Teen's case raises doubts about 10-day quarantine [SARS]

Globe & Mail ^ | 2003-05-29 | ANDRÉ PICARD

[Lorenb420]

A Toronto teenager developed SARS 12 days after her SARS-infected parent was hospitalized, a finding that suggests the incubation period for the disease may be longer than had been thought.

The authors of a new study, published on-line by the Canadian Medical Association Journal, say that, as a result, they quarantined SARS carriers for 14 days, instead of the 10 days now recommended by public officials.

"We were most comfortable with 14 days," Monica Avendano, a respirologist at West Park Healthcare Centre, where the patients were treated, said in an interview.

"But we're clinicians. We don't want to tell public health what to do."

James Young, Ontario's Commissioner of Public Security, said last night that despite the new research, the 10-day quarantine policy will remain in place. "We would not change something like this based on one case," he said.

Dr. Young added that it's already difficult to enforce a 10-day quarantine, and extending it to 14 days would pose too much of a hardship.

Scope of SARS outbreak overstated: critics

Dr.Low: a medical maverick

Teenagers prove hard to quarantine

The research team, which included physician Peter Derkach and nurse-practitioner Susan Swan, took a detailed look at how 14 front-line health care workers who contracted SARS fared.

They found that, in addition to a host of physical symptoms, many of those who were infected with SARS are suffering a form of post-traumatic stress disorder. "Isolation, fear, lack of human contact: It's a traumatic experience to have SARS," Dr. Derkach said. "I've never seen the fear factor like this with another other disease."

The worry was compounded, he said, because the health-care workers contracted the disease on the job and were afraid of bringing it home to their family members.

All the patients in the study were treated at West Park, a 478-bed rehabilitation facility in Toronto. The SARS patients, 11 women and three men, ranged in age from 27 to 63.

Most worked at Scarborough Grace Hospital, the epicentre of the outbreak, and they were infected before control measures such as gloves, masks, gowns and goggles were introduced.

The study reveals that most developed symptoms of SARS within about four days of exposure to the virus.

"What's most remarkable is that they got very ill very quickly," Dr. Derkach said.

Four of the health-care workers had only a single contact with a SARS-infected patient; the others had multiple contacts.

During the time between their exposure and the appearance of symptoms, all the health-care workers had contacts in the community. In particular, the 14 had 33 close family contacts. Yet only two teenagers were infected.

A 14-year-old girl developed SARS a week after her parent was hospitalized, and a 17-year-old came down with symptoms 12 days after her parent was hospitalized. Neither got very sick.

While the long incubation period is worrisome, the researchers found the lack of spread among family members reassuring.

"We can only hypothesize that not all patients with SARS are as infectious as has been reported previously. This fact gives us some hope that this disease will not spread in a totally uncontrolled manner in the community," Dr. Avendano said.

She added that not a single patient infected anyone after being discharged. Still, Dr. Avendano said it was difficult for physicians to decide when to discharge SARS patients.

People in the group studied were hospitalized for 12 to 15 days, even though none was gravely ill. (None, for example, required a ventilator.) One of the nurses who developed SARS said she was surprised at how debilitated the disease left her.

Sylvia Gordon, a 50-year-old critical-care nurse, said the process of dressing up in a gown, gloves and mask to walk in the hospital hallway left her exhausted, and she worried constantly about her family.

Ms. Gordon said she continues to suffer from abnormal blood tests and from stigmatization because of her bout with SARS.

The researchers noted that virtually all the SARS patients reported lingering effects of the illness, including severe insomnia, depression and shortness of breath. At least one continues to suffer from unexplained fevers almost nightly. Most will likely require some psychological counselling to deal with the trauma.

The researchers said that at first, all the patients were treated with ribavirin, a powerful antimicrobial, but it was discontinued in all but two of them because of side effects. They recovered without the drug. Dr. Avendano said this suggests that ribavirin is not an effective treatment for SARS and may actually make the condition worse.

[aristeides]

I wonder if the incubation period is longer for teenagers.

[Judith Anne]

This remark jumped right out:

Dr. Young added that it's already difficult to enforce a 10-day quarantine, and extending it to 14 days would pose too much of a hardship.

This just infuriates me. Dr. Young can tell that to the new victims.

[aristeides]

Canada Quarantines 5,000 Due to SARS.

[aristeides]

Londoners under SARS quarantine: The 13 people had contact with Toronto hospitals or people suspected of having the deadly illness. That's London, Ontario. The quarantine is spreading, first from Toronto to Peterborough, now to London.

[aristeides]

Drunks broke into isolation ward to see Sars patient. Not a bright move.

[aristeides]

Taiwan reports biggest increase in SARS cases in six days .

[Judith Anne]

From your link in #4, I see that the quarantine is still 10 days.

I'm going to my favorite place right now: the edge of a limb. I predict that very soon, within two weeks, the 10 day quarantine limit will be publicly acknowledged to be too short, and two weeks will be recommended. In my opinion, it should be three weeks minimum.

[TaxRelief]

Longer incubation period? It is more likely that he picked it up in the home sometime later.

Questions that need answers :
(1)Did his mother have the diarrhea variety?
(2) Did the house get sterilized?
(3) Did the teenager stay out of his mother's room after she left?

[TaxRelief]

Why do you think the quarantine period is too short?

[Judith Anne]

Good question...contaminated objects could account for some transmission after 10 days...and truthfully, I'm not sure exactly why I'm going out on this limb. I do know that some recovered SARS victims continue to shed virus in stool for an extended period (over two weeks) after they "get well." Such a person, if not scrupulous about hygiene, could transmit the virus.

I don't know if any studies have been done, referencing shedding virus in coughs, sneezes, etc. I can't remember reading any, but that doesn't mean they weren't done.

Call it an uninformed, strong hunch. And I can be (and have been) wrong. As I said, I'm going way way out on a limb, here.

[TaxRelief]

Another point:

"Ribavirin may cause anemia, which is a decrease in the number of red blood cells in the body. This can be dangerous, especially for patients who already have heart or circulatory problems. Your doctor will want to check your red blood cell count before starting treatment and periodically during treatment." link

>

"Do not take ribavirin without first talking to your doctor if you have

• a history of heart disease, high blood pressure, or a heart attack;
• a hemoglobin disorder such as anemia (low red blood cell count), thalassemia (Mediterranean anemia), or sickle-cell anemia;
• pancreatitis;
• kidney problems;
• liver problems (other than hepatitis C infection);
• mental health problems such as depression or anxiety;
• a history of organ transplant;
• thyroid disease;
• alcoholism or drug abuse or addiction;
• cancer;
• infection with hepatitis B virus and/or human immunodeficiency virus (HIV or AIDS);
• diabetes; or
• past interferon treatment for hepatitis C virus infection that did not work for you.

You may not be able to take ribavirin or you may require a dosage adjustment or special monitoring during treatment if you have an of the conditions listed above."

[EternalHope]

Two Chinese men have been jailed for breaking into a hospital isolation ward to see what a Sars patient looked like.

Darwin awards?

[TaxRelief]

More on rivavirin:

Stop taking ribavirin and seek emergency medical attention or call your doctor immediately if you experience

• an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives);
• depression or suicidal thoughts;
• chest, arm or neck pain; or
• trouble breathing or increased cough.

  link

[Judith Anne]

Good posts on ribavirin. Thanks, because I've gone on record several times as saying that ribavirin is a poor treatment for SARS. Now they're saying in Canada that it doesn't make any difference, and have stopped using it.

[TX Bluebonnet]

I thought I had read somewhere that the incubation period was more like 20 days. Anyone else remember that?

[TaxRelief]

The researchers noted that virtually all the SARS patients reported lingering effects of the illness, including severe insomnia, depression and shortness of breath. At least one continues to suffer from unexplained fevers almost nightly. Most will likely require some psychological counselling to deal with the trauma.

The researchers said that at first, all the patients were treated with ribavirin, a powerful antimicrobial, but it was discontinued in all but two of them because of side effects. They recovered without the drug. Dr. Avendano said this suggests that ribavirin is not an effective treatment for SARS and may actually make the condition worse.

The ribavirin stuff is posted in response to the last two paragraphs in the posted article.

[Judith Anne]

Thanks. BTW, it's VERY hard to sleep when you are short of breath...

[twigs]

I work in a small office and half of them are going to Toronto in June for a conference. I think they're crazy. I was going to take the three days off after their return, but now I'm taking the following week off as well, a total of 8 days. I'm not happy about using all of my vacation time because of their stupidity, but I have a daughter at home with asthma. If it were not for steroids, she would not have survived several past colds.

[Judith Anne]

Air hunger is excruciating. I did have asthma as a child, outgrew it. I'll keep your child in my prayers.