Taipei Times: Since the first SARS cases were admitted to NTUH, have you detected any link between those cases and the mysterious atypical pneumonia spreading in China and Hong Kong? What motivated you to quarantine the cases in the first place?
Chang Shang-chwen (張上淳): The husband [we treated] was diagnosed with pneumonia. His wife also had pneumonia.
PHOTO: TONY YAO, TAIPEI TIMES
I began to wonder whether the husband had infected his wife. I was also worried that if the pneumonia was contagious, the wife may infect more people.
I demanded that both of them be isolated. That afternoon, which was March 14, I saw the newspaper reports about Hong Kong's atypical pneumonia outbreak. My instincts told me something was wrong.
After reading the newspapers, I demanded our isolation measures be stricter. Isolation measures on the couple's ward were upgraded to biosafety level 3.
TT: What are the major difficulties you have experienced in treating SARS patients?
Chang: I read the newspapers reports about the atypical pneumonia outbreaks in Hong Kong and Vietnam on March 14. Two days later, which was March 16 and a Sunday, two officials from the US Centers for Disease Control and Prevention (USCDC) arrived in Taiwan.
They brought us information about the outbreak in Vietnam's Hanoi French Hospital. We were told 14 out of the 25 health workers who had had contact with the SARS patient in HFH were infected. The infection rate was nearly 60 percent. After knowing the situation, our pressure has greatly increased. Our biggest pressure was the worry about how many of our hospital staff might be infected with the disease.
In Vietnam's case, a single patient was able to infect more than 10 health workers.
The husband we were treating had not been isolated in the first few days he stayed in our hospital. I didn't know how many of our hospital staff could have been infected by him.
This was where my greatest pressure came from in my first week handling SARS cases.
TT: In some SARS affected countries, many health workers have come down with the disease, even though their hospital facilities are advanced and quarantine measures have been imposed. In Taiwan, only one hospital staff is listed as a probable SARS case. What has made the difference?
Chang: We imposed isolation measures at a very early stage. Besides, we imposed the strictest isolation measures, which even now still exceeded the standard required by the World Health Organization (WHO). This is a very important factor.
Second, since the husband had not been isolated in the first few days -- according to our theory -- many of our hospital staff might have been infected with the disease. However, in those days, the husband mostly stayed in an emergency ward or an intensive care ward. Both are special wards in our hospital.
In these wards, we usually have standard prevention measures. Most health workers in these wards wear facemasks and gloves whenever they need to have close contact with patients. Health workers in intensive care wards even don surgical robes.
These measures have significantly helped prevent our doctors and nurses from being infected with SARS.
TT: Have you been afraid you might also be infected with SARS?
Chang: Of course. (Laugh). Apparently, health workers are easily infected with SARS. If we don't take good prevention measures, of course we run a big risk of being infected. Now we require all our hospital staff to take very strict prevention measures. Basically, there will not be big problems with our health workers.
TT: Do you want to say anything to encourage health workers afflicted by SARS because they have tended to SARS patients?
Chang: We only have one doctor infected with SARS. Actually, his mood is calm now. After his infection, we had a talk to try and find out what went wrong. It was an exceptional case.
The doctor was very responsible. He entered the isolation ward to help with the patient's intubation procedures. The position he took was very dangerous.
Besides, he stayed in the ward for too long. He was in the ward for nearly an hour. Moreover, he did not wear his facemask properly.
Fortunately, under our care, he did not suffer breathing failures. He didn't need intubation, either, and recovered very soon.
TT: In some Vietnamese hospitals, a lot of health workers came down with SARS; whereas in other hospitals very few health workers have been infected. Why is that so?
Nguyen: We may look at our two hospitals [HFH and the Institution of Tropical and Infectious Diseases (ITID)]. In HFH, a lot of health workers suffered from SARS. In ITID, the situation was not so. There are several explanations [for the difference].
The index patient we received was the first SARS case in the world. At that moment, we didn't know and nobody had any idea that the patient carried such viruses. Even the WHO had not yet recommended how to deal with the situation. That's why our health workers had direct contact with the patient every day.
Our health workers were exposed to the viruses without the proper protection that [health workers] have nowadays. That's why we have many hospital staff suffering from SARS.
ITID received SARS patients at a later stage, when everything [about] SARS had become clearer. They [ITID's health workers] knew how to protect themselves. That's why they have fewer hospital staff infected with SARS. Nevertheless, it is unnecessary to panic, because it is possible to prevent SARS.
Another explanation is concerning the generation of the virus. We know that when one patient infected the other patient, the virus transmitted from the first patient to the second moves from its first generation to the second.
The toxic level of the virus consequently decreased, and the risk of being infected by the virus is also reduced.
TT: What are the major problems in determining whether a parent is infected with SARS?
Nguyen: All SARS patients must be hospitalized and isolated to protect themselves as well as other people. It is not very good for a family. If parents must stay in the hospital, then someone should take care of their children.
TT: What medications are the best for SARS patients?
Nguyen: SARS is caused by a virus. So far we have no specific medication to deal with the virus. Supportive care is very important. What's more important is to know to how to prevent the disease.
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