I don't really believe the media are putting a spin on this John, although
the public themselves may be over-reacting (slightly). The plain facts are
that it is highly infectious, with early attack rates of around 50% among
healthcare workers caring for patients with SARS. At the start of the
outbreak in Hong Kong, the index case infected 88 healthcare workers! And in
the community there, one discharged patient infected some 237 residents in a
local housing estate. The figures are showing no signs of slowing down in
heavily affected areas, with death rates running around 6% generally, but
higher in Canada and Singapore.
What makes life difficult however, is that there is still no such thing as a
SARS test, and diagnosis depends on the clinical picture, which itself is
very non-specific. However all patients have high fever (>38C) malaise and
myalgia, but only some have respiratory symptoms in the early stages, and
similarly CXR changes may not develop until later in the illness. Most have
lymphocytopenia and thrombocytopenia and mild LFT abnormalities, but again,
very non-specific. All cases have occurred within 11 days of contact.
Furthermore there is no reliable effective treatment, although ribavirin and
steroids have been used empirically. As Danny suggests, it's during the
early febrile phase, before respiratory symptoms develop, that the patients
might pose the greatest threat in terms of transmission. Luckily Ireland is
not considered to have a "local chain of transmission"
http://www.who.int/csr/sarscountry/2003_04_26/en/ and although the UK has
had some local transmission, I don't believe this is ongoing at the moment.
It's at times like these, as healthcare workers, we don't get paid enough -
or rewarded, valued, call it what you will - for what we do (especially if
you work in the supra-regional infectious diseases unit!). But hey, that's
another thread entirely!
Adrian Fogarty
----- Original Message -----
From: "John Ryan" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, April 27, 2003 10:22 AM
Subject: Re: SARS & NHS modernisation
> It is also worth bearing in mind that before we get some significant
> outbreak we will have a number of 'test cases' which turn out to be
nothing
> or at most suspect cases. At the moment the most immediate threat to the
> function of emergency departments in the UK and Ireland is probably the
> mis/under-informed public / primary care, the spin put on the situation by
> the media and volume of false negatives that we will have to deal with.
> All these will distract us from contiuing to provide care for the chap in
> the corner who needs our attention for ventilatory support, or the septic
> elederly patient with a perf, or an abused child.
>
> We have had high profile media attention over the last week from the
> management of one case and consequently attracted a significant extra
volume
> of SARS related work - telephonic and clinical eg:
>
> 'I am touring Ireland from toronto, should I come in for a SARS test ?'
> 'I was in Toronto in February and have been short of breath since - my GP
> said he would fax the letter in (he did)'
> 'We need a letter to say we can go to work - the 'Burger King two' who
were
> given a letter by their GP saying '? SARS' because they had been in China
2
> weeks ago and in fact had no symptoms
>
> Nevertheless these cases are also an opportunity to get our preparedness
> right and we should not lessen our guard because of an inevitable high
> number of false positives in the early days.
>
> John Ryan
>
> ----- Original Message -----
> From: "Danny McGeehan" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Sunday, April 27, 2003 09:41
> Subject: SARS & NHS modernisation
>
> Colleagues
> Thanks to John Ryan and Rowley the implications of SARS are beginning to
> sink home to an increasingly complacent list. I have been concerned for
> several months. Yesterday I was reviewing the expereriences of the
Canadian
> medics and the disease has ground the mechanisations of the hospitals to a
> halt. The staff literally get knackered doing 12hour shifts under the
> protective equipment.
>
> As sure as eggs are eggs and night follows day it will hit the UK. With
> any viral illness from smallpox to flu it is infective before the patients
> have clinical manifestations. My extensive research of the condition
> defines two camps. The clinical virologists of whom I hold the highest
> regard recommend strict quarantine while the CMO and the CCCD's are in my
> opinion more laissez faire.
>
> I am somewhat alarmed because it will have a profound effect on the A&E
> modernisation.
>
> Kind regards
>
> Danny McGeehan
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