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.
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.
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