Taiwan Gov. SARS Panic Traps 1000 People in Taipei Hospital [first hand Freeper report]

First hand report ^ | 4/25/03 | R. Shouse

[zook]

Here's the headline from today's Taiwan News:

"Just euthanize us," workers say

For the first 24 hours, there was no food, no masks, and inadequate basic facilities. Today, there are many doctors who are so far refusing to report back to the hospital. Apparently, doctors have more clout than nurses.

Yesterday many nurses staged a protest at one of the entrances to the hospital. Today they are being threatened with some fine or jail term.

A government official has warned everyone not to post "rumors" on the Internet under threat of fine or other punishment.

Not sure what a "rumor" is. Perhaps I'm exposing myself to risk by posting this. Under law, I suppose I should be under quarantine because I am "family" of a hospital staff member and I was staying at her house (albeit for one day before she reported back). But I'll remain a "fugative."

[Nov3]

FYI

[discostu]

See this is the kind of craziness I fear when people start talking about mass quarentines. Apparently some idiot decided on zero notice and with no preplanning to quarentine an entire hospital because it had SARS patients. Nobody bothered bringing food and water or warning visitors for other patients not to show up. They just locked the doors and turned off the AC. They couldn't even be bothered to properly secure the perimeter so people escaped via the ground floor windows. Unreasoning fear causes dangerously stupid actions, the good news is that so far nobody has died, if this paranoid behavior keeps going on we won't continue to be so lucky.

[Nov3]

Apparently some idiot decided on zero notice and with no preplanning to quarentine an entire hospital because it had SARS patients.

Despite the author's viewpoint the reason they are quarantining hospitals is because it is spreading among the staff. You just can't let the staff wander around in a case like this. If you were a member of the staff who came down with a mild flu that MIGHT be SARS would you report it knowing that you would be quarantined with real SARS patients? Hell no. They have to quarantine after any staff has the disease.

That being said it was as you said poorly planned

[discostu]

While quarantining the hospital MIGHT be a good idea (not in this case, SARS simply isn't that contagious), but this was totally out of control. Hell yes I'd report it, the death rate is dropping now that we're figuring out how to treat the illness. I'm one of the most reluctant people in the world to go to a doctor (I generally only go to doctors for things I can't make stop bleeding, I hate doctors and I hate admitting I've been felled by some germ), but with a 1-in-20 chance of dieing even I know you've got better odds being truthful and getting medicated than by toughing it out. Anyway the quarantine area is probably light duty.

[Nov3]

While quarantining the hospital MIGHT be a good idea (not in this case, SARS simply isn't that contagious)

Are you serious? You seem well educated so it must be ignorance of this topic. Let me ask a few questions:

Are the doctors in Toronto morons?

Are they taking it seriously in the isolation wards?

Why are the doctors and nurses contracting this non-contagious disease in a modern hospital isolation unit if it isn't contagious?

How did one man in Hong Kong infect five people standing in front of an elevator? They went to Vietnam, Toronto, and China and caused further cases. Were they just lucky?

Finally why do you think the CDC listed this guideline for transport of SARS patients? Does this sound like the guidelines for a non contagious disease?

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SARS Home > Transport of Patients >

Interim Guidance: Air Medical Transport for Severe Acute Respiratory Syndrome (SARS) Patients
April 25, 2003, 11:30 AM

Download PDF version formatted for print (116 KB/5 pages)

Introduction
The current outbreak of Severe Acute Respiratory Syndrome (SARS) has included reports of cases in Southeast Asia, North America and Europe, and required urgent air evacuation of patients with severe illness. This guidance is intended to assist air medical transport (AMT) service providers using specialized aircraft to transport SARS patients while ensuring the safety of patients and transport personnel. It should not be generalized to commercial passenger aircraft. These interim recommendations are based on standard infection control practices, AMT standards, and epidemiologic information from ongoing investigations of SARS, including experience from air transport of patients during this outbreak.

Currently recommended infection control measures for hospitalized patients with SARS include Standard Precautions (with eye protection to prevent droplet exposure), plus Contact and Airborne Precautions. Respiratory protection using respirators providing at least 95% filtering efficiency (e.g., N-95) with appropriate fit-testing is recommended.

I. Air Transport of SARS Patients, General Considerations

• SARS patients should be transported on a dedicated AMT mission minimizing crew size. There should not be any patients or passengers who do not have SARS on board. If a parent is to accompany a sick child, the parent should use protective equipment during transport as described in section IV, below.
• If possible, a single primary-caregiver should be assigned to the SARS patient.
• All SARS patient movement involving U.S. citizens should be coordinated with appropriate state and federal health authorities, including the Centers for Disease Control and Prevention (CDC) (24 hour response number: (770) 488-7100) and the Department of State, before movement begins. International movement of SARS patients might require special approvals by countries that will be over-flown, aircraft-servicing locations, patient rest-stop hospitals, and/or final destinations.

II. Airframe Selection and Cabin Airflow
Cabin airflow characteristics may reduce exposure of occupants to airborne infectious particles; however, based on current understanding of how SARS is transmitted, airflow alone does not provide complete protection of personnel when sharing airspace with an infectious SARS patient. N-95 (or better) respirators are recommended for personnel in any part of an aircraft that shares air (directly or through the ventilation system) with the patient-care cabin.

Fixed-wing, pressurized aircraft:

• AMT service providers should consult manufacturer(s) of their aircraft to identify cabin airflow characteristics, including: HEPA filtration and directional airflow capabilities, air outlet location, presence or absence of air mixing between cockpit and patient-care cabin during flight, and the time and aircraft configuration required to perform a post-mission airing-out of the aircraft.
• Aircraft with forward-to-aft cabin airflow and a separate cockpit cabin are preferred for transport of SARS patients. Aft-to-forward cabin airflow may increase the risk of airborne exposure of cabin and flight deck personnel.
• Aircraft ventilation should remain on at all times during transport of SARS patients, including during ground delays. Aircraft that re-circulate cabin and flight-deck air without HEPA filtration should not be selected for SARS patient transport.
• Aircraft that provide space for crew members to perform necessary personal activities (eating, drinking, handling contact lenses, etc.) in an area that does not share air with the patient-care cabin should be selected for flights likely to exceed 4 hours.

Rotor-wing, and non-pressurized aircraft:

• In aircraft with uncontrolled interior airflow such as rotor-wing and small, non-pressurized fixed-wing aircraft, all personnel should wear disposable, N-95 or better respirators during transport of SARS patients.

III. Patient Placement
The in-flight environment might preclude the creation of a true negative pressure space; however, some aircraft designs permit a downwind zone of relative airflow isolation. The airflow of each aircraft should form the basis for litter and seat assignments. In general:

• SARS patients should be positioned as far downwind with regard to cabin airflow as possible.
• In AMT aircraft with vertical litter tiers and top-to-bottom airflow, SARS litter patients should be placed in the lowest position in the tier.
• Ambulatory SARS patients should be seated next to the cabin sidewall.
• If a non-SARS patient must be transported simultaneously with SARS patient(s), the non-SARS patient must wear an N-95 respirator during transport and should not be positioned downwind from, or within 3 feet of, the SARS patient.
• If several SARS patients are transported, they may be moved as a group (cohorted) in an aircraft that provides appropriate airflow characteristics as described above.

IV. Infection Control
General:

• Personnel should not wear leather or other “flight” gloves while providing patient care.
• Eating, drinking, application of cosmetics, and handling of contact lenses should not be done in the immediate patient care area.
• Handling or storage of medication or clinical specimens should not be done in areas where food or beverages are stored or prepared.

Protective equipment and procedures:

• Disposable, non-sterile gloves must be worn for all patient contact.
• Gloves should be removed and discarded in designated trash bags after patient care is completed (e.g., between patients) or when soiled or damaged.
• Hands must be washed or disinfected with waterless hand sanitizer immediately after removal of gloves.
• Disposable fluid-resistant gowns should be worn for all patient care activity.
• Gowns should be removed and discarded in designated trash bags after patient care is completed or when soiled or damaged.
• Goggles or face-shields must be worn for all patient care within 6 feet of the patient. Corrective eyeglasses alone are not appropriate protection.
• Disposable, N-95 respirators are approved for in-flight use. Personnel using N-95 respirators should be fit-tested.
• If air is shared between the cockpit/flight deck and the patient-care cabin, cockpit/flight deck crew should wear disposable N-95 respirators.
• For cockpit crews, aircraft aviator tight-fitting face-pieces capable of delivering oxygen that has not mixed with cabin air may be used in lieu of a disposable N-95 respirator.
• Personal activities that require removal of respirators should not be performed in the patient-care cabin.
• Patients should wear a paper surgical mask to reduce droplet production, if tolerated.
• Oxygen delivery with simple and non-rebreather facemasks may be used for patient oxygen support during flight.
• Positive pressure ventilation should be performed using a resuscitation bag-valve mask. If available, units equipped for HEPA or equivalent filtration of expired air should be used.
• Cough-generating procedures should be avoided during transport (e.g., nebulizer treatments).

V. Mechanically Ventilated Patients

• Mechanical ventilators for SARS patients should provide HEPA or equivalent filtration of airflow exhaust.
• AMT services should consult their ventilator equipment manufacturer to confirm appropriate filtration capability and the effect of filtration on positive pressure ventilation.

VI. Clinical Specimens

• Standard precautions must be used when collecting and transporting clinical specimens.
• Specimens should be stored only in designated coolers or refrigerators.
• Clinical specimens should be labeled with appropriate patient information and placed in a clean self-sealing bag for storage and transport.

VII. Waste Disposal

• Dry solid waste (e.g., used gloves, dressings, etc.), should be collected in biohazard bags for disposal as regulated medical waste in accordance with local requirements at the destination medical facility.
• Waste that is saturated with blood or body fluids should be collected in leak-proof biohazard bags or containers for disposal as regulated medical waste in accordance with local requirements at the destination medical facility.
• Sharp items such as used needles or scalpel blades should be collected in puncture resistant sharps containers for disposal as regulated medical waste in accordance with local requirements at the destination medical facility.
• Suctioned fluids and secretions should be stored in sealed containers for disposal as regulated medical waste in accordance with local requirements at the destination medical facility. Handling that might create splashes or aerosols during flight should be avoided.
• Suction device exhaust should not be vented into the cabin without HEPA or equivalent filtration. Portable suction devices should be fitted with in-line HEPA or equivalent filters. Externally vented suction should not be used during ground operation.
• Excretions (feces, urine) may be carefully poured down the aircraft toilet.

VIII. Cleaning and Disinfection

• After transporting a SARS patient, exits and doors should be closed and aircraft air conditioning turned on at maximum capacity for several minutes in accordance with the airing time specified by aircraft-manufacturers to provide at least one complete air-exchange. Non-pressurized aircraft should be aired out with exits and doors open long enough to ensure a complete air-exchange. Blowers and high-powered fans that might re-aerosolize infectious material should not be used for airing out aircraft.
• Cleaning should be postponed until airing out is complete.
• Compressed air that might re-aerosolize infectious material should not be used for cleaning the aircraft.
• Non-patient-care areas of the aircraft should be cleaned and maintained according to manufacturer’s recommendations.
• Cleaning personnel should wear non-sterile gloves, disposable gowns and face shields while cleaning patient-care areas.
• Patient-care areas (including stretchers, railings, medical equipment control panels, and adjacent flooring, walls and work surfaces likely to be directly contaminated during care) should be cleaned using an EPA-registered* hospital disinfectant in accordance with aircraft manufacturer’s recommendations.
• Spills of body fluids during transport should be cleaned by placing absorbent material over the spill and collecting the used cleaning material in a biohazard bag. The area of the spill should be cleaned using an EPA-registered hospital disinfectant. Ground service personnel should be notified of the spill location and initial clean-up performed.
• Contaminated web seats or seat cushions should be placed in a biohazard bag and labeled with the location and type of contamination for later disposal or cleaning.
• Contaminated reusable patient care equipment should be placed in biohazard bags and labeled for cleaning and disinfection at the AMT service medical equipment section.
• Personnel should wear non-sterile gloves, disposable gowns and face shields while cleaning reusable equipment.
• Reusable equipment should be cleaned and disinfected according to manufacturer’s instructions.

IX. Logistical Planning and Post-Mission Follow-Up

• Sufficient infection control supplies should be on board to support the expected duration of the mission plus additional time should the aircraft experience maintenance delays or weather diversions.
• Flight planning should identify emergency or unexpected diversion airfields, and coordinate with authorities in advance.
• Upon mission termination, the AMT team should provide the following information to their medical director: mission number/date; address of the team/aircraft basing; duration of patient transport; names, contact information, and crew positions (including estimated duration of direct patient care provided) of mission personnel.
• AMT services should designate individuals responsible for performing post-mission monitoring of mission personnel and reporting results to the AMT service medical director.
• Mission personnel should be monitored (directly or by telephone) at least once daily for 10 days for evidence of fever or respiratory illness that would require evaluation and follow-up.

* There are no disinfectant products currently registered by the U.S. Environmental Protection Agency (EPA) specifically for the inactivation of the newly identified viruses associated with SARS. However, related viruses with physical and biochemical properties similar to the possible SARS agents are known to be readily inactivated by EPA-registered chemical germicides that provide low- or intermediate-level disinfection during general use.

X. Ground/In-Flight Emergency Procedures
AMT service providers should have a written plan addressing patient handling during in-flight and/or ground emergency situations. Activities such as donning life vests and litter-patient emergency egress may create special exposure risks. Use of N-95 respirators must be weighed against time constraints and on-board emergency conditions (e.g., smoke in the cabin, sudden cabin decompression). Gowns and latex gloves represent a fire/flash hazard and should not be worn during ground or in-flight emergency situations.

Acknowledgements:
This guidance was prepared in cooperation with and with contributions from:

United States Department of Defense

U.S. Transportation Command (USTRANSCOM)
Headquarters Air Mobility Command (HQ AMC)
U.S. Pacific Command (USPACOM)
Headquarters Pacific Air Forces (HQ PACAF)
U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID)

United States Department of State
Commission on Accreditation of Air Medical Transport Services (CAMTS)
Aerospace Medicine Association (AsMA)
Air Medical Physician Association (AMPA)

 

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You are right it is not that contagious. Nothing to it

[Nov3]

but with a 1-in-20 chance of dieing

You aren't even close to the latest "official" figures. They are WAAAY low.

[discostu]

You ever hear of hilight and link? I didn't say it was not contagious, do you think I'm a moron, or maybe you're the moron since you can't tell the difference between not THAT contagious and not contagious. Simply put SARS doesn't tranmit very well, people can spend significant time around infected people and not become infected themselves, nobody else in that nurse's family got SARS and she was symptom positive and non-quarantined for quite a while. I'm not saying standard precations, including quarantine for known and probable SARS patients, shouldn't be taken. I'm saying shutting down an entire hospital because of a RUMOR that somebody on staff got SARS is STUPID. The hospital has an isolation ward, use it.

[discostu]

The last official numbers I saw were 5%, which is the same thing as 5/100, which simplifies to 1/20, or 1-in-20. I've seen people doing a bad job of statistical sampling trying to push 15 to 20% but their methods are grossly suspect and their "data" should be ignored.

[Nov3]

Simply put SARS doesn't tranmit very well, people can spend significant time around infected people and not become infected themselves, nobody else in that nurse's family got SARS and she was symptom positive and non-quarantined for quite a while.

You must have your head in the sand. People in isolation rooms in world class hospitals are infecting the staff who wear respirators, masks eye protection, and suits in negative pressure rooms. To say this disease is not highly contagious is moronic.

In China hospitals are being quarantined because the staff is being infected in large numbers. Do you really think they aren't careful having probably watched dozens die? This disease is a monster from the infection standpoint

I would hate to see a contagious disease.

[_Jim]

People in isolation rooms in world class hospitals are infecting the staff who wear respirators, masks eye protection, and suits in negative pressure rooms.

I am going to have to place an account of this type in the 'hearsay' category.

MANY of the staff infected seem to have been infected when these types of procedures hadn't been put in place yet - or were BUT other persons on staff were infected BEFORE full protective methods had been called into play.

[JulieRNR21]

Thanks for posting your report about the situation in Taipei Hospital.

Keeping you & your family in my prayers.

Please ping me when you post an update.

[Nov3]

Fair enough, though one article recently stated specifically that 2 people were infected in full gear. One of them had his face mask slip but the other one was reportedly uncompromised.

Let's just look at China. In Bejing - as an aside have you seen a newscast from Bejing recently? My wife remarked thet the Foxnews report on Bejing was broadcast from Hong Kong and I realized I haven't seen a report from Bejing in a week. Reporters have more sense than I give them credit for. Back to to the point at hand. They don't have the facilities we do but these doctors are no doubt fearful of this virus. It has to be a really powerful learning tool watching someone drown in their own fluids. I would assume they are being VERY CAREFUL. Yet they are falling like flies.

It is spreading in at least four hospitals including their supposed flagship hospital causing them to be quarantined. That is just the one's we know about. Taiwan has quarantined one recently and they are not a third world country and by the time it was quarantined the dangers had been well known for weeks. Toronto has had quarantines also, but to be fair that happened before they got their shit together. Now if I had time I would search the dozens of articles on SARS for the infections in the isolation ward but I think the examples given above illustrate the point I was making. This disease is extremely contagious during at least the final stages.

It is not out of control anywhere but China and I believe they are screwed. I don't think a hundred or so deaths could create a panic like they are experiencing especially since the papers print what they are told.

The good news is they have stopped it cold in Toronto (except among health care workers). The number of cases is decreasing in Hong Kong. We can control this thing. The only real danger is China. They have messed up as only a communist country can and created a billion person resevoir for this virus. Hopefully it will burn out there. The truly sad part of this is that this could have been stopped early on and it would have been a footnote.

p.s. I don't think we are doomed but I am paying attention

[zook]

Latest on Hoping Hospital: There are 19 SARS cases. For this they "quarantined" 500 nurses, many of whom were on vacation or had been cleared of the disease.

Today, government officials are calling on Hoping nurses who were *outside the country on vacation* to come back to Taiwan and report for "quarantine."

If someone's been out of the country for 10 days on vacation, why in the world would you force them to report for "quarantine"? You wouldn't, unless what you were actually asking them to report for "involuntary servitude."

Consider this--let's be generous and assume that each SARS patient requires 10 nurses (2-4 for each 8 hour shift). There are 19 cases, do the math. So, why force all 500 nurses into Hoping? Why not, instead, ask for volunteers? Offered extra pay? My sister-in-law would have gladly volunteered.

Now the nurses have been told that they will be at Hoping for at least 30 days. The Taiwan media is closing ranks to help the government cover up its unjustified actions. Now they are even turning the nurses into targets for attack (e.g., how dare they refuse to serve their nation? etc.).

[ET(end tyranny)]

Now the nurses have been told that they will be at Hoping for at least 30 days.

Did they get those doctors to return?

[Steel Wolf]

If they're planning on shutting down every hospital with a suspected SARS case for 30 days, including the entire staff, their entire health care system will be shut down in short order. Mortality rate aside, it seems that sheer panic is the worst symptom of SARS.

[Lake]

>>If someone's been out of the country for 10 days on vacation, why in the world would you force them to report for "quarantine"?

Because they may carry SARS virus due to their previous exposure to the SARS environment.

[zook]

No. If you're symptom free for 10 days, you can be safely assumed not to have the disease. If the government is really concerned and has some doubt, they could ask these staff members to stay at home a couple more days.

To force them into public quarantine is irrational.

[zook]

My understanding is that many doctors have not reported. The chief administrator finally came in, but he has taken an entire floor of the hospital as his own.

Meanwhile, many nurses still are going without food or beds. You would think they would have prepared for this.

[Travis McGee]

Nursing nightmare ping.