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.
Related Articles
Internet Links
- Toronto Public Health
- Ontario Ministry of Health
- Centers for Disease Control and Prevention
- World Health Organization
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
In Pictures:
