SARS in Canada

Johanne Rosnick, Emily Adams, Savannah Frederick, Clayton

Judas, and Shayna Quibell
 What is SARS?
Severe acute respiratory syndrome (SARS) is an abnormal pneumonia caused by a

strain of coronavirus.

It is thought that SARS is an animal virus that spread to humans in 2002 though a

marketplace in Guangdong, China by consumption of exotic animals.

SARS is transmitted mainly through respiratory droplets and direct contact, usually

during the second week of illness.

Symptoms of SARS: Fever, cough, soar throat, and shortness of breath. Can lead to

pneumonia, respiratory failure, and sometimes death.

 How did SARS spread to
Canada?
Two locations where SARS was spread in Canada: Toronto and Vancouver.

Three travelers brought SARS to Canada and they were all staying at the same hotel in

Hong Kong.

One infected traveler (index case) returned to Greater Toronto Area and the other two

returned to Vancouver.

Travelers returned to Canada before the World Health Organization (WHO) issued its

first global alert.

 SARS in Vancouver
As soon as the couple arrived, they went straight to their family physician.

The man was sent straight to Vancouver General Hospital, which was prepared

for his arrival.

Staff at the hospital had previously been informed to look for respiratory illness

from patients who recently travelled to Asia.

Vancouver General Hospital consistently used the highest level of precautionary

measures to contain the pandemic.

 SARS in Toronto
The index case transmitted the disease to a family member, who was admitted to the hospital where the

outbreak spread.

From there it was contracted by two ER nurses and spread further throughout the hospital. 77% of cases in

Toronto were either health care workers or people who sought care at health care facilities (Department of

Health and Human Services Centers for disease Control and Prevention, 2004).

There were two waves of the outbreak March to April and April to July and unrecognized SARS among patients

was the underlying cause of a resurgence or second phase.

The SARS Commission Spring of Fears by the Ministry of Health and Long-Term Care of Ontario in 2006

claimed that the system was a failure and was due to the lack of preparation against infections, decline of

public health, the failure of the system that should protect nurses and paramedics and others from infection at

work.
 Different Health Care Responses
B.C. released a pandemic plan before the outbreak, whereas in Ontario, there was no plan in place.

In Vancouver, within about 2 hours the man was put in isolation, examined by specialists, treated by health

workers wearing full respiratory protection, and moved into a negative-pressure isolation room. In Toronto it

took 21 hours for the same procedures. (Vancouver: A Tale Of Two Cities.)

Vancouver reported 5 confirmed cases, 4 of which were imported. Toronto reported 247 patients with SARS

and 43 related deaths, of which 3 cases were imported. (Skowronski, D., 2005)

In the early stages of the outbreak, the Workers Compensation Board (WCB) in B.C. issued guidelines for

how to protect health workers and undertook proactive inspections of hospitals. Meanwhile in Ontario, the

Ministry of Labour was not given a primary role. (Vancouver: A Tale Of Two Cities.)
 What did we learn from this?
1. Increased knowledge about the biology and epidemiology of the disease.

2. Increased awareness of our ethics and values as a society in response to a

disease, outbreak or natural disaster (Solomon R. Benatar).

3. Value of having a national public health institute that is prepared to control

disease outbreaks and that coordinates well with regional and international health

authorities (Jeffrey P. Koplan, 2013).

 Eight Broader Needs
Public health officials in Canada recognized 8 policy and system needs that needed to be established.

1) Stronger/more integrated coordination between animal health authorities and public health authorities.

2) Stronger disease and symptom surveillance systems that would quickly share information with authorities in

Canada and in other countries.

3) Prepared, capable, and quick responding public health laboratories whose main role is infectious disease

control.

4) The need for infection control to be constantly emphasized in every health care setting.
 Continued
5) Development of criteria for isolation/quarantine and the evaluation of these measures.

6) Make risk assessment and communication important components of the public health

workers skill set.

7) Fast and practiced public health response with responsibility falling on all regional health

authorities nation wide.

8) Most important takeaway was the need for a national public health institute that has a main

focus of prevention/control of disease outbreaks.

 In Sum
From the SARS outbreak we learned:

1) More about the disease itself.

2) That our ethical values need to be established so we can respond

quickly.

3) That a national public health institute is of the utmost importance.

 Works Cited
Jeffrey P. Koplan, D. B.-J. (2013). Public Health Lessons From Severe Acute
Respiratory System A Decade Later. Emerging Infectious Diseases , 861-862

Ministry Reports. (2006, December 1). Retrieved November 2, 2014, from

http://www.health.gov.on.ca/en/common/ministry/publications/reports/campbell
06/campbell06.aspx

Poutanen, M. S., Low, E. D., Henry, B., Finkelsetein, S., Rose, D., Green, K.,
McGreer, A. J. (2003). Identification of Severe Acute Respiratory
Syndrome in Canada. The New England Journal of Medicine. doi:
10.1056/NEJMoa030634

SARS Outbreak in Canada. (n.d.). Retrieved November 2, 2014, from

http://www.ehatlas.ca/sars-severe-acute-respiratory-syndrome/case-
study/sars-outbreak-canada

Scabas, R. (2003). SARS: prudence, not panic. CMAJ, 168, 1432-1434.

http://www.cmaj.ca/content/168/11/1432.short
 Works Cited
Severe Acute Respiratory Syndrome (SARS). (2004). Retrieved
November 1, 2014 from http://www.who.int/csr/sars/en/

Skowronski, D. M., Petric, M., Daly, P., Parker, R. A., Bryce, E., Doyle, P.
W., Brunham, R. C. (2006). Coordinated response to SARS,
Vancouver, Canada. Emerging Infectious Diseases, 12, 155158. doi:
10.3201/eid1201.050327

Solomon R. Benatar, M. B. Ethics and SARS: Learning Lessons from the

Toronto Experience. Toronto: The University of Toronto Joint Centre for
Bioethics.

Supplement C: Preparedness and Response in Healthcare Facilities.

(2013, April 16). Retrieved November 2, 2014, from
http://www.cdc.gov/sars/index.html

Svoboda, T., Henry, B., Shulman, L., Kennedy, E., Rea, E., Ng, W., ...
Glazier, R. (2004). Public Health Measures To Control The Spread Of The
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