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April 4, 2003
New information is emerging almost daily about Severe Acute Respiratory
Syndrome (SARS), a highly contagious respiratory disease that began
in China and continues to spread unpredictably. Although there are as
yet no reported SARS-related deaths in the United States and very few
cases among those who have not traveled to SARS hot spots overseas,
it is important for all of us at The Johns Hopkins Hospital and other
parts of Johns Hopkins Medicine to understand the facts and uncertainties
about this disease, and to prepare for the possibility of SARS patients.
As always, our goals in initiating plans for managing a potential public
health problem are straightforward: to treat patients and visitors properly
and safely; to prevent the spread of illness in our institutions and
in our neighborhood; to protect our faculty, staff and other employees;
and to coordinate wherever possible with government health agencies.
To accomplish these goals – always keeping in mind that the risk
at present is low – a team of Hopkins experts and senior administrators
developed a plan, which will be implemented over the next week.
Specific details of the plan will shortly be made available to some
of you directly by clinical and administrative directors, managers and
supervisors; others will be posted on our intranet at www.insidehopkinsmedicine.org.
General information about SARS can be found at http://www.cdc.gov/ncidod/sars/.
But I would like to share key points of the overall plan with you and
ask for your cooperation and patience as we put it into action.
• Patient Screening. Beginning at 7 a.m., Wednesday, April
9, at all public entrances, all patients, and those who accompany them
to The Johns Hopkins Hospital inpatient services and outpatient clinics,
will be asked – with the help of posters, flyers and hospital personnel
– to "self screen" and let Hopkins staff on hand know
1) if they have traveled in the past two weeks to mainland China, Hong
Kong, Vietnam, Singapore or Toronto, Canada; and 2) if they have
any symptoms such as fever, cough, shortness of breath, difficulty breathing,
headache or muscle aches. If patients or those who accompany them
have any of these symptoms and have traveled recently to those regions,
they will be directed to Patient Service Coordinators at Information
Desks or elsewhere, who will escort them to designated areas set aside
for medical evaluation and notify the clinic expecting the patient of
the delay. (Details about the location of lounges, information desks
and portals can be found at SARS Emergency Preparations site at www.insidehopkinsmedicine.org.)
Plans also are in place to manage a significant number of patients in
optimal environments to limit health care workers' exposure.
• Patient Evaluation and Education. Evaluations will be
conducted as quickly as possible during business hours, Monday through
Friday, by on-call members of the Hospital Epidemiology and Infection
Control staff, paged at 3-3855, with further consultation if needed
from a member of the Infectious Diseases faculty. Patients who meet
the U.S. Centers for Disease Control criteria for suspected SARS will
be escorted to the Adult Emergency Room for further evaluation and possible
admission to selected isolation units. After hours and on weekends,
patients who self-screen and meet the criteria will be further screened
in the Adult Emergency Room. Family members and friends who are with
them also will be provided with appropriate evaluation and education.
Patients who do not meet the criteria will be directed to continue to
their clinic or other appointments, where every effort will be made
to accommodate them. Infection Control staff will notify Patient Service
Coordinators that the patient is cleared to keep a clinic appointment,
and the coordinators will contact the clinic and verify the patient's
appointment. All patients and accompanying adults who are evaluated
will receive printed information about SARS and what they should do
to monitor their health over a period of days or weeks for possible
emerging symptoms of SARS.
• International Patient Screening. To every extent possible,
Johns Hopkins International Services and Executive Health staffs will
contact patients immediately before these patients come to Hopkins for
care and will conduct the basic Patient Screening by telephone or e-mail.
If these patients meet the criteria for suspected SARS, they will be
asked to come to the Adult Emergency Room and they will be evaluated
there.
• Non-Clinical Staff Training. Training sessions began on
Friday, April 4. Beginning Monday, April 7, training sessions for selected
employees who will be involved in patient screening activities will
begin. The one-hour sessions will be held in the JHOC at 7:45 a.m. (Room
2140); noon (6150) and 3 p.m. (5152). Further information about who
should attend these sessions will be available from managers and supervisors.
Sessions will be held also Tuesday through Friday, April 8-11. Tuesday's
sessions will be held at 7:45 a.m. and 3 p.m. in Hurd Hall, and at noon
in School of Nursing Room 140. Wednesday's sessions will be held at
7:45 a.m. in School of Nursing Room 140, and at noon and 3 p.m. in Hurd
Hall. Thursday's session will be held at 7:45 a.m. and noon in School
of Nursing Room 140, and at 3 p.m. in Hurd Hall. Friday's sessions will
be held at 7:45 a.m. in Phipps 240, and at noon and 3 p.m. in Hurd Hall.
In addition, printed information and "scripts" will be distributed
to all employees who may be called upon to screen patients or answer
questions from patients and visitors. (Centrex operators, registrars,
desk clerks, clinic coordinators, Security officers, etc.).
• Posters and Flyers. As noted above, materials will be
available to help patients identify themselves as possibly at risk for
SARS. Posters (a sample can be found at www.insidehopkinsmedicine.org
) will ask questions about travel and symptoms. Flyers will describe
the (so far) very low risk of SARS to those who have not traveled to
Asia or parts of Canada, provide answers to many questions patients
and visitors may have and explain the need for the precautions we are
taking to protect them and their families, along with our employees
and our community.
• Faculty, Staff and Employee Travel Guidelines. Although
a number of scientific and professional meetings have already been canceled
because of the war in Iraq and SARS outbreaks, Johns Hopkins recommends
that any plans for international travel in the immediate future be considered
very carefully, and be undertaken only if absolutely necessary. Anyone
who decides that international travel is essential at this time should
be sure to leave a detailed itinerary and contact information with his
or her departmental office or a colleague, and should be alert to symptoms
of SARS upon return. (See http://www.cdc.gov/ncidod/sars/
and http://www.cdc.gov/travel/).
• Clinical Staff Information. Materials are available from the
CDC at http://www.cdc.gov/ncidod/sars/.
Specific questions should be directed to Infection Control at 3-3855.
• Other Johns Hopkins Medicine and Health System Sites. Materials
and recommendations will be shared with other parts of Hopkins Medicine
and with all members of the Clinical Practice Association to inform
development and implementation of plans tailored to those sites.
• Other Sources of Information. Links to other sources of information,
and answers to frequently asked questions about SARS, can be found at
www.insidehopkinsmedicine.org
and http://www.cdc.gov/ncidod/sars/.
General emergency preparedness information can be found at http://www.hopkins-cepar.org.
Once again, the purpose of these activities is to prepare and protect,
our patients, visitors, community and staff. The CDC and other health
agencies at the federal, state and local levels are working tirelessly
to determine the cause, prevention and treatment of SARS. As new information
emerges, we will amend our plans and our communications and keep you
updated.
I know Hopkins can count on your full cooperation as we implement our
SARS plans.
Sincerely,
Ronald R. Peterson
President
The Johns Hopkins Hospital and Health System
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