Toronto Hears a WHO
by NIH medical correspondent, Semolina Gatorade
Torontonians are indignant at the World Health Organization (WHO) for recommending that people avoid travelling to Toronto, the reason being the current outbreak of Severe Acute Respiratory Syndrome (SARS) there. Torontonians note, correctly, that Toronto has contained the outbreak, that it has been three weeks since a case of SARS in Toronto originated outside a hospital, that the average visitor to New York City has a greater chance of dying from bullet wounds than he does of dying from SARS contracted in Toronto. There is one thing that indignant Torontonians are not noting, however.
What the indignant are not noting is that a large number of Torontonians are acting just as if they thought the WHO was right. They are avoiding large groups of people – they are not riding public transit, they are not shopping, they are not going to restaurants. They don't care if there hasn't been a new case outside a hospital in three weeks, they're taking no chances. It hardly seems fair to accuse the WHO of over-reacting when they are only acting the same way Torontonians are.
Well, you might object, the WHO is supposed to be well informed, and should not make decisions like this. But aren't we all supposed to be well informed these days? Isn't this the Information Age? Aren't our leaders giving us reliable information on which to base our decisions?
Of course, as another article on this site argues, this is not an Information Age. That article argues that dealing with information became too stressful for us, because it made us questions our own firmly held beliefs. Rather than change our beliefs so that they conformed to reality, we stopped dealing with information.
In a society more accustomed to communicating information, public health authorities would have considered the implications of what they were telling the public. At first Torontonians were told that among the signs of a new case of SARS was a body temperature of 38 Celsius. Since the normal body temperature is 37 Celsius, and since the other signs of SARS were similar to the signs of a cold or influenza, many people reasonably concluded that a lot of people who might get infected by SARS would just assume they were fighting off a cold or the flu and keep going about their public business – riding the subway, going shopping, going to restaurants, and so on. Not surprisingly, many of the people who thought like this stopped going out in public as much as they could.
Oh, of course we can blame a lot of the problem on the news media. As yet another article on this site observes, a journalist is someone who wakes up in the morning hoping a lot of people died horrible deaths overnight. Press coverage has tended to make SARS sound like the Spanish flu. However, the public authorities are not powerless.
One thing the Toronto and provincial public health officials could have done is send accurate information about SARS to citizens. Whenever Ernie Eves gets his hair relacquered the government of Ontario sends every household in the province an attractive four-color booklet telling us how this is a great step forward for the province. When many of us think our lives are in danger from a deadly infection that is indistinguishable in the beginning from a cold, we don't get nothing. We are inundated with television commercials about how the government of Ontario has supposedly saved public education, but about a topic which is damaging the provincial economy we don't get nothing. You have to have priorities, and apparently Ernie Eves' is getting re-elected.
The municipal public health authorities haven't done any better. As the former Chief Medical Officer for Ontario, Richard Schabas, has observed, their heavyhanded use of quarantine has not inspired confidence in the population. Most people are smart enough to judge others by their actions rather than their words, and when they see drastic measures being taken they assume there are drastic reasons for taking them. And the city has been so busy quarantining people that it seems to have been unable to find the time to give us information about SARS. No posters, no transit cards, no special newsletters from councillors, no nothing.
Of course, the bureaucrats and politicians in charge of dealing with SARS think they've been great successes, and they have some reason to think so. Although the containment of SARS may primarily be due to measures taken elsewhere, SARS has been contained – no need to let the populace in on the secret, though, since public opinion doesn't affect our job evaluations. However, in containing SARS they have destroyed public confidence.
And they have destroyed WHO's confidence, which is scarcely surprising, since WHO doesn't seem to be have been dealt a lot of high cards by Canadian officials. You know, throughout my life I have been spared the responsibility of administering public affairs, so perhaps I am a bit naive in believing that a responsible approach to SARS would have included maintaining communication with WHO and ensuring that it was provided with accurate, up to date information about the outbreak. Whether I'm naive or not, that seems not to have been done, and we're the worse off for it.
So, Torontonians, spare the poor WHO your wrath. If you want the WHO to believe SARS has been contained in Toronto, you might consider acting as if you believed it yourself.
Posted on April 24, 2003
Toronto Hears a WHO © Coolth, 2003
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