Table 3.
Differences between 2003 and 2020 in preparedness for a novel coronavirus at a large academic hospital (Sunnybrook Hospital) in Toronto, Canada*
| 2003: SARS in Toronto | 2020: COVID-19 Toronto case | |
|---|---|---|
| Public health structures and infrastructures: |
||
| Adequate funding and human resources |
No |
Yes |
| Protocols for information sharing among different levels of government |
No |
Yes |
| Link between public health and hospitals |
Weak, fragmented, uncoordinated |
Coordination and information sharing present |
| Rapid and accurate diagnostic testing: |
No |
Yes |
| IPAC program structure and related hospital program: |
||
| ICP staffing level |
Understaffed: 3 ICPs for 1257 total beds (0.23 ICP/100 beds) |
Adequate: 13 ICPs for 1355 total beds (0.96 ICP/100 beds) |
| ICP certification (Certification Board of Infection Control and Epidemiology) |
Not universal |
Required |
| Occupational Health & Safety |
Disconnected from IPAC |
Coordinated with IPAC |
| IPAC administrative controls: |
||
| Syndromic triage in ED |
No |
Yes |
| Febrile respiratory illness surveillance |
No |
Yes |
| Isolation of all patients with acute respiratory symptoms |
No |
Yes |
| Awareness of super-spreading events and individuals |
No |
Yes |
| Minimizing AGMP and protected intubation policies |
No |
Yes |
| Hand hygiene program: |
No |
Yes |
| Healthy Workplace Policy (work restrictions for HCWs with acute infectious symptoms) |
No |
Yes |
| Presence of a pandemic plan |
No |
Yes |
| Engineering and environmental controls: |
||
| Number of airborne infection isolation room |
20 (0 in ED) |
46 (8 in ED) |
| ED infrastructure |
Shared air system; no protective barrier at triage |
Isolated air system with negative pressure in each zone; protective barrier at triage |
| Terminal disinfection completed twice at patient discharge for high-consequence pathogen |
No |
Yes |
| Personal protective Equipment (PPE): |
||
| Regular N95 fit-testing of HCWs |
No |
Yes |
| Clear recommendation on PPE for any novel high-consequence pathogen | No | Yes |
IPAC − infection prevention and control, ICP − infection prevention and control professional, AGMP − aerosol-generating medical procedure, HWC − healthcare worker, ED − emergency department.
*Adapted from [42].