The Asian respiratory virus SARS (Severe Acute Respiratory Syndrome) made an unannounced visit to the city’s hospitals in March, and with it a flurry of activity to contain it. With its close affiliation with hospitals and its reservoir of public health expertise, U of T has been at the forefront of the virus war, both in dealing with the crisis and being affected by a virus whose epidemiology is not entirely known.
“It’s affected all of us,” says Harvey Skinner, chair of the Department for Public Health Sciences, Faculty of Medicine.
Management of the SARS fallout was organized through the Dean’s Executive Committee, Faculty of Medicine, which is responsible for the overall management in all aspects of the department.
To help deal with the two Toronto outbreaks, departmental chairs and associate deans quickly co-ordinated plans to study the disease, disseminate information, and help protect students coming in and out of the hospitals.
Beginning on March 26, the faculty’s Senior Advisory Committee, the most senior committee in the running of the medical school, began convening several times a week and sometimes daily to make sure students did not come down with the virus.
In addition to taking part in infection-control measures upon entering a health care facility (such as donning masks and goggles), students were asked to self-screen and declare any symptoms of illness as a preventative measure, said Dr. Richard Frecker, associate dean, Faculty of Medicine. Dr. Frecker is in charge of undergraduate medical education and served on the Senior Advisory Committee and the Dean’s Executive Committee.
“We’ve had to put in place guidelines and ones that cut across because each of the hospitals have directives,” adds Skinner, who also sat on the Executive Committee.
The measures were on the whole successful. As of June 24, only one third-year medical student was suspected as a probable SARS case on June 6; 12 clinical clerks in contact with that student were subsequently quarantined. There have been 245 probable cases of SARS and 37 deaths in Toronto. The number of active hospitalized cases continues to fall.
The six week interruption was enough to temporarily derail some in the post-undergraduate medical program. Third-year students missed a total of six weeks, which they will have to make up at the beginning of fourth-year and forego one of two six-week elective periods that would have ordinarily been used to seek additional experience. As things are, Dr. Frecker sees “no delay in current third year,” and expects them to graduate on time.
Others fared better. All fourth-years in medicine met the essential requirements for graduation, while first-years had their half-day-a-week in-hospital training terminated and replaced instead with readings, lectures, and seminars.
Dr. Frecker believes that the quarantine experience and the mobilization of students has taught the department to deal effectively with any future small outbreaks. Only a larger outbreak, he said, would warrant a delay in medical education.
Students in the Department of Public Health Sciences, though doing research in hospitals during the SARS epidemic, were not as badly affected. Some students missed one to two weeks of research; others saw a postponement of exams and special accommodations made for students who missed time due to quarantine. Students researching in the hospitals continue to be under their directive. “A lot of our graduates work in the research institutes and hospitals and are affected the same way the undergraduate medical students are,” said Skinner.
Now that age-old preventative measures such as isolation and quarantine are doing well against SARS, what now remains are the lessons learned. Dr. David Naylor, dean of the Faculty of Medicine, was made chair in late April of a national panel set up by Health Canada responsible for enumerating the lessons learned in Canada’s handling of the SARS epidemic.
The panel has not yet settled on any specific health policy that will best deal with future outbreaks, SARS or otherwise, said Dr. Naylor. What is clear, say health professionals, is that basic medical research about the epidemiology of SARS will be vital in combating future outbreaks – including the research that is coming out of U of T.
“I believe we need to understand a lot more about the disease,” said Dr. Naylor. “It’s perilous to make a prediction about what’s going to happen and how we’re going to fight this particular virus until we get clearer about its epidemiology.”
“There will continue to be a number of areas where research is going to be needed in an attempt to prevent future problems,” adds Andrea Sass-Kortsak, associate chair, Department of Public Health Sciences.
Dr. Naylor considers it unlikely that an autonomous regulatory authority will be set up at the university level to deal with public health issues. “We’re not looking at the role of university in terms of infection control so much as to the question of how universities might respond in terms of preparing highly qualified personnel,” he said.
