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/
