What we learned from SARS and should have used to make a robust public health system to respond to COVID-19

April 27, 2020, Kitchener, Ontario

Posted by: Robert Deutschmann, Personal Injury Lawyer

In July 2004, The Honourable Mr. Justice Archie Campbell released the SARS and Public Health in Ontario Interim Report. The intent of the report was to review how the SARs epidemic unfolded in Ontario and how the spread of SARS showed that Ontario had a broken health system in need of fixing.

The executive summary indicates that any analysis is made easier with the benefit of hindsight. It is important to remember that COVID-19 is a novel virus. That means we have never seen it before, and had no understanding of its makeup, virulence, death rates, treatments, or how it is transmitted. We still don’t have a treatment and a vaccine is under feverish development.

It is also important tot note that any talk of ‘herd immunity’ with COVID is nonsense. There is no understanding of if or how long people who have had it have resistance to it after recovery, and the only way there will be herd immunity is if everyone gets it, or if there is a vaccine widely available and given to the entire population.

Thankfully, many of the recommendations of the report were implemented, however, as we lurch through the COVID-19 pandemic it is interesting to see which of the shortcomings in our health care system were not fixed. We need to examine this closely and demand politicians don’t just do another report but that they take seriously the implementation of the recommendations in order that we be prepared for the next novel disease or pandemic that strikes Ontario residents.

While it is too early to begin any analysis of the response to the current pandemic, I will highlight the conclusions of SARS response here, and you can being to see what has changed for the better and what has not. It is also very important to note that these are system changes that are intended to make our health care response robust and able to cope with any pandemic.

SARS highlighted the faults in the structure and capacity of Ontario’s public health system. During the SARS crisis the local medical system and public health workers were left to cope and contain the disease with little help from the central provincial health system. With COVID-19 we have seen strong leadership from the federal and provincial medical officers of health across the country including in Canada. While there seems to have been be some inconsistencies in the criteria being used to order testing from individual health units this now seems to be resolved.

The Interim Report Executive Summary contained twenty-one principles for reform of the system:

Twenty-one Principles for Reform

The lessons of SARS yield 21 principles for public health reform:

1. Public health in Ontario requires a new mandate, new leadership, and resources.
2. Ontario public health requires renewal according to the principles recommended in the Naylor, Kirby, and interim Walker reports.
3. Protection against infectious disease requires central province-wide accountability, direction, and control.
4. Safe water, safe food, and protection against infectious disease should be the first priorities of Ontario’s public health system.
5. Emergency planning and preparedness are required, along with public health infrastructure improvements, to protect against the next outbreak of infectious disease.
6. Local Medical Officers of Health and public health units, the backbone of Ontario public health, require in any reform process a strong focus of attention, support, consultation and resources.
7. Reviews are necessary to determine if municipalities should have a significant role in public health protection, or whether accountability, authority, and funding should be fully uploaded to the province.
8. If local Boards of Health are retained, the province should streamline the processesof provincial leadership and direction to ensure that local boards comply with the full programme requirements established by the province for infectious disease protection.
9. So long as the local Boards of Health remain in place: The local Medical Officer of Health should have full chief executive officer authority for local public health services and be accountable to the local board. Section 67 of the Health Protection and Promotion Act should be enforced, if necessary amended, to ensure that personnel and machinery required to deliver public health protection are not buried in the municipal bureaucracy.
10. Public health protection funding against infectious disease should be uploaded so that the province pays at least 75 per cent and local municipalities pay 25 per cent or less.
11.  A transparent system authorized by law should be used to clarify and regularize the roles of Chief Medical Officer of Health and the local Medical Officer of Health in deciding whether a particular case should be designated a reportable disease.
12. The Chief Medical Officer of Health, while accountable to the Minister of Health, requires the independent duty and authority to communicate directly with the public and the Legislative Assembly whenever he or she deems necessary.
13. The operational powers of the Minister of Health under the Health Protection and Promotion Act should be removed and assigned to the Chief Medical Officer of Health
14. The Chief Medical Officer of Health should have operational independence from government in respect of public health decisions during an infectious disease outbreak. Such independence should be supported by a transparent system requiring that any Ministerial recommendations be in writing and publicly available.
15. The local Medical Officer of Health requires independence, matching that of the Chief Medical Officer of Health, to speak out and to manage infectious outbreaks.
16. The operational powers of the local Medical Officer of Health should be reassigned to the Chief Medical Officer of Health, to be exercised locally by the Medical Officer of Health subject to the direction of the Chief Medical Officer ofHeal
17. An Ontario Centre for Disease Control should be created as support for the Chief Medical Officer of Health and independent of the Ministry of Health. It should have a critical mass of public health expertise, strong academic links, and central laboratory capacity.
18. Public health requires strong links with hospitals and other health care facilities and the establishment, where necessary, of an authoritative hospital presence in relation to nosocomial infections. The respective accountability, roles and respon-sibilities of public health care and health care institutions in respect of infectious outbreaks should be clarified.
19. Ontario and Canada must avoid bickering and must create strong public health links based on Cooperation rather than competition to avoid the pitfalls of federal overreaching and provincial distrust.
20. The Ontario government must commit itself to provide the necessary resources and leadership for effective public health protection against infectious disease.
21. Public health requires strong links with nurses, doctors and other health care workers and their unions and professional organizations.

About Deutschmann Law

Deutschmann Law serves South-Western Ontario with offices in Kitchener-Waterloo, Cambridge, Woodstock, Brantford, Stratford and Ayr. The law practice of Robert Deutschmann focuses almost exclusively in personal injury and disability insurance matters. For more information, please visit www.deutschmannlaw.com or call us at 1-519-742-7774.

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