Critical Characteristics of SARS

1
Critical Characteristics of SARS

• Virus related to the common cold
• Spreads by coughing and sneezing
• Harder to spread than a cold
• Much easier to spread than tuberculosis
• Exact odds of transmission are unknown
• Looks like other common diseases
• About 8 die despite aggressive treatment

2
Hospitals as Vectors

• Hospitals and health care workers are often the
  major vector for epidemic communicable diseases
• Smallpox
• Ebola
• Now SARS

3
Why are Hospitals Vectors?

• Concentrated susceptible populations
• Workers move between patients with few sanitary
  precautions
• Patients move around freely
• Hospitals make workers bear the cost of illness
  so they do not go home

4
SARS Control

• Identify the sick people
• Treat the sick people without infecting others
• Keep contacts of sick people at home for 10-14
  days

5
Problems for Hospitals

• How do you staff when you have to send people
  home who have been exposed before the patient was
  identified?
• How do you keep people coming to work when they
  get scared?
• Who protects the facility from walk-ins?
• Do you sort in the parking lot?

6
Financial and Legal Issues for Hospitals

• Who is going to pay the extra costs of care?
• Who is going to pay for replacing furloughed
  staff?
• Who picks up the comp costs?
• What about SARS-related lawsuits?

7
Home Isolation

• Who pays people who have to stay home from work?
• Who brings them food?
• Who takes care of their medical needs?
• Who takes care of their psychological needs?
• If you ignore these, they will not stay home

8
How is Toronto different from the US?
9
Central Health Authority

• Nearly instant coordination of all docs and
  hospitals
• Ability to set uniform standards
• Ability to coordinate staffing
• Ability to control referrals and redirect
  patients
• Ability to shut down elective care and clear out
  hospitals

10
Much more extensive social service and public
health system

• People to do the things to make home isolation
  work
• Immediately set up a comp system
• No health insurance issues on payment
• Compliant Population
• No tort issues
• Few objections to isolation

11
US Model
12
Law and Plans are Cheap

• Lots of planning
• Plans never really address the impossibility of
  carrying them out
• Lots of special laws
• Poorly thought out
• Never come with staff or money to handle the
  problems

13
What Would Happen with an Outbreak?

• Would we limit transportation as was done in
  Canada?
• Would people really stay home?
• How would hospitals cope with a lot of critically
  ill patients when they cannot handle the everyday
  flow of patients?
• None of the plans include putting everyone else
  on the street