Doctors consider quick action key to averting mystery illness' spread

N.M. hospital's treatment of patient seen as model

March 23, 2003|By NEW YORK TIMES NEWS SERVICE

ALBUQUERQUE, N.M. - On March 14, a worried father wheeled his adult son into the emergency room of Presbyterian Hospital here. The younger man was gasping for breath.

Ten minutes later, the nursing staff discovered that the young man had gone through Hong Kong recently. "He was a remarkably healthy-looking guy," said Pete Herendeen, a registered nurse who first examined the patient. "But he was acutely ill. Right away we had the sense that this might be an extraordinary case."

A check of the Web site of the Centers for Disease Control and Prevention told the nurses that officials were just becoming aware of a potentially deadly disease: severe acute respiratory syndrome, or SARS, found mostly in China and Hong Kong. The nursing staff had also heard about the disease on television news.

"We removed him from the triage area and six minutes later put a respiratory mask on him," Herendeen said. "We recommended that he be put into isolation."

After being removed to isolation, the patient was sent home a few hours later, his condition diagnosed as walking pneumonia, said Dr. Kris Chongsiriwatana, an infectious disease physician at the hospital.

It was not until two days later, when the CDC issued concrete recommendations to isolate patients suspected of having the syndrome, that doctors called the patient back to Presbyterian Hospital for admission. Workers taking care of him wear special gloves, gowns, masks and eye protection.

On Wednesday, the state Health Department sent home all 15 workers who came into contact with the patient during his first visit to the hospital. They were waiting out the incubation period of the disease, which is two to seven days. They began returning to work on Friday, the seventh day after the contact. None of them has reported feeling sick, said Todd Sandman, a hospital spokesman.

No other state has taken similar measures. There have been 22 suspected cases of the disease in 12 states, the federal health agency said Friday. It is still not clear whether the young man, whose name and age have not been made public, has the Asian respiratory disease, which as of Friday had apparently infected 359 people in 15 countries since Feb. 1. It has killed 10 of them.

But health officials say Presbyterian Hospital's handling of the case illustrates the importance of a quick and aggressive response by the public health system in keeping the mysterious ailment in check.

"When this disease is properly isolated, it does not spread," said Dr. Julie L. Gerberding, director of the disease control agency.

Crucial to preventing the spread of the disease is the ability to detect it. Scientists with the World Health Organization believe they have found the virus responsible for the illness and are perfecting a test to diagnose it, they said yesterday.

The development of the diagnostic test was announced Friday, but experts were cautious because the results had not been confirmed by further experiments. By yesterday, its accuracy had been verified in eight more patients.

"The consistency of these findings indicates that the test is reliably identifying cases of SARS infection," the organization said.

The test would make it possible for doctors to quickly weed out and isolate patients with the new disease.

New Mexico health workers have long been alert to novel infectious agents, said Dr. Mack Sewell, the state's chief epidemiologist. A decade ago, an unknown pathogen, later identified as hanta virus, caused severe and sometimes fatal respiratory illness in a number of people.

"No doubt having that experience helped us," he said.

After the hanta virus outbreak, Presbyterian and other hospitals were equipped with isolation rooms in which air is filtered in the room, without escaping, for patients who can spread disease by simply talking or coughing.

The patient in Albuquerque is in fair condition, Chongsiriwatana said, and should be able to go home next week. But his ailment is still a mystery.

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