The battle to prevent a citywide SARS outbreak hit new setbacks yesterday after a nurse probably infected with the virus rode a commuter train and a man showing symptoms attended a funeral, potentially exposing hundreds of others.
In what turned into a busy Easter weekend, public-health officials tried to contain the deadly and mysterious disease that has already made its way out of hospitals and into the wider community.
The nurse, a resident of nearby Burlington who is in her 30s, was likely exposed to the disease while working in the SARS unit at Toronto's Mount Sinai Hospital, where she is now in isolation undergoing treatment.
Ontario Health Minister Tony Clement first released information about the new case on CTV's Question Period, which he called a "potential new outbreak" of SARS.
At a news conference a few hours later, health officials urged any commuters who may have been riding the GO train with the nurse on April 14 and 15 to come forward.
Yesterday's advisory issued by Toronto and Halton Region targets the six people in particular who were sitting in the same area of the train with the nurse at two specific times - from Toronto's downtown Union Station to Appleby Line in Burlington at 4:30 p.m. on April 14, and from Appleby Line to Union Station at 7:32 a.m. on April 15.
Barbara Yaffe, Toronto's acting medical officer of health, said these people don't necessarily have to go into quarantine, unless they start showing symptoms of SARS.
Just an hour or so after the press conference, another large Toronto-area region issued a SARS alert involving a man who attended a recent funeral and who is now ill with symptoms of SARS.
Anyone who was at the Ward Damiani Funeral Home in Woodbridge on Friday and Saturday at specific times, or who attended a funeral mass Saturday at St. David Parish in Maple has been asked to contact York Region Health Services.
"Placing everyone attending this event in quarantine is an aggressive, yet effective, method to prevent the further spread of SARS," said Hanif Kassam, medical officer of health for the region north of Toronto, in a release.
Health officials once took comfort in the fact that SARS was limited to hospitals or to the households of people connected to hospitals. But in Toronto, the epicentre of Canada's outbreak, potential cases of SARS are being found in funeral homes, workplaces and a church.
Last week, as many as 500 members of the Bukas-Loob sa Diyos Covenant Community, a Roman Catholic charismatic group, may have been exposed after one individual who was at Scarborough Grace Hospital, where the city's outbreak began, attended a religious service on March 28.
Health officials stepped up their fight against SARS this weekend, working with churches to issue restrictions during Easter celebrations.
Despite these efforts, Ontario reported 253 suspected and probable cases in the province yesterday, an increase of four from Saturday.
In Toronto yesterday, Dr. Yaffe said the Mount Sinai nurse had likely been exposed to SARS because she removed her protective gear briefly while at the hospital. "The feeling is there might have been a breach."
A major concern this weekend was that front-line health-care workers were the ones getting sick. On Saturday, Sunnybrook and Women's College Health Sciences Centre closed its critical care, cardiovascular intensive care and SARS units for 10 days as a precaution after four staff members began showing symptoms.
When asked why it took so long to alert the public about the Mount Sinai nurse, health authorities said she was considered a probable case only late Saturday.
Dr. Yaffe said although the woman wasn't coughing, a symptom of SARS, she was feeling ill. She added that the nurse was probably not highly infectious because she didn't cough or sneeze. The best evidence so far indicates that SARS is transmitted by respiratory droplets.
"In my opinion, the risk to the general community continues to be very low," Dr. Yaffe said.
Also yesterday, Mr. Clement said the government has made an official request to Ottawa for aid to help defray the costs of the crisis.
"The direct costs are probably in the hundreds of millions right now and the indirect costs are a multiple of that," Mr. Clement said.
A spokesman for federal Health Minister Anne McLellan said the request would be considered.
With reports from Peter Kennedy and Brian Laghi
Caroline Alphonso