FC: Henry Niman on SARS Mythical Mortality Rate: Actually 15%-20%

[Declan McCullagh <declan () well com>]

[Henry is affiliated with the Harvard Medical School and the Department of 
Bioengineering at the Shriners' Burn Center in Boston. --Declan]

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From: "Henry L Niman, PhD"
Subject: SARS Mythical Mortality Rate
Date: Sat, 19 Apr 2003 09:35:04 -0400

The mortality rate for SARS is commonly refered to as around 5% in the media
(and compared to 20% for the 1918 flu epidemic).  However, the mortality rate
is really the number who died divided by the number who died or were
discharged (assuming none of the discharged subsequently die of SARS).

The only country with a reported mortality rate around 5% is mainland China.

Here are the mortality percentages as of yesterday, based on the cumulative
data posted by WHO:

Country   Fatal   %

Canada      12    20.7%

Singapore   16    15.0%

Hong Kong*  69    14.1%

Viet Nam     5     9.8%

China       65     5.5%

*The 12 deaths reported today would raise HK's total to 81 and mortality rate
to 14.9%

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From: "Henry L Niman, PhD"
Subject: RE: SARS Mythical Mortality Rate < Correction
Date: Sat, 19 Apr 2003 16:13:57 -0400

I accidentally used 544 instead of 444 for the denominator so the Hong Kong
mortality rate as of today is 18.2%

The other countries as of today are

Hong Kong 18.2%
Canada 18.2%
Singapore 13.8%
Viet Nam 9.8%
Mainland China 5.4%

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From: "Henry L Niman, PhD"
Subject: RE: FWD: SARS Mythical Mortality Rate  15-16%
Date: Sun, 20 Apr 2003 10:04:40 -0400

The WHO data has been broken out into deaths and discharged for about 11 days
and the numbers have been pretty consistent.  The number discharged daily in
Hong Kong has gone up quite a bit recently, but so have the fatalities, so the
death rate hasn't changed much in the past 11 days

April 20 17.5%
April 19 18.2%
April 18 17.6%
April 17 19.3%
April 16 19.2%
April 15 18.7%
April 14 17.0%
April 12 14.0%
April 11 15.9%
April 10 16.3%

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From: "Henry L Niman, PhD"
Subject: SARS Mythical Mortality Rate  15-16%
Date: Sun, 20 Apr 2003 12:42:20 -0400

Yes, the range is pretty wide for country to country, but has been pretty
steady for the past 11 days:

Date       Hong Kong   Canada    Singapore   China
April 19    18.2%        18.2%*     13.8%     5.4%
April 18    17.6%        20.7%*     15.0%     5.5%
April 17    19.3%        20.7%*     14.2%     5.5%
April 16    19.2%        26.0%      13.3%     5.5%
April 15    18.7%        32.5%      13.3%     6.1%
April 14    17.0%        32.5%      12.5%     5.6%
April 12    14.0%        27.8%      10.5%     5.3%
April 11    15.9%        28.6%      10.5%     5.3%
April 10    16.3%        31.3%      10.7%     5.1%

* WHO lowered Canada's fatal cases from 13 to 12 (today media reports have
raised number to 14 after another death yesterday).

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From: "Henry L Niman, PhD"
Subject: SARS Mortality Rate - 45% in Taiyuan, Shanxi
Date: Mon, 21 Apr 2003 10:01:18 -0400

The current motality rate in the teens for major sites isn't an upper limit,
and the numbers could go higher.  The highest rate I have seen is out of
mainland China, where overall a mortality rate of about 5% in reported.
However in Taiyuan, capital of Shanxi Provence the reported rate is 45%.

>From yesterday's Promed report:

"Meanwhile, a report from Taiyuan, capital of north China's Shanxi province,
reported that [as of 19 Apr 2003] 9 people had died of SARS in the province
and there were 112 registered SARS cases in the province. 11 of these have
recovered and been discharged from hospitals."

---

From: "Henry L Niman, PhD"
Subject: SARS Mortality Rate - 50% in Hohhot, Xinhua
Date: Mon, 21 Apr 2003 11:02:32 -0400

As the numbers trickle in from the various provinces in China, a more onimous
picture is emerging.  Although the numbers are still low, Hohhot, Xinhua had a
mortality rate of 50% a week ago

http://www.rediff.com/news/2003/apr/12sars.htm

"Two people in China's Inner Mongolia region have died from the SARS virus,
the first time the disease has been reported in the far-flung north, the
official Xinhua news agency said.

A total of 10 cases were reported in the regional capital of Hohhot, Xinhua
reported late on Friday, citing the city's health department.

Two of the 10 patients had recovered, it said. Among the infected, nine were
from two families and one was a health care worker, the agency reported."

However, in yesterday's Promed report, it looks like the transmission in the
hospital may be very high, with 4/5 patients who visited from Mongolia showing
symptoms:

"China's neighbor, Mongolia, has introduced tough measures to cut the risk
of infection after 5 people were suspected, but not confirmed, to have the
virus.  Those being monitored had all visited a hospital in Hohhot, China.
Although they had gone to China for non-SARS related ailments, 4 of the 5
came back with a fever."




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