Snowy Owl
Retired in 2010, In Memoriam
We're still not ready
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Colin Q-T Lee, Citizen Special
Published: Wednesday, February 14, 2007
The Ontario SARS Commission's final report was finally released last month after more than three years of public hearings, a review of government and hospital documents, and confidential interviews with more than 600 people connected with the 2003 SARS outbreak in Toronto.
The report identified several systemic problems within our hospitals, public health departments and government agencies that hampered our ability to respond effectively to the outbreak. Among these problems were a lack of clear and timely communication within the health care sector and inadequate infectious-disease outbreak planning and preparation. There were concerns expressed about the safety of health care workers in hospitals. Frightening shortfalls in public health, disease surveillance and laboratory funding and capacity were also identified. Many hospitals were found to be without sufficient infectious-disease prevention and control expertise and infrastructure.
In the end, it appears that the SARS outbreak was contained only through the sheer determination and sacrifice of the individuals working in Ontario's public health agencies and hospitals at the time.
With the report behind us, has Ontario learned the lessons of SARS, and are we ready for the next outbreak of a virulent infectious disease or for an influenza pandemic? The short answer is that we are more ready, but there is still much rebuilding needed.
When SARS first arrived, there was a dangerous level of complacency within Ontario's hospitals regarding the threat of infectious disease, while the public health system was in a state of tremendous neglect and decline.
In the years since the outbreak, although still insufficient to counterbalance years of underfunding, there has since been an injection of long-overdue resources into public health and infection-prevention and control programs in hospitals. Disease surveillance systems have been somewhat renewed and pandemic influenza planning and preparation has been carried out.
To facilitate the sharing of provincial expertise and communication, the Provincial Infectious Disease Advisory Committee (PIDAC) and Regional Infection Control Networks have been formed. Plans are also under way for a future Ontario Health Protection and Promotion Agency, modelled after the Centers for Disease Control and Prevention (CDC) in the United States.
However, the kind of rebuilding that is necessary will take a more long-term political commitment and sustained resources. As a first priority, a serious investment must be made in the training and retaining of physicians and nurses who will make up the cornerstone of any response not only to infectious disease emergencies, but also to the day-to-day care and safety of our patients and communities.
Experts such as public health physicians and hospital doctors and nurses with experience in the prevention and control of infectious diseases are in short supply. If public health departments are to lead the fight against infectious-disease outbreaks, they need increased resources. How can we expect effective responses when about one-third of Ontario's public health units or regions are still without a fully-qualified, full-time medical officer of health?
</PAGEBREAK>There continues to be a chronic shortage of essential public health and medical microbiologist physicians in the provincial nerve centres -- the Infectious Disease Branch and the Public Health Laboratories. No one would expect a neurosurgeon to perform a delicate operation with only one-third of the required tools and staff. This is no different. The government must act now to solve this public health human resource crisis.
On the front lines, Ontario's health care workers continue to experience the psycho-social effects of their experience with SARS. Almost half of the 375 persons who fell ill with SARS were health care workers. They retain lingering memories of their experiences, as well as a sense of betrayal.
These feelings stem from the inadequate infectious disease preparations and protections that were afforded to them, as well as the poor communication that they received in their hospital workplaces. They heard mixed messages and felt that they were not listened to.
Many health care workers never dreamed that an infectious disease such as SARS could so easily overcome our modern medicines and medical technology. Even though the safety of health care workers in hospitals has improved since the crisis, it will take years before their trust in government and hospitals is restored. It may take even longer for the personal, recurring nightmares and fears triggered by the crisis to disappear. In the meantime, Ontario health care workers continue to be resilient and dedicated, and will no doubt fight side by side in the next outbreak.
Many experts predict that the next virulent infectious disease outbreak will be an influenza pandemic. Some argue that we have disproportionately invested in preparing for such a pandemic, while others say that we still have a lot more to do.
Both views reflect our unrealistic expectation that we can control and predict every element of our natural environment, such as ice storms, hurricanes, tsunamis and infectious-disease outbreaks. The reality is that Mother Nature still hides many tricks up her sleeve, and so do the viruses and bacteria that constantly mutate, change and evolve. Even the best health care system in the world will not be able to predict and prevent every outbreak.
People have many questions about the next influenza pandemic. When is it going to arrive and how bad will it be? Will it be as deadly as in 1918, when tens of millions of people succumbed worldwide? Or will it mirror the more recent pandemics of 1957 and 1968 where only one million to two million lives were lost?
Influenza pandemics are a recurring phenomenon that cannot be predicted with certainty. There have been three outbreaks in the past 90 years. In the worst-case scenario, your chance of surviving the next influenza pandemic is at least 95 per cent. In the event of a mild pandemic, your odds rise to over 99 per cent. A vaccine will likely only be available a few months after the start of a pandemic. There is currently no magic bullet that will ensure your survival.
</PAGEBREAK>The best way to survive any pandemic is to be as healthy as possible when it arrives. To improve on your already favourable odds, you should eat more vegetables and fruit, quit smoking, take the stairs instead of the escalator, get your recommended vaccinations (including the annual influenza vaccine) and wash your hands often.
Having a family emergency kit at home with some basic supplies will not only get you through the next blackout or ice storm, but will also help at the outset of a pandemic.
These are a few simple things that you can do independent of the continuing challenges faced by our public health system and hospitals.
So, have we learned from the SARS crisis and are we better prepared for the next major outbreak? Yes, but we still have much to do.
Dr. Colin Q-T Lee is an associate medical officer of health, public health physician and emergency room physician in Barrie. He is also a co-author of "The Flu Pandemic and You: A Canadian Guide."
http://www.canada.com/ottawacitizen/news/opinion/story.html?id=a361d8aa-b780-468a-9a57-cb3b179d51db
We learned hard lessons with SARS, but the health system and individuals in Ontario are far from prepared for the next outbreak<!-- start of photo -->
A man reads the warning signs on the doors at the Hospital for Sick Children in Toronto in 2003. Many health care workers never dreamed that an infectious disease such as SARS could so easily overcome our modern medicines and technology.
Photograph by : Kevin Frayer, The Canadian Press
Photograph by : Kevin Frayer, The Canadian Press
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Colin Q-T Lee, Citizen Special
Published: Wednesday, February 14, 2007
The Ontario SARS Commission's final report was finally released last month after more than three years of public hearings, a review of government and hospital documents, and confidential interviews with more than 600 people connected with the 2003 SARS outbreak in Toronto.
The report identified several systemic problems within our hospitals, public health departments and government agencies that hampered our ability to respond effectively to the outbreak. Among these problems were a lack of clear and timely communication within the health care sector and inadequate infectious-disease outbreak planning and preparation. There were concerns expressed about the safety of health care workers in hospitals. Frightening shortfalls in public health, disease surveillance and laboratory funding and capacity were also identified. Many hospitals were found to be without sufficient infectious-disease prevention and control expertise and infrastructure.
In the end, it appears that the SARS outbreak was contained only through the sheer determination and sacrifice of the individuals working in Ontario's public health agencies and hospitals at the time.
With the report behind us, has Ontario learned the lessons of SARS, and are we ready for the next outbreak of a virulent infectious disease or for an influenza pandemic? The short answer is that we are more ready, but there is still much rebuilding needed.
When SARS first arrived, there was a dangerous level of complacency within Ontario's hospitals regarding the threat of infectious disease, while the public health system was in a state of tremendous neglect and decline.
In the years since the outbreak, although still insufficient to counterbalance years of underfunding, there has since been an injection of long-overdue resources into public health and infection-prevention and control programs in hospitals. Disease surveillance systems have been somewhat renewed and pandemic influenza planning and preparation has been carried out.
To facilitate the sharing of provincial expertise and communication, the Provincial Infectious Disease Advisory Committee (PIDAC) and Regional Infection Control Networks have been formed. Plans are also under way for a future Ontario Health Protection and Promotion Agency, modelled after the Centers for Disease Control and Prevention (CDC) in the United States.
However, the kind of rebuilding that is necessary will take a more long-term political commitment and sustained resources. As a first priority, a serious investment must be made in the training and retaining of physicians and nurses who will make up the cornerstone of any response not only to infectious disease emergencies, but also to the day-to-day care and safety of our patients and communities.
Experts such as public health physicians and hospital doctors and nurses with experience in the prevention and control of infectious diseases are in short supply. If public health departments are to lead the fight against infectious-disease outbreaks, they need increased resources. How can we expect effective responses when about one-third of Ontario's public health units or regions are still without a fully-qualified, full-time medical officer of health?
</PAGEBREAK>There continues to be a chronic shortage of essential public health and medical microbiologist physicians in the provincial nerve centres -- the Infectious Disease Branch and the Public Health Laboratories. No one would expect a neurosurgeon to perform a delicate operation with only one-third of the required tools and staff. This is no different. The government must act now to solve this public health human resource crisis.
On the front lines, Ontario's health care workers continue to experience the psycho-social effects of their experience with SARS. Almost half of the 375 persons who fell ill with SARS were health care workers. They retain lingering memories of their experiences, as well as a sense of betrayal.
These feelings stem from the inadequate infectious disease preparations and protections that were afforded to them, as well as the poor communication that they received in their hospital workplaces. They heard mixed messages and felt that they were not listened to.
Many health care workers never dreamed that an infectious disease such as SARS could so easily overcome our modern medicines and medical technology. Even though the safety of health care workers in hospitals has improved since the crisis, it will take years before their trust in government and hospitals is restored. It may take even longer for the personal, recurring nightmares and fears triggered by the crisis to disappear. In the meantime, Ontario health care workers continue to be resilient and dedicated, and will no doubt fight side by side in the next outbreak.
Many experts predict that the next virulent infectious disease outbreak will be an influenza pandemic. Some argue that we have disproportionately invested in preparing for such a pandemic, while others say that we still have a lot more to do.
Both views reflect our unrealistic expectation that we can control and predict every element of our natural environment, such as ice storms, hurricanes, tsunamis and infectious-disease outbreaks. The reality is that Mother Nature still hides many tricks up her sleeve, and so do the viruses and bacteria that constantly mutate, change and evolve. Even the best health care system in the world will not be able to predict and prevent every outbreak.
People have many questions about the next influenza pandemic. When is it going to arrive and how bad will it be? Will it be as deadly as in 1918, when tens of millions of people succumbed worldwide? Or will it mirror the more recent pandemics of 1957 and 1968 where only one million to two million lives were lost?
Influenza pandemics are a recurring phenomenon that cannot be predicted with certainty. There have been three outbreaks in the past 90 years. In the worst-case scenario, your chance of surviving the next influenza pandemic is at least 95 per cent. In the event of a mild pandemic, your odds rise to over 99 per cent. A vaccine will likely only be available a few months after the start of a pandemic. There is currently no magic bullet that will ensure your survival.
</PAGEBREAK>The best way to survive any pandemic is to be as healthy as possible when it arrives. To improve on your already favourable odds, you should eat more vegetables and fruit, quit smoking, take the stairs instead of the escalator, get your recommended vaccinations (including the annual influenza vaccine) and wash your hands often.
Having a family emergency kit at home with some basic supplies will not only get you through the next blackout or ice storm, but will also help at the outset of a pandemic.
These are a few simple things that you can do independent of the continuing challenges faced by our public health system and hospitals.
So, have we learned from the SARS crisis and are we better prepared for the next major outbreak? Yes, but we still have much to do.
Dr. Colin Q-T Lee is an associate medical officer of health, public health physician and emergency room physician in Barrie. He is also a co-author of "The Flu Pandemic and You: A Canadian Guide."
© The Ottawa Citizen 2007