Early detection and hospital preparedness called major SARS concerns

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Aug 29, 2003 (CIDRAP News) – Worries about the ability to quickly detect a return of SARS (severe acute respiratory syndrome) and about hospitals' ability to handle a large number of patients were two leading issues at a recent national meeting on SARS preparedness, according to a participating physician.

Keith F. Woeltje, MD, PhD, who represented the Infectious Diseases Society of America (IDSA) at the meeting, told CIDRAP News that one major issue was "the question of how rapidly can we detect SARS, should it come back—will our surveillance be good enough?" Second, he said, "Will our hospitals truly be prepared if they get a large number of SARS patients, on the order of what we saw in Toronto?"

The meeting was sponsored by the Centers for Disease for Control and Prevention (CDC) and took place Aug 12 and 13 in Decatur, Ga. It drew representatives from US medical and public health organizations and agencies, as well as officials from Canada, Mexico, and the World Health Organization. Woeltje said there were about 30 people from groups other than the CDC and a roughly equal number from the CDC itself.

Woeltje said his understanding is that the CDC will hold additional meetings in coming weeks and intends to produce a guidance document on SARS preparedness by late fall. Another meeting is scheduled Sep 12 to focus solely on hospital issues, he said. (The CDC was contacted by CIDRAP News but did not provide information on the meeting in time for this report.)

Those at the meeting were unsure whether SARS will return this winter but were convinced of the need to be prepared, according to Woeltje, who is an infectious disease specialist and associate professor of medicine at the Medical College of Georgia in Augusta. "We'd be complete idiots not to prepare for the possibility, given that other respiratory viruses have a seasonal predilection," he said.

In a breakout group on healthcare issues, one issue that prompted much discussion was droplet versus airborne infection control precautions, according to Woeltje. He said the preponderance of the evidence is that SARS spreads by respiratory droplets when people are in close personal contact. But in a few cases people have caught SARS despite having no known history of close exposure to other cases, which suggests the possibility of airborne spread of the SARS virus.

If airborne transmission can happen, then hospitals need to use airborne precautions, meaning negative-pressure rooms, or else group patients in one unit. "It's much easier to provide a large number of droplet-precaution beds, as opposed to airborne precautions," Woeltje said. In Toronto, he added, hospitals converted regular rooms to negative-pressure rooms by installing industrial exhaust fans and HEPA filters to blow air out windows.

He said CDC officials at the meeting were encouraged "to look very carefully at the data to see if they could make a determination as to the odds of airborne versus droplet transmission. There may not be enough reported data to do that."

Woeltje prepared a report on the meeting for the IDSA, and he granted CIDRAP News permission to use information from it. Following are a few highlights.

  • SARS hospitals. In connection with hospital infection control issues, the idea of having designated SARS hospitals "was quickly dismissed as not possible. No hospital would be likely to volunteer." As a practical matter, SARS patients could show up anywhere, and nearly all hospitals need to be able to deal with at least some cases.
  • Undiagnosed respiratory infections. Attendees suggested it would be appropriate to put masks on all patients who have coughs or respiratory symptoms until a diagnosis is established. "It was pointed out that this is actually consistent with current guidelines. . . ." There was "fairly uniform agreement" on this approach. One participant used the term "respiratory hygiene" to refer to the use of masks and related droplet precautions.
  • Surveillance. Attendees saw a need to define what type of surveillance healthcare facilities should be doing in the absence of any known SARS cases worldwide. They also said they need clear definitions of "probable" and "suspect" cases.
  • Testing issues. There is a need to determine the utility of various tests and to set guidelines on which patients should be tested.
  • Clinical issues. Optimal therapy remains to be defined, and randomized trial protocols should be prepared in advance so that useful information can be gathered in the event of another outbreak.

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