By Rafael Brusilow
Unpredictable, unstoppable and inevitable–the very words used by the World Health Organization to describe an outbreak of the avian flu in human populations.
Prepared, determined and awaiting orders–the very words used by the head of Ryerson’s emergency response team Julia Lewis. As Ryerson’s chief emergency officer, Lewis heads up a five-person advisory committee tasked with Ryerson’s protection in the case of a major public health emergency such as an avian flu outbreak. Each member represents a different area of expertise: There’s the Security Officer, the Health Expert, the Communicator, the Administrator, and the Nurse. –each expected to relay orders from Toronto Public Health to staff and faculty and suggest ways to make campus a safe place to study. “We will go to the extreme to keep classes running. I can’t stress that enough,” Lewis said.
The think-tank team includes director of the School of Occupational Health Tim Sly, director of communications Ian Marlatt, associate vice-president Judith Sandys and Catherine Walker from Ryerson’s School of Nursing. In the event of a pandemic, Lewis would command the school’s security and safety staff, Sly would tabulate and advise on all incoming information from public health organizations and the government, Marlatt would send out information to students and faculty, Sandys would keep Ryerson’s executive informed and Walker would contact nursing students and help decide whether to leave them in their placements or pull them out.
That’s about the extent of the committee’s powers, and about the best committee members can expect their powers to be, said Sandys. A pandemic of avian flu would affect the entire community and therefore, Lewis said, Ryerson would be obligated to follow Toronto Public Health’s directions, which in turn would take orders from the Ontario Ministry of Health.
“If there was a pandemic, the university would probably have little discretion in what it did,” said Sandys.
No one yet knows what kinds of actions might be necessary, since the true nature of a possible human strain of the avian flu and the steps necessary to combat it are unknown. Avian flu is the common name for several strains of influenza that affect birds, particularly poultry, and that in some cases have spread to humans.
Experts believe the most virulent strain, H5N1, is poised to cause the next pandemic if it becomes readily transmissible between humans. But until the mutation happens, when the H5N1 strain infects a human being already infected with the regular flu, the extent of the danger can’t be gauged scientifically.
Still, of the 50 or so people thus far infected with the inefficient avian flu strain,40 have died. By comparison, the Spanish flu of 1918 which claimed between 20 and 40 million lives around the world killed only one out of every 40 people infected. Ryerson president Claude Lajeunesse said he has full confidence in the five-person committee. “I think we’re being ahead of the curve in making sure we have the appropriate response team.
We’re in constant discussion with Toronto Health and I’m sure the team that has been put in place firstly has the expertise that’s needed to handle the issue, and secondly they’re the right number of people,” Lajeunesse said.
The University of Toronto has a Critical Incident Response Team made up of about 25 members across its three campuses, however all of that team’s members are volunteers, unlike Ryerson’s team of paid officers, which can be expanded from 12 to about 60 people if necessary. Dr. Donald Low, a doctor of microbiology at Toronto’s Mount Sinai Hospital, said Ryerson’s goal of staying open during a pandemic makes sense, because history has shown that measures such as the closing of classrooms during times of outbreak traditionally haven’t been effective. “In 1918, the approach was to close schools, prevent public gatherings and separate people.
There’s no evidence it made any difference. In the case of a global pandemic, no amount of putting people away, locking them away is going to make any difference,” Low said. “The city has to continue to function. You can’t just close down a city, or a country, for months.” Should an avian flu pandemic hit, development of a vaccine could take anywhere fromfour to eight months from the time a mutant strain appears. Once a vaccine became available, however, Dr. Su-Ting Teo, a family doctor at Ryerson’s Health Centre, believes Ryerson could administer doses to students quickly and efficiently.
“During flu shot season, we do an hour per day, and in that time we manage to do about 50 or 60 shots with just one physician,” said Teo. Vaccines and all other medicines are covered up to 80 per cent under the RyeSAC Health and Dental Plan as long as a doctor prescribes them, although a pandemic vaccine would likely be offered free of charge by the Canadian government.
On any given day, about 500 Ryerson nursing students are either on campus or working at placements in hospitals, community centres schools and long-term care facilities such as homes for the elderly. Should a pandemic strike, that reservoir of nursing students could be called upon to assist health-care staff across Toronto.
Medicines and treatments are important and need to be readied, but without trained health staff to help administer them, patients can’t be effectively treated. Nursing students could help administer medication to patients, handle vaccines and be an extra set of eyes and ears on the hospital floor.
During the 2003 SARS outbreak, Walker said nursing students were removed from their placements because the overall threat of SARS was deemed too large to warrant putting students at undue risk, especially since the disease was spreading primarily in hospitals and not among the general population.
But every situation is different, and there’s no telling what might happen in an avian flu outbreak, she said. Lewis stressed that regardless of what Ryerson or public health agencies advised, the ultimate choice would still lie with students. “No one would ever be forced to do this–it just offers safe options for students who want to help,” Lewis said.
First-year nursing student Alan Lee said he believes the choice of whether to stay on the front lines during a dangerous pandemic or stay home is one every nursing student already made upon entry to Ryerson. “Once you choose to be a nurse, you know something like this will happen eventually, and if you don’t want that, then don’t be a nurse.
“It’s like going into a war– you know you might die, but you still go there. If we are not the ones who face these people, then no one else will help them. It’s about being professional and not just thinking about yourself,” Lee said.
Ultimately, Ryerson, like other institutions, can do little else but stay ready, play the waiting game, and keep students informed. “The only thing we can do is prepare. We can certainly go a long way by telling people how to stay healthy,” Walker said.
To avoid getting infected with any flu, Walker said the best thing people can do is take care about what they touch and make sure they wash their hands frequently when spending time in public areas.
“Clean, hot water and soap are the best. In the history of infectious diseases, mortality of patients went down when doctors and nurses realized that hand washing is essential.”