Impact of a viral respiratory epidemic on the practice of medicine and rehabilitation: severe acute respiratory syndrome.
Severe acute respiratory syndrome (SARS) is a new respiratory viral epidemic that originated in China but has affected many parts of the world, with devastating impact on economies and the practice of medicine and rehabilitation. A novel coronavirus has been implicated, with transmission through respiratory droplets. Rehabilitation was significantly affected by SARS, because strict infection control measures run counter to principles such as multidisciplinary interactions, patients encouraging and learning from each other, and close physical contact during therapy. Immunocompromised patients who may silently carry SARS are common in rehabilitation and include those with renal failure, diabetes, and cancer. Routine procedures such as management of feces and respiratory secretions (eg, airway suctioning, tracheotomy care) have been classified as high risk. Personal protection equipment presented not only a physical but also a psychologic barrier to therapeutic human contact. Visitor restriction to decrease chances of disease transmission are particularly difficult for long-staying rehabilitation patients. At the height of the epidemic, curtailment of patient movement stopped all transfers for rehabilitation, and physiatrists had to function as general internists. Our experiences strongly suggest that rehabilitation institutions should have emergency preparedness plans because such epidemics may recur, whether as a result of nature or of bioterrorism.
Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Republic of Singapore. grulac@sgh.com.sg
Peter A
PA
Lim
Yee Sien
YS
Ng
Boon Keng
BK
Tay
D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000517:prevention & control*; D017281:Cost of Illness; D004189:Disaster Planning / Q000458:organization & administration; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data; D006748:Hospital Departments / Q000458:organization & administration; D006769:Hospitals, General / Q000458:organization & administration; D006801:Humans; D017053:Infection Control / Q000458:organization & administration*; D007318:Inservice Training / Q000458:organization & administration; D009936:Organizational Innovation; D010348:Patient Care Team / Q000458:organization & administration; D010360:Patient Transfer; D010564:Personnel, Hospital / Q000193:education; D011159:Population Surveillance; D011481:Protective Clothing; D012046:Rehabilitation / Q000458:organization & administration*; D012047:Rehabilitation Centers / Q000458:organization & administration; D012134:Respiratory Protective Devices; D012307:Risk Factors; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology / Q000517:prevention & control*; D012846:Singapore / Q000453:epidemiology; D014789:Visitors to Patients; D016526:Workload