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.
Astraea Kelly is a Communist labor-party organizer under the employ of the AFL-CIO. Read my posts for some documentation on her. Watchman 123 either is her or is in contact with her when he is not selling oxidation machines.
I hope none of you are giving out your private email addresses or contact info to these people.
Just logic should tell someone "buyer beware".
I agree it is a fine line determining what should be posted and what should not be posted. But, if what the determining factor of what constitutes news has to come off the wire then we are subject to only getting the information that is allowed to be filtered out to the sheeple.
I haven't read your post re: this Kelly person but it looks really interesting. I haven't even seen any of this watchman123's posts but I did originally post something from the rense site. I did mull it over but in the end decided to post it. My thought is if SARS does hit, it will be through alternative sources that the rumblings will begin, IMO.
That is magic of this forum---the b.s. eventually exposed and weeded through.
It is a tough balance.
I agree, also. Additionally, it sent off alarm bells when she refers to it as a "sars-like" illness. Then she says she is ill with "sars-like" symptoms.
This isn't some mild illness that you can continue your daily routine and have for too long. You either have it or you don't, I would imagine.
This article says shipping fever is caused by a coronavirus, but I thought it was caused by bacteria.
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