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Tuesday, August 4, 2015

Emergency Management: Canadian SARS Epidemic

The 2003 outbreak of SARS (Severe Acute Respiratory Syndrome) in Toronto brought to light the many challenges and inadequacies that existed within the Canadian health care system should the unthinkable ever occur.  The occurrence of an epidemic within the health care system was sorely prepared for, and the ability of emergency personnel to quickly and effectively respond to the danger that the SARS epidemic posed to citizens rapidly became subjugated   Even the Canadian Hospital Epidemiology Committee noted that Canada lacked a system to "notify acute care facilities of a global health alert, with attendant recommendations for surveillance and control if persons suspected of having a new infectious disease appear in Canadian health care facilities (Public Health Agency of Canada, November 8, 2004)". 


Many of the area's hospitals were woefully overworked and understaffed and this led to the problem of not having enough beds/rooms for all of the sick, and subsequently they began placing patients, regardless of their malady, within close quarters of each other with little to no protection for themselves or others from disease.  In many situations, patients were left laying on gurneys in the middle of the hallway, many times next to undetected SARS patients.  There was a shortage of some of the equipment that was needed to protect health workers, for example, more N95 face masks were needed than were available (Howitt & Leonard, 2009).  As a result, the operational capacity of the Toronto Public Health (TPH) system became morbidly overwhelmed.
These were not the only problems that Toronto had with the response to the SARS outbreak.  There was also the problem of communication, or rather in this case, miscommunication or even, lack of communication.  In an attempt to lessen the ensuing panic that would occur, should the word that there was an epidemic running rampant within the Toronto health care system, officials tended to downplay the amount of cases and the severity of the disease.  Political leaders in Ontario continued their daily recreations and to the astonishment of all, Toronto Mayor Mel Lastman even denied knowing who the World Health Organization (WHO) was when being interviewed by CNN (Howitt & Leonard, 2009).
When comparing the SARS response to the response to the 9/11 attack on the Pentagon, the similarities and differences are clear.  From the beginning, the 9/11 attack on the Pentagon had a clear and concise method of dispersal - an airplane; SARS was an unknown disease with little known about it - its method of delivery was initially undiscovered.  Officials and emergency management responders were also ill equipped, both in manpower and resources as well as in the availability of facilities ready and able to deal with the SARS coronavirus, whereas the equipment that was needed to effectively and efficiently assist the victims was readily available from agencies and jurisdictions surrounding the area of the 9/11 Pentagon incident (Howitt & Leonard, 2009).  Not only that, but the time involved in the response for the 9/11 incident was much shorter.
Communications became an impairment during both emergency situations.  Responders were disinclined during the first few weeks of the outbreak to give out detailed information regarding the epidemic, should they be transmitting wrong information and it was this lack of information during the SARS outbreak that fortuitously led to the deaths of numerous, unnecessary citizens.  If the agencies involved in investigating the outbreak have paid more attention to the world news regarding the manifestation of a new and unknown disease which was now presenting itself worldwide, perhaps they could have mitigated the affect the contagion would have on the communities involved (Howitt & Leonard, 2009). The problems with the lack of communications within the 9/11 Pentagon response, while it may not have led to the same level of disorder that SARS did, did expedite the amount of confusion between the responders who had come from all over the area, whether they were invited or not.  This ultimately led to mass confusion and dissension within the ranks when attempting to assist those in distress (Howitt & Leonard, 2009).
The affect that SARS had on non-health emergency responders began as basic denial that there was a problem to begin with.  Some ignored the warnings and the orders to remain under quarantine and this arbitrarily led to the continual spread of the disease (Howitt & Leonard, 2009).    SARS also took an effect on the day to day routines of citizens.   Officials were ill prepared for any new rash of SARS diagnoses which they surmised would happen over the Easter holiday weekend.  This fear ended up being unfounded, however (Howitt & Leonard, 2009).
As the SARS crisis deepened in Toronto, surrounding jurisdictions outside of the Toronto area needed to have been taking better precautions to ensure that SARS did not spread any further.  This meant the placing of potential SARS patients in solitary rooms and caring for those patients in a manner that would alleviate the danger of transmission of the coronavirus to others - i.e. using masks, gloves and other protective gear.  Airports also could have done more stringent testing of passengers to identify those who may be infected.   By identifying those who may come into contact with an infected person early on, those in a position of authority may have been able to keep the disease isolated within the province/country and restricted the outbreak to Toronto, rather than unwittingly allow the transmission of the epidemic to other areas of the world (Howitt & Leonard, 2009, Ch. 2, Pg. 113.).
In order for other jurisdictions to prepare for future similar events of emergent infectious disease such as SARS or AIDS, or the dispersal of contagious agents by bioterrorists seeking to wreak havoc within the borders of a certain country, there needs to be some sort of plan created.  The United States has developed the ICS (Incident Command System) as a way to be ready to respond to these and other types of crises.  Canada also follows a similar plan, however, in the face of a health emergency such as the SARS outbreak, tensions between jurisdictions cause a breakdown in information and data sharing between organizations (Public Health Agency of Canada, November 8, 2004).   Had there been a national database of respiratory infections available, it would have been extremely relevant in assessing whether rates of such infections was unusually high (Publish Health Agency of Canada).  It was established that there were no surveillance networks that had "real-time pooling of data and rapid expert analysis. (Public Health Agency of Canada)."
It was through the implementation of the eight effective courses of action when improving an Emergency Operations Plan that the SARS epidemic was eventually and effectively brought under control.  After the first cases of SARS in Toronto, which culminated in 224 SARS cases and 38 deaths, the Toronto Emergency Medical Services were called to assist.  They had already been aware of a respiratory illness in the Toronto area and were actively pursuing ways to contain the spread of the disease and to inform the public of ways that they could avoid exposure (U.S. National Library of Medicine, 2004).
  The eight courses of action are:
"1.       Emergency planners should anticipate both active and passive resistance to the planning process and develop strategies to manage these obstacles.
2.         Preimpact planning should address all hazards to which the community is exposed.
3.         Preimpact planning should elicit participation, commitment, and clearly defined agreement among all response organizations.
4.         Preimpact planning should be based upon accurate assumptions about the threat, typical human behavior in disasters, and likely support from external sources such as state and federal agencies.
5.         EOPs should identify the types of emergency response actions that are most likely to be appropriate, but encourage improvisation based on continuing emergency assessment.
6.         Emergency planning should address the linkage of emergency response to disaster recovery and hazard mitigation.
7.         Preimpact planning should provide for training and evaluating the emergency response organization at all levels—individual, team, department, and community.
8.         Emergency planning should be recognized as a continuing process (FEMA, 2006)."
In the initial stages of the SARS outbreak, there was little to no information as to what the disease that they were dealing with was.  The doctors and other health care workers involved used the resources that they had in their attempt to stop the coronavirus from spreading.  This attempt failed due to the inability to recognize the symptomology of the disease and the lack of resources required to stop the onslaught that had already occurred.  Had officials paid more attention to the reports of a new, deadly virus that was being seen in Hong Kong and other areas of the Eastern world, had emergency management protocols been followed in the early days of the outbreak, this disaster may have been averted.
The SARS outbreak in Toronto, Canada in 2003 turned out to be a wake-up call for officials and health professionals, both in Canada and across the world.  Hospital officials suddenly became acutely aware of just how unprepared they were for an epidemic of mass proportions.   Whereas Canadian emergency management services had planned for just such a possibility, the health community seems to have viewed it as an unlikely scenario, given that Canada was a first world country and not subject to the same dangers as countries such as Hong Kong and the Philippines, and any response to such an event would be slow and subdued.



  
References

FEMA. (2006). Fundamentals of Emergency Management.  Chaper 9: Preparedness for Emergency Response. Retrieved from http://training.fema.gov/HiEdu/docs/fem/Chapter%209%20-%20Preparedness%20for%20Emergency%20Response.doc

Howitt & Leonard. (2009). Managing Crises: Responses to Large-Scale Emergencies. ISBN-13: 978-0872895706. CQ Press. February 11, 2009
 
Public Health Agency of Canada. (Nov. 8, 2004). ARCHIVED - Chapter 2 - SARS in Canada: Anatomy of an Outbreak. Retrieved from http://www.phac-aspc.gc.ca/publicat/sars-sras/naylor/2-eng.php#Guangdong


U.S. National Library of Medicine. (2004). Toronto Emergency Medical Services and SARS. National Center for Biotechnology Information. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320298/