By Stephen Leahy
BROOKLIN, Canada, Jun 25 2003 (IPS)

While the World Health Organization recently declared an end to the SARS crisis for now, Canada’s health system is still reeling over its failure to initially control the disease in Toronto.

Canada’s biggest and richest city is now coping with the end of a second wave of the epidemic, and appears to have avoided a third wave, officials said. SARS – severe acute respiratory syndrome – claimed its 38th Toronto victim Jun. 22 and 14 people remain critically ill.

The Toronto numbers are small compared to the global total of 790 deaths and nearly 8,500 infections since the virus first emerged last November in China.

But the disease’s persistence in Toronto and higher than expected death rate of 12-15 percent has driven up health care costs, spooked tourists and business travellers, and knocked an estimated 1.5 billion dollars (1.1 billion U.S. dollars) out of the city’s economy.

And it could have been much worse.

"If there had been a flu outbreak at the same time as SARS, we would have had a public health disaster," Dr. Lionel Mandel, an infectious disease expert at McMaster University in Hamilton in the province of Ontario told IPS.

In recent years, many Canadian governments have favoured tax breaks for citizens and businesses over funding for public institutions such as health and education.

Ontario’s health system had been stretched to the breaking point by chronic under funding and staff shortages before SARS, agreed Dr. Elliot Halparin, president of the Ontario Medical Association (OMA), in an interview.

"Medical staff are exhausted and personnel from the U.S. had to be brought in to help out," he said. "Even if there are no more new cases, it will take months, if not longer, to recover."

Money woes aside, there were other factors, including a surprising lack of preparedness. When Toronto public health officials discovered the first cluster of cases late one night in March, they did not have the emergency phone numbers for Health Canada or the WHO. Nor did they have phone numbers for Toronto doctors.

There was a lack of co-ordination and communication between various levels of governments in the crucial first weeks of the outbreak as well.

Perhaps the most important factor in the spread of the disease was the common practice of shuttling patients from one hospital to another. Toronto’s hospitals have various specialities and thousands of patients are transferred between them each day. Also, many nurses work part-time at two or more hospitals.

Not surprisingly, SARS-infected patients and medical staff spread the disease from hospital to hospital, so that more than 70 percent of SARS transmissions have been attributed to Toronto hospitals.

Although SARS only infected some 350 people it has led to loss of confidence in Canada’s public health system, because it proved unable to control the outbreak, said Paul Gully, senior director general of Health Canada, in news reports.

"I was surprised at how much trouble first-world hospitals were having with SARS compared to those in China and Vietnam," Dr. Earl Brown, a virologist and flu specialist at the University of Ottawa in Ontario, told IPS.

That may be a matter of differences in reporting cases, antibodies in Asian populations or even differences in the SARS virus itself, Brown speculates. "I initially was very worried about the impact on Asia when I saw the outbreak starting."

One of the mistakes Canada made was to downplay the risk at the beginning of the outbreak, he says. That resulted in some people not complying with quarantines – which in nearly all of the 15,000 cases were voluntary, involving a 10-day isolation in their own homes.

SARS symptoms do not manifest for up to 10 days after infection.

Mandel believes Canada’s health officials have something to learn about how the outbreak was handled in Taiwan and Singapore. "It’s a wake up call for Canada and the rest of the world about emerging infectious diseases."

Brown says the outbreak demonstrates that there are lots of ‘hot’ viruses moving around the globe, including dengue fever. "SARS didn’t have much of a run this time," he said. "It will come back."

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