SARS The Responsible and the Irresponsible

[mirifly]

With the rapid worldide spread from Asia of the SARS 'virus' it is reassuring to know that a lot of Airlines in the region are operating according to WHO directives. Some of the more responsible Airlines such as Thai International are actually issuing pax and Crew with masks when they fly to affected areas such as HKG and mainland China. Dragonair and Singapore Airlines have
this directive printed on their Websites.

Then we come to the irresponsible that are flying within the affected regions. Their web pages show no information whatsoever as issued by the WHO, but even more worrying is that the Crews are not being briefed as per the new directive distrubuted by the WHO. This I believe is totally irresponsible of them, there is no cause for panic, but new cases are being reported daily and perhaps vigilant Crews, Check in Agents, and more importantly Airline managers, should get their act together and do as advised by the WHO. In fact if they really used their brains they may even increase their diminishing pax figures as pax are reassured they are flying with a responsible carrier.

Anyway good on Thai and Singapore Airlines

Hmmmmm :*

[gofer]

Can see just a little of your argument, but do get rather cross when everybody says that the problem is HK or Singapore. The root of the problem is China, who never reported the start of the problem to the WHO and who only did report some of their cases after a monster set of complaints.

Now what do advise about the other countries who also have some SARS cases, such as USA, Canada, Vietnam, UK, Switzerland, Germany and I'm sure that there are others - should we also have everybody wearing masks there - or better still quarantine everybody and forbid travel completely ?

Then again there is the possibility of infection from Door Handles, Lift Buttons, Taps etc. and gloves don't necessarily help as you have to remember not to touch yourself anywhere if you have touched something that could be contaminated - so no knives or forks..... The list becomes almost endless.

The question really is - Was this ment for somebody like a certain ruler in Iraq - but boy George just got the address wrong, or was it the other way around ? But of course that is childish so whatever is done should be done by the reader, because they are a responsible adult, not because fashon or a company say you should.... Or is that too adult.:rolleyes:

[Belgique]

Sent: Wednesday, April 02, 2003 5:08 PM
Subject: 2nd EDM Update on SARS (Severe Acute Respiratory Syndrome)

2nd EDM Update on SARS (Severe Acute Respiratory Syndrome)

A Global Threat?
April 2, 2003

We published our first international hazard announcement about SARS on March 20, 2003. At that time, approximately 350 cases and 10 fatalities had been reported. Today, only 13 days later, more than 1,800 cases worldwide have been reported with more than 60 deaths in Canada, China, Hong Kong, Singapore, Thailand, and Viet Nam.

The public interest at the time of our initial statement was focused on the war in Iraq. Response to SARS was rather slow. Since then the impact of the spread of the virus has become far more obvious, and media coverage of the topic has reached the level of newspaper headlines and CNN coverage.

Airports, airlines, and the public face the risk of quarantine; air travel (not only to and from Asia) is decreasing; schools, factories, and offices in Asia have begun to close; business and leadership meetings and even Rolling Stones concerts in South East Asia and China have been postponed. With the increased interest of the media, the risk of exaggeration, misinformation, and unnecessary public anxiety is obvious.

The virus and its spread have not been contained. Today, more than 6 billion (6,000,000,000) people live on Earth. Everyday, up to 2 million people worldwide cross national borders.

Each year, the USA alone hosts 47 million visitors and 1.5 billion (!) people travel on commercial airplanes. Today, using the service of an aircraft, the SARS virus and any other pathogen can be virtually anywhere within 48 hours.

The symptoms of SARS are unspecific. They are described as a person with one or more signs or symptoms of respiratory illness, including cough, shortness of breath, difficulty breathing, hypoxia, or radiographic findings of pneumonia or acute respiratory distress syndrome AND fever AND one or more of the following: close contact within 10 days of the onset of symptoms with a person under investigation or suspected of having SARS and/or travel within 10 days of onset of symptoms to an area with documented transmission of SARS.

Worst of all, many health care workers have fallen victim to the virus, some have already died. Among the dead is Dr. Carlo Urbani, a veteran expert on communicable diseases, and the first WHO officer to identify the outbreak of SARS in Hanoi, Vietnam. The same ailment ended his life on March 29, 2003.

Like most viral infections, medication to treat SARS is useless. The risk, particularly for those working in airports, on airplanes, in the emergency services, and within the medical communities is undeniable.

It is imperative that all levels of the public and private sectors prepare for SARS. If this communicable disease, which has a fatality rate of approximately 5%, shuts down commercial aviation, it will impact many of the 127 million people employed in the aviation industry and hurt, in a ripple effect, entire economies.

We at EDM are compiling as much information as possible about the virus, its spread and contagiousness, and ways to prevent or mitigate a pandemic outbreak. At <www.edmus.info> we regularly publish SARS information from and links to distinct sources and organizations (i.e., WHO, CDC, Health Canada), including policies and activities undertaken by health officials throughout the world. The federal health department of Canada, a nation that has already faced six deaths, has implemented exemplary procedures for arriving and departing travelers.

We urge every aviation and emergency professional to stay informed and aware of new developments. More importantly, we ask that you share your experiences, best practices, and lessons learned in reducing the threat of the SARS outbreak.

Please forward to EDM any related information or procedures to be published at www.edmus.info.

SARS has the potential for a calamity of huge proportions and must already be considered a global threat. Sharing knowledge and experiences, working together, acting locally while thinking globally is a must, not a choice.

"Emergency Management is Planet Management"

To facilitate such an exchange of knowledge, EDM is announcing the development of one-day workshops on SARS and other biological agents within the very near future, the first to be held in the middle of April at Los Angeles International Airport (LAX), another one will be held at the end of April at Frankfurt International Airport in Germany. If you or your organization wishes to attend and participate, please send us an e-mail stating your interest.

Emergency & Disaster Management, Inc.
Airport Center
5959 West Century Boulevard, Suite 700
Los Angeles, California 90045
USA
Phone: (001) 310-649-0700
Fax: (001) 310-649-1126
Email: [email protected]
www.edmus.info
"Assisting Clients Worldwide in Building Disaster/Terrorism Resistant
Communities and Businesses"

[Longhauler]

I have seen nothing on the WHO website to support the media reports that SARS can be contracted by touching an infected surface. All published facts still indicate that it is spread by moisture droplets which means one needs to be in close contact with an infected person to be infected themselves.

[gofer]

Sorry but... When people don't report you don't have the stats - when some of the laggards catch up, saying that they only report monthly ..... the figures change dramatically

What we need is a graph with the numbers per country per day - then if the slopes change - you can tell if its getting worse or better at a glance.

Now if you could get us something like that Belgique, we can talk facts and not theoretical fiction.:(

[tiba]

thanks so much for all the info out there..........but what i would really like to know is if any crew member or otherwise been to either hong kong, singapore or canada lately and what is it like there at the moment???? any particular precautions one should take?? places to avoid??? any info that might help all of us who layover there regularly????

[christep]

Gofer,

I don't have the time or the data to do the whole world, but at my website http://home.so-net.com.hk/~pns/ I am maintaining a summary of the latest official figures for Hong Kong and compare them to risks associated with some other conditions (again based on WHO and other official sources).

If I have time this weekend I will add a graph (or at least a table)showing the trends over time for SARS in HK.

[Avius]

tiba,

I've been on a Layover in Hongkong/Kowloon in the second half of March just a few days after the press reported it as some severe disease now known as SARS. When I arrived, hardly anyone was wearing face-masks, maybe 2-3 people I've seen while checked out at the Airport.

Walking around town it was almost the same thing, no face-masks, apart of some people held half-heartedly tissues in front their face.

I suppose no one was panicking then. I've took rather common sence measures, like not touching anything unnecessary avoiding crowds (not using sub-way, etc.) and washing hands frequently.

4 days after I left HK while on Layover somewhere else, one night I felt extemely cold while under 4 blankets and 30 C weather outside. Once I fell asleep, I slept for 14 hours woke up for 1 hr and slept another 12 hours.

After that I was fine, and had no symtoms since. I don't know whether it had something to do with SARS, or whether it was pure co-incidence....but I've never slept for 26 hours before......

bottom line.....if I'd have to go now to HK/SIN etc. I'd get that face-mask and wear it until this thing is under control.

[greenbonnet]

Avius,

About wearing that mask in HKG and SIN, I would suggest you seriously include any stations in China too. It is quite obvious that China is the biggest evil of this current Syndrome, unfortunately.

They have a nasty habit of grossly under-reporting such dirty laundries from their own backyard. A quote from the "Far Eastern Econimic Review" issue dated 10 Apr 2003, titled "The China Virus" page 15 says, "At the end of 2001 the UN estimated that there were up to 1.5 million cases of HIV infection in China, while the Ministry of Health (China) said there were just over 30,000. The Ministry then raised its estimate of HIV infections to 1 million............."

China currently officially acknowledged that the number of SARS cases in China is about 1,200. Can we believe this to be the TRUE figure? I don't know..........

If you can help it, don't be a part of and/or be an agent that brings that virus out of any SARS infected area. You never know. The next victim could be the one closest to you. Fate... don't tempt it.

careful mates
greenbonnet

[christep]

And remeber that 65,000 DIE every year of pneumonia and influenza in the USA alone, so better wear a mask there too...

[Sick Squid]

Christep, on your site you refer to the recovery statistics. It would be interesting to have them added in the same format as the death statistics, as IMHO without them it is difficult to reach any concrete conclusions based upon the demographic issues that you use in your argument.

Excellent site though, and great information.

squid

[min]

Another interesting feature to know would be the amount of medical intervention required in atypical versus other types of pneumonia - eg oxygen requirement, ventilatory support etc. In addition, it would be interesting to know what long term effects the disease has on lung function? ie - is there any residual scarring? Also, what is the usual infection rate in the general population of atypical pneumonias generally as opposed to this outbreak of SARS?

Just curious - I haven't really been able to find any of this out, apart from anecdotal evidence that SARS patients do seem to require extraordinary amounts of oxygen/ventilation.

Pneumonia was always called the 'old person's friend', as indicated in the higher morbidity rates in older persons. As you say on your site, Chris, the worrying feature of SARS is its effects on younger people - hopefully, the longer term statistics will not support this initial aberration. Additionally, the highly infectious nature of the this particular virus in close contact, as evidenced by those infected in the lift in the first instance in HKG and the high number of HCW's infected is pertinent.

[christep]

It is hard to get all the detailed data one might like, aprticularly on the demographics of those recovering, the time taken to recover, and the percentages requiring different levels of treatment.

I have tidied up the format in recent days. The link from my page http://home.so-net.com.hk/~pns/ to the Chinese University website is useful in that it gives more data on ventilation numbers and so on.

It seems that we passed the peak today - for the first time there was a net decrease in the number of people in hospital with SARS. 50 were discharged today, and looking at the stats with the peak from the Amoy Gardens case I would expect similar numbers in the next few days.

[fire wall]

christep, my congratulations to you on an excellent website and a balanced appraisal of the facts as opposed to the media driven histeria we have been subjected to......well done.

[BusyB]

Christep, Thanks for the info from your site. The question I'm left with is "What is the purpose and effectiveness of the masks being worn?"
From what I've read the ones you wear all day are of no use unless you are trying to stop spreading your own infection(colds and coughs etc). the better ones as worn in hospitals are only effective until they become saturated with humidity from your breath (approx 1hr).
If this is so why are the gov guidelines not more clear on this?

Any info appreciated.

[christep]

Thanks to those who have complimented me on my website. I try to do what little I can to offset the media hysteria.

The HK Department of Health is now publishing demographics on mortality by age range (linked from .my page (http://home.so-net.com.hk/~pns/) ).

By comparing the WHO date of onset chart (also linked from my page) and the discharge rates, it seems that it takes about 3 weeks for most people to reach a conclusion one way or the other (i.e. discharged or dead).

The government advice on masks is not as all encompassing as people seem to think. In general they only advise a mask if you have a respiratory illnees, have been in close contact with someone who has.

I noticed today that the proportion of mask wearers on public transport now seems to be below 50%, and on the ferry with open walls it was only 10-20%. There were more people out hiking and camping today (a beautiful clear warm day) than I have ever seen before, and not a mask in sight once in the open air. So people do seem to be reaching an understanding of when a mask does and does not provide any significant reduction of risk

[christep]

Along with today's data I have now added a graph at my site (http://home.so-net.com.hk/~pns/) to show the trends since 18 March. The peak is now very clearly passed in HK. New cases have been less than 20 per day for the last few days (as at 28 April).

[OZZY AIRBORNE]

Anyone nightstopping in Singapore in the near future can rest easy. Its business as usual in the restaurants and malls, apart from places like Boat Quay and Clarkes Quay, which have been badly affected be the more than 50% drop off in tourist numbers. Most of the cases are associated with the hospitals, including medical staff, visitors and relatives of exsisting patients. One fly in the ointment was people disregarding quarantine restrictions, but the tough new laws being rushed through parliament should put a stop to that. Very few people feel the need to wear face masks, and I am quite relaxed eating out and going to the cinema. All pax and crews leaving the country go through a full body infra-red scan, so anyone with an above normal temperature will be medically screened before departure. Because of its prompt and comprehensive measures against the virus, Singapore has now been taken off the W.H.O. no go list.

[stable approach]

Today's paper reports 32 remain in hospital, with 3 new reported cases. This out of a population of approx. 4 million.

[Tinstaafl]

Compare their response to China's institutional denial...

Bloody idiots. China, I mean.

[Airbubba]

Don't know if I would call it business as usual but Singapore has been very proactive in combating the spread of SARS cases. The thermal scanners are up at the airport to check pax temperature.

Orchard Road is pretty quiet until the office workers come out for lunch. Takashimaya had more staff than shoppers a couple of days ago.

Not many masks visible except for health and food service workers.

[flapsforty]

Just read a post on Rotorheads from someone wondering about transporting potential SARS sufferers.
I wonder as well....
About the so-called SARS kits we have onboard for example. (acc to my MD dad those mouth covers are totally useless in this case) About the screening at airports. The questioning of the pax etc.
How much is effective, and how much is window-dressing, a la the post sept 11 security measures?

Some questions for those who know more than I on this forum.
Mrs Gro Harlem Bruntland (WHO) says it is still possible to stop SARS becoming a modern day plague. And that the reason the WHO focuses on it, is because of relatively high mortality rate, the quick spread and the fact that there is no treatment nor vaccin. I tend to believe her, mainly because of the credibility she built up as PM of the country where I live.
1)But is she correct or is this an overblown scare?
2)And what about the Brit Professor Roy Andersson, are his results out yet? Do they back up Mrs. Brundtland's claims?
3)Apart from washing your hands often, is there anything we as aircrew can do to decrease the risk of contracting/spreading the virus?
4) If the WHO gives out a negative travel advisory for certain places, but the shedule comes in showing a 5 day SIN layover, should I believe the company medical department or the WHO?

Got loads more questions, but if anybody has some spare time to answer the above, or point me to a website where I could find some more info, I'd be most grateful.

And errrrrrmmmm.... I am not expecting anyone to give me the definitive answers here; just wondering what the MedBods think.
Not being such a one myself.
;)


Hawk, Min, if this post is not right, please feel free to move, delete, merge or PPRuNe!
flappers

[QDMQDMQDM]

The thermal scanners are up at the airport to check pax temperature.

As a screening test for a viral respiratory illness I would suggest that thermal imaging to check passenger temperature is pretty much useless. It may be reasonably sensitive (most people with SARS probably have a temperature -- unless they take some paracetamol and brufen), but is not at all specific (the vast majority of people with a temperature don't have SARS).

What happens to the legions of hapless indivduals found to have a temp > 37 at the airport thermal scanner? Are they screened for respiratory symptoms (again most people with respiratory symptoms won't have SARS) and then if they have them carted away screaming to quarantine? The jails, sorry hospitals, must be full.

If you have a temperature before you fly be sure to take some paracetamol!

QDM

[flapsforty]

Thank you for clearing that up QDM, much obliged.

Christep, I have taken the liberty of linking to your site from the Jetblast SARS-thread as well. An infusion of facts might save it from going off on a tangent. ;)

[christep]

Another milestone in HK today with more deaths than new cases for the first time :hmm: It's the fourth day with single figure new cases. Nice to see that the WHO has published criteria for lifting the travel ban (less than 5 new cases for three consecutive days, less than 60 active cases in hospital, no export cases).

As well as continuing the summary stats I have refocussed my site (http://home.so-net.com.hk/~pns/) on discussing outstanding questions (like is the motality rate really that high, and is this really something new or just a reclassification of something "normal").

It will be nice when HK gets back to normal.

[christep]

And today data from the Hospital Authoirty that shows that the number of cases of Atypical Pneumonia in the first 4 months of 2003 was less than 5% higher overall than the corresponding period in 2002. More details at my site: http://home.so-net.com.hk/~pns/

[christep]

And yesterday HK's first day with zero new infections :D

You can come back now - we've cleared all the dead bodies off the streets. :\