Coping with SARS in the U.S.

SUSAN DENTZER:

Kurk Lew and his 11-year-old daughter Amanda are U.S. citizens from Virginia. They still retain strong ties back to Lew's native China. In January they returned there for a visit, taking along Lew's 72-year-old aunt. It was the aunt's first visit to her native land in 20 years.

KURK LEW:

She was very, very healthy, and she walked… she visited a lot of places, you know? So she was never tired. She was so excited because she has seen so many new things there, you know, since the last time she went back there.

SUSAN DENTZER:

But the joyful homecoming soured when Lew's aunt became ill in the midst of the trip.

AMANDA LEW:

Somewhere along the way she got a flu-like… flu-like symptoms. And then when she got back to her hometown, she was tired, and she ate barely anything.

SUSAN DENTZER:

The aunt's condition continued to deteriorate once she was home in Virginia. Lew telephoned his own father back in China.

KURK LEW:

My father said, you may want to take some precautions, you know, because there was an epidemic they called atypical pneumonia going on, and you may want to watch her, you know, more carefully.

SUSAN DENTZER:

Days later, the aunt was taken by ambulance to this Virginia hospital, where she spent ten difficult days. She's now fully recovered, but did not want to be interviewed on camera. Public health experts believe her illness was America's first probable case of the disease now known as SARS.

KURK LEW:

You want to take a quick trip and then all of a sudden you catch this type of thing and then it's… then you almost… I would say almost die, you know. Because, you know, she feels very, very lucky.

SUSAN DENTZER:

Aside from luck, Lew's aunt benefited from a speedy response from health care providers and the public health system.

DR. JULIE GERBERDING:

This is one of the ways that we track the global epidemic.

SUSAN DENTZER:

Dr. Julie Gerberding, who directs the U.S. Centers for Disease Control and Prevention in Atlanta, says that's one reason the U.S. has so far experienced many fewer SARS cases than other countries.

DR. JULIE GERBERDING:

We've taken very broad steps to contain the spread once we have a suspicious case, and our public health officials have done an excellent job of casting that broad net so that we have done everything we can to isolate people as early as possible.

SUSAN DENTZER:

Global disease experts say the SARS virus first appeared in China last fall, in the southern province of Guangdong. From Guangdong, a few key individuals inadvertently transmitted the virus to many more people in other parts of China and the rest of the world. Public health experts have dubbed them "super-spreaders" or "hypertransmitters." For example, almost all SARS cases in Canada can be traced to an elderly Chinese immigrant. She apparently contracted the disease in a Hong Kong hotel, and died soon after returning to Toronto. But infected members of her family transmitted the highly contagious disease to health care workers.

Public health experts say they don't know why some people are super-spreaders and they say other factors may explain the phenomenon. But for whatever reason, they say, Kurk Lew's aunt was not one. Had she been, things could have turned out quite differently. Karin Kerby is a nurse at Loudon [Hospital Center] in Leesburg, Virginia. She was in charge of the emergency room on Monday February 17, when Lew's aunt arrived at the hospital.

KARIN KERBY, RN, Loudoun General Hospital:

I was made aware of a woman that they were moving into a room who had a bad pneumonia, and what I was told was this woman needed to be in a room, to be on oxygen, because she had a bad pneumonia.

SUSAN DENTZER:

For several hours, the aunt lay in a bed in this emergency room. At that point, no extraordinary precautions were being taken against the spread of disease. Eventually a worried Lew, having learned that his aunt was at the hospital, telephoned Nurse Kerby there.

LEW KERBY:

I said, well, my aunt went to China, and there was an epidemic going on there and they called it atypical pneumonia. And I said, you know, there is a possibility that she might have caught it.

KARIN KERBY:

I had read in the newspaper the week before a little article about a pneumonia that was atypical in China that had a high mortality rate. So I put that knowledge together with what he was telling me, and red flags went off.

SUSAN DENTZER:

The emergency room staff launched a series of steps initially drawn up for responding to possible instances of bioterrorism. They first called the local Loudon County public health department. Dr. David Goodfriend is the director.

DR. DAVID GOODFRIEND, Loudoun County Public Health Dept.:

Our staff, in consultation with the hospital, made sure that she was put in an appropriate isolation precaution so that no one else in the hospital, no other patients would potentially come in contact with her until we had a chance to work her up and make sure that she couldn't spread any infection to other people.

SUSAN DENTZER:

That meant putting Lew's aunt into a special room equipped with so-called negative pressure air flow.

KARIN KERBY:

Someone with a respiratory ailment usually can spread that ailment through droplets or through some sort of an airborne vector. So by turning on the ventilation system, it at least began the process of taking the infection from the rest of the emergency department.

SUSAN DENTZER:

Kirby and other members of the hospital staff also took other precautions. They donned special gowns, gloves, and respirators, or face masks, to enter the isolation room. They then discarded those protective coverings and scrubbed up as they left. All these steps may have helped to prevent hospital workers from becoming sick, as had already begun to happen in Canada. Dr. Antonio pastor is an infectious disease specialist who was called in to treat Lew's aunt. He told us that her chest x-rays revealed clouded areas of the lungs.

DR. ANTONIO PASTOR, Infectious Disease Specialist:

We put her on oxygen, we gave her fluids — she was also dehydrated — and put her on a combination of very potent antibiotics, and, you know, she started to respond very quickly.

SUSAN DENTZER:

SARS is viral; why did the antibiotics work?

DR. ANTONIO PASTOR:

It's very possible that she had this viral infection with a superimposed bacterial infection. So her immune system pretty much responded well to the viral infection, the SARS, but then she had this superimposed bacterial infection, and that's why I think the antibiotics were so beneficial to her.

SUSAN DENTZER:

Chinese physicians whom Lew had contacted back in Foshan also e-mailed suggestions about how they had treated local pneumonia patients. At the CDC in Atlanta, officials were especially worried that the aunt's illness could be a case of avian influenza, caused by a virus that had spread from birds to humans.

DR. JULIE GERBERDING:

Just in February we also had two patients die in Hong Kong of avian influenza, and that was a great concern and a major focus for us at that time.

SUSAN DENTZER:

The CDC asked the hospital to test Lew's aunt for signs of the flu virus as well as for other illnesses. They also asked the county health department to check with anyone she'd come into close contact with since returning to the U.S. Several of those people had some symptoms and were tested, but all tests came back negative.

After ten days at Loudon [Hospital Center], Lew's aunt was released. She spent several more weeks at home recuperating. In mid-March, just about the time she was feeling back to normal, the World Health Organization issued its first global health alert about the existence of SARS. The Lews, meanwhile, are grateful that things went as well as they did.

KURK LEW:

Well, the disease over there can spread here, you know, just a day, you know, and I just cannot imagine what would happen if my aunt… the problem was not cured, you know, and then what happened to the people around her — the nurses, the doctors and so on, you know. It could have been much, much worse.

DR. JULIE GERBERDING:

In the United States we've been lucky in that the cases that were identified after the WHO put out the health alert have been very quickly isolated and we've seen very little spread to health care workers maybe because we use good isolation precautions but I think there's also an element of luck in all of this.

SUSAN DENTZER:

Now Gerberding and other public health experts are trying to improve the public health system's response to SARS even further, just in case their luck doesn't hold out much longer.