The rapid expansion of Taiwan's health-care system may have placed stresses on its hospitals and clinics and that may have compromised some of the facilities' air-handling systems during the current SARS epidemic, the head of the US Centers for Disease Control and Prevention (CDC) said Thursday.
As a result, ventilation in some hospital rooms might not be adequate for proper infection control, CDC director Julie Gerberding said in a press briefing at the center's headquarters in Atlanta on Thursday.
"I think the concerns are that the physical environment of a health-care facility, and the air handling in a health-care facility can be very variable," Gerberding said.
As a result, "there are examples where you think you have the proper airborne precautions in place, but the mechanics of the ventilation in the room fail, or the degree or air exchanges expected are not adequate to provide that level of ventilation," she said.
"And in a time of crisis and when these health-care facilities in Taiwan are undergoing rapid expansion and the whole system is under stress, it's entirely plausible that there could be breaches in infection control," Gerberding said.
Gerberding made her comments in answer to a question about the CDC scientist who developed SARS-like symptoms while working in Taiwan. The press conference was dominated by questions about his case.
Gerberding called the current situation in Taiwan "disturbing," saying that the ongoing increase in reported cases means "we fully expect the case counts to go up because of reporting delays, recognition delays, and the overall complexity of trying to track such a rapid and complex outbreak in real time."
Gerberding praised Taiwan's health authorities for "taking all of the appropriate steps to achieve containment."
"But it's a huge challenge and one that is going to take continued effort on the part of the entire health system in Taiwan," Gerberding said.
"It's a very serious and sobering situation, and I think we remain hopeful that ultimately, they too will be able to achieve containment as they did in the early stages of the epidemic," Gerberding said. "But it's a very challenging situation right now."
Responding to a reporter's question about a possible cover-up of cases by hospitals and doctors in Taiwan, Gerberding rejected the implication, saying that "our team has had a strong sense that the information is coming forward in the way that we would expect it to."
In terms of the reporting lag she mentioned earlier, the director noted that there is an advisory group in Taiwan that reviews suspected cases to see whether they actually fit the SARS definition before reporting them.
"As you can imagine with the number of cases that are currently in the queue, that reporting process is taking a bit longer," she said.
"But I think the important thing is that they are responding to the suspected cases on the ground with the appropriate public health interventions," Gerberding said.
"So, I'm not concerned at this point in time about a cover-up on the part of the government," although individuals may be too frightened to report their own sickness, she said.
Gerberding refused to speculate over how the US scientist got sick. While noting that the vast majority of transmissions in Taiwan have happened in health-care facilities, and "that's the leading hypothesis," she said that it could have been "in the community."