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

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

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

SARS Control Identify the sick people Treat the sick people without infecting others Keep contacts of sick people at home for days

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?

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?

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

How is Toronto different from the US?

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

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

US Model

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

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