Perhaps I'm just a little tired and cranky today, day 41 for me of severe acute respiratory syndrome (SARS) management-320 hours spent here at my fine facility-but the rumors, innuendo, and media hoopla are about to wear me out. The World Health Organization (WHO) lifted its advisory against travel to Toronto, but the damage has been done: not only are we dealing with a brand new virus that disrupted our health care system, the WHO's pronouncement increased people's fears. Much of our outreach and education efforts may be for naught.
To date in Ontario, there have been more than 260 reported probable or suspected cases of SARS, including 23 deaths, for a case fatality rate of 9%. The attack rate (the incidence of illness in an identifiable exposed population) is estimated to be 0.05 per 1,000 persons. By comparison, the attack rate for influenza can be 10% or even 20%.
I am the sole infection control practitioner in a 176-bed acute care community hospital about 90 minutes north of Toronto. Our ED sees more than 75,000 patients a year, and everyone is scrambling to implement the ever-changing directives from our commissioners of public security and public health. Until October 2000 I worked at Mount Sinai Hospital in Toronto, where some of my colleagues in infection control are ill with SARS, and many who remain are burnt to a crisp because one can't live on the SARS-dale diet forever.
There's still no evidence to support the notion that SARS can be spread through casual community contact. Every case we are dealing with can be traced to the original cluster; as with any infectious disease, the epidemiologic link is key. Granted, there's much we still don't know or understand-like the duration of viral shedding after illness and just why this disease erupted in Ontario-but there's much we do know:
No, you can't catch SARS from someone coughing on the subway. If you could, we'd be seeing hundreds more cases in Toronto.
No, you can't catch SARS by going to church-unless a person who is epidemiologically linked is feeling a little unwell but decides to attend services anyway and leans over for a great big howdy-neighbor-God-be-with-you kiss.
No, community-acquired pneumonia is still community-acquired pneumonia. It occurs and will continue to. Just because a person is hospitalized with pneumonia does not mean he has SARS.
Yes, theoretically, you could catch SARS from a contaminated surface, but there is no evidence that this has ever happened. Just because something survives on a surface doesn't make it infectious.
Throughout all of this, close personal contact (living with or intubating someone) has been the constant. Let's all step back a moment and think this through logically. Go back to the chain-of-infection model we all learned at some point in our nursing careers-pathogen, mode of transmission, mode of acquisition-and apply it here.
Here's how to protect yourself when in Toronto.
* Obey the hospital restrictions-the isolation unit is off limits. You can't come in and see the SARS patients and their caregivers all decked out in their finest masks and gowns.
* If you've been told that you've had contact with a person with suspected or probable SARS, do the right thing: stay in quarantine for the full 10 days.
* Wash your hands. Wash your hands. Wash your hands.
* If you work in a hospital, remember that the directives are meant to protect you, not punish you, and that protective gear must be worn, for both your safety and that of others.
* Watch the news, but also stay informed by doing some research on a reputable Web site such as Health Canada (http://www.hc-sc.gc.ca).
Remember when this is all over that the measures taken to prevent transmission are just the basic infection control precautions that we should be taking all the time anyway. Quash the wild rumors. Knowledge is power.