[Consequences of the SARS outbreak on the Health Care System in Ontario]

In March 2003 the healthcare system of Toronto had to respond to an outbreak of severe acute respiratory syndrome. This infectious disease due to a novel coronavirus spread rapidly because this infectious agent was highly contagious and contaminated many caregivers. The increase in the demand in critical care beds with concomitantly a decrease in the number of caregivers sick or in quarantine, deeply disorganized the emergency and critical care system. Lack of preparedness, absence of coordination and leadership, poor communication were identified as factors amplifying the impact of this outbreak. Rapidly, however a disaster plan was implemented allowing for better organizing the response of hospitals, allowing the control of the outbreak. During the second phase of the outbreak in April 2003, a coordinated network of hospital is designed to isolate the patients and provide best evidenced care with optimal protection of the caregivers. Several recommendations resulted from the retrospective analysis of these events. These were used to develop a transformation of the healthcare system in Ontario, with creation of local health integrated networks, reorganization of the acute care system with increased capacity, development of infectious disease control. In preparation of a new outbreak, provincial and local task forces have been implemented to provide recommendations in collaboration with the newly created Public Health Agency of Canada.