1. Severe Acute Respiratory Syndrome What can we do to help? Ed Fredkin CMU -- MIT ef@cmu.eduef@cmu.edu fredkin@media.mit.edu 4 April 2003fredkin@media.mit.edu SARS

2. The Problem of Time This is a problem of exponential growth 10% per day, doubles each week, and grows to a million times greater in 20 weeks! Whatever is done, doing it one day later… –Might not matter –Might result in a few more deaths –Might result in 100,000 more deaths It’s the nature of the problem!

3. Not Well Prepared for This! Started on Saturday, 29 March, PM Spent a few days to gather & digest info –Current from CDC (www.cdc.gov), WHO (www.who.int) and from the Web at largewww.who.int –Historical info on 1918 Spanish flu -- from the Web Made an Excel spreadsheet Model Decided on a plan of action

4. The CDC (Centers for Disease Control and Prevention) is the primary US agency. They are at www.cdc.gov The Cumulative (by state) number of cases is posted almost everyday http://www.cdc.gov/od/oc/media/sars.htm

5. WHO, The World Health Organization (United Nations) is the international agency most concerned with the SARS epidemic www.who.int This is the cumulative number of reported SARS cases updated almost every day The chart for April 4th is at www.who.int/csr/sarscountry/2003_04_04/en/

6. WHO data

7. Hong Kong is in the Forefront

8. Some See “No Problem”

9. China had not updated on a daily basis

10. SARS #1 issue after April 2nd! www.cdc.gov

11. When China didn’t update 806 reported cases, the growth rate was underestimated at 6.6% (because of the constant 806 cases) Blue is day to day, red is day to day averaged from day 1

12. The top group of 3 lines is the raw data for the previous slide. The top row is the total SARS cases counting the 806 China data. The row is the day to day % growth and the next row is the daily growth computed from the first day (smoothed growth data) The following is the data for the next slide, excluding the China data to give a more accurate measure of growth rate; 8.8%/day.

13. Excluding the constant 806 data, the actual growth rate is 8.8%

14. Sick with SARS Fatalities/week Cumulative Deaths Millions, for each week of the epidemic Small epidemic Less than 10 6 deaths

15. Sick with SARS Fatalities Cumulative Deaths Millions, for each week of the epidemic. Big epidemic

16. Sick with SARS Fatalities/week Cumulative Deaths Millions, for each week of the epidemic Bigger epidemic

17. Statistics from the 1918 Spanish Flu Epidemic October, 1918, Kansas The solid line is all deaths Dashed is Flu deaths The doubling time constant is the same as observed for SARS: One Week!

18. Major Issues At some early point there may be no further help because the number sick will be too, too many! –No more room in any hospital –No rooms in any temporary hospitals –No available Doctors, nurses or medics –No life saving equipment –No medication or other profession care The death rate may then increase

19. What to Do? Think rationally Make good models Use them and make them better! –Using Excel –Transparent; easy to understand and use –All independent parameters changeable –Clear and understandable

20. Maximize Utility Compare the Utilities of various options Show what can be controlled & what can’t Show the benefit of early intervention Show the consequences of unnecessary delay Show the consequences of indecision Show advantages of world-wide cooperation Show how lives can be saved or lost

21. Who can best do this? Just people who have nothing better to do? No! Some top computer programmers & others must stop doing other important things and work on this! It might be a waste of time When it’s obviously important; it may be too late! Maybe it is too late already, maybe its not too late. The stakes are bigger than anything ever before.

22. We are proceeding! This project is underway We will make contacts at the CDC and WHO –So what we do will be as useful as possible We will need general and organizational support from MIT & CMU to proceed swiftly & efficiently We need to encourage very serious and capable workers to implement and deploy the best possible tools What cannot be tolerated is delay!