Outbreak response: A tale of two cities
By Betsy McCaughey
Originally published March 6, 2007
If you don't remember what SARS is
- the four letters stand for severe acute respiratory syndrome - and you're not
worried, keep reading. The newly released SARS Commission report, published by
the government of Ontario, is a sobering list
of what hospitals in Baltimore
and other cities need to do to protect all of us.
On March 7, 2003, two men with undiagnosed SARS went to the
hospital in two Canadian cities. In Toronto,
this event caused an outbreak of disease that killed 44 people, infected
another 330, and forced hospitals to close. In Vancouver,
a "robust worker safety and infection control culture" enabled Vancouver General Hospital
to prevent the disease from spreading to another patient or hospital visitor.
Mr. C (the report omits names) arrived in Vancouver
after a trip to Asia. He felt ill and went to
the emergency room at Vancouver General at 4:55 p.m. Because of his fever and
difficulty breathing, the staff removed him from the crowded room within five
minutes. By 5:10, he was put on "full respiratory precautions."
Caregivers wore tight N95 masks to filter out microbial particles. By 7, Mr. C.
had been moved to a negative pressure room to prevent infectious agents from
flowing to other parts of the hospital.
That same evening, Mr. T was taken to Scarborough
Grace General
Hospital in Toronto. Mr. T's mother had come home from Hong Kong two weeks earlier, and died from what everyone
thought was heart disease. Mr. T waited in Scarborough Grace's emergency room
for 16 hours. Two patients waiting with him contracted SARS. "Infection
control was not a high priority" in Ontario
hospitals, says the report. Of all the people who contracted SARS in Ontario, 77 percent got
it in a hospital.
Hospital administrators at Scarborough
insisted that N95 masks were unnecessary. In Vancouver, the staff was ordered to don N95
masks until there was proof that less protection was needed.
On March 18, the Ontario
government recommended gloves, gowns, N95 masks and eye protection when
treating SARS patients. Health care workers had to fend for themselves. Doctors
at Toronto's Lapsley Clinic bought goggles and masks from a home
improvement store, but three of the clinic's four doctors there still caught
SARS.
Many SARS patients needed to be intubated,
meaning a tube was inserted in their windpipe to help them breathe. During intubation, mucus sometimes is expelled onto equipment and
walls. Mr. C was intubated at Vancouver General
without anyone present becoming infected. In Toronto, doctors and nurses who performed the
procedure without N95 masks caught the disease.
Hospital workers were also exposed to SARS by contaminated
equipment (the virus can live on objects for hours) and visitors whose
relatives were being treated for SARS. Mrs. M, whose husband was in intensive
care with SARS, was allowed to walk around the hospital without a mask on the
false assumption that without symptoms she posed no risk. She died of SARS in
April.
The SARS report is a tale of different hospital cultures.
The report shows that if avian flu or another virus made its way to the U.S., the death
toll would depend largely on what hospitals did when the first victims were
admitted. If hospitals have effective infection controls in place, an epidemic
might be stopped. Vancouver
proved it. Baltimore and other U.S. cities can
learn from it.
Some preparations have been made, but most hospitals in the
U.S.
are underprepared. One out of every 20 patients
contracts an infection in the hospital. Methicillin-resistant
Staphylococcus aureus (MRSA) is racing through
hospitals, spread by dirty hands and unclean equipment. How can hospitals that
are failing to prevent ordinary infections spread by touch contain a new,
unknown virus that can spread not only by touch but also in the air?
Even in Baltimore, where
hospitals such as Johns Hopkins have shown leadership in preventing infections
(Hopkins
recently announced a pilot program to screen patients for MRSA), the SARS Commission report holds important lessons. In Toronto, doctors and
nurses brought SARS home to their families. In U.S. cities, hospital workers wear
contaminated uniforms home and even into restaurants.
Such shoddy practices are poor preparation for the
challenge of an unknown disease. Our best defense against a sudden, new
contagion is rigorous hospital hygiene and routine infection prevention. That
is the lesson of SARS.
Betsy McCaughey,
a former New York lieutenant governor, is chairman of the Committee to Reduce
Infection Deaths (www.hospitalinfection.org).
Her e-mail is betsymross@aol.com.
Copyright
© 2007 by The Baltimore
Sun.