Shiloh
Editor, Senior Moderator
Source: http://include.nurse.com/apps/pbcs.dll/article?AID=/20080421/NATIONAL01/80418014/-1/frontpage
Nurses Live with the Aftermath of SARS
Heather Stringer
Monday April 21, 2008
In March 2003 the world was focused on the start of the war in Iraq. But there was another, less publicized, attack taking place in Asia. It was SARS, severe acute respiratory syndrome, an unusually lethal pneumonia-like illness killing people in China, Singapore, and Hong Kong and quickly spreading to other countries an ocean away.
Kim Campbell, RN, was a nurse in a surgical unit in Toronto when the SARS virus started spreading through several hospitals in the city. She and her coworkers at North York General Hospital were instructed to wear gowns, masks, and gloves to protect themselves while caring for patients suspected of having SARS. After three months of precautions, administrators said SARS was no longer a threat and employees could take off the protective equipment.
Two weeks later, administrators changed their minds. Hospital workers were told to start using the protective clothing again. Several more patients in the hospital had been diagnosed with SARS. Within days, Campbell developed a headache, fatigue, and a fever. She checked into a hospital and was placed in an isolation unit. She had SARS.
Although there were only eight cases of SARS in the U.S., more than 8,000 people contracted the illness globally, according to the U.S. Centers for Disease Control. The disease was more prevalent in countries such as China, Hong Kong, Singapore, and Canada. A total of 774 people died globally.
Campbell?s case was relatively mild. She expected to recover after a few weeks at home, but several months later she was still tired and short of breath. Before SARS, Campbell had been a regular at the gym and an active parent of three children. After contracting SARS she struggled on cardio gym equipment and had to nap frequently.
Five months after contracting SARS, Campbell struggled to return to a regular work schedule. Although coworkers were supportive, she found it difficult to explain why she felt so tired.
Campbell, now 51, was not alone. A SARS Commission report found that ?of the almost 375 people who contracted SARS in Ontario, 45% were healthcare workers. Most of the workers were nurses.? Forty-four people, including two nurses and one physician, died in Ontario, according to another Canadian report.
While some of Campbell?s nursing colleagues infected with SARS returned to work, others did not have the stamina to do their previous jobs because they struggled with constant fatigue, joint pain, shortness of breath, anxiety, depression, and memory and concentration problems.
In Canada, one physician started following a group of 50 healthcare workers who had contracted SARS, primarily nurses who were struggling with vague, debilitating symptoms. Data from studies in Hong Kong suggest there are SARS survivors in other countries who are having parallel experiences. These findings showed that although the SARS epidemic has disappeared from headlines, there are people who are still living with the fallout of contracting the illness.
Hard road of recovery
About a year after the SARS outbreak, Campbell was invited to join a SARS rehabilitation group at St. John?s Rehab Hospital for healthcare workers in Toronto who were still struggling with long-term health problems. The vast majority of the participants were nurses. The 18-month multidisciplinary program was led by John Patcai, MD, a medical specialist in physical medicine and rehabilitation at St. John?s. Patcai was drawn to this group of people because they were different from many of the chronically ill patients he had worked with in the past.
?For a lot of people who end up with chronic disabilities, there is a psychosocial component, but I got the feeling this was not the case for the SARS survivors,? Patcai says. ?Before contracting SARS, these people were the type who were exercising regularly, outside gardening all the time, or busy with families.?
The program included physical and occupational therapy, massage therapy, psychiatric and social services, and a support group. The participants ranged in age from the mid-20s to the mid-60s. For Campbell, knowing other healthcare workers were struggling with similar problems was a relief.
?Mentally it helped so much because the other participants understood that I was not just being lazy,? she says. ?And the staff in the program validated what was happening to me. They believed me.?
While in the program, which was three to five hours a day, three days a week, Campbell worked with therapists to improve her mind and body. The program included strengthening exercises and endurance activities on the treadmill. To improve her concentration and memory, the occupational therapist led her through mental exercises, such as listening to a story and answering questions.
Campbell was encouraged as she saw herself improving, though she admits her health will probably never return to the level it was before SARS. She still struggles with shortness of breath at times and fatigue. Also, she transferred to a job in an endoscopy clinic that does not require 12-hour shifts.
?These patients are not the same as they were before contracting SARS,? Patcai says. ?Some are in the same jobs, and coworkers cover for them in certain aspects of the job, while others found different jobs or stopped working.?
Searching for explanations
Although few U.S. physicians have followed SARS survivors as closely as Patcai, one group of Canadian researchers performed a study to evaluate patients who had been infected with SARS. The study, which was overseen by Margaret Herridge, MD, associate director of the med-surg care unit at Toronto General Hospital, evaluated 117 survivors at three, six, and 12 months after discharge from the hospital. The researchers conducted a lung function test, a 6-minute walking test, a chest X-ray, quality of life checks, and a physical examination.
According to the findings, the majority of patients returned to normal health. The chest X-rays for most of the participants were normal by one year, and the lung function tests were normal by three months. The 6-minute walk tests told a different story. At three months, 31% had a reduced 6-minute walk distance and at one year, 18% did. And similar to Patcai?s observations, this study found general vitality, health, and social functioning were below normal one year after discharge from the hospital.
Although researchers are eager to understand why some people still struggle with long-term health problems, physicians acknowledge there are no absolute answers.
?We are not exactly clear about the reasons for the fatigue and shortness of breath,? Herridge says. ?Some people lost a lot of weight while they were ill, which may contribute to muscle weakness. Some people think [the health problems] are related to psychological issues, such as post-traumatic stress disorder, anxiety, and depression. These patients were in isolation and very frightened because people didn?t understand the disease and the patients did not know what their outcome would be.?
Studies from Hong Kong suggest there are other SARS survivors globally who are grappling with similar health problems. According to one 2005 Hong Kong study, the ?exercise capacity and health status of SARS survivors were remarkably lower than those of a normal population? a year after the onset of the illness. Another study in Hong Kong had similar findings for patients six months after contracting SARS. These researchers reported the level of functional disability was higher than lung function tests would have predicted. They conclude the functional disabilities may be related to muscle deconditioning and steroid myopathy.
Hong Kong has created a SARS trust fund to assist people who are still struggling with post-SARS health problems. The fund is aiding 223 survivors, including health workers and lay people, with problems ranging from avascular necrosis, lung function problems, and endocrine or metabolism dysfunction to psychological problems.
For some, suffering from long-term health problems has led to questions about how the response to the crisis could have been handled differently.
Sylvia Gordon, RN, was resuscitating a patient in the coronary care unit at Scarborough Hospital, Grace Division, in Toronto, when she contracted SARS. It was March 14, 2003, early in the SARS outbreak in Canada. Gordon, 55, now suffers from post-SARS complications, including severe joint pain, labile hypertension, shortness of breath, peripheral neuropathy, and short-term memory problems. After 18 years of nursing, she eventually had to accept the fact that she could no longer work as a nurse because of her health problems.
When Gordon reflects on the early days of the SARS situation, she believes there are lessons to be learned. She feels she and other healthcare workers were not informed about the level of risk, and this put the community at risk of a more serious outbreak.
?If I had known there was a remote chance of having the disease, I would have quarantined myself at home,? she says. ?We need to make sure hospitals are communicating to workers. When you are putting your life on the line to care for people, you need to be sure you know what is going on, because you are risking everybody?s lives.?
Nurses Live with the Aftermath of SARS
Heather Stringer
Monday April 21, 2008
In March 2003 the world was focused on the start of the war in Iraq. But there was another, less publicized, attack taking place in Asia. It was SARS, severe acute respiratory syndrome, an unusually lethal pneumonia-like illness killing people in China, Singapore, and Hong Kong and quickly spreading to other countries an ocean away.
Kim Campbell, RN, was a nurse in a surgical unit in Toronto when the SARS virus started spreading through several hospitals in the city. She and her coworkers at North York General Hospital were instructed to wear gowns, masks, and gloves to protect themselves while caring for patients suspected of having SARS. After three months of precautions, administrators said SARS was no longer a threat and employees could take off the protective equipment.
Two weeks later, administrators changed their minds. Hospital workers were told to start using the protective clothing again. Several more patients in the hospital had been diagnosed with SARS. Within days, Campbell developed a headache, fatigue, and a fever. She checked into a hospital and was placed in an isolation unit. She had SARS.
Although there were only eight cases of SARS in the U.S., more than 8,000 people contracted the illness globally, according to the U.S. Centers for Disease Control. The disease was more prevalent in countries such as China, Hong Kong, Singapore, and Canada. A total of 774 people died globally.
Campbell?s case was relatively mild. She expected to recover after a few weeks at home, but several months later she was still tired and short of breath. Before SARS, Campbell had been a regular at the gym and an active parent of three children. After contracting SARS she struggled on cardio gym equipment and had to nap frequently.
Five months after contracting SARS, Campbell struggled to return to a regular work schedule. Although coworkers were supportive, she found it difficult to explain why she felt so tired.
Campbell, now 51, was not alone. A SARS Commission report found that ?of the almost 375 people who contracted SARS in Ontario, 45% were healthcare workers. Most of the workers were nurses.? Forty-four people, including two nurses and one physician, died in Ontario, according to another Canadian report.
While some of Campbell?s nursing colleagues infected with SARS returned to work, others did not have the stamina to do their previous jobs because they struggled with constant fatigue, joint pain, shortness of breath, anxiety, depression, and memory and concentration problems.
In Canada, one physician started following a group of 50 healthcare workers who had contracted SARS, primarily nurses who were struggling with vague, debilitating symptoms. Data from studies in Hong Kong suggest there are SARS survivors in other countries who are having parallel experiences. These findings showed that although the SARS epidemic has disappeared from headlines, there are people who are still living with the fallout of contracting the illness.
Hard road of recovery
About a year after the SARS outbreak, Campbell was invited to join a SARS rehabilitation group at St. John?s Rehab Hospital for healthcare workers in Toronto who were still struggling with long-term health problems. The vast majority of the participants were nurses. The 18-month multidisciplinary program was led by John Patcai, MD, a medical specialist in physical medicine and rehabilitation at St. John?s. Patcai was drawn to this group of people because they were different from many of the chronically ill patients he had worked with in the past.
?For a lot of people who end up with chronic disabilities, there is a psychosocial component, but I got the feeling this was not the case for the SARS survivors,? Patcai says. ?Before contracting SARS, these people were the type who were exercising regularly, outside gardening all the time, or busy with families.?
The program included physical and occupational therapy, massage therapy, psychiatric and social services, and a support group. The participants ranged in age from the mid-20s to the mid-60s. For Campbell, knowing other healthcare workers were struggling with similar problems was a relief.
?Mentally it helped so much because the other participants understood that I was not just being lazy,? she says. ?And the staff in the program validated what was happening to me. They believed me.?
While in the program, which was three to five hours a day, three days a week, Campbell worked with therapists to improve her mind and body. The program included strengthening exercises and endurance activities on the treadmill. To improve her concentration and memory, the occupational therapist led her through mental exercises, such as listening to a story and answering questions.
Campbell was encouraged as she saw herself improving, though she admits her health will probably never return to the level it was before SARS. She still struggles with shortness of breath at times and fatigue. Also, she transferred to a job in an endoscopy clinic that does not require 12-hour shifts.
?These patients are not the same as they were before contracting SARS,? Patcai says. ?Some are in the same jobs, and coworkers cover for them in certain aspects of the job, while others found different jobs or stopped working.?
Searching for explanations
Although few U.S. physicians have followed SARS survivors as closely as Patcai, one group of Canadian researchers performed a study to evaluate patients who had been infected with SARS. The study, which was overseen by Margaret Herridge, MD, associate director of the med-surg care unit at Toronto General Hospital, evaluated 117 survivors at three, six, and 12 months after discharge from the hospital. The researchers conducted a lung function test, a 6-minute walking test, a chest X-ray, quality of life checks, and a physical examination.
According to the findings, the majority of patients returned to normal health. The chest X-rays for most of the participants were normal by one year, and the lung function tests were normal by three months. The 6-minute walk tests told a different story. At three months, 31% had a reduced 6-minute walk distance and at one year, 18% did. And similar to Patcai?s observations, this study found general vitality, health, and social functioning were below normal one year after discharge from the hospital.
Although researchers are eager to understand why some people still struggle with long-term health problems, physicians acknowledge there are no absolute answers.
?We are not exactly clear about the reasons for the fatigue and shortness of breath,? Herridge says. ?Some people lost a lot of weight while they were ill, which may contribute to muscle weakness. Some people think [the health problems] are related to psychological issues, such as post-traumatic stress disorder, anxiety, and depression. These patients were in isolation and very frightened because people didn?t understand the disease and the patients did not know what their outcome would be.?
Studies from Hong Kong suggest there are other SARS survivors globally who are grappling with similar health problems. According to one 2005 Hong Kong study, the ?exercise capacity and health status of SARS survivors were remarkably lower than those of a normal population? a year after the onset of the illness. Another study in Hong Kong had similar findings for patients six months after contracting SARS. These researchers reported the level of functional disability was higher than lung function tests would have predicted. They conclude the functional disabilities may be related to muscle deconditioning and steroid myopathy.
Hong Kong has created a SARS trust fund to assist people who are still struggling with post-SARS health problems. The fund is aiding 223 survivors, including health workers and lay people, with problems ranging from avascular necrosis, lung function problems, and endocrine or metabolism dysfunction to psychological problems.
For some, suffering from long-term health problems has led to questions about how the response to the crisis could have been handled differently.
Sylvia Gordon, RN, was resuscitating a patient in the coronary care unit at Scarborough Hospital, Grace Division, in Toronto, when she contracted SARS. It was March 14, 2003, early in the SARS outbreak in Canada. Gordon, 55, now suffers from post-SARS complications, including severe joint pain, labile hypertension, shortness of breath, peripheral neuropathy, and short-term memory problems. After 18 years of nursing, she eventually had to accept the fact that she could no longer work as a nurse because of her health problems.
When Gordon reflects on the early days of the SARS situation, she believes there are lessons to be learned. She feels she and other healthcare workers were not informed about the level of risk, and this put the community at risk of a more serious outbreak.
?If I had known there was a remote chance of having the disease, I would have quarantined myself at home,? she says. ?We need to make sure hospitals are communicating to workers. When you are putting your life on the line to care for people, you need to be sure you know what is going on, because you are risking everybody?s lives.?