Will SARS crisis give Canada its own CDC?

At least one positive development might emerge from Canada's recent outbreak of severe acute respiratory syndrome (SARS): the creation of a national disease control centre similar to the Centers for Disease Control and Prevention (CDC) in the US.

Dr. David Naylor, the head of a national panel examining the handling of Canada's SARS outbreak, says the panel will consider all “reasonable options to enhance and coordinate surveillance and response capacity.” One idea being floated (CMAJ 2003;168[11]:1381) is a national centre to fight outbreaks; British Columbia already has its own centre, and Ontario may create one.

“It's too soon to say what the recommended options may be, [and] the creation of an ‘Ontario CDC’ would ultimately be a matter for Ontario to decide,” Naylor, dean of medicine at the University of Toronto, told CMAJ. “That said, since viruses don't respect national or provincial borders I hope the panel will take a pan-Canadian perspective, liaising closely with and respecting the relevant jurisdictions, but not slavishly adhering to a federal mandate.”

Naylor is well placed to judge SARS' impact because of his close relationship with hospitals in the Greater Toronto Area (GTA). He says they will be able to bounce back, but the outbreak has created some larger questions. “We can eliminate the backlog in services in the GTA if hospitals run full tilt over the summer, rather than going into summer slowdown mode. However, this outbreak raises difficult questions about surge capacity not just in public health, but in the clinical sphere.”

Naylor, who was named chair of the panel Apr. 29, says its study will include SARS' ethical, legal, social and economic implications. “Thousands of women and men rose to the occasion to contain SARS, but we have to ask if our systems were optimal to support them. If not, how can we improve them next time?”

The 10 panel members include Dr. David Butler-Jones, past president of the Canadian Public Health Association, and Dr. Michel Bergeron, chair of the Infectious Diseases Research Centre at Laval University. Among the ex-officio members is US CDC Director Julie Gerberding.

Naylor stresses that the panel's primary duty is not to assign blame. “The purpose of this panel is not so much to second guess current activities to contain SARS, but rather to look at what we can learn from this episode.”

Ontario Health Minister Tony Clement has already promised a “new normal” for health care institutions because of SARS, including reduced use of casual labour and changes in infection control practices.

“It's important that we keep our options and minds open,” says Naylor. “For example, do we really want all doctors to work in only one institution? At a minimum, is it possible that we need a flexible pool of experts in infectious disease who may primarily work in hospital A, but will be ready to move to hospital Z if Z becomes the lead institution in battling an outbreak? As we move toward a ‘new normal,’ we should be careful not to create new problems.” Naylor expects the panel to produce its initial findings in 60 days. — Steve Wharry, CMAJ