Big SARS outbreak feared

Globe & Mail ^ | 2003-05-24 | Caroline Alphonso

[Lorenb420]

Toronto — More than 20 patients are being watched as potential new SARS cases in Toronto, shattering any notion that the city has truly licked this disease.

SARS once again had health officials scrambling yesterday as they tried to search out the new source of infection that links the cases. By day's end, as they confirmed three people are in critical condition, officials believed they had traced the source to a previously unknown case at North York General Hospital.

"It's been a rough day at North York," said Donald Low, a key member of the team working to contain the city's outbreak of severe acute respiratory syndrome. "I don't have all the answers for you tonight."

He did say that there may have been a case of SARS at the hospital that doctors "understandably did not recognize" because an older patient who had surgery for a fractured pelvis had postoperative pneumonia. Such infections are not uncommon after surgery.

This patient may have infected others. The deaths of two more people are being investigated to determine if they died of SARS. One was 96 and the other was over 80, Dr. Low said. Twenty-four people have died of SARS in Canada this year, all of them in the Toronto area.

"There's obviously a lot that we don't know," Dr. Low admitted at a news conference last night.

The new cluster of cases has meant that hundreds of people who visited two hospitals — North York, and St. John's Rehabilitation Hospital in the city's north end — have been asked to go into quarantine.

"We're assuming the worst. There has likely been transmission to health-care workers. There has been transmission to family members, and there's probably been transmission to other patients," Dr. Low said.

One of the patients, a woman, could be the index case that brought the virus into St. John's, where four other people — three patients and a health-care worker — have been identified as possibly suffering from SARS. At the time of her transfer to North York in early May, the patient had had no known exposure to a SARS patient, and therefore the disease was not suspected when she reached St. John's.

"This is a setback," said Colin D'Cuhna, Ontario's chief medical officer, "because we started to ease off a little. All we do now is throw the safety net around a lot tighter."

In response to the possibility of a new outbreak of the disease, the U.S. Centers for Disease Control reinstated its travel alert to Toronto, just three days after lifting it. Americans travelling to and from Toronto will again be warned of the risk of acquiring SARS.

The new cluster of cases comes barely a week after the World Health Organization's declaration that Toronto is free from any local transmission of SARS.

The developments may put the city back on that list. But a WHO spokesman said that if these cases do turn out to be SARS, the international health body would not issue another travel advisory, which urges people to avoid non-essential travel where community transmission has been documented.

"That's way down the road," Dick Thompson said in an interview from Geneva.

A travel ban for Toronto that the WHO issued briefly last month caused economic upheaval not only in the city but around the country. Repairing that damage has been far from easy; some officials estimate that Toronto will take at least two years to recover.

A new SARS scare couldn't come at a worse time, said Cynthia Bond, spokeswoman for Starwood Hotels. "This is the time of year when meeting-planners come to the city to plan meetings years down the road. People are booking now for meetings in 2004 and 2005."

Toronto Mayor Mel Lastman demanded action from the provincial and federal governments, saying that the aid that was once promised has not materialized. "I haven't seen anything yet from them. As of last night they hadn't installed any thermal scanners at the airport. Why aren't they installed? Why are they sitting there?" he asked.

He said the new SARS cases are not going to change the city's recovery strategy. "We are going ahead. We want people to come to Toronto. We want people to shop in Toronto. We know it is not out in the community; it's in St. John's," he said.

Toronto's previous outbreak of SARS was the worst outside Asia.

The WHO yesterday lifted its advisory against travel to Hong Kong and neighbouring Guangdong Province in southern China, once the twin epicentres of the outbreak, saying that the respiratory disease was being contained in both places.

Health officials in Toronto were quick to point out that they cannot add these new patients to the list of probable or suspect cases because, according to the WHO definition of SARS, a positive diagnosis cannot be made until an epidemiological link to a known SARS case has been established.

"If one of these does turn out to a probable case, and I say if, then we would have to look for the train of transmission between that case and the previous cases," said Paul Gully of Health Canada. "There's no evidence that there's any relationship to an imported case, certainly at this present time."

Dr. Gully said results are not expected until Tuesday.

Before yesterday, the SARS outbreak looked all but over in Toronto. Only seven people with SARS remained in hospital; five of them were in critical condition. With files from Wallace Immen and Jennifer Lewington

[goldstategop]

Hmmm... wonder if Prime Minister Chretien will sleep in the historic Royal York Hotel in downtown Toronto again to assure the tourists its safe to come back.

[tuna_battle_slight_return]

SARS, SMARS. Big deal. I haven't seen anything so overhyped in the media since the discovery of the common cold (yawn).

[aristeides]

And now there's the patient in West Virginia who may have caught SARS while in Toronto.

[kinghorse]

I bet you would be a little less sanguine if you were looking forward to a stay in the hospital.

[Judith Anne]

This caught my eye, because of the new case definition I read on another thread:

Health officials in Toronto were quick to point out that they cannot add these new patients to the list of probable or suspect cases because, according to the WHO definition of SARS, a positive diagnosis cannot be made until an epidemiological link to a known SARS case has been established.

Translation: It's not SARS, and you can't make us say it's SARS, because we have a malleable case definition, and therefore there is no epidemic if we say there is no epidemic, and it hasn't spread if we say it hasn't spread. So there.

[aristeides]

Yes, the Canadians are playing games. I suspect the new cases occurred at least in part because the Canadian authorities were so anxious to have the outbreak declared over.

By the way, there's bad news. Two of the new cases (the critical cases, presumably) have now died: Sars returns to Toronto.

[firewalk]

bttt

[Dog Gone]

"We are going ahead. We want people to come to Toronto. We want people to shop in Toronto. We know it is not out in the community; it's in St. John's," he said.

The mayor doesn't know that for a fact at all. It might very well be back in the community as Dr. Low said.

One of the problems in fighting AIDS was the stigma of the disease, and the efforts of the left to insist that efforts to defeat it were politically correct. We have a somewhat different problem with SARS. Politicians and governments are trying to prevent the stigma of the disease from attaching to their cities or countries. That leads to cover-ups, and reckless statements like the one the mayor of Toronto just made.

[Cicero]

The WHO yesterday lifted its advisory against travel to Hong Kong and neighbouring Guangdong Province in southern China.

WHO is under a lot of political pressure to lift its travel advisories, and no one can exert political pressure like China. I wouldn't trust this for a minute.

I wonder if Chretien is embarrassed about forcing WHO to lift its travel advisory on Toronto. I doubt it. Nothing would embarrass Prime Minister Cretin.

[blam]

"Hopes that the outbreak of severe acute respiratory syndrome (Sars) in the Canadian city of Toronto was over have been dashed with two more deaths."

[aristeides]

Cretin has begun a trip to Europe that will keep him out of Canada for two weeks.

[Future Useless Eater]

By the way, there's bad news. Two of the new cases (the critical cases, presumably) have now died: Sars returns to Toronto.

WOW!

SARS Mortality Rates [reflects treatment] Based on World Health Organization daily tables                 (Revised:  May 23 pm)
Area	Recoveries to date	Deaths to date	Recent** Death Rate		Active Cases still in Danger	Projected Future Deaths	Projected Cumulative Mortality
China	2544	303	15.1%		2438	368	12.7%
Taiwan	82	60	* 69.8%		396	276	62.5%
Hong Kong	1255	260	13.4%		209	28	16.7%
elsewhere [30 countries]	445	66	4.9%		59	3	12.1%
**  Recent deaths are based on findings from the Imperial College of London...... that deaths take 12 days longer on average than recoveries on average..... = (12-day recent deaths) / (12-day recent deaths + prior 12-day recoveries) *Because of Taiwan's severe under-reporting of 'probable' cases, their recent death rate was calculated with a different formula to give them a more favorable (lower) rate, using total deaths to date and recoveries up to 12 days ago.

Observations - Treatment:
• Taiwan's high death rate is because they only report 'probable' cases when they are in CRITICAL condition.
• Taiwan has converted all their 'pending' cases to the 'suspected' categories, and still has a shameless 'suspected' count exceeding ONE THOUSAND patients. Taiwan waits to see the severity of their symptoms before changing a patient to a 'probable' case which is why their death rates seem so high for 'probable' cases.
• China's numbers also seem underreported.

Trend - Active Cases Still in Danger [reflects containment]
Date	China	Taiwan	Hong Kong	elsewhere 30 countries	World-wide all 33 countries
May 8	2945	92	445	106	3588
May 9	2993	110	442	101	3646
May 10	3029	128	427	99	3683
May 11 (est.)	3049	133	413	97	3692
May 12	3068	138	399	95	3700
May 13	3061	153	374	89	3677
May 14	3046	170	343	85	3644
May 15	3034	196	309	78	3617
May 16	2969	193	297	79	3538
May 17	2918	221	276	76	3491
May 18 (est.)	2870	254	263	73	3460
May 19	2799	249	250	70	3368
May 20	2700	268	236	69	3273
May 21	2618	295	227	65	3205
May 22	2526	349	217	62	3154
May 23	2438	396	209	59	3102
(includes new daily cases... excludes cases resolved by death or recovery) (some tables are supplemented with government data when WHO data is missing)

Observations - Containment:
• I believe China's numbers are highly fictional, and Taiwan's 'probable' count should be FOUR or FIVE HUNDRED higher.
• Taiwan is withholding 'probable' cases and calling them 'suspected'
                          May 23  (396) active cases
  Apr 30   (41)    [a ten-fold increase in 24 days]

[Future Useless Eater]

SARS - Treatment/Containment tables - updated through Friday's numbers here

[Dog Gone]

It sure would be nice to get some reliable numbers out of China, but I don't think they have them. I don't think they have a clue.

[Betty Jo]

All of the government agencies involved are CYA ing and fibbing.

These, I think, will come to be known as criminal acts.

When will civil law suits be filed?

When will criminal prosecutions begin?

[swarthyguy]

Right after the 9/11 report naming the countries that attacked the USA on September 11.

[firewalk]

Thanks for the ping
bttt

[Timesink]

This caught my eye, because of the new case definition I read on another thread:

Remember: Syndromes are, in and of themselves, NOT diseases or illnesses of any sort. They are merely a name slapped onto a specific collection of symptoms, and the "official" symptoms list often changes. This is why, in the mid-80s, the number of AIDS (Acquired Immune Deficiency SYNDROME) cases skyrocketed: Because AIDS is defined as "the presence of the HIV virus along with [insert giant list here of diseases, conditions, etc, that people contract by the thousands anyway]", and the WHO and CDC kept adding more and more and more diseases and conditions to that list. So people that were dying of X one night woke up the next morning and suddenly "had AIDS," just because one of their own symptoms had been added to the "AIDS List" by the government.

Now some of this is legitimate science of course, especially in the early stages or research when the medical community isn't totally certain what's going on. But, with AIDS at least, a LOT of it was pure politics, especially after the first couple of years when they finally figured out HIV to a reasonable extent. Activists and money grabbers wanted to scare the public so as to make them think it wasn't just a "gay disease" and also wanted more "reasearch funding," so they lobbied to have the list expanded, with a 98% success rate. And voila! Suddenly the "number of cases was skyrocketing," the "percentage of heterosexuals with AIDS was exploding," etc. They're doing the same thing in Africa right now: They keep expanding the symptoms list to where almost literally (not quite, yet, but damn close) every single person under a certain age with certain deadly diseases is proclaimed to "have AIDS." Except there it's even more blatant, because most of the doctors over there don't even have access to HIV tests! They just "assume," put the numbers on the WHO forms, and in a few months more and more cash - mostly from US taxpayers, of course - ends up in Africa, where it goes to buy ... well, we all know what it REALLY goes to buy.

So, in the end, all I can say is, if you wake up one morning and the AP story in your local rag says that "SARS cases in Toronto/Hong Kong/Guangdong/South Succotash up 300%," read the entire story V-E-R-Y carefully, and if doesn't give you enough information, get online and do some digging, because it will almost certainly turn out the be the result of a changed definition of "what SARS is," not an actual giant influx of new patients.

[Timesink]

I bet you would be a little less sanguine if you were looking forward to a stay in the hospital.

Not that it's directly relevant to SARS, but I gotta say I don't think there are many Americans planning on ever going anywhere near a Canadian hospital for any reason ever, except maybe to point and laugh.