Several of the processes the Loudoun County Department of Health developed after the Sept. 11, 2001 terrorist attack are what district health director David Goodfriend enacted in response to the severe acute respiratory syndrome (SARS) threat.
Goodfriend outlined the department’s response at the Committee on Government Reform’s April 9 oversight hearing on the SARS threat. He was the only local-level official to testify at the four-hour hearing, also attended by officials from the Centers for Disease Control and Prevention (CDC) and several health-related federal agencies. The hearing focused on the response capabilities of the public health system at the federal, state and local levels. The outbreak of SARS tested the system’s preparedness to handle a public health threat or a bioterrorist attack, as stated in a Committee on Government Reform statement.
"They wanted a local health perspective," Goodfriend said.
LOUDOUN IDENTIFIED a SARS patient in mid-March after investigating her unusual pneumonia case a month earlier. The woman was the first person in the nation suspected to have SARS, a new human disease believed to have originated in fall 2002 in the Guangdong province of China, where she had previously traveled. The term SARS was coined in mid-March.
"We suspected early it was an unusual pneumonia," Goodfriend said, adding that the woman has since recovered. "The same processes we put in place to help find an act of terrorism quickly will help us find a case of SARS quickly."
On Feb. 17, the woman was admitted to the Loudoun Hospital Center's Emergency Department with pneumonia. Hospital staff moved the woman into an isolated room, responding to reports of unusual pneumonia cases in Guangdong. The staff contacted the hospital's infection control chief and the Loudoun Health Department as required under a new infectious disease notification algorithm.
The hospital instituted the algorithm after Sept. 11 to use for diagnosing, isolating and treating patients showing symptoms of potentially communicable diseases. The hospital improved the hospital's existing emergency plan, trained staff for a terrorist incident and stocked antidotes and medications in case of such an incident.
The Loudoun Health Department responded to Sept. 11 by taking a more active role in the hospital's infection control committee and the Emergency Medical Services (EMS) Advisory Council, established 24-hour contact for bioterrorism and other unusual disease incidents and began reviewing complaints from emergency room patients on a daily basis.
"We consider our relationship with Dr. Goodfriend to be absolutely essential," said Tony Raker, director of community relations for the Loudoun Hospital Center. "Here at the hospital, we're focused on the patient. When it comes to regional issues, that's where we need a county health officer to take it up. ... He can provide notifications regarding our situation to various county and state authorities."
GOODFRIEND TESTIFIED at the hearing that the hospital and hospitals in Northern Virginia have limited capacity to handle an epidemic of respiratory diseases. Hospitals in the region are equipped with isolation rooms but are limited in handling "surge capacity" during epidemics.
"SARS is a challenge, particularly in the Washington metropolitan area. Many of our emergency rooms are busy and hospitals are filled on a typical day," he said.
Goodfriend mentioned the strengths of the local response to the SARS case, including having plans in place to isolate the woman and a communications system between the local health community and state health departments. The Loudoun Health Department provided a bridge between the CDC and local hospitals and the community, including schools and airports, by disseminating information on SARS, so that hospital staff and county residents were aware of the symptoms involved.
"The important thing is she got better and no one around here got sick, so we did our job," Goodfriend said.
SARS typically begins with fever and other flu-like symptoms, which generally last for two to seven days, followed by respiratory symptoms that include coughing and difficulty breathing. SARS appears to be transmitted in ways similar to a common cold.
"The most important thing is to identify it early, so the infection cannot spread. That’s our main role now," Goodfriend said.
Three suspected SARS cases have been identified in Northern Virginia, six cases statewide and 166 cases in the nation as of April 9. SARS has affected 2,890 people worldwide, with the majority in China and Hong Kong. The death rate from SARS is estimated at 4 percent.
"We don’t know if there’s any permanent lasting effects," Goodfriend said, adding that the disease’s cause has not been found and may be identified in the next one to two weeks.