Health care experts say the government’s soon-to-be-released hospital guidelines on how to prevent the spread of SARS don’t go far enough in preparing for a possible U.S. outbreak. Many hospitals don’t have the space for isolation wards for numerous SARS patients, state health officials say. There still is no accurate test for rapidly diagnosing SARS. Systems for quarantines are not set up.
And there's no national plan for rushing extra doctors to a hospital that might be overwhelmed by SARS cases.
“That part’s very problematic,” said Dr. Keith Woeltje, a member of the Infectious Diseases Society of America. “We already have a nursing shortage without SARS.”
Instead, the meetings that Woeltje and other outside health officials have attended at the Centers for Disease Control and Prevention have focused on other issues, such as how to keep SARS, or severe acute respiratory syndrome, from rapidly spreading in hospitals.
The health agency is expected to submit new hospital guidelines for controlling SARS to its parent agency, the Department of Health and Humans Services next week. CDC officials say the recommendations won’t be given to hospitals until the HHS has signed off.
New recommendations
According to early drafts, patients and hospital visitors with respiratory symptoms will be asked to wear surgical masks, a step never before pushed by federal health officials.
Hospitals also would be urged to separate respiratory patients from others. Notices would be posted at hospital entrances requiring people with respiratory symptoms to tell health officials.
People would be asked to wash their hands and maintain “respiratory etiquette” — covering the nose or mouth with a tissue when coughing or sneezing.
“Early detection and identification of patients and bold action to prevent transmission are absolutely critical to preventing a SARS outbreak,” CDC director Dr. Julie Gerberding said this week in a briefing with doctors.
SARS was first recognized in China last November and began spreading mostly through close contact with infected people. Ultimately, it was found to spread more easily and eventually infected more than 8,400 and killed more than 900, mostly in Asia. There have been no SARS deaths in the United States.
SARS return possible
Although the disease subsided in June, health experts believe it could return with the flu season as the weather turns colder, and they worry that the United States is not immune from an outbreak.
“If SARS returns in the midst of flu season ... it’s going to be even harder than it was last time to determine who has SARS and who doesn’t,” said Marc Lipsitch, assistant professor of epidemiology at the Harvard School of Public Health.
Early symptoms of flu and SARS — fever, malaise and muscle aches — are very similar. Without a rapid test, doctors will have to link SARS symptoms with other clues, such as travel to a place that has had an outbreak or contact with a SARS patient.
“Once you’ve seen it and have experience for it, you have a reasonable feel for it. But I don’t know if the vast majority of (U.S.) doctors have,” said Woeltje, an associate professor of medicine at the Medical College of Georgia.
Gerberding places some hope in the accuracy of tests used to diagnose flu viruses, which she believes will help sort out those from the SARS cases.
Still, Woeltje, worries that there is no organized plan for rotating out exhausted SARS health workers with fresh replacements. He saw the need for such a system firsthand when he helped relieve Canadian health workers at Toronto’s Scarborough General Hospital, the home of Canada’s first SARS case.
Quarantine measures
Quarantine measures are also an issue not yet addressed. State health departments need the proper legal backing to handle a SARS emergency.
A large quarantine of people with SARS “would cause a lot of disruption,” said Dr. Kate Arnold of the Georgia Division of Public Health. There must be services in place for food and other necessities if people aren’t able to leave home, she said.
Officials say that bioterrorism prevention plans have been of some benefit in planning for SARS, since many health departments have been updating equipment and manpower to handle major disease outbreaks. Still, more databases are needed for tracking cases, health officials say.
Dr. Jeff Duchin, chief of Public Health-Seattle and King County’s communicable disease section, says doctors and hospitals have struggled to comply with SARS and bioterrorism plans without extra funding.
“The battle against SARS is going to be won or lost at the local level,” he said. “Hospitals are at ground zero. They are totally overwhelmed and understaffed. The CDC has done a great job, but the CDC does not hold the purse strings.”
In July, congressional investigators reported that hospitals likely would be severely overcrowded in a SARS outbreak because they lack space for isolation wards, as well as necessary staff and equipment.