ONG KONG, May 6
Joanna Pong, a 24-year-old registered nurse, has put up with a lot
in nearly eight weeks of caring for SARS patients here.
She has had to move out of her parents' home and into the nurses'
quarters next to the Prince of Wales Hospital, for fear that she
might otherwise infect her parents or someone along her bus ride to
work.
She must wear a mask when going on weekly dates with her
boyfriend, and she seldom sees her friends any more.
She has to wear a full-length, waterproof body suit, a disposable
surgical gown, goggles, gloves and a tight-fitting mask for up to
eight hours a day, an outfit that quickly becomes hot and sticky
inside when she is moving around and then cold and clammy when she
pauses.
But the worst by far has been the fear, a constant dread that the
slightest mistake, like touching her eyes with a virus-contaminated
finger, could leave her as feverish and breathless as the patients
she treats, and perhaps even kill her.
"The most difficult part of the job is the psychological, not the
physical," she said.
While SARS is not quite as terrifying as it was nearly two months
ago, when scientists knew almost nothing about it, the disease
remains extremely dangerous for nurses. Despite many precautions,
hundreds of nurses here and in other cities in Asia and Canada have
been infected. Two or three more health care workers, usually
nurses, are still being infected in Hong Kong every day.
Indeed, there are signs here that SARS, or severe acute
respiratory syndrome, is becoming a disease that strikes nurses
harder than anyone else. Doctors accounted for many of the initial
patients here, as they became infected while checking the throats of
patients and performing other clinical diagnostic tasks. But as
blood tests and other means for identifying patients have emerged,
doctors have spent less time close to infected patients.
Nurses, however, have been falling sick in large numbers.
According to the Hong Kong Hospital Authority, nurses now make up 55
percent of the 368 health care workers who have had confirmed cases
of SARS here over the last two months. Doctors now account for just
15 percent of cases, a percentage that is steadily dropping as more
nurses fall ill, while the remaining 30 percent of cases are among
ward attendants, nursing assistants, cleaners and other workers at
hospitals and clinics.
SARS is a major risk for nurses here even when they are
performing their most routine tasks. For Ms. Pong, the most alarming
moment since the SARS outbreak began came a month ago, when an old
woman suffering from dementia as well as SARS lowered her face mask
and coughed hard right at Ms. Pong. "It was a scary feeling," Ms.
Pong said.
Nurses "are exposed to a much higher risk of infection than
doctors because usually the doctors do their rounds in the morning
and in the afternoon, so they are in the ward for less than two
hours," said Dr. Justin Wu, a gastroenterologist here. "The nurses
need to spend the whole day in the ward, looking after the
patients."
Like Ms. Pong, Dr. Wu has been treating SARS patients at Prince
of Wales Hospital, one of the city's best.
Some SARS patients have become disorderly or even violent, either
because of depression over their illnesses or because of
pre-existing mental conditions. This has further increased the
danger to nurses.
"The patients pull down their face masks and even vomit their
food on the nurses," Dr. Wu said, adding that at least two nurses at
Prince of Wales Hospital had been infected when patients vomited on
them.
There are also more nurses than doctors in the pneumonia wards
here, with 4,500 nurses caring for SARS patients, compared with
1,300 doctors.
The first health care worker to die here of SARS was a nurse, Lau
Wing Kai, on April 26. His funeral Wednesday was expected to draw
many government officials. Tung Chee-hwa, Hong Kong's chief
executive, ordered that he be buried at Gallant Garden, the cemetery
for civil servants who die in the line of duty, even though Mr. Lau
was technically not a civil servant because he worked for the
Hospital Authority, a government-owned entity separate from the rest
of the bureaucracy.
In addition to facing more risks than doctors, Hong Kong's nurses
earn considerably less. The heavily unionized nurses at public
hospitals typically earn about $38,000 a year, while staff doctors
at the same hospitals earn close to $80,000, said Joseph Lee, the
chairman of the Association of Hong Kong Nursing Staff, the union
that represents two-thirds of the territory's 30,000 nurses.
Ms. Pong said that she had no regrets about becoming a nurse
despite the difficulties of the last two months. She decided that
she wanted to be a nurse at the age of 7 because she wanted to help
people, and says she never wavered about what she wanted to do with
her life.
SARS patients frequently become deeply depressed at their steep
physical decline, and relieving that depression is as important in
some ways as curing their bodies, Ms. Pong said.
"I'm a cheerful person and outgoing," she said, "and I feel that
I can make them feel better."
While caring for SARS patients remains scary, it is not as
terrifying now as it was in mid-March, when dozens of Ms. Pong's
colleagues suddenly began falling ill.
The early stages of the illness were the worst because of the
uncertainty, Ms. Pong said. "We didn't know what precautions to
take," she added.
To make matters worse, infection-control equipment was in short
supply, and nurses had to use the same thick masks for long periods
of time, a practice that could lead to the masks becoming heavily
coated with viral particles and especially dangerous to touch.
But conditions have improved in the last several weeks. Medical
supplies have increased, Ms. Pong said. And contrary to the fears of
health professionals several weeks ago, it is now clear that the
virus that causes SARS is not capable of staying airborne for long
periods of time like a flu virus. SARS appears to spread most of the
time through close personal contact, but scientists suspect it may
also be transmitted through sewage and by rodents.
In the first weeks here, a constantly growing tide of people was
swamping wards and intensive-care units and almost no one was
recovering. But more than half the people infected in Hong Kong have
now recovered, while a 10th have died and the rest are still in
hospitals.
Perhaps most important for the long term, the rate of new
infections here has dropped strikingly, showing that it is possible
to control SARS, at least in a city with modern medical facilities.