SARS: DRESS REHEARSAL FOR WORSE TO COME

by John Thompson

April, 2003

For years, epidemiologists have been warning our societies to be prepared "for the next big one". Plague has been a frequent visitor in history, and is the deadliest of the Four Horsemen — who usually let him take the lead anyway. But, major epidemics have been rare in the 20^th Century and many have thought that we need not fear them anymore.

In 1918-19 some 30 million people around the World died from a strain of Spanish Influenza — a death toll that was double that of the recently concluded First World War. Asian flu hit around the world in 1957-58 and a major outbreak of a new virus from Hong Kong was averted in 1998 with the slaughter of over a million chickens.

For some years, the World Health Organization (WHO) and the Center for Disease Control (CDC) have worried that the 1918-19 strain of ‘Flu could soon make a return visit. Also, we are on the edge of an era where Terrorists and other non-state actors can use weapons of mass destruction to commit deadlier attacks than have yet been possible; and the revolution in bio-sciences make effective attacks with biological weapons more likely with every passing year.

In short, we have ample reason to look to our defences against man-made or natural epidemics. These defences also need to be occasionally tested.

Once again, Guangdong province in China has been the incubator of a new worldwide epidemic. SARS (severe acute respiratory syndrome), which began in November 2002, has killed well over 100 people in China, caused an entire apartment building in Hong Kong to be quarantined, and created a precedent setting alert by the World Health Organization.

In Canada, Ontario is most severely affected with 129 proven or suspected cases by the end of March 2003, with four deaths, six dozen doctors and over 170 emergency medical staff in isolation. More than 3,000 members of the general public are in voluntary isolation as well. But SARS continues to spread, with cases now in British Columbia, Alberta, Saskatchewan, and New Brunswick.

Was Canada ready? Not only were health officials surprised by the spread of the disease, they also had insufficient quantities of masks and protective coverings available for use. Major hospitals lacked sufficient isolation space, and, of course, few have the decontamination facilities that would be necessary in the event of a man-made biological/chemical threat.

More fundamentally, the protocols for examination and documentation of exposure are not well established and tracking technology is woefully lacking.

The Mackenzie Institute is aware of two separate presentations to Federal and provincial government officials in which the inadequacy of epidemiological tracking routines were pointed out. But, government officials chose to do little to address the problem and are now running to catch up.

Certainly there is a cost in lives lost and health services denied. The economic cost is almost considerable in terms of lost productivity due to the insecurity created by the uncertainty of illness. A more timely and efficient response would have reduced these losses.

Effective response requires proper planning, coordinated preparation, and contemporary technology. Bureaucratic concerns over turf, jurisdiction and budgetary priorities for routine matters have instead put human lives at risk.

It is a sad commentary on Canadian society when a politician can point out that they will be criticized for spending $2 million to stop a problem from happening, which therefore didn’t occur, but hailed for spending $100 million to solve the problem after it happens.

The outbreak of SARS has proved that we still need work in stockpiling vital supplies, expanding some of our hospital facilities, and working on command and control procedures (particularly in regards to epidemiological tracking measures). SARS, bad enough in itself, is a sign that things could be much worse when a worse threat comes calling.

We are having an inexpensive dress rehearsal and should take advantage of it.

John Thompson is President of the Mackenzie Institute which studies political instability and terrorism. He can be reached at: mackenzieinstitute@bellnet.ca