- © 2007 Canadian Medical Association
SARS in context: memory, history, policy Edited by Jacalyn Duffin and Arthur Sweetman; McGill-Queen's University Press; 2006 210 pp Can$29.95 ISBN 978–0–77353–194–9
Lessons continue to be recounted and learned in the long wake after severe acute respiratory syndrome (SARS) entered Canada 4 years ago. In February 2007 the SARS Commission to investigate the introduction and spread of SARS in Ontario, led by the Honourable Archie Campbell, released its third and final report, The Spring of Fear, a masterful account that investigates and documents the trail of the contagion and its uniquely tragic personal impact in Ontario. This third Campbell report both reduces and elevates occupational health duties and the precautionary principle (i.e., that reasonable efforts to reduce risk need not await scientific proof) to provincial and personal proportions and, some might argue, distortions.
A few months before the release of Campbell's report, the book, SARS in Context, was published. Edited by Drs. Jacalyn Duffin and Arthur Sweetman, both faculty members at Queen's University, this subtle text is based on their experiences as a medical historian and policy analyst, respectively, called to duty and account in the midst of the SARS crisis. During this period, members of the media required the editors to comment on historical precedents of “plagues” and their implications. According to Duffin and Sweetman, their sage and informed comments were often received with disappointment from members of the media who were unwilling to concede that the historical lessons delivered by plagues are simple, crude, predictable and harsh. Nature is indiscriminate and humanity is conflicted by self-interest, good will, the limits of knowledge and privilege. When uncertainty prevails, time-limited dire measures may be necessary to protect the health of populations against the unknown.
This experience seems to have had a resounding impact on Duffin and Sweetman. It resulted in a post-hoc symposium, hosted by Queen's University Faculty, between academics and the media, with the intention of reviewing the encounters between historians and journalists in the context of SARS. This has been captured in the book. In apparent contrast to the title and size of the 1200-page Campbell report, SARS in Context, is a slim text (210 pages) comprising 11 chapters, none of which — presumably in consideration of the already overwhelmed health care professional — exceeds 25 pages.
The book begins with a brisk introduction by Duffin, followed by 3 sections. The first provides personal accounts and reflections from “medical officials” Drs. James Young and Dick Zoutman, who were called to appointment at “ground zero” in the province when SARS hit. The second section recounts analyses by various medical historians who were asked to draw comparisons between previous community-acquired epidemics (e.g., the so-called Spanish flu, cholera in Toronto, AIDS). Finally, the third section looks at the federal role and the economic impact of SARS — and quite effectively debunks any concerns that the latter was either significant or long lasting.
Overall, SARS in Context, provides some refreshing accounts and balanced insights; however, there are some shortfalls. The writing and editing between chapters is quite choppy. Given that reading good writing is like looking through a clear window, I must admit that in certain chapters I wanted to spray on some window cleaner. And, although I strived to refrain from wearing a personal hat on this read, I was disconcerted to see that no members of my medical specialty (community medicine) were represented in the text. Every day medical officers of health are invited to waltz between investigating sporadic cases and declaring emerging outbreaks. That we were not even listed on the dance card of the editors of SARS in Context is sobering indeed, and makes me wonder whether it signals the editors' desires or drabness of my specialty?