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ACAD-AE-MED  April 2003

ACAD-AE-MED April 2003

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Subject:

Re: SARS & NHS modernisation

From:

John Ryan <[log in to unmask]>

Reply-To:

Accident and Emergency Academic List <[log in to unmask]>

Date:

Sun, 27 Apr 2003 20:27:33 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (157 lines)

You need to watch out for locally misinformed media generating inappropriate
work for you.  The media should be used in a proactive way, helping to
inform the public.  However watch out for journalists with their own agenda
who come out of the woodwork when their is a crisis and may fuel their own
agenda at your department's expense.  This will be a feature of SARS in the
early days.  Panic will be our worst enemy in the immediate future not SARS
though yes SARS is potentially our worst enemy.

It is good that there may be some evidence of possible containement, watch
out for more good news form Vietnam here in the next few days.

There are many issues in our own camp that we need to be prepared for:

Who will see the next patient in your department with query SARS ?
Which nurse will assist that doctor ?
Where will you x-ray your patient ?
Which bed will you admit your first probable case to ?
How will you deal with your staff ?

Most of our efforts might best be placed in preparedness right now. Enjoy
the non local chain of transmission status while it lasts.

regards from the country planning to host the 'Special Olympics 2003', due
to commence in June !

John Ryan




----- Original Message -----
From: "Adrian Fogarty" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, April 27, 2003 05:50
Subject: Re: SARS & NHS modernisation


> 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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