Posted on 05/19/2003 12:00:08 AM PDT by Judith Anne
ATLANTA (AP) -- Long before SARS became a household word and a worldwide worry, the U.S. health system has tackled contagious diseases with success. But if the new respiratory disease gets out of hand, experts say, the nation's resources may be overwhelmed.
So far, health officials haven't had to resort to quarantines or other, more creative methods - like during a tuberculosis outbreak last year in southwest Oklahoma, when state health officials nailed a sign on a woman's house warning visitors not to enter.
In another case, officials had to take a TB patient to court to ensure that medicines were being taken.
With only one new probable case reported this month, it appears SARS has been kept at bay - for now. But officials worry a major outbreak could overpower the system because of too few medical workers and too little hospital space to fight the disease on a large scale.
"We're going to try to contain it and really prevent transmission within the community," said Dr. Jon Tillinghast of the Oklahoma State Department of Health. "So far that has been successful in the United States. We don't have a Plan B right now because Plan A works, or has so far."
As Dr. Julie Gerberding said recently, "the capacity to provide care is one of the weak links in the system."
Some state health departments complain they are spread too thin by bioterrorism preparations and now SARS. The federal government is promising more money.
"We've been quite lucky," said Dr. Martin Cetron, quarantine expert for the Centers for Disease Control and Prevention. "I think we're only one 'super-spreader' away, however, and our vigilance is quite high."
On Tuesday, officials with the Centers for Disease Control and Prevention will talk to state health officials about the experiences of frontline SARS doctors in Toronto and Singapore.
Singapore, for example, has compensated for a shortage of negative pressure hospital rooms - which contain infection - by grouping SARS cases in the same ward.
Gerberding said Toronto's experience with the disease demonstrated "you have to act boldly and quickly when you first discover that you have a chain of transmission established."
California was one of the first to act quickly when the World Health Organization announced its first SARS travel warning March 15. Officials in Los Angeles County created a plan with a special radio system to alert emergency rooms and hospitals. They stressed the importance of isolating possible cases and informing health officials.
A 10-member rapid response team worked closely with CDC teams at Los Angeles International Airport to inform arriving passengers about SARS symptoms and what to do about treatment.
The airport, which handles about 4.7 million travelers a month, has had only one suspected SARS passenger.
And California, despite its deep connections across the Pacific, has not had a SARS spread, managing to contain its handful of cases. There are two dozen probable infections in the state now.
"The system worked quickly and well but we can't let down our guard," said Dr. Jonathan Fielding, Los Angeles County director of public health. "We still have to treat this very seriously."
In China, the country hit hardest by SARS, thousands of people believed exposed to the illness have been quarantined. But in Florida recently, officials simply isolated a suspected SARS spreader - a 12-year-old boy - and told parents of children who might have been exposed to watch for SARS symptoms, such as fever or respiratory problems, said Dr. Landis Crockett, director of disease control for the Florida Department of Health.
Viewing the disease from afar has been a benefit to U.S. health officials, he said.
"I think we've shown with SARS we have an approach that's even more proactive using our ability to exchange information quickly and take unified, agreed steps around the world," Crockett said.
Yet doctors and other health officials say the system needs more resources.
"I think as a whole the medical delivery system and public health workers all feel uncomfortable that we don't have easily expandable capacity in our system anymore," said Dr. Craig Smith, who serves on the bioterrorism committee of the Infectious Disease Society of America. "If you take the average hospital and ask 'Are you prepared to have 500 new casualties in one hour?', the average hospital is not prepared to do that."
Likewise, larger cities also have problems. Funding problems have prevented Seattle hospitals from providing enough rooms to contain infectious patients, said Dr. Alonzo Plough, public health director for Seattle-King County, Wash.
"We're talking about major shortfalls in negative pressure (isolation room) capacity and hospitals' epidemiological capacity," Plough said.
Gerberding says the government will provide millions of extra dollars and a proposal for extra hospital capacity for emergencies.
Another problem is whether the country would be able to effectively use quarantine and isolation powers. The CDC currently doesn't recommend quarantining people coming to the United States from an area with SARS.
Having seen SARS spread in hospitals, apartments and a hotel in Asia and Toronto, CDC officials are asking health authorities to draw up plans for quarantine and isolation in such settings.
Isolation refers to keeping infected people away from the public during the period they are infectious. Quarantine involves temporarily keeping non-infected, but exposed, people separated from the community.
The problem is that the United States hasn't had much recent experience with large-scale quarantine measures. The last large-scale quarantine in the country was during the Spanish flu pandemic of 1918-19. One person was detained in 1963 - the last federal quarantine - to prevent the spread of smallpox.
To conduct a large quarantine, the federal government will have to rely on state laws and manpower, said James Hodge, deputy director of the Center for Law and the Public's Health, a joint center of Georgetown and Johns Hopkins universities.
States have the main responsibility for isolation and quarantine within their borders and the federal government's quarantine powers are focused on preventing contagious diseases from entering the United States.
Nearly two dozen states recently revised public health laws to allow quick quarantine and isolation action in an emergency. Many of the revisions are based on a model emergency health powers act created in 2001 by the center.
"That would be a big challenge," Hodge said. "I think the organizational ability to do that would be very quickly stretched."
EDS: AP Writer Danny Pollock in Los Angeles contributed to this report.
There are scores of SARS-like illnesses in Califoria alone, I found out in talking to Astraea Kelly for an hour, a 20 yr. respiratory therapist at a major hospital in Northern California. As you read this, several nationally known papers are working on this explosive story. I have a reporter friend looking into this unbelievable story. May break any day now. Astraea told me that she is ready to hold a press conference. She ask for public demand on certain health officials to take tougher & quicker actions before more innocent people get infected with SARS-like diseases & die. Here are the facts in digest form. It will fill pages.
1. In this one hospital where she worked, she has in her 8 hour shift witnessed at least 68 patients having SARS-like symptoms (high fever, coughing, pneumonia, diarrhea) in the last 4 weeks. There are 54 other respiratory therapists in this one hospital. Multiply that & do the math. This hospital has only reported 3 cases of probable SARS to the authority. If this is not cover-up or underreporting, then what is it? It is public information to ask Sacramento's public health department for the statistics of deaths in each hospital.
2. She know of 20 who have died in 4 weeks. There are no doubt many more in other 2 shifts. She knows of more. Some of the patients were Asian. They have not tracked who have visited these patients before they died. Where have medical staffs gone on vacation recently?
To this date, none of the dead had an autopsy done! Where is the coroner on this? There needs to be media & public pressure on them to get their act together. How many more must died before they will perform an autopsy!
3. The medical staffs have talked among themselves. They are worried about their safety & felt they were not protected enough by the hospital. Astraea is their pointman & sort of spokesman. She should be commended for her courage.
4. She has already reported this to CDC with no response yet! You would think CDC is on top of things after the outbreaks elsewhere. CDC in Atlanta need to adopt a stricter policy to isolate all patients with SARS-like symptoms whether they have traveled to high-risk area or not. We don't have a reliable test yet of SARS. She has jeopardized her job by having reported this to the Ca. liscensing board...Dr. Rosenburg and Dr. Derby, state infectious disease physicians, examined the hospital's charts from May 2 - May 6 and found 12 deathsin 4 days. They showed a pattern of concern. Two were of special concern and reviewed carefully.
5. As to the hospital's latest Public relations official response , "It's a rumor started by one individual..." Could it be if you can't destroy the message, then destroy the messanger? She thinks the hospital is scared to death about their liability, potential lawsuit, and loss of business...
6. This therapist is sick after caring for these patients. She has SARS-like symptoms.
In case you think, won't this cause a panic? It might. However, if the bureaucracy is dragging its feet & not telling the full information, jeapardizing the public, the patients that get transfered around to & from this hospital, then many more will die needlessly. Let us Weigh the pros & cons. Sometimes, officials WILL NOT ACT swiftly unless you put their feet to the fire. I have reason to believe this hospital is not alone in America. Did you read of 2 deaths in a Millbrae(Ca.) convalescent home this past week with similar symptoms, diarrhea, viral cases?
Have you ever wondered why SARS patients are dying in Asia, Toronto & none have died in America even though we have scores of "probable cases". Could it possibly be that a lot a REAL SARS cases have been categorized SARS-like or non-SARS to prevent panic perhaps or just being over-confident?
Food for thought. Talk about cover-up in China, i think human nature & government's response is universal.
Have we really learned from the painful lessons from China, Taiwan, Hong Kong. You cannot act too fast when it comes to a highly contagious disease.
The report indicates it is "SARS-like", but not SARS. So far in the US there have only been six patients with evidence of SARS coronavirus infections and only one of the six is in California (and that case was in Santa Cruz at couple of months ago and linked to the Metropole Hotel in Hong Kong).
As the first dark, devastating clouds of smoke and burnt bodies cleared on our TV screens the realities that life had changed forever for each of us in the United States and the world, we opened our eyes slowly and painfully to the realities of 9/11. Quietly, we all grieved for the lives lost and families destroyed. Then we began the painful process of asking why this happened and how it happened to us as a nation.
Our first response was of determined and sometimes angry solidarity and nationalism. Immediately, the first horrors of rage became evident and the dangers, as violence was initiated to Middle Eastern citizens, businesses or religious organizations. Senators and Congressional representatives began slowly to call for sane and compassionate response to our fears; the lone and brave voice of Barbara Lee stood out for peace.
We need evidence before we attack another country and will the counter attack only increase our problems? We began discussing pre-emptive war and nuclear and biological weapons. Suddenly that “war on terror“ turned on us as citizens. Unions became alert immediately as did student activists and ethnic “minorities” that they had now become the potential “enemy of the state” along with anyone who appeared to question the current administration or the president and his policies.
Pride At Work seemed a logical place to test an official resolution against the war. We understand from our own lives what unfair discrimination and hatred can be. Our AFL-CIO leaders were silent. We had no direction as to what our official union stance would be. They were waiting to see what the union members wanted. The movement had to come from the rank and file.
“Could it be something is wrong with our information polls, they don’t seem accurate.” were voices expressed. Generic resolution examples against war were placed on peace Internet sites. I talked with our local PAW chapter and we agreed to make a resolution against pre-emptive war. I talked with Washington, D.C. and our national contacts and they indicated they would consider it if we sent one. Everyone was waiting for the other to go first.
Within a month the national Pride At Work policy convention met and voted for their resolution against war, using ours as an example. Each union that made a resolution increased the critical mass for others to do so. Sometimes we are discouraged by walls of silence. We simply do what we have always done. We educate ourselves, talk to each other, hash out our differences and respect each other’s differences, follow our conscience and our hearts and ORGANIZE.
It is our moral and ethical responsibility to do so. “The only thing to fear is fear itself.” We can change our world and future. We have the tools and we have the intelligence and I believe we have the heart and soul to be leaders and not blind followers in this life. We are union and we lead the way. We always have.
Astraea Kelly is a SEIU Local 250 steward at Kaiser Hospital, Vallejo and a community organizer for East Bay Pride At Work, affiliated with the AFL-CIO.
---------- From: "Astraea Kelly"
Reply-To: wingsong@earthlink.net
Date: Sun, 23 Dec 2001 15:34:52 -0800
To: "Jonathan Fremont"
Subject: IMPORTANT: READ
=20
=20
FYI: I got a "visit" after I posted a SF Labor Council Notice on = a research, grad student social justice listserver. (unless I forget to pay a parking ticket again)....I = am sorry, but this anti-terrorist stuff, is getting a little whacky....now they are going after labor = activists...for saying, "it's getting repressive around here". Yah....that's my point exactly. Please read...it's = important to know who is being "hit" out here. And they can't even keep their wallets on their = bodies...(smooth, guys)
Astraea
=20
----- Original Message -----=20
From: Astraea Kelly =20 Sent: 12/23/2001 2:54:29 PM=20
Subject: RE: Boycott Public Schools
=20
=20
Dennis...
I posted something on your listserver....other than private = email, I have been off the listservers for awhile, not really for a specific = reason, just I had one of the viruses and it knocked out my email posting connections for = awhile. I posted for the SF Labor Council, if you might have seen that this = weekend, so a statement would go out that the labor movement over here, is on it, for = the civil liberties losses going on...and the frightening stuff that is happening to = students and staff and citizens in general. Your listserver has been very specific = and good in getting alot of research data out. Well, I came home this = morning....and guess who came visiting sometime last night....the FBI, some idiot dropped his = wallet....I have ABC News contacts, lots of things....but they can come back and pick = it up when my attorney is here....they can explain why they were here. The = Oakland counter-terrorist task force agent's cards, along with several New York agents...a = Muslim connection, and the SF agent is all in here. What a dip shit! =
Anyway....the only thing differently that I did is post on your listserver the SF Labor stuff. They = are way out of control Dennis...and you should be aware, it is very possible your = listserver is on the "hit" list and people who post.
Let's launch a boycott on the public = schools...it is easy, it is in essence a "general strike" by the population.....and = statement that wholips=20 our local and accessible politicians, that we want our country = back...and we are tired of being in fear or harassed by the government because we don't = always agree with who is "appointed" as our administration, or their = policies...but that is what people die and died for to make our country. It's who we are. = Let's not lose it.
Let's boycott......they will pick up notice fast when they lose = daily money for each and every student who won't attend. And they can't shoot us = for staying home. I think it is just what might work right now, and yet keep = people somewhat safer from backlash out here. Let's try and move it. Talk to your = dad too, about this, please. I don't really want all that personal info on the = listserver for my experience... but I really appreciate it if you would forward to all your = contacts privately. Between the two of us, we have alot of D.C. and political contacts. = They need to know the FBI is running amok that much. And if I have the FBI on my = doorstep dropping their wallets......it's getting bad Dennis.....I am =
Caucasian...American born and raised, I just work with labor unions for goodness sakes. Everyone = else is in really serious trouble then......where do they get the money for all of = this...we have people starving all over....they don't need to visit me, my coffee isn't that = good. =20
Thanks, Astraea Kelly =20
--- Astraea Kelly
--- wingsong@earthlink.net
--- EarthLink: The #1 provider of the Real Internet.
--- Astraea Kelly --- wingsong@earthlink.net --- EarthLink: The #1 provider of the Real Internet.
Agreed. But where can you get actual news, real investigative reporting anymore? Sorry, but I trust what gets filtered through the media little more than what comes through Rense.com and the like. Both have agendas, IMO.
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