Posted on 04/23/2003 6:23:26 AM PDT by CathyRyan
Anyone harbouring complacency about SARS should look closely at Hong Kong's experience, writes Peter Cameron.
It began on Tuesday afternoon, March 11, with another bothersome call from Hong Kong's Prince of Wales Hospital administration. They wanted to take over our emergency department observation ward because the Department of Medicine had a couple of doctors who felt ill. By the night's end 20 staff were patients in the observation ward. Within five days nearly 60 staff were infected and I was facing the real prospect that a member of my own staff would die.
This was the first time I have felt threatened by the work that I do. Perhaps it's a similar experience to that of a policeman on his first "stakeout", when he realises he might get shot. As a doctor, you know you are potentially vulnerable to getting all sorts of illnesses, but rarely a life-threatening one such as severe acute respiration syndrome.
I was worried about going home in case I infected my family. When I did get home, I felt physically exhausted and emotionally drained, and didn't really want to talk to anyone.
I would not and could not touch my wife or children for fear of giving them the disease. I slept in a separate bedroom; I ate separately. Clothes were washed separately and chlorine bleach was everywhere. Some of my colleagues began sleeping in their offices, refusing to go to their homes at all for fear of infecting their families.
In the event my wife and I decided it would be easier for all of us if she and the children returned to Australia.
When I spoke to friends in Australia, I was struck by how little they had heard about the outbreak in the first weeks and how little preparation authorities seemed to have undertaken. Some "armchair experts" were even saying that it was irrelevant to Australia, just another "beat-up". In their minds, influenza was much more important.
I tried to remember the last time influenza had put 250 health care workers into hospital, with 20 per cent of them in an ICU. I tried to remember the last time all the ICU beds in a city had been filled by influenza cases. As far as I was concerned, these "experts" had clearly missed the point.
Also, initially there seemed to be a high degree of misinformation about the symptoms, signs and mode of spread of this disease. In general, the only definite symptom was fever. In the early stages of the illness, cough, rhinitis and other upper respiratory tract infections (URTI) symptoms were actually less prevalent in the SARS group than in other patients. I believe that information being promulgated by the World Health Organisation and the Centres for Disease Control and Prevention (CDC) was, in some instances, inaccurate and at other times misleading.
For example, early enthusiasm surrounding diagnostic tests proved misplaced when we found only a 10 per cent positivity rate. I felt compelled to make time for radio and television interviews to raise awareness of SARS.
In Hong Kong, I believe the authorities were initially very keen to keep the public in the dark. This was followed by an attempt to blame the hospital (and staff) for allowing the disease to spread. Initially, for fear of creating pandemonium, no moves were made to educate the public about preventive measures. We tried, through official channels, to get these messages out; unfortunately, most officials seemed to me to be more concerned with protecting the economy and preventing panic than containing disease. Unfortunately, this response seems to have been the typical one in other jurisdictions as well.
Although the Hong Kong Government has since adopted widespread public health measures, at the time of writing it still maintains that there is no crisis. I do not agree; there is no obvious end in sight. More and more of the public are becoming infected. There is a high likelihood that more health care workers will be struck down. It is distinctly possible that if the numbers of affected patients continue to rise the whole public health system may collapse. The most likely pressure point will be the intensive care setting: with more than 100 cases already requiring intensive care, it is inevitable that untrained staff will have to manage critically ill patients. Also, hospitals will have to triage patients, allocating intensive care beds and technology to those most likely to benefit before those with a lesser or low chance of survival.
Today, despite my concerns for the community, my personal fear has receded. I feel more capable of managing this threat than I did in my first fortnight's experience of it. Although I am not 100 per cent sure of the cause of this illness, I do understand something about its course and how to control its spread. And I know that most people will survive.
However, I remain extremely frustrated that others are not learning the lessons that we have learnt regarding the need for stringent infection control. Most medical staff think they know about infection control and how to manage a crisis, and are unwilling to take advice.
As a health care worker, the likelihood of contracting an infectious disease that will kill you is usually quite small. When a new, mysterious illness smites down a whole hospital and its workers, it hits at the heart of the health system.
Peter Cameron is professor of emergency medicine at Prince of Wales Hospital, Hong Kong. This is an extract from The Plague Within, published on the Medical Journal of Australia's rapid online publication (www.mja.com.au). Copyright MJA.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.