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Prepare for next wave of viruses

 The Vancouver Sun by Carol Amaratunga 7 May 2013

Caught off guard by the 2003 SARS pandemic, we should be ready to handle the likes of H7N9 Influenza A case

During the 2003 SARS pandemic, Canadians experienced a cold wake-up call.

Collectively speaking, as the World Health Organization imposed a ban on non-essential travel to Toronto, we learned the social meaning of the disaster management idiom the “YOYO effect,” or “You are On Your Own.” We also learned that, as individuals, we are each responsible for our health and the health of our neighbours, whether they live next door or thousands of miles away.

SARS provided a social imperative for policy-makers to make immediate, strategic investments to ramp up Canada’s public health system.

The creation of the Public Health Agency of Canada (PHAC) was the most notable structural outcome of the “lessons learned” from SARS. In tandem with provincial agencies, PHAC was mandated to provide an effective early warning system to alert Canadians to health risks and threats.

Today, thanks to thousands of unnamed nurses, paramedics, physicians and health-care workers, we are effectively on 24-hour alert. Whether it is Influenza A (H7N9) now winging its way through China, or the lesser-known but considerably more lethal Novel Coronavirus (nCov) that is quietly emerging in the Middle East, we can be assured that Canada is on guard.

But, as individuals, are we ready for the next pandemic? Canadians know little about the Spanish Influenza of 1918-20 that killed an estimated 40 million to 50 million people worldwide, including 50,000 in this country. What does our social memory say about the two waves of SARS that hit Canada between March and June 2003?

Have we forgotten that there were 8,000 cases of SARS worldwide, including 438 probable cases in Canada? A decade ago, 44 Canadians died, three of whom were health-care workers.

The 2003 pandemic also disproportionately affected women both as health-care workers and family caregivers. After SARS, our University of Ottawa research team examined the experiences of 1,500 front-line nurses. Nurses across Canada told us how they were poorly prepared, inadequately trained, and lacked basic supplies and personal protective equipment.

Our research team found that many hospitals did not have pandemic plans in place. Health care workers lacked social and organizational supports and essentially they were not prepared for quarantine. During SARS, almost 6,000 health-care workers were quarantined in their homes for up to 10 days, as were several thousand other Canadians.

Social memory tends to be selective after painful events. Let’s be honest; few will admit that Toronto was almost brought to its knees in 2003. So we had to relearn once again that pandemics bring illness and mass casualties. They destroy and set back economies and they undermine confidence in civil society and good governance. If history is a reliable yardstick, the bad news is that we can expect additional pandemics in the 21st century. The question is whether we now know better and will we be ready?

For the moment, the H7N9 Influenza A outbreak is in Stage 3 and is confined to China. According to WHO, Phase 3 occurs when a virus results in sporadic cases without human-to-human transmission that sustain community-level outbreaks. Confirmed H7N9 cases are occurring in Beijing and Shanghai and the virus has spread to Anhui, Henan, Jiangsu and Zhejiang. Researchers are undertaking genetic sequencing of the virus, but an H7N9 vaccine is not yet available.

As of April 18, 82 patients in China have tested positive with 17 deaths.

Reflecting back, it was essentially old-fashioned public-health practice that saved Canada from mass fatalities during the SARS disaster a decade ago. What can we, as ordinary Canadians, now do to prepare ourselves for infectious disease outbreaks in the future?

The answers are simple: First, get a flu shot; then prevent the spread of germs by washing hands frequently. Do everyone a favour and stay home if you are ill or have symptoms. Refrain from coughing or sneezing on other people and avoid crowds. Best to buy yourself a thermometer and set up a social support “flu” network with family and friends. Stock up and keep at least a week’s supply of food and bottled water in your home.

The H7N9 silver lining is that there are no cases of human-to-human transmission at present. Thanks to the Internet and social media, public-health updates are within everyone’s reach.

The onus is on all Canadians to be informed through the Public Health Agency of Canada (, the B.C. Centre for Disease Control and Prevention ( and the World Health Organization (

As Canadians, we have no excuses not to be ready for H7N9. Let us be grateful we have a competent, professional public health-care system that we can trust. We know, from lessons learned, that we need to ensure two things: that our public health workers are protected and the health care system is adequately resourced.

As Louis Pasteur once remarked: “Chance favours the prepared mind.”

Carol Amaratunga writes on issues related to public safety and population health. She recently retired as dean of applied research at the Justice Institute of British Columbia.