Will masks become the latest fashion statement? Photographs from Hong Kong show masked little girls in ballet class. Even without deliberate biological warfare, humanity is constantly threatened by emerging pathogens, especially viruses. Crowding, insect vectors, inadequate ventilation-and airplanes-are microbial allies.
Although the fastest mode of contagion is airborne transmission, many organisms, probably including the cause of severe acute respiratory distress syndrome (SARS), can survive on dry surfaces for days or weeks. Touch a handrail or shake hands, then touch your eyes or nose, and viruses have found a new host.
When caring for a SARS patient, precautions recommended by the Centers for Disease Control and Prevention (CDC), (www.cdc.gov), call for N-95 respirators, goggles, gowns, gloves, and frequent handwashing with soap and water. If hands are not visibly soiled, an alcohol-based hand rub can be used-purchase a tube at the grocery store to take on the airplane.
An N-95 respirator removes 95% of airborne particles. Various types can be ordered on-line-with exhalation valve, about $1.50 each-if available. Some vendors have them back-ordered indefinitely. If a respirator is unavailable, use a surgical mask. Remember that efficiency deteriorates rapidly as the mask becomes damp. When removing the mask, take care as the outside is likely to be contaminated.
In a Hong Kong hospital, none of 69 staff members who used mask, gown, gloves, and hand-washing became infected from contact with SARS patients, whereas 13 workers who omitted at least one of these measures acquired SARS. Both surgical masks and N-95 respirators were protective although paper masks were not (Seto WH, et al. Lancet 2003;361:1519-1520). This suggests that droplets, not airborne transmission, are the primary method of spread. However, recent infection of a doctor who supervised the infection control procedures is very concerning.
The virus may also spread in water or sewage; an aerosol from a leaking sewage drain in a Hong Kong apartment and backflow into floor drains was the probable source of one outbreak (Lancet 2003;361:1486-1487).
After returning from a SARS-affected area, travellers should check their temperature twice a day and watch for cough, shortness of breath, or difficulty breathing, for at least 10 days.
According to World Health Organization (WHO) reports posted at www.promedmail.org, a total of 7,919 cases have been reported worldwide, with 662 deaths and 3,984 recoveries between Nov. 1, 2002, and May 20, 2003. Hong Kong reports that some patients thought to have recovered relapsed more than 2 weeks after being discharged from the hospital. The death rate could be greater than 50% in patients over the age of 65 (www.medscape.com).
The U.S. has reported 67 probable cases, nearly 300 ``suspect'' cases, and no deaths as yet.
The hardest hit developed country is Canada, mainly Toronto, with 140 cases and 23 deaths so far. Health Canada has challenged the WHO assessment and asserts that it is now safe to travel there. However, system failure at all levels in Health Canada has been blamed for the fact that Canada ranks third, after China and Singapore, in the number of SARS deaths. One patient, whose mother had died of typical SARS-called a ``heart attack'' by the coroner-soon after being discharged from a Canadian emergency room on an antibiotic, exposed hundreds during his 12 hours on a gurney in the hall of the emergency room (Steyn M, National Post 4/4/03).
There is serious potential for a worldwide pandemic. A key unknown is the situation in China, especially rural China (Science 2003;300:558-559). The problem is not just poor communications. As Steyn stated: ``Because totalitarian regimes lie, China denied there was any problem for three months, and thereafter downplayed the extent of it. Because UN agencies are unduly deferential to dictatorships, the World Health Organization accepted Beijing's lies'' (ibid.).
Parenthetically, SARS could have a large political impact on China. Skeptics are beginning to ask ``how can the country be run by a system that encourages widespread statistical fraud?'' (Johnson I Wall St J 5/2/03).
Treatment is controversial. In Hong Kong, patients receive a combination of antibiotics, methylprednisolone, and ribavarin. The antibiotics are used until recognized pathogens can be excluded. Corticosteroids are to reduce tissue damage from the severe inflammatory response accompanying viral clearance. Ribavarin was chosen for potency against both DNA and RNA viruses. The coronavirus believed to cause SARS has some similarities to the hepatitis C virus, against which ribavarin has been somewhat effective in combination with interferon (Lancet 1998;351:83-87). Although initial results in 31 SARS patients were reportedly good (Lancet 2003;361:1615-1617), critics have slammed the treatment as ineffective and perhaps dangerous, and U.S. officials have rejected it (Nature 2003;423:3-4). Mixed results are reported with interferons. Drugs used against AIDS, antibodies from the plasma of recovered patients, newer products of biotechnology, and traditional Chinese medicines are also being tried (Wall St J 4/23/03).
Modern technology provides both the means for rapid global dissemination of emerging pathogens, and also of the knowledge needed to contain them. The developed world is at risk from poor sanitation and live poultry markets in the Far East. Yet mobile phones and e-mail enabled the quarantine of an airliner from Singapore in Frankfurt, perhaps crucial in preventing more rapid spread of contagion in Europe. Alert and dedicated individuals are indispensable-such as Dr. Carlo Urbani, who sounded the critical alarm in Hanoi and later died of SARS himself. But stonewalling bureaucrats can obstruct the needed actions-until an outbreak, like a wildfire, is uncontrollable (Wall St J 5/2/03).
According to biographical information he prepared in April for the upcoming DDP meeting, Mr. York performed technical photography of the first atomic detonation and did measurements of initial nuclear radiation during atmospheric tests at the Nevada Test Site and the Pacific Proving Ground. He worked on methods of hardening strategic aircraft and missiles against electromagnetic pulse, blast, and thermal and ionizing radiation, and on the protection of command, control, and communications facilities from conventional warfare, nuclear, chemical, or biological attack, sabotage, and terrorism. He also worked on the protection of industrial equipment and key workers from nuclear attack and did studies of industrial recovery following nuclear attack. He designed and tested civil defense shelters and gave generously of his time and expertise to advise and guide groups and families who were building shelters.
Mr. York's elegant presentations were always a highlight of DDP meetings, which he never missed until 2002. The opportunity to visit with him informally was even more valuable. Civil defenders never had a truer friend, nor one with a broader and deeper knowledge. His loss leaves an enormous void.
Nita York will remember her father on Sunday, July 13, at the DDP meeting, and present some materials that he had prepared.
Memorials may be made to the American Heart Association.
DDP, 1601 N. Tucson Blvd. Suite 9, Tucson, AZ 85716, (520)325-2680, www.oism.org/ddp.