than this is. For example, in Thailand, the government has announced that all returning passengers from Hong Kong will be quarantined. So we understand that there are very serious measures already being taken in many countries. So we made this decision with countries, with WHO and, more importantly, with our expert group of advisers on travel and health. We’ve spoken with many of our advisers, you know we have various advisers around the world, we have talked with them as well. And through all of these discussions, which went on all day yesterday and the day before, we’ve come to this conclusion.
The economic consequences of SARS could grow very large. Of course the tourist industry will be hit. But also various business meetings that facilitate international trade will not take place.
Update: This WHO recommendation is unprecedented. The World Health Organization has never before in its history totally recommended against travel to a specific geographic area.
This is the first time in the history of WHO that such travel advice has been issued for specific geographical areas because of an outbreak of an infectious disease.
Since 1958, WHO has issued weekly lists of areas infected with quarantinable diseases so that national authorities can decide whether to apply public health measures to arriving travellers. During the last years of the smallpox eradication campaign cases spread internationally by land. Controls at borders between neighbouring countries were relied on to prevent international spread. No global recommendations were necessary.
Here is the World Health Organization press release for the travel advisory: Update 17 - Travel advice - Hong Kong Special Administrative Region of China, and Guangdong Province, China
The SARS situation in Hong Kong Special Administrative Region has developed features of concern: a continuing and significant increase in cases with indications that SARS has spread beyond the initial focus in hospitals. These developments have suggested environmental routes of transmission from a SARS infected person which may be related to contamination of common systems that link rooms or flats together. Despite the implementation of strict measures to control the outbreak, there have continued to be a small number of visitors to Hong Kong who have been identified as SARS cases after their return from Hong Kong. The epidemic in Guangdong Province of China, situated adjacent to Hong Kong, is the largest outbreak of SARS reported and has also shown evidence of spread in the wider community. As a measure of precaution WHO is now recommending that persons travelling to Hong Kong and Guangdong Province of China consider postponing all but essential travel. This temporary recommendation will be reassessed in the light of the evolution of the epidemic in the areas currently indicated, and other areas of the world could become subject to similar recommendations if the situation demands.
Please note that this recommendation applies only to travellers entering Hong Kong Special Administrative Region of China and Guangdong Province of China, not to passengers directly transiting through international airports within those areas.
Initially when the new infectious disease SARS (Severe Acute Respiratory Syndrome) emerged early indicators were that it was not easily transmissible. The first indication that it might be more easily transmitted was the discovery of its transmission from one doctor to several people who stayed on the same floor of the Metropole Hotel in Hong Kong. As SARS continues to spread a consensus is emerging that SARS is much more easily transmissible than originally thought. Suspicions that it is caused by a coronavirus strengthen this belief because about one third of all colds are caused by coronaviruses and of course colds are fairly easily transmitted.
The Hong Kong Department of Health has today issued an unprecedented isolation order to prevent the further spread of Severe Acute Respiratory Syndrome (SADS). The isolation order requires residents of Block E of Amoy Garden to remain in their flats until midnight on 9 April.
The decision to issue the isolation order was made following a continued steep rise in the number of SARS cases detected in the building over the past few days. Concern about a possible outbreak in Amoy Garden mounted on Saturday, when 22 of Hong Kong’s 45 new SAR cases hospitalized that day were determined to be residents of the estate. On Sunday, 36 of the 60 new patients admitted to hospital with probable SARS were Amoy Garden residents.
Hong Kong health authorities today informed the public that a cumulative total of 213 residents of Amoy Garden had been admitted to hospital with suspected SARS since reporting on the disease began. Hong Kong’s outbreak began on 12 March when health officials first recognized a cluster of cases of atypical pneumonia in the Prince of Wales Hospital.
Of the 213 Amoy residents affected in the outbreak, 107 patients resided in Block E. In addition, most of these 107 patients from Block E lived in flats that were vertically arranged.
This suggests that SARS may be spreading in Hong Kong according to a different pattern, still involving close person-to-person contact with bodily secretions from an infected person. WHO epidemiologists are considering the possibility that bodily secretions containing the causative virus might somehow enter common systems that link rooms or flats together. This pattern of spread would be in addition to the well-documented face-to-face contact that has been seen in the majority of cases reported so far.
Earlier this month, Hong Kong epidemiologists detected an unusual pattern of transmission among guests and visitors at the Metropole Hotel during the critical period of 15 to 23 February. Guests and visitors at a single floor of the hotel are thought to have spread SARS to Toronto and Singapore and to have started the outbreak in Hong Kong’s Prince of Wales Hospital. No staff at the hotel developed symptoms
The guests of the Metropole Hotel who got SARS all stayed on the same floor of the hotel. This again suggests spread of the disease via air ducts.
If ducts in the Amoy Garden building are spreading SARS then quarantining the people of that apartment building and forcing them to stay inside may well turn out to be a death sentence for some of them. The ones who are not yet infected will be forced to remain close to those who are infected but not yet diagnosed. Therefore the spread of the disease within Amoy Garden may continue.
If the disease continues to spread and more quarantines are ordered then it is quite possible that people will resist being quarantined in close quarters with other people who might be infected. The Amoy Garden quarantine is already being enforced by police stationed outside to prevent people from entering or leaving.
The Hong Kong housing block, the Amoy Gardens in Kowloon, was surrounded by about 50 police officers on Monday, as the Hong Kong authorities invoked quarantine laws to try to stem the growing crisis.
In a really large scale outbreak there would not be sufficient numbers of police available to enforce quarantines. If the connection between SARS spread and air ducts is established then in the event of a large scale outbreak many people will likely flee from multi-unit dwellings such as apartment buildings.
While SARS spread on a single floor in the Metropole Hotel the pattern of SARS spread in the Kowloon apartment block is different
"They are finding that the infections are in people living in apartments on top of each other, only in one area of this apartment block. It's only two apartments, but from floor zero to 35. Not all of those apartments are affected, but most of the families affected are living in that small area of that apartment building," virologist Klaus Stohr said at WHO headquarters in Geneva.
One potential explanation for the difference in the pattern of spread in the Metropole Hotel and the Amoy Garden may be a different duct work layout. Ducts might be laid out in a more columnar structure in the Amoy Garden and more in rows in the Metropole.
If, as suspected, SARS is caused by a previously unidentified member of the coronavirus family then it is probably similar to other coronaviruses and possesses the ability to survive on exposed surfaces for a few hours at least. Therefore it might be transmissible by touching a surface at a location where an infected person coughed a few hours previously. Frequent handwashing may help to reduce its spread.
By the end of March 2003 there have been 1622 reported cases of SARS and 58 deaths. That is a nearly 4% death rate. But the actual death rate is likely even higher since some of the currently infected out of the 1622 will eventually die from the infection.
While most types of influenza tend to kill only the very old, the very young, and those who are immuno-compromised SARS kills people in the prime of life.
Dr. Carlo Urbani, an expert on communicable diseases, died today of SARS. Dr. Urbani, worked in public health programs in Cambodia, Laos and Viet Nam. He was based in Hanoi, Viet Nam. Dr. Urbani was 46.
The great influenza pandemic of 1918-1919 (popularly known as the Spanish Flu) also struck down those in the prime of life. Though while Spanish Flu caused the highest mortality rate in those aged 20-39 WHO official Mark Salter says the risks of dying from SARS are greater for those over 40 years old.
Age could be one factor, with people over 40 apparently at greater risk, while the fact that a patient was already suffering from some other chronic ailment, such as heart or liver disease, could also play a part, he said. "The indications seem to be that if the patient is over the age of 40 and has other illnesses as well...they would be more prone to developing a more severe form when the chances of survival become smaller," he told Reuters.
Here are excerpts of the March 29, 2003 CDC press conference held by CDC director Dr. Julia Gerberding. (bold emphases added)
We believe, based on what the investigations have shown us so far, that the major mode of transmission still is through droplet spread when an infected person coughs or sneezes and droplets are spread to a nearby contact. But we are concerned about the possibility of airborne transmission across broader areas and also the possibility that objects that become contaminated in the environment could serve as modes of spread.
Coronaviruses can survive in the environment for up to two or three hours ,and so it's possible that a contaminated object could serve as a vehicle for transfer to someone else.
In health care settings, we have already initiated guidance to protect against droplets, airborne and contact spread of this virus, and today we're issuing an update on how to protect people in homes of SARS patients.
We know that the individual with SARS can be very infectious during the symptomatic phase of the illness. We don't know how long the period of contagion lasts once they recover from the illness and we don't know whether or not they can spread the virus before they have the full-blown form syndrome.
But most of the information that the epidemiologists have been able to put together suggests that the period of contagion may begin with the onset of the very earliest symptoms of a viral infection, so our guidance is based on this assumption.
About one third of all common cold infections are caused by a type of coronavirus. Hence Dr. Gerberding makes a comparison to cold virus spread.
DR. GERBERDING: We are very vigilant about the possibility of spread. We recognize that there are at least some patients with SARS that are extremely efficient transmitters. We don't know to what extent all patients are particularly infectious but there are clearly some who appear to be very highly infectious, and, for example, in Hanoi where there was one patient who was a source for health care worker transmission and approximately 56 percent of the health care who had direct contact with the patient appeared to have acquired SARS.
So given that high degree of contagion and what we know about spread of cold viruses, I think we are very alert to the possibility that this could spread outside of the confined populations that I've mentioned, travelers to the affected areas, close household contacts, and health care workers. But we are not seeing that now and we are looking for it very closely.
So if we begin to appreciate that, we will have to expand our recommendations to be more inclusive of special protective measures for contacts.
The biggest danger is that SARS is spreading in places that are effectively out of sight of Western investigators. The most likely country where SARS is still spreading is China. Western disease experts still have very little visibility into what is really happening with SARS spread in China.
DR. GERBERDING: Well, from the standpoint of CDC, I would say that we are very concerned about the spread of this virus, particularly in Asia. We recognize this as a epidemic that's evolving differently, in different geographies, but nevertheless, it is a respiratory virus, it does appear to be transmitted very efficiently, and what we know about respiratory viruses suggests that the potential for infecting large numbers of people is very great.
So we may be in the very early stages of what could be a much larger problem as we go forward in time. On the other hand, this is new, we don't know everything about it, and we have a lot of questions about the overall spread.
The patterns of transmission in the individual countries vary, depending on where the primary foci of transmission is occurring.
In Hong Kong, the situation is particularly alarming because we have several hospitals that are affected, and there are so many health care workers in each of these hospitals that could have been exposed or who are developing SARS, that there's already a multiplier in the community. Every health care worker has household contacts, those contacts, when they become ill, have had other exposures.
So we are very concerned about the speed and the amplification process in Hong Kong. On the other hand, the health officials there are taking extremely efficient and aggressive steps at this point in time to contain spread in that community, including closing schools and closing hospitals, and cohorting health care workers and patients.
So it remains to be seen whether or not those measures will attenuate the spread. The biggest unknown is of course what is going on in China and we are desperate to learn more about the scope and magnitude of the problem there, because that really I think will be the biggest predictor for where this will be headed over the next few weeks.
Here we are over 5 months after the SARS disease first surfaced in China and CDC and WHO authorities still know little about how the disease developed and spread in China. As a consequence of our ignorance of the disease's spread in China we have only the information developed from the course of its much more recent appearance in Hong Kong and in places outside of China. Therefore we simply do not yet know enough to say what are all the ways by which SARS can be transmitted.
Concerns that I mentioned earlier focused on droplet transmission, so if you were in the elevator and an infectious person literally coughed on you, it's conceivable that you could acquire a respiratory infection, including SARS, through that mechanism.
On the other hand, most of the information suggests that fairly prolonged contact, on a face to face basis, is typical of the transmissions.
There are anecdotal reports, that we haven't confirmed yet, of much briefer contact. There's been a concern expressed about the potential for airborne or surface contamination in the apartment in Hong Kong, and these are all open questions that we are aggressively pursuing here.
It could be worse. A moderately severe influenza strain (i.e. not as bad as the 1918 outbreak but worse than the average influenza strain) has a higher mortality rate than SARS. Though influenza tends to take the very young and very old and hence elicits less fear in the general population.
DR. GERBERDING: Certainly, there could be other cofactors involved such as viruses or underlying illness, but this is just atypical pattern for any infectious disease. If you get pneumococcal infection, many people have completely asymptomatic. Some people get a mild disease and some people have a full blown, very, very severe illness from the infection.
So this is a typical pattern for respiratory illnesses, not something that we're surprised about. In fact if there's any good news in SARS right now, it's that the majority of patients do appear to recover and that the death rate is actually lower than what we see with epidemic influenza, about 3.5 percent of the patients have died from the illness. That is still a tragic occurrence for the people who are affected, and their families, and I would never mean to minimize it. But it is fortunate that it is not even more severe.
The real tragedy in the case of SARS is that the Chinese government has managed to make a bad situation worse. In spite of the fact that SARS first surfaced in China in November 2002 the rest of the world did not hear about it until it started causing infections in Hong Kong and Vietnam a few months later. The irresponsibility of the Chinese government may lead to a massive outbreak throughout the world.
The president of Taiwan, which has 10 cases of Severe Acute Respiratory Syndrome (SARS), has been the most outspoken. "SARS first broke out on the Chinese mainland, but the authorities covered up the information, leading to a global epidemic," Chen Shui-bian said on Friday. China initially admitted to five deaths, but a toll of 31, and 800 infections, since November was revealed on Wednesday.
The press in China is highly controlled and is not a reliable source of information about the extent of SARS in China. Also, the Chinese government has resisted providing the WHO much information about SARS. On Friday March 28 2003, over 5 months after SARS first showed up in China, the Chinese government finally agreed to allow WHO disease experts access to Chinese information about SARS infections in China. But it is far from certain that China will be completely forthcoming. One international health official quoted off-the-record in the article above says that the disease is probably far more widespread in China than the government of China is admitting to even now. There are parts of China that are poor where most of the population have little access to health care services. Even if the most developed countries take steps to slow the spread of SARS at this point it seems likely that SARS will spread in less developed countries.
If China had reported its SARS outbreak back in November of 2002 we'd be about 4 or 5 months further along in developing tests, developing vaccines, studying its mode of transmission, and developing ways to minimize its spread. But the Chinese government instead hushed it up and the result may eventually be millions of deaths that could have been avoided.
What to do to avoid becoming infected? Face masks may not help that much.
Doctors say sick people who put on masks become less likely to transmit the illness when they cough or sneeze. But it is unclear whether the masks help the healthy. They quickly become saturated with moisture from breath and lose some usefulness when worn for hours - much less for days, as is happening here now - local doctors warn.
We really need to know more about the efficacy of facial masks for blocking SARS' spread. If it looks like SARS is going to spread into the general population keep in mind that protecting the eyes from airborne droplets might also be of some value for reducing risks. Goggles or safety glasses might reduce the risks of transmission. Also, frequent hand washing when out in public places may also reduce the risks of getting the illness.
One big question in my mind is about how duct work and air filters are laid out in large buildings. Do most buildings do a good job of filtering out particles from air that comes out of each dwelling or office before that air passes into other areas in the same building? Also, could air filters be rapidly placed into existing buildings to reduce the spread of airborne virus particles? If people begin to fear living and working in large buildings the economic costs of the fear of SARS could become enormous very quickly.
If SARS breaks out into the general population the fatality rate may rise. Currently because so few people have SARS each person can receive a great deal of care including respirators when necessary. But if large numbers of people become infected there will not be enough equipment or medical workers to care for them.
SARS may cause an enormous economic impact. If the fear of SARS grows large enough then many people will avoid both business and personal travel, restaurants, movie theaters, shopping malls, and other public places with large numbers of people. Consumer demand will therefore decline and the rate at which business deals are negotiated will slow.
Also see my previous posts on SARS: Severe Acute Respiratory Syndrome Causing Concerns and Hunt For Cause Of Severe Acute Respiratory Syndrome.
But coronaviruses are prone to transformation. They have an unusually large amount of genetic material, as well as enzymes that enable them to shuffle it. A new, more virulent mutant could easily result.
American Airlines Flight 128 from Tokyo is being held on the tarmac at San Jose International Airport after two passengers and two crew members complained of feeling unwell, airport officials said.
People will become more afraid to fly if SARS continues to spread. Also, if many flights get quarantined there will even be a reduction in the number of flight crews available to fly aircraft.
Some airlines in the Southeast Asian region are moving to reduce the risk of infection. Thai Airways International and other airlines of Thailand are requiring passengers from high risk countries (Singapore, Hong Kong, China, Taiwan and Vietnam) to wear surgical masks.
Here's some more bad news about surgical masks. Australian expert David Bromwich says surgical masks do not provide much protection against airborne disease.
But David Bromwich, an expert in respiratory protection from Brisbane's Griffith University, said that passengers wearing surgical masks to guard against respiratory disease were "kidding themselves". Dr Bromwich said surgical masks were originally designed to stop transmission of saliva from doctor to patient, but offered almost no protection from tiny airborne disease particles. "It's a false sense of security," he said.
Since surgical masks do not provide much benefit I guess it doesn't matter that there is an enormous surgical face mask shortage developing. The 3M plant for manufacturing N95 surgical masks is operating at maximum capacity and can not keep up with demand.
The masks, made of a micro-fibre designed to filter out impurities, are manufactured at a plant in the United States, currently operating 24 hours a day under a "state of emergency."
Canada, which has been much harder hit by SARS than the US faces a surgical mask shortage for medical workers.
Hong Kong just reported a new single day record of 75 new cases of SARS diagnosed and other countries are reporting new cases. These cases are spurring countries in the region most hard hit by this new disease to take increasingly stringent measures to stop the spread of SARS.
Hong Kong invoked a colonial-era law Tuesday to quarantine more than 240 people in countryside vacation camps, part of redoubled efforts to halt the spread of a mysterious flu-like illness that has killed at least 63 people around the world.
The 240 are all from block E of the Amoy Garden apartment building complex.
SARS has so far killed about 3 to 4 per cent of the 1500 sufferers. But be thankful it is not as infectious as common influenza.
"If it were flu, it would be all over the world with millions of people infected," says Victoria's public health chief, Dr Robert Hall.
The containment of SARS has been found to be quite difficult for public health authorities and success is by no means assured. There is a lesson here: If a more easily transmittable disease of equal or greater lethality emerged then unless the threat it posed was recognized at a very early stage and attempts to stop its spread were very aggressive it is unlikely that it could be contained.