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Your Captain Speaking: nCoV and the Lessons of SARS

“Dick, I remember you were over there during the SARS epidemic—Hong Kong, Singapore, and Taiwan back in 2003, right there at ground zero. What should we know if the novel coronavirus shows up here with EMS?”

Here’s what I remember and shared with Samantha: Back in 2002–03, SARS—severe acute respiratory syndrome, also caused by a coronavirus—was harsh, scary, and a killer. As a field paramedic and also a pilot flying a 747, I saw some strange things I didn’t expect then but we may now see again if nCoV becomes widespread in the U.S.A.

Temperature checks—The idea was good, but the implementation was just downright goofy. As you entered the airport terminal before proceeding to customs and immigration, you would walk by a checkpoint where they checked your forehead temperature. Sounds reasonable—however, in July 2003 it was hot in Hong Kong, the bus was steaming, and I was dragging a bunch of equipment. I was sweating. As I approached the checkpoint, I realized my temperature might be up. It was too late to turn around, so I got my forehead checked, and they said it was OK.

I was happy not to be looking at 14 days’ isolation but nonetheless asked, “What was my temperature?” We know full well normal body temperature is 37ºC. They were reluctant to answer me at first, I remember, but I was persistent. The answer they eventually gave me was 34ºC! It was summer in Hong Kong, and 34ºC is profoundly hypothermic!

This inaccuracy raises an obvious question: Are temperature checkpoints at airports effective? I’ve been through many, and the only thing generally looked at is the number on the display. At other, more sophisticated entry points, I’ve seen thermal displays where temperatures showed in various shades—whiter was hotter, darker colder. Some have a little color now. Either system requires the attendants to be trained and attentive. That could be a weak point in preventing the spread of the virus.

Half, then half again—Chatting with a nurse at Princess Margaret Hospital in Hong Kong, I was surprised at what she said was the biggest challenge to working in a hot zone: scheduling! But as I looked around, I began to see what she was talking about. She said that three days after the abrupt increase of patients with SARS showing up at the hospital, staff availability dropped by half. People were scared, and that included caregivers. Three days after that, staffing dropped by half again. I could not imagine working with a higher-than-normal patient load with a quarter of normal staff. If you think you’ll be fully staffed to fight nCoV, you might be wrong.

Other slowdowns—This interference with normal business operations will spread to other industries. Hotels and restaurants have contact with large numbers of people and therefore greater risk of exposure to a virus. With SARS check-in lines became longer, service at restaurants was slower (some even closed), even transportation services were unreliable. Planes won’t move on time if the pilots can’t get from their hotels to the airports.

Take that thought a step further: Your city has documented nCoV cases, and a patient has flulike symptoms. While ordinarily they might call Uber or Lyft to seek help, fewer drivers may be accepting an increasing number of calls. Now running out of options, whom is that patient likely to call? You guessed it: 9-1-1. Lots of us have transported flu patients who have coughed in the back of our ambulance. How long must you take the ambulance out of service to do a deep cleaning in the back?

There were other problems during SARS. As staff shortages rose, some offices and functions closed. Personnel were moved to jobs they weren’t used to, dealing with patients or working in hot environments. Last-minute call-offs were common. Caregivers performing new aspects of care can result in errors.

Here’s the takeaway: Things are different now than when SARS appeared, but we still might expect shortages in staff who, rightly or not, are scared to interact with patients. These will also occur in areas that don’t interact directly. Some screening practices, such as temperature checks at airports, are not a sure way to identify the infected. But there are things we can do. Never miss the basics: universal precautions and washing your hands…a lot. We’ve had other tough bugs; we can deal with this one too.

Dick Blanchet (ret.), BS, MBA, worked as a paramedic for Abbott EMS in St. Louis, Mo., and Illinois for more than 22 years. He was also a captain with Atlas Air for 22 years and an Air Force pilot for 22 years.

Samantha Greene has been a paramedic, field training officer, and operations supervisor for Abbott EMS of Illinois for the last 10 years and a lieutenant for the Madison, Ill., Fire Department for the last five.

 

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