Posted on 06/06/2003 10:27:36 AM PDT by CathyRyan
A month before Toronto was plunged into a second, mysterious SARS crisis, nurses at Toronto's North York General Hospital warned in vain that three psychiatric patients appeared to have caught the disease.
The ward lies directly below the SARS unit that had been newly installed in the facility. Nurses heard reports of a "leakage" from the SARS unit to their ward at about the time the patients got sick in late April. But their superiors at North York General said their concerns were unfounded, one nurse said this week, the patients were never recorded on SARS logs and Toronto's outbreak was later declared finished.
Now those nurses wonder whether the new outbreak that has been traced back to North York -- and has sickened more than 65 people, killing five of them -- may have started on their psychiatric unit. "There was something leaking," said a hospital staff member this week. "The nurses at the time were thinking: this is strange that this came down and then those patients got sick."
"I wouldn't be surprised if this whole [cluster] came from one of those patients.... There should never have been a second outbreak like this."
A hospital spokesman said yesterday she had no information about such a leak and Donald Low, the microbiologist who is investigating the North York cluster, said he does not believe the psychiatric patients hold the key to the origins of the latest outbreak.
Regardless, the nurses on that ward were among several at the hospital to warn that a new batch of SARS might be brewing, only to have their concerns dismissed by hospital officials. It was not until May 22 that the city learned it could be facing a new cluster.
The warnings leave a nagging question: Could the latest outbreak of SARS have been caught and contained weeks earlier?
Nurses outside SARS wards at North York General warned at least three times in early April that they might have a patient with the disease, said Doris Grinspun, executive director of the Registered Nurses Association of Ontario.
A few weeks after the psychiatric nurses raised a red flag in late April, emergency-ward staff complained that a 96-year-old surgery patient and four family members had a virulent atypical pneumonia looked suspiciously like SARS.
Some of them said this week they were struck by the sudden shift in gears after the first outbreak was all but declared over in mid-May.
"Even before the second outbreak, even before that weekend with the family cluster, people were questioning: 'What's happening, why are we having this sudden about-face? Why are these people suddenly being diagnosed with viral illness, instead of SARS?" said one nurse. "We were told that if the public or patients ask us if we have SARS at this hospital, that we are to say 'No.' " At St. John's Rehabilitation hospital, nurses raised the alarm on May 20 about patients there who seemed to have SARS. Public health officials were called in, and the patients put in isolation. But it was another two days before official fears of a new outbreak were made public and the hospital closed to visitors, notes Barb Wahl, president of the Ontario Nurses Association, a union.
Officials traced those cases back to North York General, eventually linking them to the 96-year-old and his family. Both he and his wife died, while his daughter, son-in-law and grandchild also got sick. Experts are still baffled about how he contracted what now appears to have been SARS.
Ann Marie Sluga, a hospital spokeswoman, said North York handled the situation responsibly, calling in public health to investigate whenever any staff identified a possible SARS case. The health department's advice was always followed to the letter, she said.
"Every single time, we did it," said Ms. Sluga. "Why would a hospital not do it?"
In fact, the hospital administration may have little to do with how the early warnings were handled. In all the cases, SARS was at least initially ruled out because a crucial element in the clinical definition of the disease was missing. There must be an epidemiological link to a known source of the virus, be it a patient, a contaminated hospital unit or an Asian hot spot of SARS.
Some are suggesting that the definition be modified, at least until someone develops a laboratory test to identify SARS.
"The current criteria of having an epi-link is just not good enough," Dr. Low said. "We're going to have to ask the question: For every patient in hospital who has a fever or a pulmonary infiltrate, are we sure that it isn't [SARS]? If we're not sure, we're going to have to treat them as if they are." Meanwhile, the registered nurses are preparing a formal request for a public inquiry into the origins of the outbreak, though the idea has been rejected by the province. It has appointed an expert panel to look into how the crisis has been handled.
On a ward where patients virtually never get pneumonia, the psychiatric nurses were surprised that three of the people in their care had developed the condition.
Word of a leak, possibly water from a radiator, from the SARS ward increased their concern, said a hospital employee. Hospital officials told them, with no epi-link, the cases could not be SARS. "They were telling the nurses it definitely wasn't SARS; they didn't have to wear masks or gowns."
Dr. Low stresses the hospital did all it could to respond to the nurses' concern. He said the team investigating the outbreak had an engineer look for leaks from the SARS ward, but he found none.
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