How Vancouver may have stopped SARS, why Toronto didn’t and what it means for Wuhan coronavirus

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In the aftermath of the SARS crisis, officials at federal, provincial and local levels assured the public that lessons learned from SARS at hospitals in Vancouver, left, and Toronto, right, were ingrained at hospitals across the country. Those lessons in pandemic preparation are now being tested as the Wuhan coronavirus has come to Canada.


VANCOUVER—For Susan Sorrenti, the introduction of a new coronavirus to Canada is a stark reminder of the deadly virus outbreak that could have been prevented in Ontario, but instead threatened her life.

After all, of the health care staff who handled SARS patients on the other side of the country, only one got the virus.

When a pneumonia patient was transferred to the hospital where Sorrenti worked as an intensive care nurse in 2003, she recalled being assured that the patient did not have the mysterious new SARS virus. Unprotected by a respirator mask and suit, she was among the first of 146 health care workers to contract the virus that made her feel sicker than she’d ever felt before, and fear for the health of her family.

“Almost 20 years later, nurses have been kind of waiting for the next pandemic,” Sorrenti said. “These mistakes that we made — that’s on us for that period of time in history.

“Now, we don’t have any kind of excuse.”

In Toronto, SARS spread mainly through health care workers like Sorrenti, or hospital visitors. In the aftermath of the SARS crisis, public health experts agreed that hospital transmissions are preventable, and officials from the Public Health Agency of Canada and local health authorities are assuring the public that the “hard learned” lessons of SARS have been ingrained in hospitals across the country.

Those lessons in pandemic preparation are now being tested, as the Wuhan coronavirus — a virus causing serious pneumonia that has killed more than 80 people in China — has come to Canada with two confirmed cases in Toronto.

It’s not the first time a pandemic plan centred on the safety of health care workers will be tested in Canada. In 2003, such a plan was already in place in British Columbia, where SARS was mostly contained. But across the country, there was no such plan in Ontario, and the virus quickly spread throughout Toronto.

On the same day in March 2003, two patients infected with what we now know was SARS checked into two Canadian hospitals 4,500 kilometres apart. In Toronto, an outbreak followed that killed 44 and sent almost 250 to hospitals. In Vancouver, only four people became infected, and just one died.

The first Vancouver patient was immediately isolated, and within 15 minutes, all hospital staff were ordered to use protective N95 masks and stay back from the patient when caring for him. Within two and a half hours of being admitted, he was in a special isolation room.

In 2003, the Ontario government came under fire from the Ontario Nurses’ Association, which accused public sector health care employers of being inadequately prepared for SARS, and failing to heed nurses’ own warnings about a lack of protective equipment.

In Toronto, the patient was admitted to Scarborough Grace hospital and it took 21 hours before he was placed in similar isolation. The doctor who treated him became infected.

The Ontario SARS Commission, tasked with getting to the bottom of what went wrong during the outbreak released its final report in 2007. It concluded that part of the reason SARS never exploded in Vancouver the way it did in Ontario involved an element of luck that the first patient went directly from the airport to his doctor, limiting how many others were exposed to the virus.

It also concluded that, compared to Ontario, B.C. was much better prepared for a pandemic, especially in protocols to protect health care workers. Only one health care worker in B.C., a nurse, was ever confirmed to have SARS.

“The reason we fared so much better in Vancouver was because of the preparedness that was there, but also because we had a very strong occupational health system because the unions had been very active on occupational health,” said Doctor Annalee Yassi, who at the time of SARS headed the Occupational Health and Safety Agency of B.C., a joint union-government initiative to promote health care worker safety.

“The key to stopping an outbreak is precisely isolation of the infected individuals,” Yassi said. “All the people caring for that individual have to be protected or they’re at risk of perpetuating the epidemic.”

It’s like the warning you get when you board an airplane, she said. Put on your oxygen mask before assisting others: That’s the best way for everyone to be protected.

Prior to SARS, B.C. health authorities had already developed a pandemic plan out of concern for influenza strains originating in Asia in the 1990s. Hospital staff were trained on fitting N95 respirator masks and other protective gear, and hospitals had the equipment on hand.

By the time the doctors at Vancouver General got news of SARS, they were on alert for the symptoms and knew the response protocol. WorkSafeBC, the occupational health and safety arm of the ministry of labour, disseminated detailed directions on how to deal with infected patients safely, and began conducting proactive inspections of health care facilities to make sure they were following the rules.

Not everyone agreed with the cautious approach, Yassi recalled.

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“There were some people who may have thought in the early days that using N95 respirators was too expensive … WorkSafeBC is a very strong agency and played a good role in saying you can’t cut corners in protecting health care workers,” she said.

In Ontario, using protective equipment like N95 masks properly took much longer, partly because the province didn’t have a pandemic plan in place prior to 2003, the SARS commission found. Unlike in B.C., ministry of labour officials charged with making sure workers were safe were sidelined during the crisis as the health ministry took the lead on SARS. Labour officials were not notified about SARS cases at first, and didn’t conduct workplace inspections in hospitals with SARS patients until June 2003.

At the time, the province came under fire from the Ontario Nurses Association (ONA), which accused public sector health care employers of being inadequately prepared for SARS, and failing to heed nurses’ own warnings about a lack of protective equipment.

The aftermath of SARS contributed to Ontario’s ministry of labour hiring 100 more inspectors for its occupational health and safety branch, bringing the total number up to 330. There are currently 445 field inspectors in the province’s health and safety branch.

As of Monday, Ontario government representatives could not say how involved those inspectors are in the prevention of coronavirus.

Staff at the ministry of labour referred the Star to the ministry of health when asked if occupational health and safety teams were involved in the coronavirus preparation and containment strategy. A spokesperson for the ministry of health said they had “no information to pass along” that day.

Workplace transmissions turned out to be a defining feature of Toronto’s SARS crisis: 190 of the 247 likely cases were transmitted to either health care workers or visitors in hospitals.

“The ensuing public health crisis brought Ontario to its knees,” reads a portion of the SARS commission report. “The province ended up with 247 probable cases. Almost half were nurses… or other health care workers.”

Vicki McKenna, a registered nurse who is now president of the ONA, remembers that moment of reckoning clearly. She said there are thousands of nurses still working in Ontario’s health care system who were impacted by SARS, many of whom came away from that crisis with ongoing trauma.

Susan Sorrenti, seen in this 2012 file photo, lived through SARS in 2012. She was one of 146 health care workers to get the virus during the outbreak in Ontario.

In Sorrenti’s case, she was separated from her family, learning about the rising death toll of SARS from her own quarantine bed.

“I was the sickest I’d ever been but I wasn’t the sickest SARS patient,” she said of the experience.

She went back to work three months after contracting SARS. She was 40, and the primary income earner for her family. But the worry lingered. “My anxiety was overwhelming,” she said.

Sorrenti’s experience was not unique.

The ONA surveyed hundreds of nurses shortly after SARS and the resulting report contains harrowing feedback from workers who continued to struggle with anxiety even after the outbreak was over, and whose families were ostracized during the crisis because friends and relatives feared coming into indirect contact with a SARS nurse.

One nurse quoted in the survey report stated simply: “I no longer felt safe going to work.”

But McKenna is hopeful the province’s health care system is better prepared for a pandemic now. She said there have been “daily” calls between stakeholders, including the ministry of health and the ministry of labour, to discuss the handling of the coronavirus.

“What I say to the government and what I say to employers is: If the nurses are safe then our patients and residents will be safe,” she said. “This is about the people they care for and so we need to make sure we’re erring on the side of safety.”

Alex McKeen

Alex McKeen is a Vancouver-based reporter covering transportation and labour for the Star. Follow her on Twitter: @alex_mckeen





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