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Rapid Responses: Rapid Responses published:
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Odysseus syndrome or travel till you drop
- Alex Jablanczy, Sault Ste Marie Ontario CANADA (28 March 2003)
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Hygiene Hypothesis and SARS
- Arthur E Varner (29 March 2003)
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SARS: are immunised children protected?
- Meng-Kin Lim (5 April 2003)
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Sudden Atypical Raucous Suffocation? SARS
- Boghos L. Artinian (10 July 2003)
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Alex Jablanczy, MD private office, Sault Ste Marie Ontario CANADA
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Ebola virus West Nile virus Hanta virus HIV the result of unnecessary nonintegral meaningless travel mania. We can expect more of the same. I was overjoyed to hear the disused word quarantine reapplied albeit fragmentarily and inadequately in Toronto lately. It actually means forty days. Stet. The travel industry would collapse if all transcontinental travellers would have to spend 40 days in a closed ward or a football stadium a la Chile. Might be a bit chilly in Toronto however. Please read a brilliant article in the Smithsonian Journal of about a decade ago y-clept What is in a cubic foot of air. Apparently in the airplane it's saliva foodparticles shed cellular debris fecal particles urea ammonia dust cosmic particles to spider legs and insect feces whole insects rodent hair foam plastic carbon gasses O2 N2 of course CO CO2 perfumes deodorants droplets of water nitric acid formaldehyde sulphuric acid ozone of course aviation fuel. And since deregulation courtesy of Reagan and Thatcher instead of 10% stale air and 90% fresh, we inhale 90% recycled air with the above mentioned components concentrated and filtered and only 10%fresh air. Gesundheit. So one must consider the airplane a toxic pathogenic environment, more dangerous than a doctors office or an Emergency ward with a good supply of pathogenic mincrobes recirculated cultured concentrated to the level of infectiousness. Recall the concert cough that irritating idiotic spasmodic epidemic throat clearingand cough nearly all unnecessary and badly covered or smothered in handkerchiefs even in the best of circles or even among nurses and doctors. 3 billon droplets travelling at 300 MPH and infecteing everyone sussceptible. I read recently that Schopenhauer hated travel, good for him, all of a sudden he moved from among the least to the most favoured philosophers. Anybody who despises travellers whose only excuse is to tell their neighbours that they visited Mallorca to which the trump we only did Tibet and Mongolia during the famine it was lovely the yurts and all, we even took photographs. Brrr. Aaagh. Must have a head on his Schultern. The wonder is not that they bring back unusual microbes and flora and fauna, but that they dont cause more havoc death epidemics pandemics. I am not against reasonable educational occupational family religious etc travel but the horrendous unscientific unbiological unnecessary frivolous mass travel ought to be will be controlled, because we cannot afford to mix environments ecosystems exotic protists pathogens foolishly. The obvious cases are mammals and water borne molluscs zebra mussel to plants such as purple loosestrife. The intraspecies transmission of microbes and zoonoses swine flu BSE CJD anthrax all attest to the fact that naturam expellas furca tamen usque recurret, in vain you expel nature with a pitchfork it will nevertheless reconquer./ We cannot mix any biological entity willy nilly into foreign dystonic ecosystems, for it will cause havoc. The Hong Kong or Canton virus mutation or whatever it is was better left in Hong Kong; Toronto did not need it. As it is a major world hub of aviation the whole world will be rapidly infected. My suggestions. Except in extreme exceptional circumstances sick people must not be allowed to travel by air or any confined container. They must be quarantined. The antihuman and unsafe deregulation a la Reagan and Thatcher must be expugned forthwith. Everyone witha respiratory infection cough sneeeze must wear a surgical mask. Probably inadequate but a symbolic nod to Hygieia like scrubbing before surgery. Competing interests: None declared |
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Arthur E Varner, Allergy Diagnostic Beachwood OH USA 44122
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A current theory regarding the increase in allergy is the Hygiene Hypothesis, that is frequent infections early in life reduce the risk of allergic disease. The converse of the same data is that allergic individuals are protected from infections. That is, those with a better ability to produce anti-inflammatory TH2 type cytokines, when faced with a respiratory viral infection the immune system has never seen, will be able to temper the severity of the innate immune response to infection and promote survival. This is born out by the epidemiology of those who died from the Flu of 1918 (non-atopic) as opposed to those who survived (atopic). Once allergic disease is treated with steroids, this survival advantage is diminished. For more see my recent article in the April 2002 Chest, The increase in allergic respiratory disease- survival of the fittest. Reprints called be emailed by request. Competing interests: None declared |
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Meng-Kin Lim, Associate Professor National University of Singapore
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Dear Editor, My letter "SARS: are immunised children protected? (5 April) which you have posted contained three references that were inadvertently truncated. I guess it's because I had attached them as endnotes on my Word file but they were not picked up when electronically transmitted. Here's the complete version: It is early days yet to jump to any conclusions, but Severe Acute Respiratory Syndrome (SARS) appears to be a disease principally affecting adults and not children. In Singapore, the youngest affected so far is a twenty year old student from a tertiary institution. In Hong Kong, the youngest was 35 years old and in Canada, 24 years old. In the well-documented case of the 98-year old grandmother who stayed at the Hotel Metropole in Hong Kong and subsequently died in Vancouver, Canada, all the remaining five adult family members and their three children (5 months old, 9 years old and 17 years old) living in the same household as her were exposed, but all the children continued to be unaffected whereas four adults (aged 24 years, 34 years, 43 years and 79 years) developed SARS and one died.1,2 The New York Times (4 April 2003) today quoted the WHO team that finally got on to the trail in Guangdong Province, China as saying: “One key to the disease's speedy -- yet seemingly erratic -- transmission could lie in how the apparent first case …passed it to four people without infecting his own four children.”3 The above seem to suggest that the younger set may, for some unknown reason, be relatively immune. Is it possible that they are protected by residual cross-immunity to other diseases covered by routine childhood vaccinations such as against mumps, measles and rubella? This is worth investigating. If true, for instance, then the closure of schools as has happened in some Asian countries including Singapore, while effective in calming the psychological fears of parents, might not quite be on target from the point of view of protecting vulnerable populations. More importantly, it may point to a readily available and simple means like the MMR vaccine as a possible protective measure. References 1. Tsang KW, Ho PL, Ooi GC et al. A Cluster of Cases of Severe Acute Respiratory Syndrome in Hong Kong. www.nejm.org March 31, 2003 2. Poutanen S M, Low DE, Henry B et al. Identification of Severe Acute Respiratory Syndrome in Canada. www.nejm.org March 31, 2003 3. The associated press. China Apologizes As WHO Tracks SARS Path. New York Times, 4 April 2003 Competing interests: None declared |
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Boghos L. Artinian, Private Practice talet Zarif building, Yacoub Sarrouf Street, Zarif, 2040 3513 Beirut, Lebanon
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As is obvious in the title, I have taken the liberty of completing the mutations in the acronym 'SARS' started by Zambon and Nicholson in their editorial. Now is it proper to arbitrarily meddle with an established acronym, using the word 'sudden' instead of 'severe' especially that the illness is severe and the second word 'acute' means sudden. I hope the change was just a printing error and not an intended change in the meaning of the acronym. If a change was really necessary I would suggest VARDS ( viral adult respiratory distress syndrome). Sincerely, B. L. Artinian MD Competing interests: None declared |
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