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Lessons from the Toronto SARS outbreak


It was five years ago, when the outbreak of severe acute respiratory syndrome (SARS) forced the government to make tough choices. The need to contain the deadly disease caused widespread restrictions to be placed on non-urgent hospital admissions, hospital-based ambulatory care, and hospital transfers leading to substantial disruptions in hospital clinical practice. New research from Ontario’s Institute for Clinical Evaluative Sciences (ICES) found the restrictions enforced during the outbreak are a safe pubic health strategy to use in future pandemics and outbreaks. There were no adverse health consequences to seriously ill hospitalized patients.

“This is the first study to assess the effects of disruptions to care resulting from sudden, unplanned hospital restrictions,” says lead ICES Investigator and senior scientist, Dr. Therese Stukel. The findings published in the September issue of Medical Care looked at all patients hospitalized in Toronto, Ottawa and London. Both Ottawa and London were not subjected to the restrictions and no SARS patients were admitted to hospital. Researchers followed patients six months for mortality after date of admission for survival, and two months for all readmissions, a marker of general complications. Data were analyzed in seven areas: Hip Fracture, Gastrointestinal Bleed, Pulmonary Embolism, Respiratory Cancer, Intracerebral Hemorrhage, Acute Myocardial Infarction (heart attack) and Very Low Birth Weight. The study showed that mortality and hospital readmissions were generally no different (for these conditions) during the SARS restrictions.

This ICES study has two important messages. First, health officials took appropriate actions to control the spread of SARS and such measures can be used by policy makers and hospital administrators in future pandemic planning without jeopardizing essential care. The second message is for patients with potentially serious conditions—continue to seek emergency department and hospital care during periods of disruption. “Restrictions on hospital care imposed during SARS were the largest, unplanned infection control intervention in recent history,” notes Stukel. “Yet, in the face of when—not if—another pandemic will hit, we have had very little information on the effects of sudden, unplanned disruptions on care. The lack of adverse effects likely reflects the resilience of hospital systems, community based alternatives to specialty care, and the ingenuity, skill and dedication of hospital staff and paramedics who provided adequate levels of care, despite disruptions to routine practice and staff quarantine.”

The SARS outbreak which claimed 44 Toronto lives has already led to changes of how Ontario public health units report to the province. Reportable diseases are now entered into an integrated computer database, so we can track outbreaks like listeria, quickly. This study may be useful to policy makers and hospital administrators considering risk mitigation strategies for pandemic planning.

Funding was provided by a grant from the Canadian Institute of Health Research.

Author affiliations: ICES (Drs. Stukel, Schull, Guttmann, Alter, Manuel, Zwarenstein, Ms. Li, Vermeulen); Clinical Epidemiology Unit, Sunnybrook Health Sciences Centre (Drs. Stukel, Schull); Dept of Emergency Services, Sunnybrook Health Sciences Centre (Dr. Schull); Dept of Medicine, University of Toronto (Drs. Schull, Alter); Dept of Health Policy, Management and Evaluation, University of Toronto (Drs. Stukel, Schull, Guttmann, Alter, Manuel, Zwarenstein); Division of Paediatric Medicine, Hospital for Sick Children, Toronto (Dr. Guttmann); Divisions of Cardiology, St. Michael’s Hospital and Toronto Rehabilitation Institute (Dr. Alter) – Ontario.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


Read the Journal Article