The urban geography of SARS: paradoxes and dilemmas in Toronto's health care
Identifieur interne : 000D12 ( Istex/Corpus ); précédent : 000D11; suivant : 000D13The urban geography of SARS: paradoxes and dilemmas in Toronto's health care
Auteurs : Dyanne D. Affonso ; Gavin J. Andrews ; Lianne JeffsSource :
- Journal of Advanced Nursing [ 0309-2402 ] ; 2004-03.
English descriptors
- Teeft :
- Affonso, Biological threats, Blackwell publishing, Clinical care, Clinical uncertainties, Clinical uncertainty, Community mobilization, Community spaces, Comprehensive disease control strategy, Containment, Control measures, Disease control, Disease transmission, Greater toronto area, Health canada, Health care, Health care management, Health care professionals, Health care providers, Health care system, Health care workers, Health protection agency, Human contacts, Infrastructure, Metre, Other cities, Patient care, Programme, Provider, Rapid spread, Respiratory syndrome, Sars, Sars case matrix, Sars patients, Syndrome, Toronto, Urban geography, Varia, Workforce safety.
Abstract
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.
Url:
DOI: 10.1046/j.1365-2648.2003.02958.x
Links to Exploration step
ISTEX:A7ED6B1D062C8421613E2E7E8ADB18B061B9A93FLe document en format XML
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Andrews</name><affiliation><mods:affiliation>Associate Professor, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author><author><name sortKey="Jeffs, Lianne" sort="Jeffs, Lianne" uniqKey="Jeffs L" first="Lianne" last="Jeffs">Lianne Jeffs</name><affiliation><mods:affiliation>Director, Patient Safety Initiatives, Patient Safety Research Cluster, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Journal of Advanced Nursing</title><title level="j" type="alt">JOURNAL OF ADVANCED NURSING</title><idno type="ISSN">0309-2402</idno><idno type="eISSN">1365-2648</idno><imprint><biblScope unit="vol">45</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="568">568</biblScope><biblScope unit="page" to="578">578</biblScope><biblScope unit="page-count">11</biblScope><publisher>Blackwell Science Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2004-03">2004-03</date></imprint><idno type="ISSN">0309-2402</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0309-2402</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Affonso</term><term>Biological threats</term><term>Blackwell publishing</term><term>Clinical care</term><term>Clinical uncertainties</term><term>Clinical uncertainty</term><term>Community mobilization</term><term>Community spaces</term><term>Comprehensive disease control strategy</term><term>Containment</term><term>Control measures</term><term>Disease control</term><term>Disease transmission</term><term>Greater toronto area</term><term>Health canada</term><term>Health care</term><term>Health care management</term><term>Health care professionals</term><term>Health care providers</term><term>Health care system</term><term>Health care workers</term><term>Health protection agency</term><term>Human contacts</term><term>Infrastructure</term><term>Metre</term><term>Other cities</term><term>Patient care</term><term>Programme</term><term>Provider</term><term>Rapid spread</term><term>Respiratory syndrome</term><term>Sars</term><term>Sars case matrix</term><term>Sars patients</term><term>Syndrome</term><term>Toronto</term><term>Urban geography</term><term>Varia</term><term>Workforce safety</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>sars</json:string><json:string>disease control</json:string><json:string>health care workers</json:string><json:string>respiratory syndrome</json:string><json:string>infrastructure</json:string><json:string>blackwell publishing</json:string><json:string>varia</json:string><json:string>provider</json:string><json:string>human contacts</json:string><json:string>biological threats</json:string><json:string>clinical uncertainty</json:string><json:string>sars patients</json:string><json:string>affonso</json:string><json:string>health canada</json:string><json:string>health care providers</json:string><json:string>programme</json:string><json:string>urban geography</json:string><json:string>clinical uncertainties</json:string><json:string>health care management</json:string><json:string>disease transmission</json:string><json:string>patient care</json:string><json:string>containment</json:string><json:string>metre</json:string><json:string>sars case matrix</json:string><json:string>health care</json:string><json:string>community spaces</json:string><json:string>syndrome</json:string><json:string>comprehensive disease control strategy</json:string><json:string>health care system</json:string><json:string>other cities</json:string><json:string>control measures</json:string><json:string>clinical care</json:string><json:string>health care professionals</json:string><json:string>community mobilization</json:string><json:string>greater toronto area</json:string><json:string>rapid spread</json:string><json:string>health protection agency</json:string><json:string>workforce safety</json:string><json:string>toronto</json:string><json:string>disease diffusion</json:string><json:string>crosscutting concepts</json:string><json:string>different ways</json:string><json:string>appropriate staff behaviours</json:string><json:string>hospital infrastructure</json:string><json:string>nursing inquiry</json:string><json:string>case study hospital</json:string><json:string>hong kong</json:string><json:string>sars crisis</json:string><json:string>sick patients</json:string><json:string>transmission dynamics</json:string><json:string>study hospital</json:string><json:string>communal spaces</json:string><json:string>family members</json:string><json:string>sars cases</json:string><json:string>epidemiological studies</json:string><json:string>government organizations</json:string><json:string>policy makers</json:string><json:string>hospital settings</json:string><json:string>public health infrastructure</json:string><json:string>sociocultural groups</json:string><json:string>disease control efforts</json:string><json:string>patient safety</json:string><json:string>risk assessment</json:string><json:string>mcgillis hall</json:string><json:string>community hospitals</json:string><json:string>peak outbreaks</json:string><json:string>provincial government</json:string><json:string>smith duell</json:string><json:string>programme areas</json:string><json:string>assessment competencies</json:string><json:string>spatial risk</json:string><json:string>spatial diffusion</json:string><json:string>outbreak</json:string><json:string>ontario</json:string></teeft></keywords><author><json:item><name>Dyanne D. Affonso BS MN MA PhD FAAN</name><affiliations><json:string>Dean, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Gavin J. Andrews BA PhD</name><affiliations><json:string>Associate Professor, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item><json:item><name>Lianne Jeffs BScN MSc RN</name><affiliations><json:string>Director, Patient Safety Initiatives, Patient Safety Research Cluster, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>severe acute respiratory syndrome</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>SARS space</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>place</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>geography</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>nursing</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>infectious disease</value></json:item></subject><articleId><json:string>JAN2958</json:string></articleId><arkIstex>ark:/67375/WNG-ZLZ4NCKM-W</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>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.</abstract><qualityIndicators><score>10</score><pdfWordCount>5926</pdfWordCount><pdfCharCount>39310</pdfCharCount><pdfVersion>1.4</pdfVersion><pdfPageCount>11</pdfPageCount><pdfPageSize>595 x 782 pts</pdfPageSize><pdfWordsPerPage>539</pdfWordsPerPage><pdfText>true</pdfText><refBibsNative>true</refBibsNative><abstractWordCount>335</abstractWordCount><abstractCharCount>2391</abstractCharCount><keywordCount>6</keywordCount></qualityIndicators><title>The urban geography of SARS: paradoxes and dilemmas in Toronto's health care</title><pmid><json:string>15012634</json:string></pmid><genre><json:string>article</json:string></genre><host><title>Journal of Advanced Nursing</title><language><json:string>unknown</json:string></language><doi><json:string>10.1111/(ISSN)1365-2648</json:string></doi><issn><json:string>0309-2402</json:string></issn><eissn><json:string>1365-2648</json:string></eissn><publisherId><json:string>JAN</json:string></publisherId><volume>45</volume><issue>6</issue><pages><first>568</first><last>578</last><total>11</total></pages><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>March–April 2003</json:string><json:string>2002</json:string><json:string>2004</json:string></date><geogName></geogName><orgName><json:string>National Institute for Occupational Health</json:string><json:string>University of Toronto</json:string><json:string>WHO</json:string><json:string>Globe and Mail</json:string><json:string>Center for Disease Control</json:string><json:string>Canada and Lianne Jeffs</json:string><json:string>NIOSH</json:string><json:string>Health Canada, CDC, the Province of Ontario and Toronto</json:string><json:string>Organization</json:string><json:string>Canadian Communicable Diseases</json:string><json:string>United Kingdom, the Department of Health</json:string><json:string>Department of Health</json:string><json:string>US Centers for Disease Control and Prevention</json:string><json:string>Research on SARS</json:string><json:string>Institute of Medicine</json:string><json:string>Research Cluster, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada Submitted</json:string><json:string>Health Canada</json:string><json:string>Blackwell Publishing Ltd</json:string><json:string>Canada Gavin J</json:string><json:string>US Centers for Disease Control</json:string><json:string>Health Protection Agency</json:string><json:string>CDC</json:string><json:string>World Health Organization</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Communicate</json:string><json:string>Hong Kong</json:string><json:string>Safety</json:string><json:string>Force</json:string><json:string>George Street</json:string></persName><placeName><json:string>Torontonian</json:string><json:string>Greater Toronto</json:string><json:string>Canada</json:string><json:string>Toronto</json:string></placeName><ref_url></ref_url><ref_bibl><json:string>Riley et al. 2003</json:string><json:string>Smith & Duell 1996</json:string><json:string>Varia et al.</json:string><json:string>Health Canada 2003a, 2003b, 2003c</json:string><json:string>Varia et al. 2003</json:string><json:string>Andrews 2002, 2003a, 2003b</json:string><json:string>D. Affonso et al.</json:string><json:string>Globe and Mail 2003</json:string><json:string>Globe and Mail, 2003a, 2003b, 2003c, 2003</json:string><json:string>Health Protection Agency 2003</json:string><json:string>Hynes-Gay et al. 2003</json:string><json:string>Rota et al. 2003</json:string><json:string>Wynn & Peter 2003</json:string><json:string>Meade & Earickson 2000</json:string><json:string>Canadian Communicable Diseases 2003</json:string><json:string>Varia et al. (2003)</json:string><json:string>McGillis Hall et al. 2003</json:string><json:string>Ofner et al. 2003</json:string><json:string>Globe and Mail 2003c</json:string><json:string>May 2003</json:string><json:string>Diseases (2003)</json:string><json:string>Health Canada 2003b</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/WNG-ZLZ4NCKM-W</json:string></ark><categories><wos><json:string>1 - social science</json:string><json:string>2 - nursing</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - public health & health services</json:string><json:string>3 - nursing</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Nursing</json:string><json:string>3 - General Nursing</json:string></scopus><inist><json:string>1 - sciences humaines et 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xml:lang="en">CANADA</country></address><address><addrLine>Associate Professor</addrLine><addrLine>Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</addrLine><country key="CA" xml:lang="en">CANADA</country></address><address><addrLine>Director</addrLine><addrLine>Patient Safety Initiatives, Patient Safety Research Cluster, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</addrLine><country key="CA" xml:lang="en">CANADA</country></address></affiliation></author><author xml:id="author-0001"><persName><forename type="first">Gavin J.</forename><surname>Andrews</surname><roleName type="degree">BA PhD</roleName></persName><affiliation><address><addrLine>Dean</addrLine><addrLine>Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</addrLine><country key="CA" xml:lang="en">CANADA</country></address><address><addrLine>Associate Professor</addrLine><addrLine>Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</addrLine><country 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<ref target="http://www.tei-c.org/">We use TEI</ref></desc></application></appInfo></encodingDesc><profileDesc><abstract xml:lang="en" style="main"><p><hi rend="bold">Background. </hi> 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.</p><p><hi rend="bold">Aims. </hi> 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.</p><p><hi rend="bold">Methods. </hi> 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.</p><p><hi rend="bold">Discussion. </hi> 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.</p><p><hi rend="bold">Conclusion. </hi> 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.</p></abstract><textClass><keywords xml:lang="en"><term xml:id="k1">severe acute respiratory syndrome</term><term xml:id="k2">SARS space</term><term xml:id="k3">place</term><term xml:id="k4">geography</term><term xml:id="k5">nursing</term><term xml:id="k6">infectious disease</term></keywords><keywords rend="tocHeading1"><term>Nursing and health care management and policy</term></keywords></textClass><langUsage><language ident="en"></language></langUsage></profileDesc><revisionDesc><change when="2019-12-20" who="#istex" xml:id="pub2tei">formatting</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/WNG-ZLZ4NCKM-W/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Science Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1365-2648</doi><issn type="print">0309-2402</issn><issn type="electronic">1365-2648</issn><idGroup><id type="product" value="JAN"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="JOURNAL OF ADVANCED NURSING">Journal of Advanced Nursing</title></titleGroup></publicationMeta><publicationMeta level="part" position="03006"><doi origin="wiley">10.1111/jan.2004.45.issue-6</doi><numberingGroup><numbering type="journalVolume" number="45">45</numbering><numbering type="journalIssue" number="6">6</numbering></numberingGroup><coverDate startDate="2004-03">March 2004</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="0056800" status="forIssue"><doi origin="wiley">10.1046/j.1365-2648.2003.02958.x</doi><idGroup><id type="unit" value="JAN2958"></id></idGroup><countGroup><count type="pageTotal" number="11"></count></countGroup><titleGroup><title type="tocHeading1">Nursing and health care management and policy</title></titleGroup><eventGroup><event type="firstOnline" date="2004-03-10"></event><event type="publishedOnlineFinalForm" date="2004-03-10"></event><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:2.3.5 mode:FullText source:FullText result:FullText" date="2010-04-07"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:3.8.8" date="2014-01-28"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.1.7 mode:FullText,remove_FC" date="2014-10-23"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="568">568</numbering><numbering type="pageLast" number="578">578</numbering></numberingGroup><correspondenceTo><i>Dyanne Affonso,
Faculty of Nursing,
University of Toronto,
50 St George Street,
Toronto,
Ontario, M5S 3H4,
Canada.
E‐mail: </i><email>d.affonso@utoronto.ca</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:JAN.JAN2958.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Submitted for publication 23 July 2003 Accepted for publication 20 November 2003</unparsedEditorialHistory><countGroup><count type="figureTotal" number="3"></count><count type="tableTotal" number="2"></count></countGroup><titleGroup><title type="main">The urban geography of SARS: paradoxes and dilemmas in Toronto's health care</title><title type="shortAuthors"><i>D. Affonso</i> et al.</title><title type="short"><i>The urban geography of SARS</i></title></titleGroup><creators><creator creatorRole="author" xml:id="cr1"><personName><givenNames>Dyanne D.</givenNames><familyName>Affonso</familyName><degrees>BS MN MA PhD FAAN</degrees></personName></creator><creator creatorRole="author" xml:id="cr2"><personName><givenNames>Gavin J.</givenNames><familyName>Andrews</familyName><degrees>BA PhD</degrees></personName></creator><creator creatorRole="author" xml:id="cr3"><personName><givenNames>Lianne</givenNames><familyName>Jeffs</familyName><degrees>BScN MSc RN</degrees></personName></creator></creators><affiliationGroup><affiliation xml:id="aff-1-1" countryCode="CA"><unparsedAffiliation>Dean, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</unparsedAffiliation></affiliation><affiliation xml:id="aff-1-2" countryCode="CA"><unparsedAffiliation>Associate Professor, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</unparsedAffiliation></affiliation><affiliation xml:id="aff-1-3" countryCode="CA"><unparsedAffiliation>Director, Patient Safety Initiatives, Patient Safety Research Cluster, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</unparsedAffiliation></affiliation></affiliationGroup><keywordGroup xml:lang="en"><keyword xml:id="k1">severe acute respiratory syndrome</keyword><keyword xml:id="k2">SARS space</keyword><keyword xml:id="k3">place</keyword><keyword xml:id="k4">geography</keyword><keyword xml:id="k5">nursing</keyword><keyword xml:id="k6">infectious disease</keyword></keywordGroup><abstractGroup><abstract type="main" xml:lang="en"><!--
affonso d.d., andrews g.j. & jeffs l. (2004) Journal of Advanced Nursing45(6), 568–578
The urban geography of SARS: paradoxes and dilemmas in Toronto's health care
--><p><b>Background. </b> 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.</p><p><b>Aims. </b> 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.</p><p><b>Methods. </b> 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.</p><p><b>Discussion. </b> 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.</p><p><b>Conclusion. </b> 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.</p></abstract></abstractGroup></contentMeta></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>The urban geography of SARS: paradoxes and dilemmas in Toronto's health care</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>The urban geography of SARS</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>The urban geography of SARS: paradoxes and dilemmas in Toronto's health care</title></titleInfo><name type="personal"><namePart type="given">Dyanne D.</namePart><namePart type="family">Affonso</namePart><namePart type="termsOfAddress">BS MN MA PhD FAAN</namePart><affiliation>Dean, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gavin J.</namePart><namePart type="family">Andrews</namePart><namePart type="termsOfAddress">BA PhD</namePart><affiliation>Associate Professor, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Lianne</namePart><namePart type="family">Jeffs</namePart><namePart type="termsOfAddress">BScN MSc RN</namePart><affiliation>Director, Patient Safety Initiatives, Patient Safety Research Cluster, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</genre><originInfo><publisher>Blackwell Science Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2004-03</dateIssued><edition>Submitted for publication 23 July 2003 Accepted for publication 20 November 2003</edition><copyrightDate encoding="w3cdtf">2004</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><extent unit="figures">3</extent><extent unit="tables">2</extent></physicalDescription><abstract lang="en">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.</abstract><subject lang="en"><genre>keywords</genre><topic>severe acute respiratory syndrome</topic><topic>SARS space</topic><topic>place</topic><topic>geography</topic><topic>nursing</topic><topic>infectious disease</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Advanced Nursing</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><identifier type="ISSN">0309-2402</identifier><identifier type="eISSN">1365-2648</identifier><identifier type="DOI">10.1111/(ISSN)1365-2648</identifier><identifier type="PublisherID">JAN</identifier><part><date>2004</date><detail type="volume"><caption>vol.</caption><number>45</number></detail><detail type="issue"><caption>no.</caption><number>6</number></detail><extent unit="pages"><start>568</start><end>578</end><total>11</total></extent></part></relatedItem><relatedItem type="references" displayLabel="cit2"><titleInfo><title>Towards a more place‐sensitive nursing research: an invitation to medical and health geography</title></titleInfo><name type="personal"><namePart type="given">G.J.</namePart><namePart type="family">Andrews</namePart><role><roleTerm type="text">author</roleTerm></role></name><genre>journal-article</genre><note type="citation/reference">Andrews G.J. 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