SARS in Toronto!

RN4ev'r · Apr 20, 2003

I've been off work this weekend and have just heard the news about the ICU's being closed at Sunnybrook. As I said before, I guess we had just been lucky. The papers quoted the head of Infection Control as saying a mask or face shield slipped during the procedure. I don't work in ICU and I also wonder how an intubation could take four hours. They also report that they have cultured the virus on objects after 24 hrs., causing them to believe in can live longer than they thought. I guess I'll find out more, through in hospital news, when I get to work tomorrow.

As a side note, I have heard of how nurses, at some of the other hospitals that were closed, have been discriminated against, to the point that their children were being affected at school, and thier husbands at their work. It would be nice if the media would report on the dedication of the front line staff that put themselves at risk, on a daily basis, to try to help. They deserve all the respect they can get.

steven44121 · Apr 20, 2003

RN4ev:

http://www.globeandmail.com/servlet...//?query=picard

Hope this link works, I previously posted on the Cdn discussion board. It is a really great article. Talks about exactly what you are saying, healthcare workers and their families have suffered from negative perceptions and fear of sars, it also praises frontline staff especially nurses.

One friend who also works downtown T.O., was asked at her daughters school play "do you really think you should be here"?, by another parent who knew she was a nurse.

Another friend just lost her babysitter over her fear of exposure, potential quarantine and loss of income that would bring.

So yes, fronline staff in T.O. are definitly affected on a personal level.

RN4ev'r · Apr 20, 2003

steven44121:

Thanks for the link. Unfortunately it didn't work, but I found the one in the Cdn discussion board. Sure was glad to read something good about nurses and their dedication during this stressful time.

sixes · Apr 21, 2003

after you read the first three links you may feel as angry as i do. i don't know what this nurse was thinking and i am not in her shoes but you'd think a professional working only with sars clients would be much more responsible.being dedicated to our profession is one thing being silly is another.

why didn't nurse know

http://www.canoe.ca/torontonews/ts.ts-04-21-0004.html

disease on wrong track

http://www.canoe.ca/torontonews/ts.ts-04-21-0003.html

commuters catch go train jitters

http://www.canoe.ca/torontonews/ts.ts-04-21-0002.html

sorry for the venting. i just get frustrated when i hear of professionals esp. in the medical field acting so irresponsible.

i would like to get on with my career sooner than later. it's bad enough when the uneducated disregard other people's well being, but now it was one of us. i am sure she had her reasons, perhaps she just wasn't thinking clearly. i would certainly like to hear her side off it all

no fed cash

http://www.canoe.ca/torontonews/ts.ts-04-21-0005.html

fears alter easter service

http://ww.canoe.ca/torontonews/ts.ts-04-21-0006.html

china admits cover up

http://www.canoe.ca/torontonews/ts.ts-04-21-0007.html

visiting a sci-fi world

http://www.canoe.ca/torontonews/ts.ts-04-21-0010.html

i'm free again

http://www.canoe.ca/torontonews/ts.ts-04-21-0029.html

china reports spike in sars cases

http://www.canoe.ca/cnews/world/2003/04/16/66936-ap.html

to all you wonderful people working with sars keep up the good work and be safe.

toronto rn · Apr 21, 2003

Hi to all, I just finished a 12 hour shift working in isolation in icu with a sars patient who likely won't live out the week. My face still feels the impression of the mask which has been a second skin and I am reluctantly going to be returning this evening for another go at things. I just wanted to comment on the reported 4 hour intubation of the patient at sunnybrook hospital which resulted in staff exposure. We had a simular experience with 2 sars patients. Initially when these patients were deteriorating they required 100%o2 and then BiPaP-first mistake -- the bipap as it turns out aerisolizes the sputum of the patient making the virus airborne. The mandated protective wear- N-95 masks and goggles, gloves and gowns are not satisfactory against aerisol which can land on the face around goggles and likelybe absorbed through the conjuntiva= contamination. The difficult intubation requiring many attempts at bagging and intubating followed by suctioning and stabalization can last many hours. The other identified area of concern was using an occillating vent which also could had aerisolized the virus. Anyone in the room could have ended up with SARS. Bipap is absolutely prohibited now on all patients in our hospital. Check out the pic's from China- rows of patients on Bipap machines, no wonder the count there has multiplied.

Recommendations as of yesterday include that all staff on SARS units wear disposable scrubs, we use double gowns, gloves, caps and a face shield over 2-n-95 masks, alcohol is your best friend, we use purell or alcohol hand wash for every piece of protective gear that is removed- when leaving the isolation room

Everyone is fearful and especially now that another nurse is sick and has inadvertantly exposed passengers on the go train. In response to the post above expressing anger at the nurse who acted irresponsibly in travelling with symptoms,-Imagine every day going to work (which you previously enjoyed) and wondering if you are going to end up sick -they really don't know much about this yet. imagine wearing a tight mask all day, having to sit a minimum of 6 feet away from anyone at break, -so others are out of harms way if you cough, imagine hearing how other staff can't possibly work with those SARS cases because they have loved ones who are sick, or they are only part-time and don't have benefits, or they have children (what makes their loved ones more important than your's). Imagine having the isolation procedures changed almost every other day only to find what you were doing last week was not good enough and you wonder if you are safe. Imagine not knowing when this is going to end- you end up feeling tired, each day with such a headache from the stress, your muscles ache from the worry and you sweat to death from all the protective gear. Headache, muscle soreness and fever- 3 main SARS symptoms- how can you differentiate it -Don't be to harsh on that nurse, It is really hard to understand how dedication, and responsibility can cloud your judgement, until you have walked in those shoes.

Off to bed now after a long shower.

Stay safe all:)

SmilingBluEyes · Apr 21, 2003

EYE opening information here. MY thanks and respect to you nurses living and working with SARS. I have printed some of these posts to show/educate my coworkers as to what you are dealing with here. Thank each and every one of you for your compassion and the willingness to share your experiences here. I truly am grateful for you all. I join you in prayer this ends soon.

Trishrpn · Apr 21, 2003

Toronto_Rn brings up a good point. Working every day in n-95 masks (or higher), gloves, gowns, goggles (and now perhaps full face shields) tire you out. Your 12 hour shifts feel like 16 hours or more because of overheating, inability to breath well, stress of dealing with this situation and irritable co-workers, patients and their relatives (mostly by telephone for relatives as they are not allowed in except in special cases).

Many health care workers are developing irritation or allergies to the masks.

I'm sure many of us that are working in Toronto have symptoms that are similar to those of SARS. We certainly hope that it's a direct result of the working conditions and not true symptoms of the infection.

Personally, I'm exhausted, I've been much more tired than normal in the last week or so, literally falling asleep on the couch after eating dinner. I have muscle aches- particularly after a shift and or the next day. I've been coughing a lot in the last week, and my upper respiratory passages seem to be more congested (nose and throat- perhaps post nasal drip?). My throat has also been sore on and off in the last week- but mostly during and after shifts, the soar throat doesn't last as long as the other symptoms I'm describing. I'm hoping that my coughing symptoms, congestion and occasional sore throat are due to allergies to the masks (and or enviormental allergies- it is spring after all!). Co-workers are not talking much about how they feel but I know some of them are experiencing similar symptoms as I am.

I've been monitoring my temperature at least twice a day just to be sure that I'm not coming down with anything. So far the most I've run has been a low grade fever, but most often my temp is normal. I've even gone so far as to listen to my own chest when I've been feeling a bit wheezy or have felt tightness in my chest but so far my lungs sound perfectly clear.

Sounds like I'm being a bit of a hypochondriac, and it feels that way sometimes because I'm becoming worried about my cough ... but I certainly don't want to have this illness, and if by some chance I do get it I want to be able to realize that I have a fever or definite symptoms so that I don't end up going to work or out in public and end up exposing others to this infection.

Again I'm hoping this is allergies ... as I do have a history of mild asthma, and other allergies. Those masks are terrible! I'm experimenting with Claritin as of yesterday, so far I'm still coughing but a bit less than yesterday.

Please tell me- are any other nurses or health care workers in Toronto experiencing similar symptoms as I am? I'm working tonight and I plan on discussing this with my co-workers as well. (I walk to work so if these are not allergy related symptoms there is little chance of my travel to work causing anyone else any problems)

As for the nurse that took Go Transit last week ... well, they say she wasn't feeling well and had a mild fever but wasn't coughing. More than likely she thought that her not feeling well was due to the work conditions since so many of us are feeling the effects of wearing all this isolation gear.

I don't know if our work conditions have changed in the emergency dept or not. So far there are no new bulletins through my work email. As Toronto_RN said there are new measures being taken in her ICU dept. I would think that we would have a few new measures in our Emerg dept as well since we are the first ones to work with any potential SARS patients.

On each of my four shifts since last Monday I ended up working with suspect and definite possible SARS cases in the emerg in our Isolation area. When we go into the Isolation area or Isolation rooms we double gown, hat, put a surgical mask over our N-95 mask, put on goggles (not tight fitting ones- we need those!), put booties on our shoes, and double glove. It would be nice if we move onto the full face shields as well. (Well, not nice, I'm sure I'd hate wearing that, but I would feel more protected). I'm working tonight and I'll probably end up working with questionable cases again tonight.

When we began taking protective measures at the end of March we were told that when eating in the cafeteria we were not to sit oposite each other ... instead we were to stagger our seating so we were never facing anyone directly. Now as Toronto_Rn stated we are to be 2 metres away from each other when not wearing our masks (cafeteria, Staff lounge, outside hospital doors). We are also not supposed to get together outside of work- no socializing with fellow co-workers, or other workers from other health care settings.

My husband and I both work in the hospital and our being hospital workers has isolated us to some extent. We were invited to his parents house for Easter Dinner but we didn't think that was a good idea just in case. My mother lives out of town and she's 81 years old ... I'd love to go visit her but again, I'm holding off visiting for now- just in case. We have a lovely older neighbour beside us- she's also 81 years old ... she thinks of us as her kids and she enjoys dooling out hugs and kisses to us but we've banned that for now, and only talk to her from a distance. This might sound extreme to some, but when they don't want co-workers near each other or getting together outside work you have to wonder if they know more than they are telling us ... and I just don't want to expose my loved ones to anything if I can prevent it.

A tired Trish

Trishrpn · Apr 21, 2003

Zumalong said:

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.

Yes wearing a surgical mask over the n95 or n99 does cause more moisture to build up. And when you are doing a work up on a suspect case of SARS you can be in there for close to an hour from initial assessment of the patient to testing them and starting I.V.S etc.

If our masks become moist we can get a replacement, but I think the supplies are very low here in Toronto ... they don't want us to replace our masks unless we have to (at least at our hospital!). if we need a replacement they ask us why and we sometimes have to sign for a new one. I can see them questioning someone that is not working directly with patients or not working in one of the "at risk" areas ... but for those who work in Emerg or ICU etc they shouldn't grill us about needing new masks ... If our mask is moist we need a new one period!

Trish

toronto rn · Apr 21, 2003

Hi Trish, your reports of sore throat and cough are very common. Most nurses I work with experience a sore throat after a long shift of wearing those masks. Mainly due to breathing with your mouth open, which you may not notice but do because it is easier to keep that suffocating feeling at bay. This can exacerbate a stuffed nose and cough. Also I think we are dehydrated, nurses are a little uneasy to remove masks to drink so you may find that extra water will help with the sore throat and cough. No matter what be careful and stay home if the symptoms persist or worsen especially if you work with SARS. This past weekend at my facility if you were ill you had to have a doctors note or you wouldn't be paid---------arrrrggggh--No wonder nurses are ignoring symptoms, we actually had a bulletin from work stating to observe for the usual SARS symptoms and stay home to evaluate them unless you are a health care professional in a critically short area-then you are to report to work for screening, and may be required to work despite symptoms. After all everyone is wearing a mask---It infuriates me that my safety takes a backseat.

To all nurses out there working with SARS be careful and don't reuse any masks or gloves or gowns or faceshields--The SARS virus is capable of staying alive on dry surfaces for up to 24 hours- it is too easy to contaminate yourself if you reuse equipment-I know this has been common practice at many facilities but stand firm and demand safety for staff. Use an alcohol based wash on your hands or gloves every time you need to remove protective gear.

JMP · Apr 21, 2003

Oh Trish

As a RN in a close city, I can feel for you. I admire your dedication and obvious thoughfulness.

You are to be commended and I know it is not easy. On top of everything, the tired feeling, the gowns, masks, etc you also have the worry.

Take care and try to give yourself extra time to rest.

JMP · Apr 21, 2003

And...you too Toronto RN

Funny, I work in ICU and for the last two weeks we where in full atire- N95's - gowns-goggles-etc and just last week- they said- "no more..... no gowns no N95's ....just goggles for suctioning ( I work in ICU)

Anyhow, take care. I read your posts with interest and feel much empathy for you.

Trishrpn · Apr 21, 2003

Epaminondas, Wow you ask some good questions and also provide helpful information. :) I have to start getting ready for work soon but I'll try to answer some of your questions or provide a bit more info.

I don't know Wendy but perhaps she iisn't posting on this subject anymore due to the stress of working in this new SARS enviornment ... it's very stressful and I know a lot of nurses who are purposely not listening to the news or reading bulletins etc ... they are just following directions (changes in proceedure) as they are given to them ... they don't want to stress themselves further by hearing more about SARS or by purposely trying to get more information about it or about what is happening in the rest of the world. I take breaks from info gathering for a few days but then I get curious and I'm back at it. Everyday there is a news conference at 3pm from the Toronto Health Dept ... I watch them when I can but I find I become very stressed during and after their briefings- especially when they discuss health care workers becoming infected or the quarantining of large amounts of people.

Yes to the best of my knowledge everyone in Toronto is still showing up at work ... but as more health care workers become infected I don't know if that will continue ... Perhaps it's started ... my husband is a porter in the hospital and he wasn't scheduled to work today but we got a call early this morning asking him to come in because 4 or 5 porters had called in sick and there were only two working. Perhaps that happened because it's Easter Monday and people are trying to lengthen their holiday weekend ... or maybe it's because of all the bad news in Toronto this weekend? I'm not sure.

re: panic

No leaving footprints on the back of the person in front of you. [/Quote] LOL this reminds me of the time my husband who is afraid of dogs decided we were about to be attacked by a doberman (who ended up being chained behind a low fence but it was dark so we couldn't see the fence or that he was chained) and he literally ran over me!
I don't think anyone is panicking here in Toronto ... we are stressed but we are trying to protect ourselves as best as we can, and as you know the methods in which we protect ourselves seems to change from day to day. We are still learning- unforunately.
You asked about signs and symptoms ... a fever of 38 C is not a magical diagnostic symptom but it certainly helps since it is one of the most common symptoms along with cough, shortness of breath, and muscle aches that we are seeing. Anyone with respiratory symptoms and a fever of 38 C or greater (or history of feeling feverish in the last 24 hours) gets isolated and is investigated for SARS.
How in the world do you diagnose someone outside of a known chain of infection? [/Quote]
I'm not sure what you mean here? We are investigating everyone with symptoms of SARS (severe headache, cough, shortness of breath, muscle aches, malaise, feeling feverish over last 24 hour period, AND current fever of 38 C or greater; OR unprotected contact with someone under investigation for SARS or who has been in quarantine for SARS OR who has recently been in one of the severely affected hospitals or other area's now under quarantine). We look at symptoms first and we take it very seriously if there is also a possible connection with a known chain of infection (ie severely affected hospital) but we are investigating everyone with possible symptoms.
The course of the disease and recovery vary ... some people seem to get a very mild form of illness and others extremely serious forms of disease often needing to be intubated and put on a ventilator. Since I work in Emerg I only see the suspect or possible cases when they come in ... I don't always know how things turn out for them or how long they end up staying in the hospital.
LOL I mistook your question about infected healthcare workers ... yes It would make sense that you meant what percent of the total possible cases are health care workers. To that question I don't have an answer ... When SARS first hit Toronto I think there were quite a large number of infected health care workers because they weren't isolating in the beginning when they didn't know what there were dealing with. So more people had unprotected exposure. Then things seemed to level off and most new cases were members of the public who had connections to those first few cases ... but now we are starting to get more infected health care workers. Unfortunately I don't know what the numbers are ... I will try to find out- perhaps my boss or someone at the hospital will have some current information on that for me.
I'm glad you are optimistic about Canada's abilities to contain this disease. I hope you are right and we are successful ... but with the amount of new cases developing this past week, I'm a less optimistic than I was when this first started.
I still don't understand why there arn't more cases in the US ... luck? Are the numbers accurate? I'm perplexed because here we are gong to extreme measures to isolate and contain this disorder, and as far as I can tell in the US people are only isolated or rather protective measures are only taken when the hospital begins to suspect that they might have an infected person sitting in front of them. And that's why I'm surprised that you don't have more cases by now ... because it seems that it doesn't take a very long face to face exposure to spread this infection ... and here we are wearing all this protective gear and STILL health care workers are becoming infected ... You see how this doesn't seem to add up? I hope it's luck and that you guys really aren't seeing many cases, or perhaps we just have a much more infective form of the virus here in Canada ... I don't know.
As for your reports from Hong Kong ... I have to agree the masks do not fit properly ... we do not have a choice in sizes- we get what we are given ... I have a small face and the mask is always loose in the lower portion.
As for keeping up staff moral ... in the emerg they have been providing cases of bottle water to help combat the excessive overheating we are experiencing in our isolation gear. They were also providing one meal (pizza, pop) in the first few weeks ... I don't go in the staff room much so I'm not sure if they were still doing that this week or not, and when we are able to (not often!) as long as there is someone to cover our patients we can take a quick break from the unit to get some fresh air outside, over and above our usual breaks.
Ok I have to get ready for work! Thanks everyone for listen to our stories of what it's like to work in the health care field these days in Toronto and for your kind thoughts for our safety. It helps! I'll keep you posted and let you know if there are any more changes!
Trish