Canada Can't Handle Health Crises
Medical Association says national strategy desperately needed

 
May 27, 2003
Sharon Kirkey, CanWest News Service

Canada's health system shows many signs it is unprepared to cope with the next emerging infection that could easily be more deadly than SARS, a leading medical journal warns.

The country's tracking and reporting of infectious diseases is fragile and slow, front-line doctors aren't getting the information they need fast enough and public health units lack the money and manpower to do proper disease control, an editorial published today in the Canadian Medical Association Journal suggests.

"It was fortunate in a way that [SARS] happened in Toronto, which probably has the best public health unit in the country," journal editor John Hoey said yesterday.

"But, if this had happened in another city in the country, it would have been a different story. We might not be so lucky in the future."

The journal says politicians responded to the "epidemic of fear" unleashed by SARS by "dining out conspicuously in Toronto's Chinatown" and providing some temporary financial aid to hospitals and people forced into quarantine.

"What we need now is a hard look at public health responsiveness in the long term."

The journal says Canada needs an arm's-length agency, similar to the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, which would have the authority to run public health programs across the country and respond to a health emergency.

In the interview, Dr. Hoey argued Canada is suffering from a "real lack of sophisticated health leadership nationally." Senior bureaucrats in the federal health department are "not particularly strong in dealing with critical issues of public health" and few have any formal training in medicine, he said.

By contrast, CDC director Julie Gerberding is an expert in infectious diseases. "It gives her an ability to quickly understand what the issues are, and articulate them to the public without having to go through a heavy bureaucratic structure," Dr. Hoey said.

Had Canada had its own independent national centre for disease control as soon as SARS surfaced, "the federal presence would have been on the ground in Toronto much sooner," he said. "They would very early on have been directing the investigations in Toronto" and sharing the data with other countries, he said.

The editorial appears in today's journal just as a new outbreak of SARS emerges in Toronto, federal officials scramble to trace the source of mad cow disease in an Alberta cow and the Canadian Blood Services begins stockpiling red blood cells in case West Nile Virus starts appearing in humans before the agency can start screening for the mosquito-borne virus in July.

Even before SARS, some critics were warning that cuts to public health units were threatening to unravel Canada's ability to respond to emerging new diseases. In Toronto, health officials had to appeal to outside provinces for additional health workers to cope with the SARS emergency.

Dr. Hoey said a Canadian Office of Disease Control and Prevention would help ensure "aggressively staffed" public health units and better real-time tracking of infections.

Today, if a doctor or nurse sees a patient with a reportable disease or "something unusual" they call the local public health unit, "which has to be available 24/7 to respond and pull that information together," Dr. Hoey said. Case reports are collected provincially and then forwarded to Health Canada. That can lead to potentially dangerous lags in reporting.

Two weeks after the first case of SARS was diagnosed in Canada, some SARS patients were still not being treated in isolation, the editorial notes. That lapse may have contributed "to the widespread outbreak in Toronto, particularly among health care professionals."

While health is a provincial responsibility, Dr. Hoey said it makes far more sense to have one national strategy to combat new viral and bacterial infections and other "environmental threats" to human health rather than rely on a hodgepodge of "10 or 12" different provincial and territorial strategies.

"It's like the patchwork quilt of vaccination, where every province has its own [childhood immunization] strategy. A lot of these bacteria and viruses don't work that way."

The journal warned that the next imported infection "may be as close as the local supermarket, or among the next arrivals at any international airport" and that the next SARS "could easily be more contagious and more virulent."

Tony Clement, Ontario's Health Minister, has announced an overhaul of hospital operations in response to SARS. And Health Canada has struck an expert panel to review the SARS outbreak.

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