‘’’How will a pandemic unfold ?’’’
When doing research for the cluster graphs, I kept running across information that shocked me. It has been close to 2 years since I went through the “adjustment reaction” part of accepting a pandemic was possible, yet this gave me pause. I will share tonight, one part….
These next frames are excerpts of the updates, copied from the WHO website. It will give you chills. These are NOT all of the updates… just enough for you to get a feel how information will look in the event of a pandemic.
I try very hard to NOT be an alarmist; therefore, my instrument of persuasion relies on solid information, studies, “Official reports”, etc. Knowing disease process, and the unique and different pathogenicity, and communicability each virus has… I fear a pandemic of H5N1 would look worse, spread faster, with Many more deaths…
‘’’2002 - Acute respiratory syndrome in Democratic Republic of the Congo - Update 2’’’ 20 December 2002
Disease Outbreak Reported Cases of acute respiratory syndrome continue to be reported in the Democratic Republic of the Congo. By November 22, an Influenza-like illness was reported in Djolu, Bosobolo, Karawa and Genema health areas in Equateur Province, with Bosobolo being the most affected area.
‘’’Acute respiratory syndrome in China’’’ 11 February 2003
Disease Outbreak Reported WHO has received reports from the Chinese Ministry of Health of an outbreak of acute respiratory syndrome with 300 cases and 5 deaths in Guangdong Province.
A team from the Ministry of Health is working with health officials in the province to investigate the outbreak and collect samples for laboratory analysis.
‘’’Acute respiratory syndrome in China – Update’’’ 12 February 2003
Disease Outbreak Reported Health officials from Guangdong Province have reported a total of 305 cases and 5 deaths of acute respiratory syndrome from 16 November- 9 February 2003.
A team from the Chinese Ministry of Health is working with Guangdong health officials to investigate the outbreak and collect samples for laboratory analysis. To date, virus isolation for influenza has been negative.
‘’’Acute respiratory syndrome in China - Update 2’’’ 14 February 2003
Disease Outbreak Reported The Ministry of Health, China has reported that the outbreak in Guangdong Province is clinically consistent with atypical pneumonia. Cases had been detected in the province as far back as November 16, 2002. The majority of the patients have experienced non-specific symptoms including fever, headache, joint ache and overall fatigue and weariness.
‘’’Acute respiratory syndrome in China - Update 3’’’ 20 February 2003
The Ministry of Health, China has reported that the causal agent for the atypical pneumonia outbreak in Guangdong Province, which affected a total of 305 cases including 5 deaths, was probably caused by ‘’’chlamydia pneumoniae.’’’ Further epidemiological investigations are underway coordinated by the Guangdong provincial health department.
‘’’Acute respiratory syndrome in Hong Kong Special Administrative Region of China/ Viet Nam’’’ 12 March 2003
WHO issues a global alert about cases of atypical pneumonia Cases of severe respiratory illness may spread to hospital staff 12 March 2003 | GENEVA — Since mid February, WHO has been actively working to confirm reports of outbreaks of a severe form of pneumonia in Viet Nam, Hong Kong Special Administrative Region (SAR), China, and Guangdong province in China.
In Viet Nam the outbreak began with a single initial case who was hospitalized for treatment of severe, acute respiratory syndrome of unknown origin. Following his admission to the hospital, approximately 20 hospital staff became sick with similar symptoms.
The signs and symptoms of the disease in Hanoi include initial flu-like illness (rapid onset of high fever followed by muscle aches, headache and sore throat). These are the most common symptoms. Early laboratory findings may include thrombocytopenia (low platelet count) and leucopenia (low white blood cell count). In some, but not all cases, this is followed by bilateral pneumonia, in some cases progressing to acute respiratory distress requiring assisted breathing on a respirator. Some patients are recovering but some patients remain critically ill.
Today, the Department of Health Hong Kong SAR has reported on an outbreak of respiratory illness in one of its public hospitals. As of midnight 11 March, 50 health care workers had been screened and 23 of them were found to have febrile illness. They were admitted to the hospital for observation as a precautionary measure.
In mid February, the Government of China reported that 305 cases of atypical pneumonia, with five deaths, had occurred in Guangdong province. In two cases that died, chlamydia infection was found. Further investigations of the cause of the outbreak is ongoing.
No link has so far been made between these outbreaks of acute respiratory illness in Hanoi and Hong Kong and the outbreak of `bird flu, A(H5N1) in Hong Kong SAR reported on 19 February. Further investigations continue and laboratory tests on specimens from Viet Nam and Hong Kong SAR are being studied by WHO collaborating centres in Japan and the United States.
‘’’Severe Acute Respiratory Syndrome (SARS) - multi-country outbreak – Update’’’ 16 March 2003
As of 15 March 2003, reports of over 150 cases of Severe Acute Respiratory Syndrome (SARS), an atypical pneumonia of unknown aetiology, have been received by the World Health Organization (WHO) since 26 February 2003. SARS was first recognized on the 26 February 2003 in Hanoi, Viet Nam. The causative agent has yet to be identified. The main symptoms and signs include high fever (>38 degrees C), cough, shortness of breath or breathing difficulties A proportion of patients with SARS develop severe pneumonia; some of whom have needed ventilator support.
As of 15 March the majority of cases have occurred in people who have had very close contact with other cases and over 90% of cases have occurred in health care workers.
The mode of transmission and the causative agent have yet to be determined. Aerosol and/or droplet spread is possible as is transmission from body fluids. Respiratory isolation, strict respiratory and mucosal barrier nursing are recommended for cases. Cases should be treated as clinically indicated.
As of 15 March, over 100 reported cases have been hospitalized, at least two of whom are receiving ventilatory support. One death (index case from Viet Nam) has been reported. ’’’Travel Advice’’’
There is presently no recommendations to restrict travel to any destination. However, guidance has been issued by WHO and is available. World Health Organization issues emergency travel advisory
‘’’Severe Acute Respiratory Syndrome (SARS) multi-country outbreak - Update 3’’’
18 March 2003
Current situation Isolated cases of suspected SARS continue to be reported in new countries. As of today, health authorities are investigating reported cases in Canada, China, Taiwan (China), Germany, Hong Kong Special Administrative Region of China, Singapore, Slovenia, Thailand, Viet Nam, and the United Kingdom
‘’’Severe Acute Respiratory Syndrome (SARS) multi-country outbreak - Update 4’’’ 19 March 2003 Preliminary findings suggest a viral cause
Research teams at two laboratories, in Germany and Hong Kong Special Administrative Region of China, have detected particles of a ‘’’virus from the Paramyxoviridae family ‘’’in samples taken from patients with Severe Acute Respiratory Syndrome (SARS).
This is the first major step forward in efforts to pinpoint the causative agent. Previous tests conducted in a number of top laboratories failed to detect the presence of any known bacteria or viruses, including the influenza viruses, recognized as causes of pneumonia or respiratory symptoms, or known to be widespread in the most affected geographical areas.
The failure of all previous efforts to detect the presence of bacteria and viruses known to cause respiratory disease strongly suggests that the causative agent may be a novel pathogen.
Update on countries and cases
As of Wednesday 19 March, ‘’’a cumulative total of 264 suspected or probable cases’’’ and 9 deaths have been reported from 10 countries.
‘’’Severe Acute Respiratory Syndrome (SARS) multi-country outbreak - Update 5 ‘’’
20 March 2003 Investigation of causative agent gains momentum
Research is now focused on the ’’’Paramyxoviridae family of viruses.’’’ This family includes several well-known viruses, such as those causing mumps, measles and common respiratory ailments. It also includes a subfamily of viruses capable of infecting multiple animal species, including humans. This subfamily was implicated in the emergence during the 1990s of new and severe diseases in humans caused by Hendra and Nipah viruses. The virus jumped directly from animal hosts (horses and pigs) to humans. No person-to-person transmission was documented in outbreaks caused by either virus.
Update on cases and affected countries As of 20 March, ‘’’306 suspected and probable cases,’’’ including 10 deaths, have been reported from eleven countries.
’’’Possible cases in airline passengers and crew member ruled out’’’ Press reports have referred to 2 suspected cases of SARS, one in an airline crew member and a second in a passenger, travelling on separate flights from Hong Kong and Taipei to Viet Nam.
Both suspected cases have been investigated and are now ruled out as cases of SARS.
‘’’Severe Acute Respiratory Syndrome (SARS) multi-country outbreak - Update 9’’’
25 March 2003 ‘’’Updated travel advice’’’
On 15 March, WHO issued a travel advisory in response to the growing international threat posed by Severe Acute Respiratory Syndrome (SARS). Since then, WHO has conducted daily teleconferences with health authorities and WHO team members on the scene in all areas affected by SARS. As of today, ‘’’487 SARS cases have been reported from 12 countries.’’’
A number of persons with SARS have taken long distance flights after becoming ill. Thousands of passengers who traveled in the same flights have been traced in Germany, Canada, Singapore and the United States.
Today’s report of a possible transmission of SARS on board a flight is undergoing investigation. As “close” contact is possible during a flight, in passengers sitting close to an infected person, such transmission cannot be ruled out. The evidence to date indicates that in-flight transmission is very unusual.
‘’’Severe Acute Respiratory Syndrome (SARS) multi-country outbreak - Update 11’’’
WHO recommends new measures to prevent travel-related spread of SARS 27 March 2003
‘’’WHO is today recommending new measures, related to international travel,’’’ aimed at reducing the risk of further international spread of severe acute respiratory syndrome (SARS).
The recommended measures include screening of air passengers departing from a small number of affected areas on flights to another country. The affected areas, where transmission of the SARS infectious agent is known to be spreading in a human-to-human chain, are kept under constant review and posted each day on the WHO web site. At present, only four countries are concerned.
‘’’Severe Acute Respiratory Syndrome (SARS) - multi-country outbreak - Update 16’’’
1 April 2003 As of today, ‘’’a cumulative total of 1804 cases of severe acute respiratory syndrome (SARS)’’’…
‘’’Severe Acute Respiratory Syndrome (SARS) - multi-country outbreak - Update 21’’’
Flash report: new data from China as Ministry of Health begins daily electronic reporting 4 April 2003
Update on cases and countries As of today and including the new data from China, ‘’’a cumulative total of 2353 SARS cases’’’ and 84 deaths have been reported from 16 countries.
‘’’Severe Acute Respiratory Syndrome (SARS) - multi-country outbreak - Update 27’’’
‘’’One month into the global SARS outbreak: Status of the outbreak and lessons for the immediate future’’’ 11 April 2003
Current status of the SARS outbreak At this moment, public health authorities, physicians and scientists around the world are struggling to cope with a severe and rapidly spreading new disease in humans, severe acute respiratory syndrome, or SARS. This appears to be the first severe and easily transmissible new disease to emerge in the 21st century. Though much about the disease remains poorly understood, including the exact identity of the causative virus, we do know that it has features that allow it to spread rapidly along international air travel routes.
As of 10 April, ‘’’2781 SARS cases’’’, with 111 deaths, have been reported to WHO from 17 countries on three continents. Some outbreaks have reassuring features
In SARS outbreaks, a “super-spreader” is a source case who has, for as yet unknown reasons, infected a large number of persons. It remains unknown whether such “super-spreaders” are persons secreting an exceptionally high amount of infectious material or whether some other factor, perhaps in the environment, is working to amplify transmission at some key phase of virus shedding.
‘’’New coronavirus discovered’’’ Through new mechanisms set up by WHO, progress on the research front has been unprecedented, particularly in the rapid discovery of a new coronavirus and the rapid development of diagnostic tests. The best scientists from around the world are working on these problems around the clock, and in an unprecedented spirit of collaboration against a threat of, as yet, unknown dimensions.
‘’’Nonetheless, we still do not have conclusive proof that the new virus is indeed the cause of SARS.’’’
‘’’Severe Acute Respiratory Syndrome (SARS) - multi-country outbreak - Update 34’’’
Unanswered questions: a critical point in the evolution of SARS 19 April 2003
As probable SARS cases continue to be reported from a growing number of countries, WHO is taking stock of what is known about the new disease, particularly concerning its mode of spread, and what remains a puzzle. The agent that causes SARS has now been conclusively identified.
The SARS virus is a new coronavirus unlike any other known human or animal virus in the Coronavirus family. Because the virus is new, much about its behaviour is poorly understood. Key questions, which are undergoing intense study, include stages in the course of infection when virus shedding may be highest, and the various concentrations of virus in different body fluids.
‘’’However, information now emerging from outbreaks in Hong Kong and Canada is raising some important new questions about SARS. In Hong Kong, a large and sudden cluster of almost simultaneous cases (321) seen in residents of the Amoy Gardens housing estate has raised the possibility of transmission from an environmental source.’’’
‘’’Speculation centres on whether these cases represent infection with high virus loads, as might occur following exposure to a concentrated environmental source, or whether the virus may have mutated into a more virulent form. Viruses in the Coronavirus family are known to mutate frequently.’’’
Update on cases and countries As of today, ‘’’a cumulative total of 3547 cases’’’ with 182 deaths have been reported from 25 countries. Compared with yesterday, 12 new deaths, all in Hong Kong SAR, have been reported.
‘’’Severe Acute Respiratory Syndrome (SARS) - Multi-country outbreak - Update 44’’’ 1 May 2003
As of today,’’’a cumulative total of 5865 probable cases’’’ with 391 deaths have been reported from 27 countries.
‘’’Severe Acute Respiratory Syndrome (SARS)-multi-country outbreak - Update 59’’’
19 May 2003 Risk of SARS transmission during air travel Globally, WHO has analyzed information, as of 12 May, on 35 flights in which a probable symptomatic SARS case was among the passengers or crew. To date, symptomatic probable SARS cases on four of these flights have been associated with possible transmission of infection to fellow passengers or crew.
Update on cases and countries As of today, ‘’’a cumulative total of 7864 probable SARS cases’’’ with 643 deaths have been reported from 28 countries.
‘’’Update 67 - SARS resolution approved, situation in Taiwan’’’
27 May 2003 World Health Assembly adopts resolution on SARS Update on cases and countries
As of today,’’’ a cumulative total of 8221 probable SARS cases’’’ with 735 deaths has been reported from 28 countries
‘’’Update 91 – SARS research: the effect of patents and patent applications’’’
30 June
‘’’As no new probable cases of SARS have been reported anywhere in the world since 15 June, WHO is moving from an emergency response to a research-based agenda aimed at protecting the world against any future resurgence of SARS.’’’
The world must be considered vulnerable to a return of SARS pending better understanding of the origins of the virus and the circumstances that allowed it to jump from an animal host or environmental source to infect humans. Without such an understanding, predictions of the future evolution of the outbreak – including its end – cannot be made with certainty.
The SARS coronavirus was detected within a month by a “virtual” network of laboratories, working around the clock. The complete sequencing of the virus’ genome followed almost immediately.
As SARS has clearly demonstrated, the appearance of a new disease in a highly mobile, interconnected and interdependent world can have serious repercussions outside the health sector and far beyond the areas worst hit by the outbreak.
This sense of shared vulnerability is considered a strong motivation for continued international collaboration.
Facinating.
Now lets add in a couple of altered factors.
Highly pathenogenic, highly efficient sustained transmission, virus spreads for 3 days prior to symptoms, virus stimulates a cytokine storm in health young adults, multiple strains evolving nearly worldwide.
What would it look like then?
Bump
“What would it look like then?”
“Bump”
Thump. Thump-thump-thump, ect…
Keep trying to do the right thing anyway. Just like many of our ancient ancestors did in their lifetimes. This is our ride through the Universe.
Closed to maintain Forum speed.