The urban geography of SARS: paradoxes and dilemmas in Toronto's health care
The urban geography of SARS: paradoxes and dilemmas in Toronto's health care
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DOI：
10.1046/j.1365-2648.2003.02958.x
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发表时间：
2004-03-01
影响因子：
3.8
通讯作者：
Jeffs, L
中科院分区：
文献类型：
--
作者：
Affonso, DD;Andrews, GJ;Jeffs, L
背景。严重急性呼吸系统综合症（SARS）对加拿大社会及其医疗保健系统造成了严重影响。出乎意料的是，医院和医护人员成为疾病传播的促进者。这一经验表明需要采取全面的疾病控制策略。目标有三个。首先，考察SARS在大多伦多地区快速传播的短暂而关键的时期内微妙且变化的空间特征。其次，突出护士和其他医疗保健专业人员在照顾病人和遏制疾病快速传播方面面临的三个悖论及其相关困境。第三，提出一些解决这些困境的方法，以及一些更广泛的预防和缓解策略。方法。 “临床不确定性”和“人类接触流”的交叉概念用于解释疾病传播特征和城市空间扩散，并指导制定的特定策略。该论文的证据来自公共卫生记录、政府和非政府的健康声明以及对 SARS 的初步流行病学研究。还从最近多伦多医疗保健系统在危机期间的第一手经验中获得了直接的见解。讨论。临床不确定性和人员接触流动的概念提供了深入的见解，补充了大规模流行病学研究的结果，并有助于落实他们对加强控制措施的普遍呼吁。拟议的综合疾病控制战略包括建立专门用于遏制生物威胁的医院基础设施；疾病控制专家咨询联盟；开发生物威胁和遏制模拟实验室以及患者安全、风险评估和社区动员三个具体项目。结论。有人认为，遏制本身虽然是一项必要且紧迫的优先事项，但其本身并不能被视为目的，最好将其理解为全面解决问题战略中的一个可能的轨迹。多伦多的经验可以为其他目前缺乏此类策略、因此可能容易遭受类似危险传染病爆发的城市和国家提供参考。
Background. Severe acute respiratory syndrome (SARS) has impacted heavily on both Canada's society and its health care system. Quite unexpectedly, hospitals and health care workers became facilitators of disease diffusion. This experience has demonstrated the need for a comprehensive disease control strategy.Aims. The aims are threefold. First, to examine the subtle and changing spatial characteristics of SARS during the short but critical period of its rapid spread in the Greater Toronto Area. Second, to make salient three paradoxes, and their associated dilemmas, faced by nurses and other health care professionals challenged with caring for the sick and containing the rapid spread of the disease. Third, to propose some ways of approaching these dilemmas, as well as some broader preventative and mitigating strategies.Methods. The crosscutting concepts of 'clinical uncertainty' and 'flow of human contacts' are used to explain disease transmission characteristics and urban spatial diffusion and to guide the particular strategies developed. Evidence for the paper comes from public health records, governmental and non-governmental health statements and the initial epidemiological research on SARS. Direct insights are also gained from recent first-hand experiences of Toronto's health care system during the crisis.Discussion. The concepts of clinical uncertainty and the flow of human contacts provide in-depth insights that complement the findings of large-scale epidemiological studies, and help operationalize their general calls for enhanced control measures. The comprehensive disease control strategy proposed includes the creation of a hospital infrastructure specific to the containment of biological threats; an advisory coalition of disease control specialists; the development of a biological threat-and-containment simulation laboratory and three specific programmes in patient safety, risk assessment and community mobilization.Conclusion. It is argued that containment alone, while a necessary and urgent priority, cannot be seen as an end in itself and might better be understood as one possible trajectory within a comprehensive problem-solving strategy. The experiences in Toronto may offer insights to other cities and countries that currently lack such strategies and hence may be vulnerable to similar outbreaks of dangerous infectious diseases.