Posted on 04/25/2003 6:47:59 AM PDT by knighthawk
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."
Now, obviously, that statement is completely false, given the info presented here. Is there a chance of a flare-up in the US, of course. Are there sloppy doctors here, yep. But the health care system has already handled cases for over a month now, and it is doing a good job.
But the assertion that it hadn't spread to the US yet is not even remotely true.
I hope not, because so far we haven't been hit where we are every bit as likely to be have very similar conditions as exist in Toronto (note: I've worked there in the viral barrier protection business).
What do you have to say about the facts and personal observations I posted? Note that I am not asserting that the Canadian system is in any way superior, quite the contrary; I consider a private system to be superior, but that is hardly what we have.
IMO, so far, considering how our healthcare and public health systems are being managed, we've been damned lucky. We had better be taking the threat of SARS far more seriously in our hospitals than the "business as usual" with a few extra meetings, which is I have seen so far.
THere are no apologies necessary. I just wanted to clarify the timeline of this disease and maybe make some people reading the thread a little more at ease.
As I said in my later clarification I really was merely reffering to the natural human tendency to not go for the difficult diagnosis. I am wondering if the slight difference in timing between the Canadian problems and the US problems might be a contibutary factor to the American respomnse or was it merely that our doctors got better information and paid more attention?
I think it is as simple as US hospitals having better infection control procedures in place.
Actually, this has nothing to do with the TREATMENT of SARS, although that argument could possibly be made. I'm saying the lack of hospital based infections here in the US as compared to Canada is proof of better infection control procedures (at least).
I hope not, because so far we haven't been hit where we are every bit as likely to be have very similar conditions as exist in Toronto (note: I've worked there in the viral barrier protection business)
I have no idea what that statement means. Could you expand on that a bit?
IMO, so far, considering how our healthcare and public health systems are being managed, we've been damned lucky. We had better be taking the threat of SARS far more seriously in our hospitals than the "business as usual" with a few extra meetings, which is I have seen so far.
The operative term here is "IMO", because it is indeed your opinion. Here in Western PA, a hospital went into complete lockdown the other day when a woman showed up with bacterial pneumonia. Not data, for sure, but one story is as good as another. So just because you don't think we're taking things seriously enough, doesn't mean we aren't.
What do you have to say about the facts and personal observations I posted?
"The plural of anecdote is not data"?
I thought so; it's merely an association, and not even close to a proof. You need to spend a little more time in a wider range of hospitals to know something about common policies and procedures concerning infectious disease control. They are woefully inadequate to prevent widespread infections of a disease that is as easily transmitted as is SARS.
I worked in the viral barrier protection business. That is the design, manufacture, and sale of medical devices that prevent humans from contacting a pathogen, specifically a virus. Examples are gloves, gowns, breather masks, goggles, etc. I designed and developed such products for a living. I hold international patents for such devices. To create successful products in that industry, one needs an intimate knowledge of medical procedures, chemicals, and viral transmission modes.
That's data sonny, that indicates that my IMO means something. Now go back and read the post about my wife's experience as an RN-IV. If a world-class operation like Stanford allows such behavior among its medical staff, consider what WILL happen if SARS gets into a mad-house full of illegal aliens like County USC.
Patients occasionally lined the hallways, too numerous for a ward, including women delivering babies. My wife has seen infants stacked side by side and rolled down those same hallways on gurneys. I have seen waiting rooms so packed with sick people that TB transmission is a concern even if there wasn't SARS. Mr. Steyn's description of a hospital in Toronto was indeed reminiscent of scenes occuring in hospitals all over the Southwest.
We've been lucky. Your "proof" is a statistical joke, and an almost baseless assertion. Our situation may be better here than in Canada, but that isn't saying much. IMO the American healthcare system is not ready to prevent widespread infections of SARS.
I'm curious about a couple of things.
This article, like many others, says that China is especially vulnerable because of poor medical facilities in rural areas. I suspect that this is backwards; I'd guess that, in fact, the crowded cities are where the epidemic would be. (In fact, the concentration of SARS patients in densely populated hospitals may have facilitated its spread; nurses and doctors are especially at risk. In that sense, the medical care provided may actually have made the situation worse by causing many more people to be infected, even though it presumably saved the lives of many of those who were infected.)
As for Canada, I have no doubt that socialized medicine is a terrible system and that Toronto made a series of systematic blunders in dealing with SARS. But why hasn't SARS emerged as a major problem in any other Canadian cities? Vancouver, for instance, also has a large Asian population.
This says that the SARS outbreak in Toronto cannot be attributed just to the floundering Canadian medical system and to the general commitment in Canada to political correctness. I think Toronto must have been particularly unlucky in some way with regard to SARS exposure or vulnerability, or the socialized medical care is institutionally worse there than in the rest of Canada for some reason.
Your entire argument seems to be "this is the way it is in my hospital, therefore, that is the way it is in all hospitals". I smell a logical fallacy.
This is my point. Well, it is probably worthwhile to first revisit your initial statement:
Your implication is that SARS has been in Canada longer than it has in the US. The sources that I posted from the CDC PROVE that point to be incorrect.
It is therefore completely proper to make the assertion that there is a fundamental difference between how the two countries have handled the outbreak. Your anecdotal evidence means nothing to me, because the facts show things to be different.
The rest of your post seems to be the argument "things aren't bad now, but they will be". I guess we will see, but I will put my money on the professionalism and expertise of the physicians in this country.
I meant that Canada's disease is the socialised medicine Mr. Steyn was disparaging with his example. You missed the point entirely.
Your entire argument seems to be "this is the way it is in my hospital, therefore, that is the way it is in all hospitals". I smell a logical fallacy.
A logical fallacy would be, "SARS has been in both countries (for all of a month or so mind you) and because they have had an outbreak and we haven't (that we know of) our SYSTEM is better."
My point was, Canada's SYSTEM is merely an advanced stage of ours. By the time you add up Medicare, Medicaid, MediCal, and the manner in which HMOs such as Kaiser operate, they are all too similar.
Further, my vignette was to point out that the litany of errors Mr. Steyn described is a series of events that are entirely LIKELY in a US hospital and my examples span from the best to the worst. Your "proof" was no proof, and now is not the time to be smug about any perceived superiority in US healthcare. It may be real, but in my judgment as one experienced in infection control, that difference is insufficient to prevent a serious outbreak of SARS in the US.
What logical fallacy would that be? I'm comparing two systems under the exact same situation at the exact same frame that have essentially two different outcomes, I fail to see any logical disconnect there.
Further, my vignette was to point out that the litany of errors Mr. Steyn described is a series of events that are entirely LIKELY in a US hospital and my examples span from the best to the worst.
How does your single story prove that those events are in any way LIKELY? You story proves that the situation can and does occur, but it in no way proves it is LIKELY.
Your "proof" was no proof, and now is not the time to be smug about any perceived superiority in US healthcare.
You seem to be of the opinion that if you say something enough, it is true. You continue to say that since you had a certain experience, that experience is happening in most hospitals in this country. This is nonsense. Likewise, I show numbers from the CDC about the infection rate in this country and you say it doesn't prove anything. Well....why? You can' just ignore the numbers and say they aren't proof because they don't fit your notions.
So9
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