gurney: canadian health care would struggle in virus crises

there’s a fascinating quote in health canada’s october 2003 report into the sars crisis. sars killed 44 people in the toronto area, including three health-care workers, and brought unwelcome international attention to the city, where public health officials struggled to respond to the crisis. dr. richard schabas, identified then as the chief of staff of york central hospital, is quoted as saying, “sars i was not avoidable. we were struck by lightning. everything after that was.”to understand the reference, you have to have read the report. it breaks down the toronto area’s experience with severe acute respiratory syndrome, a coronavirus that emerged in china, into two distinct phases. the first phase — sars i, march and april of 2003 — was when hospitals in toronto and around the world were struggling to confront this new virus, even, in some cases, to realize that there was a new virus. that’s the lightning strike schabas alludes to — it came out of nowhere and did a lot of damage. sars ii was the second wave of infection that swept the toronto area after public health officials, believing the virus contained, lowered their guard. it lasted for much of may and june.as the world warily watches a new coronavirus emerge, again from china (this time, the city of wuhan) the 2003 report into how canadians met the sars outbreak makes for sobering reading.sars has long been of personal interest to me. in march of 2003, i was a university student in waterloo, ont., home near toronto for an exam-time break. my late grandfather received regular out-patient care at the above-mentioned york central hospital. my mother and i picked him up after an appointment to take him home. several days later, patients at york central began to die of sars. the hospital became one of the major flashpoints of the crisis. i ended up missing some of my exams while waiting out the 10-day quarantine period for those who’d potentially been exposed. my sars experience was terrific — i ordered in some food, skipped school with the university’s full blessing and binge-watched deep space 9. but i’ve never overlooked the fact that it was a real crisis, and my own easy ride was simply a matter of luck. it could easily have gone a different way, and for many, it did. and for the system as a whole, the crisis was an ugly wake-up call. we weren’t ready.we don’t know yet how easily the new virus spreads, or how lethal it is once contracted. but in an astonishing move, chinese officials moved early on thursday morning to quarantine wuhan — totally. trains, buses and planes heading out of the city were cancelled. videos posted to social media appeared to show police units blocking roads heading out. this is a massive step, and while it may reflect china’s dictatorship overreacting because they can, it also speaks to the level of chinese concern. they wouldn’t isolate 11 million people unless they were very, very worried.

if the virus does spread, there is some good news. china appears to be sharing more information — at least relative to 2003. our technology has improved considerably over the past 17 years. sequencing the virus’s genome is easier now than it was then, and we’ll be able to share that information more widely, faster, speeding treatment and diagnosis options. the lessons learned from sars will also, one hopes, make it easier to screen arriving passengers at canadian airports, reducing the likelihood that the virus will ever arrive here at all.that’s the good news. now the bad.the health canada report identified many major problems in the public health response to sars’ arrival in canada. information sharing was limited, many medical records were still pen-and-paper, and chains of command were muddled and unclear, causing confusion and delays. we can hope to do better this time, but it’s hard to have too much confidence that we would. and one of the report’s major conclusions is a red light flashing an urgent alarm.the report tells the story of the second canadian case, and likely the first infected here. his elderly mother had travelled to hong kong, and became infected there, after being exposed to sars in her hotel. she returned to canada, fell ill and died at home in toronto. canadian officials, unaware of sars’ spread in china, deemed her death unremarkable — an old woman dying at home. her son fell ill and went to the hospital, where he infected two others during a long emergency room stay. why the long stay? hospital overcrowding. the er doctor was clever, the report writes, and suspected tuberculosis, taking precautions accordingly, including notifying public health authorities and recommending that other family members be isolated. but the poor doomed patient waited around in that er for almost a full day, infecting others, because there was nowhere else to put him.

if that sounds familiar, it’s because that remains a constant problem. in a strange coincidence, on wednesday, as the first north american case of the wuhan virus was confirmed and china moved to totally isolate the city of wuhan, the cbc published an analysis of hospital overcrowding in ontario. the results are bad. of the province’s 163 acute-care hospitals, almost half — 83 — operated above 100 per cent of their stated patient capacity for at least 30 days during the first six months of last year. almost a quarter had at least one day when they hit 120 per cent of capacity. forty hospitals maintained occupancy of 100 per cent or higher over the survey period. the health-care system is already stretched beyond capacity by the population’s need for routine everyday care. there is little to no surge capacity for crises that hasn’t already been slowly eaten up by chronic overcrowding.this would matter in a public-health emergency here. in 2003, public health officials considered establishing one hospital in the toronto-area to serve as the sars hospital; patients needing urgent or routine care for other issues would be directed to all the other hospitals. amid concern of what would happen if that hospital were overwhelmed by the virus, the decision was made instead to establish sars wards in many hospitals, and to re-activate mothballed facilities. shortages of trained personnel and equipment complicated this effort. family-health clinics also complained of a shortage of protective gear in 2003 — both for the protection of their own staff and to rapidly isolate a patient who might arrive showing sars-symptoms.

in a statement wednesday afternoon on the new outbreak, ontario health minister christine elliott said there are “no confirmed cases in canada,” but the province is now mandating that the novel coronavirus must be reported to health authorities.“given the recent media coverage, it is also important to note that ontario’s integrated health system today is far more prepared to respond to any potential health risks than in the past. we now have mechanisms in place, which have strengthened how health-care providers work together and coordinate responses to emerging public health issues, such as this new virus,” she said.china’s decision to quarantine wuhan is dramatic. the available evidence so far presented to the world health organization suggests that the wuhan virus is dangerous, certainly, but not unusually so. serious but not catastrophic. perhaps they’re overreacting. let’s hope so.• email: magurney@postmedia.com | twitter: mattgurney