SARS: A Preventable Epidemic

By: Louis A., Catherine P., and Erin V.

Severe Acute Respiratory Syndrome struck Canada in 2003. The pathogen originated in China. A lack of communication allowed the disease to spread to other countries. Many victims died. Public complacency in modern health care was shaken. The government was ill prepared to deal with the impact. SARS demonstrated how vulnerable nurses and hospitals were to cope with any near pandemic that may emerge in the years to come.

What is SARS?
SARS was an unknown virus which emerged in 2003. The disease killed 800 people around the world, 44 in Toronto (Abraham, 2005, pp.45-50). The pathogen is virulent and highly contagious. SARS is a coronavirus made up of thirty thousand nucleotides. Ribonucleic acid stores the instructions of the viral genome to create the needed proteins. Spikes located around the crown-like proteins latch on to appropriate host cells and the virus' enzymes take over to begin reproducing the virus inside of a host cell (Abraham, 2005, pp.114-116). Nurses did not know they were dealing with a vitiating disease. Symptoms included dry coughs, sore throats, chills, myalgia (muscle pain), and pneumonia. Many needed ventilators to breathe (World Health Organization, 2003). Until SARS was diagnosed all nurses could do was treat the symptoms. Soon it was discovered SARS could spread through personal contact, respiratory droplets, and airborne contact (Hayes, McIntyre, & Cornish, 2004).
Image from Flu Med

Nursing Challenges

Nurses had no time to prepare for the onslaught of ill patients. The virus originated in China, but officials from that nation failed to share their methods to contain SARS, which left nurses in the dark. They did not know how long the incubation period SARS had, and had not taken the precaution of wearing personal protective equipment in the early weeks. There was no way of knowing how long people had to quarantine themselves in their homes. The coronavirus mutated rapidly, which gave the disease a strong resistance to antibiotics (Registered Nurses Association of Ontario, 2005). Patients needed to be kept in negative pressure isolation rooms. These rooms had lowered air pressure and built in air filters. The doors remained closed except to admit personnel, who had to wear booties, caps, gloves, goggles, gowns and masks. To limit exposure, visitors were not allowed unless a patient was dying, which was another task nurses had to enforce along with their normal obligations (Hall et al., 2003).
Nurses bore the brunt of physically caring for the SARS patients. Nurses became frustrated and exhausted. The safety equipment they had to don was complicated and cumbersome. Tasks that were normally done quickly and efficiently, were now hard to perform. All staff had to wear face masks, but only those in direct contact with SARS clients were given the high quality and expensive N95 masks. They were hard to put on and diffucult to breathe through, so that staff often became dizzy (Registered Nurses Association of Ontario, 2005). The cost of providing supplies for nurses was high and nurses were frequently frustrated by shortages.
There seemed to be little concern on the part of government bureaucrats for worker safety for nurses. Many lacked up to date training on isolation procedures. As there was already a nursing shortage, nurses had to cover for staff who fell ill. (Michener, 2007). Regular nurses were delayed getting into work because of the screening process, which prevented the on duty nurses from leaving until their replacements had arrived. Nurses that held down two or more jobs were not allowed to come in if one of their jobs was in a SARS infected hospital, which caused many problems with staffing schedules. Many nurses feared infecting their families. When nurses displayed symptoms they had to quarantine themselves which cost them pay. Their fears were justified as many nurses contracted SARS and two nurses died (Anonymous, 2007). Hospitals were not prepared to deal with SARS.

Image from SARS commission could have gone furthere, says RNAO


The spread of SARS was largely a failure on the part of the government and hospital officials to act in a timely manner, rather than a failure of nurses to control the spread of the virus. The SARS commission, Spring of Fear (Summers, 2009) found the province had ineffective communication with hospitals about implementing strategies to contain SARS. Even when nurses warned that the second wave had arrived the government ignored them in hopes of salvaging the summer tourist season of 2003. The government gave inconsistent instructions everyday. Nurses were hailed as heroes by the media, yet the public treated them as infected pariahs, adding to the pressure of caring for patients.
The Canadian health care system is not infallible. Nurses learned quickly through trial and error. SARS exposed how inadequately prepared some hospitals were to counter viral threats. Nurses need to be trained regularly on isolation procedures and provided with suitable equipment to protect themselves. Stricter enforcement of limited access to hospitals and patients would help contain viruses (Summers, 2009). Communication must be improved between the government and the nurses who are witness to emerging contagions. SARS was a valuable warning about how difficult a task nurses face in caring for patients in an overwhelmed health care system. This may be the only chance Canadian health care has to prepare for the next true global pandemic. Nurses will be waiting.

External Resources


Abraham, T. (2005). Twenty-first century plague: The story of SARS. Baltimore: The John Hopkins University Press.

Anonymous. (2007). SARS commision could have gone further, says RNAO. The Canadian Nurse:103(4):8.

Hall, L.M., Angus, J., Peter, E, O'Brien-Pallas, L., Wynn, F., & Donner, G. (2003). Media portrayals of nurses' perspectives and concerns in the SARS crisis in Toronto. Journal of Nursing Scholardship:35(3)211-216.

Hayes,C., McIntyre, S., & Cornish, L. (2004). The Ontario SARS commission interim report. Retrieved on November 14, 2009 from

Michener, L. (2007). Managing legal issues in light of the SARS crisis. Retrieved on November 15, 2009 from

Registered Nurses Association of Ontario. (2005). Registered Nurse Journal. Retrieved on November 18, 2009 from

Summers, A. (2009). Pandemic flu: Lessons from the Toronto SARS outbreak. Emergency Nurse:17(5):16-19.

World Health Organization. (2003). Severe acute respiratory syndrome. Fifty-Sixth World Health Assembly. Retrieved on November 16, 2009 from