Are we all worrying too much about Sars? Is it true, as has been suggested, that scare-mongering by the press is doing more damage than the disease itself? Usually, I would be inclined to say yes to both questions. Far too many scares are whipped up by journalists and those who feed them information. Several years ago, after reading some American research about the effect of such stories on readers, I resolved to write fewer of them.
It isn’t difficult to find reassurance that severe acute respiratory syndrome may not be as dangerous as we are led to believe. Professor Stuart Derbyshire, of the University of Pittsburgh Medical Centre, argues that it “is not infectious or virulent enough to cause global catastrophe and should not be getting in the way of people’s lives”.
And last week a British patient, released from Addenbrookes Hospital after recovering from Sars, said: “The way the media have sensationalised this outbreak has caused panic among those closest to me, which has been distressing for everyone involved. Displaying the symptoms of Sars does not necessarily mean you’re going to die, and my case is proof of that fact.”
So far, Sars has killed 126 people, and infected 3,200. In comparison with flu, this is a pinprick. Flu kills around 250,000 people worldwide every year, more in epidemic years. A really bad epidemic would produce millions of casualties.
But in spite of that, I am unrepentant about the extensive coverage The Times has given to Sars. All epidemics start small. I remember the first whisperings in the early 1980s about a mystery disease that seemed to specialise in the users of San Franciso’s homosexual bath-houses and the residents of Haiti, two groups with little otherwise in common. It was a medical curiosity, a disease that had the doctors stumped. It turned out to be Aids.
Two factors have put Sars into the headlines. The first is the recognition that infectious diseases, which in the Sixties and Seventies were considered to be on the ropes, have come out punching. The antibiotic era and the success of vaccines in taming polio and eliminating smallpox generated a self-confidence amounting to hubris that we had all the answers to infection. How wrong that turned out to be.
Since then, Aids has been arguably the greatest killer to blight the human race. No one knows — because no one was counting — how many fell victim to smallpox or the Black Death in the Middle Ages. And even the 1918 flu epidemic has widely differing death tolls, depending upon which figures you accept. Some say 20 million, some 40. But Aids has unquestionably killed around 23 million so far. A complacent world that has been taken by surprise once — by Aids — is entitled to worry when another medical curiosity comes along.
The second reason why Sars has caused such concern is that it has played to an audience prepared by well-meant propaganda about flu vaccination.
Sooner or later there will be another huge flu pandemic, unless a virus famed for its quick-change acts has finally decided to make its final bow. Pathogens do sometimes lose their potency, but three successive winters of low mortality are too few by far to write flu off. It will come back one day and hurt us badly.
So Sars, which has many elements in common with flu, found a costume ready-made when it crept upon the stage. The chances are that it is not as deadly as flu, but it is far too early to be sure.
Over the weekend seven more people died of Sars in Hong Kong. Two of them were in their thirties; four others were 40, 41, 45 and 52. Flu generally chooses its victims among the frail and elderly, but Sars seems able to kill even those who are relatively fit when they are infected.
Nor can the outbreak be blamed on poverty and inadequate health care. Hong Kong may be overcrowded, but its hospitals are good and its standards of living higher than two thirds of the world. Besides, 13 people have died in Canada, which has excellent healthcare, and the country has 270 probable or suspected cases, all originating from a single infected person who travelled to Toronto from Hong Kong.
Britain’s sixth case, being treated in Northwick Park hospital in London, caught the disease from a business contact from Hong Kong who passed through London on a lightning tour of Europe. Not only does this suggest that catching Sars may not be so difficult after all, but it emphasises how quickly it might spread — not, like the Black Death, at the speed of a horse, but at the speed of a jumbo jet.
Millions of people travel to and from the Far East every year, including thousands of students and schoolchildren. In terms of infection, we really do inhabit a global village, where only differences of climate and season inhibit the spread of respiratory disease. Sars has yet to hit India, or Indonesia, two populous countries where it might spread a long way without being detected. Nor, yet, do we really know how many cases there have been in China, where acquiring data is like pulling teeth.
Sars may not be “the big one” which virologists have been warning us to expect, a disease as catching as flu and as deadly as Aids. But it seems certain now to become established among the menu of winter diseases whose arrival can be predicted almost as accurately as the first frost.
Its capacity to spread rapidly within a hospital makes it a special menace, as does the need to isolate patients and care for them intensively. Sars has the capacity to cripple healthcare systems or to impose on them huge costs in the effort to stop its spread.
So while the toll from Sars may never rival that of flu, it is a nasty disease, hard to control, unpredictable in its virulence, and spreading in ways that are still not fully understood. Panic is never the right response, but nor is a shrug or the advice to ignore the bringer of bad news.
