Posted on 05/29/2003 12:27:11 AM PDT by Judith Anne
A new study, released early by the Canadian Medical Association Journal, shows that the toll SARS takes on health care workers is more profound than many doctors expected.
The research is based on 14 Toronto-area health care workers, many of them nurses, who developed SARS in late March. They suffered from fatigue, pneumonia, and in some cases severe life threatening anemia.
Of the 14 studied, 13 have still not returned to work, weeks after they were released from hospital. And many may be suffering from Post Traumatic Stress Disorder, similar to soldiers returning from war.
The study is the most detailed clinical analysis of what happens to people hit by the new and mysterious illness. It was released on the CMAJ website about a month before the paper's appearance in the print version of CMAJ.
CMAJ STUDY:Clinical course and management of SARS in health care workers in Toronto
The study found that the disease usually developed within four four days of exposure. It often caused full pneumonia in less than three days. Patients remained in hospital for a mean of 14 days.
Many suffered temporary heart problems and long term breathing problems that still persist up to eight weeks later, leaving them breathless and exhausted.
"These are healthy health care workers. The mean age was 42, so they are not old people," explains Dr. Monica Avendano, one of the authors of the study.
Another key finding from the study is the high number of patients who developed severe hemolytic anemia. Some required lifesaving blood transfusions.
The doctors aren't certain whether the anemia is a results of the SARS itself or a complication of treatment, possibly associated with the use of ribavirin, an anti-viral drug doctors were testing on patients at the time. The drug is no longer in use.
Most striking of all the effects were the deep psychological and emotional problem, including insomnia and nightmares. Most of the patients expressed feelings of fear, depression and anxiety at the time of the acute illness.
Pat Tamilin, one of those studied, was "sicker than I've ever been ... it's worse than any pneumonia." And she's concerned about going back to work. "I don't want to be the first health care worker to get SARS twice," she said.
In addition, many of those in the study expressed frustration at being in isolation and without contact with family and loved ones. This was particularly the case for those patients with young children, and especially the two patients whose children developed SARS.
"We are convinced that they have some sort of post traumatic stress disorder," says Dr. Avendano
There was one bright bit of news. The study found that the 14 subjects had contact with 33 family members. Of them, only two developed SARS, and both were mild cases. But disturbingly, one didn't develop symptoms until 12 days after the last contact with the family member -- suggesting that the 10-day quarantine period currently recommended may not be long enough.
The conclusion of the doctors is that SARS is a fast moving disease that if survived, results in a long slow recovery once the acute phase of the disease ends -- as long as two months.
Only one of the 14 subjects has returned to work. If that trend continues and more health care workers are similarly affected in this second wave of cases, it could seriously deplete the health care system.
"The disease continues to linger, the inflammatory process stays for a long time, and we don't know how long," says Dr. Peter Derkach, another of the study's authors.
That's why researchers plan to follow these health care workers for some time to come, to get the clearest picture of the long-term effects of the disease.
If I had SARS, they could not keep me from calling the press. Quarantine doesn't mean no contact with the world.
Mode of transmission is being studied. Treatment options are already undergoing trials. What do you think we don't know?
"Basically, what we're saying is this is a hospital disease. It has been from the start and it continues to be. It doesn't do well in the community," he said.
I am so sick of seeing this ridiculous statement, I could scream. If this were true, the best way to end SARS would be to keep patients out of the hospital. Stay in the community.
Well, in a way - if people were well-separated and didn't interact, the disease would burn itself out. By bringing people into the hospital we concentrate the pathogen. The problem is, of course, all the other people there - staff, other patients, families - who may then acquire this (seemingly) airborne virus, then while it incubates go about their business and pass it on.
If there were to be a serious quarantine where there were no interaction, then, the spread might be checked long enough to get a vaccine developed.
The problem, of course, will be getting people to stay home and not go to work if they feel ill. It's bad enough with flu and colds.
I have said the same thing.
I'll go a step further. Imagine you are in a city where there are SARS cases. An illness makes it's way through your family, killing a family member. Meanwhile, the officials and medical types try and sell you a bill of goods, telling you it was not SARS? Are you going to keep quiet?!
It most certainly does, as Taiwan, Hong Kong, and Beijing can attest. It hasn't done so in North America to any great extent because we are so aggressive about hospitalizing and quarantining.
It most certainly does, as Taiwan, Hong Kong, and Beijing can attest. It hasn't done so in North America to any great extent because we are so aggressive about hospitalizing and quarantining.
Bleach is also generally good against chemical warfare agents, so people can kill two birds with one stone as it were.
Vinegar full strength, to me, means 96% glacial acetic acid. :-) You're writing of grocery store vinegar?
As far as equipment goes, gloves are available as you note. Regular handwashing, refraining from touching one's own face, and preparing one's own food and dining at home, will probably give the greatest reductions in infection probability for the least effort.
I wrote: The problem, of course, will be getting people to stay home and not go to work if they feel ill. It's bad enough with flu and colds.
I should amplify that by noting that quarantining a person at home will likely result in infections amongst the entire family. That is not good, and the family members will likely carry the pathogen outside the home as they go about their business, which is even worse.
Zounds! Your screen name is no joke!
Nope. I've worked hard to make it so! Grad school was a real pain... grumble grumble... Three years on and I'm still complaining about it. I did learn about Free Republic while there, so it's not all bad. *grin*
There's no doubt that 96% acetic acid will make for a very effective disinfectant..! One only wonders if the substrate will survive the disinfection process...
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