SARS Hits Home

W hile most of us can only imagine the daily uncertainties and hardships associated with the worldwide severe acute respiratory syndrome (SARS) outbreak, our Clinical Editor Neil Shear, M.D., who’s based in Toronto and practices in a hospital-based clinic, was living with these stresses on a daily basis at the height of the SARS epidemic in late April. Dr. Shear’s practice was dramatically affected by the SARS outbreak. Each day, he donned goggles, a mask, gloves and a gown to see just a fraction of the amount of patients he used to see on a daily basis. The day in late April when I spoke with him about the crisis, he was only scheduled to see three patients all morning. “We’re seeing under 10% of the amount of patients we’d normally see,” he explained. “I’ve been calling my patients who absolutely need to be seen — those who have leg ulcers or pemphigus or something else of that nature.” Overcoming Fear Toronto has the largest number of reported SARS cases in the world behind mainland China, Singapore and Hong Kong — although some of the fastest spreading new cases are emerging in Taiwan, according to a May 3 article in the Toronto Star. At press time, statistics for this deadly disease indicated that worldwide, SARS has claimed 391 lives, and more than 5,800 people have been infected. What’s ironic, said Dr. Shear, is that because he practices in a hospital setting he and his colleagues are actually more aware of current screening techniques than healthcare practitioners in private practice settings. “Patients are probably safer coming here than visiting private practitioners,” he said. Of course, that didn’t quell the fear of most of his patients. With the drop in patients, Dr. Shear was also feeling the economic impact of SARS. As he explained, the majority of his income is derived from clinic visits, and with fewer patients visiting his practice for what is going on 2 months now, economic realities are hitting hard. hopeful news In many places, SARS cases are showing the first signs of decreasing. According to the May 3 Toronto Star, here’s a look at the situation from a global perspective: • Cases in Beijing appear to have leveled off. Officials reported that the city may see a decline in cases over the next 10 days, and the situation is stable. • The United States and Britain were removed from the World Health Organization's (WHO’s) list of affected countries because no transmissions were noted for 20 days. • In Hong Kong, Singapore and Toronto cases are decreasing. • According to WHO, researchers have identified a new pathogen, a member of the Coronaviridae family never before seen in humans, as the cause of SARS. Researchers are working on a targeted treatment. For daily updates on SARS, visit the WHO’s Web site at www.who.int/en/. Getting Back to Normal? When I last spoke to Dr. Shear regarding the SARS crisis in early May, the situation was looking brighter. Systems are now in place to help identify people infected with SARS, and the cases are decreasing. “All patients are screened on the phone before entering the hospital,” said Dr. Shear. “Then, they’re screened again at the hospital entrance. If we suspect SARS, we triage the patient to a special room, and a SARS assessment team takes over. The system is working well. It has helped things start to return to normal. However,” Dr. Shear added, “we don’t really know what normal is going to be from here on. “I think the most important thing we’ve learned is that we can’t overemphasize the importance of washing our hands and following other infection-control procedures,” added Dr. Shear. “As healthcare providers, I hope we remember these lessons for the future.”