PUIBLIC HEALTH: PUBLIC POLICY – SIMULATION

A woman traveling from China to Boston unknowingly became a carrier of SARS- the Severe Acute Respiratory Syndrome. The primary symptoms of the SARS are flu-like in nature, including fever, lethargy, gastrointestinal symptoms, cough and sore throat. Therefore, most initial cases were misdiagnosed as a common flu. Due to shortage of nurses and beds in greater Boston area emergency rooms, infected patients were not identified as contagious with a highly dangerous disease and were often placed in hallways or in shared rooms, increasing the spread of the disease.

SARS was identified in a patient at Mass General Hospital and was communicated to the Massachusetts Department of Public Health, with currently 3,500 suspected cases across the greater Boston area and 250 deaths.

The disease is spreading quickly through families and tight-knit communities, and as word is getting out about the disease, more and more people are fearful and are flocking to local emergency rooms. This is stressing the already maxed out hospitals and is increasing the spread of the disease.

Furthermore, as Boston is a huge hub for travel across the world, there is concern that SARS will spread outside Boston and will quickly become an international pandemic if not treated quickly.

SARS Information:

Mortality by age group is below 1% for people aged 24 or younger, 6% for those 25 to 44, 15% in those 45 to 64 and more than 50% for those over 65. For comparison, the case fatality rate for influenza is usually around 0.6% (primarily among the elderly) but can rise as high as 33% in locally severe epidemics of new strains. The mortality rate of the primary viral pneumonia form is about 70%.

• Antibiotics are ineffective as SARS is a viral disease. Treatment of SARS so far has been largely supportive with antipyretics, supplemental oxygen and ventilatory support as needed.
• Suspected cases of SARS must be isolated, preferably in negative pressure rooms, with complete barrier nursing precautions taken for any necessary contact with these patients.
• There was initially anecdotal support for steroids and the antiviral drug ribavirin, but no published evidence has supported this therapy

Day 1

This type of incident is an indicator of a broader problem with the health care system in the country. There are not enough doctors, nurses, beds, and rooms for the number of people that need them, especially when an emergency occurs. You are an advocate for your staff and your patients, you want quick financial support and additional workers to staff your hospital.

• How will you respond to the public health situation (i.e., do you need an incident command)?
• How will you collaborate with your team and participating agencies?
• Your team includes multiple agencies will someone take the lead? How do you decide?
• How will you communicate to the public? What are the key messages?
• What resources do you need?

PLEASE REMEMBER TO RESPOND TO EACH DAILY DEVELOPMENT BASED ON
THE SCENARIO AS CHIEF OF EMERGENCY AT MASSACHUSETTS GENERAL 
HOSPITAL.