X-Message-Number: 21430
From: 
Date: Wed, 19 Mar 2003 20:30:56 EST
Subject: Re: CryoNet #21417 - #21424

In a message dated 3/19/03 2:00:54 AM Pacific Standard Time, owner-Tim 
Freeman  writes:

> Mike Darwin said in Cryonet message 21416:
>  
>  >2) SARS is *extremely* infectious; those physicians treating it in Hong 
> Kong 
>  >report that it is about as infectious as influenza. 
>  
>  In contrast,
>  http://www.rferl.org/nca/features/2003/03/18032003162937.asp quotes
>  Iain Simpson of the World Health Organization's communicable disease
>  section as saying:
>  
>  >"It's not clear how contagious this infection is. What is clear is
>  >that this is not like the flu, where you can just pick it up by being
>  >in a room with someone or by being on a bus with someone. To catch
>  >this infection, it's quite clear that you have to have close contact
>  >with someone who is infected and that, even then, you won't
>  >necessarily become sick yourself," Simpson said, adding, "This is
>  >nowhere near as infectious as a cold."
>  
>  -- 
>  Tim Freeman                                        

I stand by what I said. I am in direct and indirect contact with physicians 
at the center of the outbreak in Hong Kong. Below is an update from Dr. 
Buckley as posted to the international critical care medicine forum (CCM-L). 
*Please note that two of the currently ill hospital staff in Hong Kong became 
ill after exposure consisting only of passing within 5-10 feet of the Index 
Patient!* That is very infectious by any standards you care to apply.

Several people from Cryonet have asked for some simple precautions they can 
take. Two health care providers on the front line (in ICU or Respiratory 
Therapy in large hospitals) have asked for specific suggestions. I'll address 
these in separate post.

Mike Darwin

--------------

Date: Tue, 18 Mar 2003 11:30:01 +0800
From: Tom Buckley <>
Subject: Re: Hong Kong update

Dear Les,

We are all wearing gowns, N95 masks, hats, and gloves and additional masks
with visors for any bed side procedure.  I have purchased HKs total supply
of N100 masks (7) to try them out and have requested our safety officer to
investigate suppliers of space suits.  I cannot believe HK does not have a
supply of these somewhere.  I suspect that even if we contain this pneumonia
then there will be further outbreaks in the future.

No nebulizers nor BiPAP.

All windows closed and airconditioning on.  While CDC says there is airborne
transmission we (infection control team) do not think so based on the the
index patient using a nebuliser in a very enclosed space.  See most recent
post and Colin McArthur can describe the general ward set up

We have four negative pressure rooms only but 16 patients.

Staff morale - near panic stations when it was learnt that two nurses were
off sick with this pneumonia. This was the first time I was scared. I had
literally just spent 30 minutes being as open and honest with 20 nurses as I
can.  Walked out of the room and immediately had to trouble shoot (for want
of a better word) both nurses.

One nurse had visited the index patient's ward two weeks previously and the
other while not being excluded had limited patient contact with a very short
history between contact (1 day) and symptoms.  While she has some CXR signs
she is afebrile and WCC is normal.  She looked well so I suggested she go
home rather than stay on the contaminated ward where she had been admitted
to.  Jury is out on her but she will be watched very carefully.

We have two cardiothoracic surgeons and one cardiologist in ICU who examined
a cardiac case 10 feet from the index case!!!!!  They would have walked
within 4-5 feet of this patient.

Staff morale is tense.  This is where I plan to spend most of my day.
Hospital is aware that if ICU nurses contact this then ........ I won't go
there.I am offloading the clinical side.  No one has complained but people
frequently ask me what I am doing about home.

I sleep on the floor in my office.
I go home for a shower when the children are in bed.
They are not going to school until I can be reassured that this is not more
widespread in the community.

Jeff Lipman: are you out there?  Phone me.
I have shaved my beard off because I have had everyone from the Chief
Executive to the the Safety Officer in our Department telling me that N95
will not be as effective because of an imperfect seal. If you come to HK
next week you may consider shaving yours off.

Hope this helps Les


Regards

Tom Buckley

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