02/10/2020

Good medicine is only one aspect of controlling outbreaks and epidemics

Were better prepared this time seems to have become the mantra of Ontario officials dealing with the challenge of the Wuhan coronavirus.
How the case of the 50-something male who was transported by ambulance to Sunnybrook Health Sciences Centre on Jan. 22 plays out will demonstrate whether that is true or not.
So far, so good.
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The patient disclosed immediately that he had travelled to Wuhan. He was transported to hospital by paramedics wearing protective gear, and is now in an isolation in a negative pressure room. Tracing of contacts is well under way.
Were doing the medicine right this time around, and thats comforting. Mind you, it would be difficult to respond more poorly than happened at the outset of the 2003 SARS debacle.
On March 7, 2003, two men with SARS were admitted to hospital in Canada.
At 4:55 p.m., Mr. C, 55, was transported by ambulance to Vancouver General Hospital. Three hours later, Mr. T., 43, walked into the emergency room of Scarborough General Hospital.
The aftermath of the SARS outbreak in Ontario is well known: The province would record 247 SARS cases (half of them health workers), including 44 deaths (including one doctor and two nurses), and the provinces economy virtually ground to a halt as SARS panic spread.
B.C. didnt have an outbreak; it recorded four cases, and no deaths.
The difference was that B.C. was prepared.
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The B.C. Centre for Disease Control was proactive, monitoring the spread of SARS in China closely, and sending bulletins to emergency room staff. As a result, Mr. C. was isolated immediately. Health workers took appropriate precautions, from paramedics to janitorial staff. The tracing of contacts was swift and rigorous.
By contrast, Ontario had no central agency monitoring infectious diseases. Mr. T. sat in a crowded emergency room then was placed in a ward. A nurse who was an avid reader of Chinese media was the one who alerted the hospital that the patient probably had SARS and more caution was required.
By then, Mr. T. had already become a super-spreader, infecting many health workers and patients who crossed paths with him. It took a while to trace his contacts and, in a domino effect, the infection spread into the community and to other hospitals, with tragic consequences.
But good medicine is only one aspect of controlling outbreaks and epidemics.
Communicating public health messages is, arguably, just as important.
In the grand scheme of things, 44 deaths is not that big a deal, especially when you consider that in Canada SARS was essentially a hospital-based infection that posed little risk to the general public.
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Fear caused billions of dollars in economic damage in 2003, not the SARS coronavirus.
The way to assuage fear of the Wuhan coronavirus is with good information, clearly communicated. In that regard, it is far from obvious that Ontario has learned the lessons of SARS.
At a hastily arranged press conference on Saturday afternoon, there were six people (and one microphone) at the table: Christine Elliott, Ontarios Health Minister; Dr. David Williams, Ontarios chief medical officer of health; Dr. Barbara Yaffe, Ontarios associate chief medical officer of health; Dr. Eileen de Villa, Torontos medical officer of health; Dr. Peter Donnelly, president and CEO of Public Health Ontario, and; Dr. Andy Smith, president and CEO of Sunnybrook Health Science Centre.
All of that public health firepower to make an announcement that can be summarized in a short sentence: Canada has identified its first case of coronavirus.
Talk about overkill.
Not to mention that seeing the six dour faces at the table was eerily reminiscent of the daily televised press conferences that Ontario staged during SARS, where officials often delivered contradictory and confusing messages.
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All the fine people at Saturdays presser have a role to play in the response to the threat of the new coronavirus. But, for the most part, they should be doing their work in the shadows, not in front of a microphone.
Clearly, most of them were there to mark their territory, not to offer insight.
During a crisis or emergency, the public wants a trusted and consistent source of information. When you have six people talking, it leaves the impression that no one is in charge.
What is required is one well-briefed individual with authoritative credentials to be the chief spokesperson.
That creates public confidence, and lends clarity and credibility to the messages.
During a public health crisis, what we need from our leaders is clear information, not territorial posturing.
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