Public health surveillance
SARS outbreak illustrates impediments of
Forty–four people would die of SARS in Canada in 2003; a total of 442 probable and suspected cases would occur. At the end of June, then Ontario Health Minister Tony Clement estimated that SARS had cost that province's health care system $945 million. A doctor on the front lines, Allison McGeer, microbiologist and director of infection control at Mount Sinai Hospital, contracted the disease.
In less than six months, the SARS virus wreaked havoc on lives, families and economies. During that dangerous time, health care professionals worked exhausting hours behind the scenes in an attempt to track and contain the disease. Their tools? Excel spreadsheets, coloured Post–it notes and paper files.
Dr. Barbara Yaffe, the director of Communicable Disease Control at Toronto Public Health, played a crucial role in the SARS response as incident manager. The process, she says, was hindered by an obsolete system called RDIS, which stands for Reportable Disease Information System. "The limitations of the system made it impossible to link contacts with cases and follow up contacts, so we used an Excel spreadsheet. We ended up using lots of files and even Post–it notes, and that's not really a very good way to run an outbreak of a serious illness."
The organization's internal information technology staff quickly put together a database for their use. However, the database didn't extend to other points of care, and each health unit had to create its own system. "A few years before SARS, I was on a provincial committee that made recommendations on the need for a new information system for communicable disease control in Ontario. The recommendations were not approved because of the costs, but it ended up costing the system much more in the end because they didn't have it in place," says Dr. Yaffe.
"Everywhere you turned, there were issues with not having adequate system ability," says Dr. McGeer, a survivor of the disease. "At one stage, we actually had to discard some lab samples because they had been coded for privacy reasons, and we lost the link with the name. Things were lost in the chaos."
As difficult as the challenge of tracking cases and contacts was, there was another information element entirely missing. "There was a relatively small number of SARS cases. When the pandemic comes, the truth of the matter is that tracking contacts is not going to be an important effort," says Dr. McGeer.
To save lives in a pandemic, she says, tracking the epidemiology of the disease is critical. "We're going to want to know who is getting it. Is the hospitalization rate higher in kids, adults or older people? How late in the disease are people presenting to the hospital? What complications are they having? What is our best management of cases to prevent a large number of deaths?"
In 2003, there was no system in place that would allow that process to occur. "I do all of my banking online now. When I fly on a plane, I can get my boarding pass online. In health care, we're still on pieces of paper. Our inability to manage information in health care has become, for me, a really glaring example of a failure in the system. We need to fix it."
The lessons of the SARS crisis have been taken to heart. A Public Health Surveillance IT application (Panorama) that addresses the information technology gaps identified is currently under development. The B.C. Ministry of Health is managing the project, with every province and territory collaborating on its application and design. Canada Health Infoway has invested in this pan–Canadian project. When complete, public health officials from across Canada will be better equipped to manage information in the event of infectious disease outbreaks. For more information, please visit