In an effort to understand the SARS outbreak, public health experts joined U of T researchers and Chinese health officials in a SARS symposium, hosted by the Department of Public Health Sciences and Centre for International Health (CIH) at Mount Sinai Hospital last Wednesday.
What emerged from the daylong symposium was a picture-often scathingly portrayed-of a woefully under-funded public health system with insufficient communication networks at public, government and health organization levels.
“We muddled up how we communicated,” said Harvey Skinner, Professor and Chair, Department of Public Health Sciences.
The symposium opened with a highly critical talk by Richard Schabas, Chief of Staff, York Central Hospital. Schabas complained that early fears of an epidemic were inflated, leading to a misinformed public.
“This was a hospital-based outbreak,” asserted Schabas.
Miscomunication was a prevalent theme in the 21 talks given that day. University Health Network President Tom Closson said communication was “confusing” during SARS. Vivek Goel, U of T’s Deputy-Provost, noted that the Ontario Ministry of Health website was disorganized and lacked clear links to information.
Insufficient communication about protocol concerning those in quarantine between Toronto Public Health (TPH) and the Faculty of Nursing, said Betty Burcher, a lecturer in the Faculty, hampered diagnosis. “We didn’t have the resources and the capacity to [communicate properly],” she said.
Compounding the stress were government structures incapable of dealing with such outbreaks, noted panelists. Currently, health policy is the jurisdiction of the provinces but is run by municipalities; hospitals, however, continue to operate as separate entities. Closson predicts a weak public health system until hospitals and municipal regulations are combined, and John Frank of the Department of Public Health called for tighter federal control.
“We need national standards around public health,” echoed Raisa Deber, Professor of Health Policy Management and Evaluation, Faculty of Medicine. She cited the Walkerton tragedy as an unfortunate example of shirked provincial responsibility.
In contrast, talks given by Chinese health officials-invited to offer an international perspective-revealed top-level government involvement. One talk, looking at the Shanghai region, illustrated a rapid deployment of quarantine measures and broad municipal data collection. Only eight probable SARS cases were reported in Shanghai, said Lai-Yi Kang, Professor and Chief Doctor, Shanghai Municipal Center for Disease Control & Prevention.
Chinese officials, however, were mute in criticizing their own government while their Canadian counterparts were not afraid to speak out about theirs. One Chinese official became defensive, even combative, when asked by a reporter to offer his thoughts about the Chinese government’s handling of SARS.
If national standards are needed here, hurdles remain. Ontario legislation is sorely outdated, noted Frank, and data on the costs and functioning of the public health system are not known. “SARS was just a wake-up call” to a bad system, he said.
“It’s highlighted how stretched our system is,” said Professor Karen Spalding, Faculty of Nursing.
Outdated information technology systems also caused headaches. Barbara Yaffe, Director of Communicable Disease Control, TPH, said the 1980 Provincial database for infectious diseases was ill-suited for SARS. As a result, Public Health was forced to manage patient information with an archaic system of colour-coded Post-It notes.
Closson, citing information technology as “a huge issue,” called for a standard email registration across the health care system. Goel added: “We have to start thinking of the Internet as an essential public health tool to deal with these problems”
But while data is important, said Yaffe, the real problem was volume. “It was a surge-capacity issue,” she said.
The city was forced to handle 300,000 phone calls between March 15-June 24, and as many as 47,567 in one day, with a total staff of 400 per shift for all of TPH.
The pertinent question behind the symposium is whether SARS will lead to a fundamental change in public health care. “This will be, for me, hopefully the real legacy of SARS,” said Skinner.
Closson cautioned that whatever measures are taken, the system must account for a variety of diseases, not just SARS. “It’s really important to prepare ourselves for any pathogen to enter our communities,” he said.
But there is no doubt that change will require substantial financing. A national report on the lessons of SARS, lead by David Naylor, Dean of the Faculty of Medicine, is asking for $2 billion for public health, said Paul Gully of Health Canada. “We are going to wait for the Naylor Report and respond accordingly.”
The Naylor Report is expected to come out some time this week.
