<< A total of 70 doctors are under quarantine. Five are infected and two are critically ill, the
Ontario
Medical Association reports. All worked at Scarborough Grace hospital. >>
Front Lines:
<< > We are starting to see the "second wave" of SARS cases in Toronto. Dozens of health care workers from the hospital caring for the index case in Toronto have been placed in quarantine due to symptoms suggestive of SARS. > Their Emergency Department and ICU have been shut down, no new admissions to > the hospital. Three paramedics have been hit. Public health officials are > also placing family members of SARS patients with exposure in quarantine. > They have been advised that the quarantine is "voluntary" unless they don't > follow it...then it will be involuntarily enforced.
>
> We are hoping that all of these cases related to the initial case at that > hospital, however there have been various people visiting that hospital, > health care workers may have passed this on to family members. Patients > with possible exposure have been transferred to other hospitals prior to the > outbreak of cases in health care workers, thus some of them may have not > been in isolation at all times.
>
> After many days of reassuring comments from the government and infection > control staff in hospitals, it seems that people are starting to get worried > that this may get out of control. There are many people who travel back and > forth to Hong Kong from Toronto, thus there is also the concern that we may > get fresh cases from overseas.
>
> Our critical care resources have not been overly stressed yet, however > negative pressure ICU rooms are at a premium. >>
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kps,
Good to hear from our embedded reporter on the ground in Ontario.
Of course, I'm not worried, but -
You take care of yourself - ya hear?
Let us know how things go -
Epaminondas
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Sandbox,
Most reassuring.
The WHO is saying that 90% recover within 7-9 days.
The WHO has been saying a lot of things.
I am hearing different things from different sources:
<< it’s Treatable >>
From the front lines:
< Supportive care . . .
There are no magic bullets . . .
Antibiotics, antivirals, steroids have not shown any improvement in patients clinical condition.
Limiting transmission
Limit contact
Isolate early
Hand washing, N95 masks, visors for all procedures, Gowns
Regards,
XXX XXXXXXX
XX Hospital
Hong Kong >
___________________________________________________
<< contagious by Contact Only. >>
Index patient to Hanoi-France Hospital. Transferred out late February.
By March 5, seven staff who had cared for the initial case had SARS.
By March 15, forty three staff had SARS. Five on ventilators. Soon - two dead. Approximately 60% of the hospital staff is reported to have contracted SARS.
Current death toll from the Hanoi outbreak: five dead. Three physicians, two nurses.
The latest casualty:
Carlo Urbani, M.D. ___________________________________________________
In Hong Kong, on one medical ward, 68% of the staff have contracted SARS.
This disease is more transmissible to hospital staff than any cold or flu virus I have ever experienced.
Over the past three days, 30-100 tenants of an apartment complex in Hong Kong have been reported to be diagnosed with SARS. There was one known case in the building. Method of transmission is unknown. It could be the ventilation system, the elevator, fomites - whatever.
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<< Someone I know at John’s Hopkins said “it looks like a nasty cold”. >>
Front Lines:
< Overnight in ICU despite the two deaths patients are stable though not improving. Two new admissions overnight but no more mechanical ventilation. Spontaneously breathing patients - respiratory rates improving but no improvements in A-a gradients. New admissions have all received pulse steroids on the general wards - is this limiting the inflammatory process [they are still deteriorating requiring ICU admission] or is this functional improvement due to natural course of the disease.
My impressions are that we will be left with patients with ALI/ARDS. We have been trying to wean and extubate a 23 year old medical student whose oxygenation and ventilation are very good. She has now failed the oxyvent twice now. Finally gave myself a kick in the pants and realised I am expecting too much. This girl has ARDS and we are trying to extubate her after 3 days.
8 of 53 cases with atypical pneumonias are in ICU
16 of 43 cases are patients/visiting relatives
It appears the younger fitter patients are not getting as ill.
Yesterday I was well and truly frightened and I could see the fear was palpable around the hospital. I would love to be able to thank each and everyone of you personally for your support and encouragement. I have passed on many comments to the nursing and medical staff.
They continue to amaze me. Medical staff helping me with infection control, equipment procurement, staff support have bent over backwards to help.
Over the last few years I have become very disenchanted with the direction of intensive medicine. I am privileged to belong to such a community as ours. Thank you. >
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<< Ok maybe a threat to rural Asians >>
Hanoi.
Hong Kong.
Singapore.
Toronto.
________________________________________________
<< but odds of it getting out of hand in our medical environment, are looooooong indeed. IMHO >>
That was the humble opinion of the physicians in Toronto, as well.
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Of course, we know that this could never happen in America.
I am confident of that.
Still - we are going ahead and preparing for the worst - while hoping for the best.
Of course we know it could never happen here.
Regards,
Epaminondas
___________________________________________________
From Hong Kong:
<< 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 >>
[ 03-29-2003, 06:14 PM: Message edited by: Epaminondas ]
