One of the critical lessons of the SARS epidemic of 2003, in which 44 Canadians died, was that the communications breakdowns that can occur in a stressed-out, multi-tiered health system can be as dangerous as any emerging coronavirus currently incubating somewhere on the planet in the belly of a pig, cat or bat.
That was, more or less, the conclusion of a federal inquiry that looked into the deadly outbreak. The National Advisory Committee on SARS and Public Health found a long list of “systemic deficiencies” that helped spread the virus and created obstacles for front-line workers trying to save lives.
The deficiencies included a lack of surge capacity and timely access to laboratory testing, an “absence of protocols for data or information sharing among levels of government," a “lack of coordinated business processes across institutions and jurisdictions” and “weak links between public health and the personal health services system.”
One example: In Ontario, where the bulk of Canada’s SARS cases occurred, the province’s infectious diseases lab wasn’t able to keep up with demand for testing for the virus behind the disease.
Toronto hospitals responded by developing their own capacity to test, but the SARS committee found that “poor information systems and the lack of data-sharing protocols” prevented Ottawa and the province from monitoring the findings. This made it difficult to track how many SARS cases there were in Toronto.
Another example: After a second wave of SARS cases broke out in May of 2003, “confusion arose at times as to who was in charge.” No hospitals in the Toronto area specialized in infectious diseases, and there was “no regional framework for outbreak management to coordinate responses across institutions or health service sectors.”
These were frightening findings, in their own way more scary than the disease itself.
The multiple failings in the system led to tensions within hospitals, where workers dealing with suspected SARS patients felt unprotected and ill-informed.
The lack of information also left the public in a panic, and resulted in a drop in tourism and convention attendance in Toronto that hurt the city’s economy to the tune of $1-billion.
Worst of all, the health-care system’s management failings contributed to the spread of the virus.
Ottawa and the provinces have since taken action. There are now better provincial protocols for dealing with outbreaks, and in 2004 Ottawa created the Public Health Agency of Canada, a Health Canada body with 2,400 employees and its own laboratory facilities. One of its chief roles is to lead the response to epidemics.
The agency, and Canadian hospitals, may now be facing their biggest test since SARS, in the form of a new coronavirus – a pathogen that begins in animals and spreads to people – that first struck late last month in the Wuhan region of China.
As of Tuesday, the virus had sickened 291 people in that country, and killed at least six. Given the large amount of air travel between Canada and China, health experts are taking it as a given that the pneumonia-causing virus will eventually arrive here.
Already, there are signs of better practices. Hospitals in British Columbia are girding for the possibility of cases, by stocking supplies and briefing workers on what to look for and how to respond. The Public Health Agency, meanwhile, is putting signs up at airports in Vancouver, Toronto and Montreal, asking travelers from the Wuhan region to report to border agents if they have flu symptoms.
In China, where almost half the 775 deaths directly attributed to SARS occurred, health officials have moved quickly to identify the new virus, and are cooperating with the World Health Organization to monitor its spread. The WHO has consequently been able to inform countries of how to respond to suspected cases, and provide test data that will help hospitals identify the virus.
But much is still unknown about the virus. This is flu season in Canada, and health-care workers will be treating a lot of runny noses and coughs. The pressure on hospitals to keep an eye out for a new disease from China will put a lot of stress on them, and could frighten people. There’s no need for panic, but there’s a need for Canadians to feel confident that our health system learned its lessons in 2003, and won’t make a bad situation worse.