HONG KONG - This city's health care system is spinning toward
collapse by early June if the spread of SARS isn't slowed significantly,
city officials warn.
Estimates vary on how long Hong Kong's hospital system can
adequately respond to the growing epidemic of SARS, or severe
acute respiratory syndrome; some officials say a collapse could
be staved off until July. But all agree that the virus' onslaught
is putting unprecedented stress on this city's hospital system.
"The worry that we have today is the possibility of the utter
breakdown of the health system," says Law Chi-kwong, who sits
on the health services committee of the Hong Kong Legislative
Council, the territory's governing body. "It appears to be crumbling."
The trouble is simple math. Hong Kong hospitals have a combined
450 beds in intensive care units, and 15% of SARS patients require
ICU treatment. There are about 1,000 SARS patients in Hong Kong
hospitals, which means about 150 of the ICU beds are occupied
by them.
At the same time, for weeks the city has reported about 40
new SARS cases a day, but only about 15 patients a day are discharged.
Combine that with demand for ICU treatment by people with non-SARS
illnesses, and experts say that in a matter of weeks the hospitals
will be unable to handle the load.
"Very soon, all the beds could be occupied by SARS patients,
so the needs of other cases would not be taken care of," said
Lo Wing-lok, the medical association president. "That is not
a functional health-care system."
Since the epidemic began in November, Hong Kong has experienced
1,402 SARS cases and 94 deaths. Worldwide, 3,861 cases and 217
deaths have been reported.
Hong Kong Chief Executive Tung Chee-hwa ducked questions at
a news conference last week about how the territory would respond
to a potential collapse. Tung instead emphasized that the number
of new cases each day was dropping and the number of patients
discharged after responding to a combination of steroids and
the antiviral drug Ribavirin was on the increase.
And, indeed, news over the weekend was more optimistic. The
city has seen its first three days in a row since the epidemic
began in which the number of hospital discharges has outnumbered
new reported cases.
"I am not going to make dire predictions," Tung says. "The
real issue is let's stop the spread of this disease. I believe
very soon we will see positive results from all our efforts."
What's more, because SARS' chief symptoms - high fever and
dry cough - are common in other ailments, hundreds of non-SARS
patients who come in with such symptoms must initially be handled
as if they have SARS.
To reduce the non-SARS loads, most elective surgery has been
canceled throughout the city. Bright yellow banners have been
erected at several hospitals urging people not to "stay in the
hospital unless necessary."
The situation is yet another reason the World Health Organization
continues to advise against travel to Hong Kong, because the
health system "may not be able to help you if you have a problem
that's not of major, major significance," a WHO source said
Friday.
Further adding to the problem is the high toll the disease
is taking on health care workers.
A quarter of new SARS cases announced daily are health care
workers. That reduces the number of professionals who are available
to handle patients and crushes the morale of those who continue
to do the work.
At times, as when the chief executive of the Hong Kong Hospital
Authority became a SARS patient himself this month, the situation
has felt "completely hopeless," said one nurse, Camille Leung.
Leung wept as she complained not just about the long hours
she's working but also the isolation from her family. She is
staying at one of the two dormitories set up by the government
to provide a place for workers to rest as well as keep them
from mingling with their families and neighbors.
"I am so tired," she said. "And everybody is afraid of me.
I am helping take care of these very sick people, and for that
my own friends are afraid of me. It doesn't seem fair."
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