In this issue of Longwoods Review we focus on an issue that many countries and jurisdictions are grappling with right now - creating strategies for preparing for biological/chemical terrorism or infectious diseases such as SARS or Avian Flu. Nash and Ramsay from the University of Ottawa present an intriguing idea for maximizing resources while also controlling public health risk through the introduction (or re-introduction) of house calls. The authors argue that the current system of patients coming to clinics, emergency rooms or doctors' offices is not in the best interests of public health when dealing with an epidemic. Rather they suggest it would be far more effective to assess, diagnose and treat patients in their own homes. Of course, feasibility is an issue in this scenario. The authors present a compelling case for how and why this idea could work.
Waters and Justus from the University of North Carolina at Chapel
Hill respond by offering observations from the United States where
similar strategies have been developed to decentralize the delivery
of emergency services. They endorse the strategy of containment
suggested by Nash and Ramsay and further suggest several factors
that need to be carefully considered − early and effective
communication to the public; surveillance and monitoring systems
that can identify the hazards from the outset; and, in the case of
chemical or biological terrorism, systems for decontaminating
affected patients prior to care. Water and Justus suggest that
adapting Nash and Ramsay's concept of bringing care to those in
need might be achieved through larger gatherings of isolated
We thank both teams of authors for providing a thought-provoking
yet highly practical discussion on what may well be one of major
challenges to our healthcare systems in the coming years.
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