Commentary: What Canada learned (and didn’t learn) from the SARS pandemic


As the second wave of the COVID-19 pandemic takes hold across the country, experts from Western University’s Schulich School of Medicine & Dentistry reflect on what lessons we learned from the SARS pandemic of 2003.

Drs. Michael Silverman, Saverio Stranges and Michael Clarke, say while Canadian officials implemented improvements to public health organization and in-hospital infection prevention and control after SARS, vulnerabilities remained in the long-term care sector and the supply-chain for Personal Protective Equipment (PPE), and these had a great impact in the first wave.

Their commentary, “Did lessons from SARS help Canada’s response to COVID-19” was published this week in the American Journal of Public Health

“In contrast to countries like Hong Kong, SARS did not significantly impact nursing homes and long-term care facilities in Canada, so while Hong Kong mandated that all nursing homes have a designated infection-control practitioner and maintained a month’s supply of personal protective equipment, Canada did not improve its long-term care infrastructure after SARS,” said Dr. Stranges, Chair of the Department of Epidemiology and Biostatistics at Schulich Medicine & Dentistry.

The authors point out that more than 80 per cent of all COVID-19 related deaths in the first wave in Canada occurred in long-term care settings, which is one of the highest percentage death tolls among Organization for Economic Co-operation and Development (OECD) countries.

With respect to lessons learned from SARS about PPE, the authors point out that while Ontario – the province most impacted by the SARS pandemic – initially established a pandemic PPE stockpile after SARS, the province didn’t allocate funds to replace expired product. Unfortunately, the Federal government also failed to maintain a PPE stockpile and so there was no backup supply.

“This happened despite a pandemic Influenza preparedness plan,” said Dr. Michael Silverman Chair/Chief of Infectious Diseases at Schulich Medicine & Dentistry. “This plan emphasized antiviral, but not PPE stockpiling. When the pandemic hit, this was a crucial weakness. The importance of PPE stockpiling was not appreciated after SARS because SARS did not affect a sufficient number of countries to cause the global supply chain to collapse. This did unfortunately happen with COVID-19. Currently, the n95 supply is still somewhat limited making full stockpiling for future surges difficult, and so the country remains at risk of a PPE shortage should the second wave worsen. We have however learned how to improve the efficiency of use of n95s in the first wave. Furthermore, attempts are now underway to ramp up domestic production, but these new sources are yet to be available.”

Where the country did learn from SARS were in the improvements in national, provincial/territorial and local public health Infrastructure. After SARS, the national Chief Public Health Officer (CPHO) position was created in 2004, along with the new Public Health Agency of Canada.

“The goal was to ensure greater federal coordination of responses to emerging Infectious Disease threats,” write the authors. “SARS primarily impacted acute care hospitals, and in response to SARS, training, staffing and routine processes in Infection Prevention and Control in acute care hospitals were upgraded. Unfortunately, the long-term care system did not receive these additional resources.”

The authors also point out that Public Health Laboratories were strengthened after SARS, enabling testing at a critical early point in the COVID-19 pandemic to be five times higher in Canada than in the USA.