SARS Unmasked: Risk Communication of Pandemics and Influenza in Canada (review)

Sars Unmasked presents a detailed analysis of the responses to the SARS crisis in Canada and internationally in the spring and summer of 2003, with a focus on the experiences of healthcare workers (particularly nurses) during the crisis as well as public health responses and lessons for risk communication.

The book begins with a detailed timeline of how the SARS crisis unfolded in Canada, including descriptions of responses by public health and healthcare officials. The second chapter, co-authored by nurse Cathy Paterson, provides a powerful description of how healthcare workers in a Toronto-area hospital experienced the SARS crisis. This little-known story is shocking, disturbing, and eye-opening. From ill-fitting masks, lengthy self-imposed quarantines, and experiences of unending stress and uncertainty, nurses and healthcare workers watched helplessly as patients and colleagues became infected, and fell extremely ill, with some ultimately succumbing to SARS. This chapter reveals the uniquely stressful work environment of the hospital during a pandemic. Many of the victims of SARS were healthcare workers in Canada, China, and other countries, infected by contagious patients. In light of the threat posed, many workers feared bringing home an infectious and deadly virus that could sicken, or even kill, their family members. This chapter also reveals some of the ways that the SARS epidemic caught Toronto-area hospitals unprepared, and stretched the human and physical capacity of an already strained system.

While Chapter 3 details the specific characteristics of the corona virus that caused SARS and the epidemiology of its spread, the next chapter describes how infected patients experienced SARS, including how they were diagnosed and treated in Canadian hospitals, their symptoms, and their recovery. It also presents the long-term physical and psychological challenges facing patients, including healthcare workers, who survived being infected by SARS.

Chapters 5 and 6 describe the way that the SARS crisis became amplified in the mass media, utilizing the Social Amplification of Risk framework. They also explores the way this amplification of risk stigmatized healthcare workers in Toronto and other hotspot cities, even when the actual risk of infection to the general population was, in fact, very low. After the crisis ended, Toronto enacted societal "purification rituals," such as the Rolling Stones concert, in an effort to remove stigma (but these unfortunately also failed to address the heroic efforts of healthcare workers dealing with the crisis).

With multiple co-authors, Chapter 7 outlines the gendered nature of the consequences of the outbreak, with female nurses on the front-lines being most at risk of infection, especially during patient intubation. Despite working on the front-line, power hierarchies in the hospital and healthcare setting meant that nurses' concerns about improper protective equipment, supports, resources, etc. were marginalized, and resulted in several rallies outside hospitals during the crisis demanding that their concerns, particularly with respect to the ability to protect their families, be heard and addressed. Nurses also felt that their important work-as well as the risks, stigma, and isolation they endured during the SARS crisis-were devalued by the healthcare system and the public. Female nurses experienced severe stress around their multiple roles as workers required to work extra hours, and frequently under quarantine, and their care work obligations for children and ill relatives. The authors argue that gender-sensitive and family-friendly policies and supports would have helped reduce the strain on female healthcare workers, especially nurses, during the crisis.

Chapters 8 and 9 focus on policy lessons from the SARS crisis. These lessons are based on a detailed comparison of how the different hospitals and their administrators reacted to the SARS crisis. Overall, hospitals were poorly prepared for the crisis because of chronic under-funding and disinvestment, including a failure to fully implement infection control programs and measures. Transfers of ill patients and healthcare workers between facilities accelerated the spread of SARS between hospitals. Facing these challenges, hospital administrators and staff demonstrated impressive organizational flexibility...