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Thanks for the referral, great read.

The system infected us

Mark Steyn
National Post

Thursday, April 24, 2003

One of the most tediously over-venerated bits of British political wisdom is Prime Minister Harold MacMillan's amused Edwardian response as to what he feared most in the months ahead: "Events, dear boy, events."

But even events come, so to speak, politically predetermined. If, for example, you have powerful public sector unions, you will be at the mercy of potentially crippling strikes. The quasi-Eastern European Britain of the 1970s was brought to a halt by a miners' strike in a way that would have been impossible in the United States.

So it is with SARS. The appearance of the virus itself was a surprise but everything since has been, to some extent, predictable. Because totalitarian regimes lie, China denied there was any problem for three months, and thereafter downplayed the extent of it. Because UN agencies are unduly deferential to dictatorships, the World Health Organization accepted Beijing's lies. This enabled SARS to wiggle free of China's borders before anyone knew about it. I mentioned all this three weeks ago, but only in the last couple of days has the People's Republic decided to come clean -- or, at any rate, marginally less unclean -- about what's going on.

As for our diseased Dominion, like the Chinese our leaders behaved true to form. When something bad happens in Canada, the priority is to demonstrate how nice we are. After September 11th, the Prime Minister visited a mosque. After SARS hit, the Prime Minister visited a Chinese restaurant. Insofar as one can tell, Chinese Canadians seem to be avoiding Chinese restaurants at a somewhat higher rate than caucasians. But, while it may have been blindsided by the actual outbreak of disease, the Canadian system is superb at dealing with entirely mythical outbreaks of racism. I think we can take it as read that if a truck of goulash exploded on the 401 killing 120, the Prime Minister would be Hungarian folk dancing within 48 hours. Personally, I'd have been more impressed if he and Aline had had a candlelit dinner for two over a gurney in the emergency room of a Toronto hospital. That's the issue -- not Canadian restaurants, but Canadian health care.

But the piped CanCon mood music has wafted over Jean and Aline's table and drowned out the more awkward questions. Toronto is the only SARS "hot zone" outside Asia. Of nearly 200 nations on the face of this Earth, Canada is one of only eight where SARS has killed, and currently ranks third, after China and Singapore, in the number of SARS deaths. Indeed, Canada had the highest SARS fatality rate in the world until one of two infected Filipinos died a few days ago -- and according to its government she picked it up from the mother of her Toronto roommate.

But why get hung up on details? "Over the past six weeks, health care workers across Toronto have done an amazing job," wrote Joseph Mapa, president of Mount Sinai Hospital, on our letters page yesterday. "We need to applaud these men and women for their dedication and commitment."

No, we don't. We can indulge in lame-o maple boosterism if we ever lick this thing. Until then, we need to ask: Why Toronto? London, Sydney, San Francisco and other Western cities have large, mobile Asian populations. But they don't have SARS. The excuse being made for China is that they have vast rural provinces with limited access to health care. So what's Toronto's?

Here's the timeline:

February 11th: The WHO issued its first SARS health alert, which was picked up by the American ProMed network, which distributed it to Toronto health authorities. The original alert has been described as "obviously significant" by those who saw it.

February 28th: Kwan Sui-Chu, having recently returned from Hong Kong, goes to her doctor in Scarborough complaining of fever, coughing, muscle tenderness, all the symptoms of the by now several ProMed alerts. As is traditional in Canada, the patient is prescribed an antibiotic and sent home.

March 5th: Having apparently never returned for further medical treatment and slipped into a coma at home, Kwan Sui-Chu is found dead in her bed. The coroner, Dr. Mark Shaffer, lists cause of death as "heart attack." Later that day, Kwan's son, Tse Chi Kwai, visits the doctor, complaining of fever, coughing, etc. He too is prescribed an antibiotic and sent home. Later still, the son takes his wife to the doctor. Likewise.

March 7th: Tse Chi Kwai goes to Scarborough Grace, and is left on a gurney in Emergency for 12 hours exposed to hundreds of people.

March 9th: Scarborough Grace discovers Tse's mother has recently died after returning from Hong Kong. But Dr. Sandy Finkelstein concludes, if Tse is infectious, it's TB.

March 13th: Tse dies, and Scarborough Grace calls Dr. Allison McGeer, Mount Sinai's infectious disease specialist, who finally makes the SARS connection.

March 16th: Joe Pollack, who lay next to Tse on that Scarborough Grace ER gurney for hour after hour, returns to the hospital with SARS. He's isolated, but not his wife. Later that day, while at the hospital, Mrs. Pollack comes in contact with another patient who's a member of a Catholic Charismatic group.

March 28th: At a meeting of the Charismatic group, the ailing Scarborough patient's unknowingly infected son exposed 500 others to SARS ...

Let's leave it there. If this is what the President of Mount Sinai calls an "amazing job," then we might as well head for the hills screaming "We're all gonna die!" Toronto health authorities have done an amazing job that's amazing only in its comprehensive lousiness. At every link in the chain, anything that could go wrong did go wrong.

In rural China, SARS got its start through the population's close contact with farm animals. In Hong Kong, it was spread by casual contact in the lobby, elevators and other public areas of the Metropole Hotel. Only in Canada does the virus owe its grip on the population to the active co-operation of the medical profession. In Toronto, the system that's supposed to protect us from infection instead infected us. They breached the most basic medical principle: first do no harm. Even after they knew it was SARS, Scarborough Grace kept making things worse.

Dr. Mapa's pathetic attempts at covering his profession's ass are understandable. But most people who've had experience of Canadian health care will recognize the SARS chain as an extreme version of what usually happens. The other day, a guy I know went to a Quebec emergency room, waited for six hours, was told he had a migraine, and sent home. It turned out to be a life-threatening parasite in the brain. I'm sure you've got friends and family with similar stories. A chronically harassed, understaffed, underequipped system reaches reflexively for routine diagnoses, prescriptions. Did Kwan Sui-Chu's doctor, an Asian Canadian herself with many Asian patients, get the Toronto Public Health alert? Is it normal for coroners to mark "heart attack" as cause of death for elderly patients even when they've been prescribed antibiotics for a new condition in the last week? Why, after Scarborough admitted Mr. Pollack, whom they knew to have been infected during his previous stay with them, did they allow Mrs. Pollack to circulate among other patients? Why did Scarborough compound its own carelessness by infecting York Central?

Most of what went wrong could have been discovered by a few social pleasantries: How's the family? Been travelling recently? The so-called "bedside manner" isn't just to cheer you up, it's meant to provide the doctor with information that will assist his diagnosis. In Canadian health care, coiled tight as a spring, there's no room for chit-chat: give her the antibiotics, put it down as a heart attack, stick him on a gurney in the corridor for a couple of days. Maybe you could get service as bad as this in, oh, a Congolese hospital. But in most other Western health care systems the things Ontario failed to do would be taken for granted. There might be a lapse at some point in the chain but not a 100% systemic failure all the way down the line.

You'll notice that just like Red China, the Prime Minister and Toronto's medical staff I've reacted reflexively, blaming it in my right-wing way on the decrepitude of socialized health care, which almost by definition is reactive rather than anticipatory, and belatedly so at that. But my analysis, unlike Dr. Mapa's, fits the facts. But not to worry: as our leader is happy to assure us, our no-tier health care "express da Canadian value."