Isle doctors adjust
tactics for SARS

Physicians at Queen's consider
isolating suspected patients

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By Sally Apgar
sapgar@starbulletin.com

Although Hawaii has no confirmed cases of SARS, the mystery respiratory illness from Asia, physicians here are discussing how they should alter their normal practices and the treatment of patients suspected of having the illness.

Yesterday morning, as part of a medical conference on infectious diseases at the Queen's Medical Center, doctors filled the auditorium to get the latest update on severe acute respiratory syndrome (SARS) from a satellite teleconference with Dr. John Jernigan, chief of the interventions and evaluations division of the National Centers for Disease Control (CDC) in Atlanta.

Jernigan told the audience that the CDC has 10 investigative teams studying the new virus, which is suspected of jumping from an animal species to humans. He told the doctors they have no sure-fire treatment for the illness or definitive tests to detect it. The best way to contain an outbreak, he said, is early detection and rapid isolation of the patient.

"It's still early in the outbreak, and we are still learning," said Jernigan, adding that there has been unprecedented international cooperation among doctors, scientists and governments which has dramatically accelerated the understanding of the new disease.

Hawaii has five possible cases of SARS. Yesterday, state Epidemiologist Paul Effler, who attended the conference, said the CDC has not yet confirmed whether any of the five are SARS cases.

Jernigan told the audience that as of April 3 the CDC had compiled 2,185 suspected cases worldwide and that there had been 79 deaths for an overall mortality rate of 4 percent. He noted there have been no deaths in the United States and that SARS-related deaths have mostly occurred among elderly patients with underlying illnesses that have compounded their problems.

As of Friday there had been 2,700 cases worldwide and 116 deaths. In the United States, as of Friday, there had been 166 "possible cases" and 66 had been hospitalized.

SARS, which is transmitted by "close contact," has an incubation period of two to seven days. The doctors were urged to screen patients complaining of fever, particularly one of 100.5 or higher, chills or respiratory symptoms and determine quickly whether they have been exposed to someone with SARS or traveled within the past 10 days to mainland China, Hong Kong, Singapore or Hanoi, Vietnam.

Those four locations are where the outbreaks were first reported. The four are also considered the only locations where SARS has had a widespread transmission in the community in successive waves of infection.

One theory of SARS transmission being stronger there than elsewhere is the notion of a "superspreader" patient, someone who is more contagious at spreading the virus than others.

Physicians at Queen's and other hospitals in the state are discussing masking suspected SARS patients and isolating them in a negative pressure room for observation. The masks used are made of a thicker material than a standard surgical mask and are used in cases involving patients with tuberculosis and other highly infectious diseases.

Health care workers, one of the biggest groups of victims worldwide, are urged to wear face shields or safety goggles and masks in the presence of a suspected SARS case.