The COVID-19 pandemic is unprecedented in its global assault, changing the way we interact with others and redefining daily life. Shortly after the WHO declared COVID-19 a pandemic, the federal government implemented quarantine measures, for which Canadians have had to acclimate their daily living. In 2002, the SARS pandemic also had devastating consequences for Canadians, eventually prompting healthcare professionals to prepare public health measures for future outbreaks.
With the connectedness of the world through globalization, COVID-19 has spread between different regions, countries and jurisdictions. Today, with the help and guidance of healthcare professionals, Canadian provinces have implemented bylaws and regulations to curb the spread of COVID-19. As Canada waits for a vaccine, our understanding of similar virus outbreaks in the past, such as SARS, can help guide our response to the current COVID-19 pandemic.
SARS vs. COVID-19
From February to July 2003, SARS infected 8,098 people worldwide and killed 774 people (44 deaths in Canada). To date, COVID-19 has infected over 35 million people worldwide, accounting for the deaths of over 1,000,000 people (9,000 in Canada alone). Although the case fatality rate of SARS (approximately 10%) is much higher than that of COVID-19 (between about 1.4-3%), more people have died from the latter.
Unlike SARS, most people infected with COVID-19 have mild symptoms, with some even being asymptomatic. It is therefore challenging to identify and isolate these people before they transmit the virus to others. Since the COVID-19 virus spreads via droplets, it is easy for an asymptomatic individual to infect others. Experts have also theorized that the virus that causes COVID-19 is highly transmissible (i.e., more infectious), because there is a significant viral load in the noses and throats of those infected not too long after they develop symptoms. In contrast, people infected with SARS had high viral loads only later in the course of their illness. It seems that COVID-19 will be present for the foreseeable future, with the unique challenges newly presented.
Limitations in Canada’s Response to COVID-19
After the 2003 SARS pandemic, public health experts compiled the Learning from SARS report to propose recommendations for how and where Canada could improve to better prepare for future pandemics. Despite these recommendations, it seems that Canada was ill-prepared for COVID-19 — however, the world could have never anticipated a disease whose scale and gravity is incomparable with anything that has come before it.
In Learning from SARS, public health experts emphasized the avoidance of unnecessary hospitalizations, so that hospitals could admit and accommodate patients without overwhelming hospitals during an outbreak. Today, experts have encouraged the use of at-home treatments to free up hospital space and reduce the risk of patients being exposed to COVID-19. However, since virtual healthcare in Canada has not been well-integrated across the country, patients risk receiving fragmented care that lacks cohesiveness. Although telemedicine confers benefits to both patients and even improves the quality of clinical services, there is insufficient investment and leadership to fully develop it. As Dr. Ahmad Khalid from McMaster University reflects, “It’s time to think bigger and bolder on how to transform our systems so they are ready for the challenges ahead.”
Long-Term Care Facilities
While Canada has invested financially and socially into safer hospital settings in the event of a pandemic, long-term care facilities (LTCs) have been neglected in this effort. The SARS pandemic certainly provided greater insight on how to better prepare hospitals for future pandemics. Staffing shortages and the management or care of many patients by one nurse were considered ideal conditions for the transmission of SARS in 2003. In LTCs, however, the government did not provide guidelines for testing residents and did not provide adequate PPE to these facilities. In Canada, four in five COVID-19 deaths have occurred at long-term care facilities.
According to a report from the military, who were deployed to long-term care facilities in Ontario to help manage outbreaks, conditions at nursing homes were “deeply disturbing.” The report includes accounts of poor infection control, elder abuse, and unsanitary conditions. Since these facilities are excluded from the Canada Health Act, they do not receive federally-funded health services. Additionally, since the health conditions of geriatric populations are markedly different from patients who present at acute care hospitals, the needs of patients at LTCs are also different. Sufficiently addressing the crisis at LTCs will involve implementing policies and protocols to satisfy and acknowledge the special needs of this vulnerable population.
Personal Protective Equipment (PPE)
Public health agencies recommended that hospitals stockpile personal protective equipment (PPE). The National Emergency Strategic Stockpile (NESS) is a federally operated project that stockpiles millions of PPEs in warehouses across the country. Last May, the government discarded over 2 million expired PPEs in a warehouse in Regina. It closed down the warehouse without replenishing the stockpile. After the SARS pandemic, Ontario stockpiled millions of PPEs (including N95 masks). Since an audit had not been conducted, however, in over a decade, the equipment expired and was thus deemed unusable.
To satisfy the PPE demands of COVID-19, the federal government modified its standards and regulations around PPE use. In March, the government relaxed its Health Canada pre-COVID-19 standards so that more masks and gowns could be imported into the country. At the beginning of the pandemic, Saskatchewan responded to the shortage of PPEs by allowing healthcare workers to use expired N95 masks. The masks did, in fact, pass filtration tests and were thus deemed usable. Still, the PPE shortages certainly presented some unique challenges at the onset of the pandemic.
Since provinces exercise autonomy over testing capacity, there are neither guidelines nor national coordination to inform testing. While there have been improvements to testing capacity since SARS, Canada still trails other countries and jurisdictions in this regard. To reduce a backlog of testing, many provinces modified their eligibility requirements for testing, so that it was restricted to a smaller cohort of individuals. In Ontario, for example, testing was initially limited to those who met certain conditions. There were thus low testing rates, and at the time, there seemed to be no provincial strategy for increasing these numbers.
In the Learning from SARS report, Canada’s absence from the global community on scientific investments and COVID-19 related advancements was flagged as concerning. Indeed, Canada had not satisfied the scientific recommendations outlined in the 2003 report. At the onset of the pandemic poor funding impeded Canada’s “public health science capacity” such that Canada was not assuming leadership roles in global scientific research.
On June 25th, 2020, however, Canada’s Minister of Health announced that an investment of 109 million dollars would support 139 research teams in their investigations on the transmission of COVID-19 and its impact on “people, communities and health systems.”
Transfer of Information and Data
During the SARS outbreak, the use of information communication technology (ICT) and eHealth solutions emerged. These technologies were imperative in detecting the virus early, as well as facilitating effective communication and collaboration amongst individuals around the globe by leveraging technologies, such as the internet, wireless smart devices, and mobile phones to seamlessly exchange data. However, although health technologies have offered solutions to many challenges of a viral pandemic, Dr. Eysenbach, a researcher on eHealth also stated that “it has the potential to fuel an epidemic of fear and collective mass hysteria.” For instance, health technologies were not always accurate — false positive test results often led to media reports, which then led to the creation of an epidemic of fear. Thus, although these technological solutions during SARS enabled Canadian healthcare professionals to begin seamlessly transferring information and data, they also had the potential to create negative feelings of mass fear in the general public.
Technology’s ability to create mass fear and hysteria has continued to be evident during the COVID-19 pandemic. Since SARS, the transfer of data and information has further improved and increased at a rapid pace due to the rise of social media. According to the MIT Technology Review, social media has enabled misinformation to spread at levels that have never been seen before during previous outbreaks such as SARS, MERS, and Zika. This has amplified global panic and public fear of the coronavirus, resulting in racist memes and slurs against Asians in person and online.
Despite the spread of misinformation, however, social media has also proven to be a significant source of verified information. It has allowed individuals to report on the status of the COVID-19 pandemic from different regions of the world, enabling organizations to take action during outbreaks and global health issues. Most importantly, social media has allowed people to share their thoughts and concerns with others, thus providing space for people to feel less alone during a time of quarantine, grief, and loss.
Although technology and social media may pose risks for misleading information and creating mass fear during a viral outbreak, they are crucial to the dissemination of real, verified data, and help to foster a sense of community.
It is essential that we learn from previous public health issues in order to better prepare for future health challenges. We were initially unprepared for the unique challenges of the COVID-19 pandemic, but we can continue to learn and improve from our mistakes. Communication systems such as ICTs and social media are helping to track and contain the spread of COVID-19 by sharing information and data with others. While the COVID-19 pandemic is different from SARS in prevalence and severity, Canadians are applying lessons learned in 2003 to address present-day challenges. While we are fatigued by the demands imposed by a new way of living, many of us continue to seek solace in each other through virtual means. It is only a matter of time before we finally triumph over this virus, and write a truly heroic narrative for the history books.