The beginnings of a pandemic - a topic that depresses the shit out of downzy

[SoulMonster]

I thought this was cool:

On November 16, 2002, a 45-year-old man was admitted to hospital in Foshan City in Guangdong, China. His condition was consistent with pneumonia, a high fever, muscle aches, shortness of breath, coughing and respiratory difficulties.

Four other members of the patient's family soon fell ill with similar symptoms. Three weeks later, a 35-year-old man was brought from his home in nearby Heyuan to Guangzhou provincial hospital after becoming ill. He infected the doctor who had accompanied him in an ambulance, and then seven of the medical team treating him. Whatever his illness, it was highly infectious: antibiotics proved ineffective, meaning that clinical strategy -- which would later be replicated elsewhere -- amounted to keeping him alive in the hope that his immune systems would fight off the disease.

Clusters of such outbreaks occurred throughout Guangzhou over the following months and, although physicians were acutely aware of the danger that the new, highly communicable disease posed, they were baffled as to its cause. Later analysis revealed that it was a coronavirus -- the virus associated with the common cold. This information confused scientists: it's extremely rare for a coronavirus to kill human beings, yet around 15 per cent of those infected were dying.

According to David Quammen's book Spillover, over the next few weeks 28 cases were recognised in Zhongshan, 95km south of Guangzhou. Symptoms were similar to the earlier cases and included "severe and persistent coughing, coughing up bloody phlegm, and progressive destruction of the lungs, which tended to stiffen and fill with fluid, causing oxygen deprivation that, in some cases, led to organ failure and death."

Then the outbreak really took hold: two "super spreaders" distributed it beyond where it had been found up to that point. The first, Zhou Zuofeng, arrived at Guangzhou hospital with symptoms now familiar to the staff. He transmitted the disease to at least 30 healthcare workers before being transferred to a specialist hospital. On the way, he infected two doctors, two nurses and the ambulance driver. At the second hospital, 23 doctors and nurses, plus 18 other patients and their relatives and 19 members of Zhou's family, became ill, prompting staff at the hospital to name him the Poison King.

On February 21, 2003, Liu Jianlun, a nephrology professor and one of the doctors who had treated Zhou, travelled to Hong Kong to attend his nephew's wedding. While staying at the Hotel Metropole, in the heart of one of the city's busiest shopping districts, he began to feel ill. During his stay, Liu unwittingly infected a number of people who were staying in rooms on the same floor. One of them was a 78-year-old Canadian. On February 22, she boarded a flight for Toronto. Eleven days later, she died, but not before passing the condition on to her son. The virus then spread throughout the hospital where he was treated. Over the following weeks there were at least six transmission chains in Canada; 400 people became seriously ill, 25,000 were placed in quarantine and 44 died.

In late February the Centers for Disease Control -- the US organisation that monitors and responds to emerging health threats -- and the World Health Organisation (WHO) began to investigate. However, scientists were working in the dark; they knew only that the disease was highly contagious, that it made those who contracted it become severely ill and that dozens of people had died (later -- following an admission from the Chinese government -- it would emerge that the number of deaths was in the hundreds). There was no medication -- treatment was limited to administering steroids to reduce inflammation in the lungs.

On March 12, following the news that one of its top epidemiologists had died after contracting the disease in Hanoi, the WHO issued a global health alert for what it called Severe Acute Respiratory Syndrome (SARS). It was the first time the organisation had taken such a step. The microbe responsible for the disease still hadn't been identified, prompting an unparalleled coming together of global research facilities and laboratories to pool resources. A month later, a team at the Michael Smith Genome Sciences Centre in Vancouver, Canada, announced that it had decoded the virus's DNA. The good news was that the virus wasn't mutating -- its stability meant that it would be possible to develop a vaccine that could target the way in which its proteins latched on to human cells, although this would likely take years. Eventually, public health practices put in place across the world contained the virus.

The 2003 SARS epidemic infected 8,096 people worldwide, killing 744 of them. These are not big numbers compared to other pandemics -- smallpox, black death and flu have killed hundreds of millions since they emerged millennia ago, and the swine flu outbreak of 2009 infected up to 89 million -- but it offered a rapidly globalising world an insight into how quickly an outbreak of a killer disease can cross continents. The so-called Spanish flu pandemic that followed the first world war killed between 50 million to 100 million people. If there were a proportional outbreak today -- when the global population is over seven billion -- there could be upwards of 300 million deaths. SARS, although infectious, wasn't as virulent as first feared, but its effects were amplified by the way carriers moved across the world: there is no evidence that the Canadian woman who brought the disease to Toronto met the Chinese "super spreader" in Hong Kong. It is likely the virus spread through the air in a lift or via a point of contact such as a door handle. Such unfortunate encounters are now part of the modern world.

Source: http://www.wired.co.uk/magazine/archive/2014/05/features/pandemic-hunter

Edited June 2, 2014 by SoulMonster

[Redhead74]

Amazing. I always thought that these new viruses became so rampant because of the fact that not only were they so severe in symptoms but because no one has any defence over them. Common colds and flu have so many mutations that you can come into contact with someone that you can be resistant to if you have already been exposed to that particular strain, but when a virus is completely new, literally no one has any resistance to it. And if its aggressive you're gonna be goner.

The other thing I find fascinating is the fact that Liu Jianlun travelled to Hong Kong carrying the virus. Was there no reported cases of him passing the virus on by his means of travel? And the Canadian woman would have travelled by plane back to Canada by air, and anyone who's travelled by air knows that aeroplanes are like disease feeders, especially for airborne germs. Why was it not spread by the plane's air conditioning system to other passengers given the fact that the virus was virulent enough to travel through the air conditioning system to other guests? Maybe it was and it wasn't reported. Who knows?

I was in Singapore during the SARS outbreak and travelled quite a bit by air over that period. Yet I never came into contact with a single person that came down with the virus or knew anyone who knew anyone that contracted the virus. The surveillance was heavy duty though. Special detectors were erected at customs which monitored body temperature as you walked through it and anyone with a higher than normal temperature was detained until it was proven that SARS was not a possibility. I guess that is why Singapore never suffered the virus breaking its shores.

My greatest affect from SARS was that I had tickets to see David Gray and he cancelled the show due to the SARS outbreak (what a pussy) and the cancellation was advertised in the Chinese newspaper but as I didn't read the Chinese newspaper I didn't know it had been cancelled. I turned up on the night and wondered why no one else was there.

[SoulMonster]

You are right. Not having any immunity is what gets you sick and you acquire immunity from being exposed to viruses (in addition to the innate immunity we are born with). When you have been exposed to one type of virus, and acquired immunity against viruses of that particular structure, you probably won't get sick from that virus or similar viruses for quite some time. That's why relatively mild diseases wrecked such havoc in the New World when the first colonists arrived there in the 14th century. The poor natives had been separated from the Eurasian population of humans by at least 10.000 years and during those years new diseases had popped up in Eurasia, probably because of our domestication of animals, diseases which we had developed immunity against but to which the natives in America had no resistance.

I guess that Liu Jianlun didn't spread the virus when flying to Hong Kong because he had just recently been infected himself. Just after infection the total virus load in your body is very low, and hence you aren't really able to infect others effectively. By the time he came to Hong Kong the disease could have entered a stage where the viruses where replicating copiously and literally oozed from his body through phlegm, snot and coughing. But this is just guesswork from my side.

I also find the Poison King fascinating. What is it with him that mad him such a "super spreader"? Did he just have particularly bad hygiene, was the disease at the worst stage for contagion when he was travelled around, or was there something else going on with him and the disease that caused it to be so virulent?

If anyone else thinks this is interesting I can recommend the app game Plague Inc

Edited June 2, 2014 by SoulMonster

[Redhead74]

That's the caveat there. The fact that at the point in time when these people travelled they were not completely contagious yet but were already carriers. It's absolutely fascinating. I imagine that's also why airports were so intensely anal about the whole thing. If you had even a slight temperature you were detained until further tests could be done. That would have contained the virus significantly I think because I know that in Singapore alone a couple of people were prevented from entering and were hospitalised. By the sounds of things that would have been enough to spread the virus throughout the country.

It's equally fascinating the way the bubonic plague spread throughout medieval Europe and the fact that certain people who came into close contact with plague sufferers DID NOT contract the virus, yet others were bowled over and dead within days. It came down to the Delta 32 gene that only some people are born with. Anyone who had the Delta32 gene present were completely immune from the plague. Absolutely fascinating!

[SoulMonster]

That's why if you want to be a really famous bioterrorist you try to engineer a virus that has a very long incubation period but that when it really starts messing up your body it is near 100 % deadly. In nature you don't really find such viruses. Take Ebola as an example, it is very deadly but also has a short incubation period meaning that it usually dies out (read: kills off all susceptible hosts in an African village) before it succeeds at spreading further. The problem as seen from the entrepreneurial bioterrorist's perspective is that the effectiveness of which the virus spreads is directly correlated with it's pathogenicity - meaning that it is the viruses killing your cells which causes it to be both spread to new hosts but also kill you. So you need a virus that multiplies within the victim's body making it infective without the victim noticing it or at least not suspecting it is harbouring something that will lead to his death. Perhaps such a virus could work through stages where it at first masquerades as the common cold by attacking and destroying tissue in the throat, spreading through sneezing from people who go about their lives as normal thinking they only have a mild flu or something, but then the virus enters another stage where the sheer amount of viruses being released from the infected tissue allows it to infect some other part of your body, say lung tissue, causing a horrible deadly disease that kills quickly and effectively. It would have to be a fairly complex virus but I believe it could be done.

Uhm, if I am not logged on the next weeks I guess the NSA got me.

As for bubonic plague/black death. Recent studies have shown that CCR5-Δ32 did not give us any immunity as earlier believed, since Yersinia pestis (the bacterium which caused black death; and which was the subject for my wife's PhD dissertation) does not seem to interact with the corresponding CCR5 protein. CCR5 is a receptor protein found on the surface of white blood cells. But CCR5-Δ32 seems to confer some resistance to HIV infection (the HIV virus infects our white blood cells through interacting with the CRR5 protein; removing a part of the protein reduces the efficiency of this interaction causing some immunity to HIV). Unfortunately, CCR5-Δ32 causes increased of the West Nile Virus, so it is not all good.

[Axls Rocket Queen]

That's why if you want to be a really famous bioterrorist you try to engineer a virus that has a very long incubation period but that when it really starts messing up your body it is near 100 % deadly. In nature you don't really find such viruses.

Johne's disease in cattle. They typically don't show signs for 2-5 years so have plenty of time to spread the infection, and you can get asymptomatic carriers, but once clinical signs start it's invariably fatal.

I know that doesn't so much apply to bioterrorism, but still

[SoulMonster]

It could definitely be used as a model system to understand how to create a new and horrible virus. Or, if possible, be used as the chassis for a brand new synthetic human virus. Like so many other viruses that kills humans, and SARS being one of them, they at one time took the leap from livestock to humans (which also explains why many such novel viruses are so virulent - they are new to us and our immune systems after having just recently crossed the species barrier) - so a cattle virus could be a good starting point, specially when it has so promising - in lieu of a better word - properties. Come to think of it, HIV and AIDS are similar, too, in having a long period of being infectious before victims even know they are infected themselves, and for being non-human in origin (HIV coming from other primates), which sort of underlines the horror of diseases that are able to infect many other before you know you are infected and which are really deadly when the disease breaks out. Luckily, for AIDS we have treatment options.

Edited June 2, 2014 by SoulMonster

[Thin White Duke]

We are all gonna die.

[Axls Rocket Queen]

SoulMonster you scare me

Also Johne's is actually a bacterial disease caused by Mycobacterium avium paratuberculosis, not a virus [/pedantic]

[Dazey]

Amazing. I always thought that these new viruses became so rampant because of the fact that not only were they so severe in symptoms but because no one has any defence over them. Common colds and flu have so many mutations that you can come into contact with someone that you can be resistant to if you have already been exposed to that particular strain, but when a virus is completely new, literally no one has any resistance to it. And if its aggressive you're gonna be goner.

The other thing I find fascinating is the fact that Liu Jianlun travelled to Hong Kong carrying the virus. Was there no reported cases of him passing the virus on by his means of travel? And the Canadian woman would have travelled by plane back to Canada by air, and anyone who's travelled by air knows that aeroplanes are like disease feeders, especially for airborne germs. Why was it not spread by the plane's air conditioning system to other passengers given the fact that the virus was virulent enough to travel through the air conditioning system to other guests? Maybe it was and it wasn't reported. Who knows?

I was in Singapore during the SARS outbreak and travelled quite a bit by air over that period. Yet I never came into contact with a single person that came down with the virus or knew anyone who knew anyone that contracted the virus. The surveillance was heavy duty though. Special detectors were erected at customs which monitored body temperature as you walked through it and anyone with a higher than normal temperature was detained until it was proven that SARS was not a possibility. I guess that is why Singapore never suffered the virus breaking its shores.

My greatest affect from SARS was that I had tickets to see David Gray and he cancelled the show due to the SARS outbreak (what a pussy) and the cancellation was advertised in the Chinese newspaper but as I didn't read the Chinese newspaper I didn't know it had been cancelled. I turned up on the night and wondered why no one else was there.

I always wondered why Severe Acute Respiratory Syndrome wasn't just called Acute Respiratory Syndrome as the "Acute" element would surely imply that it was nothing trivial. I pondered this until I realised that the alternate acronym would've been ARS.

[Lithium]

Reminds me of the movie Contagion

[SoulMonster]

SoulMonster you scare me

Also Johne's is actually a bacterial disease caused by Mycobacterium avium paratuberculosis, not a virus [/pedantic]

Ah, but then it simply won't do! There are way too many antibacterials available to base a new agent of bioterrorism on bacteria, they are also much harder to disperse effectively. Viruses are the answer. Easier to engineer, easier to propagate and disperse in populations, and much, much harder to fight through medicine.

[Axls Rocket Queen]

SoulMonster you scare me

Also Johne's is actually a bacterial disease caused by Mycobacterium avium paratuberculosis, not a virus [/pedantic]

Ah, but then it simply won't do! There are way too many antibacterials available to base a new agent of bioterrorism on bacteria, they are also much harder to disperse effectively. Viruses are the answer. Easier to engineer, easier to propagate and disperse in populations, and much, much harder to fight through medicine.

You say that, anthrax is a bacterial disease and it's pretty damn scary (and hard to get rid of).

Plus, antibiotic resistance is an ever-increasing problem. If a resistant strain develops, usually easy-to-cure bacterial diseases can cause massive problems.

[downzy]

Interesting. But can we change the title of the thread to "Topics that depress the shit out of you."

[SoulMonster]

SoulMonster you scare me

Also Johne's is actually a bacterial disease caused by Mycobacterium avium paratuberculosis, not a virus [/pedantic]

Ah, but then it simply won't do! There are way too many antibacterials available to base a new agent of bioterrorism on bacteria, they are also much harder to disperse effectively. Viruses are the answer. Easier to engineer, easier to propagate and disperse in populations, and much, much harder to fight through medicine.

You say that, anthrax is a bacterial disease and it's pretty damn scary (and hard to get rid of).

Plus, antibiotic resistance is an ever-increasing problem. If a resistant strain develops, usually easy-to-cure bacterial diseases can cause massive problems.

It was a general point. Being living cells bacteria are much more susceptible to antibiotics (because there are many more molecular mechanisms that can be targeted by antibiotics). Not so much with viruses. Except for vaccines we barely have any medicines against viruses, and vaccines take a lot of time to develop and really isn't helpful when our industrious terrorists launches a novel virus upon the world. Antrax is an interesting case because it isn't contagious but since the cause of the disease, Bacillus anthracis, can exist in spore form you can easily transport the bacterium in its dormant spore stage and even release it rather easily through spray cans and the like.

But anthrax really is old-school bioterrorism. It's just soooo 1916. Any ambitious terrorist of today who really wanted high mortality rates would go for an bioengineered virus. Already in 2002 scientists demonstrated that "anyone" could synthesize Polio virus by simply ordering the virus genome form commercial DNA synthesis suppliers through online ordering (!), and naive scientists published recently the whole 1918 flu virus genome in public databases available to all scientists to study and learn from. Of course measures have been put in effect, or will be, to reduce the possibility of anyone with an account to order any DNA sequence they want, but such measures aren't efficient enough and will never be able to stop everyone from synthesizing and compiling genomes of extremely scary viruses (e.g. you can order the genome in pieces from various suppliers). The CDC (Centre for Disease Control) in Atlanta, USA, doesn't even have DNA sequences on their lists of select agents which they monitor and control (the lists contain 24 viruses, 12 bacteria, 12 toxins and two fungi (as of 2008 when I did a talk on bioterrorism)), so it really is easy to get started!

Still can't get over being dubbed "the Poison King". If this doesn't inspire at least a dozen thrillers then something is wrong with today's authors.

[Ace Nova]

Interesting. But can we change the title of the thread to "Topics that depress the shit out of you."

Yeah...I was wondering what the title was about....I guess it's because you live in Toronto?

[downzy]

Interesting. But can we change the title of the thread to "Topics that depress the shit out of you."

Yeah...I was wondering what the title was about....I guess it's because you live in Toronto?

To be a bit of an asshole about it, SARS only directly affected me by way of a kick ass concert. "SARSfest," or whatever they called it, was a pretty awesome music festival that resulted from the outbreak. Seeing AC/DC and the Rolling Stones in one concert with a half million other people was a lot of fun.

[wasted]

I thought this was going to be about the lack of love for generic police procedurals.

It's like what if HIV was transmitted via the Internet? Then we be fucked.

[Rovim]

SoulMonster you scare me

Also Johne's is actually a bacterial disease caused by Mycobacterium avium paratuberculosis, not a virus [/pedantic]

Ah, but then it simply won't do! There are way too many antibacterials available to base a new agent of bioterrorism on bacteria, they are also much harder to disperse effectively. Viruses are the answer. Easier to engineer, easier to propagate and disperse in populations, and much, much harder to fight through medicine.

You say that, anthrax is a bacterial disease and it's pretty damn scary (and hard to get rid of).

Plus, antibiotic resistance is an ever-increasing problem. If a resistant strain develops, usually easy-to-cure bacterial diseases can cause massive problems.

It was a general point. Being living cells bacteria are much more susceptible to antibiotics (because there are many more molecular mechanisms that can be targeted by antibiotics). Not so much with viruses. Except for vaccines we barely have any medicines against viruses, and vaccines take a lot of time to develop and really isn't helpful when our industrious terrorists launches a novel virus upon the world. Antrax is an interesting case because it isn't contagious but since the cause of the disease, Bacillus anthracis, can exist in spore form you can easily transport the bacterium in its dormant spore stage and even release it rather easily through spray cans and the like.

But anthrax really is old-school bioterrorism. It's just soooo 1916. Any ambitious terrorist of today who really wanted high mortality rates would go for an bioengineered virus. Already in 2002 scientists demonstrated that "anyone" could synthesize Polio virus by simply ordering the virus genome form commercial DNA synthesis suppliers through online ordering (!), and naive scientists published recently the whole 1918 flu virus genome in public databases available to all scientists to study and learn from. Of course measures have been put in effect, or will be, to reduce the possibility of anyone with an account to order any DNA sequence they want, but such measures aren't efficient enough and will never be able to stop everyone from synthesizing and compiling genomes of extremely scary viruses (e.g. you can order the genome in pieces from various suppliers). The CDC (Centre for Disease Control) in Atlanta, USA, doesn't even have DNA sequences on their lists of select agents which they monitor and control (the lists contain 24 viruses, 12 bacteria, 12 toxins and two fungi (as of 2008 when I did a talk on bioterrorism)), so it really is easy to get started!

Still can't get over being dubbed "the Poison King". If this doesn't inspire at least a dozen thrillers then something is wrong with today's authors.

Are there forums for people like you? You know, pretend up and coming terrorists.

[downzy]

LOL, just noticed the change in title thread.

[Ace Nova]

LOL, just noticed the change in title thread.

That's what I was referring to.

[AxlisOld]

I thought this was going to be about the lack of love for generic police procedurals.

It's like what if HIV was transmitted via the Internet? Then we be fucked.

Or what if spiders could fly?