Abstract

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 patients.

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.