TB Scare Recalls the First Days of SARS

June 5, 2007 — -- Sitting in isolation in a Denver hospital, his mouth and nose covered by a mask, Andrew Speaker has become the public face of tuberculosis.

The Atlanta-area lawyer's fight with the infectious disease and the story of his flight back to the United States from abroad in spite of warnings from the CDC have been dominating American news headlines since last week.

But for those living in Asia, the story is familiar. Of course, it's bird flu, not TB, that fascinates and frightens the region, and instead of one infection, the numbers reach into the thousands.

Hong Kong-based physician Dr. C.M. Chu lives these numbers every day from his station on the front lines of a continent's battle with SARS (severe acute respiratory syndrome), recalling the first days of the epidemic.

On March 17, 2003 -- his 39th birthday -- Chu, head of respiratory medicine at United Christian hospital, made his usual rounds at the hospital. That night, instead of going home to celebrate, he was called into an emergency meeting about the virus now commonly known as SARS. A week later, a patient was admitted to his hospital with the same alarming symptoms as those described in the meeting. The experience would change his life forever.

According to the Faculty of Medicine at the University of Hong Kong, SARS originated in southern China in November 2002, arrived in Hong Kong in February 2003 and then rapidly spread to 29 regions on five continents.

Nearly 8,100 people worldwide were infected and 774 died.

While these numbers may seem small next to a global population of 6.5 billion, they were overwhelming for the professionals who had to battle the invisible disease against the clock.

It is now four years later, early on a Saturday morning. Chu waves his hand over a sensor to trigger open the heavy double sliding doors he must enter to make his regular ward rounds. They're the same floors he worked on during the outbreak.

Wearing black, wire-rimmed glasses and a boyish smile, he is dressed to perfection despite being color blind. He wears a crisp white shirt, blue and white striped tie, pressed beige pants and silver cuff links that peek out from under his stark white lab coat. The doctor's attire today is in stark contrast to the protective gear he wore in 2003.

Back then, each time he entered the ward Chu donned a hooded face mask, a special N95 mask with a wire to fit the bridge of his nose and protect his face, gloves, a plastic gown, and goggles. His patients came to recognize him by his eyes -- the only part of his body they could see. Today a room on the floor serves as a designated dressing room, stacked with boxes upon boxes of protection supplies in the case of another outbreak.

Chu walks past one of the original isolation rooms on the floor. There are four, with one bed in each. That was all they thought they would need in 2003. But they were wrong.

As patients began arriving in droves over a short period of time, staff responded quickly by sectioning off the ward, first a quarter of the floor, then half the floor, then the entire floor, then the floor upstairs.

The doctors and nurses divided themselves into teams -- the "dirty" team and the "clean" team. Chu headed the "dirty" team, which meant he was in charge of all of the infected patients. Two hundred patients were admitted overall. The doctors became isolated from each other.

In the end, they all became part of the dirty team.

Chu's demeanor is quiet but intense. He smiles as he makes his rounds this morning, using louder Cantonese to greet his eldest patients. Most are there for various lung conditions and they all seem happy, even relieved, to see him.

As Chu holds X-rays up to the light boards that line the halls, he is reminded of the X-ray lines during the SARS outbreak. Extra machines were rolled up to his two floors, and people lined the walls to wait their turn. Chu raced through each result as soon as he received them. How infected? How much time? Was the medication working? Chu shakes his head, remembering the moment when they ran out of X-ray film.

The scary part then was not knowing what was making patients sick. Doctors at surrounding hospitals originally thought SARS was a lung problem, but when patients started having diarrhea, alarm bells went off. It meant that the risk of contamination was increased from spreading not only by air droplets but also by touch -- something almost impossible to control, especially in such tight quarters.

In this state of emergency, Chu found himself with no time to feel and little time to think. He was focused on treating his patients, finding the right medication and leading his team. Amid the chaos, the staff had to make a personal decision: Were they going to stay overnight in the hospital or go home and risk the possibility of infecting their families?

Chu admits that his decision came easily and also adds that it perhaps wasn't a very good one. "I went home every night because I simply couldn't bear the thought of not seeing my wife," he said. "She was alright with it. She's not the worrying type. I'm the worrying type," he said, smiling.

As days passed, the speed at which patients were admitted to his ward increased. Even more distressing was that the medication they had been using was not working. Patient after patient -- including friends and colleagues -- became infected. At the same time, Chu saw their conditions worsening. Eventually many of the infected were taken down the long corridor to the intensive care unit. Only a few survived.

Physically, mentally and emotionally overwhelmed, and with only three doctors to manage four wards, Chu called on a two friends for help -- one of them his former mentor and close friend. Both reported without hesitation. Together they racked their brains to find an alternative treatment. Their concern was that the virus had either already mutated or the viral load was too much to treat. As the doctors worked seven days a week nonstop, the clock kept ticking.

Chu remembers being asked if he had drawn up a will. He describes the sleepless nights, the crushing psychological stress and the infection risk as "walking through the valley of the shadow of death." He soon reached a breaking point.

People were dying and nothing was working. Everyone felt helpless. The responsibility fell heavily on the shoulders of the hospital's leaders. In a moment of sheer desperation, Chu, his mentor and the head of the ICU gathered in a room in a separate building and "simply prayed," he said.

But that night, as if by miracle, an alternative drug they had been testing began to show positive results. They were later proven by decreasing numbers of patients being admitted to the ICU.

Only four years later is Chu able to speak openly of the experience. On the surface he seems to have moved on with his daily life and routine. Underneath he has the inner strength of a survivor, and a deep resolve to be prepared for anything that comes through his respiratory wards in the future.

This morning, after finishing his rounds and taking off his mask, he walks back to his office on the other side of the building.

He punches in a code and enters what will be Avian flu and SARS headquarters if there ever is another outbreak. The four-room area is empty except for his work area and a few stacks of plastic chairs and folding tables. The walls are bare except for a single white board in the outer room. The view through the blinds looks out to wards he just came from.

Chu sits at his desk and looks ahead, the room around him ready. He looks as if he is waiting for the calm to pass before the storm.