Life 'Surreal' for Nurse Under SARS Quarantine

Health Central.com ^ | May 30, 2003 | Amanda Gardner

[Judith Anne]

FRIDAY, May 30 (HealthScoutNews) -- Peggy Dawson's workday begins with a thermometer being thrust into her ear and an N-95 mask snapped on to her face. That mask, which she must change every four hours, has become a semi-permanent part of her uniform.

The 29-year-old registered nurse and other employees at Toronto's Scarborough Hospital are allowed to take the tight-fitting, sweltering masks off when eating in the cafeteria, but they're also encouraged to sit in every other seat so there's at least a meter's distance between them. Even in the nurses' lounge, employees are advised not to sit together.

Welcome to a regular working day at Scarborough, one of Toronto's "ground zero" facilities for treating patients with SARS, or severe acute respiratory syndrome.

"It's very surreal," Dawson says. "I've only been practicing since 1999, but my mother was a nurse for 30 years and 25 of them were spent in the emergency room, and I never remember anything like this. It's very scary."

Dawson estimates that there are currently about 20 SARS patients in the hospital, about 10 of whom are staff members. Several other employees with the illness are at home monitoring their own symptoms.

Hundreds more, like her, are on working quarantine.

Outside of Asia, Toronto has been hardest hit by the SARS epidemic: it has had the bulk of the 159 cases and 28 deaths in the country. The original outbreak occurred through March and April, brought in by travelers who had returned from Hong Kong, where SARS spread from mainland China in February.

Dawson's first and only contact with a SARS patient took place during that first outbreak.

Towards the end of a shift one day in late April, she volunteered to spell a colleague who had been assisting with a SARS patient. The patient had taken a turn for the worse and eventually died.

Dawson spent about an hour with the man, who was in isolation, taking his vitals, giving him medications and monitoring his overall status. Although thousands of people in Toronto were quarantined, Dawson was not because she had been wearing full protective gear at all times.

In early May, the epidemic finally appeared to be dying down, prompting the World Health Organization to lift its travel advisory. Canadian health officials and citizens heaved a collective sigh of relief.

By last week, however, another SARS cluster had appeared. Because health workers had not all been wearing protective gear, anyone who worked at Scarborough or North York General Hospital between May 12-22 was put on "working quarantine." That means for 10 days, these employees -- more than 3,000, according to the Toronto Star -- report to work for their regular shift, but otherwise stay at home. All visitors to the hospital during that period have been advised to "self-isolate."

Dawson was included in the second group of people quarantined.

"To my knowledge, I was not in direct contact with a SARS patient [during that time]. However, there were other members of the staff who could have been exposed, from people who clean the floors to physiotherapists and respiratory therapists," she says. "We all share the same cafeteria, come in through the same entrance. It's a contact of a contact, and that's why we are all under quarantine, the entire hospital."

Because Dawson lives alone, the quarantine is not as onerous as it might be for people who have families or roommates. If she were living with someone else, she would be expected to set aside personal-use items like linens, towels, and dishes. She would be expected to sleep alone in a separate room.

As it is, she has to have someone do her shopping for her. She couldn't visit her father on his birthday earlier this week. And she can't finish the countless errands and appointments that she normally saves for her days off.

"I thank God for technology because I have a phone, a television and the Internet. I've been able to entertain myself that way. What do you do except for the dishes and cleaning?" she says.

The one thing she must do is check her own temperature twice a day. "Every time I put that thermometer in my mouth I'm praying that there isn't a change," she says.

Dawson's only personal contact with other people is at work, but that is circumscribed because of the ubiquitous face masks.

"It takes away the humanity of our job. It really does," she says. "Patients take a lot of cues from your facial expression, and now they're only looking at your eyes."

On another level, though, Dawson is grateful for the masks and other infection-control paraphernalia, which, had they been worn continuously, might have prevented the current quarantine.

"Everybody's very disheartened because we put a lot of faith in the people who make the decisions. A lot of people are feeling really let down right now," she says. "Don't get me wrong. It was very nice to be liberated from the mask, nice to look at colleagues and be able to smile again and look at patients with your whole face, but everybody was a little leery as to whether we were easing up on precautions a little too soon."

She is not alone in feeling this way.

"When you have a flare-up of infectious disease, you have to take precautions to contain it and to protect yourself," says Diana Mason, editor-in-chief of the American Journal of Nursing in New York City. "Nurses are educated about infection control measures and it's part of what we do." That part of the job is not nearly as stressful as the quarantining, Mason adds.

Dawson comes off quarantine on Monday, but doesn't think even that will relieve the anxiety she has been feeling.

"Just because I'll be off quarantine and symptom-free doesn't mean that it still can't happen to me," she says. "It's not gone and I don't think it ever will be gone. It has really changed the face of nursing and changed the face of health care forever."

[Judith Anne]

Wonder what it's like for nurses who are married, and mothers of small children who can't understand...I think it would be a good idea for people to mentally prepare themselves for what a quarantine could involve...because we may see them in some areas...

[Judith Anne]

aristeides, thanks (again!) for the excellent link...information for those who want to know what quarantine would involve...

[Fracas]

Both of you are doing an excellent job keeping us informed about SARS.

Thanks for your links to the latest information and commentary.

[aristeides]

Ping.

[EternalHope]

"It's not gone and I don't think it ever will be gone. It has really changed the face of nursing and changed the face of health care forever."

Maybe not "forever", but at least until we can find a practical way to test for it, and a successful way to treat it once you have it.

We are not even remotely close to either of these, and it looks like they could be a long time coming.

[EternalHope]

Nurses are on the front line for this, much more so than doctors. I don't think the general public has even the remotest idea what that really means. (Right now, most nurses probably don't either.)

Many thanks to you and your compatriots.

[riri]

Hey JA, thought I would give you a follow up on my neighbor.

I talked with his wife a bit ago and they are admitting him into the hospital today. He has had a fever for 12 days. She said Saturday night, he awoke at 2am with it being 104.something.

She says his other symptoms are massive headache in back of head and tingling extremities. He is an otherwise healthy 37 year old man.

Still no cough and, supposedly, clear lungs.

The doctors are at a loss. They have asked him if he has been out of the country, if anyone at work has been ill or if he has been bitten by any insects. (all apparently no)

One last note, everyone else in house has no symptoms at this point (day 12) and is in good health.

Let me know what your professional opinion is, if you will.

[blam]

"I think it would be a good idea for people to mentally prepare themselves for what a quarantine could involve...because we may see them in some areas..."

I can't see how it can be anything but a nightmare...and probably undoable for people with large active families.

[iceskater]

It would be onerous but if the choice is quarantine or death, I'd chose quarantine. But that's just me. Quarantine was what people used to do before modern vaccines, antibiotics, etc. And family size, in general, was much larger then than it is now.

[Judith Anne]

I'd be glad to let you know what my personal opinion is, but I don't practice nursing here...Missouri scope of practice is very strict about things like that.

I'm REALLY glad he's going to the hospital--at least there they can do the tests that will let them find out what's going on. It's definitely not normal to run that high a fever, but fever can be due to a lot of things. Our concern here on this forum is naturally SARS, but we can't let that blind us to the fact that there are a lot of bugs out there that cause infections--kidney infections, for instance.

If he's run the temp for 12 days, and nobody else in the family is sick, then I would say it's likely that what he has isn't communicable--but again, I don't know what he has and don't have enough clues to even guess.

If they're not sick, then I don't see how there could be a problem for you or your family...

[Judith Anne]

It would be hard, I'm sure...but how could anyone in good conscience break quarantine, knowing they might infect someone?

[Judith Anne]

I remember quarantine for scarlet fever...and I did have a mild childhood case of polio at age four, but I was too young to know anything about quarantine then...

[Judith Anne]

Here's what I think:

If nurses in the US have to be in working quarantine, the citizens of this country have a right to expect that they'll observe it conscientiously. No fudging, no running out for a pair of shoes, or a couple of steaks for dinner--but a full-fledged voluntary isolation for the good of every one of the people who go to the hospital for WHATEVER reason--broken arm, appendicitis, to have a baby...

And I don't think people will be very forgiving of a nurse who goes out shopping, or who takes in a show, or who just can't resist a party or a holiday, who then infects one of them. You know?

And what you all expect of your nurses--that we faithfully carry out our duties 24 hours a day for your health and welfare in scrupulous honesty--we CAN'T expect from you. Because you might find it inconvenient? Or burdensome? Or a pain?

Quarantines have never been imposed frivolously. In the case of SARS, they could be lifesaving....if such a thing happens in the US to one of us posters, will the poster obey the quarantine order? Or not?

[riri]

Thanks for the input, I'll be glad to find out whatever it is that he has, I will tell you that.

[riri]

SARS Vaccine in 3 Years

[Judith Anne]

Dang, riri! That was a depressing article about the vaccine...I should post it, but I'm too tired right now...

[Chemist_Geek]

but how could anyone in good conscience break quarantine, knowing they might infect someone?

You are aware of the large number of selfish, stupid people?

Even on FR, I read talk of quarantines equated with "Marshall Law" (sp) and how a quarantine would be an abominable infringement on the Right Of Free Travel, or something like that.

[CobaltBlue]

One of the things that would help with quarantine is for charitable organizations and/or government agencies to establish ways to make it easier to stay in quarantine.

Someone to bring the essentials, like groceries, medication personal health care and grooming items (toilet paper, soap), cleaning items (disinfectant), pet food. Someone to help make arrangements for bill paying, like stamps and envelopes. Someone to bring and return things like library books and videotapes. Leave them outside the front door and ring the doorbell.

If you were in quarantine, how would you cope? Who could you call? History teaches us that the people who break quarantine are not the ones who can plan ahead, they are selfish, stupid people. Making it easier on them to remain in quarantine seems like a good idea to me.

And what does quarantine mean? Can you go for a walk in the park? Can you drive around in your car? Can you work in your yard? Seems to me that the answer to all three questions is "yes."

[CobaltBlue]

It's spelled "martial law", derives from Mars, the Roman God of War, and means military rule or authority imposed on a civilian population when the civil authorities cannot maintain law and order, as in a time of war or during an emergency.

I suppose if a lot of people insisted on breaking quarantine and the civilian authorities were overwhelmed, martial law might be called for, but most people in the US are law-abiding, either because they recognize the wisdom of the law, or because they fear the consequences.

[snowstorm12]

What about people who get sick on vacation and have symptoms but think it's a cold and decides to take cough syrup or whatever. Then at disneyworld spreads it to many people.

I think if I got sick I would try to fight it off at home and not risk going into a disease ridden facility or doctors office. I'd check in if things got really bad. If you have good disease immunity you won't die.