Critical Response to SARS in Toronto, in Howitt and Leonard, Managing Crises, pp. 75-130
The Toronto SARS crisis serves as an important case study for emergency operations personnel. During the unfolding of the crisis, there were some actions that were laudable actions and some others that were unsatisfactory. Given that 43 people lost their lives and scores of others suffered infection, a deep introspection on this emergency episode is called for. The rest of the essay will critically examine the actions taken during the event and identify areas in which emergency responses could be ameliorated.
As author Pamela Varley repeatedly points out in her case study, the ‘novelty’ factor of the SARS epidemic put conventional Emergency Operation Plans (EOP) to test. But the quick rate of spread of the virus, with hospitals themselves proving to be mediums for contagion, had made the Toronto emergency response team all the more arduous. Further, the medical team dealing with suspect patients were found wanting in diagnostic skills. There were speculations that the infection could possibly be a typical Pneumonia or even Tuberculosis. The delay in developing diagnostic algorithms for identifying SARS proved too late for the 43 citizens who lost their lives and the 3 hundred odd who survived a bout of infection.
One could also identify complacency as a major factor in the unraveling of the SARS outbreak. The Toronto Public Health’s (TPH) Communicable Disease Control division had virtually become obsolete as major infectious diseases were brought under control towards the end of the last century. With the conquering of small-pox and measles, the division had been turned into a nominal institution. Its personnel did not anticipate any emergency work of the sort the SARS epidemic would make exigent. This proved to be a big handicap as SARS unfolded in Toronto during that fateful month.
Another factor that proved counterproductive in checking SARS is the decentralized organizational structure of the Canadian healthcare industry. With the general public resorting to both public and private healthcare facilities as it suited them, there was no centralized command structure applicable to all hospitals. Given how even one infected patient can spread the virus to other patients, nurses and doctors in the hospital premises, this lack of control over disparate institutions proved a big handicap. For example, no standard precautionary orders or measures could be ordained upon all hospitals across the city, thus thwarting a concerted effort.
There are some crucial differences between the SARS crisis and the 911 attacks on the Pentagon and the World Trade Center. The former was a live unraveling crisis that posed the threat of a large-scale health hazard. The latter, on the other hand, was a sudden and shocking terrorist attack that left no room for emergency response. Hence the nature of these two episodes is quite different. While during the SARS crisis the onus was on emergency operations personnel to stop and nullify the threat, the 911 attacks left very little time for emergency response. Yet, the New York Fire Department and other allied emergency responders showed a lot of courage and presence of mind in saving those trapped in the twin towers. Operational capacity was a more pressing issue during the SARS crisis.
Non-health emergency responders were affected to the extent that the strategy of ‘quarantining’ that the TPH adopted created bottlenecks in their access. As the crisis began to snowball toward the end of March, many non-health responders found themselves cut-off from points of emergency. What did not help non-health responders is the tendency of both TPH and OPH government officials to get into panic under stressful conditions. Moreover, they got caught up in the blame-game between the two agencies as the death toll started to increase. Yet, non-health emergency responders’ efforts were nothing short of heroic. They brought their previous experience in emergencies as diverse as plane crashes, ice storms, power failures, hurricanes, etc to bear upon the SARS situation.
Since the outbreak in Toronto was sparked by one single Chinese-Canadian individual, questions need to be asked about international airport screenings. It is convenient to apportion the blame on Canadian airport authorities for not having in place a rigorous screening procedure for spotting infected individuals. But when we consider how China had been the epicenter of the epidemic in the months leading up to the virus’ global transmission the Chinese government (especially its international transportation jurisdiction) should take a bigger share of the blame. More importantly, they have to get their act together to prevent such transnational contagions in the future.
To me, the most important lesson or insight understood from the Toronto SARS episode is how the world has turned into one big village. In an environment of high transnational mobility of people, there are no more local epidemics and local health hazards. The threat of infectious disease anywhere is a threat everywhere simultaneously. Towards preparing for tackling such threats in the future, a consortium of several national agencies should be formed. The time has come for a centralized global emergency response organization, much like how the WHO or the UN have come to serve this role in the domains of health and geo-politics respectively. There were also other problems of jurisdiction, where some confusion prevailed as to the responsibilities of Toronto and Ontario public health services. Toronto Public Health officials seemed unsure as to when and how to tap into provincial resources. What also hindered TPH’s efforts is the poor skill level, meager resources and limited statutory authority held by Ontario Public Health.
One of the components of the 8 courses of action is ‘comprehensiveness’. When we look at how the SARS crisis was handled, it is fair to claim that this feature was lacking. Lack of global precedents had deprived emergency planners of all possible manifestations of the health hazard. Moreover, the potent biological traits of the SARS virus provided challenges on technological front. While emergency planning is largely about logistics, co-ordination, distribution and communication, a new potent challenge emerged in terms of understanding the bio-chemical and pathological behaviors of the virus. This elicited a multi-pronged response, involving the service of pharmaceutical and medical research personnel. This is over and above the regular litany of health-care providers and paramedics.
Robust EOPs will also have ‘progressive’ traits, whereby the plans anticipate future disasters and prepare for preventative and safeguarding actions. The objective hereby is nothing short of creating communities that can withstand any sort of unexpected contingency. Likewise, the EOP will also need to be ‘risk-driven’ and ‘integrated’. By integrated, it is meant that emergency personnel act in a coordinated and synergistic manner serving as conduits between government orders and affected communities.
The best EOPs are those that work on the basis of ‘collaboration’ among people and organizations. The objective is to create strong trust, consensus and compassion among all those involved. The other important feature of a good EOP is its flexibility. While plans serve as guiding forces, emergency managers should have the ability to think on their feet and be able to address unexpected situations. Finally, ‘professionalism’ is an inevitable feature of EOPs.
Finally, the Toronto outbreak illustrated how the semblance of an EOP that had then existed was found wanting in the 8 ideal qualities of EOPs. If the authorities and personnel involved will be humble enough to learn from their failings, then constructing and implementing an ideal EOP is not impossible. The 8 features of a good EOP are fairly commonsense principles, which can be acquired through attention to detail, logical analysis and team spirit.