• ED was closed to ambulances • Transfers to and from other hospitals were restricted • Most surgical procedures were cancelled March 27 Further measures were taken in response to a provincial directive • Inpatients were not permitted visitors, with rare exceptions • Staff, patients and visitors in the ED were required to wear masks • Nonemergency ambulatory care was cancelled March 28 • Access to the hospital was limited to 1 entrance and the ED • An 18-bed negative-pressure isolation unit was established in compliance with a directive from the Provincial Commissioner of Public Safety and Security*† March 30 • All people in the building were required to wear masks • Masks, gowns and frequent handwashing were required for all patient contacts • For contacts with patients with SARS, isolation precautions included wearing gowns, gloves, masks and safety glasses, or masks with an attached plastic eye shield, which were changed after each contact, and handwashing after each contact and hourly • All nonessential rounds and meetings were cancelled • Medical students and volunteers were not allowed in the hospital • Staff whose role was not essential for patient care were asked to remain at home and were paid for scheduled shifts • The cafeteria stopped selling food but remained open for seating • The gift shop closed • The coffee shop remained open • Screening of staff at the hospital entrance began. The screening procedure required handwashing, putting on a mask, answering standard questions asked by screening staff (see Appendix 1), having one’s temperature taken, reviewing the completed questionnaire with another staff member and washing hands again. Note: ICU = intensive care unit, ED = emergency department, SARS = severe acute respiratory syndrome. *Before March 28, patients with SARS were treated in respiratory isolation rooms distributed through the hospital on medical and surgical floors. †This required close collaboration between the hospital’s administration and the departments of Infection Control/Microbiology and Engineering. The unit chosen was a general medical floor staffed by nurses experienced in the care of acutely and chronically ill patients, respiratory distress and infection control procedures (for patients with vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus). Staff were prevented by provincial directives from working in multiple institutions, which imposed a financial burden on staff whose income depends on working in several institutions and on doctors who divide duties between settings. Doctors with clinical offices in the hospital were required to cancel their outpatient practices until further notice. Hospital employees with a potential contact with SARS entered voluntary 10-day quarantine. Quarantined staff had concerns about their personal safety, about transmitting disease to family members, about stigmatization and about interpersonal isolation. Working staff members were concerned about understaffing due to quarantines and about overwork caused by colleagues’ calling in sick. Staff members who were not directly involved in patient care (about 40%–50% of staff) were deemed nonessential and were asked to stay at home indefinitely. Nonessential staff reported feeling isolated and ineffective in contributing meaningfully to the crisis. The term “nonessential” may have contributed to this sense. Some were called back to work in redeployed roles and indicated that it was psychologically more satisfying to work than to stay home. Public health guidelines indicated that staff did not need to take special precautions such as using masks at home. This left many worried about transmitting illness to loved ones. Instructions to avoid meeting other hospital staff outside the hospital and not to work in multiple institutions left staff members uncertain as to whether or not they were considered potential vectors of disease. Some felt stigmatized within their communities and avoided identifying themselves as hospital workers. Prominent among the varied responses of individual staff members were themes of fear, anxiety, anger and frustration. Many expressed conflict between their