By:     Dr. Stephen Rinehart

Date:  May 08, 2003

Background: The World Health Organization (as of May 08, 2003) now estimates the death rate from SARS to be 14%-15% and survival is highly dependent upon your age. People over 65 have a death rate of 40%-50% while persons less than 24 years of age have less than 1% death rate. Beijing has ordered sweeping action to halt the SARS spread and has already quarantined over 10,000 people in Nanjing alone. If the provinces that border Shanghai become badly affected, it would be impossible to save China’s commercial center from economic chaos/paralysis. China is already facing a full-blown epidemic in its rural provinces and the rural Chinese people often do not trust their National Government or follow orders. Therefore, the Chinese Government is imposing severe prison sentences to those who do not report they are sick and is activating an additional 50,000 “volunteer policeman” to control the spread of the disease by testing people for fevers.

SARS is an “influenza” virus and appears to be a unique “hybrid” orthomyoxvirus-coronavirus because SARS contains a substance called neuramidase (i.e., glycoprotein) which enables it to attack to the respiratory epithelium of the host. There is no other known coronavirus with neuramidase. Paramyxoviruses (i.e., measles, mumps) and orthomyxoviruses (i.e., influenza) are pathogenic human respiratory viruses.

People with SARS need full-time “supportive therapy” because they cannot control the fluid build-up within the lungs from this acute respiratory disease and may need to be on ventilators. In late April there were about 170- 200 new cases per day. Estimates suggest if there are more than 15,000 cases of SARS by the end of May the disease is probably not being contained in China.

SARS is believed to be spread by contact (droplets) between persons. Unclear as to whether people who recover from SARS can become a carrier of the disease but it is possible for some people to be silent carriers. There is no anti-viral vaccine to SARS leaving officials of all countries to fall back to 19^th Century methods of full quarantines and isolation of all persons with the virus. C-SPAN 2 is airing hearings (for the benefit of the public with carefully scripted questions) regarding the threat to the US . It is also possible that a certain portion of the North European population maybe totally immune to SARS.

 Plausibility Estimates for SARS Spread: About a month ago I developed a simple spreadsheet estimate for the spread of SARS assuming an incubation period of 7 days (10 days max estimated by WHO) and two other people contacting the disease (i.e., spouse, children, relatives, friends) assuming a 6% death rate. I have updated the tables to include a 15% death rate if the disease continued to spread worldwide. The results are as follows:

Month	Infected	6% Death Rate	8% Death Rate	15% Death Rate
1	3000	180	240	450
2	9000	540	720	1350
3	27000	1620	2160	4050
4	81000	4860	6480	12150
5	243000	14580	19440	36450
6	729000	43740	58320	109350
7	2187000	131220	174960	328050
8	6561000	393660	524880	984150
9	19683000	1180980	1574640	2952450
10	59049000	3542940	4723920	8857350
11	177147000	10628820	14171760	26572050
12	531441000	31886460	42515280	79716150
13	1594323000	95659380	127545840	239148450
14	4782969000	286978140	382637520	717445350
15	14348907000	860934420	1147912560	2152336050

As of early May the “official” death total from SARS is 495 deaths from 6903 probable cases. It appears there are 15-20 new deaths each day with Hong Kong’s death rate the highest and this is following the trend in Column 2 (8% death rate). I will modify these tables to reflect the “age factor” of SARS.

Conclusions: It is too early to say that SARS is being contained as regards China’s quarantine efforts because there are new SARS cases being reported in India and Pakistan. If the number of SARS cases at the end of May exceeds 15000 and then goes above 18000 - the disease is probably not being contained. Knowledge of the disease’s transport and infectivity characteristics as well as the geonome (already on Internet) are key to finding effective anti-viral solutions and 18 BSL III Labs are awaiting the live virus from CDC (i.e., possibly on an emergency, national priority basis). Until we find a solution, Governments must move rapidly to quarantine infected people, shut-down foreign travel AND quarantine anyone with a fever coming into the US.

SARS disease infectivity could be related to various “bird flus” such as Avian Infection Bronchitis Virus (AIBV) which is a coronavirus of birds and ducks. In China they keep ducks and pigs together so another outbreak of a form of Spanish Swine Flu (a la 1918) is possible in China if these diseases are related. It is believed the Russians experimented with infecting “Gooney birds” with pathogenic viruses in the 1960s which were migrating to Midway Island with a form of AIBV. My step-father (who was in the Navy and CO of Midway Island at the time) was in-charge of shipping dead birds back to Bethesda Medical Hospital’s labs for analysis (nothing ever revealed to him on findings but my step-father became suddenly very ill and died “in quarantine” at Bethesda Naval Hospital from an “unknown” respiratory virus contracted on Midway Island). Thus, I do not yet believe we should rule out the possibility of this “hybrid coronavirus” being modified or developed in a Chinese or Russian bio-lab many years ago (i.e., something may have gone very wrong in handling the live virus).

SARS is rapidly becoming a threat to world health and has spread to 29 countries. Fortunately, we live in an age of instant communications worldwide to stop the disease. It is possible children infected by parents may become immune carriers of such a disease for some period of time. The disease may also target nerve cells or other organs of the body. The world Governments are taking this threat very seriously and we should too.