Maryn McKenna

Journalist and Author

How The New Coronavirus Might Be Like SARS: Hospital Spread (Part 2)

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The most recent official update on the novel coronavirus raises the possibility that most of the recent cluster — 13 cases out of 30 — may be due to the novel disease spreading within one hospital. (Yesterday there were reports of the spread having to do with dialysis. I’m skeptical of that.) Infectious disease experts find the idea of hospital spread very worrisome, because when the related disease SARS arose 10 years ago, hospitals unknowingly caused its first rapid spread. International health authorities are taking this threat seriously: On Monday, the World Health Organization published a multi-page infection-prevention guide for any hospitals that might take in victims.

When SARS broke out of southern China in early 2003, I was in the midst of a year-long project shadowing members of the disease-detective corps of the Centers for Disease Control and Prevention, known as the Epidemic Intelligence Service. Some of the most explosive SARS outbreaks they were sent to investigate were in hospitals, and front-line health care workers were some of the earliest victims.

This is the second of two excerpts from a book I wrote in 2004 about the EIS, Beating Back the Devil, describing what the early days of SARS were like. In the previous one, a hospital swamped by SARS locks its doors, with its sick staff inside. In this one, a doctor who worked in that hospital — and alerted the world to the threat — loses his life to the disease.

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How The New Coronavirus Might Be Like SARS: Hospital Spread

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The most recent update on the novel coronavirus that has been spreading in the Mideast since last summer adds three more cases to the outbreak, and raises the possibility that most of the recent cluster — 13 cases out of 30 — may be due to the infection spreading within one hospital. Infectious disease experts find that worrisome, because when the related disease SARS arose 10 years ago, hospitals unknowingly amplified its first rapid spread. International health authorities are taking this threat seriously: On Monday, the World Health Organization published a multi-page infection-prevention guide for any hospitals that might take in victims.

When SARS broke out of southern China in early 2003, I was in the midst of a year-long project shadowing members of the disease-detective corps of the Centers for Disease Control and Prevention, known as the Epidemic Intelligence Service. Some of the most explosive outbreaks they were sent to investigate were in hospitals, and front-line health care workers were some of the earliest victims.

I thought it would be worth remembering what the early days  of SARS were like, while we wait to see what this new virus does next. So over the next few days, I’m going to run a couple of excerpts from a book I wrote in 2004 about the EIS, Beating Back the Devil. In this one, a hospital swamped by SARS locks its doors, with its sick personnel inside. In the second excerpt, a doctor who worked in that hospital — and alerted the world to the threat — loses his life to the disease.

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News From The Road: No Drugs, Few Strategies, But A Little Good News On Antibiotic Resistance

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So, hi, constant readers. Sorry, didn’t mean to disappear for quite that long. I’ve been on the road, first teaching for a week at the University of Wisconsin as their Science Writer in Residence, and then in New York to attend the annual meeting of the American Society of Journalists and Authors, where I received the June Roth Memorial Book Award for Superbug. (Plus, in between those two, I recorded an episode of the Virtually Speaking Science podcast with Tom Levenson, which you can find here, about the looming post-antibiotic disaster; and an episode of Skeptically Speaking with Marie Claire Shanahan, which you can find here, about the emerging story of H7N9 flu; and got tangentially involved in the Boston bomber manhunt.)

While I was offline, a far amount of news happened. In the next few days, I’ll do my best to catch up. Here’s a start, all on infections and antibiotic resistance.

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Antiseptics Used to Prevent Health Care Infections Might Cause Them. Oops.

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Well, this is ironic. The Food and Drug Administration is warning the country of the possibility of health care infections caused by the antiseptics used to disinfect skin before health care procedures — that is, to prevent infections. They consider it a serious enough problem that they have scheduled a hearing about it next week.

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Warm Weather Increases Hospital Infections, And What That Might Mean For Climate Change

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What makes hospital-acquired infections so intractable? There’s no question that some of the organisms that cause them are tricky: MRSA hangs out on the skin and and in the nostrils, and E. coli resides in the gut, making it easy for them to be carried into hospitals undetected. Hospital workers’ poor performance on hand-washing is well-documented. And recently, researchers have begun to wonder whether hospitals have missed an opportunity by not emphasizing environmental cleaning —- of rooms, computers and equipment, for instance -— given how persistently some bacteria can linger.

A new paper in PLoS One, though, says there’s another factor contributing to the problem, one that has missed consideration until now: weather. An 8-year study of infection data from 132 hospitals finds that as outside temperatures rise, in-hospital infections with some of the most problematic pathogens rise also.

The analysis is a warning to healthcare institutions to be additionally on guard when it is warm outside. But the authors say it’s also a warning to the rest of us: If global climate change raises ambient temperatures, it could increase the likelihood of deadly hospital infections as well.

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Some hospital infections sharply reduced. Others, not.

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Important news from the CDC Tuesday: A particularly deadly kind of hospital-acquired infection, CLABSIs — central line-associated bloodstream infections — was sharply suppressed across the 2000s. There were an estimated 43,000 in intensive-care unit patients in 2001 and an estimated 18,000 in 2009, a drop of 58 percent. That’s excellent: Up to one out of four patients who contracts a CLABSI dies as a result of it. According to the CDC report, the numbers represent — just in 2009 — 6,000 lives saved and and $414 million in healthcare costs that didn’t have to be spent. Across the decade, the lives saved might go as high as 27,000, and the total savings, $1.8 billion.

But the news is not uniformly good. CLABSIs are still prevalent outside of ICUs, in general in-patient care, and especially in outpatient care such as dialysis. In 2009, there may have been 23,000 CLABSIs in hospitals but outside of ICUs, and 37,000 in dialysis-clinic patients. [Read more…]

News break: 1 in 7 Medicare patients seriously harmed by hospitals

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I’m giving a speech at a conference this morning, so this has to be quick, but I can’t let it pass by, and neither should anyone else: It’s huge, sad news.

The Office of the Inspector General of the US Department of Health and Human Services released a report this morning showing that 13.1 percent of Medicare patients experienced a medical error during hospital stays that caused serious patient harm: prolonged hospital stay, permanent harm, life-sustaining intervention, or death.

If you project the study population — 780 patients over one month in October 2008 — out to the US population, that’s the equivalent of 134,000 people suffering serious medical harm in a year.

One and half percent of the patients died as a result of those errors: the equivalent of 15,000 patients in a year.

And an additional 13.5 percent experienced a medical error that caused them temporary harm.

And those adverse events, permanent or temporary, caused — just in the study month — an additional $324 million in health care spending.

And — if your jaw hasn’t dropped to the floor by now, this will do it — FORTY-FOUR PERCENT of those harms and errors were preventable. (Sorry to shout.)

Just. Outrageous.

And the government agrees, saying in the report’s Executive Summary that these errors are occurring at an “alarming rate.” (p. iv)

Those of you who are on the hospital and infection control sides of the aisle will know how long — and sometimes seemingly fruitless — the struggle against medical error has been. (Medical error includes hospital infections, which include MRSA, the subject of my recent book and therefore my part-time obsession.) It seems sometimes that we have done nothing since the publication of To Err is Human, the seminal 2000 Institute of Medicine report that exposed the rate of medical error in the US to be at least 98,000 events a year, but rack up fresh estimates of horror.

The report came out of the new initiative by the HHS Center for Medicare and Medicaid Services to deny reimbursement for care following adverse events, as a carrot-and-stick approach to attempting to force errors down. It is dry and sober and precise in its methodology, and not long, less than 80 pages. It is worth reading in its entirety.

(H/t to my AHCJ colleague Charles Ornstein of ProPublica, who flagged the report’s release on Twitter.)

Image by Flickr user Romana Klee under CC