Half way along the road we have to go, I found myself obscured in a great forest.
I'm out of the woods now. I finally feel that I can return to normal life after a month or so of exams and final papers. I still have a mid-term to write (due to some technical screw-up) but basically everything is done and I can stop dreaming of log curves, for the moment anyway. I've also completely recovered from a bad case of "no, it's not SARS" strep throat, which made last week particularly pleasurable, especially the exam that I had to write during that time.

Speaking of SARS, Andrew inquired about my thoughts on the matter. There's one thing I can tell you for sure is that SARS has made this last month a logistical nightmare for many people around here. It even has thrown a few spanners into the works for me. At the beginning of April, the hospitals closed themselves off to non-essential staff. This meant that I, as an entirely non-essential researcher with an office at CAMH, the mental hospital here in Toronto, could not get into work. Then, the University of Toronto, where I go to school, decided that people who worked in places that were shut down, shouldn't gather with other people who worked in places that were shut down. This meant that basically everyone in my classes, who are associated somehow or another with the hospitals or research facilities attached to hospitals, suddenly became defacto quarantined. My biostats class, for instance, normally about 100 people, was decimated--only about 6 people made it to class that week. The school later relaxed its definition of people who shouldn't come to classes, restricting only people who actually worked with patients, but by then it was too late. Classes and exams were already rescheduled. My exam yesterday, for instance, should have taken place last week and the date wasn't confirmed until 2 days before, because they had to work out an arrangement to get exam proctored individually for people who were legitimately quarantine, including about a dozen people who worked at Sick Kid's. Anyways, it looks like the SARS effect on my personal life is almost over, and I think I'll even be able to get back to my office tomorrow.

An outbreak like SARS is really glory-time for epidemiologists; it's one of the few occasions where it's recognized that public health workers do actually deal with disease on a hands-on basis. Some of my profs are heavily involved in work on SARS and my friend's supervisor actually contracted the disease herself. There's an atmosphere of battle-like excitement/desperation around school, which is, to be honest, really enjoyable in a certain way. I'm planning on doing some volunteering over the next couple of weeks to help out.

I think the jury is still out about SARS. I think we still can't even confirm that the coronavirus is the actual causal agent. We don't know how deadly it is yet either. About half of the cases in Canada have made a full recovery and gone home while 4-10% who had the disease have died (most of those people were over 70 years old). Worldwide, the stats look even better: 90% recover fine, 10% require intensive treatment and about 4% die from the disease. Compare that to another rare form of pneumonia called Group A streptococcal pneumonia where about 40% of the people in Canada who got it died. Many other types of pneumonias have case-fatality rates in the 20% range. We don't know what the long term effects are, however, and we don't know what would happen with this disease if it became wide-spread in the community. An infection in a nursing home, for instance, could be disasterous. So far in Toronto, SARS seems to be under control. The number of new cases each week is fairly low and has not shown the exponential growth associated with uncontrolled epidemics. Another really good sign is that no one has got the disease from someone who wasn't coughing and feverish at the time--this makes identification and control so much easier.

The thing to watch for is if people start getting the disease who don't know where they got it from. This is key. Right now, there have been some cases like the Catholic church group where people in a general, as opposed to hospital, setting got the disease. That's bad, but so far most of the "confirmed" probable cases have been able to be linked back to the few people who brought it back from Asia, so it's still alright. Once we lose track of the chain of infection, then the nature of the outbreak could change entirely. As long as we can keep track of transmission, we have the possibility of controlling it. If we lose those links, the shape of the epidemic curve will change, and instead of a few cases each week, there might be exponential increases. At the moment, there are about 10 people who we don't yet have links for, and those are the people to worry about, if their infections cannot in fact be traced back.

You can find a comforting graph at the New England Medical Journal site. It shows a fast, but linear increase of the the number of cases world wide and a much lower rate of death from the disease. This Health Canada website also has some really good information. A prof at John Hopkins has a good presentation about SARS on his website.