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On April 29, Geoffrey Rhone, 32, was lying in a hospital bed at George Washington University Hospital surrounded by people dressed in what Rhone calls “a full-body infectious-disease outfit of head-to-toe plastic.” “I felt a little radioactive,” he says. The hospital staff had prepared for the worst: They suspected that Rhone might have SARS.
Rhone’s roommate had called the hospital before their arrival. When the two got to the emergency room, hospital workers isolated Rhone in a room, then took an X-ray and blood samples. Within 90 minutes, the X-ray came back with no signs of pneumoniaevidence that Rhone wasn’t likely to be a “probable case” of SARS. “[The doctors at the hospital] told me, ‘We don’t think you have it,’” recalls Rhone. “‘But if you could stay in your house for 10 days….’”
Rhone says he wasn’t surprised that doctors would quarantine him. He was surprised, however, that he hadn’t heard of any other suspected cases of SARS in the District. “I thought, It seems strange. This is D.C. There have to be other cases,” he says.
In fact, Rhone is one of 11 District residents suspected of having SARS between March 15 and May 2, says D.C. Department of Health Senior Deputy Director Dr. Michael Richardson. None have proved to be actual cases. And in marked contrast to Virginia’s and Maryland’s, District health officials have decided not to discuss suspected SARS cases unless asked.
Richardson says that despite their reticence with the news media, public-health officials and medical providers are keeping each other in the loop about suspected cases. “I don’t believe in crying wolf,” says Richardson. “When people phone me and ask, ‘Do we have any cases?’ the answer is ‘No.’ We have had no cases….It’s just like I don’t tell you every time someone has a headache, they may have meningitis. I will tell you, though, if they do have meningitis.”
If D.C. ever has a probable case, Richardson adds, he will release the information then.
Richardson isn’t obligated by law to tell the public about suspected cases. And each state determines which diseases health-care workers must report to public-health officials. In April, both Maryland and Virginia began requiring medical-care providers report suspected SARS cases to the states. The District, however, has not followed suit, says Richardson.
As of May 5, Maryland has had five suspected SARS cases, but no probable ones. Virginia has had five suspected cases and three probable cases. In the United States, there have been 319 suspected or probable cases, and no deaths, according to the Centers for Disease Control and Prevention (CDC). The World Health Organization reports that worldwide there have been 6,583 cases and 461 deaths.
Richardson says District health officials are tracking SARS with a “passive surveillance system” that largely lets clinicians determine, based on CDC-issued criteria, if a case might be SARS. Clinicians also decide whether a suspected patient should be isolated. At the same time, doctors in conjunction with D.C. Department of Health officials choose whether to send blood samples to the CDC for testing.
In Rhone’s case, doctors chose to quarantine him because he had a fever of more than 100 degrees for four days and he told them that a friend of his had recently traveled to Toronto. On April 22, the World Health Organization issued a ban on travel to Toronto because of the city’s SARS outbreak, then lifted it on April 29.
Rhone’s friend, however, had returned to the United States on April 4. And his friend hadn’t been ill while he was in Toronto nor since his return. “It was a stretch,” Rhone says. “My friend had been to Toronto a month ago.”
All 11 suspected SARS patients were isolated for varying periods of time, says Richardson. The District has investigated other potential SARS cases in addition to those who were quarantined, but Richardson declines to give an exact figure. Instead, he says the District has looked into “not many more” than 11 cases. From the 11 cases, Richardson says, the District has sent five specimens down to the CDC for further examination.
When Rhone left George Washington University Hospital around midnight on Wednesday, he thought his blood was making its way down to Atlanta, too. “I was sent home with the impression that it was in process,” he says.
Rhone says doctors released him with a box of surgical masks and little other information. “They basically said, ‘We’re not sure what you have. It’s going to take us a while to find out what you have. And even if you have it, there’s nothing much we can do about it but admit you and monitor you.’”
Rhone told his employers he couldn’t come in to work. For two days, he followed a regimen of taking Tylenol, sleeping, drinking fluids, and calling the hospital for his SARS test results. Most of his phone calls, he notes, went unanswered. When he called Friday morning, he says, his doctors told him that his blood was still in D.C.; the Department of Health had never sent it to the CDC. Richardson says that in cases where it is not likely the patient has SARS, public-health officials may wait a couple of days before sending the sample to the CDC, either in anticipation of further test results or to see if the patient recovers on his own.
By Friday, Rhone had indeed begun to feel better. The doctors at George Washington diagnosed him with the flu and told him that he was free to leave his house. He is now fully recovered and has returned to his job.
The whole time he was home, he notes, no one from the D.C. Department of Health or the CDC checked on whether he was adhering to the quarantine. Nor, he says, did anyone contact the friend who had traveled to Toronto.
Looking back, Rhone says he wishes he had been kept better informed, including about the existence of other suspected cases in D.C. “I might have felt more comfortable or more nervous. I don’t know,” he says. “I still would like to know.” CP