SARS in Toronto! - page 10

Hey I just saw on the news that a thousand people have been quarentined at a hospital in Toronto! Do you all know anything about this? I hope our Toronto members are alright. Is this virus... Read More

  1. by   ainitfunny
    Are we really being told what we need to know or what others want released to manage public perception?


    Unmasking A Crisis

    As SARS rages in China, some cadres are more intent on saving face than saving lives. TIME investigates a cover-up that may have killed

    This is the hospital ward China's Ministry of Health doesn't want you to see. There are more than 100 Severe Acute Respiratory Syndrome (SARS) patients crammed into tiny rooms in the infectious diseases section of Beijing's You'an Hospital. "Every single one of us in this building is a SARS patient," says a nurse surnamed Zhang who worked at the People's Liberation Army Hospital (P.L.A.) No. 301 until 11 days ago, when she was diagnosed with the disease and admitted here. "There are at least 100 SARS patients here, if not several hundred. The conditions here are really bad. We're not allowed out of this room. We piss in this room, crap in this room and eat in the room. As far as I know, at least half of the patients here are doctors and nurses from other hospitals." As a Time reporter continued through the ward, another nurse who wouldn't give her name stopped him and explained, "Look, I'm not pushing you away. I do this for your own good. It's too dangerous here. It's really a terrible disease, even we who work here don't know when we'll get it. No place is safe in this hospital. All of these wards are full of SARS patients, there are over 100 at least. Don't believe the government--they never tell you the truth. They say it's a deadly disease with 4% mortality? Are you kidding me? The death rate is at least 25%. In this hospital alone, there are over 10 patients dead already."

    According to the Chinese government, most of these patients--and perhaps hundreds or even thousands of others across the nation--simply do not exist. Before the reporter is hustled out of You'an's teeming isolation ward, nurse Zhang warns, "Never believe what the Health Ministry tells you."

    SARS: What Did Beijing Know?
    Unmasking a Crisis
    Stalking a Killer
    April 21, 2003 Issue
    CNN Top Headlines

    China, flush from having won the right to host both the Beijing 2008 Olympics and the 2010 Shanghai World Expo, may be presenting a rosy, reformist face to the rest of the world. But the country's handling of the deadly SARS epidemic, which is believed to have originated in the southern province of Guangdong last November, shows that behind closed doors Beijing can be as inscrutable and secretive as ever. Numerous reports from local doctors over the past week suggest that the nation's health-care system remains hostage to a government that values power and public order before human lives. "You foreigners value each person's life more than we do because you have fewer people in your countries," says a Shanghai-based respiratory specialist, who sits on an advisory committee dealing with epidemic diseases. "Our primary concern is social stability, and if a few people's deaths are kept secret, it's worth it to keep things stable."

    The question is: Just how many deaths can be kept secret before the health epidemic itself becomes a threat to social stability? For decades, China's Ministry of Health has deliberately kept killer outbreaks hidden, hoping that deadly diseases will burn out on their own without interference, or scrutiny, from the international medical community. After all, China is a big country, it says, and it's natural for a case or two of plague or rabies to pop up; why worry the populace unnecessarily? But Beijing's emergency plan may be backfiring with SARS, which has burst out of the mainland's national boundaries to kill 116 people and infect 2,890 worldwide as of last weekend. Yet even as the deadly pneumonia proliferates around the world--Africa is the latest continent afflicted with the bug--China continues to massively underreport its own SARS epidemic. In the metropolises of Beijing and Shanghai, local doctors and nurses whisper of hundreds of cases piling up in epidemic wards. And citizens who have put faith in China's health-care system for decades are beginning to wonder whether their long-held trust has been dangerously abused.

    Even as late as last Saturday, China's health authorities continued to stick to an accounting of 60 SARS deaths and 1,300 cases--even though China's Premier Wen Jiabao visited You'an Hospital, where medical staff say the full caseload there has not been incorporated into the figures. In an effort to ease an increasingly worried populace, Beijing's recently appointed Mayor Meng Xuenong claimed last Thursday that Chinese health officials have "full control over atypical pneumonia." Meanwhile, medical authorities maintained that most SARS cases in China outside of Guangdong were "imported," proving that cities such as Beijing and Shanghai were not themselves breeding grounds for the disease.

    But even as the government continued its policy of denial, a number of whistle-blowers began contesting Beijing's numbers. On Tuesday a retired military hospital surgeon alleged that in one Beijing hospital there were more than 60 SARS patients and seven deaths from the disease. A local cadre from Shenzhen told Time that during an internal meeting last week, a city health official spoke of at least six deaths there so far while still publicly denying any cases. And in Shanghai, local doctors spoke of 14 cases at one hospital, while Dr. Li Aiwu of the Shanghai Pulmonary Hospital confirmed that seven foreigners were being treated for the disease--contradicting the city's previous claim that no foreigners were suspected of having SARS. "I guess that means I don't exist," jokes a middle-age Englishman who has been confined to its 14th-floor isolation ward for a week.

    The Manchester native connects with the outside world by cell phone. "The care here is good, but I must admit I'm feeling a little cut off from the real world."

    China's continued obfuscation contributed to the U.S.'s issuing a travel advisory warning against nonessential trips to China. At about the same time, Malaysia barred all tourists from mainland China and Hong Kong. In Hong Kong, the government reacted to the continued increase in local SARS cases and criticism it had been slow in dealing with the disease by finally ordering household contacts of confirmed patients to stay in home quarantine. Travelers wishing to fly from Hong Kong's Chek Lap Kok airport would also have their temperature taken before they were allowed to board their flights. In the mainland, luxury-hotel occupancy in Shanghai has slipped from the usual overbooked 120% this time of year to 30%. High-level trips by former U.S. President George Bush, Singaporean Prime Minister Goh Chok Tong and a World Economic Forum event have been postponed or canceled. "The drop-off in visitors is worse than in 1989," grumbles a Shanghai foreign-affairs official, referring to the foreign exodus after the Tiananmen crackdown.

    In a country where mass revolts have regularly paralyzed empires and regimes, the Communist Party is apprehensive about panicking the people. And now that China's booming economy is more dependent than ever on foreign investment--54% of Shanghai's industrial output, for instance, derives from foreign-owned or partially foreign-owned companies--the Party is doubly concerned about maintaining the appearance of stability. "Look at what happened in Hong Kong, where everybody's scared and wearing a mask," explains a senior aide to Shanghai's vice mayor, blaming the foreign media for stirring up jitters about the killer virus. "We don't want everyone to get panicked like that for no reason and destroy our economy." Furthermore, with the major May 1 holiday week rapidly approaching, local tourism officials are worried that the SARS scare will deter Chinese from traveling and spending their yuan.

    China has a long history of not facing up to its medical problems. Prior to SARS, the country had been notoriously unwilling to publicly admit to its burgeoning aids epidemic. When news trickled out three years ago of tens of thousands of farmers in central China infected by HIV after selling blood to traffickers using tainted equipment, the government delayed more than a year before conceding the truth. Even then, Beijing insisted the virus contaminated only one tiny village in Henan province. Finally, in 2002, the Chinese leadership revised its HIV estimate from 30,000 cases to 1 million--in a single day. Similar night-and-fog tactics kept quiet an outbreak of food poisoning in the northeastern province of Liaoning last month, when three schoolchildren died and 3,000 were sickened after drinking tainted soy milk. Even with hundreds of students flocking to hospitals, local authorities denied for weeks that there was anything amiss.

    Most doctors are too frightened of losing their jobs to tell the truth about such cover-ups. A doctor who told a TIME reporter that there were dozens of SARS cases being isolated in a tuberculosis ward at Beijing's No. 309 People's Liberation Army Hospital backed out of continuing the discussion, saying, "I'm embarrassed that I can't talk to you. I had really wanted to, but I'm young and I can't afford to lose my job." But other brave souls are finding the courage to speak out. Last week, in a case first reported by Time, retired military surgeon Jiang Yanyong alleged that at the same hospital there were 60 SARS cases and seven deaths, and that at the P.L.A.'s No. 301 Hospital (where nurse Zhang works) at least 10 doctors and nurses had contracted the disease from their patients. Jiang, who initially submitted his statement to the state TV channel CCTV 4 but received no response, says he was spurred to report more accurate numbers because he was so dismayed that the Ministry of Health reported only 12 cases and three deaths in the capital in early April. According to Jiang, another military hospital, No. 302, admitted two SARS patients first diagnosed at No. 301 in early March just as Beijing was convening the politically sensitive National People's Congress. It was only after both patients had died, says Jiang, that health authorities called a meeting, but instead of instructing doctors on how to contain the disease through public-education campaigns, Jiang says medical officials told physicians they were "forbidden to publicize" the SARS deaths "in order to ensure stability."

    Doctors in Shanghai have faced similar political interference. Early last week, physicians at a hospital in the city's Huangpu district were called in by their superior to discuss a new policy initiative straight from the municipal health bureau. For the past couple of months, doctors had been clandestinely searching the Internet for information about SARS, and they hoped for solid information from their director. Instead, he told them not to wear masks in the hospital, save in isolation wards and a few select diagnostic rooms. The gathered physicians were confused. One top administrator meekly said, "I thought wearing masks was supposed to stop SARS from spreading to medical staff." Their superior responded curtly, "Wearing a mask will scare the patients. We do not want panic, especially since SARS has already been controlled."

    Local health authorities can get away with such reckless policies because there's little oversight from above. Health Minister Zhang Wenkang actually ranks lower in the government hierarchy than the Communist Party secretaries of Shanghai and Guangdong. That gives the regional Party bosses far more power than the Health Minister to dictate even medical policies in their fiefdoms. Furthermore, each city's center for disease control (CDC), which is responsible for updating China's SARS caseload, reports first to the local Party boss, then to the Ministry of Health. The head of each city's local health bureau is appointed by local Party cadres, not by the Ministry of Health. That structure means local health workers have little incentive to reveal the true magnitude of the crisis.

    Even doctors on the front lines have been left in the dark, sometimes to their detriment. At Beijing's You'an Hospital, for instance, nurse Zhang estimates that about half of those in the isolation ward are medical staff from other area hospitals. To complicate matters further, the only people who are officially allowed to diagnose SARS in China are CDC researchers, not the physicians who are treating the patients. "I had a patient whose symptoms clearly seemed to be those of a SARS-positive patient," says a doctor who consults at a hospital in a leafy district of Shanghai. "But after I contacted the CDC, the patient was suddenly transferred without my knowledge and I never found out whether he had the disease or not." The physician presumes the patient did indeed have SARS; otherwise, why would he have been transferred so mysteriously? "We doctors are all left with a lot of questions," he says. "I think it's shameful to not let us know what's going on." That information blackout has resulted in unnecessary deaths as local doctors have resorted to trial-and-error treatments rather than using therapies that have proved relatively effective in other hospitals. Physicians in some Guangdong hospitals, for example, were told by Beijing to treat SARS patients for mycoplasma pneumonia and chlamydia pneumonia, which are bacterial infections, even though they had already found that a combination of antiviral medications and steroids showed better results.

    Part of the confusion might be springing from China's accounting methods. Current diagnostic tests for SARS are unreliable at best, and doctors worldwide have had to diagnose primarily by evaluating symptoms and proximity to other SARS patients. But with places like Beijing refusing to acknowledge true numbers of infected patients, it becomes difficult to prove that a person has been near a SARS patient, because those victims aren't supposed to exist in the first place. That, plus a more stringent set of requirements applied before confirming a case as SARS means that many patients who would be diagnosed as having the virus elsewhere in the world are only considered "suspected" cases in China. The English patient at the Shanghai Pulmonary Hospital, for instance, has been quarantined for a week, yet the physicians there have told him there's no way they can tell whether he has SARS. "I've heard that in other countries they're able to diagnose within a few days," he says, between dry coughs. "Why can't they diagnose our cases? It's very strange." (The Englishman's doctor says he is treating the man's case as SARS, although the CDC has yet to confirm the case as such.)

    Last Thursday it seemed the Ministry of Health couldn't even agree on its own SARS count. At a press briefing in Beijing, Qi Xiaoqiu, director of the Ministry of Health's Disease Control Department, said China's official SARS statistics include "confirmed and suspected cases." Just minutes later Vice Minister of Health Ma Xiaowei told reporters that the numbers he had stated referred only to confirmed cases. Either way, experts agree that the ministry's reckoning still seems far too low. Mainland doctors fret that with continuing ignorance about the disease, the virus could spread even farther. Misinformation abounds: a Shenzhen-based health official named Zhang Shunxiang warned last week that people shouldn't wear masks because they impede proper breathing and contribute to public panic--contrary to advice given almost everywhere else in the world. State-run newspapers in the mainland suggested that a protein-rich potion containing cicada shells and silkworms could be a SARS panacea. Even more worrisome is the possibility that the disease is making its way into China's estimated 100 million-strong migrant worker community, which has little access to health care. Already, doctors suspect that the first case of SARS in Beijing was a migrant who worked in Guangdong. If the virus is indeed infecting members of China's vast floating population, experts fear it could spread quickly into the country's undeveloped interior. With much of China still in the dark about the killer bug, the worst may be yet to come.

    --With reporting by Bu Hua/Shanghai and Huang Yong and Susan Jakes/Beijing
  2. by   oramar
    Wow, ain'titfunny, did you read that part about the nurse that claimed the death rate is 25%? That is why I wrote in my last post that said nothing is for sure yet. The printed reassurances that I have read all sound a little to smug for a situation where no one is sure of anything. The same day those articles saying "don't worry about it, the death rate is the same as any other pneumonia" came out I saw the head of the NHI saying "we can't confirm those numbers" during senate hearings.
  3. by   epaminondas
    Greetings Ontario!

    I write from south of the border.

    No SARS deaths here yet. Not even any cases yet in our state.

    I am looking to your experience with SARS to learn. Wondering if I am looking into the future . . .

    Or if SARS is now something for which we might be prepared - based on others' hard-won experiences - so that the U.S. might not get hit as hard.

    Until coming across this bulletin board I have not really had much feel of real people writing from the front lines.

    I have two areas of concern:

    (1) Are things calming down in Ontario? Getting back a bit to normal, or perhaps developing a "new normal?"

    Or are things getting a desperate feeling of getting out of hand?

    Is the fire being put out - or is the fire out of control?

    How would you describe the situation - both intellectually and gut?

    Any raw fear in the middle of the night?

    Or just going about one's necessary business, day by day?

    (2) What do you think might happen down here?

    Thank you,

    Last edit by epaminondas on Apr 16, '03
  4. by   sixes
    i don't know that things are getting any better but i am also reluctant to say they are getting worse. everyone in health care must be very cautious and regimental about taking precautions. there are no sars cases in kirkland lake yet. it seems to be mostly in toronto and near by communities. i think i heard of some cases as far north as barrie ont. all our hospitals are on alert and everyone entering the hospitals are screened.
    many nursing students are in limbo and those of us that were to start new jobs or hospital related schooling are on hold.
    here are some new links. sorry i don't know how to get the stories transfered like the rest of my brillant friends on this board.
    have a good day and may you all be sars free. i pray every day for you all.

    stay home: md

    constant quarantine for dialysis

    how 1 case became 600

    baby born to dying sars mother

    eves:rises above fear

    who say beijing has 100 - 200 sars cases- more than publicly reported
  5. by   fergus51
    Fatality rates here are not 25%, they are less than 5%. I can't comment on China, cause I don't know about how they are treating the illness.

    The latest here is that someone with SARS went to a church function before knowing that he was infected so they are trying to track down the others who were there. It is a definite setback.
  6. by   steven44121
    The situation is -- we are now in a new normal. Healthcare delivery will be a pre an post sars world. The public health admits that stringent visitation, screening and most disheartening masks are here to stay until such time as a vaccine is developed.
    Masks are horrible, you get sweaty, lightheaded and headachy.
    I know I cannot work like this for a long period of time and will look at other options besides hospital nursing if this does indeed continue.
    You asked for gut feelings -- well my gut tells me this is getting out of control. Whether or not the recent exposures at a church service can be traced back to the initial cluster, however you say it, the fact is this is community transfer. These people are now in isolation or have sars after going to church. I think we are going to see much worse before we see things get better.
  7. by   ainitfunny

    Affected Areas - Severe Acute Respiratory Syndrome (SARS)

    16 April 2003

    Country/ Area
    Canada Toronto
    Singapore Singapore
    China Beijing, Guangdong, Hong Kong Special Administrative Region of China, Shanxi
    Taiwan Province*
    United States of America Areas not reported*
    United Kingdom London*
    Viet Nam Hanoi

    An "affected area" is an area in which local chain(s) of transmission of SARS is/are occurring as reported by the national public health authorities.

    *Area with limited local transmission and no evidence of international spread from area since 15 March 2003 and no transmission other than close person-to-person contact reported.

    About WHO | Employment | Other UN Sites | Search | Site Map | Suggestions
    Copyright 2003 World Health Organization
  8. by   sixes
    More links
    Provinces Holiday Plea

    Tests confirm Virus

    Beijings hidden cases

    City feels Pain

    Angry Medics slam order

    Scientists confirm cause of SARS

    This is far from over but at least they say they know what to look for and prehaps it won't take long for a vaccine to be developed. All we can do is cross our fingers and pray.
    Stay safe everyone and have a great day
  9. by   Trishrpn
    Hi: I'm new to this forum but I just wanted to post on this subject. I'm an RPN working in a busy emergency dept in Toronto. I've read all 7 pages of discussion on Sars in Toronto and the rest of the world.

    I've been very curious as to how nurses/hospitals in the USA are handling suspect or probable SARS cases. Have any American nurses in this group worked with any SARS cases yet?

    Here in Ontario, particularly Toronto, we've really been clamping down in our fight against SARS. It feels like a war and as a nurse in the emergency room I can tell you that it certainly feels like I'm one of the front line soldiers in this fight.

    As you all probably know by now- By March 27th we were under order from the Health Dept to carry out
    Isolation precautions on all suspected cases (I believe our hospital was
    already doing that) and for all staff in Toronto Emergency Dept's to begin
    wearing protective Respiratory Isolation gear at all times in the dept. By March 29th the order was changed to cover not just the city of Toronto but
    all of Ontario, and all non-essential personnel, volunteers and visitors
    (except in palliative, severely ill, or Maternity (the father) cases) were
    not to be allowed into the hospital. We are also only allowing employees
    to enter and exit the hospital by one door; visitors that are allowed in -
    enter and exit by another door, and Emerg patients only are allowed to
    enter through the emergency entrance. Everyone is being screened for SARS before entering the hospital- temperatures are taken, questionnaires filled out, everyone is given a mask that they must wear at all times (except when eating) and health care workers are given isolation gowns to wear. In Emerg we are now supposed to be wearing the N99 mask, but of course they usually don't have these masks.

    So, for the last 21 days, when I've been working, I've had to wear
    Isolation gowns, gloves, goggles and heavy duty masks. We generally work
    12 hour shifts in the Emerg dept so wearing all this extra gear for the
    whole shift makes for an even longer day. I believe they have also shut down or restricted the ventilation systems in our emergency dept and Isolation ward so with all this gear on and lack of air circulation it's very hot.

    On top of that when we are caring for a person that is in Isolation as we try to determine if they are a suspect or probable case we double glove, wear goggles, double gown, wear a hair net and put a light surgical mask over our N95 or N99 mask. Work ups on suspect cases of Sars in the emerg take approximately one hour with ecg, initial blood work, then secondary Sars Work up blood work and swabs, plus starting IV etc. We are almost always close to passing out from overheating and lack of 02 by the time we come out of an isolation room or area.

    The first masks that we were
    issued didn't have a special vent on the front so we were breathing our own carbon dioxide all day ... picture working for 12 hours with headache and nausea and with the added distraction of realizing that you keep forgetting things- ie going into a room with only one item when you should have brought 5 ... this too was a side effect of the first masks we had to
    wear. Now the masks we are wearing have the special vent ... but wearing
    a mask all day has made many of us develop skin problems or worse allergic
    reactions (some of the masks have rubber or latex at the bridge of the noseand or are filled with fiberglass). Plus even with the vent we still suffer from lack of O2 and side effects from that.

    Toronto is listed as the most diverse city in the world .. we are a
    melting pot of many different cultures and nationalities. At the best of
    times this can make caring for an ill person difficult simply because of
    language barriers ... in the Emerg dept it's very important that these
    people have someone with them that can translate or be their spokesperson
    as far as care goes. Now, unless the patient really can't understand or
    speak English at all their relatives are not allowed in ... and if a
    relative is allowed in only one is allowed in for a very short time. So we are dealing with irate relatives due to the restrictions (not just for the patients that can't speak English well!), very unhappy patients that would likely do better if they could have visitors or someone there to speak up for them regarding their care, and naturally we are likely getting overwhelmed with phone calls from relatives regarding patients that they are not allowed in to visit with. We have police officers and security guards at all the entrances to help us deal with screening anyone coming into the hospital and to deal with the problems that these restrictions have caused the
    hospital (ie violent irate patients and visitors).

    It's all very stressful! And I've probably only told you half of it ...
    if I went into every detail this post would be 10 times longer than it
    already is! I'm not too worried about getting SARS ... I mean it's a
    frightening illness since we don't really know what we are dealing with yet
    and we don't have any definitive tests for it. As everyone who works in
    health care in Toronto Hospitals has been doing for the last 21 days I've
    been taking isolation precautions (ie the masks, gowns, gloves and
    goggles), and since everyone else is doing this I probably stand a good
    chance of coming out of this even healthier than I started since I'm also
    protected from everyone elses' cold, flu etc germs, as well as SARS.

    The emergency dept is not quite as busy as it usually is- there are
    less stubbed toes and minor illnesses that should be seen elsewhere anyways coming in ... but the people who are coming in are generally very sick ... so it's a mixed blessing ... less patients but sicker patients and always
    the possibility that someone coming in will have SARS.

    Someone asked:
    (1) Are things calming down in Ontario? Getting back a bit to normal, or perhaps developing a "new normal?"
    It's a new normal and we'll likely be doing this for quite a while.

    Things are not calming down, I believe they are getting worse. I last worked on Tuesday and we had a total of 7 suspect or probable cases come in on my 12 hour shift ... 5 cases came in within a 45 minute period. It was horrible and shocking to see so many come in so fast. Two of the 5 that came in around the same time are definitely probable cases, one had apparently had a relative die the day before with a suspect or probable case of sars. There is still no report in the news of any additional deaths due to Sars this week ... so I don't know if this case was ruled out or what .... but there seems to be some discrepancy in the number of cases (probable and suspect) and deaths that I've been hearing about (and in some cases seeing (probables) and what is being reported in the news.

    Or are things getting a desperate feeling of getting out of hand?
    Hard to say ... we have a number of people in quarantine in this city ... more and more are put in quarantine each day. The latest news is that a condominium in the east end of the city is being quarantined because of a suspect case (maybe 4 cases- missed the full update).

    The number of cases in Canada (mainly Ontario) jumped to a total of 303 suspect and probable cases (126 probable) on April 16th. The 4% death rate that is being reported ... I don't believe it ... in Ontario where we have been most affected by SARS we currently have 122 probable cases with 13 deaths which is a 10.6% death rate.

    I'm stressed and yes I'm worried about this. I was extremely stressed when I came home from work this past Tuesday, but I'm prepared to start a new round of shifts tomorrow.

    As I said I have no illusions of this going away any time soon. I feel the measures we are taking in Ontario are the correct measures to prevent the spread of this disease, unfortunately compliance with quarantine and or people not realizing that they were in "at risk" situations have compounded the situation.

    (2) What do you think might happen down here?
    If the health care system is starting to see probable and suspect cases in the US (and we know that they are) I strongly believe that if you aren't taking similar measures as we in Toronto are you will have major outbreaks of SARS. Especially within the healthcare system (i.e. nurses) if they are not wearing masks and isolation gowns etc at all times in "at risk" depts like emergency depts.

    Whew! This is a long introduction to this nursing forum! Hope it's not too long, and that it has let some people know what it's like to work in the emergency dept and deal with SARS cases.

    I'm looking forward to hearing more opinions on what is going on with SARS in different areas. Trish

    BTW I think I might be allergic to the masks ... well I hppe that's what my symptoms are ... I'm wheezy and often have a sore throat these days ... don't feel too bad otherwise and If I have several days off between shifts these symptoms calm down ... so I am hoping it's allergies! Better not be anything else! Also- I have crohns so I do worry about my immune system and it's response to Sars and all that's going on but so far I seem to be maintaining my health.
  10. by   RNonsense
    SARS nurses told to wear goggles
    Health worker may have contracted disease through eyes

    Lori Culbert
    Vancouver Sun

    Thursday, April 17, 2003

    All health-care workers should wear goggles while treating people with probable cases of SARS, the provincial health officer is recommending after a B.C. nurse contracted the virus from a patient.

    Dr. Perry Kendall said it is possible the 44-year-old nurse at Royal Columbian Hospital may have contracted the virus through her eyes while treating a person with a probable case of SARS for two days.

    "There's a possibility of droplet spread, I guess, to the surface in the eye. That's one hypothesis. We are now recommending that goggles be routine in nursing symptomatic persons with probable SARS cases," Kendall said.

    The B.C. recommendations go beyond Health Canada guidelines, which advise doctors and nurses to wear goggles during procedures in which SARS patients could spray blood or other bodily fluids, but not necessarily in everyday care.

    "We have perhaps some evidence here that just nursing an individual who is highly infectious may be an exposure procedure, so we're extending -- just to be on the safe side -- precautionary measures. We are going beyond what is recommended in the [federal] guidelines," he said.

    B.C. is following in the footsteps of Ontario, home to most of the Canadian SARS cases, which passed new provincial guidelines Monday that require anyone treating a probable patient to wear goggles.

    A Health Canada spokeswoman said Wednesday there are no immediate plans to change Ottawa's guidelines.

    The infected nurse -- the first case in which the virus has been spread from one person to another in B.C. -- followed Health Canada rules by wearing a gown, gloves and a mask, as well as washing her hands, while treating the SARS patients.

    Kendall is confident that with the addition of goggles, the equipment will protect health care workers as long as they are vigilant in its use.

    While a specific type of face mask is required to fend off SARS, any type of medical goggle can be used. Goggles are considered more effective than safety glasses because they are tight to the face.

    Kendall said the case of the infected nurse doesn't mean the public needs to wear goggles or is at any greater risk.

    But he acknowledged there is always the chance of secondary spread in the community.

    Kendall does not want to see a repeat in B.C. of a recent situation in Toronto, in which an infected person was misdiagnosed and sent back into the community, eventually causing more than 500 members of a religious group to be quarantined.

    He stopped short of saying mistakes were made in the case of the Royal Columbian nurse, but noted she was at home when her symptoms emerged -- the most contagious time for a person with probable SARS -- but had not been diagnosed at that point.

    "She reported ill towards the end of the incubation period. With hindsight, it would be nice to think in the future we would recognize that and get the report in to the public health authorities a little quicker," Kendall said.

    Dr. Patricia Daly, director of communicable-disease control for the Vancouver Coastal Health Authority, said no different action plan is needed now that B.C. has its first case of SARS spread from person to person.

    "There has always been the possibility of secondary spread, we had been fortunate [before] that we hadn't had any cases," she said. "Our plan was always ... to limit that secondary spread."

    A detailed investigation has been launched into how the nurse caught the virus, but it will require an interview with the woman once she is feeling better.

    Daly said she does not yet know if a lack of goggles could explain the transmission of SARS, but added health care workers should be safe as long as they use the gear properly. They should not, for example, touch their face or scratch under their masks or goggles before washing their hands.

    "We're still confident that if you follow all those practices, that you will be protected," she said.

    The unidentified nurse's last day of work was April 3, and she was scheduled to go back to the New Westminster hospital April 9, but was feeling fatigued and called in sick. She remained home until the 14th, when she became more ill and checked herself into the hospital.

    During the time she was feeling ill, she came into contact with about 30 people, including her family, and those individuals are under home quarantine.

    Because people with SARS are believed to be contagious only after symptoms appear, there is no fear she spread the virus to her co-workers.

    None of the people who were put into quarantine after contact with B.C.'s three other probable cases of SARS has developed any symptoms.

    Dr. Robert Parker, deputy medical health officer for the Fraser Health Authority, which includes the Royal Columbian, said his region is also investigating how the nurse contracted the virus while following all the proper procedures -- but he noted the measures are only as reliable as the people practising them.

    "No procedure you put in will be absolutely, 100-per-cent perfect all the time. And people are only human," Parker said. "So at times you may get a secondary case in a health care worker who is doing their job but perhaps getting exposed to the virus."

    He said other doctors and nurses at the hospital are concerned about the nurse's health, but have not refused to work with any suspected SARS cases.

    Since a team of B.C. scientists discovered the genetic code for SARS, labs around the world are scrambling to develop a test sensitive enough to detect the virus. It isn't clear when that work will be complete, or when a potential vaccine will be found.

    On Wednesday, Dutch researchers announced they had produced the disease in monkeys by infecting them with a recently discovered coronavirus, producing the final piece of evidence that the virus is the cause of the outbreak.

    "We now know with certainty what causes SARS," said Dr. David Heymann, executive director of the World Health Organization's Communicable Diseases programs. "With the establishment of the causative agent, we are one step closer" to developing more effective preventive programs and treatments, he said.

    Health Canada reported Wednesday 303 probable or suspect cases of SARS in the country, and 13 deaths in Ontario.

    In B.C., there are four probable and 38 suspected cases of SARS.

    All four of B.C.'s probable cases -- one in each of St. Paul's, VGH, UBC Hospital, and Surrey Memorial -- are in stable condition. One is on a ventilator, and the others are breathing on their own.

    - - -

    And a few thought living off credit cards was a bad idea
  11. by   RNonsense
    Nurse first case of SARS contracted here

    Steve Berry
    The Province

    Wednesday, April 16, 2003

    A nurse has become B.C.'s first health-care worker to come down with SARS.

    The 44-year-old acute-care nurse, who became ill while looking after a patient at Royal Columbian Hospital, is the third probable case of Severe Acute Respiratory Syndrome in Vancouver, and the fourth in B.C.

    Hers is the first SARS case transmitted in B.C. The others who have come down with the sometimes-deadly virus are travellers who caught it in Hong Kong.

    The nurse had limited contact with others before going into hospital. Her contacts -- fewer than 30 -- have been located and are in a 10-day quarantine.

    "They will go on 10 days of home quarantine and we will monitor them every day for temperature and signs of symptoms," said Dr. Patricia Daly, the Vancouver Coastal Health Authority's director of communicable disease control.

    Health authorities are concerned because the nurse apparently took all precautions against infection and yet still became ill.

    "She seemed to have followed all the appropriate infection-control procedures," said Dr. Robert Parker, deputy medical health officer with the Fraser Health Authority. "That's the worrying thing. She obviously got it somehow."

    Parker added that an investigation is under way to see what procedures were followed.

    "It's very much of a concern for the Royal Columbian staff, both for themselves and for their co-worker and friend," he said.

    Other staff at Royal Columbian are likely beyond the incubation period and no more infections are expected, said Parker.

    "There are no other exposures at Royal Columbian that I know of," said Parker.

    The nurse, a Vancouver resident with a family, is in St. Paul's Hospital in stable condition. She is not on a ventilator, as are some others who are infected in B.C.

    B.C. Nurses Union president Debra McPherson pointed out last night that nursing is a dangerous profession.

    "The day-to-day work of a nurse is such that they are exposed every day," said McPherson, who added that all precautions seemed to be in place to deal with SARS. "We just don't know enough about it yet. The precautions that are available, based on the knowledge we have now, are being used."

    A stroke of luck prevented the possible further spread of the disease. The nurse, whose last day of work was April 3, was on days off when she became ill and did not return to work before going to St. Paul's Emergency on Monday with the SARS symptoms -- fever, fatigue and cough.

    "She did not work while she was ill, which is a good thing," said Daly.

    The nurse looked after a SARS patient at Royal Columbian for two days. The patient had picked up the disease in Hong Kong.

    "There is no risk to the general public. We're not seeing cases spring up in the community," said Daly. "The only cases we've had are travellers, and now this health-care worker. It isn't easily spread."

    Health Canada yesterday reported 296 probable or suspect cases of SARS in Canada. There have been 13 deaths in Canada, all in Ontario. There are 37 suspect cases in B.C.

    The original patient diagnosed with SARS in B.C. was seen at Vancouver General Hospital March 7. That patient is still on a ventilator but is in stable condition.

    The patient at Royal Columbian was transferred to Surrey Memorial and is stable, as is the patient at University of B.C. Hospital.

    For more info on SARS, contact the SARS line at 604-708-5300. If you feel you have symptoms or have been exposed, call the B.C. Nurse Line at 604-714-4700.

  12. by   RN4ev'r
    The hospital I work in is one hospitals in Toronto. We have had 50% of the SARS patients admitted to hospital in our facility, according to what we have been told. To date, there has been no staff members contracting SARS. All the precautions everyone else is taking, gowns, gloves, masks and googles, are being used. We are also screened before entering. I do not understand why staff in other hospitals have contracted SARS. Is there more contamination in the community or is there something else we should be doing for infection control as we have just been lucky so far?
  13. by   epaminondas
    sixes, fergus, steven, Trish, RN4ev'r,

    Thank you for the "you are there" perspective.

    It is extremely helpful. Particularly the information on masks.

    Mask questions:

    Actual mask preferences: N95s, N99s, or N100s?

    3M or other manufacturers?

    Standard (valveless) or valved?

    Is everyone wearing a standard paper mask over their N95 (or whatever) mask? (a new idea to me).

    Are you getting new N95 (or whatever) masks every day? Or reusing the ones you have?

    Storage of used masks: if you put them in a bag overnight, won't they just self-contaminate?

    Anybody using the electrical ("space suit") HEPA head gear? I hear that they are noisy and would probably scare your patients into the next county - but they may alleviate the complaints about decreased PO2 that we are hearing with the N95 masks.

    Other questions:

    (1) What percentage of Ontario SARS victims are Health Care Workers?

    From news and other sources, I have seen the following reported (corrections are welcome!):

    (a) Hanoi-France Hospital outbreak - approximately 90% Health Care Workers.

    (b) Initial Hong Kong outbreak at Prince of Wales Hospital - initially approximately 60% Health Care Workers and medical students. Hong Kong infection rate in general now running at about 24% Health Care Workers.

    (c) Singapore - infection rate approximately 90% Health Care Workers.

    (d) United States - infection rate approximately 3% Health Care Workers. :-)

    (e) China - unknown. Lotsa health care workers reported affected, but the official Chinese data is largely considered unreliable.

    (f) Canada - unknown.

    Two things about the above:

    One - despite plenty of information on this matter in regard to other outbreaks, I have not seen any information on Health Care Worker infection rates from Ontario.

    Musta missed it.

    Could someone please clue me in?

    Two - I do find the U.S. statistics (3%!) most heartening. :-)

    But, uh - is the U.S. really that good?

    I hope that this is not just an artifact of this being early in the infection cycle.

    __________________________________________________ _______________

    (2) Is everybody showing up for work?

    At one point around half of nurses and other hospital workers in Vietnam and in Hong were reported to be staying home: "Asian Nurses Stay Home, Imperiling Respiratory Patients" by Lawerence K. Altman, The New York Times, March 21, 2003.

    The international WHO doctors were saying that the local nurses on the ground were wrong to stay home. The WHO doctors were saying this safely from their offices in Vienna.

    In the discussions at our hospital, about half of the female nurses have declared outright that they are not coming in if SARS hits the hospital. Each of these nurses then says "I have children."

    Point made. That is the end of their discussion.

    None of the guys has said any such thing.

    They just stay quiet.

    The way our ladies say it - it is as if they are seeking agreement or approval for their cowardice in advance.

    Or disagreement - so they have someone to react against.

    I just reply "I understand what you are saying" in a very noncommittal way - and they each read into it whatever they choose.

    I have never seen this before. The fear in the air.

    Aggressive fear.

    It is becoming my impression that feminine cowardice is a very social phenomenon.

    Something to be shared.

    Guys, on the other hand, keep their mouths shut.

    Why declare cowardice in advance - particularly if you may never need to act on it?

    Best to leave such a decision until such time when the decision may actually be needed.

    A day which, if one is lucky, will never come.

    But the guys are also keeping their eyes on the exits.

    I understand the view that we have a sacred trust and duty to stand by our patients through thick and through thin - and that anyone who does not do so is abandoning that trust in a terrible and dishonourable way.

    On the other hand, I understand the point of view that this is each person's decision to make for himself.

    It would appear to me that the different views are irreconcilable. You either feel one way, or you feel the other.


    I have never had any desire to be a dead hero.

    But I am not sure that I am brave enough to run.

    It looks like courage and cowardice may not be simply flip sides of the same coin.

    I wonder how many people in this world have become heroes because they did not have the courage not to be?

    __________________________________________________ ______________

    Sorry to wander off like that - but watching SARS head towards us with all the speed of a twenty foot high wave of molasses gives us a lot more time to think about it than you probably have on the front lines.

    The waiting is wearing thin.

    I'll almost be glad when it finally gets here.

    Funny to think that we may one day long back for of our current state of uncertainty.

    __________________________________________________ ______________


    You asked:

    << I've been very curious as to how nurses/hospitals in the USA are handling suspect or probable SARS cases. Have any American nurses in this group worked with any SARS cases yet? >>

    I am wondering, too.

    Nothing here. Just waiting. And waiting.

    The following gives you an idea of our level of readiness. It is probably about what would happen here:

    I guess that it's nice to get your picture in the paper, but I kinda wonder how people are going to treat you if you do.

    And I also wonder about lab and x-ray and admitting and housekeeping and . . . .

    Here we are thinking about what to do. But there is a strong desire to not look silly, to not be paranoid. To not get ready.

    After all - SARS is not an American problem. More likely to be hit by lightning. Don't be silly!

    And that is all probably true.

    Most preparation is now going on through informal networks. From below, not from above.

    I am told that the Infectious Control Committee has never met. That it is a paper committee - there only for hospital accreditation, not a reality. I do not know whether that is true, or no.

    Perhaps it will meet if and when there is a case in the state.

    The safety committee met and the subject was brought up - infection control brought it up, to some interest. People - floor nursing, ER, radiology, lab - have now gotten N95 masks fit. We are ordering goggles. Extra this and extra that now in the supply pipeline. And just thinking through things -

    E.R. protocol now includes asking people with symptoms about travel. But no masks on at the front door.

    Starting to think about talking about the matter with EMS personnel.

    Our trigger point is when the first case hits the state.

    Then things will start to get moving.

    But I like to think that it will never happen here.

    Anyway - thanks again. Any information from the front lines - above and beyond newspaper reports - would be most appreciated.

    All the best,


    __________________________________________________ _________________________

    Oh - the latest from Hong Kong:

    << April 17th 2003

    Dear All,

    I have been asked why I have stopped posting.

    Another hospital in HK has received 600 SARS patients. The ICU has been expanded from 14 to 46 beds.

    Unfortunately 4 of the 6 dedicated ICU docs and 25% of that hospital's ICU nurses have contracted SARS.

    I was asked to go over and implement strict infection control measures and sort out clinical management.

    I am now responsible for a 46 bed ICU, which now has several hundred relatively inexperienced nurses, 20 docs (some with ICU experience), and 42 patients all very young with MOF.

    All staff are completely unfamiliar with each other, that hospital's ICU routines and how that hospital works. I have introduced some structure and systems all in the name of SARS.

    The infection control aspect was easy but compliance is only 99%.

    Clinical management - well that's another very confusing story.

    As you can imagine I am a bit busy.
    Regards to all