May 15, 2003
Taiwan SARS Cases Jump, but Officials Think Tally Is Low
By DONALD G. McNEIL Jr.
AIPEI, Taiwan, May 15 ? Even as Taiwan was reporting its biggest one-day jump in probable SARS cases, health officials said today that the outbreak here is being inaccurately counted and is probably much bigger than reported.
The outbreak spread today to another major hospital and to an ambulance service, infecting drivers by routes that have not been traced and doctors wearing full infection gear.
Taiwan said today that its "probable" cases of severe adult respiratory syndrome increased by 26 to a total of 264, with 34 deaths.
But the World Health Organization is unhappy with the way Taiwan counts its cases ? dividing them into "reported," "suspect" and "probable," based on how many symptoms a patient shows.
In the absence of a quick, reliable laboratory test, "probable" is as specific as the W.H.O. gets. It doesn't use lesser categories.
Taiwan has more than 1,000 "reported" and more than 200 "suspect" cases, "so there may be a lot that aren't counted and we don't even know about," said Dr. R. Palmer Beasley, dean of the University of Texas at Houston's public health school, who complained about the problem to President Chen Shui-bian today.
Dr. Beasley, who spent years here fighting hepatitis B, spoke for the W.H.O., which cannot deal with the government because China objects.
Dr. Lee Ming-liang, the former health minister leading the fight against the epidemic, said Taiwan would conform to W.H.O. standards by next week.
When it does, there may be many new "probable" cases.
China has 5,124 probable cases and today Hong Kong repored it had 1,703 cases.
Throughout the day here, the news here grew steadily worse.
Seven doctors and nurses were reported infected at George MacKay Memorial, the biggest religiously affiliated hospital in Taipei, founded by a 19th-century missionary. They had all been in "full, tight protection" with patients, a spokesman said, and the hospital could not explain how they were infected.
An ambulance driver, a recruit working for the Fire Department in lieu of military service, died of SARS today, and his roommate and two other drivers were said to be sick.
City officials said it was unclear how they were infected. Also, the driver, Kuo Kuo-chan, 24, did not quarantine himself when he became feverish, but left for his hometown.
On Wednesday the National Taiwan University Hospital, the country's best, shut its emergency wards, cut off visitors and called 250 employees back to be quarantined among its more than 1,000 patients. The hospital had been overwhelmed trying to care for up to 150 suspected SARS cases at a time, and cases began to spread in the emergency wards.
Dr. Beasley said the hospital had done a poor job of triaging feverish patients as they arrived.
In Kaohsiung, in southern Taiwan, an anonymous caller to a television station who said he was quarantined inside the large, modern Chang Gang Hospital, said morale inside was low and many staff members wanted to quit.
"It's pretty chaotic in here, but management tells us to `shut up, shut up, don't talk to the media,' " he said.
Some small hospitals reported staff cases.
Although dozens of Taiwanese doctors have now been quarantined, Dr. Lee said he was not yet worried that the health care system was in danger of collapse.
"We still have quite a reserve of doctors," he said, "and these are not all the top infectious-disease specialists in the country. Many of them are low- and mid-level staff."
What did worry him, he said, was a dangerous combination of mendacious patients and too-casual doctors.
"Patients hide their real history because society gives a negative connotation to a SARS patient," he said. "Like in the early days of AIDS ? people don't want to disclose that they have a SARS patient in their family."
Doctors are supposed to treat all those with fevers or dry coughs as if they were suspect, "but they underestimate the problem," he said, and don't take the right infection-control measures.
The first doctor to die was among today's five fatalities.
Lin Chung-wei, 28, a doctor at Taipei Municipal Ho Ping Hospital, was believed to have caught the disease from a patient on April 14. He was transferred to Cathay General Hospital two weeks later when Ho Ping was closed down. |
