From: matus@matus1976.com
Date: Fri May 16 2003 - 15:58:20 MDT
> On Mon, May 12, 2003 at 03:14:45PM -0400, matus@matus1976.com wrote:
> > A more recent skeptical look at SARS by columnist Michael Fumento.
>
> Not recent enough, unfortunately.
>
> > How lethal is SARS?
> >
> > Globally, it's about seven percent, in the same league as other forms of
> > pneumonia. This is notwithstanding the May 1 Washington Post
> reporting that
> > WHO official Mark Salter said it was 10 percent. A CNN.com
> article that day
> > was titled: "SARS Death Rate Rising," but it had Salter saying it "could
> > likely reach 10 percent." "Could" and "is" are not the same.
>
> On this same day this article is dated, WHO raised estimated SARS fatality
> rate to 15% (see
> http://www.washingtonpost.com/wp-dyn/articles/A27675-2003May7.html) while
> the Lancet published a paper putting SARS fatality rate in Hong Kong at
> 20%.
>
AND
Adrian Tymes wrote:
"With an estimated fatality rate of 40% among those over 60 I don't find it
particularly minor. "
The problem with the Lancet data is that it's heavily skewed towards the
elderly and we know the elderly are far more likely to die of any type of
pneumonia, and second it all comes from a single source. Had they done the
study in the US and Europe they would have found a SARS rate of zero
percent. If one is willing to extrapolate from a subset of people in Hong
Kong to all of SARS, they should be willing to extrapolate from ALL US and
EU cases. Obviously the SARS death rate is heavily dependent on the quality
of hospital care. The 20% fatality rate of SARS is 20% *in Hong Kong*. Any
idea what the fatality rate is for post industrialized west nations with
decent health care systems? Answer, 0% See -
http://www.who.int/csr/sars/country/2003_05_16/en/
Regards,
Michael Dickey
http://www.fumento.com/advise.html (posted today)
The spread of SARS continues to slow and at less than 7,739 cases and 611
cases it's still just a bit shy of the 1918-1919 flu pandemic (with 40
million deaths) to which the media is wont to compare this new disease. So
it wasn't surprising that they jumped all over a new study published in The
Lancet online indicating that the fatality rate for SARS might be much
higher than would seem by simply dividing deaths by cases. Indeed, said the
study, the death rate could be as high as 20 percent. But there are just a
few minor problems here. First, the subjects in the study were
disproportionately among the elderly. SARS, like all pathogens that kill
primarily through pneumonia, picks on old people. Indeed, The Lancet study
found "The estimated case fatality rate for patients younger than 60 years
was 13.2% and 43.3% for patients aged 60 years and older." Second, not only
did all of these patients come from a single city, a huge percentage came
from a single place in that city - the now-infamous Amoy Gardens apartment
complex. Third, as the study also was careful to note, it could only look at
hospitalized persons. How many times have you had the flu? How many times
have you sought a doctor's care for it? Right. Surely it's the same with
SARS. As with flu, probably the vast majority of people who contract it
never get any medical attention; they simply recover on their own. Taking
that into account, even looking at worldwide cases versus deaths probably
grossly overstates the SARS death rate.
Finally, if the study had instead chosen as its subjects all persons in the
U.S., Europe, and Australia with SARS it would have found 109 cases as of
May 15 with no deaths. For the mathematically challenged, that's a zero
percent death rate. Obviously, the quality of medical care dramatically
impacts the death rate. In any case, it makes no more sense to extrapolate
from a portion of Hong Kong cases to the world as it does to extrapolate
from all U.S., European, and Australian cases to the world. That would be
like basing your odds of contracting malaria in Zaire based on malaria cases
in New York or vice-versa. So the best data remain those WHO posts daily on
its website. Not that the media or public health officials care anything
about all this. They've got sales and budget increases to worry about.
(Posted 05-16-2003)
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