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Posted on 04/12/2003 6:12:41 AM PDT by Lessismore
Toronto — The deadly SARS virus is unlikely to be eradicated in Ontario and could increase slowly or escalate out of control with disastrous consequences, a scientific advisory body says.
In a working document obtained by The Globe and Mail, the scientists advising Ontario's SARS team say they are "cautiously optimistic" that the disease that has killed 10 people in Canada and 116 worldwide will be controlled here. But they have developed four scenarios for the future that strongly suggest recurrence.
The most frightening scenario — an epidemic spread of severe acute respiratory syndrome in the community, with a rapid increase in cases — "could occur, with further exacerbation resulting from repeated introduction of cases by infected travelers," the document says.
"The health-care system would be overwhelmed. Case fatality rates could rise due to inability to provide optimal care. Considerable societal disruption could occur and maintaining even essential services could be problematic."
The dire prognostication comes as the level of fear about the disease remains high in Canada and abroad, forcing health officials and politicians to assure the public repeatedly that the chances of contracting SARS in this country are minimal.
The number of deaths in Canada has held steady at 10 for several days, but doctors said yesterday that, given the serious condition of some patients, they wouldn't be surprised to see the toll rise. The number of suspected and probable cases across Canada climbed to 266 yesterday, up from 253 the day before.
The paper from the scientific advisory panel says the course of the disease will ultimately be determined by several variables, including changes in the virus, changes in human behaviour, the presence of the virus in animals and the development of new tests, vaccines and treatments. But it is apparent from both the document and interviews with scientists that a primary factor will be international travel.
"I think it's the ongoing concern," said James Young, Ontario's commissioner of public security. "If we succeed in the direction we've been moving, then clearly what we have to do is maintain vigilance about travel in the future."
Dr. Young plans to meet with the federal government to determine whether controls over travel are adequate.
Donald Low, the chief microbiologist at Toronto's Mount Sinai Hospital, said a major concern is that people from high-risk areas of the world will travel to South America or Africa, where there are no facilities to recognize or control the disease.
"The problem in China is out of control so this is a virus that is not going away. We've got this forever," Dr. Low said. But if Canada can stop SARS in the short term, he said, it will "buy us time" to get a vaccine, or at least better therapeutic measures and diagnostic tests, before it returns.
The advisory group's most optimistic forecast is the elimination of SARS infection worldwide. But the scientists say that is unlikely.
The second scenario is an end to the outbreak in Ontario. But even if that occurs, the scientists say the disease would likely be reintroduced from abroad.
The third scenario is the current outbreak continuing with a slow increase in cases. The implications of that would be "enormous," said the scientists, because the current level of response to the SARS infection cannot be sustained.
The fourth scenario envisions a full-scale epidemic.
The advisory group points out that a single new case has the capacity to spread the disease to health-care workers, household contacts and the community. If left uncontrolled, another outbreak could follow.
Numerous countries, including Australia, Ireland, Austria and Jamaica, have warned their citizens about travelling to Canada. And Dr. Young said yesterday he has heard that some countries are asking Canadian travellers for doctors' letters advising that they do not have the disease.
In a measure designed to contain both the infection and damage to its international reputation, Hong Kong — another SARS hot spot — announced yesterday that people ordered into quarantine there will be barred from leaving the city.
"We are obviously concerned at international countries taking unfavourable action against Hong Kong," Hong Kong chief executive Tung Chee-hwa said.
Meanwhile, a top Chinese epidemiologist has disputed his government's claims that SARS is under effective control.
Zhong Nanshan, the director of the Guangzhou Respiratory Disease Research Institute who has been at the forefront of China's battle with SARS, said yesterday that the central government's long-held view is neither objective nor based on medical analysis.
"Looking at this from a medical point of view, this disease has not been effectively controlled at all, including in Hong Kong," he said at a briefing.
"The origin of this disease is still not clear, so how can you say it has been controlled?" he asked, adding that "effectively contained" would be a better expression.
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2. AIDS, compared to SARS, is not contagious unless you share bodily fluids.
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