Mike Darwin's scary health alert

From: randy (cryofan@mylinuxisp.com)
Date: Mon Mar 17 2003 - 19:14:06 MST

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    It's a bit scary and peculiar. Here it is, crossposted from cryonet:

    From fake-header-service

    From Mgdarwin@cs.com Mon Mar 17 23:49:28 2003
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    From: Mgdarwin@cs.com
    Message-ID: <160.1d7e3562.2ba7b8fc@cs.com>
    Date: Mon, 17 Mar 2003 18:49:16 EST
    Subject: URGENT HEALTH WARNING
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    I am communicating with you only because I believe this is a matter of
    life
    or death.

    This is a warning of a possible near term pandemic which may be highly
    lethal
    and result in serious disruption of civil order and normal daily life.
    As
    most of you probably know from news reports there has been an unusual
    communicable form of "pneumonia" which does not respond to any
    treatment
    currently available including antivirals and antibiotics.

    What you may not know is that the media is severely (in my opinion)
    underreporting the gravity of the situation in general, and the
    severity of
    this illness in particular. I first became aware of this problem about
    6
    months ago when reports came out of China that a new flu had emerged
    and the
    local population was "overreacting" according to the Chinese
    government. One
    of my Internet medical colleagues in China advised me that the disease
    was
    quite serious, virulently communicable (had failed containment using
    standard
    Universal Precautions and cloth and disposable surgical masks). I was
    also
    told that heath care workers were heavily affected and that draconian
    containment measures were being used in the province where the disease
    began.
    I was also told that it was *rumored* that the area where the epidemic
    began
    was in proximity to military installations involved in defensive
    nuclear-chemical-biological (NBC) research. Shortly afterward, he
    died,
    possibly of the new illness. His last message indicated that all
    attempts he
    knew of (i.e., civilian) to isolate the etiologic agent responsible
    for the
    disease in China had failed. In short, it did not appear to be an
    influenza,
    although the province where it originated is in the heart of the world
    influenza generation zone (which, BTW, is in China).

    On 15 March, the World Health Organization (WHO) issued an alert and
    gave the
    illness a name: SARS, or Severe Acute Respiratory Syndrome. My
    contacts in
    other areas of epidemiology and medicine have informed me that the CDC
    has
    also so far failed completely to characterize the etiologic agent for
    SARS.

    Many of you will also note that I relocated to a remote, isolated area
    in
    September of this year. Some of you may have wondered why. Now, you
    know part
    of the reason and Dave Pizer's comment about my post being "almost
    scary" can
    be put into perspective. As a sidebar, unfortunately, I currently work
    at a
    facility that services travelers and tourists, so, unless my timing is
    flawless in the face of a US epidemic of SARS, all my precautions may
    have
    been futile.

    Several things are clear:

    1) SARS patients who require hospitalization do not seem to improve
    and those
    who become ventilator dependent remain so. It is not known how many
    people
    recover from the illness who do not reach hospital, but in well
    nourished
    urban populations it appears that the mortality rate may be as high
    10%-20%.

    2) SARS is *extremely* infectious; those physicians treating it in
    Hong Kong
    report that it is about as infectious as influenza. So that you can
    understand the gravity of this statement this would mean that SARS is
    more
    infectious than Ebola or the other hemorrhagic fevers and would
    require the
    highest level of biosafety containment for handling in the laboratory.
    *For
    practical purposes it means that complete civilian protection can best
    be
    achieved by complete isolation until the epidemic is over. * Masks
    (respiratory) and conjunctival protection (eye shields) coupled with
    gloves
    will probably provide a significant degree of protection against
    casual
    exposure. A principal purpose of the gloves is to remind you not to
    touch
    your face. However, these methods of protection will likely fail if
    contact
    with infected person(s) is prolonged in indoor or contained spaces
    (homes,
    vehicles, aircraft, etc.).

    3) SARS is likely to spread rapidly and public health officials are
    likely to
    react too slowly to contain it. Only draconian measures would allow
    any
    significant degree of protection and these measures are likely to be
    so
    severe that normal commerce and travel would be severely or completely
    disrupted. SARS may well behave much like the 1918 Flu. For an
    excellent and
    comprehensive review of this pandemic I highly recommend Gina Kolata's
    FLU:
    THE GREAT INFLUENZA PANDEMIC OF 1918 AND THE SEARCH OF THE AGENT THAT
    CAUSED
    IT (ISBN: 0374157065
    Publisher: Farrar, Straus & Giroux, LLC). Used copies are available
    from
    bookfinder.com for as little as $1.00 (US). The 1918 Flu killed more
    people
    than W.W.I. Estimates for deaths in the US are as high as 18 million.

    4) I suggest that if you have not done so already, you stockpile
    emergency
    food, water, and minimal protective equipment for you and your loved
    ones. It
    is impossible to be comprehensive here, but other measures such as
    having
    bleach and dispensing equipment available for disinfection of surfaces
    should
    you have to care for someone infected with SARS should also be
    undertaken
    Many websites for disaster and NBC preparedness exist, and many of
    these sell
    supplies which may be useful. Frankly, these are supplies you should
    *all*
    have in any event as a routine part of preparedness for life. *Anyone
    seriously concerned about their survival should have these kinds of
    preparations in place. * Survival Unlimited.com is one such website.
    There
    are many others.

    5) The elderly and immunocompromised appear to be particularly hard
    hit by
    SARS and appear to constitute a disproportinate number of those who've
    died.

    6) I emphasize that media coverage is not accurately reflecting the
    severity
    of the disease or the extent of SARS in China, although the media is
    beginning to report that SARS "is of concern to healthcare agencies."

    7) Those involved in healthcare, cryonics care, and those who deal
    with
    tourists (freeway related businesses, tourist centers, and
    hotels/motels) are
    IMHO likely to be at very high risk of exposure to the initial wave of
    infection with SARS should it become epidemic in the United States and
    Europe. A disproportinate number of sentinel provincial Chinese cases
    were in
    hoteliers and shopkeepers at trade hubs. If you are involved in such a
    business it would probably be wise to cease operation (where possible)
    at
    such time as the first cases are reported in your country or region of
    your
    country.

    Healthcare and cryonics workers should acquire active full-head HEPA
    protection for all staff and impermeable full-body protective suits.
    In the
    case of cryonics personnel, Standby staff who deal with the patient
    while
    alive will be at very high risk. Volunteers for these high risk
    positions
    should be sought at the earliest opportunity and training to minimize
    the
    risk of SARS transmission (using influenza as a model) should begin at
    once.

    Cryonics organization should also, in my opinion, modify handling and
    operative procedures to deal with this illness. The external surfaces
    of all
    patients who arrive should be scrubbed with detergent and 2% sodium
    hypochlorite.

    Finally, impending war is likely to provide a fertile opportunity for
    rapid
    spread of SARS since it mandates movement of manpower and material
    across
    multiple borders even the presence of disease, concentrates people in
    barracks and shelters, and results in immunocompromise from stress
    (even in
    healthy and well nourished soldiers and civilians) from increased
    glucocorticoid secretion. War is the handmaiden of epidemic disease
    and in
    this case the timing could not be worse in my opinion.

    Thank you for your consideration of this message. The communication
    from Tom
    Buckley, as posted to the Critical Care Medicine Forum (CCM-L), is
    reproduced
    below.

    Mike Darwin

    The implications of SARS for the cryonics community are overwhelming.

    I will close this message with a communication from Tom Buckley, an
    Intensivist in Hong Kong. Tom's is a superb physician and Intensivist
    and his
    communication below should give you snap shot of what is happening in
    a
    major, highly sophisticated medical center in Hong Kong.

    Dear All,

    I have not read all of the below because we seem to be close too or
    are the
    centre of this form of atypical pneumonia.

    So just a brief summary of our experience.

    Male arrives on the medical ward having been admitted thru A & E.
    Other
    patients and STAFF start to develop symptoms - fever, headache, dry
    cough.

    Unresponsive to various combinations of cefotaxime, chlarithromycin,
    levofloxacin, doxyclycline and Tamiflu. All microbiology is NEGATIVE
    (after
    one week).

    Physicians have started patients on ribovarin and steroids.

    As of yesterday there were 64 patients with "atypical pneumonia" in
    the
    hospital - a large number of whom are staff.

    Patient visitors, medical consultation staff, medical students
    visiting
    patients have all developed symptoms and to a large degree CXR signs.

    While most of our cases revolve around the patient admitted to the
    medical
    ward we have admitted (to ICU) another patient from another hospital
    with
    atypical pneumonia.

    In ICU we have twelve patients admitted so far

    Five are ventilated. Seven breathing spontaneously but very oxygen
    dependent.

    My impressions
    CXR reveal progressive bilateral infiltrates starting at the bases.
    Patients invariably have a low WCC and maybe thrombocytopenic.
    Patients invariably have an elevated CPK. No ECG changes and Troponin
    T
    negative. Post mortem on an Indonesian maid (not in our hospital)
    showed
    evidence of ARDS and myocarditis.

    So far 2-3 of our older patients with chronic disease have
    deteriorated
    fastest. Medical staff - younger and fitter have faired better.
    Their
    radiological findings have deteriorated in all but one case.

    We receive 2-3 admissions per day. So far no-one has shown any
    improvement.
    Once intubated however they remain relatively static but very oxygen
    and
    PEEP dependent. Those ventilated have solid lungs. Interestingly one
    patient developed a pneumothorax on the medical ward and after chest
    drain
    and re-expansion his pneumonia involves only the side without a chest
    drain.
    Another patient (ventilated) has developed surgical emphysema.

    ICU is now closed for all but atypical pneumonias. All our other
    "clean
    cases" have been transferred to other ICUs. All elective surgery is
    being
    cancelled and wards are being closed and evacuated. Al ambulances are
    being
    diverted.

    We are taking strictest possible isolation procedures available to us
    including hand washing, gloves, gowns, N95 masks and visors.

    Masks are worn throughout the hospital.
    Staff are not going home to children.

    Please take the warning below seriously. My impression is that even
    with
    minimal contact with an infected person people have been becoming ill.

    Staff morale in ICU is high but If ICU staff start developing symptoms
    then
    this is a big problem as we have instituted isolation procedures
    earliest.

    Other hospitals in Hong Kong are admitting sporadic cases.

    I am off to a noon update.

    Any suggestions will be gratefully received.

    Tom Buckley
    Consultant Intensivist
    Department of Anaesthesia and Intensive Care,
    Prince of Wales Hospital
    Shatin,
    Hong Kong

     



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