SARS 10 years later: How has the health care system changed?

A consortium of international scientists has discovered a SARS-like virus recovered from a Chinese horseshoe bat. Getty Images

TORONTO – Martin Johnston was a rookie paramedic in Toronto 10 years ago, just a year into his career.

While on the job, he noticed a spike in calls for fevers, shortness of breath and coughing. No one knew what to make of this pattern in patient complaints, Johnston recalls.

“You didn’t really know what you were walking into. Some people on the news were saying it was very bad, some people were saying it wasn’t much.”

By Mar. 5, Toronto paramedics transported their first SARS patient to hospital; 78-year-old Siu-Chi Kwan was also the city’s first death in the viral disease that crippled the Greater Toronto Area for months.

Her son died just a week later.

Meanwhile in Scarborough, Ont., Dr. Eric Hurowitz says news surfaced from around the world as information poured in about this disease taking lives in China.

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“It was our Chinese-speaking nurses who watched Chinese television who knew what was going on in Hong Kong when the first people who came to our emergency came in,” he told Global News.

“They clued into the concept that maybe this was actually something we were going to be facing from day one.”

In the weeks that followed, Hurowitz saw empty hospital hallways, doctors fielding calls from their cars as spaces were quarantined.

“And almost the ghostly images of everybody clad in these transparent yellow gowns and masks,” he says.

Johnston, also on the ground at the epicentre of the pandemic, recalls the chaos as information about what they were dealing with slowly trickled in.

Paramedics tried to roll with the punches – should they wear masks when treating patients with a simple cough? When should patients be quarantined when they make it to hospital?

Looking back, it’s clear that SARS exposed the gaping holes in Ontario’s health care system.

This week marks the 10-year anniversary of the first case of SARS in Canada as the pandemic made its way into the country, changing the medical community’s landscape when it comes to managing viruses that have the potential to spread like wildfire.

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The decade-old epidemic that brought the international community to its knees has offered valuable lessons to front-line health care workers. The protocols for nurses, doctors and paramedics alike have changed dramatically, and surveillance is now in place brokering intelligence on rising diseases that could pose a threat to the country’s medical safety.

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Filling holes in the health care system

While doctors concede they weren’t ready for what hit 10 years ago, they believe the legacy SARS left behind resulted in crucial improvements in patient care.

Dr. Michael Gardem was in the first year of his career at the onset of SARS. The outbreak shaped his work, along with many professionals in the infectious disease field.

“SARS kind of changed our lives in terms of what we do,” he told Global News.

“SARS comes along and then there’s very deep interest in the spread of infectious diseases, how they spread, how we can actually prevent it and that’s all translated 10 years later into a very different approach to things,” he said.

Gardem is now director of infection prevention and control at University Health Network.

He suggests the health care system in 2003 became “complacent,” and Hurowitz agrees.

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“Pre-SARS we thought we were omnipotent. We thought we had all the tools necessary to treat absolutely anything that came in the door. We never, in most of our lifetimes, experienced an epidemic of significant proportions,” Hurowitz said.

Doctors wouldn’t have guessed that patients would need to be quarantined, that an untreatable virus could make its rounds so quickly through communities.

SARS ultimately claimed 900 lives worldwide and another 8,500 people became infected.

In Toronto, 44 people died from the disease including three health care workers.

That scare forced Canadian health officials to rethink their lines of defense.

Patients are now screened for a fever, cough or trouble breathing. They’re asked if they’ve recently returned from another country. They’re given masks and they’re separated from others as a safety precaution.

The setup of hospitals has been rethought: they’re redesigned with smaller spaces so there are single rooms.

In Johnston’s work, paramedics hand patients face masks and their equipment has been upgraded. When providing oxygen to patients, the tubes used release the air patients are breathing out. Now, the device filters the air at 98 per cent efficiency before it’s returned into the room.

Even simple procedures such as hand washing came to the forefront as a preventative measure in keeping health care workers and patients safe.

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Health care workers were fitted for N95-level respirators – the mask you traditionally wear to “sand your floor,” according to Gardem – to protect against any contagious disease.

“We didn’t do that before. Because of SARS, it became fairly mandated…”

Communication barriers broken down

Communication lines opened up between provincial, federal and international health bodies.

At the height of SARS, Gardem said he relied on newspapers for his information on what was happening on the ground.

“There simply wasn’t a way of sharing that information, and I’m not going to press conferences everyday to hear what’s happening.”

By H1N1, authorities streamlined communication – health care workers received daily emails from Toronto Public Health, from the Ontario Ministry of Health and from Public Health Ontario, giving them a heads up on any patterns or red flags.

“Clearly what happened in Ontario stuck with us, even how we plan for pandemics in Ontario,” Gardem said.

“We had spent years thinking about this. This was all because of SARS.”

Meanwhile, international leads, namely the World Health Organization, increased their monitoring of emerging viruses.

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Surveillance networks pick up novel viruses on the rise, and that information is then transmitted from city to city.

More work ahead in preparing for future outbreaks

Still, adequately preparing the health care system for another outbreak needs work.

Hospitals need improved patient flows, smaller rooms to segregate patients and ventilation. Screening is still done by relying on patients’ information.

“We’ve come a long way but I think we’re kidding ourselves if we think we’re ready,” Gardem says.

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