Getting the Low down

U of T’s makeshift SARS czar speaks about the outbreak

“It was all–consuming. Everything stopped. My whole life was put on hold‚ it was completely focused on SARS. Some nights lying in bed after I’d finally got home I’d think ’Is this ever going to end?’”

Dr. Donald Low‚ Chief Microbiologist at Mount Sinai Hospital and Professor of Microbiology and Medicine for U of T‚ was Toronto’s man of the hour during the SARS outbreak last spring. He dealt with patients himself on the front lines. He reviewed treatment and containment procedures‚ and helped develop policies with the city. He reviewed reams of suspected and probable SARS cases. He became an ad hoc spokesperson for the city’s health care system‚ appearing on the evening news almost daily.

“He fulfilled a need that we had—Don is very much an expert in infectious diseases and his help and assistance to Toronto Public Health was just invaluable in helping us to learn about this disease and how to control it‚” says Bonnie Henry‚ Toronto’s assistant medical officer of health. “Don speaks his mind‚ he’s very honest and open‚ and I think that made him a perfect spokesperson for these complex issues. He was able to put them in a framework that people understood.”

“He did a fantastic and exemplary job—he had quite an intense amount of responsibility‚ and he certainly met the challenge extremely well…the pressure was on‚ and he rose to the challenge‚” says Dr. Hanif Kassim‚ associate medical officer of health for York region. “He is different in the sense that he took a lot of time out of his busy schedule to assist us and to provide information to the public.”

“None of what I did for this city was in my job description‚” says Dr. Low. He stretched himself so far that his weight dropped from 170 lbs. to 145 lbs. during the outbreak.

“In the early days of SARS‚ it was incredibly stressful…we really didn’t know what we were dealing with‚” he says. “When we saw the disease spread to [nurses and hospital workers]‚ we thought ‘Oh god‚ are we going to be remembered as the entry point for this disease for the rest of North America?'”

Dr. Low was put into quarantine himself after coming into contact with a colleague who had developed SARS. “There was a real concern that he may have gone on to get sick‚ and we were very grateful that he didn’t because we needed his help‚” says Dr. Henry‚ who ordered Dr. Low into isolation.

Dr. Low didn’t really think he really had the disease‚ but being in an age group with a mortality rate of 40 per cent made his safety a real concern. By going into isolation‚ he became the quarantine poster child‚ setting an example for all those who disregarded orders to remain in isolation. The quarantine however was not an opportunity for rest—Dr. Low found himself just as swamped with work at home. Sitting through two–hour–long conference calls and fielding phone calls and faxes from the media every day barely left him time to eat.

Despite the toil‚ Dr. Low doesn’t regret offering his help to the city. “I wouldn’t have missed it for the world. It was probably one of the most significant things that’s happened in my life…it was just so surreal‚ medically nothing compares to what happened in those four months.”

Not being connected to Toronto Public Health or the Ministry of Health placed Dr. Low in a unique position‚ one that many people in this city found reassuring. “I think people appreciated having somebody as spokesperson that was more involved at the grassroots level‚ instead of [Ontario’s Chief Medical Officer of Health] Colin D’Cunha or [Commissioner of Safety] James Young‚ who were involved at a much higher level and hadn’t even seen a patient‚” he says.

Dr. Low became particularly well known for saying that the WHO travel advisory was “a bunch of bullshit‚” a gut reaction that came moments after hearing about the advisory from a CBC journalist. “I was absolutely livid‚” says Dr. Low. The advisory was issued after the first phase of the outbreak was over and it was clear that the spread was not going to get worse.

“It was actually quite funny—that day‚ we were so busy‚ I had two cell phones and a pager. These people came in from the Center for Disease Control [in Atlanta] to help us. They were sitting across a table from me at a hotel‚ and I was on both cell phones for fifteen minutes…they were just shaking their heads…they must have been wondering what the hell they’d gotten themselves into.”

Dr. Low himself held a phone meeting with the WHO to discuss the advisory. “There was no good explanation. They didn’t present any data to convince any of us that this was an appropriate thing to do‚ it was not based on any science‚” he says. As scary as the SARS outbreak may have been‚ the disease spread was almost entirely confined to the hospital environment. Many assume that the advisory was issued for political reasons‚ as China was outraged at being given travel advisories themselves. The WHO had no criteria for a travel advisory at the time. They came up with criteria later‚ which Toronto did not in fact fulfill during the peak of the outbreak.

Dr. Low became notorious during the SARS outbreak for refusing to mince his words or gloss over the truth. He received more than 1500 requests for interviews through Mount Sinai. “The media attention was unbelievable.

“You have to give the government credit‚ nobody ever once told me to shut up. They used to shudder when I spoke. I wasn’t trying to be sensationalist or anything‚ I mean if somebody asks me a question I give an honest answer.”

Dr. Low wasn’t even reprimanded after he criticized Health Canada’s definition of what constitutes a “probable” SARS case. The definition categorized a “probable” case as being “severely progressive‚” but to define an individual as such would require monitoring them over a period of time. So an individual walking into emergency with a cough‚ a fever‚ a suspicious chest X–ray‚ and who had been working at a hospital could only be defined as “suspect‚” lowering the total number of defined cases and masking the severity of the outbreak. After Dr. Low told CBC radio‚ “I can tell you that there’s a lot more patients out there that have SARS than we’re letting the rest of the world believe‚” Health Canada changed its definition within 24 hours.

Toronto’s response to the crisis was at best makeshift‚ and many mistakes were made. Dr. Low surmises that somebody should have been put in charge of the entire affair from the beginning‚ a “SARS Czar‚” to effectively coordinate the city’s efforts. Dr. Low doesn’t however think that he himself should have been Toronto’s SARS Czar. “I wanted that to be David Naylor [Dean of the Faculty of Medicine at U of T]‚ somebody with that kind of organizational ability.” Dr. Naylor’s report on the SARS outbreak‚ yet to be released‚ is expected to be highly critical of the way the outbreak was handled.

Dr. Low doesn’t think that SARS will come back to Toronto. Should any new disease threaten the city in the future‚ it is likely that the infrastructure will be in place so that somebody like him won’t be loaded with so much responsibility.

Since the outbreak Dr. Low’s schedule has in fact gotten busier. A SARS expert‚ he is constantly traveling to conferences throughout North America to discuss the outbreak. “It’s another layer of responsibility. But‚ you know‚ its fun.”

Dr. Low is the author of over 170 published articles. His laboratory at Mount Sinai conducts research on antibiotic resistance in bacteria and on necrotizing fasciitis (the “flesh–eating” disease). He also has part–time teaching responsibilities‚ mostly through the Faculty of Medicine.

When asked if he would rather be a full–time professor at U of T‚ Dr Low replied‚ “Oh‚ god‚ no—this is the best job in the world.”