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.
You are most likely correct. The best we can do is watch it and learn all we can from what little they will tell us.
I think cheating and fudging are universal. Take Germany for example, rarely if ever do they report a 'probable' case until AFTER s/he recovers.
And the U.S. still has 32 VERY sick patients it seems, as that number is refusing to come down. It's been considerably longer than the worldwide 'average number of days till recovery'. Several of them must be near death and kept alive by extreme measures.
And I don't have much confidence in that Kaiser Permanente SARS situation either. That organization was the WORST!!!
A reasonable cocern, but I would stipulate that it is nearly impossible to maintain a position that would be able to absorb the effects of any pandemic. The O&M costs would be staggering. I am not saying that we shouldn't take reasonable steps which would allow us to move to a full up defensive posture more rapidly if this SARS turns out to be more deadly in the second round as was the Spanish Lady.
I have followed all of the SARS threads (or most of them). I dropped off posting early on in the SARS discussions because the uninformed naysayers were getting on my nerves. I note that you have hung in there from nearly the beginning. Kudos to you.
The latest round of speculation in the press is that we have paid too much attention to SARS to the detriment of more menacing problems, the latest being the West Nile problem. I guess some folks think everything is a zero sum game. The concept of parrallel processsing and dynamic response is totally foreign to their pea pickin' intellects.
I'm not in the medical profession so I can't say for certain. I would note that after 9/11 that the feds started stockpiling bio/chemical/medical gear and then palletized the material so as to be able to transport it to affected sites by military cargo planes. That wouldn't be out of the question. Surveying capabilities, by region, to deal with a SARS pandemic is doable. This would at least identify where investment in the infrastructure is critical. Even without SARS rearing its ugly head, the statistical occurence of pandemics suggests that we are overdue and if SARS goes away then what other bug is around the corner?
Given the role of viruses in nature, and given the total biomass available on the planet for a mutated virus to exploit, it is inevitable that we will be dealing with a massive problem, probably within most of our lifetimes.
Do the majority of SARS patients require ventilators and, if so, just masks or with trach tubes?
The Fall/Winter could see a return of SARS in pandemic proportions and I certainly hope that the supply of ventilators will be sufficient for such a situation.
It appears that SARS outbreaks in areas without sophisticated medical device availability would result in a vastly greater mortality rate than that experience so far!
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