Johnny Rullán, M.D., FACPM Hotel Melia Lima, Peru 29 mayo 2007
Infectious Disease – SARS: What have we learned? David Butler-Jones MD MHSc CCFP FRCPC FACPM...
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Transcript of Infectious Disease – SARS: What have we learned? David Butler-Jones MD MHSc CCFP FRCPC FACPM...
![Page 1: Infectious Disease – SARS: What have we learned? David Butler-Jones MD MHSc CCFP FRCPC FACPM Toronto March 4, 2005.](https://reader030.fdocuments.net/reader030/viewer/2022020117/56649d795503460f94a5d7ae/html5/thumbnails/1.jpg)
Infectious Disease – SARS:What have we learned?
David Butler-Jones MD MHSc CCFP FRCPC FACPM
TorontoMarch 4, 2005
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Big Risks?
Bright Future?
Something’s Gonna Getcha
David Butler-Jones MD MHSc CCFP FRCPC FACPM
Chief Public Health Officer for Canada
Or Maybe Not
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SARS Corona Virus
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Outline
1. Infectious disease in context
2. SARS in retrospect
3. What we learned
4. What went right?
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Outline (cont’d)
5. Preparing for the next pandemic
6. Actions taken
7. Where the Agency fits in
8. Closing thoughts
9. Q & A
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“One Half of children die before their 8th year. This is nature’s law. Why try to contradict it?”
Rousseau
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1. Infectious disease in context
• Plague wiped out 1 in 3 in Europe
• 90-95% of population of Americas lost within two centuries of Columbus’ arrival
• Typhus Napolean and Russia
• GC/syphilis Allied casualties in Italy
• Malaria & Vietnam
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Context (cont’d)
• Infection/malnutrition kills 40,000 children/day
• Children’s deaths in Afghanistan 100X risk of Western forces
• 1 Million deaths from malaria/year
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Context (cont’d)Population health
Prerequisites• Peace• Shelter• Education• Food• Income• Stable ecosystem• Sustainable resources• Social justice & equity
Determinants• Child development• Working conditions• Education• Choices & coping• Income & social status• Physical environments• Health services• Social support network
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Context (cont’d)
Health & Global Change
• Urbanization
• Climate change
• Globalization
• Economic gaps
• Technology
• Social change
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Context (cont’d)
Health & Global Change
But…• The basics still matter!!!
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The Fog of SARS
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2. SARS in retrospect• 27 November Guangdong Province, China:
• 11 February Guangdong Province, China:
• 14 February Guandong Province, China:
• 18 February Hong Kong:
• 13 March Singapore
• 15 March
Hanoi 43 Hong Kong >100 Singapore 16 Canada 7
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Chain of transmission among guests at Hotel M (Hong Kong, 2003)
Source: MMWR Weekly, March 28, 2003 / 52 (12); 241-248 (found on CDC webs20ite at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5212a1.htm)
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SARS in retrospect (cont’d)
Epidemiology
• Incubation period – 2-10 days
• Prodromal illness:
• Lower respiratory phase
• Transmission from an asymptomatic person is very unlikely
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SARS in retrospect (cont’d)
Transmission
• “Close contact” with symptomatic person
• Most ill = most communicable
• Maximum infectivity around day 14
• Medical procedures that are likely to generate respiratory aerosols are high risk
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SARS in retrospect (cont’d)
Case Fatality (Canada)
• 43 deaths
• Median age 75 years (range 39-99 years)
• Health workers at greatest risk
• Antibiotics/anti-virals not effective.
• Rx-supportive care and steroids (Chinese herbs?)
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SARS in retrospect (cont’d)
Ontario & British Columbia
• A tale of 2 outbreaks
• First case in BC
• First case in Ontario
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“To Prevent Disease,
to Relieve Suffering, and to Heal the Sick,-This Is Our Work” Sir William Osler
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3. What we learned
• Nature inventive & unpredictable – the greatest bioterrorist threat
• Infections have little respect for borders or sensibilities
• Next PH crisis just a plane ride away
• Huge potential economic toll from new infections
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What we learned (cont’d)
• Preparation & response not uniform across country
• Confusion & in-fighting compromise responses
• Effective coordination & communication essential
• Clear decision lines matter
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What we learned (cont’d)
• Hospitals = magnifiers of risk
• Better coordination between hospital I/C and PH
• Strong PH infrastructure, expertise & surge capacity essential
• Need for new national PH agency
• Political & PH leadership needed
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4. What went right?
• Practitioners & public rose to challenge
• Swift collaboration to identify organism & basic epidemiology
• Broad public cooperation
• Fortunately not as infectious as some
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What went right? (cont’d)
• Heightened media/public interest in PH
• Silver lining – broad consensus on need for new national agency
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CDC
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5. Preparing for the next pandemic
Planning, Planning, Planning!
• “Victory awaits him who has everything in order – luck people call it. Defeat is certain for him who has neglected to take the necessary precautions in time – this is called bad luck” – Roald Amundsen
• “Dig a well before you are thirsty” – Chinese proverb
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Preparing for the next pandemic (cont’d)
• Not if, but when
• Coordination & preparation across all levels of government (F/P/T/R)
• Table top exercise – Constant Vigil
• Stockpiling of antivirals
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Preparing for the next pandemic (cont’d)
• Rebuild capacity (PH & I/C)
• Enhanced surveillance
• Rapid response & surge capacity
• Strengthen communications channels
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6. Actions taken
• Real-time alert system
• Hospital-based surveillance network
• Global Public Health Intelligence Network (GPHIN)
• National case definitions
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Actions taken (cont’d)
• Standardized lab tests
• Guidelines, protocols & tools
• But, there’s a caveat…and it has a lot to do with communication
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7. Where the Agency fits in
• A focal point for Canada’s expertise & research in public health
• Our role is to support, facilitate & coordinate
• Build & expand PH partnerships nationally & internationally
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8. Closing thoughts
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Closing thoughts (cont’d)
“The Health of The Public is the Foundation Upon Which Rests the Happiness of The People, and the Welfare of The State” – Disraeli
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Hang in There-
Spring Has Always Followed Winter (so far)
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9. Questions & answers
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Infectious Disease – SARS:What have we learned?
David Butler-Jones MD MHSc CCFP FRCPC FACPM
TorontoMarch 4, 2005