Toronto's health department in action: Influenza in 1918 and SARS in 2003

Journal of the History of Medicine and Allied Sciences

Volumn 62, Issue 1, 2007, Pages 56-89

  MacDougall, Heather ^a  

^a UNIVERSITY OF WATERLOO   (Canada)

Author keywords

Disease control; Epidemic; Influenza; Pandemic; Public health; SARS; Toronto

Indexed keywords

ARTICLE; CANADA; EPIDEMIC; GOVERNMENT; HISTORY; HUMAN; INFECTION CONTROL; INFLUENZA; SEVERE ACUTE RESPIRATORY SYNDROME;

COMMUNICABLE DISEASE CONTROL; DISEASE OUTBREAKS; HISTORY, 20TH CENTURY; HISTORY, 21ST CENTURY; HUMANS; INFLUENZA, HUMAN; LOCAL GOVERNMENT; ONTARIO; SEVERE ACUTE RESPIRATORY SYNDROME;

EID: 33845221438     PISSN: 00225045     EISSN: 14684373     Source Type: Journal    
DOI: 10.1093/jhmas/jrl042     Document Type: Article

References (203)

1. André Picard, "Mommy, Are You Going to Die?," Globe and Mail, 5 April 2003, F5. This news story revealed the name of the index case and noted that it was an alert Chinese-speaking nurse at Scarborough Grace Hospital who informed the emergency room physician (who had already called Toronto Health because he was concerned about infectious TB) that there was an atypical pneumonia outbreak in China, according to the Chinese-language press. The combination of an alert medical and nursing care team meant that although the index patient had infected nursing staff and other patients while initially waiting for attention in the ER, local health authorities in the hospital and in the community moved to quarantine and isolation procedures in both areas promptly. This story also exemplifies the way that reporters use individual cases to alert their readers to the dangers inherent in outbreaks.
2. See also Chris Daniels, "The SARS Fighters: Agnes Wong, Ontario/Dr. Sheela Basrur, Ontario/Dr. Mona Loutfy, Ontario," Time Canada, 5 July 2004, 164, 32.
3. Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849 and 1866 (Chicago and London: University of Chicago Press, 1962);
4. Geoffrey Bilson, A Darkened House: Cholera in Nineteenth-Century Canada (Toronto: University of Toronto Press, 1980);
5. Judith W. Leavitt, "Politics and Public Health: Smallpox in Milwaukee, 1894-1895," in Sickness and Health in America: Readings in the History of Medicine and Public Health, ed. Judith Walzer Leavitt and Ronald L. Numbers (Madison: University of Wisconsin Press, 1985), 372-82;
6. John Joseph Heagerty, Four Centuries of Medical History in Canada (Toronto: The Macmillan Company of Canada, 1928), 1, 17-211;
7. Margaret Humphreys, "No Safe Place: Disease and Panic in American History," Am. Lit. Hist., 2002, 14, 845-57;
8. Martin S. Pernick, "Contagion and Culture," Am. Lit. Hist., 2002, 14, 858-65;
9. Nayan Shah, Contagious Divides: Epidemics and Race in San Francisco's Chinatown (Berkeley: University of California Press, 2001).
10. The historical literature on epidemics both past and present is best understood through reading Charles E. Rosenberg, Explaining Epidemics and Other Studies in the History of Medicine (New York: Cambridge University Press, 1992);
11. Caroline Hannaway, Victoria A. Harden, and John Parascandola, eds., AIDS and the Public Debate: Historical and Contemporary Perspectives (Amsterdam: IOS Press, 1995);
12. and Shah, Contagious Divides.
13. In her study The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998), Nancy Tomes presents a convincing argument about the impact of the "germ" theory on American attitudes to infectious disease and demonstrates how various groups adapted new behavior patterns and beliefs as a result.
14. More recently, in "Epidemic Entertainments: Disease and Popular Culture in Early-Twentieth-Century America," Am. Lit. Hist., 2002, 14, 625-52, she examines how contemporary problems such as the AIDS, Ebola, and West Nile viruses have been used by the media to create a climate of fear that prompts citizens to ignore significant public health threats by focusing on exotic and unlikely "risks." But her focus is on the way that advertising agencies used scientific discoveries in the mid-twentieth century to sell products by claiming to educate consumers in basic health principles. The use of radio and film for similar purposes is also analyzed to demonstrate the way that science becomes part of popular discourse and is, in turn, modified by popular perceptions.
15. The major North American studies of the 1918 flu epidemic include Alfred W. Crosby, Jr., Epidemic and Peace, 1918 (Westport, CT: Greenwood Press, 1976);
16. nd ed. (New York: Cambridge University Press, 2003);
17. Gina Kolata, Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused It (New York: Farrar, Straus, and Giroux, 1999);
18. Eileen Pettigrew, The Silent Enemy: Canada and the Deadly Flu of 1918 (Saskatoon: Western Producer Prairie Books, 1983);
19. Kirsty Duncan, Hunting the 1918 Flu: One Scientist's Search for a Killer Virus (Toronto: University of Toronto Press, 2003);
20. and Carol R. Byerley, Fever of War: The Influenza Epidemic in the U.S. Army during World War I (New York and London: New York University Press, 2005).
21. An excellent historiographical overview is found in Howard Phillips, "The Re-appearing Shadow: Trends in the Historiography of the 1918-19 Influenza Pandemic," Can. Bull. Med. Hist./Bull. Can. Hist. Med., 2004, 21, 121-34.
22. For a popular history of virology, see Peter Radetsky, Invisible Invaders: The Story of the Emerging Age of Viruses (Boston: Little, Brown and Company, 1991), especially chapter 12
23. "The Quick Change Artist," which discusses the 1918 flu epidemic.
24. See also Eugenia Tognotti, "Scientific Triumphalism and Learning from Facts: Bacteriology and the 'Spanish Flu' Challenge of 1918," Soc. Hist. Med., 2003, 16, 97-110.
25. Anne McIlroy, "1918 Redux?," Globe and Mail, 5 April 2003, F9. In this article, the Globe's science reporter provided readers with specific parallels between 1918 and 2003 but argued that virologists would be able to sequence the genetic makeup of the coronavirus thought to cause SARS.
26. J. M. S. Careless, Toronto to 1918: An Illustrated History (Toronto: James Lorimer & Company and National Museums of Canada, 1984), 157-72, 183-202.
27. James Lemon, Toronto since 1918: An Illustrated History (Toronto: James Lorimer & Company and National Museums of Canada, 1985), 11-23, 92-94, 113-87.
28. See also Lila Sarick, "Visible Minorities Flock to City," Globe and Mail, 18 February 1998, A8. Sarick stated that 1996 census data indicated that 32% of the greater Toronto area's population was visible minorities. The story noted that Toronto's services and language classes were provided in many different languages and that these were under threat because of provincial plans to reorganize the education funding system.
29. Gay Abbate, "Toronto Board of Health Defies Order to Cut Budget," Globe and Mail, 30 July 1997, A5;
30. John Spears, "Budget Blueprint Holds Line on Taxes," Toronto Star, 10 March 1998, B1. According to a TPH Budget Fact Sheet dated 10 March 1998, the department received 1.6% of the $5.9 billion-dollar gross budget for the city. The $44.2 million allocated for TPH services in 1998 was 4.6% less than in 1997 and 9.4% less than in 1996.
31. In 1867 the British North America Act, now known as the Constitution Act, 1982, divided legislative powers between the federal and provincial governments. Health, education, and social services were allocated to the provinces, while the federal government was responsible for national economic policy, the military, criminal law, agriculture, immigration, and only minor health duties such as immigrant inspection, quarantine, and the care of sick mariners and aboriginals.
32. R. D. Defries, ed., The Development of Public Health in Canada, ist ed. (Toronto: Canadian Public Health Association, 1940)
33. and Defries, ed., The Federal and Provincial Health Services in Canada (Toronto: Canadian Public Health Association, 1959, 1962).
34. Ian Hugh Maclean Miller, Our Glory and Our Grief: Torontonians and the Great War (Toronto: University of Toronto Press, 2002), 185. Miller notes that from August to midSeptember 1918, Torontonians received news that 2,127 men were killed, wounded, or missing.
35. Heather MacDougall, Activists and Advocates: Toronto's Health Department, 1883-1983 (Toronto: Dundurn Press, 1990), 26-32.
36. K. M. Yorke, "Saving Lives on the Wholesale Plan: How Toronto Has Been Made the Healthiest of Large Cities," Maclean's Mag., July 1915, 28, 20-22, 93-96.
37. Charles J. Hastings, "The Modern Conception of Public Health Administration," Conservation of Life, July 1917, 3, 49-54
38. continued in Conservation of Life, October 1917, 4, 86-90
39. reprinted in Saving the Canadian City: The First Phase, 1880-1920, ed. Paul Rutherford (Toronto: University of Toronto Press, 1974), 123-36.
40. "A Pull all together," Pub. Health J., 1918, 9, 32-34;
41. F. N. Stapleford, "Causes of Poverty," Pub. Health J., 1919, 10, 157-61;
42. F. N. Stapleford, "The Policy, Spirit and Programme of the Neighborhood Workers Association," Pub. Health J., 1919, 10, 382-86.
43. MacDougall, Activists and Advocates, 60-64.
44. Crosby, America's Forgotten Pandemic, 17-41.
45. H. O. Howitt, "Some Observations on the Recent Epidemic," Pub. Health J., 1919, 10, 508.
46. "The Present Epidemic," Can. Med. Assoc. J., 1918, 8, 1028-29.
47. See Heather MacDougall, '"Enlightening the Public': The Views and Values of the Association of Executive Health Officers of Ontario, 1886-1903," in Health, Disease and Medicine: Essays in Canadian History, ed. Charles G. Roland (Toronto: Clarke Irwin Inc., 1984), 436-64;
48. Michael Bliss, Plague: A Story of Smallpox in Montreal (Scarborough, ON: Harper Collins Canada, 1991);
49. Barbara Craig, "State Medicine in Transition: Battling Smallpox in Ontario, 1882-1885," Ontario Hist., 1983, 75, 319-47.
50. Charles Hastings, "The Value of a Credit Balance in Public Health Administration," Am. J. Pub. Health, 1916, 6, 115.
51. See also MacDougall, Activists and Advocates, 140-41.
52. The Provincial Board of Health of Ontario, "Spanish Influenza," Pub. Health J., 1918, 9, 478.
53. This item is followed on pages 482-85 by an article reprinted from Chicago papers of 3 October 1918. Chicago's Health Commissioner, John Dill Robertson, provided citizens with information from Surgeon-General Blue of the U.S. Public Health Service that focused on the origin of the disease, its symptoms, and treatment. An editorial on page 495, entitled "Influenza, " reminded Pub. Health J. readers that there was ongoing controversy over Pfeiffer's bacillus as the cause of influenza and noted that the Connaught Laboratories of the University of Toronto were undertaking to study whether the causative agent was a filterable virus or B. influenzae and if a prophylactic vaccine were possible.
54. "The Provincial Board of Health of Ontario," Pub. Health J., 1919, 19, 27-30.
55. "Mayor Clashes with Two MOH," The Globe, 9 October 1918, 8;
56. "Can Keep Down the Mortality," The Globe, 11 October 1918, 6. In the latter article, Mayor Church apologized for criticizing Hastings for failing to improve conditions in the military hospitals because the mayor now understood that the city's MOH did not have jurisdiction over such facilities.
57. Judith Walzer Leavitt, The Healthiest City: Milwaukee and the Politics of Health Reform (Princeton, NJ: Princeton University Press, 1982), 227-39.
58. Hastings was also attending an emergency APHA Executive Committee meeting in New York City because it was clear that the annual meeting would have to be postponed due to the ravages of the epidemic in eastern and central North America. See "The Annual Meeting Postponed" in Am. J. Pub. Health, 1918, 8, 786-87.
59. Miller, Our Glory, 185-86.
60. Miller, Our Glory, 186.
61. Pettigrew, Silent Enemy, 48.
62. J. T. H. Connor, Doing Good: The Life of Toronto's General Hospital (Toronto: University of Toronto Press, 2000), 203-4.
63. Irene McDonald, C.S.J., For the Least of My Brethren: A Centenary History of St. Michael's Hospital (Toronto and Oxford: Dundurn Press, 1992), 79.
64. John W. S. McCullough, "The Control of Influenza in Ontario," Can. Med. Assoc. J., 1918, 8, 1084-85.
65. "Hearty Response Made By Nurses," The Toronto World, 17 October 1918, 5.
66. Activities of Central Neighbourhood House, formerly Sc 5, Series D, Box 1, Central Neighbourhood House fonds, City of Toronto Archives. See finding aid number 1005 for current content records.
67. Activities of Central Neighbourhood House, Ibid. The Health Department recognized the additional need in poorer districts and used Salvation Army cadets to assist public health nurses in their home visits.
68. See "S. Army Cadets Fighting 'Flu,'" The Globe, 31 October 1918, 10.
69. "Sunshine Aid to Combat Flu," The Globe, 10 October 1918, 6;
70. "Can Keep Down the Mortality," The Globe, 11 October 1918, 6.
71. File 34081, Series 952, File 7, History of Public Health Nursing, November 1963, 10, City of Toronto Archives.
72. Pettigrew, Silent Enemy, 53.
73. "Deaths from 'Flu' Are on Increase," The Toronto World, 18 October 1918, 4.
74. See also the Globe, 18 October 1918, 4
75. and Globe, ibid, 29 October 1918, 10.
76. Globe, 1918, 10, Ibid.
77. "University Classes Cancelled," The Toronto World, 17 October 1918, 5. The news story stated: "All students in the faculty of medicine are asked to volunteer their services to fight the epidemic."
78. "Victorian Order of Nurses," Pub. Health J., 1919, 10, 290. The VON usually cared for maternity cases, but their small staff of eighteen volunteered to care for the sick during the flu epidemic. The St. Elizabeth Visiting Nurses performed similar duties for Catholic Torontonians.
79. Marion Royce, Eunice Dyke: Health Care Pioneer (Toronto: Dundum Press, 1983), 69-70.
80. Can. J. Med. Surg., 1919, 45, 212 states that Toronto suffered 1,408 deaths from influenza and 1,307 from pneumonia, for a total of 2,715, which was 1,980 in excess of the normal October death rate of 735.
81. "The Provincial Board of Health of Ontario," Pub. Health J., 1918, 9, 542 noted that since influenza was not a reportable disease, "the only means we have of getting anywhere near the deaths caused by the epidemic is from returns made by Undertakers . . . ." The result was an ongoing recalculation of the provincial morbidity and mortality rates as new information arrived. By 1919, McCullough had concluded that Ontario had experienced roughly 40,000-50,000 cases, with 10,000 deaths.
82. "Get Busy With Masks," The Toronto World, 18 October 1918, 4.
83. "Conditions in Industry," The Globe, 29 October 1918, 13 estimated that production had declined 35-39% as a result of the epidemic.
84. See also Miller, Our Glory, 188-89. Miller notes on page 188 that "Officials estimated the loss in [coal] production from the flu to be about 50,000 tons daily."
85. "Want Follows 'Flu' Ravages," The Globe, 31 October 1918, 10;
86. History of Public Health Nursing, 1963, 10, City of Toronto Archives.
87. Miller, Our Glory, 187-92.
88. Charles J. O. Hastings, Democracy and Public Health, Presidential Address to the American Public Health Association, 9 December 1918
89. reprinted from Am. J. Pub. Health, 1919, 9, 13.
90. "To Organize Dept. Of Public Health - Federal Government Will Ask Parliament to Pass Bill," The Globe, 25 October 1918, 2.
91. See also J. Dickin McGinnis, "The Impact of Epidemic Influenza: Canada, 1918-1919," Historical Papers (Canadian Historical Association, 1977), 120-40
92. reprinted in S. E. D. Shortt, ed., Medicine in Canadian Society: Historical Perspectives (Montréal: McGill-Queen's University Press, 1981), 447-78.
93. J. W. S. McCullough, "Control of Influenza," Can. Med. Assoc. J., 1918, 8, 1084-86.
94. This article was republished by the Canadian Medical Association Journal on 26 April 2005
95. accompanied by an article in "The Left Atrium"
96. section by Dr. Gillian Arsenault called "Lessons from History," in which she reminds her readers that we still do not have an effective treatment for influenza, and that we too should use early twentieth-century techniques of providing information and immediate closure of all but essential services to ensure that "when our time comes, we will be able to match the intelligence, energy, coordination and cooperation of our forebears." See www.cmaj.ca/cgi/content/full/172/8/965/DC1 for the full text.
97. P. A. Bator with A. J. Rhodes, Within Reach of Everyone: A History of the University of Toronto School of Hygiene and the Connaught Laboratories, Volume 1, 1927-1955 (Ottawa: Canadian Public Health Association, 1990), ix-24.
98. Tognotti, "Scientific Triumphalism and Learning from Facts," 102-8; see note 24.
99. Robert D. Defries, The First Forty Years, 1914-1955: Connaught Medical Research Laboratories University of Toronto (Toronto: University of Toronto Press, 1968), 49-50;
100. Toronto, Local Board of Health, Monthly Report, November 1919, 4.
101. J. J. Heagerty, "Influenza and Vaccination," Can. Med. Assoc. J., 1919, 9, 226-28;
102. "Official Report on Influenza Epidemic, 1918," Can. Med. Assoc. J., 1919, 9, 351-54;
103. Major T. F. Cadham, "The Use of A Vaccine in the Recent Epidemic of Influenza," Can. Med. Assoc. J., 1919, 9, 519-27;
104. F. H. Wetmore, "Treatment of Influenza," Can. Med. Assoc. J., 1919, 9, 1075-80.
105. See also Tognotti, "Scientific Triumphalism and Learning from Facts," for an overview of the Italian response to the epidemic.
106. In The Globe, there were daily reports about the role of civilian volunteers, and the women's pages during and after the epidemic listed the work of local chapters of the Liberal Association, the IODE (Imperial Order of the Daughters of the Empire), the Samaritan Club, the Red Cross Society, and women's church groups.
107. See The Globe, 16 October 1918, 4;
108. The Globe, ibid, 25 October 1918, 4;
109. The Globe, ibid, 2 November 1918, 10;
110. The Globe, ibid, 6 November 1918, 10.
111. See also Esyllt Jones, "Contact Across a Diseased Boundary: Urban Space and Social Interaction During Winnipeg's Influenza Epidemic, 1918-1919," J. Can. Hist. Assoc., 2002, New Series 13, 119-39.
112. History of Public Health Nursing, 10, City of Toronto Archives.
113. "The Provincial Board of Health of Ontario," Pub. Health J., 1919, 10, 29-30.
114. "A Working Program Against Influenza," Am. J. Pub. Health, 1919, 9, 1-13.
115. Dr. T. H. Whitelaw, "The Practical Aspects of Quarantine for Influenza," Can. Med. Assoc. J., 1919, 9, 1070-74. Edmonton had to enforce Alberta Provincial Board of Health regulations requiring modified quarantine and found that many citizens objected because their neighbors were not subject to the same limitations, even though they too had mild cases of the disease.
116. S. Boucher, "The Epidemic of Influenza," Can. Med. Assoc. J., 1918, 8, 1087-92.
117. "Influenza," Pub. Health J., 1920, 11, 98;
118. "University Course in Public Health Nursing Established in Ontario," Pub. Health J., 1920, 11, 430-31.
119. "Preliminary Programme," Pub. Health J., 1919, 10, 189.
120. MacDougall, Activists & Advocates, 123-25;
121. Paul Bator, "The Health Reformers versus the Common Canadian: The Controversy over Compulsory Vaccination against Smallpox in Toronto and Ontario, 1900-1920," Ontario Hist., 1983, 75, 348-73;
122. and Katherine Arnup, "Victims of Vaccination? Opposition to Compulsory Immunization in Ontario, 1900-90," Can. Bull Med. Hist./Bull. Can. Hist. Med., 1992, 9, 159-76.
123. MacDougall, Activists & Advocates, 157-58.
124. Jane Gadd, "Tuberculosis makes Comeback among Homeless and Poor," Globe and Mail, 7 March 1996, A1, A10;
125. Trish Crawford, "Return of White Plague," Toronto Star, 18 April 1997, B1-2.
126. Andrew Nikiforuk, The Fourth Horseman: A Short History of Epidemics, Plagues, Famine and Other Scourges (Harmondsworth: Viking, 1991);
127. Laurie Garrett, The Coming Plague: Newly Emerging Diseases in a World Out of Balance (New York: Farrar, Strauss & Giroux, 1995);
128. Garrett, Betrayal of Trust: The Collapse of Global Public Health (New York: Hyperion, 2000).
129. See also the epilogue to Nancy Tomes's study The Gospel of Germs
130. and her article "The Making of a Germ Panic, Then and Now," Am. J. Pub. Health, 2000, 90, 191-98.
131. D. R. O'Connor (Hon.), Report of the Walkerton Inquiry: The Events of May 2000 and Related Issues (Toronto, ON: Ministry of the Attorney General, 2002).
132. Gay Abbate, "Toronto Board of Health Defies Order to Cut Budget," Globe and Mail, 30 July 1997, A5;
133. Colin Vaughan, "The Gap between Promise and Reality," Globe and Mail, 5 August 1997, A5.
134. As Colin Vaughan noted, the province was arguing that amalgamation would save money, but previous cuts to Toronto's Health Department had already reduced staffing levels by 25%, and the Toronto region had been designated as under-funded in a 1996 provincial study called Towards Equitable Funding for Public Health.
135. "The Toronto Experiment," Globe and Mail, 6 September 2003, M10-11.
136. Globe and Mail, Ibid. The figures that are derived from the 2001 Canadian census do not include the 35.5% of the population who identified their origin as "Other European." The census also allowed citizens to indicate up to six different ethnic origins, with the result that the overall totals equal more than 100%.
137. Toronto Public Health, Public Health Budget Fact Sheet, 10 March 1998.
138. Justice Archie Campbell, The SARS Commission Interim Report - SARS and Public Health in Ontario, 15 April 2004, 46. The Campbell report can be located online at www.health.gov.on.ca/english/public/pub/ministry_reports/campbell04.
139. Canada, National Advisory Committee on SARS and Public Health, C. David Naylor, chair, Learning from SARS: Renewal of Public Health in Canada: A Report of the National Advisory Committee on SARS and Public Health (Ottawa: Health Canada, 2003), chapter 2, "Anatomy of an Epidemic," 2-3, viewed at www.hc-sc.gc.ca/english/protection/warnings/sars/learning/EngSe30 on 26 October 2003
140. (hereafter, Learning from SARS).
141. Learning from SARS, 3-7.
142. Sheela V. Basrur, Barbara Yaffe, and Bonnie Henry, "SARS: A Local Public Health Perspective," Can. J. Pub. Health, 2004, 95, 22.
143. Mr. Justice Archie Campbell, Second Interim Report: SARS and Public Health Legislation, 5 April 2005, 213-30. This report can also be viewed online at www.health.gov.on.ca.
144. Campbell, The SARS Commission Interim Report 2004, 146.
145. Weizhen Dong, "Beyond SARS: Health Care in a Highly Diversified Society - A Case Study of Toronto," University of Toronto Centre for Health Promotion, 14th Annual Report 2003-2004, 9-10, viewed at http://www.utoronto. ca/chp/download/AnnualReports/2003-04.pdf on 11 July 2006.
146. Mark Hume, "In Search of a SARS Vaccine: 'It's been a Heck of a Ride,'" Globe and Mail, 7 February 2004, F6.
147. Campbell, The SARS Commission Interim Report, 2004.
148. See Inadequate Infectious Disease Information Systems, 100-110
149. and Lack of Surge Capacity: The Toronto Example, 146-52.
150. Campbell, The SARS Commission Interim Report, 2004, 147-49. Justice Campbell noted a variety of criticisms about the lack of sustained follow-up by TPH staff who were familiar with the individual or family's case and several instances where TPH staff called to inquire about the health status of patients, only to discover that they had died in the hospital days earlier.
151. See also Basrur et al., "SARS: A Local Public Health Perspective," 22-23.
152. In his Second Interim Reports: SARS and Public Health Legislation, 5 April 2005, Justice Campbell discussed the legal meaning of the term "quarantine" in chapter 8.
153. He also cited an article by Clete DiGiovanni, Jerome Conley, Daniel Chiu, and Jason Zaborski, "Factors Influencing Compliance with Quarantine in Toronto during the 2003 SARS Outbreak," published in Biosecurity and Bioterrorism: Biodefense Strategy, Practice and Science, December 2004, 2, 265-72, in which Torontonians and health care personnel who had been quarantined reported that they had complied with quarantine requests "to reduce the risk of transmission to others," to protect community health, and because they saw it as their "civic duty." Fear of legal consequences had little influence in the decision to undergo the hardship that ten days in isolation imposed.
154. Caroline Alphonso, "Hospitals Scramble to Protect SARS Staff," Globe and Mail, 22 April 2003, A1, 4;
155. Carolyn Abraham, "Virus Can Live 24 Hours Outside Host," Globe and Mail, 22 April 2003, A1, 4. The second story notes that a team from the Centers for Disease Control in Atlanta had arrived in Toronto to assist infection control experts at Mount Sinai and Sunnybrook and Women's College Health Sciences Centre in determining what measures to take to protect health care workers from infection. Torontonians seemed calm about the outbreak, and even those who regularly used the GO transit system to commute to their jobs were not unduly worried about the possibility of having shared the train with a symptomatic nurse from Mount Sinai on 14 and 15 April.
156. See Colin Freeze, "Commuters into Toronto Ride out Scare," Globe and Mail, 22 April 2003, A5.
157. Chapter 2 of Learning from SARS describes the "Quest for containment" between 8 April and 23 April, 10-12, and notes that the media highlighted each story about possible community spread, leaving the impression that TPH and provincial authorities were not doing their jobs effectively.
158. Rhea Seymour, "Courage Under Fire," Univ. Toronto Mag., Winter 2004, 31, 30. The writer notes that medical and nursing students at the University of Toronto had their classes and clinical rotations canceled as a result of the SARS outbreak. In contrast to 1918, they were not asked to volunteer their services.
159. André Picard, "Outbreak Is Easing, Expert Says," Globe and Mail, 24 April 2003, A1, A8.
160. Campbell, SARS Commission Interim Report 2004, 56-63.
161. Carolyn Abraham and Caroline Alphonso, "Crossed Wires put Toronto on Hit List," Globe and Mail, 24 April 2003, A1, A7.
162. Seymour, "Courage," 32-33.
163. Danylo Hawaleshka, "SARS: Is This Your Best Defence?," Maclean's Mag., 14 April 2003, 116, 24;
164. Murray Campbell, "Disease Is Damaging Ontario's Economy, Cabinet Officials Say," Globe and Mail, 23 April 2003, A4;
165. Jonathon Gatehouse, "SARS: Fear and Loathing of Toronto," Maclean's Mag., 5 May 2003, 116, 19-22
166. and Mary Janigan, "Room at the Table," Maclean's Mag., 5 May 2003, 116, 24-25.
167. Kylie Taggart, "Independent SARS Commission Set up in Ont.," Med. Post, 2003, 39, 5. In this story, Taggart notes that a ninety-six-year-old man who died at NYGH was thought to be the index case for the second SARS wave: a health care worker on the same floor may have contracted SARS from her mother, who had been a patient in the Scarborough Grace Hospital.
168. Learning from SARS, chapter 1, 1, 4.
169. According to Mark Hume's article, "In Search of a SARS Vaccine," China experienced 5,000 cases, with 349 deaths, and was leading in the race to produce a vaccine against SARS. Worldwide, the disease infected 8,500 people in 30 countries and killed 800, including the 44 in Toronto.
170. Terry Murray, "Health-care Staff Have a 'Duty' to Treat," Med. Post, 2003, 39, 6.
171. Seymour, "Courage," 26-29.
172. See also Terry Murray, "MD's Illness Gave Her a Unique View of SARS," Med. Post, 2003, 39, 5.
173. Jackie Smith, "First, Tell the Real Story," Globe and Mail, 28 April 2003, A13;
174. Carolyn Abraham and Lisa Priest, "Cutbacks Fed SARS Calamity, Critics Say," Globe and Mail, 3 May 2003, A1, A6;
175. Richard Mackie and Murray Campbell, "Public-health Spending Cuts Went too far, Critics Say," Globe and Mail, 6 May 2003, A9.
176. Campbell, SARS Commission Interim Report 2004, 132.
177. Campbell, SARS Commission Interim Report 2004, Ibid., 133.
178. Nick McCabe-Lokos, "Know What Is Known about SARS," Toronto Star, 28 March 2003, D5;
179. André Picard, "Fear Factor: So just how Big a Risk Is SARS?," Globe and Mail, 5 April 2003, F8.
180. Gatehouse, "SARS," 22. What made the statement more surprising is that Pat Green's husband was a Toronto firefighter and her son, Derek, was a Toronto Transit Commission bus driver, indicating that all three of them were in occupations that would be at risk if SARS had been spreading in the community.
181. Campbell, SARS Commission Interim Report 2004, 60-61.
182. The Learning from SARS report estimated that SARS would cost Canada two billion dollars, while the former Ontario auditor, Erik Peters, stated that SARS-related spending by the provincial government would cost $720 million, only $250 million of which would come from federal coffers. See Justice Campbell's 2004 Interim Report - SARS and Public Health in Ontario, Appendix E: The Economic Impact of SARS.
183. "Voices from the Front," Maclean's Mag., 5 May 2003, 116, 23-24. Tess Malolos, a member of the Bukas-Loob sa Diyos congregation, explains the misinformation that was harming her family and the Filipino community.
184. Paul Farmer, "Pestilence and Restraint: Haitians, Guantánamo, and the Logic of Quarantine," in AIDS and the Public Debate: Historical and Contemporary Perspectives, 139-52.
185. Danylo Hawaleshka, "Is This Your Best Defence?," Maclean's Mag., 14 April 2003, 116, 21-23;
186. André Picard, "Mommy, Are You Going to Die?"
187. Learning from SARS, chapter 2, 16. "SARS has provoked welcome discussion of the occupational culture in health care .... Countless health care workers faced a fundamental conflict between self-preservation, and a professional obligation to serve the greater good. ... The Committee would like to salute each and every one of them for their courage and commitment."
188. Judy Gerstel, "Doctor's Diary of Deadly Disease, Hong Kong M.D. Shares Experience, His Notes Help Toronto's Battle," Toronto Star, 28 March 2003, D1, D4.
189. Learning from SARS, chapter 2, 16. "Nurses have long voiced concerns that their knowledge and experience is not taken seriously by senior decision makers. At North York General Hospital, nurses alleged that administrators ignored their warnings of an impending second SARS outbreak."
190. For the nurses' perspective, see "SARS War's Unsung Heroes - Nurses at Their Posts through Crisis despite Stress, Danger," National Nursing Week Supplement, Globe and Mail, 12 May 2003, N1. In a more pointed critique of the system, thirty nurses who contracted SARS as a result of nursing patients decided to sue the provincial government.
191. See "Nurses Sue over SARS," The Record, 26 March 2004, A1, A2. The case is still pending.
192. Celia Milne, "SARS Will Strike Again - and Again," Med. Post, 2003, 39, 5, quotes Dr. Mark Lipsitch of Harvard University, who stated that "TPH did a very good job under completely uncertain circumstances."
193. See also City of Toronto Press Release, 12 July 2004, viewed at wx.toronto.ca/inter/it/newsrel.nsf on 15 August 2004.
194. Justice Campbell, Second Interim Report: SARS and Public Health Legislation, April 2005.
195. Prithi Yelaja, "Fear Recalls Past Outbreaks," Toronto Star, 28 March 2003, D2;
196. Anne McIlroy, "1918 Redux?," Globe and Mail, 5 April 2003, F9;
197. Danylo Hawaleshka, "Killer Viruses," Maclean's Mag., 2003, 116, 50-51.
198. Mark Hume, "In Search of a SARS Vaccine";
199. "SARS Vaccine Team Hits Serious Hurdle," The Record, 29 November 2004, A3;
200. Toronto Star, small news item, 20 June 2005, A13;
201. Sheryl Ubelacker, "SARS Link to Acute Lung Failure Discovered in Laboratory Mice," Globe and Mail, 12 July 2005, A11.
202. Carolyn Bennett, "Building a National Public Health System," Can. Med. Assoc. J., 2004, 170, 9;
203. Richard Mackie, "Ontario to put SARS Lessons into Practice," Globe and Mail, 23 June 2004, A9. As a result of experience during the SARS outbreak and growing concern about a future influenza pandemic, all three levels of Canadian government have created pandemic influenza plans. See www.health.gov.on.ca for information on the Ontario plan and its links to the federal plan. See www.toronto.ca/health/pandemicflu/index.htm for Toronto Health's plan.