American doctor volunteers to fight SARS in Toronto

The epidemiologist says the experience in Canada made her better prepared if this or some other emerging communicable disease strikes closer to home.

By Victoria Stagg Elliott, amednews staff. July 21, 2003.

The emergence of severe acute respiratory syndrome in Canada and Asia in March caused worldwide panic. Conferences changed venues. Travelers cancelled their plans.

But when a Canadian doctor attending the Society for Healthcare Epidemiology of America meeting in May made a plea for help to those in attendance, Tobi Karchmer, MD, jumped at the chance. Dr. Karchmer, an assistant professor of infectious diseases at Wake Forest University School of Medicine and a hospital epidemiologist at North Carolina Baptist Hospital in Winston-Salem, now says she learned a lot about what would have to be done here if SARS strikes.

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Question: Why did you go to Toronto when everyone else was avoiding it?

Answer: It was an amazing opportunity to learn from what was going on in Toronto -- what a SARS outbreak meant to hospitals, health care systems, hospital epidemiologists and infection control.

It was also important to bring information back that might be important for us to use when we see SARS or other emerging communicable diseases.

Q: What was the hospital like when you arrived?

A: The first day we went in, we were on a list of people to be allowed in. You had your temperature taken as you came in the door. You also had to fill out a screening tool to look at your potential risk.

It really was an incredible effort. [There was] limited access. One entrance in. One way out. One for staff. One for visitors. Everybody coming in got screened. Everybody got a mask.

Q: What steps did you take to maintain your safety?

A: We followed the same protocols as all the hospital personnel. We were wearing N95 masks in the hospital. You do sort of get used to it, but it can be a little bit uncomfortable.

You were supposed to be wearing them whenever you were in the hospital and in contact with other people. You can't wear a mask while eating, so there were policies in place about how far you needed to be sitting from somebody else.

Q: Can you talk through the mask?

A: Yes, but it is still a little bit strange to be in a meeting where everybody is wearing an N95. It's hard to read facial expressions. It's more difficult to interpret body language. You can't scratch your nose.

Q: In what ways did you help out?

A: We were primarily doing infection control. Since SARS had started in late February the infectious disease doctors and a lot of the infection control people had been working seven days a week. They really just needed more people to give them a break.

Q: What was life like outside of the hospital?

A: SARS had a pretty broad economic impact on the city. They had a lot of tourists and conventions cancel, but there were still lots of people out and about. Life was going on.

Q: Why did SARS hit Toronto so hard?

A: They had some bad luck in that one of the first cases to come from the hotel in Hong Kong came back to Toronto.

That person was seen on a few occasions [in the health care system] prior to people recognizing that this might be SARS. That person [also] had family members who got sick who also weren't recognized as potentially having SARS. The window of recognition was missed.

On top of that, there are some people who appear to be much more contagious, and it seems that some of the early cases that occurred in Toronto were these type of people.

Q: How significant was the burden on the health system?

A: The system in Toronto was essentially shut down with the first wave of SARS. A lot of people could not access care for their chronic diseases or even acute illnesses that came up. There is going to be an impact. I'm not sure we even know yet how that's going to pan out.

With the second wave of SARS, the system had figured out better ways to attempt to maintain care for the people in the area.

Q: SARS sickened and killed many health care workers. What was the impact of that?

A: I was very impressed by how devastating this had been to health care workers, even for those who hadn't gotten sick. It seemed like health care workers were suffering from a combination of survivor's guilt and some posttraumatic stress.

I was impressed with the fact that mental health professionals were there to talk to the health care workers who were still working, those who had gotten sick, patients in the hospital, and try to provide support for that.

Q: Any thoughts on how the United States would respond if an American city had a similar outbreak?

A: The potential for something like that to happen in one of our cities is definitely there, but I'd like to hope that many places have plans in place because of bioterrorism preparedness that would help in a major outbreak.

ADDITIONAL INFORMATION:

Helping hands stop spreading germs

During this year's SARS outbreak in Toronto, health workers donned N95 masks, gloves and gowns to protect themselves. They also washed their hands as often as possible.

"I've never seen so much alcohol hand rub in my entire life," said Keith Woeltje, MD, who volunteered at a Toronto hospital in June. "There were multiple bottles sitting out at every nursing station. People were heavily encouraged and actually did seem to wash their hands very frequently," said Woeltje, who is a hospital epidemiologist at the Medical College of Georgia Health System in Augusta.

Public health agencies have long sought to encourage hand washing among health care workers. The Centers for Disease Control and Prevention last year released guidelines for hand hygiene in the health care setting because more than 2 million patients annually acquire infections in U.S. hospitals, and as a result about 90,000 die each year.

According to the CDC, the SARS outbreak has reinforced the importance of hand washing because experiments indicate that the coronavirus that causes the disease can exist on a surface for as long as 24 hours.

"We knew that from the beginning," said CDC Director Julie Gerberding, MD, MPH. "That's why we recommended the importance of hand hygiene and contact precautions in health care settings."