COVID-19 evokes memories for nurses who went through SARS

When retired nurse Hedda Canlas first heard about the outbreak of COVID-19 in Canada, her response was immediate. “Can I volunteer?” she wondered.

“Being a nurse,” she explained, “you really have an instinct to help.”

But she quickly realized that at the age of 70 she was at elevated risk of getting sick and passing infection to her husband and other family members. Coronavirus disease 2019 (COVID-19) was killing tens of thousands of people worldwide, many of them seniors. Instead, she decided, she would pray for the nurses and doctors who were confronting the virus on the front line ... a role she was in 17 years ago.

In an interview from her home east of Toronto, Canlas recalled that time. It was 2003 and she was being thrust onto the front line of another novel infectious disease, severe acute respiratory syndrome (SARS). The virus struck her workplace, Scarborough General Hospital, where she was working in the dialysis unit that received patients routinely transferred in from the hospital’s Scarborough Grace campus.

Also at Scarborough General was Mirander Chan-Wah, a registered nurse at the coronary care unit, which treated patients with acute heart problems. Chan-Wah had grown up in Hong Kong, where SARS first spread from Mainland China. Because she still had family in Hong Kong, she was familiar with the disease even before the first Canadian case came to light.

On March 7, 2003, a patient showed up at Scarborough Grace with high fever and difficulty breathing. The patient’s recently deceased mother had visited Hong Kong and been infected there with SARS, it later emerged. Unknowingly, the man spread the infection to two other patients waiting in the emergency room.

Once the SARS outbreak became known, precautions were instituted throughout the hospital. The situation suddenly became close to Chan-Wah, she recalled in an interview from the hospital, where she still works.

The outbreak revealed a system that was unprepared to deal with a spreading epidemic. “We didn’t have a proper room – a negative pressure room,” she said. The hospital had to install a massive air exhaust system to ensure the virus would not escape into other parts of the building.

In 2003 Canlas was administering dialysis to patients, many of them elderly. Since it wasn’t always known who might be infected, she took standard precautions around every patient. When she was treating someone known to be SARS-positive, even more stringent measures were applied, such as working in the new negative-pressure area.

“We took precautions for everyone,” Chan-Wah said, but with identified SARS patients, they took “extra, extra care. We really all [had] to dress up like a spaceman.”

Chan-Wah recalled having had adequate personal protective equipment during the SARS crisis. “Not like this time – there seems to be a shortage of masks, for example.”

The scale of the SARS outbreak was also smaller, both women noted, contrasting that event with the global nature of the current crisis. In 2003, Canada was one of only five nations with more than 100 cases. This time, more than 130 countries have exceeded 100 COVID-19 cases, and the top five nations have well over 100,000 cases each.

SARS also didn’t have much in the way of community spread, that is, spread of an illness for which the source of infection is unknown. Instead, with some notable exceptions (see sidebar), SARS in Ontario was largely confined to the hospital system.

Chan-Wah described it as “alarming” that a large proportion of persons who got sick were themselves health-care providers being exposed on the job. Among Ontario’s 375 probable or confirmed SARS cases, health-care workers accounted for 169 cases, a staggering 45 per cent.

“Nobody wanted to work, but we had to,” she said. The prevailing attitude among staff was “It’s our job.” One educator even came in despite being pregnant, so she could demonstrate for staff how to put on protective equipment properly.

“Personally, I take [COVID-19] a bit more [calmly] just because we have experience [from] before. The last time, nobody really knew what to do.”

The grounding effect of experience with SARS is illustrated in the person of B.C.’s Provincial Health Officer, Dr. Bonnie Henry, whose level-headed response to the COVID-19 pandemic has been widely credited for slowing the spread of the disease within the province more effectively than elsewhere in Canada. In 2003, Henry was at Toronto Public Health coordinating its response to the SARS outbreak.

Canlas said, “They’re quite prepared this time. I hope they’re fully prepared, but at least they have the experience.”

Chan-Wah even chuckled as she thought about everything she and her colleagues went through 17 years ago. “I can still remember the time. It was so stressful. You had at least one or two persons to help you put all [that] equipment on: double mask, a cover, then a special suit, double gowns. They even had a little fan inside the suit to keep the circulation going so we wouldn’t get suffocated. It was awful!”

“Deep down, the fear [of the] unknown – every one of us [had] this same feeling. But we tried to work, to function as normally as we could,” Chan-Wah said, recounting one staff meeting at which she had flown off the handle over a minor matter, though her manager excused the outburst as understandable. “Everybody was so tense that you [could] break so easily.”

Canlas and Chan-Wah both recall their fear of inadvertently infecting family members. Once the nurses got home, their uniforms would go straight into the laundry to be washed alone and they would shower immediately. As staff working directly with SARS patients, both had to stay self-isolated even at home. Chan-Wah wore an N95 mask at home when she couldn’t avoid being around family members. Each woman had her own eating utensils.

As for dealing with the stresses past and present, Canlas said, “The only consolation I have all the time is talking to God, prayer – and he answers ... in his time.”

At Scarborough General during the SARS outbreak, she said, she tried to comfort distraught patients in the dialysis unit. She offered prayer to patients who were open to it.

Churches also remained open during the SARS outbreak and Canlas was able to attend Mass. This time, she said, it’s “a different scenario.” Toronto Cardinal Thomas Collins’ decision in March 2020 to suspend public Masses throughout the Archdiocese of Toronto is something she is reconciled to. “It’s for the safety of everybody. The Cardinal knows what’s going on.”

And although she longs now to go back to church, she said of the current restrictions, “It’s not forever!”

For Chan-Wah, the deeper meaning behind the SARS crisis wasn’t something she pondered, but it’s different now with COVID-19. She regards the pandemic as a punishment from God or the environment. “The environment is telling us we’ve done too much damage. I don’t have a religion, but I do believe in God. I believe that someone up there is watching us.”

That idea of COVID-19 as a wake-up call is echoed by friends of Canlas, who surprised her when they said of the COVID-19 crisis, “Oh, this is God’s way.”

“It’s an amazing thing,” she said, that in the context of COVID-19 some friends she characterized as Catholic and churchgoing but not especially devout turned to her for prayer.

For Chan-Wah, the 21st-century pandemic has been a time to email friends and share what she calls a more positive perspective. With fewer distractions, she said, “we’re actually more connected to our surroundings ... to the trees, the grass, the flowers. It’s almost a time to calm everybody down. And also to realize how vulnerable human beings are. We’ve invented so many things, we think we are so superior to other living things, but we can’t even fight against an invisible virus.”

Canlas shares a similar view. “The enemy is invisible,” she said. With alarm in her voice, she added, “And it’s spreading! You can see with your own eyes what’s going on in the world.”

She too emphasized the limitations of human beings. “It’s only God you can really depend on in this crisis,” and “it’s only through prayer because there’s nothing we can do.”

She remembers coming to a similar conclusion during SARS. “It’s only God who has the reason why this is happening.” One of the results was a deepening of her faith.

She and her husband Ricardo are members of Couples of Christ. She recalled how in 2003 their son, Ricardo Jr., belonged to CFC Youth for Christ. It was he who persuaded his parents to join CFC. “It was a blessing that we were a part of that community,” said Canlas.

Currently she and Ricardo Sr. participate in virtual prayer meetings with neighbours who are fellow CFC members. Every Monday at 9 p.m. they pray the Rosary together through video chat. “So, actually, it’s more intimate. God is telling us one thing: just to love one another, to be close together even if this thing is happening.”

“This is one way of telling us to be together, united, to love each other, love your neighbour. No more fighting.”

The effects of the current pandemic on those living through it won’t be known for years, but it will certainly leave an indelible mark on front-line health workers, just as SARS affected Canlas and Chan-Wah in ways that continue to resurface today.

Chan-Wah recalled, “It was 17 years ago, but it’s just that this feeling is always there when I think about SARS. Every time when it was mentioned, it all came back to me.”

Catholic group faced negative press during SARS crisis

Seventeen years before the COVID-19 pandemic led to cancellation of public worship services across Canada, another deadly public health threat in Toronto limited certain Catholic practices during the Easter Triduum and kept many Catholics from attending Easter Mass. 

During Holy Week of 2003, the Archdiocese of Toronto announced that reception of Holy Communion from the chalice, kissing of the crucifix on Good Friday, and handshakes at the Sign of Peace were all suspended to prevent the spread of severe acute respiratory syndrome (SARS), a highly infectious disease closely related to COVID-19. 

More severely restricted were hundreds of members of a Filipino-based charismatic prayer group, Bukas Loob sa Diyos, who had been under city-mandated quarantine since Palm Sunday, April 13, 2003. BLD members therefore watched Easter Mass on television and had Holy Communion brought to their homes.

Bukas Loob sa Diyos (Open in Spirit to God) has chapters in Canadian cities including Surrey. In 2003, the Toronto BLD community was at the centre of a potential “super-spreading event” when on the weekend of March 28 and 29 some 500 people, including a BLD member infected with SARS, attended a BLD retreat. In the days that followed, several more people associated with BLD, as members or social contacts of members, fell ill with SARS.

On April 3, 2003, Toronto Public Health recognized the spread of SARS into the community and began an investigation. The next day, BLD leaders themselves recommended voluntary self-quarantine to their members. In particular, the BLD community would tell its members it was their religious duty to stay home at Easter.

BLD came in for some negative press at the time, and the five-volume Report of the SARS Commission of Ontario noted some “unfortunate cases in which news stories (about BLD and SARS) did not appear to be completely accurate or fully balanced.”

The commission noted the difficulty with reporting on issues like BLD and SARS “is that they are easily sensationalized and require scrupulous accuracy, balance and fairness.” In public emergencies the media need to use “extraordinary efforts to ensure accuracy, balance and fairness,” said the report.

At the same time, the commission commended BLD leadership for guiding members “through a difficult and dangerous time, while at the same time setting an example for governments and their agencies.”

A post-SARS article co-authored by Dr. Bonnie Henry referenced the BLD incident, noting “one religious group within the Filipino community experienced tremendous stress from both the effects of the illness on several of its members and the disclosure that the entire group of about 500 persons was under quarantine.”

The article said “In managing the ‘risk communications,’ there was a recurring trade-off between the need to protect individual privacy and the need to broadcast timely and relevant health risk messages to the wider community.”

Partly because of the spread of SARS within and beyond BLD, the U.S. Centers for Disease Control listed Toronto as an “affected area” on April 21, and two days later the World Health Organization issued a travel advisory warning against travel to Toronto. Alarmed by the economic fallout, the Ontario government lobbied the WHO to rescind its advisory, which it swiftly did. 

In compliance with provincial directives, North York General Hospital relaxed its precautions in early May, and Ontario’s own state of emergency was lifted on May 17, 2003. Soon, however, a second wave of infections and deaths began spreading, accounting for an estimated 118 further cases. Among the 17 people who died during this second wave was Nelia Laroza, a highly respected nurse at North York General’s orthopedic unit. As had happened a century earlier during the Spanish Flu pandemic, premature loosening of protective measures led to an unnecessary second peak of illness and death.

A federal advisory committee and the provincial SARS inquiry analyzed the handling of the outbreak. The Ontario report decried systemic weaknesses in the province’s public health system, which it said had been “on the edge of a complete breakdown.” 

By contrast, in British Columbia only five confirmed cases of SARS emerged: four local residents who had been exposed in Hong Kong, and a nurse whose exposure at the Royal Columbian Hospital in New Westminster prompted the Fraser Health Authority to further tighten its protective measures. No British Columbians died of SARS, and no further spread occurred at Vancouver General Hospital after a patient with SARS arrived at the emergency department there on March 7.

The Ontario commission credited B.C.’s stronger worker safety culture and infection-control procedures, as well as fortuitous circumstances, for the province’s success in keeping SARS in check.

Alan Yoshioka is a writer, medical editor, and speaker with a PhD in the history of medicine. He worships at Eastern Catholic Church, Richmond.