In Taiwan, hospitalized novel A(H1N1) influenza, or swine flu, patients who are placed in single rooms — as opposed to staying in shared wards — have to pay the extra cost out of their own pockets. This is the case with other communicable diseases, too, and is an obstacle to disease control.
The media have criticized the practice, saying that hospitals are breaking regulations and treating patients like cash cows. However, these reports overlook the need to take measures to prevent infection among hospital patients.
As with enterovirus, the death rate for people infected with the novel flu strain is no more than 0.1 percent, with most patients suffering only mild symptoms. Still, enterovirus type 71 causes severe symptoms or death in several dozen children each year. In Taiwan, more than 20 people have died of swine flu. There is a certain risk for anyone who catches it, especially for those who are already suffering from other illnesses or staying in a hospital.
Swine flu and enterovirus are both legally defined as communicable diseases, but for both illnesses, regulations only require that authorities be notified and patients placed in isolation when there are severe complications. From a medical point of view, however, patients who do not have severe complications but need to be hospitalized, such as those who have to be placed on a drip because of dehydration, should be isolated to an appropriate degree to cut the risk of infecting other patients, which could be life-threatening.
The important thing to understand is that all infected patients who have not yet fully recovered — whether their symptoms are mild or severe — can spread the virus. Among hospitalized patients, those with severe symptoms are not able to move around, so they may actually have less chance of infecting others than those who have mild symptoms. It therefore makes no sense to say that only patients with severe symptoms need to be isolated.
Influenza, enterovirus and other infectious diseases can be spread by airborne droplets or contact. It is not necessary to place patients in negative-pressure isolation rooms, but if they are placed in shared wards there will be a risk of them infecting others.
Although the effective range for infection by droplets is usually only about 2m, it is very hard to prevent infection through contact between patients staying in the same room, and this kind of infection is not limited by distance.
Enterovirus and influenza viruses can survive outside the human body for several hours or even days. Once doorknobs, basins and other objects used in common by patients in the same room are contaminated with the virus, it can be transferred to others by contact.
The US Centers for Disease Control and Prevention advise placing people suffering from respiratory tract diseases in individual rooms to control nosocomial, or hospital-acquired, infections. Last year, when discussing measures for preventing the spread of enterovirus, the Taiwan Pediatric Association (台灣兒科醫學會) also recommended that during outbreaks of enterovirus type 71, suspected cases should in principle be placed in individual rooms. When single rooms and beds are in short supply, hospitals may consider placing suspected enterovirus patients with similar clinical symptoms together in multiple-occupancy wards.
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