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Letter
SARS in Teaching Hospital,
Taiwan
Yee-Chun Chen,*† Ming-Fong Chen,*† Shuen-Zen Liu,‡ James C. Romeis,§
and Yuan-Teh Lee*†
*National Taiwan University Hospital, Taipei, Taiwan; †National Taiwan
University College of Medicine, Taipei, Taiwan; ‡National Taiwan University
College of Management, Taipei, Taiwan; and §Saint Louis University, St.
Louis, Missouri, USA
Suggested
citation for this article
To the Editor: During the global epidemic of severe acute respiratory
syndrome (SARS), the illness was transmitted rapidly within hospitals,
which created pools of persons who became infected and through whom the
disease was spread. Intrahospital transmission amplified regional outbreaks
and augmented spread of the illness into the community (1–3).
Healthcare workers, hospital patients, and hospital visitors accounted
for 18%–58% of all cases of SARS in the five countries with the largest
outbreaks (1,2). The concentration of SARS among hospital
staff strained hospital facilities, personnel, and finances.
National Taiwan University Hospital, established more than 100 years
ago, is the first teaching hospital and the best resource in Taiwan for
managing patients with illnesses that are difficult to treat. The hospital
has 2,400 beds and provides primary and tertiary care services in Taipei.
Taipei City was among the hardest hit areas by SARS in the world (3).
From March 10 to July 23, 2003, the hospital reported 270 patients with
SARS, many of whom were severely ill. The hospital treated 180 of the
665 patients with SARS reported in Taiwan, even though it was staffed
by 4,450 of the country's 178,000 healthcare workers. SARS had an impact
on this hospital for three likely reasons. First, the hospital identified
and treated the first SARS patients in Taiwan (4,5).
Second, it provided easy access through the emergency room and outpatient
clinics. Febrile persons with a travel history to SARS-affected areas
or other risk of SARS exposure came directly to this hospital for care.
Third, many hospitals, particularly private facilities, were reluctant
to report and admit patients with SARS during the early stage of the epidemic
because of financial considerations and fear.
The hospital felt the brunt of the epidemic in Taiwan during early May
2003, which paralleled the severity of the SARS epidemic in Taipei (3,4,6).
The maximal number of SARS patients admitted to the hospital within 24
hours was 12 on May 3. The maximal number of SARS patients reported within
24 hours was 15 on May 6; 8 patients were transferred to other hospitals
on May 7. However, 18 patients stayed overnight in the emergency room
on May 7. Subsequently, SARS developed in 12 emergency room healthcare
workers (6,7).
Our preliminary studies showed that the average inpatient cost for patients
with SARS was not higher than for patients with pneumonia, after adjustment
for age, sex, and length of stay (MF Chen, unpub. data). However, SARS
caused financial and operational disruptions in the hospital. During this
period, hospital utilization rates decreased. Compared with the previous
year's rates, outpatient and emergency visits fell to 37%, inpatient admissions
fell to 29%, and surgical procedures fell to 15%. Bed occupancy decreased
from 86% in May 2002 to 38% in May 2003. SARS also imposed physical and
psychological concerns on the healthcare workers.
During the later stage of the SARS epidemic, the Taiwan government offered
special financial assistance to hospitals and healthcare workers as an
incentive to help fight SARS. The country's National Health Insurance
program compensated hospitals for the decrease in revenues, based on the
hospital's reimbursement amount before the SARS epidemic. This measure
was effective in motivating other hospitals to accept patients with SARS.
The proportion of inpatients with SARS at the hospital dropped from 79.5%
during March 10 to April 23, to 46.2% during April 24 to May 1, to 11.6%
during May 2 to July 23. This financial assistance program remarkably
reduced the impact on the hospital as other hospitals began treating patients
with SARS.
Preparations for a medical emergency must address the availability and
quality of medical care as well as the implications for public health
policy, including political, legal, social, financial, and ethical issues
(1). The importance of a sound financial policy cannot
be overemphasized. Since the 1980s, healthcare systems have become free
market enterprises. Laws and regulations are needed to allow governments
to mobilize the resources of all hospitals and compensate them during
health crises. Government agencies need to work together with the healthcare
system, including health insurance systems and social services, well in
advance of epidemic emergencies to maximize limited resources and distribute
them equitably.
Democratic societies must preserve human rights (including the right
to medical care and freedom from fear), while respecting and protecting
the rights and safety of hospitals and healthcare workers. We now face
the potential resurgence of SARS, other emerging and reemerging infectious
diseases, and the threat of bioterrorism. Careful consideration of the
financial issues of hospital management should be an important part of
social policy. The emergence of SARS provides a reminder of the potential
threat to the entire healthcare system when a new disease suddenly appears.
A major lesson from the SARS experience is that government planning and
intervention are required.
Acknowledgments
We thank Calvin
Kunin for critical review of the manuscript.
This study was supported
by a grant from the National Science Council, Republic of China (NSC
92-3112-B-002-043).
References
- Centers for Disease Control and Prevention. Public
health guidance for community-level preparedness and response to severe
acute respiratory syndrome (SARS). [cited 2003 Nov 1]. Available from
http://www.cdc.gov/ncidod/sars/guidance/
- World Health Organization. Summary table of SARS cases by country,
1 November 2002–7 August 2003. [cited 2003 Nov 1]. Available from http://www.who.int/csr/sars/country/2003_08_15/en/
- Lee ML, Chen CJ, Su IJ, Chen KT, Yeh CC, King CC, et al. Severe
acute respiratory syndrome—Taiwan, 2003. MMWR Morb Mortal Wkly Rep.
2003;52:461–6.
- Twu SJ, Chen TJ, Chen CJ, Olsen SJ, Lee LT, Fisk T, et al. Control
measures for severe acute respiratory syndrome (SARS) in Taiwan.
Emerg Infect Dis. 2003;9:718–20.
- Chen YC, Chen PJ, Chang SC, Kao CL, Wang SH, Wang LH, et al. Infection
control and SARS transmission among healthcare workers, Taiwan.
Emerg Infect Dis. 2004;10:895–8.
- Chen YC, Huang LM, Chan CC, Su CP, Chang SC, Chang YY, et al. SARS
in hospital emergency room. Emerg Infect Dis. 2004;10:782–8.
- Sun HY, Fang CT, Wang JT, Chen YC, Chang SC. Treatment
of severe acute respiratory syndrome in healthcare workers. Lancet.
2003;362:2025–6.
Suggested citation
for this article:
Chen YC, Chen MF, Liu
SZ, Romeis JC, Lee YT. SARS in teaching hospital, Taiwan [letter]. Emerg
Infect Dis [serial on the Internet] 2004 Oct [date cited]. Available
from: http://www.cdc.gov/ncidod/EID/vol10no10/04-0356.htm
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