Hospital Staff Are Hit Hardest by Deadly Lung Disease
|
|
|
|||||||||||||||||||||||||||||||||||
By Rob Stein
Washington Post Staff Writer
Sunday, April 13, 2003; Page A01
Patricia Tamlin was working the night shift at Scarborough Hospital in Toronto when she started feeling hot. She was caring for a man fighting a dangerous new pneumonia, but had been protecting herself with masks and gloves. So she swallowed a Tylenol and finished her shift. What no one knew was that another man Tamlin had nursed was also infected.
Within days, the intensive care nurse was sicker than she had ever been in her life. Her fever spiked. She began coughing. Her appetite disappeared. Then came cramps, and dizziness. Barely able to walk a few steps without collapsing or vomiting, she struggled to catch her breath. And when she did, it sounded like paper crunching.
"My lungs were being affected by the illness. They would sound just like crackles," Tamlin said. "I was so weak I just couldn't move. I would throw up going from a bed to a chair. I couldn't make it to the shower for a week. It was too much work for my body. It was scary."
Tamlin's experience exemplifies one of the most insidious aspects of the epidemic that has unfolded over the last month: Severe acute respiratory syndrome (SARS) has hit hardest at those most involved in fighting it -- hospital workers. And hospitals, supposed to be havens during medical emergencies, have often turned out to be fountainheads of contagion.
Hundreds of doctors and nurses around the world have been struggling to save the lives of thousands stricken by an untreatable disease no one yet understands, even as they and their medical colleagues often fall victim to the new pathogen.
"It is putting a huge burden on the system," said Mark Salter, who is leading the World Health Organization's medical response to the worldwide emergency. "Intensive care units are full. People who need liver surgery can't get liver surgery. People who need heart surgery are not having it done. The beds are being occupied with people with SARS. And the vast majority of the patients are, in fact, health care workers."
SARS has become the 21st century's first major test of the global medical system's ability to respond to a worldwide infectious disease crisis. And even if the emergency ends soon, it has shown that a new bug, whether a natural germ or a terrorist's weapon, can push even the most well-prepared cities to their limits.
In Toronto alone, where more than half the victims were health care workers, SARS has sickened hundreds, killed at least 13, isolated two hospitals, forced thousands into quarantine and turned a cosmopolitan Western metropolis into a place where some people wear surgical masks on the streets.
As Scarborough Hospital in Toronto tried to cope, similar scenes were playing out around the world. In Hanoi, the French Hospital would eventually be cordoned off after dozens of workers became infected by Johnny Chen, a Chinese American businessman. He would later die in a Hong Kong hospital, but not before infecting Carlo Urbani, the WHO scientist who first alerted the world to the emerging epidemic, who died in a Bangkok hospital bed. In Singapore, dozens of hospital workers were infected at two medical centers by a Chinese patient in his sixties, who was dubbed a "super-spreader."
In Hong Kong, which has a sophisticated health care system, several hospitals were overwhelmed as doctors and nurses began falling ill just as dozens of patients flooded in seeking help. One of them was the man believed to have brought the epidemic to the city, a doctor who had been treating people suffering from a strange pneumonia in China's southern province of Guangdong since November.
In the weeks since, scientists have begun to crack the mystifying illness's secrets. Experts think it's caused by a virus that usually spreads by a sneeze or cough. Masks and gloves help arrest the transmission. Most patients get better after about a week. The rest get sicker; about 3.5 percent die. There is no cure.
But none of that was known on a weekend in March, at a hospital in Toronto, when a 43-year-old man arrived in the intensive care unit where nurse Tamlin was working. Two days earlier, the man's elderly Chinese Canadian mother had fallen ill and died on her return from a trip to Hong Kong.
As soon as his doctor, Sandy Finkelstein, saw the feverish man laboring to breathe, he became alarmed.
Finkelstein, the director of Scarborough Hospital's intensive care unit, feared the man had a contagious case of an ancient scourge that had been resurging in recent years -- tuberculosis. He ordered the patient isolated in a specially ventilated infection control room, where everyone had to wear protective masks and gloves.
"The nurses started giving me the story. He had come into the emergency room the night before. His mother had died two days earlier. That's all I needed to know," Finkelstein said. "I knew nothing about SARS. I thought this might be TB. I put him in isolation."
Finkelstein prescribed intravenous antibiotics to fight the bacterium that causes TB, and oxygen to help the man's infected lungs. A chest X-ray looked like pneumonia. But he seemed stable. The next morning, however, the patient suddenly worsened. Doctors rushed a tube down his throat to keep him breathing. Chest X-rays showed whatever was attacking his lungs was spreading. His fever flamed.
The night before, Finkelstein had met with the man's extended family. They didn't look well.
"The sister was breathing quick. The wife was just sitting very quietly. I sent everyone in the room for a chest X-ray," Finkelstein said. Four of them showed the same ominous shadow on their lungs as the man in intensive care. Finkelstein gave them surgical masks and told them to stay home.
"They were concerned. Their mother had just died, and their brother was near death," Finkelstein said.
For the first time, he started to worry that he might be dealing with something other than TB, which doesn't usually cause such a rapid downward spiral. He notified local public health officials, and the hospital sent a team to the family's home to make sure they were isolated.
As Finkelstein's patient deteriorated further, every TB test came back negative. Doctors gave him drugs to try to keep his blood pressure up and antibiotics in the hopes of killing whatever was attacking his lungs.
By then, rumors were starting to circulate about a strange "bird flu" from Hong Kong. Finkelstein began consulting with infectious disease specialists from nearby Mount Sinai Hospital, some of whom would later fall ill.
But there was nothing more Finkelstein or his colleagues could do for their patient.
"He was not salvageable. His blood pressure was not sustainable," Finkelstein said. He died on Thursday, March 13, just 15 days after he first started feeling ill.
By this time, the man's relatives had gotten worse. His brother, sister, wife and father were all hospitalized. The brother and sister were so sick they had to be put on respirators.
"We knew the mother had traveled to Hong Kong. We wondered if there was a connection, but even at that point we didn't know what it was," Finkelstein recalled. Later, doctors would realize that the elderly matriarch of the family had stayed in the same Hong Kong hotel as the Chinese doctor from Guangdong, and there she had picked up the infection.
Over the mid-March weekend, WHO issued an unprecedented global health alert about a new disease being spread in Asia by air travelers. It wasn't the bird flu. WHO gave it a name -- severe acute respiratory syndrome, or SARS -- but still didn't know what it was.
When Finkelstein returned to work the following Tuesday, he found another man had been admitted to the intensive care unit with similar symptoms. He was already so sick he needed a ventilator.
This was the patient nurse Tamlin had been caring for when she began to get feverish. When she told Finkelstein about her temperature, he sent her to give a blood sample and throat swab and go home. Her patient would die the next day, Friday, March 21. That night, public health officials came to her home to take more samples for testing.
By now, other hospital workers were beginning to get sick. It wasn't until later that doctors would unravel how the disease was spreading. The first patient had infected two other men when he was in the emergency room. One was the man for whom Tamlin was caring. But the other was a heart patient who was transferred upstairs to the cardiac care unit, where no one was wearing masks and gloves. No one realized he had SARS until after he had been transferred again, this time to York Central Hospital north of Toronto, where he subsequently died.
"He was the one who spread it to the hospital staff," Finkelstein said. "With this illness, it's not so much the patients you know about -- it's the ones you have not yet identified. That's what's scary."
By Sunday, March 23, Tamlin was feeling worse. She went back to the hospital. That night, she and 14 other staff with similar symptoms were put into isolation in a special ward hastily set up at another hospital.
Scarborough, a 270-bed facility in Toronto's suburbs, started to shut down the next day. It closed to new patients within two days and quarantined all employees. The 430-bed York Central Hospital shut down about a week later, after the heart patient died of SARS.
As dozens of other doctors and nurses fell ill, health authorities asked hundreds of hospital workers and visitors to isolate themselves for 10 days. Eventually, the quarantine would affect thousands. At least 223 possible cases would be reported in Ontario, making Toronto the worst SARS hot spot outside of China. At least 13 people would die. Worldwide, SARS struck at least 2,960 suspected victims in 19 countries, including 166 in the United States. At least 119 people would die worldwide.
Tamlin lay in a hospital bed, feverish, too weak to move or eat, coughing and short of breath, dizzy, racked by cramps and vomiting.
"I never thought I was going to die. I'm a young, healthy non-smoker. But as I got better and started talking to family and friends, I did realize that I was extremely ill," Tamlin said. "That whole first week I just laid there. One of my co-workers came in and looked at me at one point and said, 'My goodness, you've never looked so bad.' "
While she was sick, her 15-year-old daughter Nicole developed a fever. Tamlin's husband rushed her to a clinic. Nicole was sent home, but her father and sister were told to stay in isolation for 10 days. No one else fell ill, and Nicole got better.
Finally, after 10 days, Tamlin also started to recover.
Finkelstein never got sick, but he moved out of his house for 12 days to make sure he didn't infect his wife or two daughters.
A few days after Tamlin's fever finally broke, she was feeling well enough to go home, having lost 18 pounds. "I'm still tired. I still get short of breath. I still don't have an appetite. I'm still pale. But I'm improving daily," she said.
Despite everything, Tamlin is looking forward to returning to work at the hospital, where a skeleton staff has been working under strict infection control conditions -- wearing masks and gloves at all times, taking a bus to work and getting their temperatures taken before they enter or exit.
"I have no fear about going back to work," she said. "Certainly it has been difficult for my family and friends. But I'm not going to let it intimidate me from the rest of my life."
© 2003 The Washington Post Company