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The outbreak of SARS in the spring of 2003 had a profound effect on the use of emergency rooms of Ontario hospitals, according to newly released data.Not surprisingly, the number of people visiting the ER at the eight hospitals where the virus was detected fell sharply, by about 45 per cent at the peak of the outbreak of severe acute respiratory syndrome in April, 2003. The number of non-urgent cases was down even more markedly, by about 60 per cent.

But even hospitals in "non-infected" areas well away from Toronto saw substantial reductions in ER visits, about 16 per cent overall and 30 per cent for non-urgent cases in the corresponding time frame.

However, the number of patients with serious conditions like major trauma or cardiac arrest did not drop. All the reduction was among those with minor ills like sore throats. The data show that this group continued to stay away from Ontario emergency rooms for 10 full months after SARS fears faded.

"If they didn't go to emergency, where did they go?" wondered Kira Leeb, manager of health-services research at the Canadian Institute for Health Information, which published the data. "That's the $1-million question."

Ms. Leeb said a review of physician billing data shows that "they weren't going to their family physician or to walk-in clinics" because billings were actually down in that period, too.

Another possibility is that patients with minor ills turned to Telehealth Ontario, the health hot line, but there is no data to show if calls are up in that period. Or, patients may have chosen to defer their care, or treat themselves because of concerns about SARS in hospitals, but that is even more difficult to gauge.

Regardless, Ms. Leeb said, the numbers "suggest that people are open to other options for care, and maybe care could be offered differently." She said the lessons from SARS could also be useful to jurisdictions around Canada, who have all struggled with how best to ensure that only true emergencies are treated in ERs.

Dr. Tom Chan, medical director in chief of Scarborough Hospital, whose Grace site was the epicentre of the SARS outbreak, said the numbers reflect the experience at his hospital. "We saw a big drop in ER use, particularly among lower-acuity patients."

But Dr. Chan said he was surprised that hospitals outside Toronto saw they same patterns, though to a lesser degree. "That's interesting. But that's all it is -- interesting. I'm not sure we can use this information to reform health care."

Dr. Chan cautioned that you cannot read too much into raw data. "We don't know if this is a direct result of SARS . . . quite a few things changed after SARS."

He noted, for example, that new policies such as having respiratory isolation rooms available have created a backlog of patients in ER beds, and that translates into much longer waits for patients with minor conditions. "These longer waits may be dissuading them," Dr. Chan said, adding that is not necessarily a good thing.

More than five million patients visit emergency rooms in Ontario each year, according to CIHI. There are 188 ERs in the province.

SARS killed 44 Canadians and sickened a few hundred others. It also led to the quarantine of about 30,000 people and the temporary closing of some hospitals.

Two inquiries were conducted into the official response to SARS, one by University of Toronto dean of medicine David Naylor and the other by Mr. Justice Archie Campbell of the Ontario Superior Court. Both were scathing indictments of the public-health response, and of the lack of investment in public-health infrastructure.

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