Managing SARS in Toronto: Lessons in Biosecurity

SARS! The name leaps out at us as from a horror film. The plague doctor, with his frightening mask stuffed with gauze, herbs, and camphor during the pneumonic plagues of earlier centuries, symbolizes the terror of victims and caregivers. As the story of SARS unfolded, they were often the same, as caregivers were both the victims and the vectors of disease in the outbreak in Toronto.

So begins a Harvard Health Policy Course presented by Martin McKneally, MD, PhD, of the Department of Surgery and Joint Centre for Bioethics at the University of Toronto. Dr. McKneally is not an authority on epidemics or infectious disease, but delivered this excellent presentation "as an unembedded reporter who has good access to some of the frontline heroes of the SARS wars."

This is an interesting and informative narrative with a slide show that is a great read from beginning to end. We highlight here this important excerpt:

First, the lesson that stands out most clearly is the need to upgrade the public health system through public education of citizens. It is imperative that people at all levels learn how to protect the public's health through elementary sanitation, isolation and quarantine measures. A powerful lesson was delivered when Jim Young, the Commissioner of Public Security, sent the police to the home of a quarantined citizen who defied the quarantine and was not there to answer the phone when he was called by the public health nurses. Second, we need to intensify health worker education. The work ethic that drove one nurse to ride on the commuter train when she had myalgia and fever led to a far greater problem in "chase & trace" epidemiology than the benefit of her living up to the commitment to put her patients first. I feel that all health workers should be appropriately retrained. After training, they should be "on call" for public health responsibilities, so that the problems and the solutions do not have to be learned ad hoc during an epidemic or a terrorist attack. Third, screening for illness should be part of the entry level requirements for travelers. Far better to know whether a patient is febrile than whether he is carrying nail clippers. I don't say this to criticize the efforts that have been made, but to refocus them.