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Thursday, August 7, 2014

SARS and Ebola

I remember clearly the SARS outbreak in 2003. My job at the time was commercial marketing for a line of products in Asia. A colleague of mine went to China during the outbreak, came home sick with symptoms of SARS, and was deemed to have been infected by the SARS agent unless he could be diagnosed differentially. He recovered fully after a lengthy illness, but his experience was unsettling. Furthermore, because of the magnitude of commerce between the U.S. and China and the thousands of people who normally fly between the countries every day, the SARS outbreak rapidly affected how business got done.

Ebola has been around since 1976, but until several weeks ago it was of no concern for 99.99% of Americans. Why? There isn't much commerce between the U.S. and nations of western Africa. Africans comprise only about 3% of immigrants to the U.S. And let's face the truth: Africa tends to be ignored by westerners until there is some kind of crisis that commands attention (although not necessarily a helpful response). Well, we have a crisis on our hands now — even if the number of people who travel between the U.S. and western Africa each day is a relatively small number.

Both SARS and Ebola are caused by viruses, but the two are significantly different. The SARS agent is a Group IV or positive-sense ssRNA virus, as are viruses that cause common colds and yellow fever. The Ebola agent is a Group V or negative-sense ssRNA virus, as are viruses that cause influenza and measles. One reads of cytokine storms resulting from both SARS and Ebola, but the diseases play out differently. Although SARS acquired an early reputation for mortality, statistics show that with supportive treatment, fewer than 10% of confirmed SARS cases progressed to death. Ebola, on the other hand, is being attributed a mortality rate of at least 50% based on statistics from Africa. I don't believe anyone knows yet what the mortality rate would be if those victims were being given supportive treatment per western standards of medical care, but the fact that we are already hearing about experimental treatments suggests that without those treatments, mortality could remain high even under western standards of care.

What does one do at this point? Just follow the news and, as always, sort out the responsible journalism from the sensational. I'm on another transatlantic flight Monday. I'm not taking a mask, and I won't worry one bit about who will be standing behind me in the immigration queue at Heathrow. By nature I am not a doom-and-gloom guy — but no one can rule out the possibility that the Ebola outbreak will reach outside Africa later this year.