In 2003, Canada failed the pandemic test. Here's what we've learned since

This is the moment Canada has been preparing for over the past 17 years — a chance to pass the pandemic test this country failed during the SARS outbreak of 2003, and to find out through our response to the COVID-19 pandemic just how much we've learned from our mistakes.

Those mistakes had tragic and deadly consequences. They also exposed systemic flaws in how Canada's health care system copes with a fast-moving viral outbreak.

Outside of Asia, Canada was the country hit hardest by SARS: more than 400 probable cases and 44 deaths, most of them in Toronto and surrounding areas. Thousands more were forced to self-isolate in their homes.

Back then, Ontario did not even have a pandemic plan. There was virtually no co-operation between the federal and provincial governments. There was no Public Health Agency of Canada, no Chief Public Health Officer at the federal level.

A 'broken' public health system

Far too many health care workers were exposed to the SARS coronavirus; 100 became ill and three died. There were not enough microbiologists to do the required testing. The provincial government's communications plan was almost incoherent — not enough Canadians were told what they needed to know, when they needed to know it.

The conclusion of the SARS Commission, launched by the Ontario government and led by Justice Archie Campbell, was about as damning as it could have been:

"The public health system was broken, neglected, inadequate and dysfunctional," said the final report, released in 2007. "It was unprepared, fragmented, unco-ordinated. It lacked adequate resources, was professionally impoverished and was generally incapable of fulfilling its mandate."

The recommendations coming out of that report, and another done for the federal government, did lead to key reforms, including the creation of a public health agency at the federal level to lead the co-ordination of treatment and containment.

'Almost every one of those gaps has been filled'

Back in 2002, Tony Dean (now a senator) was named secretary of the Ontario cabinet and clerk of the executive council, making him responsible for leading and co-ordinating the provincial government's response to SARS. Today, Dean remembers it as a time when experts and public servants alike were "wandering around in the dark."

Official communications were contradictory, he said, and authorities lacked the ability to track cases. Hospitals were unprepared, lacking both the proper equipment and a degree of experience with irregular viruses like SARS.

"Fast forward to today," he said, "and almost every one of those gaps has been filled, including governance and who [is] in charge."

The SARS outbreak caught Canada flat-footed, despite numerous warnings that the country's approach to public health needed to change to cope with fast-moving viruses.

Warnings ignored

As a result, said the final report of the National Advisory Committee on SARS and Public Health, chaired by Dr. David Naylor, the SARS outbreak left politicians and public health officials with a long list of lessons learned — because so many earlier lessons had been ignored.

In 1993, after HIV emerged as a major public health threat, a Health Canada working group called on the federal government to build up its public health infrastructure and create "a national strategy for surveillance and control of emerging and resurgent infections."

The Krever Inquiry into Canada's contaminated blood system filed a report in 1998 that also called for improvements to public health infrastructure.

It took the SARS outbreak to wake Canada up.

Dean said that wake-up call seems to have worked — and public health officials have a much better toolkit for dealing with COVID-19 than they did in 2003: "Better training for health professionals, better hospital protocols, better equipment, more negative pressure rooms in hospitals, [the] ability to track cases digitally and better and faster testing of cases in real time."

In short, he said, "So far, so good."

Could hospitals be swamped?

That doesn't mean Canada has its pandemic response nailed as COVID-19 continues to spread around the world. Hospital capacity could be a point of vulnerability. More than 15,000 Canadians were hospitalized as a result of the H1N1 pandemic in 2009, but the system was able to cope, according to the Canadian Institute for Health Information.

COVID-19 could put hospitals under severe strain this time. A recent CBC News analysis found that some of Ontario's biggest hospitals were filled beyond 100 per cent occupancy every day in the first half of last year.

In its report issued in 2003, the federal National Advisory Committee on SARS and Public Health concluded that "the system is unable to absorb a large influx of patients associated with an emergency while still maintaining normal activity levels."

On Monday, Federal Health Minister Patty Hajdu tried to reassure Canadians about the system's current ability to handle large numbers of hospitalizations. "This is the work we are conducting right now with provinces and territories, to make sure they have the capacity should they see a surge of illness in their communities that require increased hospitalization," she said.

Seventeen years ago, the federal SARS committee warned us that the next viral outbreak could be more "insidious."

Now it's here. Have we done enough? Are we ready? We're more ready than we were in 2003.