There is good pasture, if they don't stray

Thanks to Mike Beltzner for his very good post and links.

Just got back from a meeting at school about the departmental response to SARS. Some very interesting discussion, mostly about long-term research and lessons learnt. There was an unspoken consensus not to speak about the current epidemiological work, so as not to step on anyone's toes or to pipe in with what would appear to be petty and ill-timed criticisms. Some interesting points:

It appears that the WHO decision about a travel advisory was made on the basis of very poor data. What made Toronto different from Singapore in WHO's eyes was a story about a man who caught SARS in Toronto and flew to Australia. However, it turns out that it was a false alarm and the man never had SARS. It may be possible that there was a desire to include Toronto in the travel advisory, so as not be seen as singling out Asia.

Everybody's thankful that SARS did not hit at flu season because the symptoms are so alike. If SARS is still serious when November and the start of the new (hopefully normal) flu season rolls around, it's going to be really difficult in distinguishing flu from SARS and the number of false diagnoses will skyrocket. Unless there's a good, quick and accurate test for SARS by then, officials may be put in the position of quarantining thousands of flu sufferers. (By the way, update on the problems they're having linking SARS to the coronavirus here.)

One of the AIDS researchers at the meeting brought up the point of the harm that analogies with AIDS had on the current situation. Everyone's heard the stories about medical staff in th 1980's dealing irrationally with HIV patients: using tongs to handle the paperwork of patients, for instance. There was an attempt not to stigmatize SARS patients in the same way. Of course, it turns out that catching SARS is a hell of a lot easier than catching AIDS from casual contact, and the anti-stigma attitude may have lead to unnecessary infections of health care workers and their families.

On the other hand, the question was raised about at what point does the public health community work to start normalizing SARS. We accept all sorts of diseases and risks as part of normal human existence and, in the greater scheme of things, SARS may not be relatively that great a threat. If SARS is here to stay, we have to learn to live with it, without freaking out. Right now, we may be able to contain it completely and the overwhelming force approach is the best way we know how to handle it. But it can't work as a long-term solution.

In that regard, there was discussion about normalizing infection control itself. We're so used to living without the burden of infectious diseases, but it wasn't that long ago that quarantines and isolation orders were a normal part of life. When polio, diptheria, measles, scarlet fever, et c. struck a household, the red quarantine sign in the window was expected, and not unusual. Do we return to that level of care? Do we have to radically alter our idea of what quarantine means? Are the laws about quarantine, which haven't changed since the 1930's, still adequate and appropriate? Are quarantines disportionally punishing towards marginal groups in society, who don't have the resources to work around them? These are questions that need to be answered.

One of the ironies pointed out was that the Chinese community iin Toronto may be the most prepared and consequently at lower risk than the rest of the population because of more direct, and earlier, links to information about the disease than the rest of the Canadian public. Also, we normally think of infectious diseases as disproportionally striking poor populations, but SARS is a disease in Canada that has basically only affected those wealthy enough to travel or relatively high status health care workers.

Finally, on a more cautious note, from the Wall Street Journal (via Sarswatch ):
"As summer approaches and the SARS epidemic declines, there will be an understandable urge to celebrate. But we must eschew premature celebrations and self-congratulations. History teaches us that the devastating 1918 influenza epidemic began with a modest "herald wave" in spring that faded away during the summer, only to explode and wreck global devastation the following fall and winter. It is possible that SARS, now seeded around the globe, could follow a similar pattern and fade away this summer, only to erupt again next winter."