SARS - Five Years Later
[Rachel's Introduction: "SARS ushered in significant improvements to the health-care system [in Ontario], not the least of which is adoption of the 'precautionary principle.' That dictates hospitals take measures erring on the side of caution in the face of a potential public health threat rather than waiting for scientific proof."]
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By Lisa Queen
Five years ago today, Chi Kwai Tse arrived at The Scarborough Hospital, Grace Division with an unknown respiratory illness, the same one that had killed his mother two days earlier.

No one knew it at the time but he was infected with severe acute respiratory syndrome (SARS), a deadly new disease that would spread to others as Tse was left untreated for 16 hours in the hospital's emergency department.

What started with the 44-year-old, who died six days later, would springboard the Greater Toronto Area into medical and financial devastation through two outbreaks, including SARS II which broke out at North York General Hospital.

Justice Archie Campbell's commission into SARS pointed to Tse's hours in Scarborough Grace's ER as the kick-start of the outbreak.

"During these hours, he transmitted SARS to two other patients, sparking a chain of infection that spread through the Scarborough Grace Hospital, then to other hospitals through patient transfers and ultimately killed 44 and sickened more than 330 others," said the report, which urged officials to learn from SARS or face catastrophe when the next pandemic strikes.

At a press conference March 4 to mark the fifth anniversary of SARS, Health Minister George Smitherman announced Ontario's new Health Protection and Promotion Agency -- modelled on the U.S. Centers for Disease Control and Prevention -- will be named after Dr. Sheela Basrur, Toronto's former chief medical officer of health for Toronto, whose reassuring public appearances helped calm a terrified city and province during the SARS crisis.

"SARS shocked us out of a complacency we didn't even know we had," she said.

The mandate of the agency, which will be located steps from Queen's Park on College Street, includes providing scientific advice to the health community, carrying out population health assessment and public health research, operating laboratory services and providing emergency management.

Smitherman also used the press conference to assure Ontario residents the province is in a much better position to fight a future pandemic, at the same time admitting there is still more work to do.

"We've made good strides, we've been applying lessons learned, and we can never be satisfied with the progress that we've made," he said.

In addition to the new agency, Smitherman said Ontario has and continues to make improvements to public health such as stockpiling 55 million N95 masks to stop the spread of airborne diseases and hiring 10 disease-tracking experts at public health labs. There was only one such expert when SARS began.

But while critics acknowledge the improvements since SARS, many warn Ontario is not prepared for the next pandemic.

As recently as December, Conservative health critic Elizabeth Witmer pointed out the province's auditor general warned the province's lack of preparedness could result in 12,000 deaths, two million outpatient hospital visits and 52,000 hospitalizations should an influenza pandemic occur.

"The McGuinty government continues to demonstrate a lack of urgency to put in place a system to protect Ontarians from an eventual pandemic. In doing so, the premier is ignoring the lessons of SARS and the warnings of many health experts," Witmer said in a statement.

Others are also alarmed.

Carol Oates, president of Local 24 of the Ontario Nurses Association at Rouge Valley Health System, said she doesn't believe there are enough nurses to handle another outbreak.

And she worries about the emotional strain a pandemic would have on health-care workers, who lived in terror of contracting SARS and passing the disease on to their families.

"I don't think we could stand the emotional strain. Everybody in the hierarchy thinks they're ready but I don't know if that is the case on the front line," she said.

"I speculate we're no further ahead, other than some paper work in place. I question whether we would be ready on a dime based on manpower."

An emergency department doctor from The Scarborough Hospital, who did not want to be named, said while negative-pressure rooms have been built for patients with potentially contagious respiratory diseases, they are usually full.

That backlog means other patients who show up in the ER with unexplained coughs and fever -- as Tse did five years ago -- can spend hours in the waiting room before a negative-pressure room becomes free.

"If you have someone coming in with stomach pains and (someone else) with a fever and a cough, the patient with the fever and cough would wait the longest," the physician said.

In early 2007, 36 emergency room doctors at The Scarborough General wrote two letters to management voicing concerns about an impending infection control crisis in the ER and fears a mass exodus of nurses was crippling the department.

Former CEO Dr. Hugh Scott, who left last year following a court challenge, said management was doing everything possible to address the doctors' concerns including hiring several new nurses.

This week, hospital supervisor Rob Devitt and acting CEO John Wright said The Scarborough Hospital and the health-care system are much better equipped to handle a pandemic than they were when SARS hit.

For example, in addition to new negative-pressure rooms and ongoing construction of a larger and modern emergency department, staff are tested every two years to make sure their N95 masks fit properly.

But Wright admitted the negative-pressure rooms are routinely occupied and the emergency department full of waiting patients.

Devitt pointed out every hospital is struggling to cope with chronic care patients such as the frail elderly taking up acute care hospital beds, which prevents emergency department patients being admitted upstairs to medical wards.

Wright said no precautions can be foolproof.

"Is there a health system in the world that is invulnerable? Nowhere," he said.

Ontario Nurses Association President Linda Haslam-Stroud said SARS ushered in significant improvements to the health-care system, not the least of which is adoption of the "precautionary principle." That dictates hospitals take measures erring on the side of caution in the face of a potential public health threat rather than waiting for scientific proof.

At the same time, she complained about inadequate numbers of front line health-care workers and a lack of sufficient negative-pressure rooms.

"I don't think we are there yet but we have take some giant steps forward. I can't say to you with all certainty that all is perfect but I think we've come a long way in (five) years," Haslam-Stroud said.

"We still have a ways to go. I would say we were at a one (on a scale assessing Ontario's pandemic readiness) pre-SARS. Now, we're at a 6 1/2."

In his commission's report, Campbell warned how close the disease brought Ontario to the brink of collapse. More importantly, he warned of the dangers of failing to learn from SARS' mistakes.

"SARS had Ontario's health system on the edge of a complete breakdown. The wonder is not that the health system worked so badly during SARS but that it worked at all," he said.

"SARS may be the last wake-up call we get before the next major outbreak of infection, whether it turns out to be an influenza pandemic or some other health crisis.... The tragedy of SARS, these stories of unbearable loss and systemic failure give the public every reason to keep the government's feet to the fire in order to complete the initiatives already undertaken to make us safer from infectious disease."

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