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Modeling Lessons Learned from the SARS Outbreak

Modeling Lessons Learned from the SARS Outbreak. Paul A. Dreyer Jr., Ph.D. Associate Mathematician RAND. Outline. Brief Introduction to SARS Lessons Learned Quarantines Differing Control Measures Communication Hoaxes Conclusions. Introduction to Severe Acute Respiratory Syndrome (SARS).

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Modeling Lessons Learned from the SARS Outbreak

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  1. Modeling Lessons Learned from the SARS Outbreak Paul A. Dreyer Jr., Ph.D. Associate Mathematician RAND

  2. Outline • Brief Introduction to SARS • Lessons Learned • Quarantines • Differing Control Measures • Communication • Hoaxes • Conclusions

  3. Introduction to Severe Acute Respiratory Syndrome (SARS) • Symptoms • Initially, high fever and chills, body aches • After 2-7 days, dry coughing (along with possible oxygen depletion of blood) • Incubation period up to 14 days • Fatality rate about 10 percent (as of 4/25) • Treatment • CDC recommends treatment for pneumonia • Still working on vaccine, determining vectors (transmission by ‘close contact’) • SARS coronavirus identified, sequenced

  4. Lessons Learned: Quarantines • Quarantines seem to be effective, provided people actually quarantine themselves • Individual refusals to quarantine in Toronto • Concerns about stigmatization lead to concealment of illness • Lack of notification to quarantine • Taiwan: Personal attendants for inpatient care may have spread disease

  5. “Ideal” Quarantine Method Contact w/SARS Infected Person Healthy Person Symptoms? Notification Of Possible Contact No Yes Treatment and Notification Yes Symptoms? Quarantine Until Contact + 10 Days No

  6. “Realistic” Quarantine Issues Contact w/SARS Infected Person Healthy Person Symptoms? Notification Of Possible Contact No Yes Problems: - Misdiagnosis - Non-reporting Treatment and Notification Yes Symptoms? Quarantine Until Contact + 10 Days No

  7. “Realistic” Quarantine Issues Contact w/SARS Infected Person Problem: 100% coverage of all contacts difficult Healthy Person Symptoms? Notification Of Possible Contact No Yes Treatment and Notification Yes Symptoms? Quarantine Until Contact + 10 Days No

  8. “Realistic” Quarantine Issues Contact w/SARS Infected Person Healthy Person Symptoms? Notification Of Possible Contact No Yes Treatment and Notification Problem: Refusal To Quarantine Yes Symptoms? Quarantine Until Contact + 10 Days No

  9. Lessons Learned: Differing Control Measures

  10. Lessons Learned: Differing Control Measures • United States • No limitations on travel (travel advisories by CDC) • CDC activated its Emergency Operations Center • CDC recommends isolation of SARS-infected individuals • Basic infection control procedures at hospitals • CDC distributing health alert cards to passengers • returning from travel in infected regions

  11. Lessons Learned: Differing Control Measures • Canada • Hospital and school closings • Checks at airport of incoming passengers • Quarantines of health care workers

  12. Lessons Learned: Differing Control Measures • Singapore • $10k fines and jail for breaking quarantine • Illegal to mislead officials about travel history • Health Ministry can: • Quarantine any building • Destroy any materials suspected to be • sources of infection

  13. Lessons Learned: Differing Control Measures • Taiwan • 10 day quarantines of all incoming passengers • from SARS-infected areas (+ masks on flights) • Widespread education of healthcare workers • Full protective clothing for healthcare workers • (including disposable 2nd layer of clothing) • Active surveillance of exposed healthcare workers • and contacts of patients (+ quarantines)

  14. Lessons Learned: Differing Control Measures • Control measures vary from minor (US) to highly restrictive (Taiwan, Singapore, China) • Differing control measures should be reflected in any modeling of global epidemics

  15. Lessons Learned: Communication • Communication methods are imperfect • Not everyone receives notifications • Not everyone believes the notifications • However, new methods are developing • Hong Kong hoax • 6 million SMS messages sent to cell phones • Location-based SARS updates via cell phone • Real-time updated websites of SARS information • SARS helpline also used for case detection

  16. Lessons Learned: Hoaxes • Hong Kong hoaxes • Los Angeles airplane scare • Hoaxes (or misinformation) cause: • misallocation of resources • increased fear/confusion in populace • possible health risks (smallpox)

  17. Conclusions • Epidemiological models should: • Incorporate realistic quarantine models • Acknowledge differing (and possibly conflicting) control systems across nations • Consider imperfect information gathering as well as new communication methods

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