Study of the 2003 outbreak of SARS reveals fears

A new study of the 2003 outbreak of SARS in Toronto shows how fears of a virulent contagious disease can affect health-care providers and reveals that some of those surveyed who experienced SARS-like symptoms during the outbreak still went to work.

These results emerge amid current concern that another infectious disease, avian influenza, commonly known as bird flu, could cause a deadly global epidemic.

The study, to appear in the September/October issue of the journal Psychosomatics, used data from survey responses submitted by 193 physicians, including 45 who provided direct care in the three large teaching hospitals in downtown Toronto where SARS (severe acute respiratory syndrome) patients were treated.

Sherry L. Grace, lead author of the study team assembled by the University Health Network in Toronto, says the experience of Toronto’s physicians is proving enlightening. “What we have learned,” said Grace, “are some basic things to better prepare doctors everywhere with the means for battling highly infectious diseases.”

Over a five-month period, 247 probable and 128 suspected cases of SARS were reported with 44 deaths recorded, including one physician and three nurses. More than 50 percent of the Toronto SARS cases involved health care providers, with the outbreak causing widespread suspensions of clinical services and quarantines.

The main concern expressed by those surveyed was that the SARS outbreak diminished their ability to care for non-SARS patients and, as a secondary result, caused them to lose income.

Despite the fears and anxieties they expressed, those surveyed possessed and applied coping skills that proved “fairly resilient” and felt that it was their duty as physicians, according to the report, to care for highly infectious patients with life-threatening diseases.

Of the 193 physicians surveyed by mail, 35 reported experiencing SARS-like symptoms and 21 of them continued to work. The survey format did not allow follow-up questioning, and the authors recommend additional investigation of the issue.

Another finding revealed a racial component - that many respondents felt stigmatized during the SARS outbreak by others who knew they had possibly been exposed to the corona SARS virus. The initial cluster of SARS cases occurred in Hong Kong. Among the Toronto physicians surveyed, those with an Asian background reporedtreported a far higher degree of stigmatization than their Caucasian counterparts.

Virtually all the physicians surveyed experiencing varying levels of elevated stress during the period of the outbreak. Those providing direct care to SARS patients report significantly higher rates of psychological distress (45.7 percent) than those not providing such care (17.7 percent).

A host of anxieties included concerns about getting SARS, dying from it, spreading it to others, especially family and friends, and being quarantined or otherwise kept from providing care.

Noting that public health officials increasingly believe that an influenza pandemic is in the offing, Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, called the Toronto study “evidence of the extent to which we are behind in what must be done to prepare for a tragedy of epic proportions.”

“Our health-care providers are going to need tremendous help,” Osterholm says, adding that a pandemic “will cause widespread dislocations and, in all cases, a lot of planning is needed to avoid the worst consequences that might befall us.”

The SARS study lists issues to address: procedures for timely sharing of information to support physicians, appropriate infection control procedures, systems for securing health income during disease outbreaks, risk management for family members of health care providers, and measures for reducing the disruption a high contagious disease can cause for other clinical care requirements.