modeling lessons learned from the sars outbreak
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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). - PowerPoint PPT PresentationTRANSCRIPT
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Modeling Lessons Learned from the SARS Outbreak
Paul A. Dreyer Jr., Ph.D.Associate Mathematician
RAND
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Outline Brief Introduction to SARS Lessons Learned
Quarantines Differing Control Measures Communication Hoaxes
Conclusions
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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
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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
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“Ideal” Quarantine Method
HealthyPerson
Contact w/SARSInfected Person
Quarantine Until Contact + 10 Days
Treatmentand Notification
NotificationOf Possible Contact
Symptoms?
Symptoms?
Yes
Yes
No
No
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“Realistic” Quarantine Issues
HealthyPerson
Contact w/SARSInfected Person
Quarantine Until Contact + 10 Days
Treatmentand Notification
NotificationOf Possible Contact
Symptoms?
Symptoms?
Yes
Yes
No
No
Problems:- Misdiagnosis- Non-reporting
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“Realistic” Quarantine Issues
HealthyPerson
Contact w/SARSInfected Person
Quarantine Until Contact + 10 Days
Treatmentand Notification
NotificationOf Possible Contact
Symptoms?
Symptoms?
Yes
Yes
No
No
Problem: 100% coverageof all contacts difficult
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“Realistic” Quarantine Issues
HealthyPerson
Contact w/SARSInfected Person
Quarantine Until Contact + 10 Days
Treatmentand Notification
NotificationOf Possible Contact
Symptoms?
Symptoms?
Yes
Yes
No
No
Problem: Refusal To Quarantine
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Lessons Learned: Differing Control Measures
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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
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Lessons Learned: Differing Control Measures
Canada- Hospital and school closings- Checks at airport of incoming passengers- Quarantines of health care workers
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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 besources of infection
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Lessons Learned: Differing Control Measures
Taiwan- 10 day quarantines of all incoming passengersfrom 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)
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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
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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
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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)
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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