[Domestic Church]

Oy Vey...but we knew it was going to happen.

[Mother Abigail]

U.S. travel alert: Cancel trips to Vietnam


WASHINGTON, March 21 (UPI) -- The State Department urged American citizens Friday to defer all non-essential travel to Vietnam because of an increase in the cases of severe acute respiratory syndrome.

The alert notice said the State Department is aware of at least one American catching SARS in Vietnam. The patient is known to have traveled in the country's northern provinces.

The U.S. Centers for Disease Control and Prevention on Friday reported 22 cases of SARS infection in states stretching from Maine to California.
Nine people have been infected in Canada. Two of them died.
Doctors in Hong Kong, Taiwan and Germany have identified a virus taken from the noses of some SARS patients as causing the infections.

On Friday night, the State Department issued a travel alert, warning Americans of "health concerns in Vietnam regarding an increase in the number of cases of severe acute respiratory syndrome or SARS."

The State Department has suspended official travel to Vietnam until further notice due to "reduced availability of medical facilities," the announcement said.

[Mother Abigail]

Houston Chronicle

A Harris County woman who traveled to Hong Kong recently is among Texas' first two suspected cases of a mysterious flu-like disease that has stricken 337 people worldwide and killed 10.

The Texas Department of Health said today the Harris County case and one in the Dallas-Fort Worth area are under investigation.

[Mother Abigail]

The son of a Vietnam-based U.S. diplomat was admitted to a local hospital early yesterday for treatment of what was suspected to be Severe Acute Respiratory Syndrome (SARS), doctors said. Taiwan's health authorities came under fire, however, for allowing the boy to be treated in Taiwan after asking Taiwanese businessmen on Wednesday to be treated in their overseas locations rather than returning to Taiwan if quality medical care is available. The boy, whose name was withheld, was airlifted to Taipei in a special medical plane around 7:30 yesterday morning and transported to National Taiwan University Hospital to receive care in an isolated ward, according to doctors at the hospital.

[steve86]

This is an update from Dr. Buckley in Hong Kong. His hospital is accepting SARS patients only.

Note: "Septic" refers to an infection of the bloodstream.

From Listserve For Emergency Medical Practioners: [EMED-L]

http://www.ucsf.edu/its/listserv/emed-l/11411.html

Update from Dr. Buckley in HK.

-------- Original Message -------- Subject: Re: SARS Date: Fri, 21 Mar 2003 06:07:15 +0800 From: Tom Buckley To:

-snip of recipient's address-

We are using routine community acquired antibiotics but all our cases who have had contact with ward have not responded. We are now only admitting cases to our hospital who have had contact with our original case. We are now seeing the second wave - relatives of primary contacts.

So far no staff have been infected once isolation procedures were put in place. No one is wearing ordinary surgical masks. There have been some close calls with some nurses being reported as having atypical pneumonia after precautions have been taken but in all cases our contact tracing team has established that there was an earlier contact. Everyone has been wearing N95 masks and while I think (though don't know for sure) that N95 is satisfactory staff have not been wearing them properly or they do not fit.

We are switching to the N100 masks not because they are ~ 5% more efficient but because the nurses have found them more comfortable to breath through (less resistance) and they fit more comfortably on the face. The N95 masks, despite a variety of brands and sizes have been uncomfortable and difficult to breath through. There is also the psychological aspect as well.

We are going to try BIPAP. I do not expect it to work (hypoxic respiratory failure only) but because of the higher flow rates (along the lines of the nebulized ventolin in the Index Case) and potential for environmental spread I want it to be as safe as possible. So besides all our "usual" precautions we are going to do this in one of our isolation rooms - increased ventilation flow rates and personal HEPA units. If the staff can tolerate them we will distribute to all staff. Many problems with these but I cannot afford to lose one nurse. Mind you haven't made a final decision about the BiPAP.

Last night senior nurse rang me to say she was resigning. She is petrified. HK Government is down playing the whole thing presumably because of the economic implications but own hospital has been taken over completely by this infection. We currently have 24 cases of atypical pneumonia in ICU - now is that impressive or what.

It also appears to be out in the community. GPs are being admitted.

All of our patients in ICU are either on 100% O2 or they are ventilated (some prone).

Pulse steroids have been given by the physicians to patients on the general ward. They initially improve but are now septic and being referred to ICU. They claim some patients are better on the ward but I think these patients would have improved anyway. While I was able to dissuade them from using pulse steroids in ICU patients I had no control over the general wards.

Sorry to ramble. I am very tired but hope this is helpful

Tom Buckley