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medpundit |
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Thursday, April 24, 2003In spinning through some of the stats I see on SARS, the one thing I keep seeing (but about which I may be very wrong) is that the vast majority of deaths seem to be occurring in countries with socialized medicine. In fact, the bulk of the cases are occurring (at least for now) in countries with socialized medicine. I don’t recall anybody making that connection (but then, I may not be looking in the right places) and have to wonder. Funny thing, I commented on just the same thing to my husband yesterday at breakfast, and was on the verge of blogging the thought when I had reservations. After all, Hong Kong is a hotbed of capitalism. Surely, they don’t have socialized medicine, do they? Well, if a second person had the same thought, it’s worth looking into. So, with the help of Google, I learned that Hong Kong has a dual system - 90% socialized, 10% privatized. Judging from this analysis the socialized portion is quite popular: The fees of public hospitals per bed day are cheap. The emergency service is free of charge, attracting many non-emergency patients in the evenings and on public holidays. The almost free-of-charge public hospital services provide few incentives for radical reform, apart from the expectations for continued improvements. Of the others among the top four SARS nations, Canada has a socialized system. China, of course, has a socialized system. Singapore, like Hong Kong, has a hybrid system: 80% of the primary healthcare services is provided by the private practitioners while the government polyclinics provide the remaining 20%. For the more costly hospital care, it is the reverse situation with 80% of the hospital care being provided by the public sector and the remaining 20% by the private sector. Hmmm. Seems to be a definite trend. However, China, Hong Kong, Canada, and Singapore also had the disadvantage of having SARS before it was recognized as a highly contagious new illness. The rest of the world had the advantage of their unfortunate experience. As a result, subsequently infected countries have been able to initiate infection control and quarantine measures as soon as a case was suspected, making it less likely to spread among the general population. Another reader brought up two very good questions regarding the infection: (1) Is it possible, or could it be theoretically possible to catch SARS more than once? (Or is it like Chicken Pox?) Answer: We don’t know yet, and aren’t likely to know until it’s been around for a year or two more. (2) Is it possible, and what is the current thinking of the medical community, on whether or not people can be contagious prior to exhibiting symptoms of SARS? It does appear that people can be contagious before exhibiting symptoms. That may be one reason that it has spread so easily. Again, it’ll take more time and more cases to know exactly when someone becomes contagious, and for how long communicability lasts after infection. So much remains to be learned - and observed. And from another reader, a link (subscription required) to a Wall Stree Journal article that suggests the mortality rate for SARS may, indeed be higher than stated: The World Health Organization maintains that the mortality rate for severe acute respiratory syndrome is currently about 5.6%. That figure, often cited by public health officials and the media, represents the number of known SARS-related deaths divided by the number of probable cases world-wide. But some medical officials believe the real mortality rate may be 10.4%, or nearly twice as high. That's because in its calculation, the WHO includes not just known cases of recovery from the disease but also patients who remain hospitalized -- in other words, people who may yet die. A more accurate method of calculating the mortality rate for a disease, some disease experts say, is to use only known outcomes: divide the number of deaths by the number of recoveries plus deaths. That excludes sick SARS patients whose fate is still unknown, as well as those who are listed as "suspected" cases but may not have SARS at all. Using that method backs up the contention that SARS is worse in countries with socialized medicine: Calculating the mortality rate using only deaths and recoveries, the death rate for Hong Kong is currently 17.7%, according to data posted Monday on the WHO Web site. Canada's is about 18.2%, and Singapore's is around 13.3%. No deaths have been reported in the U.S. Some outlying areas of China, Dr. Niman says, appear to have mortality rates of nearly 50%. Although in Canada, they’ve noticed a difference in mortality by age: In Canada, some doctors support calculating the mortality rate by deaths and recovering patients, and excluding those in early phases of the illness. Using those criteria, Canadian doctors estimate that the mortality rate is about 1% for patients under 50, and about 25% for patients over 65. And, they’ve noticed that the critical stage comes far into the illness: "This is a three-week illness," with many patients hitting the most critical period from days 11 to 16, says Allison McGeer, director of infection-control at Toronto's Mount Sinai Hospital. Some patients who become critically ill or eventually die of the illness don't seem all that sick at first. "We don't have any good markers at onset to tell us how serious a case is going to get," says Dr. McGeer, 50, who is now at home recovering after spending almost three weeks being treated in the hospital for the illness. The same reader sent along this Washington Times column that says China needs to feel the heat from the international community for endangering the world: The cover-ups have got to stop. No considerations of Chinese pride or special political circumstances can excuse this kind of behavior, which exposes the whole world to risk. Pressure should be brought on the Chinese government to guarantee that next time, everybody in the world hears about a new disease at the same time. How much pressure? As much as necessary. But how do you change someone's basic nature? China, like most totalitarian regimes, seems to encourage the elevation to power of people for whom lying comes easily. It's so entrenched, only a complete shake-up would change it. posted by Sydney on 4/24/2003 08:38:00 AM 0 comments 0 Comments: |
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