Study offers first picture of effects of SARS

CTV.ca ^ | May 28, 2003 | CTV.ca News Staff

[Judith Anne]

This article is from a link aristeides provided on another Canadian SARS thread, thanks aristeides. I thought readers here would like some more information on the actual disease itself.

These nurses could be US nurses, this fall...I'm glad they aren't using ribavirin anymore, it is very toxic and doesn't help with SARS, but I wish it had been more useful against the virus...

[Judith Anne]

aristeides, thanks for the link on that other thread. This article talks about the course of SARS, and what some healthcare workers went through and are still going through. I think US nurses reading these threads should see this.

[per loin]

Have you decided whether you will treat SARS patients?

[DoughtyOne]

I believe most of the stress associated with the onset and progression of this disease had to do with the terror instilled in the infected individuals prior to their procurement of the disease. I'm not going to dismiss the reality of their condition, but the fact is most of them probably expected to die, the way this issue has been presented to the health care and public at large.

[Judith Anne]

Yes, I will, if and when we have cases here. It isn't the patient's fault, and they need the care. It's my chosen job--it's what I do.

[Judith Anne]

I think the article mentioned that the two weeks of isolation were one of the most stressful things about the illness. No doubt the nurses in the article had seen the effects of the illness on their patients, and nothing about their own symptoms was news to them. I doubt they were shocked.

[goldstategop]

Which means patients need a lot of human contact and help to make it through. Isolating them from fellow patients is a bad idea. Seeing others make it boosts your own will to recover and resume an active life. That's one of the lessons of SARS.

[DoughtyOne]

There haven't really been all that many cases when you get down to it, so it wasn't an observable event until these nurses came down with it themselves. As the article made abundantly clear, we still don't know the full ramifications of contracting this disease and experiencing it's full course.

[Judith Anne]

A lot of human contact--nice thought, but it's going to be hard. I'm thinking of nurses with small children...hard to be away from your babies...hard to be away from your spouse, and only talk on a phone...

As a nurse, I know how much a touch can mean, sometimes a hug, it's healing and does something good for patients AND the nurse...when a patient has SARS, no skin to skin contact for a good long while...think of it...and how long are we going to be in the patient's room--the guideline is to minimize the amount of time spent in the room...impossible to leave someone when they're weeping, though...especially a fellow nurse...

Just mentioning a few issues with the isolation...

I've worked with isolation techniques on patients a lot of times, it's hard on regular people even just for a few days...much less two weeks or more...

[goldstategop]

Exactly. No wonder recovery from SARS lasts longer for people who've survived the ordeal. Being alone and feeling abandoned and treated like you're going to die hurts even worse than the disease. So it comes as no surprise to see accounts of people taking longer than is normal to resume a normal life.

[Judith Anne]

I know what you mean...but the isolation necessary was one of the first things about the disease that struck me, even a couple of months ago in March...that, and the mechanical ventilation...

Imagine being on a vent, if you can...a lot of patients become psychotic and require massive tranks...it's horrible...add to that, no one even to hold your hand, skin to skin...everyone around you wearing Jupitor suits in fear that some virus from you will jump to them...none of your loved ones in the room to give you the REAL reassurance you need to maintain hope....And before and after the mechanical ventilator, the knowledge that hugging your children or your spouse might infect them...watching everything you've touched, even your plastic fork and spoon, carted away in bright red biohazard bags...

Add to that, the knowledge that you have a disease that kills 15% of its victims in spite of everything medicine can do...that out of every 7 who get it, one will die...will that one be you? No one will guarantee your survival...

[Judith Anne]

Not to mention the fact that the disease itself is very debilitating and damaging to the lungs...we don't know for sure that people ever fully recover...it's too soon to know that...

[DoughtyOne]

I agree that isolation is a problem, but then it's been a problem for any communicable disease over time. It's a necessary evil.

BTW are you really seeing 15% mortality on this. Early reports stated there was around a 96% survival rate, which compares quite favorably with general run of the mill influenza outbreaks contrary to the hysteria surrounding SARS.

[Prince Charles]

But disturbingly, one didn't develop symptoms until 12 days after the last contact with the family member -- suggesting that the 10-day quarantine period currently recommended may not be long enough.

That's something I've said for some time now... SARS victims need to remain in some type of isolation environment for a period of time after they have appeared to recover.... we know they will still be shedding the virus for weeks afterwards.

[Judith Anne]

The mortality rate has been extensively discussed on these threads, and is well known to be 15% for patients under 60, and 50% for those over 60. Please see previous articles posted here for more discussion.

Ordinary flu has around 1% mortality rate for all patients. The Spanish flu epidemic had a mortality rate of around 2.4%. SARS is deadly.

[Judith Anne]

Yes, I agree wholeheartedly.

Have you, or anyone, noticed any after SARS length of quarantine recommendations from the CDC or WHO?

[Prince Charles]

Nope, I think the Canadian model is what was used: as soon as the docs signed them out they were free to go wherever they wanted (and to take the bug along).

[Future Useless Eater]

SARS - Treatment/Containment tables - updated with Wednesday's numbers
...China cheating on their SARS reporting - smoking gun evidence here

[Judith Anne]

That's what I thought, and it's not good news. From what I recall reading, the virus is shed in stool for a long time during the recovery period, like a month or more.

[DoughtyOne]

I'm not sure what conversations you refer to on this forum, but here is the CDC breakdown for your edification.
 

5/23/03 MMWR Weekly | Update: SARS --- United States, May 21, 2003

Updates numbers of reported cases in United States as of May 21, 2003. A total of 7,956 SARS cases reported to the World Health Organization from 28 countries ;666 deaths (case-fatality proportion: 8.4%). United States reports 355 cases from 40 states, no deaths. Laboratory testing to evaluate infection completed for 122 cases; six cases confirmed. Case reports for United States continue decrease; most cases associated with international travel. New interim surveillance case definition provides criteria to exclude reported cases subsequently found to have other causes of SARS-like symptoms. Clinical judgment should be used to guide management of patients.
 

5/14/03 MMWR Weekly | Update: SARS --- U.S., 2003

Provides update on reported SARS cases worldwide. As of May 14, 2003, a total of 7,628 cases reported to the World Health Organization from 28 countries; 587 deaths (case-fatality proportion 7.7%). Total cases account for 345 reported from 38 states in United States; 281 (81%)classified as suspect and 64 (19%) classified as probable. No deaths reported in United States. Most cases continue to be associated with international travel to areas affected by SARS. Provides CDC recommendations to prevent and control transmission for inbound travelers from areas with community transmission of SARS. CDC not recommending
quarantine for persons traveling from such areas.

5/9/03 MMWR Weekly | Update: SARS --- Singapore, 2003

Summarizes epidemiologic features of SARS in Singapore; discusses super spreaders and national prevention and control programs. As of April 30, 201 probable cases and 722 suspect cases reported; 25 patients died (case-fatality proportion: 12.5%). Surveillance indicates 76% of infections acquired in a health-care facility. Five patients categorized as super spreaders who were associated with transmissions to > 10 health-care workers, family and social contacts, or visitors to health care facilities. Infection-control measures include designating one hospital for SARS cases, expanding environmental practices to protect health-care workers, stopping general hospital visitation, and providing dedicated ambulance service. Infectious Disease Act amended, requiring more stringent quarantine measures and providing penalties for violations.
 

Morality rates of 8.4, 7.7 and 12.5% are reported here.  I included the worst report, which was from Singapore, but the figures seem to be somewhat sketchy, since 722 suspect cases are not computed in the mortality rate.  Therefore I'm more comfortable sticking with the 8.4 and 7.7% figures reported globally on the 14th and the 23rd of May.

15% is obviously an inflated figure.  It's about double the actual mortality rate.  Around 92% of people who contract SARS will recover.  Obviously some age groups and other compromised patients profiles may experience elevated mortality, but I doubt mortality approaches 50% in any but the most compromised groupings, people who would be very weak to begin with.