May 7, 2003
How Vietnam Halted SARS
By SETH MYDANS


HANOI, Vietnam, May 5 — Doctors and nurses clustered around the bed of Nguyen Thi Men when she emerged in mid-March from a nine-day coma, urging her to stay alive.

"Breathe, breathe," they said. "Keep trying. Your husband and your children are waiting for you."

She heard them and she tried, although she felt as if she were drowning, she said in an interview this weekend at her home.

"I saw a lot of doctors looking at me and it really raised my spirits," she said. "So many people looking after me. I was very touched."

What she did not yet know was that they had gathered to view a miracle. She was the only survivor from among the six most critically ill patients infected when SARS broke out in the Hanoi French Hospital more than two months ago.

Her survival became a hopeful symbol for Vietnam, which on April 28 was declared by the World Health Organization to be the first nation to contain and eliminate the disease. Vietnam earned that distinction by going 20 straight days without a new case after recording 63 infections, including the six critical cases. Five people had died.

"Vietnam has been able to show the world that there is hope that SARS can be contained," said Pascale Brudon, the World Health Organization representative for Vietnam.

The country's success was not a miracle, said Aileen Plant, who led the fight against SARS in Vietnam for the World Health Organization. "This was real, old-fashioned infectious disease containment," she said. "It all comes back to the same thing, which is stopping infected people from infecting other people."

After a crucial meeting on March 9 with members of the World Health Organization, the government decided to fight the outbreak openly and aggressively, Ms. Plant said. A task force was formed, information gathering was centralized and virtually the whole government was mobilized to deal with the infection and its consequences.

"It was the speed, the leadership, the transparency, the flexibility, the intensity with which they educated people what to do," she said. "It all sounds a lot easier than it is."

Vietnam's luck was that the disease had entered the country through just one infected person, an American who brought it from abroad. The Vietnamese capitalized on this luck by moving fast to confine the outbreak to the hospital.

That patient, Johnny Chen, a 50-year-old businessman, came to Hanoi in late February after a stay at the Metropole Hotel in Hong Kong, where many of the early cases were contracted.

He fell ill and was taken to the privately run Hanoi French Hospital. He was later evacuated to Hong Kong, where he died. His illness was first identified as a new and unknown disease by a World Health Organization doctor, Carlo Urbani, 46, who later died of SARS himself.

At the urging of Dr. Urbani and his colleagues, Vietnam closed the hospital to new patients and visitors on March 11. Most of the hospital's staff remained inside, some falling ill, others watching their colleagues sicken and die.

"The net effect probably was that they gave SARS to each other and not to the outside world," Ms. Plant said.

Ms. Men, 46, is a pediatric nurse at the hospital, but she often helped out in other wards. It is impossible to know exactly how she was infected, but on the evening of March 1, she said, she spent some time in the room of Mr. Chen, who was critically ill.

In the following days she began to suffer headaches, fever, diarrhea and exhaustion. "It was strange," she said. "A strange, overpowering tiredness."

When she checked herself into the hospital, two other nurses had already fallen ill, but, she said, "it never entered our heads that we could die."

They were friends in nearby beds and they joked, they gossiped, they sang and they left their rooms to wash their hair. But they grew sicker. One nurse, Nguyen Thi Luong, who would be the first to die, was put on a respirator in the next room. Ms. Men could hear it, "Beep-beep, beep-beep."

As the hospital's doctors and nurses were falling ill, the government was coming to grips with the crisis.

It formed a steering committee, led by the health minister, that reported directly to Prime Minister Phan Van Khai and involved the departments of transportation, customs, finance, education and the interior as well as medical experts.

Provincial officials were ordered to file daily 4 p.m. updates. They were told to isolate patients and send them to two designated hospitals in Hanoi. Two suburban hospitals were prepared as isolation centers in case they were needed.

Health workers traced and monitored hundreds of people who had interacted with workers or patients at the hospital, including one "very friendly" man, the father of a patient, who had more than 120 close business and social contacts.

Each of these people was visited every day, said Huang Thuy Long, a steering committee member who heads the National Institute for Hygienics and Epidemiology.

An immigration screening system was set up, soon to be bolstered by seven $50,000 infrared machines at airports and border crossings to detect people with high temperatures, Mr. Huang said. Hundreds of electronic thermometers are being bought for use by immigration agents.

He said 2,000 Vietnamese students studying in China would be isolated for 10 days whenever they returned.

Health experts say there are sure to be more cases of SARS as travelers pass in and out of Vietnam.

The challenge for the government will be to identify and isolate them quickly, as it has now learned to do, before another epidemic is touched off.

The Hanoi French Hospital, in which the outbreak was contained, has transferred the last of its patients to another hospital and is being thoroughly disinfected.

The walls are being repainted, the carpets are being changed and medical equipment is being steam cleaned.

Ms. Men desperately wants to go back to work when the hospital reopens, but it is not certain that she can.

She is still weak and short of breath, and her right leg, immobile during her coma, is painful and has lost some of its function.

When she emerged from the coma six weeks ago, she said: "I couldn't even recognize my own body. It wouldn't do anything I wanted it to. It seemed to belong to someone else."

There was pain everywhere, as if she were being tortured.

"The doctor told me, `Now everything depends on you,' " she said. " `You have to try hard to breathe.' "

Before he removed the tube that had been forcing oxygen into her lungs through an incision in her throat, she practiced breathing, in and out, as if the training wheels were being taken off her bicycle.

"I felt that I was drowning," she said, "like somebody was pushing me under water."

Her doctors stood over her, the only colleague they had managed to save. "Keep going, otherwise all our work will be wasted," she said they told her. "That made me stronger. That made me feel that I was living for other people."

At home with her husband, she has two small daughters to raise. She also has two grown sons. At work she has newborns to care for.

"I want to go back and see my friends and start my life again," she said. "I like my work. It's a happy job." A few days ago, one month after she was discharged, a doctor checked her lungs and found severe scarring. He could not tell her how well she would heal or how long it might take.

At the end of the interview, as her 7-year-old daughter jumped rope outside, Ms. Men limped to a dresser to fetch a certificate from a long-distance race.

It will not be enough for her to walk again, she said. Ms. Men is a competitive runner.

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