SARS and the Government....

Lemming

Originally posted by hallelujajordan
There is no rational for believing this might ever occur ! The NDSC is in place and will be able to deal with an early stage outbreak quite effectively. We have seen countries with a much less sophisticated health-care system than us gain very early control of this condition (eg Vietnam) . . .

Given how the health-care system reacted to *possible* anthrax cases, I am not instilled with confidence. Given how the system reacted to a *possible* case of SARS was even less so since it is far more recent.

So it's not irrational to consider the possibility, however far away it may seem. With the special olympics being hosted here, the chances of infection are higher, given that there will be high concentrations of country 'X' resprentatives in a specific area. Lets be clear here .. I am not screaming "OH my god we're gonna die". What I am saying is that you're being a little too complacent about the threat.

Why ? ? There are no medical countermeasures for SARS. . . no vaccine / no treatment ...... so why do you believe that 12 mutations is worrying ? Its already pretty virulent and is unlikely to mutate and become more so . . . . the frequency of the mutations seen to date are more to do with its instability than anything else . . .

I'm not referring to treatment. I am referring to the fact that the virus is mutating so soon after becoming known. Thus far the mortality rate is rather low, but the virus is refinining itself. I'm not looking at the here and now. I'm looking at the potential future .

We do not need to spend money getting ready to cope with something that will not happen.

SO you're a world expert and clairvoyant to boot eh? :rolleyes:

Prudence with such a phenomenon is not a bad thing, rather than this blaise attitude.

Put it this way. I've friends in Donegal, one of which has two little children (about 2 years of age) with Cystic Fibrosis. Needless to say, ANY infection and they are f*cked. Can you tell him that he's no need to be concerned about the welfare of his children given the last 2/3 years "performance" of our illustrious health-service?

hallelujajordan

Originally posted by Lemming

I'm not referring to treatment. I am referring to the fact that the virus is mutating so soon after becoming known. Thus far the mortality rate is rather low, but the virus is refinining itself. I'm not looking at the here and now. I'm looking at the potential future .

SO you're a world expert and clairvoyant to boot eh? :rolleyes:

This is quite simply not true and it is this kind of information in the press that is causing this panic. The fact that they have found genetic variants of the virus that they believe causes SARS does not mean that it is mutating to refine itself. . . . it means it is an unstable virus and hey thats what they do !! The capacity for this to mutate is only relevant if there is a vaccine or a treatment that the mutation would render less efficient and we are not likely to have such treatments for a very long time. (We're also conveniently ignoring the fact that this coronavirus has been identified in less than 60% of SARS cases - In fact, in the one suspect case that Ireland has had, this virus was not detected)

I am neither world expert or clairvoyant but I am a microbiologist . . . I have worked in the past with dangerous pathogens and I understand the epidemiology of infectious disease and I can assure you that this country is plenty prepared to deal with SARS . . . If you want any better that what we currently have you need to answer the question posed by skyeirl . . ie. where do we draw the line. . . should we be ready to cope with ebola, plague, anthrax, smallpox, vaccinia. . . . the list goes on, there are many diseases out there that you wont have even heard of that "could" under very unlikely circumstances enter Ireland . . . should we have the proper measures to deal with each of these ?

I've friends in Donegal, one of which has two little children (about 2 years of age) with Cystic Fibrosis. Needless to say, ANY infection and they are f*cked. Can you tell him that he's no need to be concerned about the welfare of his children given the last 2/3 years "performance" of our illustrious health-service?

With respect, these children are more likely to be infected with a common cold / respiratory virus than a disease that so far has travelled only very minimally outside of Asia...
And you have actually hit the nail on the head . . . we need a healthcare system that can more adequately and efficiently deal with the likes of your friends kids and my dad and we won't even get close to that if we keep putting pressure on Micheal Martin to react to whatever happens to be in the news that day. . .

Sparks

Oh for pity's sake.
Look, here's the situation, according to the prevalant news sources. SARS isn't well-understood. The WHO is saying the mortality rate is rising (the press release I read said they were now saying 10%) and other quoted medical experts are warning that they're underestimating. Because of the nature of people, we're worried. Understand that word - worried. Not screaming with panic, worried. The media is playing on our fears? Of bloody course they are. The job of the health boards includes countering this! Dammit, if someone had stood up and countered what the right-wing idiots running sky news and it's peers have been screaming for ages, we wouldn't have those twats at clonmel cancelling their hosting of the Special Olympics team from Hong Kong.
You can happily sit there as much as you want and say it's all our fault for listening to the media - the facts won't change. One of the responsibilities of the health system is to keep the general public informed as to the nature of the threat, it's seriousness and preventative and diagnositic measures. That shouldn't have been left to the idiots running most of the TV and print media.

Secondly, if the NDSC is working so well, where are all of the reports coming from on people not notifying the correct people in relation to different cases? The legionaires case for example - why wait until it's confirmed before picking up the phone? The point (unless I don't understand this at all) of the ndsc is to monitor on a national level to spot potential epidemics and to nip them in the bud - which would require notification as early as possible, even if that risks false alarms. And if I'm wrong on this - again, where are the ndsc representatives pointing out why?

Thirdly, I'd be quite worried if we didn't have the means to deal with a large number of nasty bugs showing up on our shores.

Fourthly, I doubt you'll find many people that don't think that the health system is in a mess and needs fixing - saying that they're yelling at MM about different things every week is ignoring what they've been yelling for the last few years.

GuanYin

Originally posted by Sparks
The job of the health boards includes countering this!
<snip>
One of the responsibilities of the health system is to keep the general public informed as to the nature of the threat, it's seriousness and preventative and diagnositic measures. That shouldn't have been left to the idiots running most of the TV and print media.

*sigh*

Yes, and there have been public health doctors and officials on TV every night this week saying that there is no need to be worried.
They have been trying but until they get their own tabloid, its never going to be half as effective.
Unfortunately its probably drowned out by the rest of the stuff so you seem to have missed it.

Originally posted by Sparks
Secondly, if the NDSC is working so well, where are all of the reports coming from on people not notifying the correct people in relation to different cases? The legionaires case for example - why wait until it's confirmed before picking up the phone? The point (unless I don't understand this at all) of the ndsc is to monitor on a national level to spot potential epidemics and to nip them in the bud - which would require notification as early as possible, even if that risks false alarms. And if I'm wrong on this - again, where are the ndsc representatives pointing out why?
[/B]

Ok in your ideal scenario, if I see a patient and I scream "disease X" when I get a suspected case, the NDSC comes running and the press go mad. Everyone sits around while the tests (which still have to be done to confirm the case) are carried out and then after there has been worry we find out if the diagnosis is right.

No infection is stopped. The patient isn't going anywhere, anyone infected is still infected and an epidemiologist can't go looking for a disease if he/she doesn't know what it is exactly.

If it turns out to be a false alarm, alot of time and money is wasted, a public worry is started for nothing, the doctor looks publically very silly and the patients privacy is invaded.

Its just common sense to confirm a diagnosis before treatment. Its a quite common thing that doctors do, just in case they accidently tell you you have a heart condition instead of say, heartburn.

Originally posted by Sparks
Thirdly, I'd be quite worried if we didn't have the means to deal with a large number of nasty bugs showing up on our shores.
[/B]

And there are protocols. Which are probably being covered quite efficiently. Look at the CDC or WHO website on SARS and I guarentee you they say keep a suspected case in isolation, but won't say in a hospital.

Originally posted by Sparks
Fourthly, I doubt you'll find many people that don't think that the health system is in a mess and needs fixing - saying that they're yelling at MM about different things every week is ignoring what they've been yelling for the last few years. [/B]

I think the Irish Health System is a very bad joke. But I see problems in practical every day areas like lack of equipment, staff and even actual hospitals. I don't see problems because the public health workers aren't being drawn into hunting the bogeyman.

I think I'll take a leaf from bugs book and agree to differ. Personally I think the soundbytes I have heard on primetime television and radio has been more than adequate and that the irrational reactions are due to people believing what they want to believe...the worst case scenario.

hallelujajordan

Originally posted by Sparks

Secondly, if the NDSC is working so well, where are all of the reports coming from on people not notifying the correct people in relation to different cases? The legionaires case for example - why wait until it's confirmed before picking up the phone? The point (unless I don't understand this at all) of the ndsc is to monitor on a national level to spot potential epidemics and to nip them in the bud - which would require notification as early as possible, even if that risks false alarms. And if I'm wrong on this - again, where are the ndsc representatives pointing out why?

How well or not the NDSC is working should be judged on epidemiological evidence and not on irrational hysteria. The legionnaires disease case was dealt with appropriately and in accordance with protocol. The simple fact is that until they had identified the organism in question there was nothing to report. It seems that if you had your way every infectious disease would be considered reportable before a diagnosis had been made, we would have many people in quarantine every day. . . a health system that would crash completely with the cost of this and a public that is frightened to go outside the door.


Also, can you link to the WHO report that says that the SARS mortality rate is rising because I cannot find such information . . .

Sparks

Yes, and there have been public health doctors and officials on TV every night this week saying that there is no need to be worried.
They have been trying but until they get their own tabloid, its never going to be half as effective.
Unfortunately its probably drowned out by the rest of the stuff so you seem to have missed it.

I've seen Martin saying all is well, and one or two other mandarins, but no doctors. (You'll have to forgive me for not trusting a politician's word, I'm Irish). I guess you're right, it's been drowned out - so it's about time whoever handles the public education in the health department stepped their game up a bit.

Ok in your ideal scenario, if I see a patient and I scream "disease X" when I get a suspected case, the NDSC comes running and the press go mad.

No, that's not what I said. My ideal scenario is noone gets sick.
Next-best is someone comes in, gets diagnosed as possibly having contagious disease X. Patient is isolated, doctor calls the ndsc and says "I have patient john doe, suspected disease X, here's the medical information, tests are due back tuesday from such-and-such a lab." NDSC says thanks very much, takes note of the case and checks back later (or doctor calls back with a progress report). If confirmed and it's serious enough, the media are used to inform the public. If significant numbers of suspect cases turn up, that step is taken prior to confirmation, with the advisory that it's unconfirmed. In case of epidemics, preprinted leaflets on the disease, symptoms and contact details and so on are distributed to the population. Spokepersons are made available to every news station for every program.

the patients privacy is invaded.

Anyone here know the names of any suspected SARS case? I've not heard of any. And besides, in cases of public health concerns with contagious diseases, patient privacy gets modified. For example, if you get influenza, you are required to inform your library of the fact so they can destroy books you have out on loan at the time. Where's your privacy there?

It's just common sense to confirm a diagnosis before treatment. Its a quite common thing that doctors do, just in case they accidently tell you you have a heart condition instead of say, heartburn.

It's actually common sense to take preventative measures for the worst-case scenario prior to confirmation to give the patient the best chance. If someone may have had a heart attack, they're not generally given an packet of Tums and sent home...

HJ,

How well or not the NDSC is working should be judged on epidemiological evidence and not on irrational hysteria.

In other words, wait till the **** hits the fan and something really nasty shows up - and in the meantime pay no attention to reports in the national news about poor and nonexistant communication between hospitals and the NDSC?

Also, can you link to the WHO report that says that the SARS mortality rate is rising because I cannot find such information . . .

Here are the general news reports...
And here's the report that confused me - Prof.Anderson in Imperial stated that the WHO figures indicated a 10% mortality rate...

GuanYin

Originally posted by Sparks
I've seen Martin saying all is well, and one or two other mandarins, but no doctors. (You'll have to forgive me for not trusting a politician's word, I'm Irish). I guess you're right, it's been drowned out - so it's about time whoever handles the public education in the health department stepped their game up a bit.

The information is there I think its being overlooked and ignored... you seem to have done it yourself. I was amused to see the link you posted quoting Prof. Anderson :

"This is not a highly transmissible infection," he said.

"It's been effectively contained in most of the developed countries in the world with a very limited number of cases, Britain being a good example."

He added that the world has a "long way to go" before it learns how
to clinically better manage the disease.

However, he said that some of the "doom and gloom predictions" about the spread of the disease had been exaggerated


This has been the message the government, doctors and hospitals have been giving over the past few weeks. People are ignoring them or argueing against them (as you are now) and I am beginning to think that most people, like yourself, will believe what they want, despite how little they know about the facts of the issue.

Originally posted by Sparks

Next-best is someone comes in, gets diagnosed as possibly having contagious disease X. Patient is isolated, doctor calls the ndsc and says "I have patient john doe, suspected disease X, here's the medical information, tests are due back tuesday from such-and-such a lab." NDSC says thanks very much, takes note of the case and checks back later (or doctor calls back with a progress report).

Generally the NDSC get the call after the labs have confirmed the test and respond immediately. Exactly what the difference you think this effect will be is is beyond me.

Originally posted by Sparks

If confirmed and it's serious enough, the media are used to inform the public.

Please god, no!

Originally posted by Sparks

Anyone here know the names of any suspected SARS case?

In Ireland? I know one suspected.

I've not heard of any. And besides, in cases of public health concerns with contagious diseases,

Originally posted by Sparks

It's actually common sense to take preventative measures for the worst-case scenario prior to confirmation to give the patient the best chance.

What difference will it make. All hospitals are well versed on SARS. There is noone at the NDSC that knows more than the people already at the hospital. I think you really should read up on epidemiology and come back before you start giving opinions on how the NDSC should run.


You know in general, you seem to be missing the point. I'll leave you with a quote from the wonderful gospel for news that you love: The Internet, and indeed your own link:

"It's been effectively contained in most of the developed countries in the world with a very limited number of cases, Britain being a good example."

There is no major risk.

Sparks

Thanks so much for the patronising slapdown there syke, nice to know that the health service has the same approach to the public's wellbeing as the US has to the wellbeing of the iraqis :rolleyes:

There is no major risk.

From SARS?
Yes. I know. Been reading my posts have you?

From the health system?
"Where did all those fcuking indians come from?"

GuanYin

If you think that repeatedly disagreeing with you because I feel you're points are inaccurate a slapdown, I'm sorry, I don't intend to patronise but really the internet and news reports you are sourcing are the root of the problem in your arguements.

I am not the health service, I work in public health, yes, but I can have an opinion on a public forum that is attributed to me and me alone, thank you.

I agree with you on the state of the health service, I made that clear early one. However your choice of SARS as the soapbox to make your arguements is a very bad one.

I'm not irish myself, so I take offence to that last remark.

mike65

Originally posted by hallelujajordan
The legionnaires disease case was dealt with appropriately and in accordance with protocol. The simple fact is that until they had identified the organism in question there was nothing to report.

Legionnaries disease is notifiable by law but the case in Waterford was'nt disclosed for a week.

Mike.

Sparks

syke,
That last remark wasn't a racist comment - it's an old joke, namely "What were Custer's last words?". It was used in this context to mean that saying there is no major risk with regard to the health system's capabilities is to display a lack of situational awareness similar to Custer's.

And SARS isn't a soapbox, it's an issue that's worrying people because of a lack of responsible media, accurate information and a poor presence in the media by the health system.

And it's not the repeated disagreements that are a slapdown, it's this sort of thing:

Until I see it in a memo at work I don't believe it. Where are your reports from? CNN? Sky News?
Gimme a break!

You don't really understand the nature of disease do you?

If confirmed and it's serious enough, the media are used to inform the public.

Please god, no!

And the biggie :

most people, like yourself, will believe what they want, despite how little they know about the facts of the issue.

That's the biggie because the response of questioning or arguing with doctors is a learned response, brought about by personal experience in most cases. Besides, when you are dealing with the health of other people, you can't simply dismiss their concerns with a wave of the back of your hand. Exactly which part of the health service do you work in to say that you don't know this?

ps. Just seen in the Irish Times that there is now an inquiry into the communication with the NDSC over the legionaires question.

bonkey

Originally posted by Sparks
And SARS isn't a soapbox, it's an issue that's worrying people because of a lack of responsible media, accurate information and a poor presence in the media by the health system.

And it's not the repeated disagreements that are a slapdown, it's this sort of thing:

First of all, I agree 100% with the claims of irresponsible media. No question. If more people realised how irresponsible the media are, there would be less of a problem. Some years ago, my mum got very very irate when I gave out to her for trying to tell me that if I got a headache, or just felt under the weather, I should take myself immediately in to an emergency room in a hospital to get urgently checked for something-or-other....which she had heard an expert on the Joe Duffy show say was the best course of action.

She couldnt understand what I was driving at when I pointed out that there are more people in Ireland who feel "under the weather" or have a headache every day than there are hospital beds...and this muppet was encouraging every single one of those people to descend on the hospitals. He even apaprently said "do not go to your GP. He cant tell you if you have this or not. Go directly and immediately to the hospital".

However....you go on to say that there is poor information available. I agree - there is, because so little is known. Every "pronouncement" we've had has been challenged and superceded within days. First it was a multi-vector virus, then it wasnt. Then it was "just" a coronavirus, now it mightnt be. It was highly deadly, then it wasnt, now it might be again.....

However, you then go on to criticse the health service for not taking part in this media circus. Exactly what do you want them to say? That they havent got a clue? That they will tell you to do X, but be aware that they may tell you tomorrow not just to stop doing X, but that its the worst possible thing you could be doing according to the latest findings?

I mean seriously....while I fully agree with the general idea that the Health Service needs a good beating with a large stick, this is the wrong stick from my perspective.
If anyone disagrees, then I challenge them to tell us what the health service should be saying in the media....because if anyone can figure out the message they should be sending that would have been consistent from the start and in any way beneficial, I'm sure companies will line up around the block to offer you large amounts of money to join their PR departments.

jc

Sparks

bonkey,
The media is irresponsible - which is why the health system should have a seriously heavy presence there, to counteract stupid, pointless or panic-causing information, to answer questions from non-medical people. They may not be able to say what the precise genetic makeup of the virus is, but they can tell you the symptoms, whether anyone's developed these symptoms in the country, what precautions are being taken and so on. If it was necessary to wait until all of the details were fully confirmed and well-known before announcing something, we'd never hear about new strains of influenza until half the country was sick.

GuanYin

Originally posted by Sparks

And SARS isn't a soapbox, it's an issue that's worrying people because of a lack of responsible media, accurate information and a poor presence in the media by the health system.

Well I just disagree. I think there is sufficient information out there. I've heard all the correct soundings from the right people, its just the hype is louder.

Originally posted by Sparks

That's the biggie because the response of questioning or arguing with doctors is a learned response, brought about by personal experience in most cases. Besides, when you are dealing with the health of other people, you can't simply dismiss their concerns with a wave of the back of your hand. Exactly which part of the health service do you work in to say that you don't know this?

I don't dismiss the concersn of anyone. However I am allowed to have an opinion. How I feel about people and how I treat people are two different things. This isn't a hospital, this isn't a clinic, its a BBS and I think th e whole point is opinions.

People arguing or questioning personal diagnosis is one thing. But people causing mass hype over something they read second hand is another.

And I'm sorry, but you don't live in utopian society and until you can get robots to work as clinicians, you will get doctors, nurses and others looking at disdain at the amount of idiotic self-diagnosis people still come in with. Its not to say you express that to these people, but jesus here I'll tell you exactly what I think.

What I think is, (for the millionth time). The SARS problem is only a problem due to the media portrayal. If Ebola stories started tomorrow in the same light, there would be front page stories on every paper saying we have a plasma shortage in this country etc etc. and people would panic and we'd be having this thread about Ebola.

Originally posted by Sparks

ps. Just seen in the Irish Times that there is now an inquiry into the communication with the NDSC over the legionaires question.

I think they'll find it made no difference. I also bet it was initiated by a press hounded politician somewhere.

GuanYin

Originally posted by Sparks
bonkey,
The media is irresponsible - which is why the health system should have a seriously heavy presence there, to counteract stupid, pointless or panic-causing information, to answer questions from non-medical people. They may not be able to say what the precise genetic makeup of the virus is, but they can tell you the symptoms, whether anyone's developed these symptoms in the country, what precautions are being taken and so on. If it was necessary to wait until all of the details were fully confirmed and well-known before announcing something, we'd never hear about new strains of influenza until half the country was sick.

Or we can harrass the media into responsible reporting rather than spend money from the already inadequate health budget which will ultimately mean that some hospital will eventually not be able to offer the required treatment to save someones life.

You are suggesting spending money using the time of people who are already thinly stretched, when the problem isn't with them to begin with.

hallelujajordan

Originally posted by sykeirl


I think they'll find it made no difference. I also bet it was initiated by a press hounded politician somewhere.

This is EXACTLY the problem .. .. . Public / Media hound the poiticians because they believe that there is a threat that we are not ready for. Politians are forced into diverting funds to "be ready" to deal with this non-existent threat. This diverted money has to come from the health budget so someone else suffers! Meanwhile, nobody is paying any notice to what the epidemiologists are saying. It's just not a sensible way to manage disease surveillance.......

Sparks

HJ,
That is an excellent summation of the problem - but the solution is to overcome the hype that skye and yourself bemoan through better public relations. It's not an easy job, but it's exceptionally necessary. And this issue is demonstrating why. If education is left out of the response to such a disease, then people will panic due to a lack of information.

We spend 9 billion euro a year on the health service - that's a quarter of the total government spending annually. I'd love to know how that figure can be inadaquate. Organisational reform seems deperately necessary.

hallelujajordan

Originally posted by Sparks


We spend 9 billion euro a year on the health service - that's a quarter of the total government spending annually. I'd love to know how that figure can be inadaquate. Organisational reform seems deperately necessary.

Agreed !