The
following is a personal account of a Canadian anesthesiologist’s
experiences with severe acute respiratory syndrome
(SARS) during the height of the “SARS scare”
earlier this spring. The doctor wishes to remain
anonymous, and will only be referred to as Alan T.
Much of the information here was taken from e-mail
correspondences between Alan T. and friends and coworkers
in the months of April-June 2003.
April 22, 2003
Thanks to everyone who wrote to wish me well, either
directly or on the GASNet list. John O. phoned
while I was still in isolation in the hospital and
read me numerous e-mails. I’m just emerging
from home convalescent quarantine and have finally
regained access to my computer.
I have generally had a history of good health, and
my only in-hospital experience was an overnight stay
20 years ago for minor elective surgery. I’ve
never been as sick with anything before acquiring
SARS, and it will be a few months before I’m
back to my premorbid level of fitness.
On March 20, 2003, I came down quite suddenly with
a high fever. I had intubated an elderly man
with suspected “atypical pneumonia” in
the intensive care unit on March 17, so I immediately
contacted the infectious disease specialist. We
were only just starting to learn about “SARS”
at the time. I was advised to isolate myself
in a separate room and was told that I’d likely
just have a few days of flu-like illness, and that
the severe cases with pneumonia were probably the
extreme “outliers.” I stayed in
bed with fluctuating temps for a few days, but I went
to the emergency room when I began to cough. By
then they realized it was much worse than a flu-like
illness.
Several other medical staff were coming down with
this simultaneously. A wing of a respiratory
hospital had been opened for us, and we were all (some
15 nurses, X-ray technicians, respiratory technicians
and moi) transferred and admitted that night. I
was told I had an “infiltrate” in the
right middle lobe (RML) and also advised that transmission
to family members was frequent. I was put on
an antiviral regimen of levaquin by mouth 2 gm a day
and intravenous (I.V.) rivaviri 500 mg four times
a day. My chest X-rays progressed to an RML
consolidation and some left-lung infiltrates. They
remained confined to these areas with the remaining
lung staying clear. I never needed oxygen, although
I had furious bouts of dry coughing the first one
and a half weeks that only gradually subsided as my
lungs began to clear on X-ray.
After five days, they began to discontinue the antivirals.
As with most of us, I developed a hemolytic
anemia as well as disordered liver enzymes and elevated
bilirubin with visible jaundice. I was given
several I.V. boluses of methylprednisolone to halt
this. Within a few days, everything began to
normalize.
Unfortunately my 14-year-old who had been very helpful
bringing food and water to my room when I first took
ill came down with the same thing four days after
I was admitted. She had a quicker recovery and
was sent home a week later, thus arriving here several
days before me. Fortunately my 12- and 6-year-olds
and my wife have been OK. Nonetheless they were
in quarantine almost three weeks. It has been
especially taxing to my wife who, until now, has had
to worry about two convalescing people at home still
dependent on her to make and bring us our meals. I
lost more than 10 Kg from the illness and accompanying
anorexia the first one and a half weeks of my illness.
After that I quickly turned the corner and was
sent home on the April 9. Upon exertion I found
I was easily tired and got short of breath far faster
than before the illness, probably from the anemia
as well as muscle wasting, the antiviral treatment
and prolonged inactivity. I am eating well and
regaining some weight and have started to exercise
and am able to increase my performance each day. I
am allowed to go outside on my own property and have
increased how much yard work I can do each day.
I haven’t actually lost any income relative
to colleagues since my hospital was at the epicenter
of the SARS outbreak. Most area hospitals have
had to operate on a greatly reduced scale or not at
all this past month because of SARS and the efforts
to contain its spread. I hope to return to work
in a few weeks when it begins to reopen in stages.
I would warn anyone with a suspected SARS patient
to be very cautious, particularly if intubating.
When I came into contact with the virus, I was wearing
a sterile gown, a standard paper mask, gloves and
an operating room hat —pretty standard at the
time. I even went straight to the change room afterward
to wash my face, arms, shoulders and armpits with
antiseptic soap and water and change my scrub suit.
In retrospect, I should have been double-gowned
and gloved and worn a high-quality mask and goggles
and perhaps even a plastic faceguard. I learned
from the news that 25 percent of the 250 or so likely
or suspected SARS cases in the Toronto area involve
health care workers. In one instance, a difficult
intubation requiring several attempts over a several
hour period resulted in more than 10 suspected new
infections in medical staff! Because of this,
I don’t fault any unaffected country for stricter
screening of incoming travelers. It’s
especially important to be very suspicious and prepared
for the first case that presents in the emergency
room. I won’t feel offended if any of
you choose not to visit the Toronto region in the
near future.
OK, my arms and hands are getting a bit tired and
shaky. I’ll be signing off now for a while.
I have too much else to do after a month of this lying
and sitting about than sitting at the keyboard! Best
regards to all, Alan T.
April 23-27
From all indications, I’m the first anesthetist
in Canada and indeed the non-Asian world to get SARS,
although a general practitioner who first treated
“patient zero,” as well as an internist
who is her boyfriend, beat me to it by a few days
as Canada’s first M.D.s. There were a
cluster of other health care workers (nurses and technicians)
who all fell ill the same time as I did. We
were in many respects a group of guinea pigs, and
I imagine we’ll furnish considerable material
for clinical and academic publication in the coming
months.
April 28
I was back for a follow-up again today, three weeks
after my discharge from the hospital. Everything
is coming along fine. There is still a bit of
haziness in the RML and left peripheral area, although
it is considerably improved from the residual infiltrates
two weeks ago. This is typical for a number
of us at this stage. I’m ready to go back
to work as soon as my hospital gets the green light,
although my doctors have advised me to take another
two to four weeks off. Another interesting piece
of data: the 15 of us hospitalized had a total of
58 cohabiting family members when we took ill, and
typically we remained at home the first two or three
days with prodromal fevers. At the time, none
of us was advised to wear masks or to be strictly
quarantined. Only two of these 58 cohabitants
got SARS — my 14-year-old daughter and a registered
nurse’s daughter (I presume also a teenager
or young adult). Initially the rate of transmission
to family members was quoted as 50 percent to 100
percent.
[Here Alan T. corresponds with a friend from Calgary,
Alberta, Canada, who was concerned about SARS spreading
beyond Toronto.] When the epidemic started here,
I assumed that there must have been a number of returning
travelers from Hong Kong who carried the virus, but
all indications were that it was only a single one
that slipped by and triggered the “epidemic.”
SARS is on the wane here, and it never escaped
from the hospital or close-personal-contact-stage
out into “the street.” It’s
funny, the World Health Organization and the popular
media are just now ramping up SARS paranoia. The
garbage handlers who take the city’s trash are
threatening now to inspect trash and “reject”
any with discarded masks and gloves. My daughter
and I both recently got out of convalescent quarantine
at home, so heaven help us if they happen to open
one of our trash bags, especially since I also discarded
my junk mail and read-through magazines there!
April 30
Last evening I took my 15-year-old to the SARS assessment
clinic near Markham-Stouffville Hospital where she
was admitted for a week. The doctor there, with
whom I am acquainted, compared notes with me for a
few minutes. I noted the low incidence of infection
to family members. He told me that among the
smaller number of probable SARS cases at his hospital,
there were much higher numbers of affected family
members. (By the way, her follow-up chest X-ray
had completely cleared up, and she was given the official
OK to return to school.)
August 12
I have made a full recovery. My blood tests, stress
cardiolite (Technecium) scan and pulmonary function
are back to normal. A bit of interstitial thickening
in one spot in my lungs was reported on computed tomography
scan of the chest where I had the densest infiltrates
on chest X-ray while I was sick. I’m back to
my usual levels of physical activity, including 2,000
meters of swimming at just over 30 minutes, three
miles on the treadmill at eight miles per hour and
6,000 meters on a rowing ergometer at maximum resistance
in just over 22 minutes.
Another death of a SARS patient in the ICU was reported
during the third week of August, raising the Toronto
area total to 44. There are still a few critically
ill patients in the ICU; however, no doctors have
so far died of the illness.
Sincerely, Alan T.
Editor’s Note: Sadly, the
next day, August 13, Nestor Yanga, M.D., a general
practitioner at the Lapsley Family Doctors Clinic
in Toronto, died after a four-month battle with the
disease. He was the first, and so far only, North
American physician to die from SARS. In Asia, however,
Carlo Urbani, M.D., a World Health Organization communicable
disease expert who was the first to tip the organization
to the existence of SARS, died in Thailand on March
29.
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