YAY!... A letter I wrote on SARS and submitted by email this past Sunday was published today in the South China Morning Post's "Letters" section. Not only that but it was the "featured" letter in the section, printed in bold and set between two thick rules (view a scan of it)! OK, OK, yes, I am "haolian" (sort of like "too proud"), as my wife (and other Singaporeans) would say!

Well, here's my letter as it was published. Of course, the SCMP editor added a bit of polish to my original which I'm thankful for.

Tuesday, April 8, 2003

Why the Sars virus is so dangerous: key facts are still unknown

A few readers' letters published in the South China Morning Post suggest that statistics, as in the statement "many more people die of typical pneumonia than of severe acute respiratory syndrome", means that Sars is not as serious as the "mass hysteria" would indicate.

This is despite the fact that noted institutions on disease control — the World Health Organisation and the US Centres for Disease Control — have declared Sars a worldwide health threat and advised international travellers to postpone trips to Hong Kong and southern China.

Also, the recent release of the "real" figures for mainland China are shocking.

One of your correspondents claimed that "99.99 per cent of the people in Hong Kong are completely free of Sars and the number of new cases reported daily appears to be dwindling."

The truth is that at this stage, we cannot be sure how many people are free of Sars because there may be some who have the virus and do not show symptoms. And it is too early to say that the number of new cases is dwindling because on Sunday there were 42, three more than Saturday.

Experts do not yet know the cause of Sars (a new coronavirus is the leading candidate, but paramyxovirus and/or chlamydia as a co-factor have been hypothesised), or the routes of transmission (droplets, animals and environmental factors have been put forward).

While most who have died from Sars were elderly and/or had chronic diseases, Sars has in fact struck down young, healthy people as well and that is unusual.

Another concern is whether those infected can infect others before showing symptoms. If you look at the daily updates and statistics on Sars on www.who.int/csr/sars/en/ you will see that it is far from being under control globally.

It has spread across the globe very fast and under undetermined circumstances can infect a huge number of people (and not just in hospitals) in a very short time — as in the Amoy Gardens and Metropole Hotel cases. These are the few facts and certainties about Sars.

The bottom line is that there are many uncertainties and unknowns about Sars and the information is changing daily.

We — indeed, the experts — cannot yet reach any conclusions as to what are "sensible precautions" or how serious the disease really is. Do masks help? Common sense tells me that if an infected person sneezes in an elevator just before I step in, my chances of catching Sars will be much less if I am wearing an N95 mask.

Also, with more people wearing masks the potential of spread via droplets is reduced — the droplets of the infected will be better contained and masks will help prevent the infection-free from breathing in the virus.

While I appreciate that the statistics provided by the correspondent have been insightful, my worry is that such letters may persuade readers to let their guard down and not take, or be more lax about, "sensible precautions".

I feel that the more of us who err on the side of caution, the quicker we will be able to get this virus under control and get on with life as normal.

DEREK TOM, Wan Chai

If you're interested, here was my original letter:

Optimistic statistics may be a disservice

Several readers' letters published in the SCMP over the past few days suggest that based on statistics such as "many more people die of typical pneumonia than of SARS", the danger of SARS is not as serious as the "mass hysteria" would indicate. This is despite the fact that international experts on disease control — the World Health Organization and the US Centers for Disease Control — have declared SARS a worldwide health threat and have advised international travellers to postpone trips to Hong Kong and Southern China. Also, the recent release of the "real" figures for mainland China are much more shocking.

One of your respondents claimed that "99.99 percent of the people in Hong Kong are completely free of SARS and the number of cases reported daily appears to be dwindling." The truth is that at this stage, we cannot be sure of how many people are free of SARS because there may be people who have the virus and don't show symptoms, as was reported in today's SCMP. And it is too early to say that the number of new cases are dwindling because Saturday's numbers are 39, 12 more than the day before.

Experts don't yet know the cause of SARS (a new coronavirus is the leading candidate but paramyxovirus and/or chlamydia as a co-factor have been hypothesized) and routes of transmission (droplets, animals, and environmental factors?). While most who have died from SARS were elderly and/or had chronic diseases, SARS has in fact struck down young, healthy people as well and that is unusual. Another key concern is whether those infected can infect others before showing symptoms.

If you look at the daily updates and statistics on SARS on http://www.who.int/csr/sars/en/ you'll see that SARS is far from being under control globally. It has spread across the globe very fast and under certain but undetermined circumstances it can infect a huge number of people in the community (not just in hospitals) in a very short period of time — as in the Amoy Gardens and Metropole Hotel case. These are the few facts and certainties that we have about SARS.

The bottom line is that currently there are many uncertainties and unknowns regarding SARS and information about it is changing daily. We — indeed, the experts — cannot yet make any conclusions as to what are "sensible precautions" or how serious the disease really is.

Do masks help? Common sense tells me that if an infected person sneezed in an elevator just before I stepped in and I wasn't aware of that, my chances of catching SARS would be much less if I were wearing a N95 mask. Also, with more in the community wearing masks the potential of spread via droplets is reduced — those infected will have their infectious droplets better contained and those virus-free can prevent from breathing in the virus and getting infected.

While I do appreciate that the statistics provided have been insightful, my worry is that such letters may persuade readers to let their guard down and not take, or be more lax with, "sensible precautions". I feel that the more of us who err on the side of caution, the quicker we'll be able to get this virus under control and get on with life as normal.