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.

[Prince Charles]

Bingo. And because this malady is so debilitating, it's entirely likely that the recovering victims (at least the ones who developed full-blown ARDS) will not have the energy to keep their bodies and domiciles as clean as they should be.

[Judith Anne]

So, if China has stopped reporting any new cases, and now a Russian has a confirmed case near the China border, and Taiwan is fudging numbers, and Canada if fudging numbers...

Probably means it's out of control, that's my guess, and nobody's going to report numbers any more.

From the beginning, though, the numbers were suspicious...we've never had any accuracy for various reasons. That just leads me to think worst-case scenario for the fall.

[DoughtyOne]

Thank you for the link. Yes I believe China and other nations do fudge their figures. The problem is, their health care is nowhere near as advanced as ours, so even though their figures are fudged, our's wouldn't match theirs anyway. Extrapolating meaningful implications for our citizens is very difficult. I still maintain that mortality in our nation would be sustained in the 90 plus percentile.

I haven't pulled down Canadian figures yet, but I'll bet this bears out up there.

[Judith Anne]

So, what about the unresolved cases? Are they all going to recover, or will a percentage die? I told you before, these numbers and percentages have been extensively discussed on this forum. I'm not going to argue about it, I think you are badly informed. Perhaps others would care to waste their time giving you information you can get on your own.

This is my last post to you.

[Future Useless Eater]

as of May 21, 2003. A total of 7,956 SARS cases reported to the World Health Organization from 28 countries ;666 deaths

Just scrutinize the very same statistics you are posting...

On May 21st...   3,205 of those cases were still sick; not yet dead, and not yet recovered, so subtract those out.

That leaves 666 deaths (oooh, hadn't noticed that earlier)
divided by 4751 cases resolved on May 21.

By your very own numbers, that makes it 14.0% mortality (one out of seven)

[DoughtyOne]

No problem Judith. I wouldn't respond either if I were you. Why don't you trot out those 50% mortaility figures for those who are gullible enough to buy off on your spin and go into a full scale panic.

Canada has a modern medical system. Are they seeing 50% mortality rates in patients over 60? I seriously doubt it. And I seriously doubt they are seeing 15% mortality rates overall.

[Judith Anne]

Much obliged. Sheesh!

[Prince Charles]

SARS DEATH RATE FOR OLDER PEOPLE MORE THAN 50%: WHO

WHO Raises SARS Fatality Rate Estimates

[Future Useless Eater]

Canada has a modern medical system. Are they seeing 50% mortality rates in patients over 60? I seriously doubt it. And I seriously doubt they are seeing 15% mortality rates overall.

You haven't been studying this for long I see...

Canada has considerably WORSE than the worldwide average...

27 deaths to date, vs only 112 recoveries!

and to make matters worse, deaths take 12 days longer than recoveries, so discarding any recoveries in the last 12 days, gives you...

27 deaths and 106 recoveries

so 27 / ( 106 + 27 ) equals 20.3% mortality in Canada.

[I think Canada's problem is their slow and rationed socialized medicine, and lack of honesty which has cost some patients their lives]

[Judith Anne]

From your second link. Let him who has eyes, see: Case fatality ratio WHO has today revised its initial estimates of the case fatality ratio of SARS. The revision is based on an analysis of the latest data from Canada, China, Hong Kong SAR, Singapore, and Viet Nam.

On the basis of more detailed and complete data, and more reliable methods, WHO now estimates that the case fatality ratio of SARS ranges from 0% to 50% depending on the age group affected, with an overall estimate of case fatality of 14% to 15%.

The likelihood of dying from SARS in a given area has been shown to depend on the profile of the cases, including the age group most affected and the presence of underlying disease. Based on data received by WHO to date, the case fatality ratio is estimated to be less than 1% in persons aged 24 years or younger, 6% in persons aged 25 to 44 years, 15% in persons aged 45 to 64 years, and greater than 50% in persons aged 65 years and older.

[DoughtyOne]

I couldn't find that 3205 figure, but did find 3195 on the WHO site. So this does back up your and Judith's comments. It appears I was incorrect. Thanks for the information. I'd rather be proven wrong than remain under a false impression.

[DoughtyOne]

Judith, thanks to FL_engineer, I do understand where you are getting your data now, and have to admit you are correct. I am sorry I challenged your veracity.

PC, thanks for the link to the WHO site data on the 50% figure as well.

As I said to FL_engineer, it's more important to me to be corrected than to continue on with a false impression. I appreciate your bringing this to my attention. Sorry I gave you a hard time.

[Judith Anne]

Nicely said. The problem is that SARS is a serious illness and a serious threat...it's hard to get accurate information out, and that's been our effort here at FR since the beginning of news of the epidemic.

In many instances, informed speculation on these threads has been borne out in news articles up to a month later. FR is ahead of the curve, in accurate SARS information.

[Prince Charles]

No problem... this virus is a persistent bugger and things change from week to week... just look at how the Canadians thought they could wash their hands of SARS after the travel alert was lifted -- SARS came back and bit them on their great white behinds!

[DoughtyOne]

Thanks again Judith. I appreciate it.

[Judith Anne]

Not a problem, apology accepted. ;-D Stick around, there are some real experts on FR, I'm just a lowly nurse...

[DoughtyOne]

I will be sticking around. This is just the first time I've delved into the subject recently. Evidently the mortality rate was judged to be less early on. These new or more accurate findings, at least to me, are impressive.

[per loin]

As there are no reasonable excuses for believing China's figures, the largest outbreak for which we have figures is Hong Kong. They have recorded 1732 cases. 1302 (75.2%) of these have recovered sufficiently to be released from the hospitals (after an average stay of just over three weeks). 273 (15.8%) died. 157 (9.1%) are still in hospitals. In addition, there are eight suspect cases hospitalized.

[DoughtyOne]

Just wanted to admit to acting like a horses ass to you. My appology didn't reference that and I like to tell it like it is, even if it's at my expense. Thanks for your willingness to accept my appology.

[Judith Anne]

Among our many discussions, that lower mortality rate was extensively discussed...as I posted earlier, the Spanish flu epidemic of 1918 had a mortality rate of around 2.4% and 675,000 Americans died...at 4 or 5%, SARS had double the mortality of that epidemic, so we were very concerned before we knew the true figures.

You made an excellent point earlier, that no one in the US has died of SARS to date...our concern is hospital capacity for isolation, reverse airflow rooms (required in TB and SARS) and the number of ventilators available for the inevitable victims (some say around 20% of those with SARS) who will need them. Tommy Thompson, US health secretary, recently ordered 3000 additional vents for US hospitals, since even now, with ordinary capacity, 95-100% are in use during a NORMAL flu season.

Frankly, I don't think US hospitals are prepared.