MERS outbreak: 3 lessons Canada learned from SARS

As South Korea faces an outbreak of Middle East respiratory syndrome, or MERS, Canadian health officials are staying vigilant in case the virus makes it inside our borders.

Knowledge, protocols, communication have improved, experts say

A nurse wears protective clothing at Sunnybrook Hospital in Toronto in March 2003. For the people who fought Toronto's devastating SARS outbreak that year, the news of MERS in South Korea sounds eerily familiar, but experts say we're better equipped this time around. (Kevin Frayer/Canadian Press)

As South Korea faces an outbreak of Middle East respiratory syndrome, or MERS, Canadian health officials are staying vigilant in case the virus makes it inside our borders.

It's more than a decade since severe acute respiratory syndrome, or SARS, infected 8,000 people and killed 774 around the world. Experts say that based on lessons learned from dealing with SARs, the Canadian health system is much better equipped to handle any potential outbreaks — even if the risk of MERS coming to Canada is still very low.

The SARS outbreak in 2003 "both from public's perspective, and certainly within the healthcare system, was extremely frightening, extremely traumatic," says Dr. Brian Schwartz, chief of communicable diseases, Emergency Preparedness and Response for Public Health Ontario.

Workers in full protective gear disinfect the interior of a subway train at a Seoul Metro's railway vehicle base in Goyang, South Korea, on June 9. (Kim Hong-Ji/Reuters)

Schwartz, who was vice-chair of the Ontario's SARS Scientific Advisory Committee, says the preparedness and emergency response at the time was "very, very basic and minimal at best." A federal report released the year after SARS was contained criticized Canada's handling of the outbreak, pointing to poor leadership and co-ordination.

But those missteps eventually led to a culture change in the health care system, says Schwartz, and now we are seeing what he calls "the new normal."

So what are some of the lessons that we learned from SARS that will help us in the event of a MERS outbreak?   

1. Knowledge is power

One of the biggest challenges with SARS in the beginning was that no one knew anything about it. When it first appeared in southern China, it was a mystery to the health community. There was no test to identify it, no knowledge of how contagious it was or how it spread, and no ideas on how to treat it.

"Initially, it reminded me a lot of when AIDS first started," says Jody Macdonald, a registered nurse and lecturer at the Bloomberg Faculty of Nursing at the University of Toronto. "There was a lot of fear."

"Initially, it reminded me a lot of when AIDS first started. There was a lot of fear." – Jody Macdonald,  Bloomberg Faculty of Nursing

Macdonald, who was the chair of the university's undergraduate nursing program at the time, says fear and uncertainty were rampant among front-line health care workers. She recalls that some nurses were so afraid, they resigned rather than be forced to work with SARS patients.

This time around, we have a much better understanding of MERS, and there are tests that can diagnose it within a couple of days, says Schwartz.

Experts also know that the virus doesn't generally spread within communities, but rather within health care facilities and households, so it's easier to identify who is at risk and how to prevent transmission.

"You won't get SARS from going to the grocery store or buying a coffee at Tim Hortons — SARS or MERS," says Schwartz.

2. Have protocols for front-line workers

During the SARS outbreak there were no clear procedures for health care workers regarding how to screen patients or protect themselves from getting infected.

A hospital worker wears a mask during Toronto's SARS outbreak at North York General Hospital in May 2003. In total, 44 people in Canada died from SARS. (Kevin Frayer/Canadian Press)
"There were a lot of things we had to consider that were all very new to us," says Macdonald.

She recalls controversies over what kind of protective gear health care workers should wear and whether it was a good idea to have nursing students screen anyone entering the hospital.

"I think there were communication issues, there were mixed messages," says Macdonald. "We weren't entirely clear and everyone wasn't on the same page around these issues. I think that caused a lot of stress for people."

Now health care agencies have much more robust infection prevention and control procedures to identify and manage potential cases. These include screening procedures, such as assessing a patient's travel history, as well as protocols around isolating potential cases and ensuring health care workers wear proper protective equipment.

Is it perfect? Probably not. But we're certainly farther ahead than we were 10 years ago.– Dr. Brian Schwartz, chief, Communicable Diseases, Emergency Preparedness and Response for Public Health Ontario

In the case of MERS, Canadian health agencies are actively preparing. Soon after it was first identified in 2012, Public Health Ontario and the Ontario Ministry of Health and Long-Term Care started working together to create guidelines and provide support for health care facilities, says Schwartz.

These new protocols have yet to be fully tested, but if the response to the appearance of the H7N9 virus in Canada this year was any indication, Schwartz says it appears that health care workers and physicians, at least, have an increased awareness and a sense of what to do in case an infectious disease does appear.

"Is it perfect? Probably not," Schwartz says. "But we're certainly farther ahead than we were 10 years ago."

3. Clear, timely communication is key

Another area where health officials have made progress is in how agencies and health facilities communicate with each other in an emergency.

The federal report on the SARS response revealed that health care workers were frustrated that there was no effective way for Health Canada to communicate with health workers on the ground. As a result, there were conflicting messages from different agencies, out-of-date advice, and a lack of clarity over who was behind the messages.

There are much better communication systems in place now, says Schwartz, not just in Canada but on a global level. Countries also have a responsibility to report any cases of communicable diseases in their area — including MERS, Ebola and avian flu — to the World Health Organization, which in turn issues alerts and disseminates information.

"That's very important with global travel," says Schwartz.

Passengers wear masks to prevent contracting Middle East respiratory syndrome (MERS) at Incheon International Airport in South Korea. There have been seven reported deaths and almost 100 cases in the country. (Kim Hong-Ji/Reuters)
While authorities in Canada are keeping vigilant and preparing themselves in case of a MERS outbreak, experts emphasize that it's still very unlikely.

"The risk to the general public is extremely low and the idea of wearing masks out in the community should be a non-issue," says Schwartz.

If someone is sick with a fever and a cough or shortness of breath, they should visit their doctor and be sure to tell them if they've been traveling, he says. But he adds that for now, people shouldn't restrict their travel to South Korea. 

"There's zero risk of travelling to South Korea unless somebody happens to be in one of the affected health care facilities," he says.

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