E-Coli, West Nile, SARS and Mad Cow: Four crises that call for a reform of public health in Canada.

Angus Reid
Vancouver Sun

Maybe it's time to declare an orange alert here in Canada, not because of the threat from terrorists but from microbes. E-Coli floating in the drinking water in Walkerton, Ontario, mosquitoes carrying West Nile, SARS and now Mad Cow disease—hardly a season goes by, it seems, without some new pestilence causing anxiety and wreaking havoc with the economy.

The bugs, viruses and other contaminants invading Canada are worry enough, but I'm becoming equally disturbed about the reaction of our authorities and politicians. Each new attack seems to reveal a public health system in disarray, suffering from labour shortages, under-funding and a general lack of coordination. Most notably absent is decisive federal leadership.

Every microbial attack seems to begin with statements by various experts and talking heads that it's just an isolated problem—nothing really to worry about—and then, with each successive day, the diagnosis becomes gloomier.

In the case of Walkerton, people started showing up at doctors' offices and hospitals almost exactly three years ago. At first the people in the region were assured the water was safe to drink, despite concerns from doctors that the bloody diarrhea they were seeing was normally due to contaminated water. In the end, several thousand people became ill, seven died and scores remain under treatment today.

When the West Nile Virus first began to infect people in the northeastern United States, we were told Canada would likely be immune from the worst effects because of our long winters. Then crows started dying in Ontario and Quebec, people got sick and some died. It now turns out that the Canadian summer is perfectly suited to the mosquito which carries this virus. Oops!

In the Toronto case of SARS, the issue was more delay than denial. When Dr. Sandy Finkelstein's first SARS patient showed up, he assumed he was dealing with pneumonia or tuberculosis. Unlike British Columbia physicians, he had received no official warning of a mysterious flu-like illness breaking out in China. The sick man was not isolated right away. Instead, he spent 24 hours in the emergency room, infecting the patient in the bed beside him. Both died days later, triggering a chain of infection.

I don't know how the Mad Cow issue will play out but I've got a deja-vu feeling. What started as one cow on one farm early in the week has become a search for many cows on several farms. One day one we're told that BSE isn't in the food chain. On day two, that it's "possibly" in the food chain. The trajectory of this story isn't encouraging.

There's also a disturbing pattern that links the severity of these microbial assaults to cutbacks, staff shortages and jurisdictional wrangling.

According to justice Dennis O'Connor's Walkerton inquiry report, much of the blame for the tragedy rests with the Ontario government, which instituted severe cutbacks, including discontinuation of government laboratory tests for municipal water and a reduction in the staff assigned to monitor ground water.

Health officials and professionals in Toronto have been rightly credited with heroic efforts to contain the SARS outbreak, but questions are increasingly being raised about the role under-funding may have played in hastening its spread. According to Dr. William Bowie, a University of British Columbia specialist on infectious diseases interviewed in a recent CBC documentary, the SARS operations centre in Toronto was constrained by poor coordination and a jurisdictional maze.

"Ontario has largely decimated its frontline public health folk," said Bowie. "Infection control, which is the key line within the hospital setting, has also been compromised...largely because of cutbacks."

The most troubling aspect of the Mad Cow scare is the four months the infected animal's head sat in a lab refrigerator awaiting testing. Alberta's chief provincial veterinarian, Gerald Ollis, said the cow was not a priority because it had not displayed any of the symptoms of Mad Cow disease or the other central-nervous-system afflictions that are of primary concern to inspectors.

"In a perfect world, we would have had results in five to seven days," he told a news conference in Edmonton. "But it's not a perfect world."

It seems it has become even less perfect over time. A decade ago the province had four fully staffed labs—now there is only one.

Meanwhile, prime minister Jean Chrétien clowns around with the media, plays golf and clings to the delusion that all is well in his little kingdom.

Before he leaves office he should at least initiate a comprehensive review of public health infrastructure. At a minimum it will reassure a concerned public and may even serve as a springboard for reform, reinvestment and renewal for the next Liberal government.

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