Preparing for the Next Pandemic: Lessons Learned from Severe Respiratory Distress Syndrome

• Published in: Canadian Association of Radiologists journal 2009-04, Vol.60 (2), p.116-118
• Main Author: Goldberg, Ronn E.A., MD, MBA, FRCPC, DABR
• Format: Article
• Language: English
• Subjects: Communicable Diseases, Emerging - diagnostic imaging; Communicable Diseases, Emerging - epidemiology; Communicable Diseases, Emerging - prevention & control; Diagnosis, Differential; Disaster Planning - methods; Disease Outbreaks - prevention & control; Humans; Medical diagnosis; Ontario; Pandemics; Practice Guidelines as Topic; Radiography; Radiology; Risk assessment; Severe acute respiratory syndrome; Severe Acute Respiratory Syndrome - diagnostic imaging; Severe Acute Respiratory Syndrome - epidemiology; Severe Acute Respiratory Syndrome - prevention & control
• ISSN: 0846-5371; 1488-2361
• DOI: 10.1016/j.carj.2009.03.001

In 2003 SARS, an airborne viral illness of the corona virus type, spread from China to North America. In Toronto, Ontario, there was a primary phase, as well as a secondary phase during which the infection spread back into the community from hospitalized patients. There have been 2 commissions to assess the Ontario SARS experience. The federal commission (Nay lor report) [1] focused on systemwide and public health issues to be addressed when dealing with future pandemics. The provincial commission (SARS Commission Report) by the late Justice Archie Campbell [2] looked at the SARS experience from the provincial and hospital perspectives. I also note that during both the initial phase (SARS 1) and secondary phase (SARS 2) of the pandemic, computed tomography (CT) of the chest often detected infiltrates in patient with suspected SARS with negative radiographs. This reflected the increased sensitivity of the CT technology compared with the images produced by the radiographic equipment. Planning for future pandemics will need to account for surge capacity in CT imaging to supplement general radiography. The importance of the radiologists in the detection of respiratory airborne diseases in the index hospital was acknowledged by the authors of the federal and provincial reports. The presumptive diagnoses of recurrent SARS made by individual radiologists were transmitted to the attending clinicians verbally and through radiology reports. There was no centralized process to collate and analyse all the radiology reports for new diagnoses of suspected pneumonia. It is recommend that within each hospital, and possibly each region, that there be a centralized system to collate and analyse multiple radiologists' reports for key words or phrases to detect clusters of respiratory disease on wards, or changes in the incidence of respiratory infiltrates within an institution, or even within the community. This is easier to implement where there is an electronic patient record.