SARS in Toronto!

RN4ev'r · Apr 21, 2003

Toronto RN:

Thanks for your input on intubating sars patients. I heard at work today that there was a lot of secretions and that the goggles fell off of one of the staff during the procedure. (Supplied with one size fits all.) On my floor we are now wearing full face shields when giving direct care to a sars patient.

I heard rumours of transmission happening even with double gowning, gloves, masks...Has anyone else heard that?

Is there a need for shoe covers? Have asked at work and it was being questionned, but no one has answered it yet.

To everyone working - be safe.

steven44121 · Apr 22, 2003

Re: what percentage of sars pts are health care worker?

An article in today Toronto Star states 45% of the current sars cases are health care workers.

Shoe covers are not part of the ministry directives, however, many of us choose to wear them at my hospital.

Thanks to all for so much info. I did not realize that Bipap and the oscillator caused a problem.

Our hospital as well has begun asking for M.D.s note if you call in sick. So on one hand , public health says if you feel unwell or have any symptoms even a cough stay home for a few days until things either declare themselves or clear up, then the hospital is saying they want a doctors note if you are off.

I am sure the nurse from Mount Sinai who took public transit did not realize she was sick. We all feel sick, dizzy, headachy after 12 hours with that horrendous mask on. She probably thought she was fine and just felt lousy after work like every one of her co-workers. I feel badly for her, according to the papers she worked in the sars unit, she probably gave her all caring for these pts. and now she is ill with sars herself , away from her family and I can only imagine worrying she may have passed it on to her family, friends and even strangers on a GO train.

steven44121 · Apr 22, 2003

Oh one question from all of my smart well informed friends out there.

Could you have sars, recover from it, and never even know you had it? In other words, could it present as just a really bad cold?

hapeewendy · Apr 22, 2003

hey guys, thanks for all your concern and good thoughts for myself and other nurses caught in the SARS fray...

I appreciate it to no end

(zuma , missed you , glad to see ya!, lil one - call me! , fergus - we are so going out once this SARS stuff eases a lil!)

I worked this past weekend and it was a tough one.

2 of our nurses are now admitted with suspected SARS

we have to double gown, N95 mask for the entire shift, and goggles when doing direct care.

It was easter weekend, felt so awful for the patients ,no visitors allowed, it was very sad, lots of tears shed , a few by my overly tired,fatigued,exhausted self.

Its a real challenge to even communicate with your patients with the whole garb on ,I feel like I'm shouting

I have checked my O2 sat during my shift and its gone down to 86%

feel exhausted all the time

we have to sit 2 metres away from eachother in the cafeteria

my patient load has increased to 10 patients, which is insane and crazy.

we are short staffed, my home base unit is now staffing the SARS unit , so those few of us who are not able to work the SARS unit have been deployed to other units.

Although I understand that frustration of family members not being able to come visit, I have gotten a lot of attitude from some of them, its not our decision , we didnt make the rules, unfortunately , for everyones safety we do have to abide by them.

for example , on easter sunday , patients daugther called , crying , saying that her father is also ill and she needed to see her mom (mom is comatose, being transferred to long term care in the morning) just to be with her , etc, so I go above and beyond the rules, called the U/A on call and got permission for ONE person to come , I told the family member this, and she was educated and smart so she knew that meant one person, she brought 3 other family members, so you know I felt like such a jerk, I mean the nerve, at any rate, they all saw the patient so it was fine , but then I thought , okay we bent the rules once, but what about my 9 other patients who are not permitted to have anyone come to see them? made me think.....

it would be so awful to be in the hospital and not have your family near you.

also , some of our doctors are hypothesising that there is more to the SARS story then we are being told ,and they themselves are making their in hopsital time sporifice and limited.

suspected cases are still increasing

a health care professional (no less) was on quarantine , disregarded the rules, went to a funeral, and the church etc, so now hundreds of ppl need to be at home ...

14th death from SARS recorded

Nurses are admitted in many toronto hospitals with suspected/probable SARS.

My heart is heavy , I feel lightheaded and dizzy, exhausted

and each day we hear something more.

I go to class at sunnybrook ,so the start of my next semester is in question , as was the completion of the previous semester.

thanks so much for all the support

it has mean a lot to me

and thanks to all of you for posting such helpful information

and making me realize that I'm not alone in this situation!

PennyLane, RN · Apr 22, 2003

Oh Golly Wendy that sounds so scary. Please take care of yourself and stay healthy.

For all you Toronto dwellers--your friends to the south are thinking of you.

epaminondas · Apr 22, 2003

steven44121wrote:

>

Steve,

I just read through 10+ Toronto Star SARS articles trying to hunt this down and I could not find it.

Could you please post the url?

Thank you,

Epaminondas

sixes · Apr 22, 2003

More links

TO flies in Experts

http://www.canoe.ca/TorontoNews/ts.ts-04-22-0003.html

Critism hurts Nurse

http://www.canoe.ca/TorontoNews/ts.ts-04-22-0004.html

Wash Up

http://www.canoe.ca/TorontoNews/ts.ts-04-22-0005.html

Go riders wished they'd known

http://www.canoe.ca/TorontoNews/ts.ts-04-22-0006.html

Fear down tube

http://www.canoe.ca/torontoNews/ts.ts-04-22-0007.html

Doctor's lapse put lives at risk

http://www.canoe.ca/TorontoNews/ts.ts-04-22-0008.html

Welcmoe to Pariah City

http://www.canoe.ca/TorontoNews/ts.ts-04-22-0009.html

N.Y. man eyed after T.O. trip

http://www.canoe.ca/TorontoNews/ts.ts-04-22-0047.html

Outbreak Slows

http://www.canoe.ca/TorontoNews/ts.ts-04-22-0048.html

Hi tech firm flags virus sites

http://www.canoe.ca/TorontoNews/ts.ts-04-22-0049.html

Love waits for SARS ( India)

http://www.canoe.ca/TorontoNews/ts.ts-04-22-0050.html

Health workers blamed for spreading SARS

http://www.canoe.ca/CNEWS/Canada/2003/04/21/70147-cp.html

passing thru · Apr 22, 2003

I just read all of those links. Sounds like a lot of stress for people living in Toronto. I can just imagine how the same scenario would affect my city. Hope it starts winding down soon.

steven44121 · Apr 22, 2003

Epaminondas - good morning

http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&call_pageid=971358637177&c=Article&cid=1035781086877

I have a feeing this attempt at putting up the URL did not work.

Anyways, the article was yesterdays paper page A7 "Docors Look at Flu For Answers" by Tanya Talaga. 2nd last column. It states

"In the current Sars outbreak 45% of the people who've got the disease are health care workers".

Todays paper, front page says "the total number of Ontario health care workers with probable or suspected sars has grown to 66....We thought the precautions we were currently implementing would be adequate to protect workers, but what we are seeing is that, despite those precautions, they are still becoming ill" this is from Donald Low chief of microbiology at Sunnybrook Hospital.

Now 66 health care workers infected is more like 25%, perhaps yesterdays figures were based on probable cases not including suspect. Whatever --the percentage , the bottom line is, all the assurances at the beginning of this ie that we were safe with proper infection control is no longer the case.

I think the hospitals need to be doing a lot more education as far as proper procedures and order of gowning/ gloving and degowning/degloving. Doctors are the worst for having gloves on, touching the pt. then touching phones computers etc. with their gloved hands. I really hope it is a matter of breakdown in proper procedures, otherwise we will see many more dedicated co-workers getting ill.

epaminondas · Apr 22, 2003

When you come to a fork in the road, take it.

Yoggi Berra

______________________________________

This post is intended to be more on the sociology of SARS than on the medicine, nursing, or science.

RN4ev'r wrote:

>

Sixes wrote, in regard to the nurse on the train:

>

The above two concepts are flip sides of the same coin.

In Hong Kong, HCWs (Health Care Workers) are simultaneously heroes and pariahs.

Heroes merely for having the courage to get up and go to work in the morning.

Simultaneously avoided by friends and family, neighbors, cab drivers, baby-sitters, etc. Their children taunted and ostracized at school.

All out of instinctual fear of the spread of the disease.

At first the fear seems wrong. Ignorant prejudice. Completely misguided and unfair.

As the epidemic has unfolded, however, such treatment appears, often, to be appropriate.

Let's step back from Toronto for a minute and look at how HCWs have typically dealt with the disease on a personal level in Hong Kong.

The average HCW in Hong Kong is reported to have been treating himself at home for an average of four days or so before seeking medical attention.

Why the delay?

(1) Denial. Denial. Denial.

Would you want to admit that you have SARS?

Even to yourself?

(2) Early symptoms often do not match official definitions of SARS. HCWs have been drilled on the official signs and symptoms of SARS: temperature above 38 degrees C plus dry cough, SOB, or difficulty breathing. They do not have that, so they do not have SARS: so goes the denial.

But apparently SARS often starts out with a lower fever, muscle aches and fatigue. Hey - these guys are overworked - fatigue is a given. Fever actually may go down over the next several days - causing the HCW to think he is getting better. Around day four or five, the dry cough hits. Uh - oh - the alarm bells go off and he ploughs through his denial and he knows it is time to get some help. Off to the hospital - but this time, through the other entrance.

From the writings on this bulletin board, the dry cough business may also be masked by the presence of a cough anyway related to respirator use over 12-hour days. If you already have a cough, how in the world do you know when you are getting a COUGH?

A week after the Hong Kong HCW is admitted to the hospital, the spouse and kids come down with it. Panic at school - the school closes. And every kid in the school knows why - it seems that the children who were ostracizing the children of HCWs find themselves proven to have been right all along.

This happened five times in Hong Kong before they finally just said to hell with it and closed the schools down altogether.

Similar patterns have occurred in the workplace secondary to spread via HCWs spouses, relatives, and friends.

Two taxi drivers in Singapore with SARS: one did a lot of hospital pickups.

The word is out among Singapore taxi drivers not to pick up HCWs.

I can't really blame them.

They may even be right.

With every tale of the spread of SARS from HCWs to the public that occurs in Toronto - and there has been at least one newspaper report of a Canadian nurse passing SARS on to a patient - I suspect that there will be further backlash against HCWs.

For the HCW who is risking his neck - and putting up with horrible working conditions - to do the right thing - who then comes home to an unkind public - it might all seem just a tad unfair.

And it is.

Life is unfair.

It is just one more thing HCWs are going to have to put with for the duration.

The following links to a typical article on the topic from Singapore - there are plenty of other similar articles if you care to search. This particular article is from earlier in the epidemic, when only six Singaporeans had died. I suspect that Toronto nurses may begin to find themselves facing something similar, though I expect that it will have its own gentle Canadian twist:

http://www.singapore-window.org/sw03/030406a1.htm

_____________________________________

Blaming The Victim

Initial outbreaks among HCWs in Hong Kong and in Singapore were blamed on the HCWs involved - often correctly. It was early in the epidemic, and infectious control was not yet up to snuff.

Failures in technique were analyzed, corrections were made, training increased, and standards became more strict.

These investigations were well publicized and were used to inspire HCWs to greater vigilance.

As the epidemic has progressed in Asia, however, HCWs continue to be infected even after strict protocols are in place and are followed to the letter.

This has shaken confidence in the concept that following strict protocols will protect HCWs from the disease.

We are seeing the same sorts of things evolving in Canada.

Initially the "nurse on the train" was accused of violating protocol.

She struck back - no, she was there and she was right on top of things.

The reply - from someone who wasn't even there - was that she MUST have broken protocol.

The underlying thinking is obviously that if she did not, then the protocols are not effective. Therefore she must have broken protocol.

It is a lot easier - and a whole lot lazier - to believe that she just broke protocol rather than to understand that the protocols may be insufficient.

This tactic of attacking the HCW for contracting SARS no longer plays in Hong Kong.

In the latest Hong Kong figures - long after strict protocols have been in place - 25% of the latest round of people diagnosed with SARS are HCWs.

That has been running steady for quite a while.

Let us see how this concept applies to Toronto:

Tuesday, April 22, 2003

Criticisms hurt nurse

Woman at heart of GO fear 'a scapegoat'

By KEVIN CONNOR, TORONTO SUN

http://Http://www.canoe.ca/TorontoNews/ts.ts-04-22-0004.html

Consider - you go in to work and you do your duty. You get SARS anyway. And then you get blamed for getting SARS.

Thanks a lot.

That is the sort of thing you can expect to see.

What is sad to me is that I do not see Toronto as having learned much from the Asian SARS experience.

Toronto is turning to the CDC for help - when it should be turning to the Prince of Wales Hospital in Hong Kong for experience.

It looks to me like Toronto is determined to make the same mistakes that were made in Asia - at Toronto's own pace - in Toronto's own way.

No matter how many get hurt in the process.

I just hope that the U.S. does not make the same mistakes that Toronto is making.

There is no reason for a slow learning curve, filled with mistakes.

Hong Kong and Singapore have already done all that for us.

If we would just have the sense to learn from them.

________________________________________________

Little One2 wrote:

>

Little One2,

Those are the questions, aren't they?

I think that each of us has to come up with the answers for ourself.

On the one hand - there is duty, honour, habit and income.

And just plain doing the right thing.

http://straitstimes.asia1.com.sg/singapore/story/0,4386,184237,00.html?#arclink

On the other hand there are the issues of HCWs contracting SARS themselves.

In regard to this:

(1) Please see above.

(2) Percentage of SARS patients who are HCWs:

Mainland China - currently being reported as 23% (456 HCWs/2001 total cases). the accuracy of the Chinese statistics is questionable.

Hong Kong - reported as 24-25%.

U.S.: 3% (CDC)

Toronto - reported as 45% (Tip of the hat to Steven44121. Thanks!)

Singapore - 90% of SARS cases are reported as contracted in the health care setting, but this lumps together HCWs, patients, and visitors. I have not been able to tease out HCW stats separately on Singapore.

(3) The WHO has been reporting that 90% of SARS patients recover within 7-9 days and that mortality rates are around 3-5%.

Unfortunately, there is considerable question as to whether or not the above is true.

(4) In Singapore you apparently have your heroes, your average Joes and your bums.

I figure that, after all is said and done, I'll probably end up treading water somewhere in the middle category.

The following from a web log by a hospital resident in Singapore. The Sunday April 20, 2003 entry - just a bunch of doctors sitting in a restaurant and talking - caught my eye:

http://www.spacefan.blogspot.com/

I also found her entry of Thursday, April 17, 2003 to be - almost touching.

(5) I came across this in the Straits Times, the Singapore newspaper:

The logistics of keeping a team of health-care workers confined at work for 10 days or more is nightmarish.

But the way the illness has cut down families, the heartbreaking stories of doctors and nurses dying, then their loved ones dying, is a worse nightmare. >>

http://straitstimes.asia1.com.sg/singapore/story/0,4386,184384,00.html?

Interesting to watch all of this unfold. Don't you think?

I would say that this is about a lot more than a medical battle against a microbe.

Of course, it is good to know that it could never happen here.

All the best,

Epaminondas

Scotty · Apr 23, 2003

Hello,

I'm an ICU nurse in Scotland and this is the first time I've written a message here.

We have no known Sars here (yet).

I am grateful to the nurses in Canada who are dealing with Sars for their insights and also to the others elsewhere for their questions and observations. This is so much more informative than the official information. I am sure you are making it safer for health care professionals elsewhere - if and when they have to deal with Sars.

I sincerely hope you are all well. I don't even know you but I worry about you.

You may find the following site useful. It's emails up to April 17th from a senior ICU doctor in Hong Kong:

http://zzorglub.ifrance.com/zzorglub/infectieux/buckley.htm?

Best Wishes,

Scotty