Fear of SARS is gripping Toronto. Many believe the outbreak is growing in strength and spreading rapidly in the community. And some people are calling for drastic measures. These fears are not warranted.
Public perceptions are out of line with reality. Let's review the facts.
The SARS outbreak in Toronto peaked in the last week of March. A review of the epidemic curve for SARS that appears in today's Globe and Mail clearly shows this. In the past four weeks, the rate of new cases has been steadily declining. Why is this the best-kept secret in town?
The SARS outbreak in Toronto was a hospital-based problem. The vast majority of SARS victims have acquired their infection either directly in a hospital or by infected hospital staff, patients or visitors who infect other members of their household. This hospital-based problem has been brought under control.
There have been very few cases of community-acquired SARS, and there is no evidence of a sustained community spread in Canada.
SARS transmission is by respiratory droplets; it is not airborne-spread. This means that, in practical terms, it requires prolonged close contact with a SARS patient to become infected.
The disease has been effectively controlled in Toronto since stringent respiratory precautions were introduced in hospitals over the latter half of March. The success of these precautions is the great story of the Toronto experience and our lesson to the world.
The Ontario government declared SARS a health emergency and introduced a series of drastic measures to control it. How effective have these measures been, and were they worth the cost?
The government mandated the introduction of stringent respiratory precautions in Ontario hospitals, and it deserves considerable credit for these measures.
The government also took the unprecedented step of postponing scheduled and elective hospital services across the Greater Toronto Area for a period of three weeks. This action came at considerable cost to patients who were deprived access to important health services and it was, with all the wisdom of hindsight, probably unnecessary. SARS was spread in emergency rooms and intensive care units; it was not spread in operating rooms, cardiac catheterization suites and outpatient mental health programs.
Public anxiety and panic over SARS is now our biggest problem. Some of these concerns were unavoidable with a new disease. But several key errors have compounded this problem.
First, the Ontario government's public communication has been poor. For reasons that I cannot begin to understand, Ontario has insisted on describing the progression of the outbreak by reporting the cumulative number of cases. This number is irrelevant from an epidemiological standpoint and highly misleading. It creates the impression that the outbreak is growing when, in fact, it is shrinking. The key statistic is the number of new cases.
This method of data presentation has obscured the real course of the outbreak and hidden the fact that the news in the past few weeks has been very good. Ontario should emulate Health Canada and present a more balanced picture.
Second, the widespread use of quarantine helped to confirm the popular perception that the general community is at risk for SARS.
Third, the Ontario government set unrealistic expectations for SARS control and, not surprisingly, public confidence was damaged when these expectations were not met. We were never going to be able to stamp out SARS with quarantine, a very limited and imperfect tool for controlling respiratory infections.
Ontario spent too much time worrying about what SARS might do, instead of focusing on what SARS was actually doing. Health officials were so spooked by the expectation that SARS would be the next pandemic that they were slow to realize it wasn't behaving like one. SARS is a nasty infection, but it's not the next plague.
Toronto's SARS outbreak appears to be petering out. Despite our fears, we are living to fight another day. The World Health Organization's decision to issue a travel advisory for Toronto is foolish and irrational, but we can expect it to be lifted soon. Our real challenge is to learn the lessons from the SARS outbreak so we can do a better job next time.
Dr. Richard Schabas, chief of staff at York Central Hospital in Richmond Hill, Ont., was Ontario's chief medical officer of health from 1987 to 1997.