Canada's largely immigrant population visiting "the old country"
is a part of the ritural of being Canadian. On one such occasion
a woman visiting her family in Asia required a layover at a hotel
in Hong Kong before returning to Toronto. This hotel was the same
one used by a businessman travelling from Guangdong province, Mainland
China on his way to Vietnam and who was, unknowingly, infected with
SARS. This was the incidental contact that brought SARS to Toronto,
population four milion.
on the arrival of SARS in Toronto, Canada's Globe and Mail newspaper
Editorial of March 28 2003 stated, "Globalization means that
if someone in China sneezes, someone in Toronto may one day catch
a cold. Or something worst ---- If, in Guangdong province, 80 million
people live cheek by jowl with chickens, pigs and ducks, so, in
effect, do we all. Global village, indeed." These realities
of international jet travel have tested Toronto's capability in
managing the latest unknown disease to threaten the human race.
preparation for the possible appearance of West Nile Virus this
summer, Dr. Sheela Basrur, Toronto's Medical Officer of Health,
explained that in compliance with requirements of its 2002 submission
to the International Olympics Committee (IOC), Toronto had a state
of continuous preparedness for such emergencies as SARS. In the
Canadian context this means municipal, provincial and federal government
officials working effectively together. In such a knowledge vacuum,
as exists with SARS, local events are coordinated daily with experiences
around the world through consultation with the U.S. Centre for Disease
Control (CDC) and the World Health Organization (WHO).
classic public health protocols, what could have been a major epidemic,
has been "contained" into primary and secondary clusters
of confirmed and suspected SARS cases. Most persons who initially
came in contact with the first SARS patient were physicians, nurses
and paramedics. These people accepted voluntary quarantine for ten
days. Two hospitals where patient transfers had occurred prior to
realization of the infectious nature of the disease were totally
closed to the public with full infection control procedures in place
for all staff and patients. Patient transfers, elective surgeries,
outpatient clinics and visits were cancelled in all hospitals across
the province of Ontario (population 12 million), until proper protocols
were in place.
health authorities kept the public informed through daily media
briefings about the number of SARS related deaths as well as probable
and suspected cases. Torontonians were repeatedly, instructed to
follow basic public health practices such as voluntary isolation
if required, and hand washing. Ontario’s Minister of Health,
Hon. Tony Clement, demonstrated for the media how people should
wash their hands. Public health officials stressed that SARS in
Toronto was being "contained," was not an ethnic-based
disease and that there was no need for the general public to be
concerned about moving around the City. At international airports,
which are under federal jurisdiction, the Canadian government instituted
protocols for surveying and monitoring incoming flights, particularly
from the SARS related high-risk regions.
over a month after the first SARS case was identified in Toronto,
there were 13 SARS related deaths with 97 probable, 137 suspected
cases and around 4000 people in quarantine with court orders issued
for 11 individuals not voluntarily complying with quarantine requirements.
At the daily media conferences, which were broadcast live on TV
nationally, it was stressed that the SARS was being "contained"
and all suspected cases could be traced to the original patient.
As the weeks progressed people in quarantine were released and persons
infected with SARS made "natural" recoveries. SARS was
proving to be fatal among elderly patients who had pre-existing
these events from his office in Mississauga west of Toronto, Stan
Seggie, President, RBC Travel Insurance, Canada's largest provider
of travel insurance, was asked to comment on how SARS could affect
the travel industry relative to such events as 9/11 and the Iraq
war. Stan said, "With all the events that have happened it
is hard to relate what has attributed to what. But SARS does seem
to be quite a concern of people now. Thank God it seems like they
(public health) have got it under control." Asked if he saw
light at the end of the tunnel for the travel industry he responded
"Absolutely! The travel industry is a very resilient. One thing
we know is that people will travel. Once confidence comes back to
a normal level people will be back in the planes and trains."
the lessons SARS provides Stan said "SARS will not make us
change our policies or anything like that. We hope these events
don't happen but we know they do and that is what insurance is all
about. What we have learnt from SARS is to make sure you have communicated
well with your customers, whether your customer is your distribution
channel or the public at large. Because at times like this there
is uncertainty and the public wants answers and they want them quickly.
We have learnt that we have to be effective communicators."
insurers provide acute episodic care at time of need. What makes
it possible for people to confidently sit besides strangers in planes,
sleep away from home in strange beds, and enjoy exotic meals in
far away places is the public health vanguard that must be in place
locally. Following SARS the travelling public may look for some
recognition of confidence in local public health standards globally
as well as locally.
stated by Stan Seggie, and demonstrated by Toronto public health
authorities, communication is critical at the first sign of infectious
disease emerging. Perhaps international travellers could be given
some assurance that their destination meets basic public health
standards through some kind of accreditation. WHO, CDC, or possibly
the IOC, could set in place basic standards for public health that
communities should meet in serving the international traveller.
If the IOC had more aggressively required China to meet the same
infectious disease management standards as Toronto has demonstrated,
then SARS may have been better contained locally, or, alternatively,
Toronto may have won its bid for the 2008 Olympics over Beijing.
the current outbreak being contained the most likely way a new cluster
can appear in Toronto is from another airplane passenger. Unlike
most international destinations, Toronto has proven it can handle
Notwithstanding the professionalism demonstrated in Toronto's
handling of the SARS situation WHO to issue a travel alert on Toronto
the week subsequent to the posting of this article and then rescinded
it's warning a week later.