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22nd March 2003  Latest update 2nd April 2003.

AUSTRALIAN  DIARY

 - IRAQ -

Funny thing, our government funded "Australian Strategic Policy Institute" said back in February 2002 that a US Iraq war was impossible.  The ASPI is very useful.  If ASPI thinks it will happen, it is unlikely.  If they think it is impossible, then it is a near certainty.

The invasion of Iraq is now two days old.  It started four days ago with a 48 hour ultimatum to Saddam - "leave Iraq or there will be serious consequences."

Two days ago about 30 cruise missiles struck Baghdad.  The targets were presidential residences and government offices.  Intelligence sources had advised that Saddam & cronies were visiting those sites.  The consensus is that Saddam survived, although it is thought that elder son Uday did not, nor did two presidential cronies.  Serious consequences indeed!

Mohammed taught that Islamic states should not attack each other, and by corollary, that Muslims should support each other when attacked by the Infidel.  Although most of the world's estimated one billion Muslims acknowledge that Saddam is a vicious murderer that should be executed, world response to the US invasion shows that muslims do not appreciate it that an Infidel should be the one to bring him to justice.  (of course there are a few muslim countries where the citizens believe that he is so evil that even infidels are welcome to off him, e.g. Kuwait & Qatar.)

The fog of war in Iraq is dense.  It seems that Basra has fallen.  On the northern front Turkey and the US are in dispute, with Turkey attempting to trade limited air passage for US approval that they invade the Kurd part of Iraq.  The US is not taking that deal, and Turkey is reported as having sent in 1,000 commandos despite US objections.  Turkey has not got many friends in the region.  People who have few friends would be well advised to tread carefully.  I suspect that the cost of that action by Turkey might well be that a separate Kurd nation having substantial oil revenues might exist before 2004.  Possible scenarios that might arise are that the Iraqi Kurds capture an ordinance & munitions dump owned by Saddam.

In western Iraq the US has captured two airfields.  This will render the need for Turkish airfields superfluous, although the equipment of 20,000 elite troops is left uselessly on transports in the Mediterranean.  Tank battalions are reported as striking upwards from Kuwait through the western desert with the intent of turning north east for Baghdad.  The US threatens massive bombing of any unsurrendered military formations. It offers easy surrender.  Battalion (8,000 men) sized defections have occurred.  It is reported that Saddam is considering an escape to muslim Mauritania.  Unlike Idi Amin of Uganda in Saudi Arabia, it seems unlikely that Saddam would long survive in a Muslim country without a battalion of his elite guards.
 

 - SARS PANDEMIC? -

A new disease that has been given the name "Severe Acute Respiratory Syndrome" arose in Guangdong province, China last November (2002).   Information presented below was garnered from the Center for Disease Control, (CDC) Atlanta, and the World Health Organization (WHO).

The question is, is this a new influenza pandemic like that of 1918?    The influenza of 1918 had a mortality rate of around 2.5%, which would mean about 7 million deaths in the present day USA, or half a million in Australia.  The indications are that this virus is much more virulent.

 FROM "WHO" FACT SHEET

The incubation period of SARS is usually 2-7 days but may be as long as 10 days. The illness generally begins with a prodrome of fever (>38°C), which is often high, sometimes associated with chills and rigors and sometimes accompanied by other symptoms including headache, malaise, and myalgias. At the onset of illness, some cases have mild respiratory symptoms. Typically, rash and neurologic or gastrointestinal findings are absent, although a few patients have reported diarrhoea during the febrile prodrome.
 
After 3-7 days, a lower respiratory phase begins with the onset of a dry, non-productive cough or dyspnea that may be accompanied by or progress to hypoxemia. In 10%-20% of cases, the respiratory illness is severe enough to require intubation and mechanical ventilation. The case fatality among persons with illness meeting the current WHO case definition for probable and suspected cases of SARS is around 3%.
The estimate of 3% case fatality appears to be based on the current fatalities divided by the current cases (e.g.9/264 = 3%).   A more accurate estimate would be obtained by dividing the count of fatalities by the count of cases who have either died or recovered.  For instance WHO advised:
As of today, Hong Kong remains the most seriously affected area. Authorities there have reported a total of 222 cases in health care workers, medical students, and family members and hospital visitors who have been in close contact with patients. Of these, 217 have developed symptoms of pneumonia, and many are in serious condition.
Index case in Hong Kong outbreak
WHO has welcomed a report from the Hong Kong Department of Health, released yesterday, that may have identified the “index” case in the outbreak in the Prince of Wales Hospital in Hong Kong. In an outstanding example of detective work, epidemiologists have determined that 7 people who contracted SARS recently stayed in or visited the Metropole hotel in Kowloon last month. The 7 persons investigated include 3 visitors from Singapore, 2 from Canada, one China Mainland visitor, and a local Hong Kong resident.

The investigation revealed that all 7 stayed in or visited the same floor of the hotel between 12 February and 2 March. The local Hong Kong resident is believed to be the index case, who subsequently infected other early cases in the outbreak. He had visited an acquaintance staying at the hotel from 15 to 23 February. The visitor from Mainland China, who became sick a week before staying at the hotel, is considered the original source of the infection. No further cases have been linked to the hotel.


March 27th & 29th update.

Based upon recent (3/27) data, I have expanded the previous table.  I have excluded the data from China, which is only available for 3/23 (using the US dating system).
 

 
DATE
1/23
3/19
3/20
3/21
3/22
3/24
3/25
3/26
3/27
3/28
3/29
3/31
4/1
4/15
5/1
7/1
CASES
1
264
306
350
386
456
487
531
602
679
744
816
998
-
-
-
DEATHS
0
9
10
10
11
17
17
18
19
19
20
24
28
-
-
-
FORMULA
1
266
295
328
364
449
498
553
613
681
756
931
1034
4,455
24,000
600,000

The "FORMULA" is a simple geometric progression (using r=1.11) that fit the data.  Working backwards, the index case was infected on the twenty third of January.   The formula was composed on 27th March.  So far, the extrapolation is in good agreement with new data (in red).

The latest data from WHO site (3/27) is

Disease presentation:    All of the clinicians described presentations of SARS patients and a general consensus is agreed that presentation is relatively consistent across all nations. Presentation is of a prodromal illness with a sudden onset of high fever. In a great number of cases this sudden, high fever is associated myalgia, chills, rigors and non-productive cough. At presentation (which is often three to four days after onset of symptoms), a large proportion of patients have characteristic changes on chest x-rays.

Disease progression:    Following presentation, chest x-rays continue to worsen and most patients demonstrate bilateral changes with interstitial infiltrations (fluid build-up between cells in the lungs). These infiltrations produce x-rays with a characteristic cloudy appearance. Patients then fall into one of two groups. The majority, 80 to 90% of patients at day six or seven, show improvement in signs and symptoms. A second smaller group, progress to a more severe form of SARS, many of whom develop acute respiratory distress syndrome and require mechanical ventilatory support. Mortality associated with the more severe group is high, however, a number of patients have remained on ventilator support for prolonged periods of time. Mortality in the severe group appears to be linked to a patient's other illnesses (co-morbid factors).

Prognostic indicators:   Generally, patients over 40 with other illnesses are more likely to progress to the severe form of the disease.

Therapy:     Numerous antibiotic therapies have been tried to date with little clear effect. Ribavirin with or without use of steroids has been used in an increasing number of patients. But in the absence of clinical indicators, its effectiveness has not been proven. Currently the most appropriate management measures are general supportive therapy, insuring the person is hydrated and treated for subsequent infections.

My own (3/29) calculations of the fatality rate, based on the data and an estimate that the disease takes fifteen days to kill, shows that the fatality rate of all those that catch the disease is around 10%.  If the disease kills more rapidly, then that estimate would be high, and vv.

The WHO estimate of 3% case fatality (implying 97% survival rate) is obviously far too low.  For instance, consider that (28-9) people have died in the thirteen days between 3/19 and 4/1.  If incubation rate was 13 days, (from 3/19 to 4/1) the fatality rate is approximately (28-9)/(266-69) which is 9.6%. (where 69 is the estimate of the number of cases on 6th March 2003.)  The fatality rate is thus about 10%.  The survival rate is about 90%.

That is why everybody is so worried.  That is 30 million American fatalities, about 2 million Australian fatalities, about 600 million fatalities worldwide.

Most families would lose at least one close (parent, child, cousin) family member.

Let us pray that those heroic medical researchers find a cure or innoculation before the disease spreads into the wider community.


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