When healthcare workers get sick, or go into quarantine, everybody suffers. Last week a Hamilton cancer specialist tested positive for coronavirus after returning from a trip abroad. The doctor developed mild respiratory symptoms after her return. She appropriately isolated herself from the public. Her cancer patients will be missing her services.

To reduce their chances of getting sick, doctors are now cancelling travel plans. Medical meetings and educational conferences are also being called off. But front-line healthcare workers remain vulnerable. What about getting sick from one’s patients?

I adjust my mask before I open the door to let them in. I’m wearing it to protect them in case I am carrying a potentially deadly disease. Renée is returning from work and bringing our 11-year-old son, Jonathan, home from school. Toronto, 2003. I’ve just had a risky contact with the SARS virus.

I am quarantined, not allowed to leave home. The Public Health authorities say I can be with family members but stay in a separate room. No eating together. No hugging. No visitors. A Public Health nurse has instructed me to take my temperature every twelve hours and phone her with the results. I am immediately to report any fever, cough, difficulty breathing, or just feeling unwell. If anything develops I will be put into hospital at once, in isolation.

Why the fear? In 2003 SARS (Severe Acute Respiratory Syndrome) is a new, unknown disease and there is no cure. It usually starts with dry cough, fever, sore throat, muscle aches, and weakness. It can progress to shortness of breath and serious pneumonia. Its victims in Toronto and China are in intensive-care units, on mechanical respirators. In Canada, 17 percent of people who catch SARS die. Forty-four will die in Toronto during the outbreak.

I’m in quarantine to prevent other people from coming in contact with me in case I have caught the virus and it is incubating.

The disease started in the Guangdong province of China where it is believed to have jumped to humans from live-animal markets. A doctor treated patients there with an unusual, “atypical” pneumonia. He travelled to Hong Kong to attend a wedding in February, 2003. While staying at a hotel he began to get sick. In less than 24 hours, the illness spread to a dozen other hotel guests. One of them was a 78-year old woman from Canada who was in Hong Kong on holiday.

When she returned home to Toronto she developed symptoms and died in March. In retrospect, the cause of her death was SARS. It was unrecognized then; China initially covered up the extent of the SARS outbreak. Before dying, the woman transmitted the virus to a family member. He has now been admitted to a Toronto hospital, leading to a large outbreak among the other patients, and SARS has become identified as a new disease. Toronto is the only city outside of Asia significantly affected. Reporters and broadcasters are converging, and it is now the lead story in the international media. The World Health Organization issued a travel advisory recommending people not visit Toronto. The WHO is criticized for this, since SARS isn’t spreading through the community. Transmission of SARS is mainly limited to hospitals, and the households of patients. Eight days after it was issued, the travel advisory is lifted.

However, healthcare workers treating patients are getting sick. These days anybody with fever, sneezing, or a cough is potentially in danger, and also dangerous to their doctors, nurses, and paramedics. In our waiting rooms, patients need to have their temperatures taken and wear masks. We’re told the virus is transmitted in large respiratory droplets, especially within one metre of a patient. So in our examining rooms, we’re putting on disposable, plastic gowns over our clothing. Then latex gloves, and goggles to protect our eyes from infected droplets. Finally, we put on special masks we can hardly breathe through, called N95 respirators. Because ordinary surgical masks leave gaps around the mouth, and don’t filter all the air we breathe in, we wear these respirators whose tight facial fit blocks almost all airborne particles. The seal between mask and chin is checked to be sure it is air-tight. The N95’s are stifling. After a few minutes in the full gear we feel hot, light-headed.

The public is scared. People wear masks in the streets and on subways.

It is early May, and the SARS outbreak is now thought to be over because no new cases have been identified after four weeks, two virus “incubation periods”. Health Canada runs advertisements to reassure the public. The new, enhanced infection control practices are being eased, including the rules about hospital visitors and procedures, and protective gear. We are told we can remove our gowns, goggles, and suffocating respirators. You can feel a collective sigh of relief, the entire metropolitan area, over five million people, relaxing.

But in the Emergency department, doctors are continuing to see cases of fever and cough of uncertain cause. Suspicious, some decide on their own to continue wearing protective gear. It frightens the patients.

On Thursday, May 22 at 3 p.m. I sit down in my office for a talk with a patient in her thirties, a nurse at my hospital, the North York General. Ellen doesn’t feel ill. She’s come to discuss some personal problems, and we talk for half an hour.

The next evening, a fax comes in. Ellen has been admitted to hospital through the emergency department, diagnosed with SARS. Rapidly advancing. My chest tightens.

I phone the nursing station. Her symptoms began shortly after seeing me, the clerk says. Cough, fever, chest tightness. She quickly became very sick with shortness of breath. She is now in strict isolation, on oxygen. Before seeing me, she had nursed a hospital patient who later developed SARS.

I worry for her, and for myself. I had a prolonged, unprotected contact with her— no mask, gown, or eye shield. Dangerously face-to-face, from a distance of less than a metre. I am now at high risk for the disease. At a lesser risk are my staff, my colleagues in my group practice, and our patients who were in the waiting room when she arrived.

I call the Public Health Department to report my exposure. A public health nurse lays down the law about my quarantine. Other public health workers go over my appointment schedule for that Thursday. They identify and phone every patient who might have crossed paths with my patient. Tell them the symptoms to watch for. Tension is high.

On May 24 there is a surprise announcement at a news conference: SARS is back. Officials acknowledge that a second lethal round is underway. They’re calling this second wave “SARS II.” Ellen’s illness was the beginning of it. My hospital is the hotbed.

All the infection-control rules that were previously dropped are resumed. But for me, and my unprotected contact with Ellen, the precautions come two days too late. To prevent further spread of infection, the hospital is now closed to all new admissions except for patients with SARS. There are no deliveries, no operations. At the end of May, there are 61 patients with SARS in my hospital, most of them nurses and physicians.

A doctor friend, Tom, is one of those who caught SARS in the hospital. Sick with lung infection, he is in the strictest isolation. His wife and children are allowed to see him only by gathering on the hospital lawn below his room. He stands at his fourth-floor window. They wave to each other.

Medical workers on the front lines die during the outbreak. Nelia Laroza is the first. A well-respected nurse at my hospital, she dies when SARS reappears, after authorities thought they had beaten the outbreak. It is ironic— her colleagues described her as ‘paranoid’ about SARS and meticulous in taking precautions against infection. Like her colleagues, she did not hesitate to put herself in danger by treating SARS victims. Another Toronto nurse, Tecla Lin, and a family physician, Dr. Nestor Yanga, have also given their lives in treating their patients.

My quarantine days are long, alone, and uncertain. I worry about infecting my family. I knew there were risks for myself, but I never signed up for placing my family at risk.

Renée phones often from work to find out how I am feeling, ask if anything has changed. But one day she calls me three times in three hours. I ask her to stop calling. While I wait to see if I’ll get sick, I look after my patients over the telephone when possible: renewing prescriptions, giving advice, counseling.

Sharon, my office assistant, brings patients’ medical charts to my house so I can keep them up-to-date. We aren’t allowed contact, so she leaves them on the doorstep. I wave to her through a window. I hope my eyes look grateful above my mask.

When Ellen is out of intensive care, I phone her in her isolation room.

“I’m getting better now,” she says. She’s still a little short of breath when she talks. “Just awfully weak.”

Relief spreads through me. My colleague Tom is already home, convalescing. Now there is only me to worry about, and other friends in quarantine.

A radio station phones to interview me.

“So now you are the patient, doctor. What’s it like to be on the receiving end?”

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“Well, uhh… I’m okay, I’m more concerned about the health-care workers who are still out there. Putting themselves at risk. Doing a great job.”

“Sure, no question. But I’m asking about you.” The interviewer isn’t going to let go. “What’s it like?”

“It’s… umm… well, maybe not a bad thing for a doctor to see things from the other side.”

Some patients hear this broadcast and in their anxiety for me, completely misunderstand. A number of them think I’m already seriously ill with SARS. They worriedly phone my office. Sharon calms them down. Their concern touches me.

No symptoms appear. My twice-daily temperatures stay normal. I emerge from quarantine after two weeks with nothing worse than stiffness from being cooped up. My son smiles to see me without a mask.

Until SARS, healthcare workers hadn’t felt so vulnerable. In Canada, more than 70 per cent of SARS cases were contracted in hospitals. Some 45 per cent of those who caught SARS were nurses, doctors and paramedics. I think of Tom waving to his family from his hospital window. About the healthcare workers who died. The risks we take in constantly hanging out with sick people, putting ourselves out there. There is a selflessness implicit in health care, but it sometimes includes taking chances, placing oneself in harm’s way.

It was total unpreparedness for the second wave that put my life and that of many others at risk. The ‘all clear’ announcement came too soon. To be fair, SARS was new, surrounded by unknowns, and there was no diagnostic test available during the outbreak. But SARS is not the first new disease to startle us. HIV and AIDS seemed to come out of nowhere, too. Deadly Ebola fever took us by surprise. As did Zika virus. Superbugs continue to emerge, resistant to our antibiotics. And now, a worldwide epidemic of COVID-19, a SARS cousin. All these new viruses and bacteria shock us until we figure out what’s happening and how to control them.

As we face the coronavirus pandemic, it’s worth looking back. Have we learned from SARS, and is it enough? In some ways, clearly no. China silenced whistle-blowers, and once again initially hid the magnitude of the outbreak. If the public had been honestly informed, the spread might have been reduced, lives saved.

Controlling of information isn’t confined to China. In the U.S., the Trump administration has silenced some scientists and played down the risks, perhaps to reassure anxious stock markets.

In other ways, however, we’ve learned much from SARS. We saw how swiftly epidemic infections can spread and turn life upside down. And can stick around — the ‘all-clear’ must not given prematurely. Perhaps we’re a little battle-hardened. Since SARS, front-line emergency departments and doctors’ offices have screening procedures to identify patients at risk. The screening and testing procedures are regularly updated, by vigilant public health departments. And front-line providers have learned how and when to use proper protective equipment.

Of course it can be scary as we can visualize worst-case scenarios. Situations can deteriorate, and quickly. Hospitals in Wuhan initially ran out of beds, and had to send many sick patients home where they infected their families. In China, the U.S., Latin America and elsewhere, testing-kit shortages persist. Not all infected people are being identified.

In Canada and the U.S., a surge of people who need to be tested and treated could overwhelm doctors’ offices and hospitals. We could exhaust our supplies of personal protective gear, such as the N95 masks that healthcare providers need to practice safely. And as occurred in Italy, we could run out of hospital isolation rooms, intensive care unit beds, and life-saving ventilators.

For we have a new disease, no immunity to it, and no vaccine.

How best to respond? Beware of misinformation from politicians who gag scientists and falsely reassure people. And from social media that promote mistrust of science, bogus prevention with vitamins and supplements, magical cures. The World Health Organization is calling it an ‘infodemic.’

Panic may be the biggest danger in controlling an epidemic. A concerned but calm, rational approach pays dividends. Look for objective, level-headed information from trusted sources: the WHO, infectious disease specialists, and public health officials.

I’ve been on both sides of SARS. What is the right balance between prudence and panic? At the moment I’m washing my hands more often, practicing social distancing, avoiding handshakes. But I’m not wearing a mask when well, and not emptying supermarket shelves. And as the situation rapidly evolves I’ll remain vigilant, ready to adjust and respond accordingly.

SARS and COVID-19 startled us, yet new infectious diseases will continue to emerge. They are reminders that healthcare workers are in harm’s way, and can get critically sick from their patients. They also remind us that we need trusted, objective information, and a collaborative and powerful international public health community to protect us.

For there will certainly be more surprises.