Posted on 05/24/2003 3:19:00 PM PDT by CathyRyan
At least 25 people are being investigated for SARS and 1,000 more are in quarantine after an undetected suspected case of SARS spread through a ward at North York General Hospital and into St. John's Rehabilitation Hospital.
Health officials are also investigating the deaths of two people — a 96-year-old and a patient believed to be at least 80 — to determine whether SARS was a factor.
Public health officials were quick to caution the public against panic, saying new cases were to be expected as the disease is brought under control.
"This is the new `normal,'" Dr. Colin D'Cunha, Ontario's chief medical officer, said yesterday.
"As we wrestle SARS down, we knew we'd have to investigate certain new individuals."
The news was enough to prompt the U.S. Centres for Disease Control and Prevention in Atlanta to re-issue a travel alert, which tells travellers to be aware that SARS exists in Toronto, and urges them to avoid health-care settings where exposure may be a risk.
The World Health Organization has already assured Health Canada that it has no plans to put Toronto back on its SARS watch list until it receives more information from health officials here.
WHO officials said they'll be speaking with Canadian health officials again on Tuesday to get an update.
"We were informed right away. Every question we could possibly have has been answered," WHO spokesperson Dick Thompson said yesterday from Geneva.
Federal finance minister John Manley, in Toronto to meet with TV industry representatives, said yesterday's development "is not good news" for Canada's economy, which had already been pegged to lose about $2 billion this year because of business lost to severe acute respiratory syndrome. Just two days ago, Toronto's hoteliers reported they'd lost $125 million due to SARS-related cancellations.
"What we need," Manley said, "is as soon as possible to determine whether in fact we have other SARS cases. We have to demonstrate that we're dealing with them in the appropriate way and as quickly as possible. And then we're in a position to reassure people that this is not something that you can catch on the street or in a hotel or restaurant, that you really have to go to extraordinary lengths to contract it."
Yesterday's developments prompted tourism officials to hold off on airing a TV commercial intended to reassure American tourists and lure them back to Toronto this summer.
The commercial, a variation of the one that began airing on Ontario channels two weeks ago, was to have begun airing this weekend on local stations in Detroit, Cleveland, Buffalo, Syracuse and Rochester.
While public health officials were silent on the details, Mount Sinai microbiologist Dr. Donald Low revealed last night that a 96-year-old patient developed SARS — which went undiagnosed — while being treated for a pelvis fracture at North York General Hospital.
The illness appears to have spread through a ward in the hospital, and is now the chief suspect in the deaths of the 96-year-old and another person, believed to be at least 80.
A North York General patient who subsequently came down with SARS symptoms was then transferred to St. John's Rehabilitation Hospital, where five others — three patients, a 39-year-old health care worker and a 44-year-old visitor — were apparently infected.
That's prompted Ontario's health ministry to ask anyone who visited North York General between May 13 and 23 to put themselves in isolation, monitor themselves for SARS symptoms and contact Toronto public health.
Anyone who was in the hospital between April 22 and May 13 is also being asked to monitor themselves for symptoms and contact Toronto public health.
Quarantine has already been ordered for anyone who visited St. John's Rehabilitation Hospital between May 9 and 20. Anyone affected by the quarantine has been asked to contact Toronto public health.
Last night, the hospital announced it would no longer accept new patients and had closed its emergency to ambulances and walk-ins at its Leslie Street site, but was still accepting pregnant women for deliveries.
No visitors will be allowed except children's parents, the spouses of women in labour, and family of patients in critical condition, and hospital staff will not be allowed to work at other facilities.
The new protective measures do not apply to the hospital's Branson site, the Seniors' Health Centre or Phillips House.The quarantine includes 34 paramedics who transported various patients, as well as Wheel-Trans staff and two homecare nurses from the Victorian Order of Nurses.
What sparked the latest cluster of SARS cases remains a mystery.
"It's been a rough day at North York and we don't have all the answers for you yet," a clearly fatigued Low said.
"It is not clear what the source of the infection was. What we are clear about is that it was not community-acquired. It is either travel-related or health care institution-related," said Dr. Barbara Yaffe, an associate medical officer of health with Toronto public health.
Officials say one of the five patients at St. John's recently returned from a trip to Asia.
Health Minister Tony Clement stressed that the risk to the general community is "small."
Low, however, warned that there has been some possible transmission to health-care workers and family members who visited the North York General hospital ward. .
"We're assuming the worst, that it was transmitted to health-care workers, family members and other patients," he said.
No one was responsible for the transmission, he said, and it couldn't be blamed on infection control measures, such as gowns, gloves and masks, which were relaxed last week.
"This is nobody's fault," he said.
"I think that this is a setback, but I think it would be going down the wrong path if we tried to slough it off," he said.
Clement, who made brief remarks at a SARS news conference last night, didn't mention the 25 cases being investigated and said he was surprised to learn of some of the information Low provided about the outbreak.
After a brief respite from strict infection control measures, hospitals around the Greater Toronto area were back to wearing gloves, gowns, goggles and masks. Paramedics have also resumed taking full infection-control precautions, including gloves and masks.
Weary public health officials were being recalled to work yesterday to deal with the latest developments. Staffing levels at the public health command centre had dropped from a high of 400 to about 20. By last night, another 80 staff were working the phones trying to reach people who had visited the hospitals to warn about the quarantine.
SARS patients are currently being treated at Rouge Valley Centenary, Toronto General and Sunnybrook hospitals. Late yesterday, Toronto General closed its emergency department to ambulances, amid fears health care workers may have been exposed to SARS.
One reason for the closing is the loss of 15 health-care workers who were quarantined because a St. John's patient was transferred to Toronto General earlier this week.
A World Health Organization spokesperson said the re-emergence of the illness is not enough to warrant another travel advisory against the city. But they're carefully monitoring whether this latest cluster will lead to community transmission.
When asked if WHO was satisfied with the level of screening Canadian officials have put in place at Toronto and Vancouver's international airports such as questionnaires and fever-detecting scanners, spokesperson Dick Thompson said: "We don't look at individual measures countries are taking to protect themselves from SARS or to contain an outbreak."
However, they're keeping a close eye on whether this cluster will lead to cases being exported from Toronto. Dr. Paul Gully, senior director-general of Health Canada's population and public health branch, said there's no evidence the infection was acquired outside of Canada.
"There is no evidence that travel had any bearing on those cases at all," Gully said. "We've always said no net is perfect. If people are not sick when they come in or when they go out, it's not possible to identify whether or not they've got SARS."
Gully said additional thermal scanners used as part of a pilot project to screen air passengers who may have a fever — a symptom of SARS — should be in place today at Pearson airport.
Yaffe downplayed the importance of scanners. In the case of the patient who recently returned from Asia, Yaffe said, they would have been useless.
"In that particular instance, it would not have helped at all because the individual had no symptoms, no fever when they were returning through the airport," she said. "They developed symptoms quite a bit later."
With files from Paul Moloney, GAvin taylor and Star wire services
That's unfortunate.
When you see Gerberding speak, would yu expect anything but?!
Sounds like Low did not get the word about those patients at North York not existing.
Canada, being the most PC country in the world
refuses to publish any indication whatsoever
about the people infected with SARS.
Yup. Maybe me!
That only could happen if their skulls weren't two inches thick.
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