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Classrooms in Mexico are empty and public gatherings have been cancelled as that country reels from its epidemic of swine flu. The handful of cases seen so far in the United States and Canada, by contrast, have been relatively mild: The 2003 SARS epidemic killed at least 774 people worldwide, including 44 in Canada, the 1968 Hong Kong flu killed about a million people and the 1918 Spanish flu pandemic killed as many as 50 million.
The World Health Organization declared yesterday that "the likelihood of a pandemic has increased" and raised its alert level to match. Even if the Mexican outbreak becomes a pandemic - meaning that it spreads easily between humans and affects a wide geographic area - a pandemic can be mild. But at the moment, there are mixed messages - serious and fatal cases in Mexico and mild cases elsewhere. It's prudent to go on high alert and to prepare for any eventuality.
Canada learned hard lessons from the epidemic of severe acute respiratory syndrome in 2003. Tragic though it was, SARS made Canada better prepared for swine flu. One of its lessons is that leadership matters. After SARS, the federal government created the Public Health Agency of Canada and the position of chief public health officer.
In a pandemic, it's important to have a national public health expert in charge, working in close co-operation with provincial public health leaders. The public needs a trusted voice as a source of information and guidance, because individual actions, such as staying home when sick, are critical to controlling any outbreak. Also, global threats like a pandemic need a co-ordinated international response and someone to speak authoritatively for Canada.
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The sudden and near-constant stream of news reports about swine flu are leaving some feeling anxious and worried, but there are several precautions doctors and experts recommend to protect yourself and your family.
World health officials, racing to extinguish a new flu strain that is jumping borders, raised a global alert to an unprecedented level as the outbreak claimed more lives in Mexico.
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SARS stimulated the development, adoption, and updating of pandemic plans in health-care institutions, businesses and non-profit organizations such as schools and places of worship. A hospital pandemic plan might speak to screening procedures for visitors, guidelines for transferring patients into and out of the facility, and the stockpiling of masks, gowns and anti-viral drugs. There is also a national stockpile with more than 55 million doses of anti-viral drugs.
The adoption of pandemic plans by thousands of organizations across the country also makes us better prepared. During SARS, the ethical challenges came fast and furious. Should public health authorities identify the person later found to be infected who took mass transit? How should intensive-care beds and anti-viral drugs be allocated? What is the duty of health-care workers, from doctors to librarians, to come to work and take on personal risk? We saw stories of personal courage and sacrifice and learned to value the efforts of front-line health workers, especially nurses. The ethical questions admit no easy answers, but they are now addressed in many pandemic plans.
Another SARS lesson is that science matters in a public health epidemic. With record speed, the genome of the SARS virus was sequenced in a Canadian lab, and diagnostic tests and vaccines were developed. Public health laboratories in Winnipeg have already played a role in helping to diagnose Mexican virus samples, and have begun work to develop a vaccine, although this might take six months.
We learned that preparedness depends not only on government, but on citizens. The Public Health Agency of Canada has urged us to wash our hands thoroughly, to cough and sneeze in our sleeves, to stay home when sick. Simple measures and common sense can make a big difference. A key lesson from SARS is that preparedness includes us.
In coming days, it will become clearer whether this outbreak is the world's next severe pandemic. Canada is better prepared as a result of the tragic dress rehearsal of SARS. Even if we are ready for opening night, the response to a severe pandemic is a difficult production to stage.
Peter Singer is director of the McLaughlin-Rotman Centre for Global Health, University Health Network and University of Toronto.