How NZ doctor's diary of death alerted the world

Tired and worried, Tom Buckley sat down at his hospital computer in Hong Kong and began to type warnings that would shock and inspire his fellow doctors around the world.

"Dear All," the New Zealand-born doctor wrote in an email to about 1500 intensive care specialists from Toronto to Auckland. "We seem to be close to or are the centre of this form of atypical pneumonia ... "

Over the next three weeks Dr Buckley, 48, the acting head of intensive care at Hong Kong's Prince of Wales Hospital, wrote a series of electronic bulletins warning his colleagues.

"I was able to disseminate a lot of information very quickly ... when newspapers, CNN, were not carrying anything. I wanted intensive care specialists around the world to be aware and on their guard," he explained to the Weekend Herald.

One specialist wrote: "Keep it up, Tom. There have been, in the past, valued, heroic representatives in the annals of medicine. I believe you have just joined their ranks."

March 16, 11.40am: "As of yesterday there were 64 patients with 'atypical pneumonia' in the hospital - a large number are staff ... All elective surgery is being cancelled and wards are being closed and evacuated. Masks are worn throughout the hospital. Staff are not going home to children. Please take the warning below seriously. My impression is even with minimal contact with an infected person people have been becoming ill."

March 16, 9.36pm: Dr Randy Wax from Mt Sinai Hospital in Toronto, Canada, confirms the first case of Sars there and criticises attempts by public health officials to downplay the disease. Dr Buckley agrees that public health officials and the health minister in Hong Kong have done the same. "If ICU staff contract this pneumonia then we are well and truly up the creek. If our families do (and I have been very careful to limit contact) heaven help all of us. We are all extremely worried."

March 17: "We now have 87 cases in the hospital (3 more than yesterday). . All staff who've had direct contact with this ward have developed the illness within 4-5 days. Visiting relatives to other patients have developed the illness ... TWO of my nurses are sick." . .

March 18: "We're all wearing gowns, N95 masks, hats, gloves and additional masks with visors for any bedside procedure. I've bought HK's total supply of N100 masks (7) to try them out and have requested our safety officer to investigate suppliers of space suits."

March 19: "Yesterday was a bad day. 7 admissions to ICU. Total of 24. Unfortunately 2 died last night. Yesterday I was truly frightened and the fear was palpable around the hospital."

March 21: "Last night senior nurse rang me to say she was resigning. She is petrified.

"HK Government is downplaying the whole thing presumably due to the economic implications."

March 26: "This is a real rollercoaster ride in terms of emotions. What is even more scary is that: 1. Schools have not been closed; 2. The sevens rugby tournament is still going ahead this weekend; 3. The Rolling Stones are due in HK this weekend.

"Politicians will not take the tough decisions. When they do it will be too late. If this comes to you (and I sincerely hope it does not) it will potentially overwhelm your critical care services."

Thanks for posting this article.

I am not a doctor, but I was fortunate enough to see some of the early material from Dr. Buckley. To say this thing is "just the latest version of the flu" or some such related nonsense is clearly uninformed.

It is certainly a very serious disease, but actual facts are a lot harder to come by than most people think.

Incredible as it may seem, there is STILL no firm consensus on what causes SARS. China, today, publicly claimed it is related to chlamydia. The United States, today, said it is 99% certain it is caused by a new virus from the corona virus family. Other candidates have been advanced in the past as well.

Nor is there a generally accepted and readily available test to confirm a case. The diagnosis of SARS is based on a fairly common set of symptoms, not a laboratory test. Hence, actual statistics on how many people have this disease, how many have recovered, etc., are based on underlying data that cannot be confirmed.

The United States, for example, reports cases of "possible" SARS. It is almost certain that this overstates the number of cases. Here in Washington state we have 7 reported cases of "possible SARS", but the public health authorities are already saying they may reclassify all of them as something else.

The world is very, very early in this course of this disease. We do not even know if it is airborn or not. We do not know why some people seem to be super infectors and others are not. We do not know the death rate, or how many people will require intensive care. We do not how many people will have such mild cases that they never even know they had SARS in the first place.

We have possible natural allies as well. It could burn itself out. We could successfully contain it. It could prove seasonal, giving us a naturally occurring breather in which to prepare a better response to the next outbreak.

There is no reason to panic, but we should certainly be doing our best to keep it isolated and unable to spread. With luck, we will contain this new virus so well that all the folks running around accusing the WHO and the CDC of "chicken little" behavior will be able to say, "See, I told you so."

""Politicians will not take the tough decisions. When they do it will be too late. If this comes to you (and I sincerely hope it does not) it will potentially overwhelm your critical care services."

Tom Buckley was so right to get the word out from the first. It is too soon to know if it is waning. Serious stuff. Hemmoraging of the lungs and no specific treatment is of concern to us all.

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