With the recent death of a Liberian Ebola patient in Dallas and the infection of two of the nurses who supported the patient, concerns about Ebola have gone viral.

Those worries strike close to home in Ontario, especially for those who were involved with the 2003 outbreak of SARS. As a reminder, 375 people in the province were infected with SARS, including 169 health care workers. Forty-four people died, including two nurses and a physician. At various points in the emergency, three Ontario hospitals were shut down.

I recall a meeting with the late Dr. Sheela Basrur, Toronto’s chief medical officer of health, in which I asked for a private gloves-off risk assessment of where SARS was heading. Sheela was calm, cool and evidence-driven in her assessment – as well as being totally right as it turned out.

As concern about Ebola has been elevated in the past days, we have seen an active, but appropriately measured, response from Ontario health officials.

Health Minister Eric Hoskins and Ontario’s interim Chief Medical Officer of Health, Dr. David Mowat, issued a statement on Ontario's preparedness for Ebola in the province. On Friday, they announced enhanced measures to contain and treat any potential case of Ebola in the province.

In the language of risk communications, the statement had a two-fold purpose: acknowledging public concern while putting the degree of risk into perspective. Particularly important, though, was the additional message that the safety of front line health workers is a top priority.

And what a difference we are seeing at the federal level. From being a mostly silent partner during the SARS episode in 2003 the federal government is all over the Ebola file with a big announcement mid-week from Health Minister Rona Ambrose about a federal rapid response team being readied to respond to any outbreaks of Ebola in Canada.

Canada’s Chief Public Health Officer, Gregory Taylor, is also convening weekly meetings with provincial chief medical officers to discuss preparedness and ensure the designation of dedicated hospitals specially equipped to receive any Ebola infected patients.

Central in both provincial and federal statements this week are references to the experience and lessons from SARS. Hoskins and Mowat pointed out that “our health care facilities now have sophisticated infection control systems and procedures to protect health care providers, patients and all Ontarians. They are fully equipped to deal with any potential cases of Ebola.”

Canada, and Ontario in particular, did learn some sharp lessons from SARS, many of them captured in the final report of the SARS commission headed up by the late Honorable Archie Campbell. As reports go, this is a page-turner. And many of those lessons have led to significant changes in the public health system, which have filled large gaps in system architecture, accountability and preparedness.

For example:

New legislation clarified the lead role of the province’s chief medical officer of health and created tools for the government in managing emergencies;
Public Health Ontario (PHO) was created as the centre of scientific expertise on public health from a perspective of both prevention and response;
There has been a considerable increase in scientific and technical capacity to monitor, detect and manage infectious diseases in Ontario, which has seen a significant upgrade in laboratory facilities and testing capacity – including for Ebola;
The SARS experience has also resulted in a significant improvement, and greater consistency, in infection and control guidelines and protocols, work that has been led by PHO’s provincial infectious disease advisory committees, which includes Mt. Sinai Hospital’s respected infectious disease specialist Dr. Allison McGeer among its members.
A significant gap in communications and co-ordination has been filled by PHO - a previous paper-based approach (we learned that colour coded “stickies” were used to keep track of SARS cases) has been replaced by an integrated disease surveillance system, which provides for monitoring, detection and management of infection outbreaks, such as C difficile in hospitals.

Given the experience of front-line health workers with SARS in 2003, it’s not surprising that concerns are being flagged by nursing associations.

Linda Haslam-Stroud, president of the Ontario Nurses’ Association told the Toronto Star: “We might be prepared on paper but up on the front lines I do not believe we are fully prepared.” The Star reported that while Haslam-Stroud acknowledged the concern of public health organizations about protecting the public and health care workers, nurses still have concerns about policies on training, patient movement, the use of protective equipment and the supply of safety gear.

This will explain Hoskins’s carefully crafted message to front-line health workers in his statement when he emphasized that his ministry is “continuing to work with health care workers and employers to further strengthen protective measures and ensure they're in place at all times … Our health care workers are on the front lines and it is times like these when we are all reminded of how critical their work is in protecting the public. We want them to feel safe.”

Dean: In Ebola crisis, lessons from SARS come in handy

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