First we hear there’s an Ebola case in Dallas. The man is in hospital, in isolation and everything is fine. Today, October 2 we hear when he first went to hospital he was turned away. And I thought oh my god it’s like Toronto.
In 2003 SARS hit Toronto. And everything fell apart. The first SARS case in hospital was the fortyish son of the elderly patient zero. She got it in China came back to Toronto, passed it to her son. And died. First screwup, she got a sign out autopsy. That’s where if you’re old and have multiple diseases when you die they don’t do an autopsy they just pick one of them and call that the cause of death. This is considered completely acceptable. So her son is in the emergency room coughing all over everybody the doctor he saw, an intensive care doctor, thought he had tuberculosis. Funny thing, tuberculosis is a reportable disease. To public health and you’re supposed to isolate the person. Like immediately. (Isolate means put the person in a room by themself where the air from that room can’t mingle with the air from the rest of the hospital. It’s very clever and it stops airborne diseases from spreading.) Did they isolate him? No, didn’t have the facilities to isolate people at that hospital. Because hey the age of epidemics is like over right? So he coughed on a guy named Pollock, Pollock then passes it to his wife and they both died.
Before people die from SARS they have trouble breathing so they get intubated, the people who do that are anesthesiologists. Anesthesiologists got sick with SARS and passed it to their family members and at least one anesthesiologist and his teenage daughter were both on respirators in the hospital. But did not die. An entire hospital Westpark IRCC was taken over for just nurses and doctors who were sick with SARS. A lot of people were on respirators all at once. This actually helped lots of places prepare for the and H1N1 outbreak in 09. They were ready with the respirators because they knew they might have to, and would be able to deal with, an epidemic of people needing help breathing. Please be aware, the hospital in your town does not have 30 respirators just sitting around in the basement. They may well have used them many during H1N1. They had to order them. That’s one good thing that came out of this and where people showed that they had their head screwed on right. During SARS, and planning for what came in 09.
Two family doctors died because patients were sick with a cough went to see the family doctor. The city didn’t have adequate protocols or places to put people with suspected SARS. No isolation rooms.
Except for Sunnybrook hospital, the major trauma center in Toronto. The guy in charge there as soon as he heard about the SARS thing rented compressor units that allowed him to turn regular rooms into isolation rooms. They’re called negative pressure rooms. They’re used in treating cancer too when the patients’ immune system is all buggered. In cancer they keep everybody else’s germs away from the cancer patient. They worked. None of the other hospitals did that. Not right away anyway. Two infectious disease doctors at another hospital both got SARS. They lived.
In an epidemic like this the public health department of the city government is one of the most important agencies in keeping it from being an even worse disaster. What a thrill. They are in charge of tracing contacts. Anybody who came into contact with the person who has in this case the respiratory-cough-the-germs-all-over the place disease. We’ve all heard about contact tracing when there’s an outbreak of foodborne illness. At a banquet or from a store. Whatever. This is a little more complicated. It’s some individual person’s trail through the city. Okay so public health departments did this all the time in the era of polio. They do it now for sexually transmitted diseases. The city of Toronto was completely unprepared. Their computer crashed. They were reduced to using tiny slips of paper with peoples names on being stuck into little charts on for floor. Well you might say nobody expected SARS. Everyone knew it was coming for a fact. They didn’t know what the disease would be but they knew that an epidemic like that and like Ebola now, was coming. They’ve had a name for it since at least the 90s and that name is jet spread. Okay you may say but if they didn’t know what disease was going to be spread by the jets then they couldn’t prepare for it. BULLSHIT. The way you fight epidemics of air- or sputum-borne diseases is with barriers. With the negative pressure room. With gowns and masks and gloves. It doesn’t matter what the microbe, the germ, is. What the microbe is matters for the drugs you give the person who is sick. But the keeping it from being spread is a whole other critter. They didn’t preplan they didn’t prepare they were fuck ups.
People were in quarantine, now it’s s called isolation in, their homes. They had suspected SARS and some of them did, some of them didn’t but nobody could tell until a certain period of time had passed. So they had to stay in their homes in a different room from the other people in it and wear masks. And they had to change the masks every so often and they had to take Their temperature. And they were checked on by an organization that was monitoring them, the Salvation Army? I think. Lots of quarantined people to monitor. They had to call in volunteers. Like during a hurricane or something. So that sounds pretty good right? And it would’ve been if they had been able to do it competently. They kept calling to check their temperatures of people who had already died of SARS. Competent planning, competent administrative stuff in a crisis would have completely prevented that. This stuff is doable. But you have to spend the time and money before the crisis to prepare for it. You do drills. They didn’t drill. Is that on the Salvation Army? It’s on the city of Toronto public health department. Let’s hope the Dallas one is more competent.
It gets better. The epidemic was slowing, maybe it had stopped. But with epidemics you have to wait until there have been no new cases for some period of time. Depending on the incubation period for the disease. Okay so one hospital in the north of Toronto said oh it’s over we’re going to stop doing our special procedures with the gowns and masks and gloves. We’re going to stop isolating people in the hospital who have pneumonia when we don’t yet know that it’s SARS. You know, the proper precautions. So they stop them. And there was a secondary outbreak of SARS in that hospital. Old people died who were in there to get joint replacements. Even though the outbreak was in a completely different ward. Why did it affect them. Weaker immune systems. That’s medicine 101. They had all the information they needed to do a good job. And this secondary outbreak was in the media for days before the goddamn hospital administration brought back the gowns and gloves and masks. Everyone knew what was going on and some idiot in charge managed to keep the right thing from being done for days or weeks. So elderly people in for joint replacements died. So did a young woman who was in having a fibroid removed from her uterus. Something you can wait six months or six years before you have done. Absolutely elective surgery. If the hospital had told her the truth about this possible SARS outbreak, that in fact was one, she was simply have had it done later and she would be alive today.
This is why the level of governmental that is in charge of fighting epidemics in our society can’t fuck up on every possible point.
Let’s just hope they don’t do this in Dallas.