FRIDAY, May 30, 2003 (HealthDayNews) -- Peggy Dawson's workday begins with a thermometer being thrust into her ear and an N-95 mask snapped on to her face. That mask, which she must change every four hours, has become a semi-permanent part of her uniform.
The 29-year-old registered nurse and other employees at Toronto's Scarborough Hospital are allowed to take the tight-fitting, sweltering masks off when eating in the cafeteria, but they're also encouraged to sit in every other seat so there's at least a meter's distance between them. Even in the nurses' lounge, employees are advised not to sit together.
Welcome to a regular working day at Scarborough, one of Toronto's "ground zero" facilities for treating patients with SARS, or severe acute respiratory syndrome.
"It's very surreal," Dawson says. "I've only been practicing since 1999, but my mother was a nurse for 30 years and 25 of them were spent in the emergency room, and I never remember anything like this. It's very scary."
Dawson estimates that there are currently about 20 SARS patients in the hospital, about 10 of whom are staff members. Several other employees with the illness are at home monitoring their own symptoms.
Hundreds more, like her, are on working quarantine.
Outside of Asia, Toronto has been hardest hit by the SARS epidemic: it has had the bulk of the 159 cases and 28 deaths in the country. The original outbreak occurred through March and April, brought in by travelers who had returned from Hong Kong, where SARS spread from mainland China in February.
Dawson's first and only contact with a SARS patient took place during that first outbreak.
Towards the end of a shift one day in late April, she volunteered to spell a colleague who had been assisting with a SARS patient. The patient had taken a turn for the worse and eventually died.
Dawson spent about an hour with the man, who was in isolation, taking his vitals, giving him medications and monitoring his overall status. Although thousands of people in Toronto were quarantined, Dawson was not because she had been wearing full protective gear at all times.
In early May, the epidemic finally appeared to be dying down, prompting the World Health Organization to lift its travel advisory. Canadian health officials and citizens heaved a collective sigh of relief.
By last week, however, another SARS cluster had appeared. Because health workers had not all been wearing protective gear, anyone who worked at Scarborough or North York General Hospital between May 12-22 was put on "working quarantine." That means for 10 days, these employees -- more than 3,000, according to the Toronto Star -- report to work for their regular shift, but otherwise stay at home. All visitors to the hospital during that period have been advised to "self-isolate."
Dawson was included in the second group of people quarantined.
"To my knowledge, I was not in direct contact with a SARS patient [during that time]. However, there were other members of the staff who could have been exposed, from people who clean the floors to physiotherapists and respiratory therapists," she says. "We all share the same cafeteria, come in through the same entrance. It's a contact of a contact, and that's why we are all under quarantine, the entire hospital."
Because Dawson lives alone, the quarantine is not as onerous as it might be for people who have families or roommates. If she were living with someone else, she would be expected to set aside personal-use items like linens, towels, and dishes. She would be expected to sleep alone in a separate room.
As it is, she has to have someone do her shopping for her. She couldn't visit her father on his birthday earlier this week. And she can't finish the countless errands and appointments that she normally saves for her days off.
"I thank God for technology because I have a phone, a television and the Internet. I've been able to entertain myself that way. What do you do except for the dishes and cleaning?" she says.
The one thing she must do is check her own temperature twice a day. "Every time I put that thermometer in my mouth I'm praying that there isn't a change," she says.
Dawson's only personal contact with other people is at work, but that is circumscribed because of the ubiquitous face masks.
"It takes away the humanity of our job. It really does," she says. "Patients take a lot of cues from your facial expression, and now they're only looking at your eyes."
On another level, though, Dawson is grateful for the masks and other infection-control paraphernalia, which, had they been worn continuously, might have prevented the current quarantine.
"Everybody's very disheartened because we put a lot of faith in the people who make the decisions. A lot of people are feeling really let down right now," she says. "Don't get me wrong. It was very nice to be liberated from the mask, nice to look at colleagues and be able to smile again and look at patients with your whole face, but everybody was a little leery as to whether we were easing up on precautions a little too soon."
She is not alone in feeling this way.
"When you have a flare-up of infectious disease, you have to take precautions to contain it and to protect yourself," says Diana Mason, editor-in-chief of the American Journal of Nursing in New York City. "Nurses are educated about infection control measures and it's part of what we do." That part of the job is not nearly as stressful as the quarantining, Mason adds.
Dawson comes off quarantine on Monday, but doesn't think even that will relieve the anxiety she has been feeling.
"Just because I'll be off quarantine and symptom-free doesn't mean that it still can't happen to me," she says. "It's not gone and I don't think it ever will be gone. It has really changed the face of nursing and changed the face of health care forever."
More information
For more information on SARS, visit the World Health Organization or the U.S. Centers for Disease Control and Prevention.
