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Learningfrom SARS Learningfrom SARS Renewal of Public Health in Canada . Learningfrom SARS Renewal of Public Health in Canada A report of the National Advisory Committee on SARS and Public Health October 2003 . i . The members* of the National Advisory Committee on SARS and Public Health were: • Dr. David Naylor, Dean of Medicine at the University of Toronto (Chair) • Dr. Sheela Basrur, Medical Officer of Health, City of Toronto • Dr. Michel G. Bergeron, Chairman of the Division of Microbiology and of the Infectious Diseases Research Centre of Laval University, Quebec City • Dr. Robert C. Brunham, Medical Director of the British Columbia Centre for Disease Control, Vancouver • Dr. David Butler-Jones, Medical Health Officer for Sun Country, and Consulting Medical Health Officer for Saskatoon Health Regions, Regina • Gerald Dafoe, Chief Executive Officer of the Canadian Public Health Association, Ottawa • Dr. Mary Ferguson-Paré, Vice-President, Professional Affairs and Chief Nurse Executive at University Health Network, Toronto • Frank Lussing, Past President and CEO of York Central Hospital, Richmond Hill • Dr. Allison McGeer, Director of Infection Control, Mount Sinai Hospital, Toronto • Kaaren R. Neufeld, Executive Director and Chief Nursing Officer at St. Boniface Hospital, Winnipeg • Dr. Frank Plummer, Scientific Director of the Health Canada National Microbiology Laboratory, Winnipeg (ex officio) * The Committee was materially assisted through corresponding members of the US Centers for Disease Control and Prevention and the World Health Organization. This publication can also be made available in/on computer diskette/large print/audio-cassette/Braille upon request. For further information or to obtain additional copies, please contact: Publications Health Canada Ottawa, Ontario K1A 0K9 SARS Tel.: (613) 954-5995 Fax: (613) 941-5366 ©Her Majesty the Queen in Right of Canada, 2003 Cat. H21-220/2003E ISBN: 0-662-34984-9 Publication Number: 1210 Learning from SARS: Renewal of Public Health in Canada . Learning from ii SARS and Public Health PREFACE . The National Advisory Committee on SARS and Public We learned very rapidly that Canada’s ability to fight an Health was established in early May 2003 by the outbreak such as SARS was tied more closely to the Minister of Health of the Government of Canada, the specific strengths of our public health system than to the Hon. A. Anne McLellan, in the circumstances surrounding general capacity of our publicly-funded personal health the outbreak of Severe Acute Respiratory Syndrome services system. By public health, we refer to systems [SARS]. The Committee’s mandate was to provide a that are population-focused, and include functions such “third party assessment of current public health efforts as population health assessment, health and disease and lessons learned for ongoing and future infectious surveillance, disease and injury prevention (including disease control.” outbreak or epidemic containment), health protection, and health promotion. Our analysis and our The Minister asked the Committee to build on current recommendations accordingly set out a plan for a public health interventions, and to foster and encourage comprehensive renewal of both the public health system collaboration among jurisdictions, professionals, and in general, and the nation’s capacity to detect, prevent, institutions. We were urged to work towards integration understand, and manage outbreaks of significant of all aspects of the containment of SARS (epidemiology, infectious diseases. management, communication, and international coordination). The outbreak of SARS in the Greater The Committee went about its data gathering and Toronto Area was contained during our mandate, as analysis in the following way. expected. Therefore, we extended this integrative approach to our analysis, and recommendations regarding We reviewed a broad range of source documents, research, emerging infectious diseases and public health in general. and reports from Canada and other countries applicable to SARS, communicable disease control, and public Most of this report deals with two major elements of our health infrastructure more generally. The chair and a staff in Canada mandate: provision of a short-term assessment of lessons member personally interviewed in person or by learned from current public health interventions to telephone a range of informants involved in the Toronto contain SARS, and advice regarding issues for necessary outbreak. The Committee’s deliberations were also longer-term action regarding infectious disease control greatly assisted by one full-time policy and research and prevention. advisor, and two part-time research/editorial associates. iii Renewal of Public Health . Two key reports were solicited from outside consultants. As noted in the Acknowledgements, our work was One, by Prof. Sujit Choudhry of the University of informed not only by our own experience and that of Toronto Faculty of Law, dealt with legal issues, including our colleagues, but by the many non-governmental and the difficult question of jurisdictional authorities. With voluntary sector stakeholders who wrote briefs, letters, permission, we borrow directly from Prof. Choudhry’s responded to requests for interviews, and provided report in this document, although it should not be information that enriched our deliberations and assumed that he would agree in all respects with the recommendations. In this regard we reviewed conclusions we have drawn from it. The other approximately 30 written submissions (see report consultancy, by the Hay Health Care Consulting Group appendix for list). [the Hay Group] in Toronto, entailed interviews, a survey, and an analysis of hospital service profiles, to We also requested preparation of extensive background provide an overview of the preparedness of the Greater documents from Health Canada staff in the Population Toronto Area health system to respond to SARS, the gaps and Public Health Branch. The Committee was allowed perceived by stakeholders, and the steps that had been direct and unfettered access to leading professionals in or might be taken to improve responses to infectious the Branch who in turn were given explicit licence to outbreaks in future. We worked with the Hay Group offer their expert opinions and advice, unconstrained by to incorporate their findings directly into our report. the normal reporting hierarchy. Some senior staff drafted Health Canada’s Office of Nursing Policy organized material for the report itself. All such material was first roundtables with front-line health care workers; the revised by staff as per the Committee’s requests, then findings from that valuable exercise have also been edited or rewritten extensively by the Committee incorporated into the report. members. Discourse among members involved about thirty hours of face-to-face meetings, and a substantial amount of electronic and telephone traffic. We live, work, and pay taxes in several different provinces. The members of the Committee represent a multitude of disciplines and perspectives, and several were directly involved in responding to SARS in diverse capacities. SARS . Learning from iv SARS and Public Health TABLE OF CONTENTS . Preface. iii Executive Summary. 1 Acknowledgements . 13 Chapter 1 — Introduction . 15 Emerging and Re-emerging Infectious Diseases . 15 Globalization and Communicable Disease. 16 The World Health Organization (WHO). 17 US Centers for Disease Control and Prevention (CDC) . 17 A “CDC North”? . 18 Emergency Preparedness . 18 The State of Canada’s Public Health System . 19 Federal/Provincial/Territorial Structures and Linkages . 19 Canada’s SARS Experience. 20 Learning from SARS. 20 References . 21 Chapter 2 — SARS in Canada: Anatomy of an Outbreak. 23 2A. A New Disease in Guangdong (November 27, 2002 - February 22, 2003). 23 2B. From Kowloon to Scarborough (February 23, 2003 - March 12, 2003) . 24 2C. SARS I: The Outbreak Begins (March 13, 2003 - March 25, 2003) . 26 2D. The Emergency (March 26, 2003 - April 7, 2003). 28 2D.1 Information Technology and Data Sharing . 28 2D.2 Scientific Advisory Committee . 30 2D.3 Leadership . ..
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