Wheeling(WV) on SARS Watch

A probable SARS case has been identified in Ohio County, but the county medical director said his "index of worry is low" that it is an actual case of severe acute respiratory syndrome. However, every precaution required by the federal Centers for Disease Control and Prevention when there is a probable case is being followed and the person with West Virginia's first possible SARS case is in isolation at Wheeling Hospital.

"People in the Ohio Valley are at no risk. They can go to the mall, do their shopping, visit family and friends in the hospitals, and they don't have to wear masks," said Dr. William C. Mercer, the medical director of the Wheeling-Ohio County Health Department.

Mercer said Friday the individual with the probable case of SARS is a 68-year-old Ohio County resident who is a "business person who travels frequently." He is hospitalized in stable condition.

"He traveled to Toronto, (Ontario, Canada) last weekend and came back Thursday ill," Mercer said. The man was taken by ambulance Thursday to the emergency room at Wheeling Hospital after he "passed out at home.

"Luckily, a very smart nurse at the emergency room asked the appropriate questions about travel and when they were informed the man had just been in Toronto, he was taken immediately into isolation," Mercer said.

"He didn't present like the typical case of pneumonia or respiratory distress associated with SARS," he said, explaining that typical symptoms for a possible SARS victim are fever, cough and shortness of breath. "He passed out at home and they thought initially he had had a stroke.

"His age is a key. If he were a 35-year-old, I would have more concern. At age 68, there are a lot of other reasons he could be this sick."

Mercer said personnel at both Wheeling Hospital and Ohio Valley Medical Center have been thoroughly trained on what to look for with SARS and there are signs posted for those entering the emergency room area to go no further if they have SARS symptoms and have traveled to any area where SARS has been detected.

Because the local man came to the emergency room via ambulance and without the usual symptoms, Mercer considers it a "success" from a public health standpoint that the travel history connection was made so quickly, thus keeping countless other people from having contact with the ill person.

"There were 17 people who were in close contact with the man and there was no heavy exposure," Mercer said. The 17 include family members of the victim, emergency medical technicians who transported him to the hospital, and health care workers at Wheeling Hospital, he said.

"The CDC says they are at low risk and all we must do is watch them. They are free to work. In the meantime, we are checking their temperatures twice a day for 10 days for symptoms," he said, explaining that the health department is monitoring the family and EMTs and Wheeling Hospital is monitoring the health care workers and reporting its results to the health department.

Mercer noted that of the 356 suspected and probable cases of SARS in the United States, only one has been a health care worker or EMT.

According to information from Mercer, to be listed as a suspected case of SARS, the requirements include respiratory illness of unknown etiology with onset since Feb. 1 and the following criteria: measured temperature greater than 100.4 degrees; one or more clinical findings of respiratory illness, such as cough, shortness of breath, difficulty breathing or hypoxia; and travel within 10 days of onset of symptoms to an area with documented or suspected community transmissions of SARS.

What elevates the case to being a probable case is radiographic evidence of pneumonia or respiratory distress syndrome, Mercer said. "Why he is a probable case and not a suspected case is the abnormal chest X-ray. It shows pneumonia or some type of respiratory distress.

"Of the 356 suspected and probable cases so far in the United States, there have been only 65 probable cases and he's number 66. Most are younger. Only 12 are over the age of 65," he said.

"I talked to the CDC (Thursday night) and we have taken all required precautions. I do not think this is going to be SARS. From a public health standpoint, the way we have handled this is a success."

A sample of the man's blood has been sent to the CDC in Atlanta, but the results of those tests won't be known for two to three weeks.

Mercer admitted he became more concerned after learning that four new cases of SARS were reported on Thursday in Toronto. A new travel alert for Toronto was issued Friday.

The health department official said the best news he could receive would be to be advised they had "grown a bacteria in his (the ill man's) blood and we would know definitely it isn't SARS." He explained that it takes 48 hours for bacteria to grow in blood, so if a pneumococcal pneumonia bacteria could be grown in the victim's blood in the next 48 hours if would confirm he is not infected with the SARS coronavirus.

Mercer said both Wheeling Hospital and OVMC have isolation facilities for use with possible SARS cases as well as other infectious diseases like smallpox.

Mercer said the CDC has done blood tests in which they check for antibodies in the blood of the victims in 122 of the suspected and probable cases of SARS and so far have only "six confirmed cases in the U.S. In the United States, there is very low risk of SARS being transmitted," he noted.

The health official issued a special warning to anyone who believes he or she could have SARS. "If you've been to Toronto or another of the areas with documented cases of the disease, and have a fever and a cough, call your doctor first. Don't go to the doctor's office first." If a person with SARS goes to the doctor's office, that could expose many more people than going directly into one of the prepared isolation areas at a local hospital, he said.

From today's Wheeling Intelligencer:

The 68-year-old Ohio County man hospitalized in isolation at Wheeling Hospital as a probable SARS case is "still critical, but stable," Dr. William C. Mercer, Wheeling-Ohio County Health Department medical director, said Sunday.

Mercer reiterated his belief there is only "low risk" that the man actually has SARS and said local residents can go about their normal routines without worry.
The man was taken by ambulance to Wheeling Hospital Thursday night after collapsing at home on the day he had returned from a business trip to Toronto, Canada.

"We will have results from the preliminary antibody (blood) test in five days (from Saturday) to see if this man has severe acute respiratory syndrome," the doctor explained Sunday night.

Mercer said he talked with officials at the federal Centers for Disease Control and Prevention in Atlanta Saturday night and asked what should be done if that test does come back negative for SARS.

"They said that as a precaution, we have to wait three weeks" from Thursday when results are due back from the first blood tests that were taken before lifting the quarantine.

"I believe there is only a low chance that this actually is SARS. The person has lots of other medical conditions" that are causing his problems, Mercer said. However, he said the CDC, which has reinstated its travel alert for Toronto, Canada, after 34 new suspected cases were found in that city last week, "wants us to be so careful, even super cautious. Even if there is another diagnosis (for the Ohio County patient in isolation," they've said don't let down your guard" until the final blood tests results are back in early June.

Asked where the man had been in Toronto, Mercer said he had not been at an airport but had stayed in a hotel for two days. He said the man also had been in Toronto about a month ago. He said an investigation is now going on to determine if the Ohio County man could have had any relationship with people connected in any way to the two hospitals that are a common thread in the newest suspected cases in Toronto.

Mercer said he has been impressed with how "accessible" the CDC personnel have been to him as the case in Ohio County is being monitored. He said he believes this is how the United States has been successful in keeping any widespread outbreak from occurring.
http://www.news-register.net/news/story/0526202003_newsars.asp

Potential Wheeling SARS Patient 'Hanging in There'

Thursday, May 29,2003

By MICHELLE BLUM

A man suffering from an illness with symptoms consistent with those of Severe Acute Respiratory Syndrome remains in "critical but stable condition" at Wheeling Hospital, according to Dr. William Mercer, medical director of the Wheeling-Ohio County Health Department. "He's hanging in there," Mercer told members of the health department's board of directors Wednesday at their regular meeting.

The case is the first probable case to be reported in West Virginia, Mercer said. In comparison, Ohio and Pennsylvania each have one probable SARS Case. Ohio has 13 suspected cases, while Pennsylvania has 14, according to information from the U.S. Centers for Disease Control.

Mercer said he was expecting to hear late Wednesday or today on the results of antibody tests sent to the CDC.

But should those results on tests to identify the antibodies specific to SARS be negative, Mercer said it won't completely rule out the possibility of the disease. Cultures, which would take about 21 days to complete, would further confirm either a negative or positive finding.

Mercer said it was his "personal feeling" that the man does not have SARS.

In the meantime, local medical professionals are searching for another possible diagnosis for the man's condition, he said.

The 68-year-old Wheeling man, who had returned from a monthly trip to Toronto, Canada, shortly before his collapse last Thursday evening, is being treated in isolation at Wheeling Hospital, he said

Mercer credited an employee of the hospital's emergency department with taking time to question the man about his symptoms and travel experience. An abnormal chest x-ray further led medical professionals to suspect SARS, he said.

In all, 11 hospital employees and six others are being monitored but are doing well, Mercer said.

Mercer said they are at low risk and are free to work. Their temperatures will be checked for 10 days after exposure to determine whether it is elevated. The health department is monitoring the family and paramedics while Wheeling Hospital is monitoring the health care workers and reporting its results to the health department.

Mercer said he takes issue with the CDC's choice of phrases under which the federal agency identifies the man's case as "probable" SARS.

"To me, probable means you've probably got it," Mercer said, noting it hasn't been confirmed by testing.

The criteria for "suspected SARS" includes a fever of more than 100.4 degrees, a cough, shortness of breath, and a low oxygen level, he said.

As of Wednesday, there were 66 other probable cases of SARS in the U.S., he said. In all, 122 cases have been investigated and only seven were found to be SARS.

The Wheeling case came as the CDC considered lifting its alert on travel to Toronto.

The primary way SARS appears to spread is by close person-to-person contact, the CDC says. Most cases have involved people who cared for or lived with someone with the disease or had direct contact with infectious material such as respiratory secretions from a person who has SARS.

Most of the U.S. cases of SARS have occurred among travelers returning to the United States from other parts of the world. There have been very few cases as a result of spread to close contacts such as family members and health care workers.

LINK

An article from another paper in the area, The Washington(PA) Observer-Reporter

Doctor skeptical of possible SARS case in Wheeling

BY CHRISTIE CAMPBELL

THE OBSERVER-REPORTER

A 68-year-old man is being treated for possible SARS in a Wheeling, W.Va., hospital, but the head of the health department overseeing the case questions if the man really has the disease.

Dr. William C. Mercer, a family physician and medical director of the Wheeling-Ohio Valley Health Department, said Wednesday that he would "be surprised" if it turns out the man actually has SARS (Severe Acute Respiratory Syndrome).

SARS is believed to be responsible for 745 deaths, mostly in China, though cases have been reported in other areas of Asia, North America and Europe.

The man was brought to Wheeling Hospital on Friday morning, not long after returning from Toronto, Canada. However, Mercer noted that the man was sick before leaving on his trip north.

Toronto was put back on a World Health Organization list of SARS-affected places this week after dozens of new cases were reported there, despite precautions at Toronto hospitals since a SARS outbreak last month.

"My feeling here is this person is not going to have actual SARS," said Mercer, who is waiting for confirmation on tests sent to the Centers for Disease Control and Prevention in Atlanta.

In the meantime, the man, whose name is not being released, is being treated with antibiotics while in the hospital's isolation ward.

Lynn Wood, public relations director for the 277-bed hospital, said the hospital's infection control coordinator is working with the staff. Those treating him are required to wear gloves, masks and goggles to prevent possible spread of the disease.

When the man was brought to the hospital after collapsing at home, he was thought to have had a stroke. But once a nurse determined he had been in Toronto, the medical staff immediately took precautions.

It was determined that 17 people had come in close contact with the man. They are taking their temperatures twice a day and reporting daily to the health department. So far, no one has shown signs of illness.

While Mercer said he has doubts whether the man has the disease, "because it can be so contagious we're just not willing to take a risk."

In order for medical personnel to suspect SARS, a person must have three symptoms: a temperature of 100.4 degrees or more, coughing or shortness of breath, and having been in a city or country where SARS has been reported. To be listed as a probable case, a person must also have an abnormal X-ray.

In confirming the disease, the CDC looks for antibodies to the coronavirus in a patient's blood. However, some people do not respond immediately to the disease and it could take as long as three weeks to determine if antibodies exist. Mercer said it may be necessary to keep the patient in isolation for that time.

"The general public is at little risk," Mercer said "You can still come to Wheeling, go shopping and visit your friends in the hospital."

The CDC has been diligent in monitoring SARS, which is perhaps why so few cases have been reported in the United States, Mercer said. As of Friday, there had been 122 SARS cases listed as probable in this country, but just seven of them turned out to have a positive blood test. This is the first such case reported in West Virginia.

LINK

Local health officials say they are "pretty confident" a man being treated at Wheeling Hospital is not suffering from Severe Acute Respiratory Syndrome.

Dr. William Mercer, medical director of the Wheeling-Ohio County Health Department, said officials with the Centers for Disease Control reported that two of the three samples sent for analysis had no antibodies that would be consistent with those normally attributed to SARS patients. Results of the third sample are expected to be reported on Monday, he said.
A 68-year-old man has been treated at Wheeling Hospital since May 22 as what the CDC has classified as a "probable SARS case."

Mercer said Friday the man remained in critical condition in isolation in the intensive care unit of Wheeling Hospital.

"He shows signs of getting better," Mercer said.

The man, who had collapsed, was taken to the facility shortly after his return from Toronto, Canada.

Meanwhile, 11 hospital employees and six others, including the paramedics who transported the man to the hospital, are showing no signs of the disease, Mercer said. Sunday will mark the 10th day from exposure. The disease, Mercer said previously, has a 10-day incubation period.

"After discussing the case with the CDC, we feel pretty confident it's not SARS," Mercer said late Friday.

After one of the samples reported on Friday, which involved blood, was negative for the SARS antibodies, Mercer said he would be "pretty surprised" if the third came back positive.

And Mercer said Dr. V. Chokkavelu, an infectious disease specialist, feels he can explain the man's symptoms "by another type of pneumonia."

Mercer said the "whole picture" must also be considered in making a SARS determination.

At about the time the man's illness was discovered, a series of SARS cases were reported in Toronto but all those patients have been accounted for in terms of their whereabouts and contacts.

As a result, the man's case would be the only "community-acquired" case, but the hotel where he was staying in Toronto "doesn't match" as the scene of other SARS infections, Mercer said.

Mercer said local health officials have "learned a lot" as a result of the case but are glad the test results are pointing to a diagnosis that excludes SARS.

He noted that representatives of a Clarksburg tour bus company had called earlier in the week, expressing reluctance to come to Wheeling because of the reported "probable SARS case."

At Wednesday's meeting of the Wheeling-Ohio County Board of Health, Mercer took issue with the CDC's classification of SARS cases as either "probable" or "suspected."

"To me, probable means you've probably got it," Mercer commented.

The criteria for "suspected SARS" includes a fever of more than 100.4 degrees, a cough, shortness of breath, and a low oxygen level, he said.

A history of recent travel to areas where SARS has become prevalent including China, Singapore, Hong Kong, other areas of the Far East, and Toronto, Canada, and an abnormal chest X-ray place patients in the "probable" category, he said, referring to the CDC's criteria.

May 31, 2003
http://www.news-register.net/news/story/0531202003_new02.asp

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