Monday, March 17, 2003

A pair of disturbing first-hand reports on the mysterious pneumonia that has swept Asia and has now reached Europe and Canada. No cases have (yet) been reported in the USA. These posts are written by Dr. Tom Buckley, an intensive care specialist in Hong Kong on the front lines. Note that the ICU staff are sufficiently alarmed that they are not going home to their families, and that many of the the hospital personnel are themselves becoming sick. Dr. Buckley states, "We now have 80 cases of atypical pneumonia in this hospital (64 yesterday) and over 50% are either Health Care Workers or Medical students... My impression is that even with minimal contact with an infected person people have been becoming ill." An extended excerpt is quoted below. (Link via Boing Boing.)

The CDC (Centers for Disease Control) website on this disease is here. Steven Den Beste has a very interesting analysis here.

[Dr. Buckley writes:]

Unresponsive to various combinations of cefotaxime, chlarithromycin, levofloxacin, doxyclycline and Tamiflu. All microbiology is NEGATIVE (after one week).

Physicians have started patients on ribovarin and steroids.

As of yesterday there were 64 patients with "atypical pneumonia" in the hospital - a large number of whom are staff.

Patient visitors, medical consultation staff, medical students visiting patients have all developed symptoms and to a large degree CXR signs.

While most of our cases revolve around the patient admitted to the medical ward we have admitted (to ICU) another patient from another hospital with atypical pneumonia.

In ICU we have twelve patients admitted so far.

Five are ventilated. Seven breathing spontaneously but very oxygen dependent.

My impressions CXR reveal progressive bilateral infiltrates starting at the bases. Patients invariably have a low WCC and maybe thrombocytopenic. Patients invariably have an elevated CPK. No ECG changes and Troponin T negative. Post mortem on an Indonesian maid (not in our hospital) showed evidence of ARDS and myocarditis.

So far 2-3 of our older patients with chronic disease have deteriorated fastest. Medical staff - younger and fitter have faired better. Their radiological findings have deteriorated in all but one case.

We receive 2-3 admissions per day. So far no-one has shown any improvement. Once intubated however they remain relatively static but very oxygen and PEEP dependent. Those ventilated have solid lungs. Interestingly one patient developed a pneumothorax on the medical ward and after chest drain and re-expansion his pneumonia involves only the side without a chest drain. Another patient (ventilated) has developed surgical emphysema.

ICU is now closed for all but atypical pneumonias. All our other "clean cases" have been transferred to other ICUs. All elective surgery is being cancelled and wards are being closed and evacuated. All ambulances are being diverted.

We are taking strictest possible isolation procedures available to us including hand washing, gloves, gowns, N95 masks and visors.

Masks are worn throughout the hospital. Staff are not going home to children.

Please take the warning below seriously. My impression is that even with minimal contact with an infected person people have been becoming ill.