Feds warn SARS return could swamp hospitals
Insufficient staff, resources, equipment
Many hospitals will be besieged and "severely overcrowded" if an outbreak of severe acute respiratory syndrome (SARS) occurs during the 2003-2004 influenza season, a government watchdog agency recently warned Congress.
Marjorie Kanof, director of clinical and military health care issues at the General Accounting Office (GAO) in Washington, DC, delivered the report as testimony July 30, 2003, before the Permanent Subcommittee on Investigations, Committee on Governmental Affairs in the U.S. Senate.
"While hospital officials we spoke with stated that they are taking steps to ensure that they have the necessary preparations to address a large-scale SARS outbreak, hospitals may still be limited in their capacity to respond," she said. "Because of the inability to precisely determine if someone has SARS, many people may be treated who do not have the virus. In the event of a large-scale outbreak, this imprecision may result in severe overcrowding in health care settings — especially if a SARS resurgence occurs during a peak season for another respiratory disease like influenza."
In the event of a large-scale SARS outbreak, entire hospital wards (along with their staff) may need to be used as separate SARS isolation facilities, the report stated. Moreover, certain hospitals within a community might need to be designated as SARS hospitals.
"Few hospitals have adequate staff, medical resources, and equipment, such as N95 respirators, needed to care for the potentially large numbers of patients that may seek treatment," Kanof testified.
The findings echo a previous GAO survey, which found that hospitals lack the surge capacity to respond to mass-casualty incidents. Those findings do not bode well for handling SARS, particularly if it ever hit the United States the way it struck Toronto. "The availability of medical equipment varied greatly among hospitals, and few hospitals reported having the equipment and supplies needed to handle a large-scale infectious disease outbreak. Half the hospitals we surveyed had, for every 100 staffed beds, fewer than six ventilators, three or fewer personal protective equipment suits, and fewer than four isolation beds," she said.
Even though the United States was only mildly affected by the emergence of SARS in late 2002, shortages of N95 respirators occurred because of the high demand. Shortages in the United States may have been due to high demand in other countries, particularly when the World Health Organization (WHO) recommended that health care workers in all affected countries use N95 respirators, the GAO report stated.
Health officials noted that there is a lack of qualified, trained personnel, including epidemiologists, who would be needed in the event of a SARS resurgence. "This shortage could grow worse if, in the event of a severe outbreak, existing health care workers became infected as a result of their more frequent exposure to a contaminated environment or became exhausted working longer hours," Kanof said.
Work force shortages could be further exacerbated because of the need to conduct contact tracing. According to WHO officials, an individual infected with SARS came into contact with, on average, 30 to 40 people in Asian countries — all of whom had to be contacted and informed of their possible exposure. In contrast, New York City health department officials said that infected individuals came into contact with four people on average, the GAO found.
Assume that it will reappear
In testimony delivered at the same hearing, a Centers for Disease Control and Prevention (CDC) epidemiologist outlined the agency’s strategy to fight resurgent SARS.
"We do not know if SARS will reappear, but we must assume that it will," said James Hughes, MD, director of the CDC center for infectious diseases. "Possible sources of the virus include the original animal reservoir or other SARS-infected animals, unrecognized transmission in humans, or persistent infection in humans. Since other respiratory viruses are seasonal, it is possible that SARS may be more likely to re-establish infection and spread during respiratory virus season: fall, winter, and spring."
The CDC currently is working with commercial, academic and federal partners to develop rapid and reliable SARS diagnostics. "This is particularly crucial to be able to confirm SARS and rapidly rule out other causes of illness," he said. The agency also is looking at SARS isolates to try and detect changes in the virus that may reveal transmission patterns. Beyond the microbiology, the CDC has fully staffed all eight of its quarantine stations in the United States, Hughes said.
During the SARS outbreak, the CDC issued travel advisories to airline passengers traveling to SARS-affected areas and distributed more than 2.5 million health alert notice cards to airline passengers on more than 11,000 flights arriving in the United States from those areas.
"As part of CDC’s preparedness planning process, state and local public health officials will be provided guidance on the implementation of containment measures in the event of a resurgence of SARS," Hughes testified. "These will address isolation of cases, tracing and monitoring of contacts, and implementation of individual and community-based quarantine measures."
The upcoming guidance will address essential preparedness activities for isolation and quarantine, including legal authorities, personnel, and facility requirements; enforcement plans; and coordination with public and private partners, he said. In addition, the necessity of rapid and accurate communications will be underscored in CDC plans.
"Strengthening linkages and communication among clinicians, emergency rooms, infection control practitioners, hospitals, pharmaceutical companies, and public health personnel have been of paramount importance to CDC for some time," he said. "We are also strengthening the communications channels with our international partners, including WHO, which benefits Americans and the global community in that it reduces confusion among travelers and helps people assess personal risk from SARS."
Many hospitals will be besieged and severely overcrowded if an outbreak of severe acute respiratory syndrome (SARS) occurs during the 2003-2004 influenza season, a government watchdog agency recently warned Congress.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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