First-hand account from a surgeon involved with the Toronto SARS outbreak<br><br>From: Stan Feinberg <sfeinberg@ROGERS.COM><br>
Date: Mon May 26, 2003  10:35:18 PM US/Pacific<br>
To: ASCRS@HOME.EASE.LSOFT.COM<br>
Subject: SARS <br><br>Allow me to make another few comments about SARS,  it is not a colorectal subject, but it may affect your practice in the future.<br><br>I'm not sure how many doctors get this listserv.  For many of you, SARS is a 30 sec. clip on CNN and seems foreign to you.  Some kind of bizarre illness found in foreign countries, China, Hong Kong, Singapore and Toronto.<br><br>Since March 28, SARS has been the focus of my professional life.  It took a maximal effort to control the initial outbreak, virtually bringing to halt medical care for 5 million people in the Greater Toronto Area.  Then we went without an obvious cases for a number of weeks. It has now returned with a vengeance.<br><br>The epicentre of the current outbreak is my hospital.  Our orthopedic ward is the ward in question.  The public health people are amazing.  They can trace back about 30 cases which have broken out to a few specific rooms side by side.<br><br>SARS is an unusual illness.  It is a hospital illness.  In Toronto , the only place you are going to get it is when you step into a hospital, or if you step into the bedroom of someone who just came home from hospital.  This illness specifically attacks the health care system. Virtually all cases are Health Care workers, patients admitted for another illness or visitors of patients.  This illness is severe.  We have for example 2 health care workers in their early 30's who've been on ventilator for up to 8 weeks. Both of them at times have required inotropic support.  It is nothing short of a miracle that they are still alive.  Knowing that this can happen to a 31 year old makes a 47 year old surgeon a little nervous.<br><br>My hospital will be extensively studied by Health Canada and the CDC to answer why this has happened.  There is no doubt that the answer will relate to environmental issues.  Part of the answer is going to be simple. The new standard for health care is going to be private rooms for every patient. Many of our rooms have 2-4 patients.  Tell me if you would check into a hotel where you shared a bedroom with strangers and shared a toilet with strangers and had to walk down the hall for a shower.  Why do we accept this standard in hospitals.<br><br>We have had VRE, MRSA and now SARS.  I may be a surgeon,  but some things are obvious. I encourage all surgeons to ask their administrators about plans to create this new type of standard.  Trust me, you don't want to see SARS.<br><br>Toronto's SARS nightmare is traced back to one person arriving in the city. With current ease of travel,  it will show up in more cities.  I'll admit that in the past I didn't always wash my hands between patient encounters. If there was no internal exam and it was just a quick listen to the lungs and look at a clean wound..... Well the first thing you should learn is wash your hands frequently and well.  I use so much of those alcohol based washes, I smell like a drunk.  I also go out of my way to be nice to the floor cleaners. They are the people who are most key to ending this outbreak.<br><br>I encourage you to visit Toronto.  The canadian dollar is cheap. The hotels are empty and the streets are safe. Even the waiters in fancy restaurants are nice now that they are starving for business. As long as you don't develop a perforated ulcer and require hospitalization you won't get SARS.<br><br>By the way,  I have time for these lengthy e-mails because I am on work-quarantine for 10 days.  By public health directive I am quarantined to work and nothing else. ( when we had gone for over a month without any cases we had relaxed our use of masks away from high risk areas, so as a result me and everyone who works in my hospital has been exposed to SARS virus and we are at risk of developing this illness.  My hospital is closed to all activity.  Normally we see 100,000 ER visits per year on 2 sites. We've closed the ER, the only admissions we accept are our own sick hospital staff.<br><br>I will leave you on a positive note.  When faced with this type of stress and risk the vast majority of people show up to work and do their utmost. Our nurses, floor cleaners come to work, they all look scared but they are there to do their job. Our building services people literally transform wards to negative pressure in hours as we need additional isolation areas. I needed several volunteers to take over the care on the highest risk ward so that numbers of individuals at highest risk would be limited.  It took about 10 seconds for two doctors to come forward.<br><br>I was looking forward to New Orleans, now it will depend on whether the situation stabilizes<br><br> Stan Feinberg <br>Chief of Surgery <br>North York General Hospital, Toronto, Ontario  <br>