Its last two SARS patients released only about eight weeks ago, Ditan Hospital is calmly preparing for a possible recurrence of the disease as the country approaches the winter season.

On September 11, the Beijing municipal government issued a regulation outlining three levels of emergency measures to prevent the re-emergence of SARS (severe acute respiratory syndrome). In the regulation, Ditan Hospital is designated as the first specialist hospital to take in SARS patients from Beijing and neighbouring areas if the flu-like disease resurfaces in the region.

Staff training

"We are ready for the SARS recurrence," said Li Xiulan, vice-director of medical affairs department of Ditan Hospital, who has been busy supervising the training of the medical staff in the hospital and working out step-by-step measures to deal with any possible resurgence of SARS.

She said the training work in the hospital actually began in July when the spring outbreak of SARS was tapering off. The core members in the hospital went to the intensive care unit (ICU) of the Peking Union Medical College Hospital where they received extensive training in operating respirators, which should be immediately employed when patients show any sign of respiratory failure. It is considered a key measure in reducing the fatality rate.

Li said a number of other doctors and nurses in the hospital have taken part in a series of training classes organized by different professional associations in Beijing. Also, its own information collection staff have been taking epidemiological training at the Beijing Centre for Disease Control to upgrade their knowledge of diagnosis methods and other essential training for assessing and handling epidemic situations.

"The knowledge some key members bring back will be combined with our own past experience to make our emergency measures more effective," said Li.

Each afternoon, medical workers not on duty take part in ventilation training, not just the theories, but also practise operating the respirators. "There will be several rounds of training," she said, "and every single medical worker will be guaranteed a chance to benefit from the training.".

Now Li is preparing tests to check the medical workers' speed in handling emergencies. "A SARS patient should be properly hospitalized within half an hour after admission," said Li.

A big improvement compared with the hospital's practice during the spring outbreak is that Li and her colleagues now have worked out detailed flow charts to illustrate each process in treating SARS patients, from diagnosis, through hospitalization, treatment, disinfection procedures, isolation, medical workers' self protection all the way down to final discharge.

"Upon reading these charts, everyone should have a clear understanding of what they have to do. They will not grope in the dark as we did during the first weeks of the spring outbreak," Li said.

Li and her colleagues have prepared a contact sheet with address and directions to get hold of all the medical workers on it, so that in case of any emergency, the most appropriate people can be called in so they can get to work immediately.

Quick response

The hospital's emergency plan fits in with the three-level emergency alert system of the municipal government.

At the back of the hospital, there are four separate three-storey buildings for hospitalized patients. For its third level of response, six ICU beds and 35 common beds at the back of the first floor of the building will be open for the first batch of patients.

If the SARS epidemic further progresses, the second floor with 40 beds will be opened for the second level of response, and the third floor with 32 beds will open as the upper level of response.

The other three buildings will be kept open to handle patients with other diseases.

Li recalled that although the hospital's administration building was located only dozens of metres from the building receiving SARS patients, and that medical workers there wore their usual hospital uniforms, with some of them even sleeping there during the spring outbreak, no one had been infected.

"The past experience shows that such a practice - strictly separating the SARS buildings from other buildings in the hospital - is quite important," said Li.

Medical workers at Ditan Hospital are likely to charge forward again in the front line of the fight against the still not fully understood SARS virus, Li said.

"None of us will be hesitant. The question of who should treat and care for the SARS patients does not mean anything to us. It is simply our job and we are duty-bound, as we are infectious disease doctors," said Li.

More than 20 years ago, still a fresh Beijing Medical University graduate, Li chose to go to Ditan Hospital, an infectious disease hospital, while most of her classmates shunned such a choice. "Applying to work in an infectious disease hospital showed their courage to face danger when they made such a choice after graduation," said Li.

However, the doctors' determination and enthusiasm were not enough to quickly reassure the public that the hospital was a safe place to go after the spring outbreak.

Although the spring battle ended nearly two months ago, the number of patients at the hospital is still away down, Li said.

The number of in-patients has been reduced from about 450 to 197, she added.

"Things got worse when the government announced the new alert, making the patients even more nervous about the hospital," she said.

"With fewer patients, the hospital's income has fallen greatly. It's bad news for all the doctors and nurses here.

"We hope that the government will help us get through the hard times with more financial support so we can be better prepared for any future challenges."

(China Daily October 14, 2003)