I was the model of calm all through the SARS outbreak. But I got nervous the moment Toronto's danger was declared over. That's because it seemed that all the important insights generated by this emergency "teachable moment' might evaporate in the frenzy to boost tourism. Here are some observations I hope won't get quaranteened:
Toronto deserves its reputation as "the city that works." Through a month of anxiety when no one knew much about SARS except that it spread quickly, few of us panicked, wore masks, looked for scapegoats to blame or shame, or otherwise lost it.
This is not to be sneezed at. Outbreaks like SARS are a good distance along the emergency spectrum: far from natural disasters like earthquakes that usually draw people together, and closer to environmental disasters such as fishery closures and exposures to toxic pollution that tend to pull people apart. But despite its potential for dividing people, Toronto showed few signs of destructive infighting.
This grace under pressure is a tribute to the city's deep reserves of "social capital" accumulated over decades of living in mixed and multicultural neighbourhoods where coalitions among people from all walks of life, and partnerships with relatively responsive local governments, became a normal means for resolving controversies.
The very qualities that make our city a hip place - gay-positive, bohemian-friendly, diversity-tolerant and a good place to do business - also make it a safe place in which to have a health emergency. Social and political inclusiveness pays off big time.
Though most observers acknowledged the calming and capable leadership of the local public health department, many couldn't help noting how uptight public health staff were about protecting the privacy of people with SARS and warning against stigmatization of the ethnic communities most at risk. These are the precise precautions, learned by health staff when AIDS first became an issue in Toronto, for protecting inclusiveness.
But despite the effectiveness of public health officials and the intelligent response of the populace, many pundits mourned the absence of leadership. The Globe and Mail opined on our behalf that "people want strong leaders telling them what to do when bad things happen.' Without direction, people "lose their way and make poor decisions." This from people who think social democracy is patronizing and authoritarian!
As SARS shows, there is no such thing as public health cost savings. The Ontario government cut about $200 million from the budgets of local public health departments over the past four years, and nipped and tucked a few million more paring back microbiology labs that might have identified the disease threat earlier. These and other cuts allowed the province to rebate about $200 in tax savings to wealthy individuals. It's estimated that SARS will cost the Canadian economy $3.7 billion. Do the math to figure out if public health cuts represent good economic management and a good rate of return on taxes.
Not only are politicians not supporting public health adequately -- Toronto Public Health gets one-tenth the funding of police -- but they still don't understand the concept of "due diligence.' In the business world, companies are expected to adopt practices that protect investors and customers in case the best-case scenario doesn't pan out. For all the talk by economic conservatives about governments imitating business standards of efficiency, this is one corporate practice they don't promote.
To give two local examples, there's virtually no planning for how we evacuate Toronto in the event of a nuclear accident in nearby Pickering or where we get our food when a new disease leads to a border closing so trucks from Florida and California can't get through.
Federal politicians thought enough about nuclear issues to pass a special law limiting nuclear organizations' liability for property damage, but planning escape routes for the population must have seemed too much like thinking the unthinkable.
Chance favours the prepared mind, the great microbiologist Louis Pasteur said. Likewise, danger favours the unprepared government. In a turbulent era when weapons of mass destruction are as likely to come from innocent chance encounters as from callous conspiracies, practices of due-diligence planning need to become embedded in government.
The foofaraw around SARS reminds us that threats from disease are socially constructed. Acute infectious diseases account for less than 1.3 per cent of preventable deaths in Canada, while heart disease and cancer, chronic health problems, account for 64 per cent. Which problems get the headlines?
Worldwide, hunger kills 15,000 children a day. Water-borne diseases kill 30,000 daily. Malaria a million each year. Two million Chinese have AIDS, mostly poor peasants infected while selling their blood to government clinics; yet the Chinese government has already spent 10 times more on SARS than on AIDS.
Because of the way viruses glom onto human and animal cells, it's almost impossible to develop "silver bullets" that kill the virus without killing the host. By the time someone invents a drug, the virus will have mutated.
Though no one has figured out how to make money off it yet, our immune systems remain the most reliable defence system. Dr. Luc Montagnier, a world-renowned expert on AIDS and professor at France's Institut Pasteur, prescribes public health efforts that strengthen the immune system as the best offence.
Given the "avalanche" of communicable diseases in a globalized world, he says, it's time for health care workers to change their shooting arm. "The medicine of tomorrow must be preventive" and focus on keeping individual and collective levels of health high, he told Le Devoir. Odd as it may seem, Montagnier's comments have been ignored across North America. Perhaps after Iraq nobody thinks a Frenchman can tell us much about fighting disease or anything else.
Then there's the way globalization of the world's economy puts protection of immune systems at the top of the health agenda. When 700 million people travel from one country to another each year, diseases are going to spread faster than ever before.
That's an issue for the Chinese economy, already well down the road to being the leading exporter of cheaply manufactured goods to the developed world. It's now clear that the filth, poverty and tyranny associated with Everyday Low Prices comes with an extra price tag: communicable diseases that fester amidst filth, poverty and tyranny.
SARS is the kind of infectious disease that was supposedly brought under control over the course of a hundred years of Western technology and medicine. But this virus from the East has shoved both public health and the "social determinants" of strong immune systems - food, shelter, esteem and love - back on the public government agenda.