Time to get a grip and put SARS panic epidemic into perspective

By Terry Prone

There inside one remark stand all the contradictions of the SARS panic.

Even if that man never buys a mask, even if he heads for Beijing right away and follows that trip with a dirty weekend in Toronto, he is much more likely to die of smoking than of SARS.

Yet nobody expects to hear announcements on incoming flights saying smokers should be aware of the symptoms that may indicate danger (starting with wheezes and coughs and other signs of respiratory distress) and ensure they don't damage the health of others (by forcing them to be passive smokers).

We're used to the smoking threat and downplay its risk.

Similarly, we're used to killing each other by car.

Some 45,000 road deaths each year in Europe merit a shrug while around 300 SARS deaths worldwide get us to react as if Judgment Day has suddenly dawned.

It's disproportionate. It's over-the-top. It's out of kilter with the actual threat. It's symptomatic of our chronic incapacity to calibrate risks.

If an illness emerged called "Chinese flu", which existing vaccinations didn't seem to guard against, required fairly sustained contact with a sufferer in order to spread, wasn't easy to treat and had a one-in-ten mortality rate, it would not have caused international panic.

We don't like flu, but we don't give it an acronym, use it as an excuse to take the temperature of incoming coughers and as is happening in London avoid Chinese restaurants.

Yet influenza killed more people in World War One than any of the armaments deployed in that conflict.

A particularly vicious strain, emerging in Kansas, ran like wildfire through a military camp, killed more than 500,000 Americans and was then sent to Europe on troop ships.

Now, in the face of 300 international deaths, the world is making much more fuss about China being sneaky on the SARS issue than it did about China exterminating its citizens by gunfire in the middle of Beijing.

Panic is hitting the livelihoods of hundreds of thousands of perfectly healthy workers in Toronto and crippling airlines.

Ireland, with one suspected case and no fatalities, is behaving as if the nation was under a death sentence.

We need to get a grip. A sense of balance. A realistic appreciation of the risk.

This isn't Black Plague Mark 2.

It's a plague of a different kind a panic-plague created by an over-supply of information and an under-supply of judgment.

Few things reveal as much about a society as an epidemic does.

And what the SARS epidemic reveals is we have as much faith in magic as any earlier, less sophisticated generation.

In Biblical times, lepers were forced to carry bells and cry out their medical status ("Unclean, unclean") ostensibly to warn the healthy to steer clear of them in the belief that even a casual "Howya" encounter with a leper would cause infection a belief unsupported by fact.

Today, people are wearing masks lest a "Howya" with someone who sneezes on the Dart infects them, a possibility equally unsupported by fact.

The healthy have always wanted outward and visible signs to reassure themselves epidemics are being dealt with.

Ring a Ring a Rosie, the children's game, goes back to bubonic plague in the middle ages, when people carried little bunches of flowers (the "pocketful of posies") in which they would bury their noses to protect themselves, in surgical mask fashion, when surrounded by strangers.

The ring of roses in the nursery rhyme referred to the reddened lesions of the plague and the "atishoo, atishoo, we all fall down" to the sneezing and sudden collapse typical of the disease, which could kill its victims within a day.

During the recurring plagues of the medieval period, crosses were painted on the doors of houses where plague victims lived.

The crosses served as a notice of quarantine on the imprisoned sufferers, offered a warning to potential visitors and gave passersby the comforting illusion that whatever caused the illness was contained by the four walls of the house.

The illusion was comforting but lethal, as Bubonic plague was spread by a particular kind of flea, which used rats as preferred vehicle.

Whereas rats are not good at obeying quarantine rules, they are unequalled in their efficiency at flea-and-virus transportation: fast, ubiquitous and amphibious.

It was the rat, sneaking up ropes holding ships to the quayside, that brought plague on board, and it was the rat, scampering down the same ropes on arrival at a new port, that delivered its toxic cargo, duty-free, to each hitherto healthy country.

Belief in magical symbols is one of the predictable societal responses to epidemics.

Fortunately, some countries, notably Vietnam and Singapore, have eschewed magic in favour of sensible action, which has had demonstrable payoff.

Vietnam is lobbying to be registered as the first country to get and get rid of SARS.

Singapore, the ultimate city state with an enormous and enormously transient population, is an inadvertent petri dish for the SARS outbreak.And it knows it.

From the beginning, Singapore was ruthlessly efficient in its determination to corral those infected with SARS into one location, to study and manage the disease, even electronically tagging those quarantined for the virus, so that anyone who flouted the law by leaving their home could speedily be traced.

If Singapore is a case-study in epidemic-management, it's also the site for one of the few notes of good-humoured opportunism in the international SARS hysteria; a sex-promotion campaign.

Traditionally, epidemics have put people somewhat off sex.

That serial adulterer Samuel Pepys recorded in his diary how, one night in the middle of a plague-dominated summer, he visited one of his frequent sex partners, the delightfully-named Mrs Bagwell.

"I went into her house and did what I would," he wrote, with a smugness that rapidly came unstuck when she told him her servant had just died of the plague.

He scampered out of there pronto and downed a pint of wine to ease the terror that infection might result from having had a quick bit of the other with Mrs B.

Five centuries later, some people in Singapore are taking a much more positive attitude to sex and SARS.

Those quarantined have been advised not just to stay at home but to have lots of sex while they're there, transforming their bedrooms into "love nests" during the scare as a way of solving the local population problem.

Singapore's birth rate sank to a 14-year low last year, with only 40,800 babies born, 3% fewer than in 2001.

Bigger families are officially encouraged through tax breaks, cash bonuses and subsidised childcare.

The encouragement to regard SARS quarantine as an invitation to stay in and multiply is unofficial.

Possibly persuasive.

Certainly positive.

And a welcome antidote to irrational panic.