January 18, 2006

SARS Showed How Epidemics Cause Chaos

By Maggie Fox, Health and Science Correspondent

WASHINGTON -- Hospitals may have to adapt military-style triage in case of a bird flu pandemic, and must get plans into place now for dealing with one, a Canadian expert said on Wednesday.

Toronto hospitals that had to deal with the 2003 SARS outbreak learned the hard way that it pays to have plans and procedures in place before an emergency happens, said Dr. Laura Hawryluck, of the University of Toronto, and a member of the Critical Care Pandemic Triage Provincial Committee.

Severe Acute Respiratory Syndrome spread out of southern China in 2003 and eventually was spread to spots around the world by air travelers, killing about 800 people and infecting close to 8,000 before it was brought under control in July 2003.

It killed 44 people in Toronto and forced the quarantine of more than 10,000.

A pandemic of H5N1 avian influenza would be worse. The disease now mostly affects birds but it has occasionally jumped to people, killing just around 80 in six countries.

The fear is that the virus could mutate into a human influenza, spread quickly and kill millions globally.

World health leaders say no one is ready to deal with this. Canada learned some lessons from SARS but will not have all the resources needed to cope, said Hawryluck.

"What we have been told is to expect about a 34 percent attack (infection) rate over a six-week period," Hawryluck told an Internet-based seminar of medical professionals.

That would overload current capacity for intensive care units with influenza patients alone -- not including all the other needs for an ICU, which are already almost full to capacity every day, she said.

During SARS, many ICUs were overwhelmed, she said. "Our staffing was reduced because of illness, because of quarantines and because of fear," she added.


Military-style battlefield triage may be needed at peak times when patient numbers outpace the number of beds, ventilators, the supplies and drugs and the number of people needed to tend to them, Hawryluck told the seminar, sponsored by hospital supplier Pall Corporation.

"The military had used triage systems for many years," she said. Her system has already adopted the military color codes for patients, she said.

"The red people would be the highest priority for ICU care," she said. "Yellow -- those are the people you know they might do well with ICU care, they might do well without, it would be nice if the resources were available," she added.

People deemed "blue" or "black" would receive only palliative care -- to reduce pain and suffering while they died, while people given a "green" rating would not require immediate attention.

Hospitals also should plan for equipment needs now, she said, and also negotiate any government contracts and agreements ahead of time, so that bureaucracy does not bog down things in an emergency.

Controlling media-generated rumors may be impossible so it will also be useful to set up a clear communications system with all workers, she said.

"During SARS we created our own teleconference," she said.

"It is hard to separate fact or fiction. The front-line workers are usually the last to find out about things and that needs to change."

Counseling, psychological support and little touches like supplying cold drinks to workers sweating under gowns and masks also are useful, Hawryluck said.

Health care workers were especially likely to be infected with SARS because the virus spread during lifesaving procedures such as inserting a breathing tube into a coughing patient.

"We were treated as pariahs by the rest of the community and by the general public and that was very difficult," Hawryluck said.