Originally created 01/17/04

Bad flu season helps U.S. prepare for SARS should it erupt again



ATLANTA -- When a glut of flu patients swamped medical workers in Nashville, Tenn., one day last month, Vanderbilt University Medical Center pulled out its SARS disaster plan.

For six hours, hospital officials considered setting up a special ward for flu patients, something right out of their pages for handling a SARS outbreak.

Ultimately, the makeshift ward wasn't created because enough beds were freed up by discharging patients early. But the situation was a test of Vanderbilt's SARS response plan and helped the hospital knock out some kinks.

This year's early and harsh flu season has opened a door for hospitals and health agencies to doublecheck their readiness for SARS as world health authorities closely watch for another outbreak in Asia. So far, China has just one confirmed case and two suspected cases.

Some of the lessons learned from last year's SARS outbreak - which killed 774 and sickened more than 8,000 in Asia and Canada - have been useful during the flu season in this country. And it helped Asian health officials spot and attack an outbreak of bird flu that has killed three people.

SARS and influenza are similar, both being highly contagious viruses that spread mainly when an infected person coughs or sneezes. In the United States flu typically kills an average of 36,000 people annually. SARS has not killed anyone in this country and was only confirmed in eight people in the U.S. last year.

The precautions for preventing the spread of either disease are the same.

For example, coughing and wheezing flu patients are being asked to wear surgical masks in some U.S. hospitals, just as SARS patients have been required to do in other parts of the world.

At Vanderbilt, anyone with a cough is given a packet of tissue, a surgical mask and handwashing materials such as soap or alcohol gels, said Dr. William Schaffner, head of preventive medicine.

Many hospitals have posted signs reminding people with a fever and cough to notify medical workers and avoid contact with others. During the peak of the flu season, Vanderbilt and other hospitals were overwhelmed with people who thought they had the flu.

"If there's a silver lining in this cloud, it helped us with our SARS preparedness planning," Schaffner said. "It illuminated some areas where we have to do a little more work."

One example: doctors trying to quickly free up beds for flu patients ran into problems rescheduling elective surgeries of patients traveling from far away.

That, Schaffner said, was not something hospital officials had thought about or addressed in their plans for a possible SARS outbreak.

Yet many problems remain. The Centers for Disease Control and Prevention says some health departments still do not have systems to efficiently control outbreaks or computer databases to track cases.

Other health officials say many hospitals could be overwhelmed by flu or SARS because they don't have enough isolation rooms. Hospitals still struggle over how to handle patients who show up at clinics not designed for contagious patients.

They don't always show up with SARS in a hospital emergency room, said epidemiologist Dr. David Calfee of New York's Mount Sinai School of Medicine.

Just last week the CDC updated its Web site offering hospitals guidance on diagnosing SARS cases.

If SARS hasn't shown up in a particular region, doctors are to use strict criteria designed to keep them from chasing false cases: X-ray evidence of pneumonia, especially those with a travel history to China, Hong Kong or Taiwan; anyone working in health care with a SARS risk. Clusters of atypical pneumonia also would be a red flag.

U.S. SARS cases would prompt health officials to broaden their search for potential cases to make sure SARS isn't missed, said Calfee. Once person-to-person transmission of SARS has occurred anywhere in the world, SARS should be considered even without X-ray proof of pneumonia, he said.

That would result in isolation of SARS patients, tracking down people who had contact with them and even quarantines.

Such measures are needed because there is no vaccine, effective drug treatment or natural immunity for SARS.

Much more is known about SARS than when it first emerged in China in November 2002 as a mystery disease. Now diagnostic tests are more accurate and labs across the country are being trained to identify SARS cases, said CDC director Dr. Julie Gerberding.

"Regardless of what kinds of tricks Mother Nature has in store for us, we're better prepared in a global public health way," said New York University's Dr. Martin Blaser, vice president of the Infectious Diseases Society of America.

Besides dealing with flu epidemics, many have tackled the emergence of AIDS, hantavirus, West Nile virus and even monkeypox.

"So far public health has been able to meet any challenge that's come down the pike, and I don't think SARS would be any different," said Helen Fox Fields of the Association of State and Territorial Health Officials.

On the Net:

CDC SARS guidance: www.cdc.gov/ncidod/sars/guidance/