SARS in Context

SARS in Context: Memory, History, and Policy

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  • Book Info
    SARS in Context
    Book Description:

    Former Ontario Chief Coroner James Young and infectious disease expert Dick Zoutman recount their efforts to contain the mysterious new disease. In answer to questions about "lessons from the past," several distinguished historians of epidemics examine how their knowledge of responses to older plagues influenced their perception of SARS. They also reflect on how the advent of SARS alters their views of the past. Finally, policy experts comment on possible changes to health care that the SARS experience suggests should be made.

    eISBN: 978-0-7735-7684-1
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-viii)
  2. Table of Contents
    (pp. ix-x)
    (pp. xi-xii)
  4. Acknowledgements and About the Cover
    (pp. xiii-xiv)
  5. 1 Introduction: Lessons and Disappointments
    (pp. 1-16)
    Jacalyn Duffin

    Severe Acute Respiratory Syndrome (SARS) began in China in November 2002 and rapidly swept the globe to appear on five continents. From February to July 2003, it affected over 8,000 people worldwide, leaving 774 dead (including 349 in China, 299 in Hong Kong, 44 in Canada, 37 in Taiwan, and 33 in Singapore).¹ This highly contagious lung infection had a predilection for health-care workers and its victims included doctors, nurses, and their family members. The causative agent was quickly identified through international collaboration as a new strain of coronavirus, SARS CoV; it was sequenced by the Michael Smith Genome Sciences...

  6. PART I Memory:: Two Medical Officials Recall SARS in Toronto
    • 2 My Experience with SARS
      (pp. 19-26)
      James G. Young

      As provincial coroner and commissioner of public safety and security, my job is to pick the right people and then sit back and follow their advice. With SARS, we were able to draw on great minds from across Ontario and get them working as a team. Kingston played an important part in the SARS outbreak. Queen’s professor Dick Zoutman led the Science Committee, and I often counted on him for advice. If you learn nothing else from what I tell you here, please remember that problem-solving is much easier when you surround yourself with good people and you are willing...

    • 3 Remembering SARS and the Ontario SARS Scientific Advisory Commitee
      (pp. 27-40)
      Dick Zoutman

      I first learned of SARS while sitting at my computer sometime in early 2003. Almost every morning, I go to see what’s hot by logging on to ProMed and checking the Global Electronic Reporting System. Hosted by the International Society for Infectious Disease, it is available in multiple languages to provide rapid notification of outbreaks around the world. As the SARS outbreak emerged in early 2003 and well before it had a name, I was aware that something had been happening in China.

      The respiratory illness had been evolving in Asia from February or earlier and there may have been...

  7. PART II History:: Historians of Disease Reflect on SARS
    • 4 SARS and Plagues Past
      (pp. 43-68)
      Ann G. Carmichael

      The SARS outbreak evoked different resonances with past plagues. The most obvious connections were immediate and personal, centring around impromptu quarantines and streets full of people in gauze masks. Health-care workers, who were at much greater risk of SARS infection than the general population of any affected area, also communicated their experiences with an immediacy reminiscent of Defoe’s narrator inA Journal of the Plague Year,as they confronted the moral and professional dilemmas that their risk and fears presented. World Health Organization (WHO) interventions led to significant functional revision of international public health surveillance protocols, many of which were...

    • 5 SARS Viewed from the Etiological Standpoint
      (pp. 69-78)
      K. Codell Carter

      SARS came along at a moment in time when the idea that an infectious disease must have a single, unique cause had already captured the scientific and popular imagination. We can contrast its arrival with the multi-factorial possibilities that greeted new infectious problems in a fairly recent past, obscuring solutions that seem obvious to us now. Individual patients with the same disease could have personalized reasons for being ill and vastly different needs for treatment. In this chapter, the rise of etiological thinking will be traced with reference to its many successes, including SARS. Each triumph served to consolidate this...

    • 6 From Cholera to SARS: Communicable Disease-Control Procedures in Toronto,1832 to 2003
      (pp. 79-104)
      Heather A. MacDougall

      In his recently releasedthriller Pandemic,¹Dr. Daniel Kalla drew on his experience as the emergency room doctor who helped to contain Vancouver’s only case of SARS to posit the use of disease as bio-terrorism and to highlight the need for more effective preparations to prevent and control such outbreaks. His hero, Professor Noah Haldane, an infectious disease specialist who works as a trouble-shooter for the World Health Organization (WHO), opens the story with the observation that SARS “has been good for us” because

      SARS put global infectious disease control measures to the test. And guess what? Not one country...

    • 7 Making History: TB and the Public Health Legacy of SARS in Canada
      (pp. 105-120)
      Georgina Feldberg

      When the family of Toronto’s first (but as yet undiagnosed) SARS victim arrived at the emergency room of the Scarborough Grace Hospital, on 7 March 2003, the attending physician suspected that their coughing, fever, and shortness of breath were signs of tuberculosis (TB). Tuberculosis was a logical diagnosis. “We have a large immigrant population in this hospital, Chinese and Indian,” Dr. Finkelstein observed, “and here everything is TB until proven otherwise.”² The radiologist’s interpretation of chest X-rays, taken the following day, supported a diagnosis of tuberculosis. However, Dr. Finkelstein had never previously seen a cluster of TB cases. His inquiry...

    • 8 SARS in the Light of Sexually Transmitted Diseases and AIDS
      (pp. 121-126)
      Jay Cassel

      I come from a place that taxi drivers call the “fruit basket,” locals call the “ghetto,” and the City of Toronto calls Church-Wellesley. When SARS struck in March 2003 the locals were preoccupied with another issue: “barebacking.” Only the police ride horses in downtown Toronto. In the gay ghetto barebacking means anal sex without the use of a condom. Word on the street was that many gay men had sex occasionally without a condom. Some gay men did it by preference many times. Recently there was a major outbreak of syphilis in Montreal and Toronto. Nationally, the number of HIV-positive...

  8. PART III Public Policy in the Aftermath of SARS
    • 9 Introduction to Economic Issues in Epidemiology and Public Policy
      (pp. 129-146)
      Arthur Sweetman

      Epidemics have substantial economic implications, and addressing epidemics has substantial economic motivation. The SARS epidemic has brought these ideas to the fore, and much attention is being paid by the press, think tanks, academia, and government to economic and governance issues in the preparation for future public health crises. Somewhat more recently the threat from avian flu has served to increase the attention paid to this area. These events have stimulated the subfield of economic epidemiology, which considers these topics, but has only begun to develop in the last decade or so. Much is yet to be learned about the...

    • 10 Governance in Pandemics: Defining the Federal Government’s Role in Public Health Emergencies
      (pp. 147-174)
      Kumanan Wilson and Harvey Lazar

      Public health renewal has emerged as an important policy issue in Canada, largely in response to the outbreak of SARS in Toronto in 2003 and in preparation for a possible avian flu pandemic. Of particular concern has been the capacity of this country to respond to public health emergencies in a rapid, coordinated, and effective manner. In attempting to address this issue, the federal government has chosen to take a largely collaborative approach with the provinces, on the assumption that effective relations between orders of government can be maintained in the event of an emergency.¹ In doing so, Ottawa is...

    • 11 The Economic Impacts of SARS and Pandemic Influenza
      (pp. 175-196)
      Steven James and Timothy Sargent

      The SARS outbreak in 2003 and the current threat from the H5N1 avian flu virus have led to a great deal of concern in public health circles. There are fears that the H5N1 virus will mutate into a form that could be transmissible among humans, and that this new virus could spark an influenza pandemic possibly as severe as that observed in 1918. Much of the focus has been on the human cost of such a crisis, which is certainly very substantial. However, it has also prompted governments, business interests, economists, and the general population to speculate about the economic...

  9. About the Authors
    (pp. 197-200)
  10. Index
    (pp. 201-206)