SARS in Toronto!

fergus51 · Apr 18, 2003

We are using the n95 masks and gowns and gloves (have to change the mask every 8 hours). The province has something like 80 000 nurses so, it certainly isn't like a large percentage of nurses get sars (even 1% of our nurses would outnumber the total cases of sars almost 3 to 1 and that's not counting RPNs). Everyone seems to still be showing up for work, and we're using precautions. So far I don't know any of the health care workers who contracted SARS and don't think any have from my hospital.

I would be extremely concerned if people just refused to show up for work at this point for a reason like "I have children". To date Canada has had approximately 300 SARS cases and 13 deaths (of the deaths one person was in their 40s, one in their 50s, one in their 60s and all the rest were over 70). It is something that should be taken seriously (which is why we use our precautions religiously) but I don't think it is a reason for complete and uneducated panic.

fergus51 · Apr 18, 2003

There you go, health care exposures are broken down in the graph if you hit April 17 for the most recent one.

For those interested at good link:

http://www.hc-sc.gc.ca/pphb-dgspsp/...ras/prof_e.html

JMP · Apr 18, 2003

Originally posted by fergus51
We are using the n95 masks and gowns and gloves (have to change the mask every 8 hours). The province has something like 80 000 nurses so, it certainly isn't like a large percentage of nurses get sars (even 1% of our nurses would outnumber the total cases of sars almost 3 to 1 and that's not counting RPNs). Everyone seems to still be showing up for work, and we're using precautions. So far I don't know any of the health care workers who contracted SARS and don't think any have from my hospital.

I would be extremely concerned if people just refused to show up for work at this point for a reason like "I have children". To date Canada has had approximately 300 SARS cases and 13 deaths (of the deaths one person was in their 40s, one in their 50s, one in their 60s and all the rest were over 70). It is something that should be taken seriously (which is why we use our precautions religiously) but I don't think it is a reason for complete and uneducated panic.

Agree with you Fergus.

Uneducated panic is one of the worst things we could have now/

We wear the N95's. We also wear googles-gowns-gloves.

No ONE has refused work and if anything our sick calls are down. Which is a relief for many I am sure, since it was thought in the beginning sick time would climb. It has not.

zumalong · Apr 19, 2003

Hello to my friends across the lake (Ontario). Wendy---how are you--you haven't posted in several days. When I started reading about SARS in Toronto I thought of you first. (no offense to everyone else but I haven't posted for many months due to total hip replacement and lack of money for internet connection and Wendy is an ole timer who I remember when I last posted)

Did anyone see or read the book, "...and the Band Played On" I see some eerie parallels with the HIV virus and this one. I agree that we are seeing a new era in healthcare. Any of us who were nurses before HIV remember that gloves were not available and if they were you would never use them because it "decreased your tactile sensitivity etc."

As someone with severe asthma (which consequently led to my need to have hip replacement) I can say I am petrified to return to acute care.

Living so close to Niagara Falls I ponder a scary scenario: One person with SARS. Coughs etc. near the mist: how many people will be infected? (if you have ever been to the Horseshoe falls you know that there is continual mist from the water)

I do have a question about the masks though. If you wear a surgical mask--won't this risk more moisture building up on protective masks???? I have been trying to imagine having to wear a mask for my whole 12 hour shift. I get short of breath thinking about it.

Does anyone wonder if this might not have been biological warfare that was released by accident (or worse--on purpose)

It does not matter how it arrived on the planet, it is not going to go away easily. Take care all my nursing colleagues--both in acute care and in all areas of patient care. We may be nurses but we are still humans with families who need us around for a long time.

RNonsense · Apr 19, 2003

There is a second nurse here now from the same hospital who as SARS. I'll post a link as soon as it hits the web.

sixes · Apr 19, 2003

Good morning all. I am a little concerned that I haven't heard from Wendy. Hope you are well. I hope alll nurses working and coping with SARS are doing OK. Keep up the good work your are truly are front line defense.

Faithful Fight Fear

http://www.canoe.ca/TorontoNews/ts.ts-04-19-0004.html

2 Stricken Hospital to reopen in days

http://www.canoe.ca/TorontoNews/ts.ts-04-19-0005.html

No help for stab victim

http://www.cnaoe.ca/TorontoNews/ts.ts-04-19-0027.html

SARS 'prisoner'

http:http://www.canoe.ca/TorontoNews/ts.ts-04-19-0029.html

Man's fight to visit in hospital pays off

http://www.canoe.ca/TorontoNews/ts.ts-04-19-0031.html

No Insurance

http://www.canoe.ca/TorontoNews/ts.ts-04-19-0036.html

450 Quarantine

http://www.canoe.ca/TorontoNews/ts.ts-04-19-0037.html

Leafs wary in midst of playoffs

http://www.canoe.ca/TorontoNews/ts.ts-04-19-0038.html

B.C. Translates SARS internet bullitens to Chinese, Pinjabi, Vietnamese

http://www.canoe.ca/CNEWS/Canada/2003/04/18/68380-cp.html

epaminondas · Apr 19, 2003

"It was involuntary. They sank my boat."

Remark when asked how he became a hero.

John Fitzgerald Kennedy

_______________________________

I have been concerned about Wendy, too, but I see that she is posting elsewhere on this board as of today. So it looks like she is doing OK.

I am happy to see it.

I wonder if perhaps Wendy became uncomfortable with the degree that the discussion here was becoming centered on people debating her own situation.

Or maybe Wendy just got bored . . .

It is interesting to hear that everyone in Toronto is showing up for work.

Perhaps the sort of conversations in which I have been participating are just a local anomaly.

Perhaps an artifact of waiting instead of doing.

Or - I wonder if it may reflect a difference in Canadian vs. American psychology.

Perhaps Canadians are more community-minded and Americans are more what's in it for me me me.

I don't know.

I would guess that Canadians might be more up on the differences between Canadian and American psychology than Americans might be.

Perhaps we will find out soon.

Fergus wrote:

>

Agreed.

That is why I am trying to learn from the Canadian experience.

Only partial and educated panic for me! ;-)

I have always been amused when people state "this is no time to panic!"

I have always wondered when the proper and right time might be.

And how one panics properly.

No leaving footprints on the back of the person in front of you.

I seem to be dealing with my own concerns through education and preparation.

Hoping that none of this will prove to be necessary.

_______________________________

Trish,

Thank you for the information. Most helpful!

Please keep it coming.

Possible future topics: signs and symptoms that y'all are actually seeing in your ER (i.e., is the temp of 38 degrees C actually magical) - are you seeing much general aching, dry cough - what?

How in the world do you diagnose someone outside of a known chain of infection?

Course of the disease, course of the recovery? How are health care workers holding up?

Or just whatever you feel like writing.

As to :

>

OOPS! I obviously have been unclear. My apologies. To clarify:

Only 3% of the SARS cases reported in the US have been health care workers.

I.e., out of the 36 cases of Probable SARS reported thus far in the entire U.S., only one (1) person, a nurse, has been a healthcare worker (3%).

Out of the approximately 220 cases of Suspected SARS reported thus far in the entire U.S., only four (4) people, all nurses, have been HCWs (2%).

The same goes for all the other statistics I reported on percentage of Health Care Workers reported with SARS in outbreaks in Vietnam, Hong Kong, and Singapore - note, though, that those stats have included doctors, nurses, and other HCWs. Those reports are of the percentage of reported SARS cases in healthcare workers, not the percentage of an entire nation's healthcare workers. The numbers are in the ones and tens and hundreds of healthcare workers affected, not in the thousands or tens of thousands.

To repeat - only one (1) U.S. nurse with probable SARS, out of 36 cases of Probable SARS reported in the entire U.S.

Again - my apologies for the confusion.

Happily, SARS does NOT seem to be growing out control: the increase in cases has generally been graphed as linear growth, not exponential. Perhaps this means that human beings are not merely blood agar on a Petri dish, after all. It looks like public health measures - quarantines and contact tracing - are succeeding in putting a major dent in the spread of the disease.

As a diagnostic test becomes available, control has the potential for becoming even better, even in the absence of a specific treatment: please recollect that TB cases were reduced to one quarter by public health measures alone, in the absence of vaccine usage, via tracing and quarantine prior to the advent of any specific antimicrobial treatment for TB.

It all now comes down to being a bit of a race between public health measures and the virus.

I am betting on -

I don't know.

Looks like one could reasonably put one's money on either side of the bet.

Current SARS growth rate graphs.

World:

http://www.sars-spread.com

Note the graph at the bottom of the page - without the aberrant mainland Chinese data - gives the most accurate overall worldwide trend.

Linear, not exponential.

Country specific:

http://www.sars-spread.com/country_breakdown.htm

The mainland Chinese curve does not fit any growth curve known to nature: it appears to be more political than real. And it distorts any other graphs containing the Chinese data, which is why many analyses exclude the Chinese data at present.

The data from Hong Kong, Singapore, and Canada all looks reasonable.

The U.S. data has been reported in its own way . . .

Any surprise in that?

Note that the Canadian graph was flattening out over the last week or so, suggesting that Canada was on the verge of having this thing licked.

I was beginning to feel pretty optimistic. Sigh of relief time.

There is no way yet to know if the recent Canadian blip is significant. We'll just have to see how this thing plays out over time.

Of course - that is assuming that the Canadian data is being reported accurately.

Another graph page:

http://www.charlesplatt.com/sars/

___________________________________________________________

RN4ev'r wrote:

>

Excellent!

___________________________________________________________

>

Fergus,

Thanks for the link.

Overall trends on that graph certainly look good.

Unfortunately the graph lists all "healthcare exposures" together. This includes all patients and all visitors who have gotten SARS from other patients, in addition to HCW (Health Care Worker) exposures all lumped together, so it doesn't really help in pinning down the percentage of HCWs who have gotten the disease.

I am still looking for the percentage of HCWs in Ontario who have come down with SARS. This is not a complex concept, and is widely reported for other countries. If anyone has seen this information for Canada, I would appreciate a heads-up.

The HCW stats for SARS are a very basic part of the news coverage about SARS in other parts of the world with the exception of mainland China. In China, of course, much that might cause concern has been concealed: such is their press culture.

So far there is better information on this issue from Vietnam, Hong Kong, Singapore and the U.S. than there has been from Canada.

The following a typical report from overseas:

http://www.abc.net.au/am/content/2003/s833427.htm

Just curious . . . I am not familiar with newspaper culture in Canada. And I do not mean to offend. I know that this may sound really stupid, but -

Does Canada have a "free press?"

Or is the Canadian press of the more "responsible" variety?

_________________________________________________________________

>

RNonsense,

Would that be this?

>

http://www.canada.com/health/story.html?id=41A63D43-44AB-4E25-922D-6E3919E002CA

Note that this follows the same pattern seen in Hong Kong and Singapore in regard to HCW's getting SARS despite strict infection control procedures in place.

I am wondering if the Hong Kong and Singapore experiences may be a dry run for the emerging Canadian experience, with Canada running around a month behind Hong Kong and Singapore. And the U.S. running about a month behind Canada.

I hope not.

My hope is that Canada can show that SARS can be successfully contained.

And that the U.S. will then follow suit.

The Canadian press is reporting occasional stories of specific HCW exposures, but so far there has been no tracking of overall HCW percentage exposures in the Canadian press. None that I have seen, anyway.

Some may find this reassuring.

The whole SARS thing is proving to be quite the cliffhanger.

I feel like I am reading the climax of an international novel which is in the process of being written even as we speak - at the rate of a few paragraphs a day.

With vital sentences blanked out from both the Chinese and the Canadian editions.

While I am merely reading the chapters of the novel as it unfolds -

Some of y'all are actually living it.

I've always preferred being the reader, thank you.

_________________________________________________________________

RN4e'r wrote:

>

That is the question, isn't it?

The only way we will know the answer in your situation is to see what happens over time.

The answers to that question from both the Hong Kong and Singapore experiences may be of concern. In those countries, attempts to stop spread among health care workers via strong infection control measures have not proven to be overly successful.

However, I think that we should remain optimistic that Canada will succeed where others have failed.

In both Hong Kong and Singapore, efforts to focus SARS treatment in one or two hospitals while getting other hospitals back to treating regular patients have also been unsuccessful.

Again, I think it best to remain optimistic that Canada will succeed where others have failed.

The comments that I have seen from Hong Kong were initially optimistic. Health care workers were putting appropriate measures into place, and hospitals other than the original affected hospital were not seeing HCWs affected.

For example, Prince Margaret Hospital is the Infectious Disease (ID) hospital for Hong Kong. At one point I saw a report that they had 90 SARS patients, without one PMH Health Care Worker affected. The reasons for their success in dealing with SARS were given as: as an infectious disease hospital they had an experienced hospital culture - both great breadth and depth - of being able to deal with infectious disease, they were using appropriate barrier and all other appropriate precautions, and their physical plant had appropriate negative pressure isolation rooms and such. It was also repeatedly noted that SARS is simply not that infectious a disease. Everyone calm down.

A week or two later I noted a news report that one doctor and 20 nurses had been diagnosed with SARS at PMH. Additional reports concerning the SARS toll followed - I believe I saw a report a few days ago that 90 PMH HCWs had been affected.

As the SARS situation continued to develop in Hong Kong, one began seeing press comments from physicians that "SARS is proving to be much more infectious than we thought." School closures. Then comments from physicians that they were concerned that things were getting out of hand. Then comments from the governments involved of concern of impending disaster.

The same pattern has then followed in Singapore. Singapore has generally run a couple of weeks behind the Hong Kong SARS curve.

In Singapore, there is a very controlling government - hey, I'm not being judgmental, they seem to like it that way - which early instituted fairly extreme tracing/quarantine, now with cameras outside of peoples' houses and tracing radio-wrist bands, early school closures, etc. The initial concept was to have all cases in one hospital so that one hospital could specialize in the disease and leave the other hospitals to function more-or-less normally for the rest of the population. It seemed like a pretty good idea at the time, really -

It just did not work.

Some ideas are just that way, I guess.

Since then, I have watched news reports of SARS spreading in Singapore, every few days, to each of the other large public hospitals in Singapore - all six, now. With large numbers of staff affected.

Generally the problem seems to stem from an unrecognized case or two on the general wards affecting large numbers of Health Care Workers - not so much from the known cases in the ICU.

Nebuliser use has been particularly implicated. Nebuliser treatment has been reported to be linked to the infection of 60 Health Care Workers.

Canadian respiratory therapists - and other Health Care Workers on wards were such therapy is taking place - might want to bear that in mind.

Note that the concern here is with nebuliser use with unrecognised SARS patients.

The Singapore SARS experience is currently at 172 cases, 16 dead. That is a raw mortality rate of 9% - but of course, a raw mortality rate in the midst of a growing epidemic understates the actual mortality rate - that is basic Epidemiology 101. Such is true of almost all the mortality rates that we are seeing reported in the press.

The reports I have seen are that around 90% of the Singapore cases have been Health Care Workers - whether or not that extends to the mortality rates, I do not know.

I found a recent report interesting. It included a quotation form a Singapore pulmonologist that SARS is the most infectious disease that he has ever seen.

This follows the same pattern that I have earlier seen reported by other physicians out of Hong Kong.

Again, I would like express my optimism that the Ontario situation will not become anything like the Hong Kong or Singapore situations.

I am certain that Canada can do better than Hong Kong and Singapore have done.

Oh - one last bit.

A few weeks ago I saw a Hong Kong report of five family physicians and one pediatrician admitted to one of the ten admitting hospitals in Hong Kong with SARS on the same day. This was followed by encouragement for community-based physicians to wear masks in their offices.

Within the last week I noticed that one pediatrician had died. I do not know if it was the same one, or no.

It will be interesting to see if we see Canadian physicians reporting in with SARS from their offices.

Well - let's all hope this is just a flash in the pan.

To your health -

Epaminondas

___________________________________________

If someone could tell me how to post PDFs on this bulletin board, I would be happy to post the current infection control procedures being used in Hong Kong. Of course, these likely will not be entirely in synch with Canadian recommendations.

In the meantime, someone might find the following of interest. I imagine that Canadian Health Care Workers are getting plenty of this sort of thing in their hospitals, anyway.

Please note the learning curve between 3/26/03 and 3/28/03.

From Hong Kong:

We now have 24 Healthcare workers in PWH caring for the first wave patients with SARS, ie 41 OF 543 staff or 7.5%.

ICU rate is 2%.

2 RNS who admitted the first patient to ICU. Even though the N95 went on straight away compliance was obviously not good. The mask was very uncomfortable and poorly fitting. There was only one size available from one manufacturer initially.

Health care assistant (cleaner) was exposed to ICU on 19/3/03. She had no prior training on infection control.

Other departments report much higher staff infection rates. 68% in the medical ward where patients are housed!!!!

Reasons give for the failure rate in order of priority include

1. POOR FITTING MASKS, UNCOMFORTABLE

2. STAFF NOT ATTENDED ANY BRIEFING ON SARS

3. CONTRACT STAFF NOT EDUCATED ON INFECTION CONTROL

4. Poor ventilation >>

____________________________________________

The number of cases continues to grow in HK. The Government has closed schools and quarantine procedures have started. The situation in the hospital has essentially been contained but we are seeing cases of HCW (24) becoming ill after isolation procedures have been instituted.

Reasons given by these HCW for catching the disease in order of importance are:

1. Nebuliser use

2. No structured course on SARS

3. Not wearing an N95 mask

4. Poor handwashing technique and facilities

5. Incorrect order of gowning and gloving

6. Communal tea breaks where masks are taken off in an enclosed space

7. No goggles when performing NPA

8. Too many staff exposed unnecessarily

9. No education for contract staff

10. Poor ventilation

11. No mask in one case

I have previously mentioned the difference between ourselves (non infectious diseases hospital) vs PMH (infectious diseases hospital). PMH staff are well educated in infection control - it is part of their culture.

In our cluster of hospitals (three in total) the standard of infection control in our ICU will become the standard. Only two nurses who saw the patient first admitted to ICU have become infected. They found the masks poorly fitting and uncomfortable.

Some general points:

1. Recognize that infection control awareness needs still to be raised.

2. Gowning and gloving sequence needs to be thought through by all departments (includes degowning and degloving)

3. No nebulisers

4. Doctors as patients create problems. They want to use the ward phone, computers. They want to read their notes and handle Xrays.

All potential sources of contamination.

As far as ICU we have upgraded our infection control measures on a daily basis.

PERSONAL

1. N95 masks at all times

2. sequence of gowning

wash hands

hat

gown

wash hands

gloves

3. sequence of degloving

remove hat

remove gown

remove gloves

wash hands

4. nothing goes into or out of the unit that is not necessary - includes pens

5. pagers are wrapped in a glove

6. Many Chinese people wear glasses. For those of us who do not we are wearing goggles or buying glasses.

N100 masks have gone to Iraq. We purchased them for their comfort and for the psychological boost. We have since found other manufacturers with N95 masks.

Personal HEPA filters will not arrive until next week. Maybe not necessary because touch wood we seem to be holding our own.

UNIT

Clear separation of clean and dirty areas e.g. Male change room has been moved out of the unit

Cleaning 3 x day of all surfaces with Na hypochlorite solution

Computers etc covered with glad ward

Decrease traffic into and out of the unit

Control centre outside of ICU

HEPA filters in the airconditioning system

Portable airfilters in the ICU

Windows closed

Temperature control

PATIENTS

No unnecessary procedures

HME on all intubated patients

Provide lowest O2 flow to maintain sats above 90%

>* housing the patients (negative pressure rooms - do you have any of these?, HEPA filtration systems within the rooms)

We only have 4 negative pressure rooms with Ventilation cycles above 12/hr.

One of the major differences between our hospital and the ID hospital is that it admits patients to single rooms on the ID wards. Viral load of these patients is high. Our general wards have bays where patients are cohorted and may be part of the problem with HCW becoming infected. Our rooms are independently ventilated.

>* masks - what are you and your staff doing - is there any local >experience suggesting that N95 masks are enough (assuming a good fit), or >the masks with personal HEPA filtration systems (N100 variants). What do >your nursesdo when they are looking after these patients for long time >periods?

This is a big problem. HCW becoming ill on the wards are the nurses. ICU nurses have been spared this because our infection control measures are as high as we can make them. We would like to decrease the amount of time nurses are exposed but that means more nurses and increased exposure.

>* what are you doing with your ventilated patients wrt exhaled gas

See above and it is a closed system

>* It sounds as though droplet dispersal of the virus is a significant >risk. Are you using mask CPAP at all and if so what are you doing to >redirect the exhaled gas?

No mask CPAP, no BiPAP AT ALL.

>* I would also be very interested (if you have the time of course) to describe >the strategy that is being used to keep up the morale of the nursing and >ancillary staff, especially in the ICU environment.

Senior nurses and myself brief honestly nurses every day

Information is dispersed verbally by email and by notices

Lots of encouragement

Lots of channels for communication

Food and drink

Encouragement from each other

We contact all nurses on sick leave each day

Nurses with ATP are seen by a senior ICU doctor

Hope this is helpful

Regards

XXX XXXXXXX >>

RNonsense · Apr 19, 2003

Story hit the web today. FYI, this is not the Markham case. This is New Westminister, BC.

New SARS case closes ward in New West

Health authorities looking for those who had contact with Royal Columbian nurse

Dan Rowe

Vancouver Sun; With files from Canadian Press

Saturday, April 19, 2003

Fraser Health Authority officials are putting a 59-bed ward at Royal Columbian Hospital into isolation because a second nurse there is suspected of having SARS.

The authority is trying to identify patients, hospital staff and others who may have been in contact with the nurse, the latest B.C. resident suspected to have severe acute respiratory syndrome.

The woman was found to have a suspected case of SARS Thursday afternoon after she told co-workers she was experiencing SARS symptoms. She had already begun her morning shift at the hospital.

She was immediately sent home, where she is in isolation and doing well, according to Dr. Roland Guasparini, the Fraser Health Authority's chief medical health officer.

As a precaution, the health authority is putting the ward where the woman worked into isolation and 35 nurses have been asked to stay home for 10 days. Public health officials will monitor their condition and they will continue to be paid.

Guasparini said the nurse with the suspected case came into contact with a patient with a probable case of SARS in late March. That is the same patient another nurse at the same hospital had contact with before she was diagnosed as a probable case of SARS last Monday.

"She (the suspected case) would have been infectious when she developed symptoms and she worked part of the night shift when she developed the symptoms [April 9] and then she worked a week or so later [April 17]," Guasparini said.

Health authority officials say they attempted to contact the nurse during the two days between the discovery of the probable case Tuesday and her return to work Thursday, but were unable to reach her.

In order for SARS to be contagious, the carrier must be showing symptoms. Guasparini said none of the 13 patients who came in contact with the latest suspected case are showing signs of having the disease.

Still, the Fraser Health Authority says it is being extremely conservative and cautious in treating the latest case.

The 13 patients are being monitored closely -- nine of them remain in the hospital, three have been transferred to other hospitals and one has gone home. Friends and family members who visit the remaining nine patients will be required to wear gowns, masks and goggles.

None of the other patients currently being cared for in that ward will be moved to another part of the hospital and no new patients will be admitted until at least April 27, by which time the disease's 10-day incubation period will be over.

"We are, of course, following the community contacts [of the suspected case], which at this point means the household contacts, and they have put on active daily surveillance. They will be checked twice a day to see if they have developed any symptoms," Guasparini said.

As of Friday, the Canadian SARS case count was 304 probable and suspect cases in six provinces. All the 13 SARS deaths in Canada have taken place in the Toronto area. Internationally, the World Health Organization is reporting more than 3,300 cases and 172 deaths.

"As we've seen elsewhere in the world, this can get out of hand very quickly and I think the expectation from the public is that we do everything we can to prevent the spread of SARS and hope to contain it," Guasparini said.

"I still think with the appropriate containment measures we can control this long enough until we at least have some diagnostic tests that will be more refined."

Speaking before the latest suspected case was announced publicly, Dr. Perry Kendall, B.C.'s chief provincial health officer, said the response of the province's medical system to the SARS crisis has, so far, been "very good."

But some people are upset because Kendall's office has only just issued Internet bulletins about SARS in Chinese, Punjabi and Vietnamese.

The resources are overdue, said Victor Wong, director of the Vancouver Association of Chinese Canadians. He urged people to check daily for updates.

"This is the gateway for thousands of travellers from Asia, the starting point of SARS, to North America every day. It seems we should have immediately been arming these people with information in their first language," said Wong, who had been lobbying for the information to be translated.

Toronto Public Health and the Ontario government have been publishing multilingual Internet bulletins, but they provide only local updates. The Vancouver Coastal Health Authority had been providing links to health sites in Hong Kong, but Wong said it is imperative that people be able to access information about the situation in their own city.

Kendall, said it simply took the province longer to get it done.

Meanwhile, the University of B.C. says it has no plans to impose restrictions on dozens of students from China expected to arrive in Vancouver Monday en route to the University of Regina.

The university suggested Thursday that the students, none of whom are suspected to have SARS, be "quarantined" at UBC, where they are to stay during a visit to Vancouver before being bused to the Saskatchewan capital.

Spokesman Scott Macrae said UBC has no plans to quarantine the students, who will be welcomed and free to move around the city.

Also See: SARS a grave risk to rural China, A5; Airlines trim flights to Asia, Toronto reeling over virus, C5

http://www.canada.com/vancouver/story.asp?id=E661C6ED-2AE2-47D5-9F2A-37D6413C02BC

Little One2 · Apr 20, 2003

Originally posted by epaminondas
"It was involuntary. They sank my boat."

Remark when asked how he became a hero.
John Fitzgerald Kennedy

_______________________________

" have been concerned about Wendy, too, but I see that she is posting elsewhere on this board as of today. So it looks like she is doing OK.

I am happy to see it.

I wonder if perhaps Wendy became uncomfortable with the degree that the discussion here was becoming centered on people debating her own situation.

Or maybe Wendy just got bored . . . "

I'm sure Wendy is fine. There are also other nurses here on this board who are dealing with SARS.

"It is interesting to hear that everyone in Toronto is showing up for work."

Why wouldn't we show up for work? What should we do?? Stay home and abandon our patients in the hospital or community. Who would look after them. Now is the time to come together and help those who need our help. Hospitals are following full precautions. Health care workers have been wearing masks, goggles, gowns, and gloves as a protective barrier.

"Or - I wonder if it may reflect a difference in Canadian vs. American psychology.

Perhaps Canadians are more community-minded and Americans are more what's in it for me me me.

I don't know.

I would guess that Canadians might be more up on the differences between Canadian and American psychology than Americans might be.

Perhaps we will find out soon."

When I took psychology, our books were written by american authors. I don't believe there is a difference between our psychology. We may have different values, opinions, and ways of handling worldwide issues.

Fergus wrote:

>

Agreed.

That is why I am trying to learn from the Canadian experience.

Only partial and educated panic for me! ;-)

Panic - Panicking will not accomplish much. It is fine to panic. But, the next step is to handle the situation. It is important to deal with it, educate people and prepare people.

_______________________________

The problem I have noticed is that people are not taking it seriously. Last week, someone exposed to sars goes to church. The next thing you, 600 people have to be quarantined.

I was listening to a talk show on the radio. They had a volunteer on who delivers the kits to the individuals under quarantine. five out of ten people were not home.

What is wrong with this picture? Does this mean there is a lack of education or a bad attitude among the citizens of this city?

steven44121 · Apr 20, 2003

I am sure you have all seen todays paper. Sunnybrook in Toronto, our major trauma , centre has closed its emerg. and ICU's after four staff have begun showing symptoms of SARS.

This despite all precautions being taken. The paper quotes the hospitals infection control person as saying, it was likely after a very difficult 4hr. intubation. (20years in ICU and I have never seen a 4hr intubation).

So what happened? Were infection control measures not used properly, or are we all at risk despite precautions?

Tweety, BSN, RN · Apr 20, 2003

I've never seen a four hour intubation either! You think they are including a trach procedure? After four hours what's the point?

Still that's very scarey that they had to close. It's only a matter of time before it moves South.

sixes · Apr 20, 2003

I am glad that my fellow nurses are showing up for work and not deserting patients. Still it must be very stressful. Every health care worker must be concerned about their families.

I sit up here in the great white north and worry about people I know who work and live in Toronto.

Canada seems to have a handle on SARS and then Bad news hits the papers again.

As for free press in Canada of course we have free press. We are not a communist country. Whether everything is being reported only WHO knows.

All we can do is educate ourselves as best we can and hope that those in charge aren't passing false information.

As for people not staying isolated they are fools who are not only risking their own health but those of there loved ones and others. Perhaps they should be treated like criminals and have those nifty little house arrest bands put around there ankles.

Costly yes necessary I think so.

I don't think that anyone should panic, I do believe that those who aren't following quarantine should be reported by friends and family immediately. Perhaps the Nursing home that was evacuated in Markham area should be used as a type of jail and all those who are suspect should be mandatorly housed there until they are cleared. This way they can't say they had to go out for food, medication etc.

I feel for those who have loved ones in hospital and have been restricted from visiting. It is for their own safety and the safety of others. Hospitals are doing there very best to cope with the situation and the more people cooperate perhaps the faster SARS will be contained and things can go back to a new normal as I don't think things will go back to the way they where.

Even sitting in Kirkland Lake I am affected. I can't go back to work as there is a hiring freeze. I also can't start my OR Nursing or Refresher course for the same reasons. So I sit and wait when I would love to be working, Yes even in Toronto in the affected hospitals.

Today is EASTER and I will say an extra prayer for all those who have SARS or are being affected by it. I will also say a special pray for those who are working on a cure

Everyone keep up the good work. Mau God bless you all.

Shut Down

http://www.canoe.ca/TorontoNews/ts.ts-04-20-0005.html

Death toll hits 185, WHO not worried

http://www.canoe.ca/TorontoNews/ts.ts-04-20-0006.html

Hope for kin of gravely ill

http://www.canoe.ca/TorontoNews/ts.ts-04-20-0009.html

Dancing with Ceath

http://www.canoe.ca/TorontoNews/ts.ts-04-20-0043.html

Easter services suffer SARS too

http://www.canoe.ca/TorontoNews/ts.ts-04-20-0044.html

Secercy no way to win war