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Critical Characteristics of SARS

Critical Characteristics of SARS. Virus related to the common cold Spreads by coughing and sneezing Harder to spread than a cold Much easier to spread than tuberculosis Exact odds of transmission are unknown Looks like other common diseases About 8% die despite aggressive treatment.

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Critical Characteristics of SARS

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  1. Critical Characteristics of SARS • Virus related to the common cold • Spreads by coughing and sneezing • Harder to spread than a cold • Much easier to spread than tuberculosis • Exact odds of transmission are unknown • Looks like other common diseases • About 8% die despite aggressive treatment

  2. Hospitals as Vectors • Hospitals and health care workers are often the major vector for epidemic communicable diseases • Smallpox • Ebola • Now SARS

  3. Why are Hospitals Vectors? • Concentrated susceptible populations • Workers move between patients with few sanitary precautions • Patients move around freely • Hospitals make workers bear the cost of illness so they do not go home

  4. SARS Control • Identify the sick people • Treat the sick people without infecting others • Keep contacts of sick people at home for 10-14 days

  5. Problems for Hospitals • How do you staff when you have to send people home who have been exposed before the patient was identified? • How do you keep people coming to work when they get scared? • Who protects the facility from walk-ins? • Do you sort in the parking lot?

  6. Financial and Legal Issues for Hospitals • Who is going to pay the extra costs of care? • Who is going to pay for replacing furloughed staff? • Who picks up the comp costs? • What about SARS-related lawsuits?

  7. Home Isolation • Who pays people who have to stay home from work? • Who brings them food? • Who takes care of their medical needs? • Who takes care of their psychological needs? • If you ignore these, they will not stay home

  8. How is Toronto different from the US?

  9. Central Health Authority • Nearly instant coordination of all docs and hospitals • Ability to set uniform standards • Ability to coordinate staffing • Ability to control referrals and redirect patients • Ability to shut down elective care and clear out hospitals

  10. Much more extensive social service and public health system • People to do the things to make home isolation work • Immediately set up a comp system • No health insurance issues on payment • Compliant Population • No tort issues • Few objections to isolation

  11. US Model

  12. Law and Plans are Cheap • Lots of planning • Plans never really address the impossibility of carrying them out • Lots of special laws • Poorly thought out • Never come with staff or money to handle the problems

  13. What Would Happen with an Outbreak? • Would we limit transportation as was done in Canada? • Would people really stay home? • How would hospitals cope with a lot of critically ill patients when they cannot handle the everyday flow of patients? • None of the plans include putting everyone else on the street

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