As the mass vaccination program begins ahead of schedule, we're getting a glimpse of how prepared the city's health authorities are for an outbreak of the H1N1 flu virus, which can't help but make you wonder how deep the preparations go, and how carefully they've planned for the worst.

Certainly, health care authorities have had a full season of the virus working its way through the southern hemisphere to draw on for precedents, and almost everyone agrees that SARS - probably a more disastrous experience for Toronto - left them prepared. "I think that since SARS has happened a lot has happened across the province when it comes to infection control," says Herveen Sachdeva, Associate Medical Officer of Health for Toronto Public Health. "There's a lot more awareness out there and a lot more resources dedicated to infectious diseases in healthcare environments."

Shona Milligan, chair of the Disaster Management and Recovery Committee for the Cardinal Funeral Home group agrees. "You look at a country that hasn't had a hurricane in a generation, and it's devastating to them because they're so unprepared. I do think that SARS has been beneficial to us in preparation."

"Our planning has always been to plan for the worst but to anticipate the best," says Dr. Charles Chan, Vice President of Medical Affairs and Quality at the University Health Network, which includes Toronto General, Princess Margaret and Toronto Western hospitals. He says they've been planning for years, with meetings every month since the summer began, and that while there have been some fatalities, they've had the effect of galvanizing the public's attention that the H1N1 virus is definitely here.

While there have been three major pandemics in the last century, the 1918-1919 Spanish Flu epidemic is the one that still galvanizes the public's imagination, and Toronto was hit as hard as any city. Thirteen hundred Torontonians died during that outbreak, and at one point during October 1918, the worst month of the pandemic, more than half of the city was infected, and hospitals were so swamped that the Hotel Arlington - now the site of the Bell Lightbox on King West - was turned into a hospital.

Chan says that as long as around forty or so new flu cases a day show up at Toronto General, they'll be able to function normally, but when the total reaches a hundred, contingency plans will kick in to draw beds, staff and resources from the hospital's many other activities. According to a plan released by Toronto Public Health in July, when the pandemic reaches a 1 per cent case fatality rate, it will be classed as severe, and plans will go into effect to close down schools and public gatherings, limit ridership on public transport, and even shut down a major airport like Pearson.

Milligan says that Cardinal employees have been issued with pandemic kits with rubber gloves and masks as well as flashlights and batteries in case of power outages; they've been told how to stock their homes with food in case of shortages, and their funeral homes have been stocked similarly in case they're forced to work overtime. "I think that we're like everybody else - we're watching the news and staying on top of it," she says. "We may not be, as an industry, be as panicked about it because we have been aware and talking."

"I'm not even sure we're even into week one of the surge, to be honest with you," says Chan. "When we talk about week one, we're talking about a significant number or patients showing up in the emergency rooms, but having to be admitted to the hospital. What we're talking about is maybe one admission or two admissions a day at some of the bigger hospitals in Toronto, and that's good news."

Photo by Roger Cullman