|
| ||||||||
| ||||||||
|
Biosecurity BriefingAnalysis of Toronto SARS Experiences Questions Effectiveness of Quarantine, Cancellation of Elective Procedures By Jennifer Nuzzo, June 22, 2007 In the June 19, 2007, issue of the Canadian Medical Association Journal (CMAJ) two articles analyze the medical and public health impacts of the SARS outbreak in Toronto and call into question the effectiveness of measures used to control the outbreak—specifically, quarantine, travel restrictions, and “restrictions on the non-urgent use of hospital-based procedures.”1 The papers also posit that such measures may have limited impact if applied to an influenza pandemic. In an attempt to control the spread of SARS during the 2003 outbreak in Toronto, Canadian provincial health authorities declared a health emergency which implemented “widespread restrictions on the nonurgent use of use of hospital-based procedures at all 32 hospitals in the Greater Toronto area.” To determine whether these restrictions were effective in reducing the use of “elective and hospital-based services” and what, if any, unintended negative consequences occurred as a result of the restrictions, investigators performed a retrospective analysis of hospital admission data from the greater Toronto area prior, during, and after the SARS outbreak.1 The analysis revealed that:
In light of these findings, the investigators conclude that “the ability of a health care system to admit large numbers of affected patients during a community-based outbreak (surge capacity) will be limited by continued high levels of hospital occupancy.” Cancelling elective procedures may have limited impact during a flu pandemic, as the 12% decrease in admissions achieved through the SARS hospital restrictions “could represent as little as one-quarter of the expected number of admissions if an influenza pandemic were to occur in Toronto.” They stress that public health authorities need to develop “patient prioritization guidelines” to guide admission for hospital-based procedures and to improve ways of communicating with the public to encourage the continued use of the healthcare system by seriously ill patients during a pandemic.1 In another paper published in CMAJ, a Canadian public health expert casts a critical analysis of the use of quarantine and travel restrictions to control the Canadian SARS outbreak. In his commentary, Richard Schabas, Chief Medical Officer of Health for Hastings and Prince Edward Counties, writes that quarantine, which was “adopted early in the [SARS] outbreak, when little was know about the disease,” was ultimately “ineffective” due to poor compliance (“no higher than 57% and possibly much lower”). Moreover, he writes that the practice “wasted resources and public anxiety and intolerance were substantial.” He maintains that SARS was not controlled through use of quarantine, but rather through the “effective isolation of cases in hospitals.”1 Despite this experience, following the SARS outbreak, the Governmental of Canada passed the Quarantine Act (2006) to reinforce health authorities’ ability to detain people who may have been exposed to a communicable disease. Canadian health authorities have called the legislation a “huge step forward in…preparing for an influenza pandemic.” However, Schabas takes that assertion to task, arguing that the SARS experience suggests that quarantine should have a “very limited role in modern public health.” In light of the SARS experience and given the particular biology of influenza, Schabas specifically cautions about the use of quarantine and travel restrictions during an influenza pandemic, warning that the “cost of attempting quarantine for pandemic influenza would be enormous” and a system of restricting travel and quarantining air passengers would “collapse in chaos.” He writes that “national borders are not, and probably never were, an important line of defence against infectious diseases” but that the “real defence lies in sanitation and hygiene, overall health and general medical care, and in immunization, antibiotics and antiviral drugs.”1 References
|