Study offers first picture of effects of SARS

CTV.ca ^ | May 28, 2003 | CTV.ca News Staff

[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.

[Judith Anne]

I take exception to your post that N95 masks aren't necessary. Otherwise, thank you for posting...

[Judith Anne]

I just read in a NEJM article here:

http://content.nejm.org/cgi/content/full/348/20/e6

that SARS can be spread from person to person DURING THE INCUBATION PERIOD, before any signs of the illness show...

That's the worst news about this disease that I've read.

[Judith Anne]

Just pinging you to my previous post, my apology I forgot to put you on the list...

[blam]

"That's the worst news about this disease that I've read."

So, even when you don't know you have it, you're already infecting others. Bad news!

[EternalHope]

Thanks for your GREAT link to SARS studies!

[Judith Anne]

No, Cathy, it wasn't like that...the article is from May 15, it's just ME who is surprised...apparently everyone else already knew it...I was going along assuming (yes, I know) that a person had to have symptoms and be out of the incubation period before the disease could spread...

[CathyRyan]

I am truly starting to believe that the people on these sars threads know more about sars that the "experts". FR is just flat out ahead the curve on sars. It seems daily there is something that pops up that we have already heard about.

[Judith Anne]

Exactly. Can you imagine some Toronto Teen, cruising the mall, sure she isn't going to come down with anything, spreading SARS all around...

[Judith Anne]

I'm still getting over the shock of learning that people can spread SARS in the incubation period...that one slipped right by me...

[CathyRyan]

I am sorry I am going to sit in the corner and be quiet. I have read so much and things have gone back and forth so much that I do not know if I am coming or going. IIRC there was an article in April that talked about someone contracting sars from someone before that person shows symptons. I wish the search engine on FR was good enough to find that needle in that hay stack. Maybe someone else remembers the article. I believe it was two health care workers.

[CathyRyan]

Night all! :)

[Judith Anne]

Cathy, I'm writing you a Freepmail...

[Concentrate]

I've read a lot of the SARS threads, but I can't remember that particular one. Diseases being so complicated, it's not illogical to entertain the possibility that one can infect others without yet having symptoms.

I hope this is just something that will pass. If I get SARS, I think I'll just stay home and deal with it. I've never been in a hospital before, and I think I'd rather do it at home. I'm in an industry which puts me on the front lines. I don't want to spend months in a hospital room and then die anyway, or have permanent lung, liver or kidney damage.

I suspect that many in China and other places feel the same way as I do.

[Screaming_Gerbil]

Any practical suggestions about what we should be doing on an individual basis NOW and in the coming few months to prepare for a possible SARS disaster in the fall?

Have enough money in the checking account and canned/dried food and related supplies in the basement to stay inside the house for one month?

Several bottles of Vinegar (white or apple or doesn't matter?).

Disposable latex gloves and disposable N95 masks?

Oxygen bottles and mask?

Get Will and Durable Power of Attorney up to date?

Plan on going up North and living in a tent in the woods from September of this year to March of next year?

Seriously, knowing that nothing is guaranteed and the best laid plans can go astray, what would be the most practical steps for concerned (non-paranoid) individuals to take between now and the Fall?

[TaxRelief]

The NEJM article is written by Jeffrey Drazen. Many consider him to be, well, impulsive. He has had to retract things in the past.

Remember this is an editorial not a research article. I am now combing through the research, and while I do buy the logic, there is no empirical evidence of pre-symptom infection. Link to research:

http://content.nejm.org/cgi/content/full/348/20/1977?ijkey=698fc666a33597e1ef563f0c35d47f5516a940a7

Let's not jump to conclusions based on one analysis by J. Drazen, (who has retracted things in the past).

[TaxRelief]

What precautions for next winter? Your #1-5 are always good to have in place anyway, but expand it to whatever is in the FEMA manuals.

#6 is an emergency option to be ready to use. Buy the land now though, while it's still cheap.

</tin foil hat

[CathyRyan]

My computer crashed and trashed (crashed and I had to reformat my hard drive so I lost all my sars data). It was part of an article that was on something else as the main topic and the getting was sars from soneone without symptoms was just like a throw away in the article. I think I will try to find it. It was at a point in time that info. on sars was changing so fast that if just got swept away. I will start digging.

[CathyRyan]

I gave up looking. :)
Please, forget I made an issue out of known prior asymptomatic transmission of sars.

[BartMan1]

Can try this link to the Lancet home page; may have to sign in , but the article is available as a free download, either as PDF or text. Volume 361, May 3rd issue, pages 1519-1520.

http://www.thelancet.com/