- Hello,
-
- Angie xxxxxx requested that I speak with you about a
pattern we are seeing in our patients at Kaiser Hospital, Vallejo, CA.
I am a respiratory therapist (20 years in the field) and I have been working
for the past 30 days, almost exclusively, with our "atypical"
pneumonia patients. Ninety to ninety-five percent of the patients I have
had since March 9th on my documentation records, have had the following
patterns of presentation and outcomes:
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- Sudden Shortness of Breath, fevers of 100.4 to 102.2
documentable. Pneumonia with ARDS developing in most. Many have gone into
liver and kidney failures, have pleural effusions or cardiac effusions,
have had unknown etiology of sepsis arising more often in the last 2 weeks
and have needed ventilator support (both invasive and non invasive) for
hypoxia.
-
- Some of my staff members say the pattern was visible
to them in ICU as long as 6 weeks ago. I was aware of it 4 weeks to 5 weeks
ago. At first the patients presented with a viral pneumonia pattern. Their
WBC were low 4,000 to 2,000. We started seeing adults with RSV in their
sputums. Those were placed in isolation, but NOTnecessarily negative pressure
isolation, immediately and our hospital staff was exposed to them without
isolation while diagnosis and sputums were made and gathered. Then we saw
a bacterial presentation coming. The bacterial pneumonias were frequently
gram negative rods, but not pseudomonas. Some were Maxilla pneumonia in
the sputum. There were no Influenza A or B in the sputums. RBC were all
over the board on the patients from high to low and we had clotting factors
lowered. ABG's showed mostly metabolic acidosis with hypoxia of moderate
to severe in the ICU cases.
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- At first the patients were able to ambulate in for care,
then they came Code 2, then in last three weeks many are coming respiratory
or full arrest and intubated in the ER or transferred from other facilities
after arrest in ER. The ARDS patterns develop quickly, within 8-14 hours.
The Xrays are nodule in patterns and grainy. Then we had a rash of intestinal
bleeding developing the patterns. Then we had intestinal necrosis. Many
of our patients started going into pulmonary edema or liver failure on
the surgery tables. Our mortality rate has become very high now with these
patients. We are needing more tracheotomies done. They require paralyzing
agents on the ventilators and large amounts of morphine for sedation or
we can't control their high respiratory rates. Sometimes up to 20mg bolus
to sedate.
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- At first we were weaning successfully in high numbers
and only losing, by my estimate, of 4-6 percent of the mechanically ventilated
patients. Then it got longer to wean, our success to death ratio started
going 50/50. It may be worse now. Then our weaned and improving patients
started to rapidly deteriorate and die after we thought they were doing
better and had transferred some ICU patients to TCU and floor care. They
started returning within 8-12 hours in arrest suddenly. We have lost 20
patients in the last 30 days on one shift alone, that we can track as respiratory
therapists trying to watch our patterns. We have lost count of the total
deaths in one month. It has become VERY disturbing. I have never seen a
pneumonia season like this in 20 years in the field. It is a very late
season for flu. We usually end our flu season in March, not increase it.
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- We do have abnormally high amounts of rain and wet weather
this year in our area. However, we are not seeing yeast or asprigillias
in the sputums or "balls or fluff" on Xray. Our physicians have
ruled all of these patients as NOT SARS. Most were not in any isolation
until just recently as mortality increased and we then moved to more contact
isolation ....usually with the diarrhea patients. Those showed a pattern
of C Diff. in the stools, but not all of them.
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- Our nurses and respiratory therapists(especially) have
reported feelingvery abnormally tired after working with these patients.
It is difficult and exhausting in 8 hours and many of us have cut our extra
hours or overtime because we just don't feel that well ourselves after
a shift. At first, the patients were older in their 60-80's. Then they
got younger and now we have had a teenager and someone in their 20's severely
ill. They were compromised with other illnesses underlying. It looks like
whatever organ was weak to begin with, was the cause of death or ultimate
failure. HIV did the worst. TB history was also a high mortality. Cancers
were hit hard, even with a 5 year free of cancer history. We had alot of
people with history of chronic fatigue syndrome and muscular sclerosis.
Cardiac patients usually died. We started having recently DIC in patients
with unknown origin sepsis. We have had several nights in the last two
weeks where we are losing 3 or 4 ICU patients per 8 shift at a time with
this same pattern.
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- Our hospital does have suspected SARS from their criteria,
of outside of the US travel. It has only been in the last week that we
have opened that isolation criteria up to the U.S. for SARS diagnosis without
KNOWN contact with a SARS patient or a health care worker directly inside
an isolation room becoming sick. This has ignored secretion spreads possible.
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- I am going to forward my personal numbers of patients
that I worked with that had this SARS-LIKE, but non SARS diagnosed pattern
that I have my notes for. Symptoms of above description "odd pattern".
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- 58 since March 9th (these are just mine). This is far
from all the patients that I have seen with this, but those I can verify
by record and name if needed. I would call them "SARS-LIKE."
We only have 3 SARS suspects listed in Napa/Solono county, although our
SARS isolation rooms have been quit active.......so I don't who is in there
taking up the space. I personally know of 20 deaths in the last 30 days
of this pattern. We have NO deaths listed anywhere in the U.S. as SARS
deaths. We have a journalist who is working with 4 other health care workers
reporting the same patterns in their patients in the Bay Area. They are
unknown to me and I to them.
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- I don't know which hospitals they are from; they wish
to remain non disclosed. One is working in a hospital that has children
as patients and says that their mortality is matching. They have also lost
20 patients MANY who are children to this same pattern in the last month.
I can not personally confirm that report ..but I can refer you to the journalist
who has that report to them and is holding the health care worker as a
confidential source at this time.
-
- I am afraid I have also gotten sick with the pattern
and become document on this Saturday as a "confidential" diagnosis
...confidential even to me. I was not given my diagnosis, it is listed
only by screening physician name. And I was required to sign that I had
a diagnosis, but that was it....."screening physician name".
My symptoms were diarrhea for 3 days, severe right lower quadrant abdominal
pain, stools more than 7 times a day for 3 days, fever (not shown to me
at the clinic) but 100 degrees during the day and up to 101 at night for
a day and a half, (now normal). Hypertension of BP 149/89 sitting and 169/98
immediately standing. Thready pulse. And mild hypoxia by pulse oximetry
of 90 to 87 percent sat at rest. and 93 percent while standing.
-
- My normal saturation is 98 percent. My peak flows were
only 250l/min at my best effort........I have been 550l/min regularly...so
that's half. My lungs were dry ..no sign of pneumonia on auscultation.
I had a mostly dry hacking cough and abnormally more frequent sneezing
times a week with occasional white thick sputum. No labs or Xrays were
taken in my screening. My ears and throat were checked.......but I do not
know what was seen by the physician.
-
- So it appears to be a "clinical" diagnosis
of "confidential" without supporting labs. I was referred to
follow up with my regular physician and told told the symptoms of distress
were usually lasting 3 days to a week. I was not instructed to self quarantine,
but I have tried to do so anyway. My travel history was taken and I was
questioned on who I live with (a non-issue) who would have had these symptoms.
The only people who have had them that I have been in contact with, have
been my patients.
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- I hope this is helpful to you.
-
- The demographics of the patients were that they were
mostly defense contractors or retired, engineers, chemical engineers, veterans
(retired) or their spouses. Not all ..but the majority of the patients
fit this social/working class group.
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- One was an embassy diplomat, and was one was a scientist
in defense. One was an RN, but she was on disability and had recent surgery
and was in the outpatient clinics often. No doctors that I am aware of.
No staff members dying that I am aware of. I don't know if any other of
our staff members have had a "confidential" diagnosis or not
for this symptom pattern. For 2 weeks in March and early April all of our
ICU physicians were not present for the whole weekend and took calls at
home only. I suspected they had placed themselves in a home quarantine
situation, but I have no confirmation of that.
-
- We seem to be abnormally reluctant to discuss from physician
to staff that we have ANY pattern and the physicians or administration
or managers have been most unhappy when I or any other staff attempts to
broach this subject with them.
-
- Most of this SARS-LIKE pattern was not in any isolation,
contact isolation at best. We have this same presenting pattern throughout
our community in the North Bay is my understanding from my manager and
from our phsyicians who confirm that concept. The two other cases of Suspected
SARS patients that I have read their chart on, were heath care workers
also from different facilities in this area. They are both doing well.
It is our NON-sars patients who are dying.
-
- Astraea Kelly
Respiratory Therapist
-
-
- Comment
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- From Name on File
-
- Jeff,
-
- Hello. I live in the Sacramento area and on May 4th,
heard some shocking information from my girlfriend. My girlfriend's sister
is a nurse at a major hospital here and according to her sister, there
were 4 patients who were treated for SARS (not SARS-like treatments, but
SARS). Some of those treated were transferred from Roseville and were
in isolation units, with doctors and nurses having to wear special gear.
I was pretty skeptical, and shrugged off the information at first and was
persuaded (by a friend I told the story to) that hospital staff/newspapers
wouldn't hide information like that and that it would be immediately in
the papers. It would benefit the public to know about and contain SARS
right? Or maybe not... It has been a week, and I still have seen no official
mention or heard anything else about it. I myself am frequently in hospitals
as I make many deliveries - and I have noticed the past couple weeks that
some regular rooms in various hospitals have signs on the doors saying
you can not enter. I even overheard two nurses whisper (as I attempted
to enter one of the rooms) that no one was allowed in without full gear.
Today, I briefly saw my girlfriend's sister myself and tried asking her
about the SARS cases, and she acknowledged that patients had been treated
for SARS but had fully recovered and been released, but would not divulge
any more information - as if she wasn't supposed to talk about it. She
didn't treat the patients herself, as they weren't in her section, but
she did see the rooms. I see no reason why she would lie about SARS, so,
I fully believe it is already here in Sacramento and that this information
is being kept secret from the public.
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