Toronto back on SARS alert list
The World Health Organisation today put Toronto back on its list of places affected by SARS
The WHO designation is routine for places with new cases of severe acute respiratory syndrome, or SARs, and a spokesman for the U.N. health agency said Toronto was nowhere near another WHO warning against travel to the city.
Canadian health authorities scrambled to limit any further spread while investigating how eight probable new cases and 26 suspected cases slipped through upgraded monitoring and reaction systems designed to halt the spread of SARS.
The new cases included two deaths.
A third death, that of a patient who had been sick for months, raised the overall toll in the Toronto area to 27 dead among more than 150 cases – the biggest SARS outbreak outside Asia.
Toronto had been removed May 14 from the WHO list of SARS-affected areas after more than 20 days passed without a new case being reported.
The new cluster is believed to come from an elderly patient whose case dates from April 19.
The 96-year-old man developed pneumonia after surgery in an orthopaedic ward at North York General Hospital.
He turned out to have undiagnosed SARS and infected health care workers, other patients and visitors on the ward, officials said.
A patient transferred from the orthopaedic ward to St John’s Rehabilitation Hospital was considered the likely source of four more cases under investigation, they said.
The outbreak prompted the US Centres for Disease Control and Prevention to issue a travel alert for Canada last week, a step short of advising against unnecessary travel there.
WHO officials stressed there were no plans to reinstate a travel advisory for Toronto.
That requires specific criteria such as proven export of the illness.
The agency imposed a travel advisory on Toronto on April 23 but lifted it a week later when Canada promised to upgrade monitoring of international travellers.
In response to the new cases, health authorities re-imposed strict controls on Toronto-area hospitals -- closing those where the new cases were found to new patients, limiting access to emergency rooms in all others, with staff required to wear protective masks and gowns and to take the temperature of anyone entering.
The new Toronto cases showed the need to upgrade so-called ”new normal” guidelines for dealing with potential SARS cases at hospitals, which were imposed after the initial outbreak, officials said.
“What it tells us at the moment is that there is a failure in our system of management,” said Dr Allison McGeer, head of infection control at Mount Sinai Hospital who has recovered from SARS she contracted in the early days of Toronto’s initial outbreak in March.
Dr Paul Gully, a federal health official, called the new cluster unexpected and a cause of concern but said visitors to Toronto have little to worry about because the illness remains isolated in hospitals that are closed to new patients.
“We still need to figure out how this happened,” Gully said, adding that the “new normal” diagnostic guidelines for identifying possible SARS cases left room for error.
“It is a difficult judgment call” to distinguish a SARS case from the preponderance of respiratory illness cases, he said.
The Toronto deaths, along with one in Hong Kong and three more in China, brought the worldwide death toll to 724.
More than 8,100 people have been infected since the disease emerged in November, apparently in China’s southern Guangdong province.
