A 40-year-old Baltimore doctor who developed symptoms of SARS after a trip to Toronto was admitted yesterday to Johns Hopkins Hospital - two days after he showed up sick for work at another local hospital and was sent home.
Health officials said the doctor, a resident at Sinai Hospital working a rotation at the Kennedy Krieger Institute, did not come into contact with patients while he was on the job Monday, although his supervisor was sent home as a precaution.
Meanwhile, fears about another possible SARS case in Baltimore eased yesterday as a 26-year-old Hong Kong woman with symptoms of the deadly respiratory illness improved at Maryland General Hospital.
Dr. Peter L. Beilenson, the city health commissioner, said the woman could be released as early as today. Nine family members in voluntary isolation at the Sutton Place apartment building in Bolton Hill have developed no signs of SARS, and those visiting from out of town could be cleared to return home tomorrow.
The Hong Kong woman had been labeled only as a "special interest" case, because her symptoms didn't fully match the official description.
But the sick doctor admitted to Hopkins yesterday meets the criteria and is Maryland's first actual "suspect" case.
Beilenson said the doctor - who developed a fever of at least 101.5 degrees and a dry, hacking cough - was taken by ambulance from his apartment at Belvedere Towers on Northern Parkway to Hopkins' emergency department and placed in a room with negative air pressure.
The man, described as being in "good condition," was scheduled to undergo tests for pneumonia, which is common in the most serious cases of severe acute respiratory syndrome.
Samples of his blood, stool and respiratory secretions will be sent to the Centers for Disease Control and Prevention in Atlanta for analysis. No diagnostic test exists for SARS, but scientists have identified a new type of coronavirus as the cause.
The CDC has reported 239 possible cases of SARS in the United States, but no deaths. The disease, which surfaced in China in November, has spread quickly in Asia and more slowly in other countries. Worldwide, it has sickened 4,288 people and killed at least 251.
Officials in Baltimore said the doctor has provided differing reports about when he was in Toronto - which has experienced a serious SARS outbreak - and when he became sick.
Beilenson said the doctor reported that he flew to Detroit on April 11 to visit his fiancee, and then drove with her to Toronto the next day to visit family and friends for a few days.
Apparently, the man was showing symptoms by the time he returned to Detroit from Toronto, Beilenson said last night. The man's fiancee also became ill and was hospitalized in Detroit, but Beilenson said he could not provide details of her illness. She has since been released.
Health officials believe that the Baltimore doctor left Detroit and flew to Cleveland on Sunday but missed a connecting flight and spent the night in a hotel there. He returned to Baltimore on Monday.
Around 10 a.m. that day, he showed up for work at Kennedy Krieger, where he is doing a residency in rehabilitation medicine, according to hospital spokeswoman Julie Lincoln.
He went straight to a room used by residents and worked on a computer, but he wasn't feeling well. At some point, he put on a mask and went down the hall to see his supervising physician, Lincoln said. His supervisor immediately sent him home.
"He was here for probably less than an hour, and while he was here he didn't come into contact with any patients or patients' families," Lincoln said. The hospital has disinfected the room and equipment that he used.
The man's supervising physician was initially cleared to see patients again, but hospital officials decided yesterday to send him home, too, to be safe.
Infection control experts at Kennedy Krieger, aided by doctors at Hopkins, are trying to find out who came into contact with either the resident or the supervising physician, Lincoln said.
Lincoln said she didn't know how many patients the supervisor had treated but said they had all been notified of the situation.
"We're just taking this very, very seriously," she said.
Dr. Trish Perl, chief of infection control at Hopkins, stressed that the resident admitted yesterday could have something other than SARS. In the past few days, she said, the hospital has treated two patients with influenza, which has similar symptoms.
"There are a lot of causes of fever and cough in the community at this point," she said. "It's very important that we differentiate all the other causes of illness from a SARS case."
Still, hospital workers are wearing gloves and gowns and donning special "powered air-purifying respirators," which use a blower to push contaminated air through a filter.
"We deal with infectious diseases day in and day out," said Perl, noting that many are more contagious than SARS. "The hospitals, if they recognize it, are unbelievably well prepared to deal with this."
Beilenson said the CDC is trying to determine whom the sick doctor came into contact with on his airplane flights and at his Cleveland hotel.
An effort to identify who traveled from New York to Baltimore on a Greyhound bus with the Hong Kong woman under watch at Maryland General has been largely unsuccessful because the bus line doesn't have electronic records, Beilenson said.
Beilenson tried to ease fears that SARS is spreading locally, given that two possible cases were reported here within days.
"These are completely, 100 percent unrelated," he said. "It is ... a total coincidence."