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ANTC68: Deconstructing Epidemics SARS, Epidemics, and the Future SARS  Viral respiratory illness caused by a coronavirus, called SARS-associated coronavirus (SARS-CoV)  Symptoms: high fever (> 100.4°F [38.0°C]), headache, body aches, cough, diarrhea, rash; most develop pneumonia  Short incubation: less than 10 days  First reported in Asia in Feb 2003  Over several months, illness spread to more than two dozen countries in North America, South America, Europe, Asia  Case-fatality rates: o 1% < 24 yrs o 6% 25-44 yrs o 15% 45-64 yrs o 50%+ > 65 yrs o approx.13% for patients <60 years o 43% for those >60 years (elderly esp. at risk)  Higher mortality rate than flu (usually < 0.03%); though considered “relatively inefficient” compared to other respiratory diseases  Close contact; nosocomial (HCW risk factor) SARS  On April 20, 2003, Beijing authorities officially acknowledged that SARS existed as a serious problem within China, more than one month after World Health Organization had issued a global travel alert on this epidemic  Time reported that the virus was first uncovered on November 16, 2002, in southern China’s Guangdong province where by early February 2003 at least five people had died and more than 300 had become infected (Zhang 2003) Toronto, ON  On March 14, 2003, the Ontario Ministry of Health and Long-Term Care alerted health care providers about 4 cases of atypical pneumonia resulting in two deaths within a single family in Toronto  By March 26, 2003 SARS was declared a provincial emergency  Over the six months from the first infection until the last patient was discharged from hospital, 375 cases were recorded  SARS in Ontario characterized by two phases: total probable and suspect cases were 257 in Phase I with 27 deaths related to SARS (centered on Scarborough Grace Hospital); Phase II total number of cases was 118 with 17 deaths (centered on North York General)  Update 37 - WHO extends its SARS-related travel advice to Beijing and Shanxi Province in China and to Toronto Canada  23 April 2003: As a result of ongoing assessments as to the nature of outbreaks of severe acute respiratory syndrome (SARS) in Beijing and Shanxi Province, China, and in Toronto, Canada, WHO is now recommending, as a measure of precaution, that persons planning to travel to these destinations consider postponing all but essential travel.  The World Health Organization has confirmed reported totals of 8098 SARS cases (to June 2003) in 31 countries including China, Taiwan, Hong Kong, Singapore, Germany, the United States, as well as other regions in Canada. Of these, 774 died. (As of August 2003, there had been 8422 cases in 29 countries, with 916 fatalities [Veldhorst-Witteveen 2004]) ..... Last cases in May 2004, China SARS Risk Factors 1. Contact (sexual or casual, including tattoos) with someone with a diagnosis of SARS within the last 10 days; nosocomial factor 2. Travel to any of the regions identified by the WHO as areas with recent local transmission of SARS (China, Hong Kong, Singapore, Ontario, Canada) Origins of SARS  “What we see is the virus fine-tuning itself to enhance its access to a new host – humans.” Dr Chung-I Wu, University of Chicago, 2004  Researchers believe that SARS made the animal-human jump in late 2002 in the Guangdong Province of China  Compared genomes of viruses isolated early in the emergence of SARS with those from later victims of the virus  Examined levels of gene mutations in one particular gene and found it to be undergoing rapid mutations at the start of the outbreak, which slowed down after it refined its ability to infect humans….led to superspreading events Masked palm civet: incidental vs. reservoir host  Palm civet ...looks like a cat/weasel ..native parts of Asia, and caught by people to be eaten  Palm civet considered to be the source of SARS  Palm civet considered incidental  Reservoir host, where the pathogen lives within the host  Incidental...transmit pathogens to other animals  Chinese horseshow bat ...harbours many disease such as Ebola(reservoir host) and SARS Common Behavioural Responses to Epidemics (Fox 1989; McGrath 1991) 1. Fear and anxiety 2. Intra-group conflict / social disorder 3. Denial or underestimation of disease epidemiology, severity 4. Resignation or acceptance of the disease 5. Flight or migration from epicenters of epidemic 6. Blaming & scape-goating individuals or institutions 7. Ostracism of sick individuals and those at risk 8. Development of therapeutic and preventive measures that are commonly not the norm (i.e., ceremonies, quarantines, business-civic coalitions) Extent of Cultural and Social Reactions to New Disease Depends on: 1. Virulence and pathogenicity of the agent 2. Pathway of transmission 3. Disease manifestations 4. Repercussions on cultural and societal norms SARS in Toronto: Public Relations vs. Public Health  Public Health Efforts: 1. Travel restrictions 2. Widespread restrictions on non-urgent hospital procedures (many surgeries cancelled, some died as a result…possibly as many as SARS dead) (Singer 2007) 3. Thousands placed in quarantine…anxiety, intolerance, income loss, psychosocial isolation (yet: Gov’t of Canada instituted Quarantine Act of 2006) o Interventions were largely ineffective and counter- productive Deconstructing SARS in Toronto: Public Relations vs. Public Health  See Shantz 2010: Neoliberal cuts to social services, public spending  From 1993 onward: 1. Reduced funding transfers to provinces (ON, - $6 Billion, 1995-99) 2. Removal of regulations to ensure health care spending 3. Cuts in hospital funding to underwrite tax cuts for wealthy and corporations (to encourage privatization) 4. Thousands of nurses laid off (25K hospital positions lost 1995-99), and many casualized to part-time work 5. Five leading scientists working with Toronto reference laboratory unit monitoring infections and new dise
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