>>SARS outbreak shuts the leading hospital in Taiwan
Donald G. McNeil Jr. NYT
Thursday, May 15, 2003
TAIPEI Taiwan's leading hospital, overwhelmed by an internal outbreak of severe acute respiratory syndrome, was effectively shut down Wednesday night, dealing a serious blow to the crown jewel in Taiwan's medical system.
More than 250 staff members at National Taiwan University Hospital were placed in quarantine, including at least 40 doctors and 68 nurses. All patients, probably numbering in the thousands, were also quarantined.
Taiwan was already officially reporting 238 probable SARS cases and 31 deaths.
This new outbreak, along with one discovered on Sunday at Chang Gang Hospital in Kaohsiung, southern Taiwan's largest city, will certainly add to that figure. In Kaohsiung, more than 100 staff members were quarantined after two patients and 10 medical staff members showed SARS symptoms.
Taiwan has rapidly surpassed Canada and Singapore to report the world's third-worst outbreak after mainland China and Hong Kong. Until last weekend, the disease was concentrated in Taipei and the surrounding area, but it now appears to be breaking out all over the country.
More and more the country seems in the grip of the disease. Military trucks spraying bleach solutions roam the streets, and the evening news is an endless stream of pictures of hospital wards, nurses in yellow or blue disposable gowns at hospital entrances and soldiers donning protective gear and marching into homes with disinfectant canisters.
At Taiwan University Hospital, doctors said it appeared that at least 15 people, including patients, doctors and cleaning staff, had become infected while in the hospital's emergency wards between April 30 and May 5.
Among those with fever or breathing problems were two nurses, an X-ray technician, a cleaner, a clerk, a patient and a patient's visitor. Last week, exhausted administrators said they were caring for about 150 suspected SARS patients. On Monday, the emergency room was closed down for disinfection.
The hospital blamed Taiwan's Center for Disease Control and the Health Department.
"We have been asking for reinforcements for days and have not gotten them," said Dr. Chem Ming-feng, the hospital's deputy superintendent. Despite wards that became more and more overloaded, the hospital got no help in turning away new patients or transferring them to other hospitals, which refused to accept them.
At 9:30 p.m., the front doors of the hospital were open, with no sign of security guards, but the huge lobby was deserted.
The facility is the star teaching hospital of a prestigious medical school, and many of its doctors have trained and taught at the best American schools.
Because Taiwan's national health system pays for care in any hospital, many patients turn up here, demanding the best, and fear of SARS made admissions skyrocket.
Dr. Chang Shan-chwen, the hospital's chief of infectious diseases, said the emergency room had been so overloaded that it was seeing more than 100 people with high fevers a day. As many as 10 might have been SARS patients, but could not be put in isolation because the hospital had filled all the beds in its negative-pressure rooms.
Chang added, "We have had difficulties casting our net, and some fish got away." In some cases, the hospital is unsure who infected whom, so infectious patients might not be isolated.
Dr. Lee Ming-liang, the former health minister who has been put in charge of fighting the epidemic, addressed the island Wednesday evening, saying the disturbing rise in cases of transmission within hospitals had three causes: Hospitals were not alert enough, patients were not admitting to all the people they had been in close contact with, and patients with minor illnesses were clogging major hospitals.
He proposed three solutions. People with mild illnesses should go to their doctors or small clinics. Neighborhoods should stop opposing the conversion of local hospitals into SARS hospitals, and family members of hospital patients should avoid visits or cut them short.
In Taiwan, families of patients try to arrange their schedules so that someone is always at the hospital. Such practices have filled the hospitals with hundreds of extra people untrained in infection control.
New suspected cases of the disease have also been found in the eastern city of Hualien and in an aboriginal tribe in remote Taimali, Agence France-Presse reported.
In Hualien a staff member at a hospital died a day after being admitted with a high fever. In Taimali, a woman was ruled a SARS victim five days after her death. A team of soldiers helped authorities disinfect her home and place 45 members of her family in quarantine. The New York Times <<
iht.com
I think SARS is still out of control in China and Taiwan. It hasn't been around long enough in Taiwan and rural China to start racking up the impressive death rates. That takes two or three weeks. |
