This is the second instalment in a three-part series on Ontario’s response to the 2003 SARS outbreak. You can read Part 1 here. Watch for Part 3 on Friday.
In 2003, the severe acute respiratory syndrome-related coronavirus came to Canada. SARS caused a major crisis, mainly in Toronto and its suburbs, for the health-care system and public-health officials. Hundreds fell ill, and 44 died, before the epidemic was brought under control. Now that cases of a novel coronavirus have been confirmed in Toronto and Vancouver, officials have begun referring to “the lessons of 2003” and how they have prepared us for this challenge. What are those lessons? In a new series, TVO.org interviews three people who were involved in dealing with the SARS crisis to ask them what insights they’d offer their counterparts today. Today, I talk to Frank Plummer, who ran Canada’s National Microbiology Laboratory, in Winnipeg, before, during, and after the epidemic.
Matt Gurney: I guess we have to start at the beginning. How did you get involved in the response to SARS in Toronto?
Frank Plummer: In March 2003, I had fairly recently taken over the National Microbiology Lab. I happened to be in Toronto for a meeting with all the provincial labs. We had heard about a new respiratory disease in China that no one had seen before. In the middle of the meeting, I got a call from my lab in Winnipeg to let me know there were urgent specimens coming from Toronto, from patients who were suspected to have this new illness. I think it was a Friday, and all my lab directors were there, and I called them together. We spent half an hour planning what we would do. We started calling back to Winnipeg to get the labs organized. Then we got on a plane back to Winnipeg. The following morning, we met again.
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Gurney: Sorry to interrupt, but just so the readers understand where we are in the timeline, what did you understand about SARS? What was known?
Plummer: We didn’t have any idea what it was, but we’d been hearing about an unusual respiratory illness in China that no one could find the cause of. The World Health Organization had sent out a global alert saying that we should be beware of unusual respiratory illnesses. So we knew there was something out there, but that’s about it.
Gurney: Okay, so walk me through what happens. There’s been this alert. You know something is out there, and now you have these samples being sent to you from doctors in Toronto. What happens next?
Plummer: My directors had called back to their labs on the Friday and ordered up what we thought we’d need — the supplies. We didn’t want to have to wait a few days to get this stuff. We just had to wait for the samples to arrive.
Gurney: Did you guys think right away that this was linked to the WHO alert? What were you feeling as all this was happening — the labs getting ready, the supplies getting organized, and all that?
Plummer: In a strange way — I know it sounds strange — but people like me, experts in infectious diseases ... we relished it. An epidemic with a mysterious cause is exciting. It’s like a firefighter who spends all their time training getting a real fire to fight.
Gurney: Right. Or a soldier who’s trained for battle getting a chance to finally see action.
Plummer: Exactly. That’s right. Something like that. In 2003, the national lab was relatively new. We were unproven, and this was a major challenge for us to rise to.
Gurney: Tell me what you guys were actually doing — what was the work you were doing like?
Plummer: Once the specimens arrived, we had to isolate the virus. We had specimens coming in from Toronto, and also, at this time, from Vancouver. We had to isolate it, grow cultures of it. We had to plate it out onto material for bacterial growth. Within the first 24 hours of receiving our specimens, we’d done every test available to us to rule out known things. With genetic testing, we could quickly rule out flu or other threats, and then we knew that we were in unknown territory.
Gurney: After you isolated the virus and had begun to grow it for testing, what’s your role? At the national laboratory, how did you fit into the national response and the international response?
Plummer: For the national effort, we were very quickly inundated with specimens from Ontario, mostly. All over the country but mainly Ontario, the Greater Toronto Area, from people with respiratory illnesses that someone thought might be SARS. We had thousands of specimens coming in. We had to set up an emergency-response operation, which we didn’t have before. We had to invent one as we went. We had to handle the media, and we did lots of interviews to explain what we were doing and what we knew about the crisis.
Globally, we were in constant communication with health authorities. I was coming into the lab at five o’clock in the morning to have video conferences with the world, basically. With WHO, and China and Hong Kong, and the United States and the United Kingdom. I remember coming in and watching pink sunrises on the white walls as I walked in the door. It was an exciting, stressful time. We isolated the virus maybe a day after the [U.S. Centers for Disease Control and Prevention] did. We collaborated with the [British Columbia] Genome Science Centre and published the first whole sequence of the virus. That was a pretty amazing achievement at the time, and that allowed a lot of other things to happen. Once we had the genetic sequence, we got tests out to the provinces. I don’t remember exactly, but within about three weeks, every provincial lab in the country had the ability to test for SARS. That really relieved the workload for us in Winnipeg.
Gurney: So, to make sure I understand this: before you had those tests, it was your job to look at a specimen and determine whether it was SARS or something more traditional, like the flu. You guys were ruling SARS in or out.
Plummer: Mostly ruling it in. Most of the work to test for known things could be done before we’d get involved. So the Ontario or Alberta provincial labs would already test for everything they could detect. Which is quite a few. The rest they would send to us. But nobody knew what this was. So we were working on the assumption that it was highly infectious and that we needed special containment to deal with it. We were the main lab in the country that had high levels of containment.
Gurney: Since SARS, we’ve talked about it as a success. It wasn’t perfect, but Canadian medical personnel and public-health officials got it under control and contained it. But, back at the time, that wasn’t a guarantee. You’ve already said you were inventing procedures on the fly to manage the emergency. What would you hope that your successors at the lab today would take from your experience in 2003?
Plummer: In 2003, the National Microbiology lab, and really the country, had really never dealt with anything like this before. We learned how to deal with it. After SARS, we put in place all kinds of things that made our capacity for response much, much better — and also much faster. If I were directing things today, I’d do pretty much the same things I did then. We didn’t know how to do it the first time. We would now, and some of our capabilities, our technical capabilities, would be faster. In 2003, coronaviruses had been known to us for a long time but had never been known to be particularly severe. This time, thanks to SARS, we’d probably know to look at a coronavirus as a possible explanation sooner than in 2003, when we looked for everything and then eventually found the virus.
Gurney: If you could go back in time with some advice, other than telling your younger self, “Look for a coronavirus!”, what would you say? What did you learn along the way that you wish you’d known at the start?
Plummer: [laughs] Well, here’s something. The national lab was divided into different labs that would run different kinds of tests. Everyone was interested in being involved in this. Every lab wanted in. People were clamouring for samples, of which there weren’t very many, to test their theories. At first it was pretty disorganized. We learned that that wasn’t working. We had to get it coordinated, so we put in place a method of organizing that. What was the most important test to do first? Everything else had to wait.
Gurney: In a similar vein, were there logistical bottlenecks in terms of personnel or supplies? You’d already mentioned there weren’t enough samples to go around, but were you adequately supplied in terms of experts, staff, technicians, equipment — things like that?
Plummer: There were two bottlenecks. One was the volume of specimens. You could automate a lot of the actual testing. But the specimens come in a box. Someone needs to open the box and unpack it and log it in, all that kind of stuff. That was a significant bottleneck. We were getting hundreds of packages a day, way more than we’d ever experienced before. Another one was managing the data, just being able to process all the data that was being generated by all the different labs. A specimen comes in — where did it come from? Who was it from? What were the lab results? And so on and so on. It was a lot of information, and we didn’t have a system in place at the time to handle that quickly. We invented one as we went. Communications were another key thing. We were getting these specimens coming in and people were calling us up wanting to know the results. It wasn’t working to have everyone in the entire lab being called up by anyone to ask, hey, where’s the result of the specimen I sent you? We had to put in place a system. The challenges were those kinds of things.
Gurney: But these were all things you learned from.
Plummer: Yeah. We had to put the systems in place. We spent years post-SARS getting them ready. And we also built a lot of stuff — like, physically built it, after SARS. We built an emergency-operations centre based off the one the U.S. Department of Health built after the anthrax scares of 2001. We trained everyone in the lab in emergency-operations procedures, using the system developed in California for firefighting. So, in the operations centre, it’s not just a room. It’s full of people, with TV monitors all over the room, all being monitored, with communication-systems capacity that’s incredible. We can video conference with 15 locations simultaneously. It was then, and probably still is, one of the best communication facilities in the G7 or in Europe, and it’s been used as a communications and command hub for other things since, issues of international concern. A lot of this we put in place after SARS, once we caught our breath. But some of it we did on the fly. We created an emergency-operations centre and communications capacity when we realized we needed it. And now it’s there, in place all the time, ready to go.
This interview has been condensed and edited for length and clarity.