SARS – BEPAST Email Update 7

Subject: SARS updates: 95 CDC/WHO slides online, NEJM online

Colleagues:

 

This morning I reviewed and recommend to you each of the 95 update slides on SARS from the five CDC and WHO speakers who will speak on today's CDC webcast on SARS (10-11:30am and 2-3:30pm EST). These 95 slides are already available at: www.phppo.cdc.gov/phtn/webcast/sars/default.asp

 

Some key highlights include:

 

1. Detailed clinical and therapeutic descriptions of SARS by Dr. Sung from Prince of Wales Hospital in Hong Kong based on > 150 SARS patients admitted there, 138 of whom had contact with the INDEX patient in their hospital (20 physicians, 34 nurses, 15 allied HCWs, 16 medical students, 19 patients, 34 relatives). SARS appears to have been very infectious within this hospital setting, PRIOR to appropriate infection control protection being initiated. Given other nosocomial SARS in hospitals in Hanoi, Toronto, Singapore, and elsewhere (included 2 HCWs in the USA per April 4th CDC's MMWR update) we have to remain highly vigilant for and respond rapidly to SARS.

 

a. Clinical data includes: Symptoms and signs, labs (High LDH: may have prognostic value, CPK, AST, aPTT, D-dimers.  And low platelets, lymphocyte count, WBC, K+), Chest X-ray and Chest CT photos.

 

b. Rx: specific doses/duration of ribavirin (oral or IV, but NOT aerosolized), steroids (oral or IV, including pulse steroids), and in advanced cases possibly "convalescent serum" from recovered SARS patients, and  plasma exchange.

 

2. CDC Lab data by Dr. Jim Hughes on a possible viral etiology e.g., a coronavirus.

 

a. Data on the types of lab assays including PCR, antibody, Electron microscopy, culture, autopsy pathology (including "multinucleated syncytial giant cells in lung of SARS patient").

 

b. Some of Dr. Hughes' "what we need to know" about SARS includes: "Importance of "hypertransmitters" of SARS, "Role of co-infection", Dx test(s), & Rx.

 

 

3. "Infection control in Healthcare setting" by CDC Linda Chiarello.

 

a. Many KEY points in 31 slides, such as types of personal protective equipment including eye protection, masks, gloves, gowns & others measures.

 

b. Information on types of masks, and when they should be placed on patient/HCW.

 

c. A sample "visual alert" for Emergency Rooms to immediately identify persons with possible SARS and initiate infection control measures immediately for both the patient and HCW to block nosocomial transmission.

 

 

Other SARS updates information includes:

 

1. New England Journal of Medicine online includes 2 papers and 2 editorials on SARS. The papers each describe 10 patients with SARS from Hong Kong and from Toronto.

 

2. Today's April 4, 2003 CDC's Morbidity and Mortality Weekly Report (MMWR) found on cdc.gov homepage includes information on the first 100 SARS patients in the USA.

 

 

The websites of multiple individual countries Health Departments continue to be valuable sources for the most updated information on SARS, as well as the WHO and CDC websites (where the individual weblinks to other countries 'SARS' websites can be found).  Our initial Washington Hospital Center ER SARS algorithm written on March 16th will continue to be updated on our bioterrorism and emerging diseases website (www.bepast.org).

 

 

In DC, the Department of Health (DOH) requests that anyone seeing patients with possible SARS contact them (DC DOH: Dr. Michael Richardson, or Dr. Karyn Berry or other persons as designated) immediately to help facilitate patient evaluation, testing, infection control measures, coordination with the CDC (i.e., via the DC DOH), and public health issues for the District of Columbia.

 

 

Thank you very much.

 

Daniel R. Lucey, MD, MPH

Director, Center for Biologic Counterterrorism & Emerging Diseases

Washington Hospital Center

Department of Emergency Medicine

Washington, DC

Consultant to: DC DOH, DC Hospital Association, Medical Society of DC.