Conclusions

SARS has resulted in significant challenges for critical care medicine. The ability of this disease to incapacitate staff has resulted in staff safety becoming a priority to maintain adequate critical care services. Indeed, the impact of this infection on the healthcare system and regional economy cannot be understated. Resources of individual hospitals were rapidly outstripped as scores of administrative and front line care providers were quarantined or became ill. In Toronto 18% of the critically ill patients were healthcare workers. The ability of this infection to spread is singularly impressive and devastating. Our understanding of the virus, its diagnosis, and treatment continues to evolve. Infection control measures remain the mainstay of regional and global health. The concept of "universal precautions" has expanded beyond policies regarding blood borne infections and now includes strict respiratory and contact precautions. The effect of these stringent policies on patients without SARS was devastating. As a result of the outbreak, hospitals were closed and advanced surgical and medical care programmes such as transplantation and organ donation were shut down. In one instance 35 critical care beds were closed (representing 38% of our tertiary ICU beds) because of an inadvertent exposure of ICU staff to a patient with SARS. The secondary morbidity and mortality from this disease on patients who were placed on hold or whose surgery was delayed remains to be determined. The guidelines and recommendations discussed here will change as our knowledge grows. No doubt information technology played an important role in allowing collaboration and rapid transfer of information throughout the SARS pandemic. Indeed, through such collaboration we can hope to improve the mortality and morbidity of our patients and, indeed, ourselves.

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