Lessons from SARS: A retrospective study of outpatient care during an infectious disease outbreak

Abstract

BackgroundDuring severe acute respiratory syndrome (SARS) outbreak in Toronto, outpatient clinics at SickKids Hospital were closed to prevent further disease transmission. In response, a decision was made by the neonatal neuro-developmental follow up (NNFU) clinic staff to select patients with scheduled appointments to have a mail/telephone assessment using Ages and Stages Questionnaire (ASQ) or to postpone/skip their visit. The objective of this study was to compare the developmental assessment and its outcome in two groups of NNFU clinic patients, SARS versus non-SARS, over three standard clinic appointments.MethodsWe compared the diagnostic accuracy (identification of developmental delay), and patient management (referral for therapy or communication of a new diagnosis) of the strategies used during SARS, April/May 2003, to the standard assessment methods used for patients seen in April/May 2005 (non-SARS). In all cases data were obtained for 3 patient visits: before, during and after these 2 months and were compared using descriptive statistics.ResultsThere were 95 patients in the SARS group and 99 non-SARS patients. The gestational age, sex, entry diagnosis and age at the clinic visit was not different between the groups. The NNFU clinic staff mailed ASQ to 27 families during SARS, 17 (63%) were returned, and 8 of the 17 were then contacted by telephone. Criteria used to identify infants at risk selected for either mailed ASQ or phone interviews were not clearly defined in the patients' charts. There was a significant under identification of developmental delay during SARS (18% versus 45%). Of those who responded to the mailed questionnaire, referrals for therapy rates were similar to non-SARS group. The lost to follow up rate was 24% for the SARS group compared with 7% for non-SARS. There was no difference in the overall rate of developmental delay in the two groups as identified at the 'after' visit.ConclusionsPoor advanced planning led to a haphazard assessment of patients during this infectious disease outbreak. Future pandemic plans should consider planning for outpatient care as well as in hospital management of patients.

Significant increase in the incidence of high-risk pulmonary embolism during the COVID-19 shutdown: the pandemic response causes serious collateral consequences

“…While the emergency decisions were successful in controlling the outbreak, they also created collateral consequences that may not have been considered when SARS outbreak focused strategies were initially developed (20). Planned surgeries were cancelled, resulting in a signi cant increase in numbers of patients awaiting cardiac surgery (21), cancer treatments were interrupted (22) and poor advanced planning led to a haphazard selection of patients requiring medical care (23). Although there is no longterm data on the impact of such measures on population health available, researchers in 2003 already warned that this could be a serious problem in future pandemics (24).…”

SARS Coronavirus 2, Severe Acute Respiratory Syndrome, and Middle East Respiratory Syndrome in Children: A Review on Epidemiology, Clinical Presentation, and Diagnosis

“…The most common laboratory test findings among pediatric patients included lymphopenia, leukopenia, thrombocytopenia, and elevated levels of lactate dehydrogenase (LDH) and alanine aminotransferase (ALT) (17)(18)(19). However, lymphopenia was not detected in a group of children who did not receive corticosteroids (12,20). In children, the most sensitive test for the confirmation of infection was Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) for the RNA of SARS-CoV in nasal aspirate or Broncho alveolar lavage specimens (11,21).…”

“…It was notable that the appropriate timing of sampling was most important in the positivity of the test. The best time for sampling was when there was a high viral load in the patient, although the viral load in children had never reached the level of adult patients (12,20). The RNA of the virus was detected in 48% of young patients within five to seven days of the symptom onset (12,21).…”

Pandemic Management in a Pediatric Hospital

“…Surge capacity is critical in disaster management, and closure of nonemergency health services to control disease spread was a common practice during the SARS outbreak. 13,14 Ramping down clinical activity by 25% to get additional nursing staff for deployment was not entertained because this would have increased the number of patients presenting to the ED. Thus, as clinics closed, chronically ill children with complex medical needs would also begin visiting the ED, adding extra work for ED staff and exposing these vulnerable patients to other children with H1N1 infection.…”