State remains on watch for potential SARS cases

By Robbie Dingeman
Advertiser Health Writer

State health officials have set up an early warning system for SARS, talking with airlines, hospitals, doctors and hotels — in some cases daily — to try to stay on top of the new respiratory disease.

The goal of the medical surveillance is to catch suspected cases right away and contain not only the illness, but the fear.

The threat of SARS has emptied restaurants in Honolulu's Chinatown, caused an increase in sales of respirator masks and kept public health officials busy preparing for an outbreak.

So far, the state has no confirmed cases of severe acute respiratory syndrome, which has sickened more than 5,050 people worldwide and killed at least 321 as of yesterday, according to the World Health Organization.

Yesterday, the state Health Department reported that the number of remaining Hawai'i-related suspected cases of SARS dropped to two, after an O'ahu woman who had traveled to China on a tour in March was ruled out for the disease.

Each day, state officials call hospitals and clinics throughout Hawai'i asking if any patients have symptoms that may be consistent with SARS.

Deputy Health Director Dr. Linda Rosen reads a summary of those hospital/clinic reports every day. The local hospital association — the Healthcare Association of Hawai'i — meets weekly with the Health Department, said Rosen and the association's emergency program manager, Toby Clairmont.

Airline pilots are instructed to radio ahead if a passenger has SARS-like symptoms. Hotel workers are subtly telling guests to monitor their health and to stay in the room if they feel sick.

Clairmont said bioterrorism preparedness has set the groundwork for good communications. He said hospitals are "capturing information regarding patients they see with symptoms that even remotely appear to match SARS diagnostic profile."

The Health Department follows up, often with a visit to the hospital or clinic to review records and speak with the treating physician and patient. Clairmont describes hospitals as "very ready" with equipment, training and isolation rooms. The basic procedure already exists in hospitals to contain any contagious disease.

Clairmont said hospital staff members are very aware of the potential for a case to emerge and respect the risk SARS could pose. And "SARS is teaching us more about how a previously unknown illness could move into the population and the problems such an occurrence poses for public health and hospitals," he said.

"We fully appreciate the economic impact and the social impact," Clairmont said. "We can't afford to take this casually. We have to plan very carefully for this."

Rosen said healthcare workers can contact the disease outbreak and prevention branch through the physicians' exchange 24 hours a day when they suspect a SARS case. She said the watchfulness begins before travelers even arrive in the Islands. The U.S. Public Health Service hands out health alert notices warning of the symptoms of the disease to travelers coming from the areas most affected by the disease: China (including Hong Kong) Singapore, and Toronto. Hanoi, Vietnam, was removed from the list yesterday after containing the disease there.

If a traveler is suspected of having SARS, Rosen said he or she can be taken to an airport medical clinic, then transported to a hospital using precautions to prevent further transmission.

For example, in the case of a China Air flight attendant who stayed at the Holiday Inn Waikiki, officials found out after she returned to Taiwan that she tested positive for SARS.

Rosen said state health officials tracked down everyone who may have been in contact with the flight attendant, including airport shuttle drivers and hotel employees.

She said the report arrived so close to the end of the 10-day incubation period that health officials were spared from having to track down people who may have come in contact those who might have been exposed to the woman. But any who might have been close to her were reached even if they weren't confirmed to have been around her. "They basically checked for illness in all the hotel employees," Rosen said.

No other illnesses here were traced to the flight attendant and she has recovered completely, Rosen said. Health officials are still monitoring a man from Shanghai who arrived the night of April 22 to spend time with relatives in Ho-nolulu. He is expected to remain isolated an additional 10 days after he has recovered. The other remaining suspected case is a man who serves with the Merchant Marine but lists his home address as Hawai'i although he hasn't been in the state since he became ill.

Some local officials say the government precautions need to be tougher. City Councilman Mike Gabbard and his daughter, state Rep. Tulsi Gabbard Tamayo, D-42nd (Waipahu, Honouliuli, 'Ewa) yesterday called for quarantining incoming travelers who show symptoms of SARS.

The Centers for Disease Control and Prevention has the power to quarantine people against their will but has been relying on voluntary isolation of suspected cases.

"I don't think we have any evidence that anything beyond voluntary isolation is needed at this time," Rosen said.

State epidemiologist Dr. Paul Effler said the Shanghai man's illness was relatively mild and that preliminary test results are expected back from the Centers for Disease Control and Prevention late this week.

"I think we're being as proactive as we can," Rosen said. She said health officials are meeting with people from the hotels and the travel industry to reduce the risk of spreading the disease from any cases that do come here.

Rosen said new guidelines are likely to include "gentle screening at check-in," where hotel officials encourage guests to be aware of their health, tell them how to get prompt medical attention and to keep the hotel informed. She said that information will urge people to remain in their rooms until their illness can be checked out. "We want to keep people safe overall," she said.

Some airlines in some countries are taking the temperatures of travelers before boarding. But Rosen said that's not particularly effective because other illnesses show up with a fever and SARS cases might not start with a fever.

Some local medical supply companies saw a big jump in sales of N95 respirator masks — hospital-quality masks that are close-fitting and tested to filter a wide range of particulates. But Effler said there's no shortage among medical staff who might need them. "We're not aware of a situation where they were absolutely needed and not available," he said.

In addition, Effler stressed that "no one is recommending that anyone put on N95 masks just to walk around."

Dauterman Medical vice president Randy Flanigan said his company sold 10 times as many masks as it normally does for a couple of weeks, but that demand has eased. He said some of the calls were from people from Hong Kong or who were planning to travel to Asia.

But Flanigan said they have a policy of holding enough supplies for their regular medical clients. "It seems like this week and last week, it kind of tapered off," he said.

Linda Nichols of Zee Medical Supply said that company was swamped by requests for masks from retail stores and sold 50 cases that retail for about $30 apiece and contain 20 masks. In the past two weeks, she said, "we actually cleaned out our warehouse."

Chinatown restaurant owners said they appreciated Gov. Linda Lingle's public lunch at six restaurants as an encouraging vote of confidence after the spread of false reports about the disease, but said business has only edged up a little since then. New Empress Restaurant manager Eva Lau, said business last week was down 70 percent, a little better than the 75 percent plunge in business for the two previous weeks.

"It's kind of difficult," she said. "People are afraid to come out still."

Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.