Atypical Pneumonia - SARS

March 29, 2003

I have pondered for a few days whether to write to you about this SARS (severe acute respiratory syndrome) . I refrained from doing so because I did not want to spread fear. However, we now possess more accurate information and I believe it is time to share with you some first hand experiences.

According to the CDC (Centers for Disease Control and Prevention), this is considered to be one of the largest outbreak of disease caused by an unkown organism since hantavirus pulmonary syndrome back in 1993 and Legionnaire's disease in 1976. This disease represents an enormous challenge to the medical community because it is highly contagious and it kills healthy people within days.

I am not going to bored you with statistics or information that you could get from various media. I would, however, like to refer you to this World Health Organisation site where you could obtain the most updated details as well as the most balanced comments and advices.

I am going to tell you what happened in our hospital over the past few weeks. As physicians, my colleagues and I have been very interested to know more about what happened in Guangdong where a strange flu-like disease has hospitalised many people and has caused wide-spread fear in the region. About 3 weeks ago, our first experience of this SARS arrived at our hospital. It was a man in his 30's coming down with a rather severe pneumonia. He told 'stories' (that's what we actually thought at that time) about how many people were dead, including his parents, in Guangdong. In view of the severe pneumonia and the history he gave, he was treated in our hospital's isolation ward. He gradually recovered over the next few days. We thought the stories about the severity of the disease were false as this patient became well rapidly. He was isolated very early on and the disaese did not spread.

Then came the news about the outbreak in Prince of Wales Hospital (PWH). As you might know, the ward 8A that started the outbreak in PWH was a Cardiology ward and I was actually quite familiar with the doctors that worked in that ward. I tried to contact them, but was shocked to find that they have fallen ill. 2 of them were already in ICU the next day because they cannot breath on their own anymore. They have to be sedated and were put on assisted ventilation. I do not have to tell you about how the disease spread in PWH. It was all in the papers.

Then came the shock in our hospital. An elderly man was admitted to our general ward for acute bronchitis. His chest condition deteriorated over the next 2 days which was confirmed by x-rays. He subsequently succumbed on the third day despite aggressive treatments. By then, the situation has got out of hands in PWH and we believed that this patient also has this very contagious disease. 4 of our staff were infected including an intern and 3 nurses. One of the nurses is a good friend of mine. When I visited her, she was crying and telling me about her fear of death and the fear that she has spread the disease to her kids. She is now in ICU and also on assisted ventilation. Luckily, her family is well so far.

Over the weekend, our department's chief decided that the condition was alarming and we immediately set up 2 extra infection controlled wards to cater for these patients. We were laughed at by other department's colleagues and they thought we were trying to justify ourselves in getting more resources. The next week proved that we were correct. Cases started pouring in. All of these patients have either went back to Guangdong or they have close contacts with an individual diagnosed to be suffering from SARS. At the moment, 2/3 of our ICU beds are occupied by these patients. There are approximately 40 patients in the 2 infection controlled wards. The more famous among these patient are the tour members of the group that went back to Beijing, the Filipino maid that died and the first community doctor who fell ill together with his 2 nurses. The number is still climbing. I think our hospital has the second highest number of SARS patients.

As more and more people came down with SARS, we went from using masks alone to fully geared infection precaution including masks, goggles, aprons, hats and shoes covers. Particularly that our Chief Executive, Dr. William Ho, also caught the disease, we no longer believe that the mask alone can protect us. The latest news is that our Cluster Chief Executive of New Territories, Dr. Fung Hong, who oversee PWH, has also been hospitalised for SARS. You can guess how stressful we are, facing the risk of getting infected ourselves or worse, giving it to our family. The other night, when I was on duty, a junior officer paged me for help. When I arrived in the ward, I found an intern sobbing at the nursing station. The story goes that the intern was trying to examine a patient suspected to be suffering from SARS. The patient was delirious, probably due to the disease, and he pulled the mask off and coughed right onto the intern's face. She started to cry immediately and the nurse who tried to comfort her also started crying. As I was the senior on call, I decided to relieve them of duty so that they could calm down and rest. People are really breaking down under the immense stress.

As Mr Tung, our Chief Executive said, we are seeing the light at the end of the tunnel. However, the tunnel is a long one and the road is rugged. The marvellous work of our microbiologists have shown us that the infective agent is a coronavirus and it is not difficult to prevent for it is easily killed by simple detergents or alcohol. However, it has a very high infectivity and we expect the number of cases will continue to climb. Our hospital has put all elective acitivity on hold so that we could concentrate on this disease. As long as you are a physician, it does not matter whether you are a Cardiologist or a Rheumatologist, you have to put down your specialty work to look after these patients. We are now split into a clean team and a contaminated team. A staff who has never come into contact with cases of SARS will remain clean bvy looking after other patients. Wheras, one who has attended to a SARS patient will be put into the contaminated team and will continue to care for these patients. The surgeons are now having a slightly better time for their activity has also been cut down so as to free out ICU beds. The administration is thinking about concentrating all the cases in one hospital but this is not possible for there simply would not be enough ICU beds to look after all those intubated patients. The public has been comforted by the fact that most of our patients are recovering. However, I must warn you that this SARS (now called coronaviral pneumonia) is no ordinary infection. One would have to go through a stormy course before recovering.

We now know very well how to treat this coronaviral pneumonia. The regimen is that of a broad spectrum anti-viral agent (we are using ribavirin), intravenous steroid injections and also a broad spectrum intravenous antibiotic to cover for secondary bacterial infection.

My advices are as follows:
1. wear a mask, preferably a surgical mask. People are talking about the use of a special category of mask call N95. I don't think this is necessary for the general public unless you expect close contact with one of these patients.
2. Wash your hands frequently. To be more precise, wash your hands before you touch your face no matter what you'd done beforehand.
3. Be particularly careful if you are expected to travel to China, Hong Kong, Vietnam and Singapore. Check out the statistics at this site, its actually all over the world already
4. Be alert of the symptoms

Never in my career have I seen something like this and I never want to see one again. Let's hope this coronaviral penumonia epidemic would be contained soon and we could get on with our lives without the wretched mask.

May God be with us all.