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.
LInfectivity might therefore be variable over time, even during the symptomatic phase of the disease. Indeed, preliminary findings from sequential quantitative RT-PCR analyses of nasopharyngeal aspirates suggest that the viral load might peak at around day 10 after the onset of symptoms and then decrease to the levels obtained on admission at day 15 (Peiris II).
Quarantine during a completely non-contagious period is obviously not needed. The standard protocol is to quarantine everyone who has come in contact with a suspected case. Since this would be unnecessary if the person were guaranteed not to be contagious, it follows that the "authorities" have concluded there is at least some chance of contagion during this period. I also suspect the quantity of virus shed is so low that the odds of infection during this time are low.
I suspect the "authorities" believe the public is incapable of making these kinds of distinctions, so the party line is simply that people during these times are not contagious.
Interestingly, the United States does NOT seem to be following the "quarantine everybody" approach that the rest of the world is following. I trust our CDC and our medical system far more than the WHO. Are we making a mistake? There is LOTS of food for thought here.
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Posted by CathyRyan to per loin
On News/Activism 04/07/2003 5:23 PM EDT #10 of 11
Disease expert stricken by SARS
The director of infection control at Toronto's Mount Sinai Hospital is recuperating in that hospital from SARS.
Dr. Allison McGeer, one of Canada's leading infectious disease specialists, contracted the disease from a staff member at the hospital. The health-care worker was not showing symptoms of SARS at the time, but went on to develop the disease.
McGeer, has been in the hospital, in isolation, for the last week, the hospital said Monday.
It was exposure to McGeer that sent the hospital's senior infectious disease expert, Dr. Donald Low, into quarantine in his home early last week.
Low has shown no signs of developing SARS. His period of quarantine was to expire Tuesday morning.
http://canada.com/national/story.asp?id=69DDE87E-D7AE-4680-A592-AE2CE1AB3A3C
If this is true...this is not good.
http://www.freerepublic.com/focus/f-news/887259/posts
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SARS patients are free of the virus once the symptoms leave. "SARS is most infectious in the incubation period. Once the symptoms disappear, the virus also goes. This virus is not like HIV, which remains in the body forever," Seth said.
http://economictimes.indiatimes.com/cms.dll/html/uncomp/articleshow?msid=43811556
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Posted by aristeides to 11th_VA; CathyRyan; Mother Abigail; Dog Gone; Petronski; per loin; riri; flutters; Judith Anne; ...
On News/Activism 05/08/2003 11:03 AM EDT #47 of 50
Dr Heymann and other health officials told the House hearing there was no evidence people transmit the virus before they develop the cough, fever and pneumonia that characterize SARS.
Curious way to express oneself. I wonder why they didn't say that the evidence suggests that there is no such transmission before the symptoms develop.
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http://www.freerepublic.com/focus/f-news/907555/posts
Sadly, no.
One of the early hopes was that SARS would burn itself out. One sign of this would have been that victims with a mild case only pass on mild cases. However, mild cases have been repeatedly shown to pass on severe cases. There is no sign of weakening even after the virus has passed through 15 generations.
Someone may not have developed the dry cough that is probably the biggest culprit in spreading the virus, but people who are not ill often cough and sneeze everyday over some minor irritant. These "routine" expulsions of air could very well be laced with the virus, and nobody thinks a thing about it.
To quote the article ("Hong Kong researchers"):
Many of those who recently caught the disease in the city are believed to have picked it up from other hospital patients before the latter showed obvious SARS symptoms.
http://www.freerepublic.com/focus/f-news/881127/posts
Certainly not, although I may have done a poor job explaining my point. I was simply trying to say that people do not need to be quarantined unless they have a reasonable chance of being contagious at the time.
The question was triggered by a discussion about when people become contagious.
The official line is that people are not contagious until they become symptomatic. However, if the "authorities" truly believe people are not contagious until they are symptomatic, then why quarantine people immediately?
My personal opinion is that the "authorities" suspect a person may become contagious before they are symptomatic, but that they are worried about the public reaction if they say so. Hence they are using a quarantine protocol that implies they think you may be contagious before symptoms develop, but telling the public not to worry.
That line of thinking led me to question why the U.S. is following a different quarantine protocol.
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