read the following newspaper article written by Pete McMartin in 2010, in the Vancouver Sun :
A VANCOUVER DR WHO STOPPED SARS COLD
By Pete McMartin, Vancouver Sun May 15, 2010
On March 7, 2003, at 1:55 p.m., Dr. Lyne Filiatrault was nearing the end of her shift when a 55-year-old man was wheeled into the emergency department of Vancouver General Hospital. He was turning blue.
That day he had returned from a visit to Hong Kong, where he and his wife had stayed on the 14th floor of the Metropole Hotel. Staying on the ninth floor of the same hotel was a physician from mainland China, who, the week the man and his wife were there, developed symptoms so debilitating that he had checked himself into a Hong Kong hospital on Feb. 22. There he was put into an intensive care unit. He died on March 4.
The illness the Chinese physician died of was so new to the medical community it did not yet have a name, but within days it would come to be known as Severe Acute Respiratory Syndrome. SARS.
From that ninth floor of the Metropole, the disease spread outward, like ripples from a stone dropped in water. A second Metropole guest died on March 13 after travelling to Vietnam. Health care workers there were infected, as were medical staff in Hong Kong, probably because they had not taken the correct respiratory precautions. Cases were reported in Singapore, Taiwan, Thailand, the Philippines and China. Fears grew that a new global pandemic was gaining momentum.
But on March 7, no one in the emergency department of VGH knew what SARS was. The BC Centre for Disease Control had sent out universal e-mails warning hospital staffs to be on the lookout for a new strain of avian flu, but SARS is not avian flu, and e-mails can go unread.
Filiatrault, however, was the kind of doctor who read all her e-mails, especially those from the BCCDC. She has a reputation for a fanatical sense of duty and hard work, often working hours past her shift's end.
"She works so hard and is so dedicated to her work," said her husband, Dr. David Haughton, an emergency-department physician at Children's Hospital, "that she'll wake up in the middle of the night because she's worried she forgot some detail, and then she'll phone the ward. She's done it so many times, they'll just pick up the phone and say, 'Lyne, go back to sleep.'"
So while Filiatrault did not know exactly what the man who came through VGH's doors on March 7 ailed from, she knew enough from reading the BCCDC's e-mails that a patient recently arrived from Asia who was having such trouble breathing that he was turning blue warranted medical care of extraordinary caution.
Often, emergency-ward patients in a teaching hospital will first be examined by students or interns, but Filiatrault, who had worked in VGH's emergency department since 1997, examined the patient herself. She summoned a respirologist. The patient was immediately put on oxygen and blood work was done. She, the attending nurse and the respirologist hoisted the patient into bed.
"Initially, when he came in," Filiatrault said, "we didn't have any protective gear, so we were lucky we didn't contract the disease. I came down with a mild flu that weekend, which freaked my family out, but I was tested, and I never developed any antibodies."
Within minutes, it was decided that the man, who would soon become known as Patient Zero, should be placed in isolation. It was a group decision made by the department personnel, Filiatrault said, not her alone.
"I don't care to, or want to, take sole responsibility for the decisions that were made concerning the patient," she said. "I can't stress enough that this was a group effort."
It should be interjected here that Filiatrault is so self-effacing she originally did not want to do an interview, and had to be persuaded to do so by her husband and VGH media-relations staff. The part she played in containing the SARS outbreak in Vancouver, as far as I could discern, had never been told in the media before because she had never spoken to the media about it. Only her peers knew of it. Even in talking to us, she played it down.
"Like I said, the stars were aligned and it just worked well. We were lucky. It could have gone the other way. We could have been infected but weren't. And in 2003, we had the luxury of no crowding and an isolation room that was immediately available."
Her peers have a different view. Dr. Roy Purssell, who was head of the emergency department at the time, wasn't surprised at her version. "She played it down, didn't she?" he asked, as if he expected her to. "But what was done ... she handled it with just an incredible attention to detail. It all got handled just as it should be, with meticulous care and great communication between staff. Lives were saved, and the economic impact that this could have had in B.C. was avoided. In Toronto, it cost the city ... what? ... over a billion dollars? I'm very proud of her, and proud to be working with her."
In Toronto, where another infected patron of the Metropole Hotel returned on Feb. 23, infecting her son before dying at home on March 5, the SARS epidemic breached the hospitals' first line of defence, to disastrous results.
Ontario did not have an equivalent to the BCCDC, and so did not have a centralized warning system for communicable diseases. When Ontario's Patient Zero presented himself to an emergency ward on March 7, the same day our Patient Zero arrived at VGH, he was thus not recognized as a special threat and was placed in general observation in an emergency room for 18 hours. He was not placed in isolation until 21 hours after arriving at the hospital.
By then it was too late. Fortyfour people would die in Ontario from SARS, thousands would be placed in quarantine and the cost just to the Ontario business economy was estimated in the billions.
Here in B.C., there were five reported cases of SARS. All of them recovered, including Patient Zero.
Filiatrault, however, counselled caution. (And it was the following that she insisted the story concentrate on.)
"In 2003, as I said, we had the luxury of an isolation room that was immediately available to us.
"Nowadays? The number-one complaint in patient surveys? Wait times. And the wait times are too long. Nowadays, what happens with the overcrowding in emergency departments is, people wait for hours in triage. If somebody has a sprained ankle, fine, they can sit there for five hours. But if somebody has a serious communicable disease, they can sit next to people for hours without us knowing it, and expose them."
This is a complaint emergency-room doctors have been taking public. There has been a recent campaign to get the provincial government to pony up another $10 million, to hire another 35 emergency physicians to cope with the 25-per-cent increase in emergency-room traffic at our larger hospitals.
"We're the safety net," Filiatrault said, "and really, if there are not enough strands, it affects your care. In the future, I think we're at the risk of potentially having people infected."
A postscript to this story:
For its work in containing the SARS outbreak in those first days of March 2003, the VGH emergency department received a special award from the province. Filiatrault was asked to speak at the award ceremony to describe the events that day when Patient Zero came through the doors.
She declined, and asked Purssell to speak in her place.
She worked her shift, instead.
pmcmartin@vancouversun.com 604-605-2905
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