The day before yesterday I submitted this brief letter to the South China Morning Post for publication.
More Sars info would be helpfulThe daily release of latest Sars figures could be improved to include detailed information such as how new patients got infected. A good example of providing this sort of information which I have found helpful and can be comforting to the public can be found on the Singapore Ministry of Health's site: http://app.moh.gov.sg/sar/sar03.asp.
Details of new patients' movements can also help the government in "contact tracing" which I understand is an important step in helping to contain the outbreak. Also, as the government is releasing a list of buildings where confirmed Sars patients reside, shouldn't patients' workplaces also be included since those would seemingly be Sars "hotspots" as well?
Thursday, April 24, 2003
More information, pleaseI think one of the biggest problems with the Sars outbreak has been the lack of information released by the government.
In contrast, Singapore's daily report gives complete details about how each Sars patient picked up the disease and possible contacts before the first symptoms appeared (app.moh.gov.sg/sar/sar03.asp).
I think the people of Hong Kong deserve to know more each day than "the remaining 29 were other patients and contacts of patients with atypical pneumonia" as we were told at the weekend. This information gives us no information on how the disease is being caught and spread in Hong Kong.
The government should immediately start to release the following information. Each day, give us comprehensive particulars on each new patient on a case-by-case basis, as is done in Singapore, including letting us know how many Sars patients caught the disease outside our borders and brought it into Hong Kong.
In the list of buildings with infected patients released each day, give the following additional information: date of first infection, date of latest infection and number of flats in each building that had a Sars infection. We can then have an idea whether the disease is spreading within families or within buildings.
For all the flights that have had a Sars passenger, give a flight-by-flight breakdown of how many people subsequently caught the disease. Such information will let the travelling public make an informed decision on how safe it is to fly (and perhaps save our airline and tourism industries).
For those fit and relatively young people who have died, give an indication of why they might have died, including facts such as late treatment, suspected high viral load or a form of Sars that is harder to treat.
Give us the death rate based on the current recovery rate, not on the number of infections to date, which an earlier correspondent showed was misleading ("Analysing the numbers and what they mean", April 16).
It is only with the above information that we can all help fight this disease and win. Not releasing these relatively straightforward details risks more people needlessly dying, and the death of Hong Kong as Asia's World City.
NAME AND ADDRESS SUPPLIED
This letter is an excellent piece that precisely conveys my thoughts and more (and I'm sure that of many others as well). Kudos to whoever wrote it! I certainly hope the government hears this message and takes appropriate action very soon.
Excerpts from two separate South China Morning Post articles today:
But six of eight deaths reported over the weekend were people ranging in age from 35 to 52 and Hospital Authority spokeswoman Elinda Luk said on Monday that officials were investigating what had happened.The senior executive manager of Hong Kong's Hospital Authority, Liu Shao-haei, told a news conference Sunday he was "unhappy" to see deaths of the younger, fitter patients but offered no immediate explanation.
Seven more people in Hong Kong have died from the atypical pneumonia virus, the Department of Health said on Monday.The latest deaths bring Hong Kong's total number of fatalities from severe acute respiratory syndrome (Sars) to 47.
The seven victims include two women with a history of chronic disease, aged 74 and 67. They died in Kwong Wah Hospital. Two men, aged 49 and 78, died in Princess Margaret Hospital. A 69-year-old woman and a 74-year-old man, with a history of chronic disease, died in Prince of Wales Hospital. A 95-year-old woman, also with a history of chronic disease, died in United Christian Hospital.
The department said an additional 40 patients with symptoms of atypical pneumonia were admitted to public hospitals on Monday. They include four health-care workers — two from Kwong Wah Hospital, one from Prince of Wales Hospital and one from Shatin Hospital — and five more patients from Amoy Gardens. The remaining 31 were new patients and contacts of patients with atypical pneumonia.
Some 229 patients have recovered from Sars and have been discharged from public hospitals. Of these, six were discharged on Monday, the department said.
Andy Rooney's TV commentaries on (against) the War on Iraq are just awesome! He's just brilliant. He reveals profound insights about the war and the Bush administration while still being very funny. For those who may not know, Andy Rooney has been a commentator on CBS's weekly news show "60 Minutes" since 1978. Each episode ends with his commentary.
I just watched his latest, Just Tell Us The Truth, tonight on local channel ATV World and it was awesome — and funny! Last week's commentary, It's Just My Opinion, was superb too. Explosive Progress starts out pretty hilarious but ends with a serious warning:
If we continue our progress inventing weapons capable of wiping ourselves out, Earth could end up without people again.
The supporting video clips add a lot to the commentary so with these links to just the text you're missing at least 50% of the humor and impact. Hope you didn't miss these on TV!
[Update: I just discovered that you can watch videos (not just read the text) of Rooney's commentaries from the links above — just look under the Multimedia tab on the right of the pages but you'll need RealOne Player. Go check 'em out!]
This excerpt from The Straits Times Interactive article Scientists' worldwide race against virus is particularly scary:
The latest theory is that 'silent spreaders' who carry the disease but show few signs may be most responsible for spreading Sars. 'There is some evidence of that,' Mr Iain Simpson, spokesman for WHO's communicable disease programme, said. 'It's something we're exploring but we don't fully understand.'That might mean there is a Sars Sally out there, akin to America's Mary Mallon, who spread typhoid fever in the US in 1907 without showing any symptoms, leading scientists to dub her Typhoid Mary.
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, 2003Why 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 disserviceSeveral 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.
Here's Justin, happy as ever!... He now enjoys pretending to talk on the phone. He'll grab his toy mobile phone or our real Siemens cordless phone (or actually anything that he can grasp in his hand and bring to his ear) and start, well, making noises — most of which sound like "aaah" and a few like "hello". He's almost 12 and a half months old now.
Latest SARS info from the World Health Organization (updated daily):
http://www.who.int/csr/sars/en/
A heart-wrenching article reveals the horrific realities of the war, any war...
Published on April 3, 2003 in the South China Morning Post.
Thursday, April 3, 2003Civilian victims were seeking US help
MEG LAUGHLIN of Knight Ridder near Najaf and AGENCE FRANCE-PRESSE in Washington
An Iraqi family that lost 11 members when US soldiers opened fire on their van were fleeing towards US lines on the advice of US leaflets, according to a survivor.
Bakhat Hassan lost his daughters, aged two and five, his three-year-old son, his parents, two older brothers, their wives and two nieces, aged 12 and 15, in the incident on Monday. He said US soldiers at an earlier checkpoint had waved them through as they drove away from their home village.
As they approached another checkpoint 40 km south of Karbala, they waved again at the American soldiers.
"We were thinking these Americans want us to be safe," Mr Hassan said.
The soldiers didn't wave back. They fired.
"I saw the heads of my two little girls come off," Mr Hassan's wife, Lamea, 36, recalled numbly. "My girls . . . my son is dead."
US officials originally gave the death toll as seven in the incident, and reporters at the scene placed it at 10. But Mr Hassan's father died later at a US army hospital near Najaf.
American officials said the soldiers who opened fire were following orders not to let vehicles approach checkpoints. On Saturday, a suicide bomber killed four US soldiers outside Najaf.
The survivors tell a distressing tale, of a family fleeing towards what they thought would be safety, tragically misunderstanding instructions.
"A miscommunication with civilians," said an army report written on Monday night.
Mr Hassan's father, in his 60s, wore his best clothes for the trip through the American lines: a pinstriped suit. Mr Hassan said: "To look American."
Mr Hassan, his wife and another of his brothers are in intensive care at the military hospital. Another brother, sister-in-law and a seven-year-old child were released to bury the dead.
The Shi'ite family of 17 was packed in its 1974 Land Rover, so crowded that Mr Hassan, 35, was outside on the rear bumper hanging on to the back door.
Everyone else was piled on one another's laps in three sets of seats. They were fleeing their farm town southeast of Karbala, where US attack helicopters had fired missiles and rockets the day before.
Helicopters also had dropped leaflets on the town: a drawing of a family sitting at a table eating and smiling with a message written in Arabic.
Sergeant Stephen Furbush, an army intelligence analyst, said the message read: "To be safe, stay put."
But Mr Hassan said he and his father thought it just said: "Be safe." To them, that meant getting away from the helicopters.
His father drove. They planned to go to Karbala. They stopped at an army checkpoint on the northbound road near Sahara, south of Karbala, and were told to go on, Mr Hassan said.
But the Iraqi family "misunderstood" what the soldiers were saying, Sergeant Furbush said.
A few kilometres later, a Bradley fighting vehicle came into view. The family waved as it came closer. The soldiers opened fire.
Mr Hassan remembers an army medic at the scene of the killings speaking Arabic.
"He told us it was a mistake and the soldiers were sorry," Mr Hassan said.
"They believed it was a van of suicide bombers," Sergeant Furbush said.
Soldiers in the region have been jittery following alleged "false surrenders" by Iraqis who have then opened fire.
Brigadier General Vincent Brooks of the US Central Command in Qatar also expressed regret, but added that civilian deaths "remain unavoidable".
President George W. Bush, through a spokesman, expressed similar sentiments to the top US military officer.
"The president always regrets any innocent loss of life. And he recognises that most innocents have been lost in this war at the hands of Saddam Hussein and his henchmen," said White House spokesman Ari Fleischer.
"That's who is to blame for the loss of innocent lives."
But Mr Fleischer declined to comment specifically on the killings, which a European Union spokesman described as "a horrible and tragic incident".
Mr Hassan, his wife, his father and a brother were airlifted to the army hospital. Three doctors and three nurses worked on the father for four hours. His right hand and right leg were amputated by a plastic surgeon.
A cardio-thoracic surgeon operated on his chest, and an internist repaired a hole in his colon. But his heart stopped and they couldn't restart it.
"We didn't know who he was and we didn't care. We just wanted to save him," said John Cho, the cardio-thoracic surgeon who worked on the father.
On Tuesday, Mr Hassan and his wife were in beds next to each other in the green hospital tent in the desert. He had staples in his head. She had a mangled hand and shrapnel in her face.
Major Scott McDannold, an anaesthesiologist, said Mr Hassan's brother, five beds down, would not make it.
Major McDannold stayed up all night on Monday with the brother, who is on a respirator with a broken neck.
Mr Hassan, a poor farmer, and his wife, who is nine months pregnant, rarely speak or sleep. They lie in their drab green beds with open, dead eyes.
http://www.who.int/csr/sarsarchive/2003_02_02b/en/
Here's an excerpt:
The SARS outbreak in Hong Kong SAR has developed an unusual pattern of transmission. This pattern is different from what is being seen in the vast majority of other SARS outbreaks, and is not yet fully understood. The number of cases is continuing to increase significantly, and there is evidence that the disease has spread beyond the initial focus in hospitals.These developments raise questions related to other routes of transmission, in addition to well-documented face-to-face exposure to droplets released when an infected person coughs or sneezes. Epidemiologists are considering whether SARS is being transmitted in Hong Kong by some environmental means for which no satisfactory explanation has been found.
Particular concern centres on a large cluster of cases linked to residential buildings in the Amoy Garden housing estate in the Kowloon district of Hong Kong.
A good friend and excellent writer, David Wall, had this to say on the war... (I concur with him, of course.)
It's an illegal war, not because of the de jure lack of a specific United Nations resolution endorsing the use of "any means necessary" in Iraq, but because the war fails to meet the accepted criteria for a just war. For lack of a better codification of what a just war is, we can consider the statement of the United States Conference of Catholic Bishops on the matter. Let's take the statement one element at a time."The damage inflicted by the aggressor on the nation or community of nations must be lasting, grave, and certain;"
We have to define "aggressor" liberally here. Saddam Hussein is obviously a bad guy, indeed one of the worst. His behaviour as a political leader is in opposition to generally accepted standards of human decency and civility. One could argue that his sympathies with terrorist groups — and despite the fact that there appears to be no particular love between Al Qaeda and the Iraqi regime, there is the "enemy of my enemy" phenomenon going on — constitute a "grave and certain" threat to humanity.
"All other means of putting an end to it must have been shown to be impractical or ineffective;"
Eh. Ten years of a weak inspection regime (which involved AIRCRAFT only in its waning weeks, probably after the die was cast) was hardly an effective attempt at peaceful resolution.
"There must be serious prospects of success;"
Sure, the West will win. No question here. It may take a while, and be a bit messier than advertised, but they'll kill all the Saddam guys' hardware.
"The use of arms must not produce evils and disorders graver than the evil to be eliminated. The power of modern means of destruction weighs very heavily in evaluating this condition."
This is the problem. The evil spawned by the current operation will likely be far worse (and certainly more far-reaching) than the evil that existed in the previous totalitarian state. For sure, the West will face a heap of terrorist attacks, against Western military targets and against civilian interests all over the world. Resentment of the West will grow in the Muslim states, on the simple grounds that soldiers from the United States, United Kingdom, and Australia are occupying land that isn't rightfully theirs. Terrible damage has already been done to the United Nations (arguably the greatest political accomplishment of the post-WWII world) and to the NATO alliance.
Speaking of which, isn't it odd that neither U.S. Secretary of State Colin Powell nor U.S. President Bush bothered to *visit* fence-sitters Russia or China during the run-up to the war? The level of hubris is shocking.
There was a time, a whopping 15 years ago, when the United States were the good guys, standing up to the demonstrably evil and obviously malignant Soviet Union. The West won that one, and properly so. Now, the country has embarked on something very close to a war of aggression, and it seems to be way out of line. The fact that the war may expand to other countries, as posited recently in the Wall Street Journal, presents a further complication.
It is a difficult time to be an American.
In the MTR (subway) trains and stations over 90% of the people are wearing face masks. On the streets, in shopping malls, and at the airport it's slightly less — probably 75-80% — but still shocking seeing so many of the public wearing masks. In my office, around 50% of the staff (including me) wear masks in the office! Hardly anyone goes to restaurants, theaters, shopping malls these days. We have to be anti-social to prevent from getting infected. Sadly, and quite shockingly, this is what life is like here now.
The safest N95 masks/respirators have completely sold out in Hong Kong and probably the rest of Asia. I had my mom FedEx over 90 3M model 8210 "N95" masks from Hawaii. She spent US$220 (4 boxes @ $55/box) on the shipping! I should be receiving the masks on Thursday.
Tonight the government evacuated the remaining residents (around 270 people) of Amoy Gardens Block E (quarantined just yesterday) to 2 government-owned holiday camp isolation centers. They have 4 of these holiday camps reserved for quarantining infected patients. The combined capacity of these camps is around 1050 people. The government is also providing 3 meals a day and daily necessities (soap, toothpaste, and disinfectant) to all those quarantined. The South China Morning Post reported, "At a glance, it now looks more like a supply station in a war zone, with bags of rice and rolls of toilet paper stacked outside." Psychologists are there to provide free counselling as well.
Latest stats:
75 new cases for a total of 685 infected in Hong Kong today. 1 more dead for a total of 16. Globally, close to 1900 have been infected in 15 countries and 63 have died.
More from CNN.com:
http://www.cnn.com/2003/HEALTH/04/01/hk.sars/index.html
