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CREDIT: (CP/Aaron Harris)
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Carecor courier Victor Dewaepenaere arrives at the entrance of St. John's Rehabilitation Hospital in Toronto Friday. (CP/Aaron Harris)
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TORONTO (CP) - A fifth person is under investigation as a potential SARS case in a new cluster of the disease to hit Toronto.
If it turns out the woman, who had some SARS-like symptoms in early May and has since recovered, had the disease, her case will both answer some puzzling questions about the troublesome new cluster and pose others, a key member of the SARS containment team said Friday.
Dr. Donald Low said the patient was transferred in early May from another health-care facility that was treating SARS patients to St. John's Rehabilitation Hospital, where four other people may have become infected with the disease.
The patient "there developed symptoms," said Low, chief microbiologist at Mount Sinai Hospital and one of Canada's leading infectious disease experts.
At the time of her transfer, the patient had had no known exposure to a SARS patient and was therefore not identified as possibly suffering from the disease when she reached St. John's. She "was not (believed to be) a recovering SARS patient," Low said, adding if the woman had the disease, she had a mild case of it.
Officials are investigating the woman as being possibly the index case that brought the virus into St. John's, where four other people - three patients, two of them related, and a health-care worker - have been identified as possibly suffering from SARS.
Two of those people - a woman, 39, and a man, 57, are in critical condition. The man has tested positive for the SARS coronavirus, officials revealed Thursday evening.
If the woman can be identified as the source of the infection at St. John's, it will be a relief for that facility, which has gone into lockdown mode.
But it will raise other troubling questions: How was she exposed? How is it she was not identified as having been exposed? Why was she transferred to another facility?
As officials here scrambled to find answers to these and other questions, those at the World Health Organization in Geneva were discussing the worrisome developments in Toronto.
The city, which was removed from the WHO's list of SARS-affected locations just last week, might find itself back on that list, said an organization spokesman.
"If there have been (new) cases found within the last 20 days . . . then it's possible that Toronto would be returned to the list of areas with recent local transmission, yeah," said Ian Thompson.
The organization was seeking clarification from Health Canada officials in a teleconference Friday, Thompson said.
Thompson added, though, that if these cases do turn out to be SARS, they would not issue another travel advisory against Toronto.
"This certainly would not be enough to return to the travel advisory," he said.
A WHO travel advisory, a tool which has been reserved for locations in which community transmission of the disease has been documented, urges people to avoid all unnecessary travel to a location.
A travel advisory for Toronto which the WHO briefly issued in April has decimated the city's tourism and convention business.
On Friday, outspoken Mayor Mel Lastman railed against the provincial and federal governments, accusing them of failing to provide promised funds to the city to help it cope with the economic fallout from the SARS crisis.
"They don't give a damn about Toronto," he told a news conference. "They make promises and they don't keep their promises."
The new cluster of potential cases was revealed late Thursday at a hastily arranged news conference.
Officials were quick to note they cannot yet add these patients to the list of probable or suspect SARS cases because, according to the WHO definition of SARS, an epidemiological link to a known SARS case has to be established for a positive diagnosis to be made.
One of the four - a 66-year old woman - returned from a trip to southern China and Hong Kong on April 22. But the onset of her symptoms came well outside the accepted 10-day incubation period for the disease, leaving officials scratching their heads as to whether she may have been infected abroad or in Toronto.
The fourth case revealed Thursday evening was a 44-year old man.
The evidence of the positive coronavirus test cannot be taken as proof-positive of SARS as false positives have been known to occur. Low said several other laboratories, including the National Microbiology Lab in Winnipeg, have been sent samples from the man's specimen and are doing independent testing to confirm or disprove the results.
The last date of onset for this group of patients was May 15 - a fact which gives public health officials here some reassurance.
While the incubation period is two to 10 days, most people who come down with the disease do so within three to five. That means if more people had been infected by this cluster, they should have been showing symptoms by now.
Prior to Thursday's development, the SARS outbreak looked all but over in Toronto. Only seven SARS cases remained in hospital; five of them were critical. To date, 24 people have died of SARS in Toronto.