TERROR PREPARATIONS -- HOSPITALS BRACE FOR SARS
31 Mar 2003
Source: Wall Street Journal, April 1, 2003
SARS: HOLDING THEIR BREATH
Terror Preparations May Pay Off As U.S. Hospitals Brace for SARS
By BETSY MCKAY and KELLY GREENE, Staff Reporters of THE WALL STREET JOURNAL
For months, U.S. hospitals have been gearing up for possible attacks from bioterrorists. Instead, the hospitals' big test might come from Mother Nature.
With a lethal respiratory illness that originated in China now spreading farther and faster than health officials expected, hospitals are calling on some of their new bioterrorism skills and resources to contain the disease.
While many of the 69 suspected cases of severe acute respiratory syndrome reported so far in the U.S. have been milder than those in Asia, and no one has died, domestic hospitals are preparing for a more serious outbreak.
The U.S. Centers for Disease Control and Prevention -- much criticized for its handling of the 2001 anthrax attacks -- issued guidelines for containing the disease in this country as soon as the virus began spreading beyond China in mid-March.
They include isolating suspected SARS patients as quickly as possible in special negative-pressure rooms (where air is vented outdoors, rather than recirculated through the hospital) and providing health-care workers with the kind of protective masks and clothing they would wear for a smallpox outbreak. One of the first questions the agency is telling hospitals to ask patients who come in with respiratory problems is whether they have traveled to Asia, or come into contact with anyone who has.
Windham Community Memorial Hospital, in Willimantic, Conn., put the CDC's advice to the test last week when a University of Connecticut student was admitted with a suspected case of SARS. After receiving a "30-minutes heads-up" before the student arrived, according to spokeswoman Karen Butler, emergency-room staff donned gowns, gloves, high-filtration masks and goggles, then rushed the patient into a negative-pressure room.
Later, health officials from the university and state discussed the illness and its symptoms with people with whom the student had been in contact in recent days and sent an e-mail to the entire student body, faculty and staff. So far, no other cases have turned up.
The small, nonprofit hospital relied on preparations it had recently put in place to handle a potential smallpox outbreak. The hospital's bioterrorism and emergency-preparedness committees had even recently discussed SARS, says Ms. Butler, who sits on both committees.
"I think we would always be prepared, but there is a heightened level of awareness right now," she says.
SARS is setting off alarms because its origin is unknown and there is no vaccine or cure. It's not even clear how contagious it is. While the CDC originally thought that the illness could be transmitted only through close contact, the agency now says the virus may also be airborne and transmitted through objects.
Most U.S. hospitals except those that handle specialty care or are very small have basic facilities to handle patients with infectious diseases, such as tuberculosis. These include isolation rooms with negative air pressure and "N95" face masks, which fit snugly and filter smaller particles than a typical surgical or paper mask.
The question is what would happen in a major outbreak. In Los Angeles, where seven cases have been reported, officials are keeping their bioterrorism plans in mind. The University of California at Los Angeles Medical Center, which has 10 rooms with negative air pressure and 30 portable filtration units at the ready, says that, should it need more such rooms, it would use a wing in a separate hospital that already is designated for smallpox.
While hospitals are equipped to isolate contagious patients, doctors' offices and clinics are another matter -- they rarely have pressure rooms or N95 masks. David Pegues, associate clinical professor of infectious diseases at UCLA Medical Center, says he has advised them to put suspected SARS patients "in a room, put a surgical mask on them, close the door, put a mask on yourself, and call the hospital epidemiology department and health department."
While precautions are being taken, some health-care workers are worried. "All the resources are being put into a nonexistent problem: smallpox," says Charles Idelson, a spokesman for the California Nurses' Association, which represents 50,000 registered nurses in the state. SARS "is a very real problem, and we do believe hospitals and health care systems should take it seriously."
A case in point is Toronto, where hospitals are grappling with 111 suspected cases. Four have died, and a few children have recently been diagnosed with the ailment. Hospitals across the city have sharply cut back elective surgery, outpatient services and visitation rights.
Donald Low, chief of microbiology at Toronto's Mount Sinai Hospital, urges U.S. hospitals to learn from Toronto's experience. "This is a disaster," he says. In the U.S., there's still time "to put health care on alert." One encouraging sign: Dr. Low has treated many of the SARS patients, and his mask, gloves and other protective gear have kept him healthy so far.