The tenth anniversary of SARS has gone with little recognition from Torontonians, and that's a problem.
In the lobby of Toronto General Hospital’s new Robert R. McEwen Centre Atrium, surrounded by staff and visitors, sits a soapstone statuette encased in glass: a two-foot depiction of an Arctic hunter holding a spear, grappling with a walrus. It’s an unlikely object to find in a hospital foyer, apropos of nothing and seemingly abandoned, as if labourers got tired and decided to set it down beside the Starbucks for lack of a better resting place.
On a silver plastic plaque beneath the case there’s an inscription missing some of its letters: “In recognition of the compassion, dedica_ion and professionalism of those __o worked at _HN du_ing the SARS outb_eak of 2003 and in honour o_ the healt_care professional_ _ho lost their lives to SARS.”
For Toronto, the North American epicentre of SARS, there has been an uncomfortable silence during this, the tenth year since the virus killed hundreds of people worldwide. On February 26, 2003, a human carrier of what would eventually be termed severe acute respiratory syndrome disembarked from a plane at Pearson International Airport and set in motion an episode the likes of which the city hadn’t seen since Spanish influenza struck 85 years earlier. By the end, Toronto’s international reputation was tainted, with overall economic losses estimated at between $1.5 and $2.1 billion. And yet, besides some perfunctory photo essays in the dailies, there has been little recognition of this anniversary.
The fact is, we need to remember what happened. Some might muse sarcastically, “Should we have a celebratory SARS parade down Yonge Street, then?” What exactly would rehashing the memory of a deadly virus accomplish? The answer is that doing so would highlight a very real and still-present danger—that of global pandemics in a world characterized by increasingly accessible cross-continental travel. Some commemoration would also help us confront the inadequate state of our public-health environment at the time the virus struck. In other words, remembering SARS is a means to help us prevent future tragedies.
When the virus was first detected, Toronto—along with municipalities and provinces across the country—was party to the particular economic gymnastics of the two federal governments (I leave aside Kim Campbell’s PCs) that had been in power during the two decades leading up to the outbreak. Apart from a general lack of investment in public-health infrastructure, a crucial problem lay in the Chretien Liberals’ attempt in the mid-90s to eliminate an inherited and crippling federal deficit by reining in spending. The taps were turned off, the valves shut, perhaps in the hope that the reviled-but-necessary Goods and Services Tax, initiated by the Mulroney government, would help. At the same time, provincial governments—particularly Ontario’s Mike Harris PCs and their “common sense revolution”—had plenty of excuses to shrug and chide municipalities for being unable to take care of their financial affairs. What chance did public-health infrastructure have when austerity measures were forcing governments to justify their very existence? (It should be noted, though, that indebted governments around the world look back upon this period as something of a “Maple Leaf Miracle.”)
By the time SARS struck, several reports had clearly underlined a lack of national preparedness. Particularly damning was the Toronto District Health Council’s report of March 2002, a year before the outbreak, which made it clear that the GTA was ill-equipped for the inevitable. Among other things, it says, “There is no coordinated emergency plan for Toronto’s health sector, and appropriate emergency response linkages between provincially funded health care agencies and the City of Toronto do not exist.” Towards the end of the report is a prediction: “Current fiscal challenges preclude the channelling of resources into programs that it is hoped will never be implemented. However, history has shown that events do happen and it is not acceptable to be unprepared to respond quickly and appropriately.” We were a city thinking “if” while everyone around us was saying “when.”
At the start of the outbreak, one of Ontario’s many handicaps was that it was the only province lacking a regional health authority. In other words, there was no body to oversee the twenty-eight hospitals operating in the GTA, all of which, because of the power-sharing structure of the time, operated largely autonomously. The flow of information about the virus and its spread was further hampered by the lack of a shared reporting database. Economic asceticism in the ’90s meant that, in 2003, Toronto Public Health, which ended up being responsible for the majority of SARS cases, was still collecting all of its case information on paper. There was no timely process for preventing a patient whose condition was unknown from spreading the virus before the system could process his or her diagnosis.
It’s significant to consider what else was going on ten years ago. North America was still reeling from 9/11, figuring out how to untangle its traditional defences against any number of then-unknown domestic threats by air, land, and even (in the case of subsequent fatalities by anthrax) post. Locally, there had been Hepatitis B and C contaminations of our blood supply. There was the E. coli outbreak in Walkerton. When SARS arrived, we had had every opportunity to anticipate something. After decades of neglect and severe (and in hindsight untenable) service cuts, with the ribcage of public infrastructure visible to those struggling to make it work on a day-to-day basis, Toronto’s municipal health service didn’t stand a chance. There was nothing in the rulebook about what to do with an outbreak like SARS, because there was no rulebook.
The city is safer now. The Martin Liberals established the position of Minister of State for Public Health on their first day in office. Shortly afterward, they created the Public Health Agency of Canada, which is dedicated to, among other things, the prevention and control of infectious diseases, as well as preparation for public-health emergencies. Investment initiatives have seen funding for Ontario public-health units increase dramatically. The province now has an advisory committee (the Provincial Infectious Diseases Advisory Committee) the goal of which is to oversee matters related to immunization, infection prevention, and surveillance. And this is all good, because while SARS was beaten back, and while we have established a vigilance toward infectious disease in Canada where before there was none, it’s simply a matter of time before another threatening virus or bacterial strain appears. The lives Toronto lost to SARS illustrate the dangers of the previous decade’s austerity measures: out of the 251 people who contracted the virus, 44 of them died. That’s 18 per cent—the highest percentage of deaths in any affected country.
It would be encouraging to believe that we’ve learned our lesson: the backwards folly of sacrificing lives and infrastructure in blind service to the economy. But part of learning is remembering, and the lack of meaningful commemoration, this year in particular, signals a worrisome amnesia. Do we just wait for those who publicly escorted us through SARS to pass away—like Drs. Sheela Basrur and, more recently, Donald Low—to trigger our collective memories, as if it were all just a bad dream? It speaks to our character as a city that Toronto is able to wax nostalgic every year over a power blackout, yet one of its greatest crises, a great and tragic teaching moment, goes without recognition. SARS has become anonymous, not unlike a soapstone statuette in a hospital foyer.