The Spread of SARS
IT WAS NOT what health-care officials had hoped for, to say the least. Only a week earlier, one of Health Canada's leading authorities on infectious diseases had speculated that SARS - severe acute respiratory syndrome - might actually be "easy to control." The comment was based on the fewer than a dozen cases in Toronto at the time, and one case in Vancouver, and the understanding that SARS required close contact to spread. How quickly things change. By last week, the numbers had more than tripled, and SARS had infected hospital workers who worked far away from the departments where patients were being treated. While it still looked as if only close contact spreads SARS, health authorities directed more than 1,000 people possibly exposed to the mysterious virus in Toronto to be quarantined in their homes. Suspected cases were being investigated in other centres. At the epidemiological epicentre of the SARS crisis in Canada, Ontario Premier Ernie Eves took the rare step of declaring a "health emergency." SARS was getting out of hand.
Don't panic - that was the word from just about every health official who had anything to say. The progress of a potentially fatal disease with no known cause and no cure created fertile ground for public apprehension, not to mention a run on sales of surgical masks. "It's proven to be more virulent than was originally expected," said Dr. James Young, Ontario's commissioner of public security. Canada was definitely a hot spot in the world outbreak of SARS, its confirmed cases reaching 28 in and around Toronto, and one in Vancouver. Other suspected cases were in Vancouver, Edmonton, Winnipeg (where almost a dozen people were asked to stay at home) and Ottawa. Doctors examined patients for telltale symptoms: sudden onset of a fever 38° C or higher, coupled with a cough, shortness of breath or difficulty breathing.
There have been three deaths from SARS, all in Toronto. Still, doctors in Ontario stressed that last week's surge in numbers was among health-care workers who tended SARS patients before anyone knew they should be taking precautions - wearing a mask, gloves and a surgical gown. Health Canada noted that all Canadian patients had travelled to Asia or had contact with SARS cases in the household or in a health-care setting.
But with SARS and the atypical pneumonia that it can bring appearing to kill one in 25 patients, many people aren't inclined to take chances. One Toronto school closed for the week after three elementary students came down with high fevers, a move Toronto officials suggested was unnecessary given the children had no known contact with SARS patients. Health Canada toughened its travel advisory, recommending that Canadians not fly to affected regions, particularly around southern China. Ottawa was also considering a request from the World Health Organization to screen all passengers flying out of the country for SARS. Travel agents, meanwhile, reported a slew of cancellations.
Toronto was showing signs of a city under siege. Ambulance paramedics, their ranks depleted by the quarantining of 140 of their 850 members, wore surgical masks to respond to all calls. Staff in hospitals throughout the region were told to wear masks, gloves, gowns and, in some cases, goggles. Relatives visiting patients were given masks, even in hospitals far from Scarborough Grace, ground zero for the Toronto outbreak, where all three patients who died from SARS had been treated. It all made sense, but it also heightened anxieties. Taking aggressive precautions is the smart thing to do, said Bhagirath Singh, scientific director of the Institute of Infection and Immunity, part of the Canadian Institutes for Health Research. But he, too, stressed the need for calm, stating: "This is not an epidemic." It is, however, a serious test of the medical infrastructure.
The first fatal victim, Sui-chu Kwan, 78, was treated at Scarborough Grace before her death on March 5. She had just returned from Hong Kong, close to where SARS is believed to have originated in southern China. Her son, Chi Kwai Tse, 44, caught it from her, was admitted to Grace, and died on March 13. An elderly man in a bed beside him, separated by a curtain in the emergency ward, became the third and, to date, only other Canadian to die.
The quarantine order affected about 1,300 people in Toronto, said Steve Armstrong, manager of disaster services for the Red Cross in Ontario. And not just health-care staff but anyone who had visited Scarborough Grace since March 16. At that time, many of the staff, unaware they were infected, were still working on site. The quarantine calls for them to remain at home for 10 days after their potential exposure (the estimated maximum incubation time for SARS). City health officials asked the Red Cross to help deliver masks and thermometers to their homes. Some of Scarborough Grace's nursing staff were under a limited quarantine - they could go to work but they, and their family members, had to wear masks at home, even if they showed none of the symptoms.
SARS appears to have arisen in November in China's Guangdong province. After a prolonged silence, Chinese officials said in mid-March that 305 people had contracted SARS and five had died. Last week, those numbers worsened - more than 800 people had caught SARS and 34 had died. The World Health Organization counted more than 1,400 cases and 53 deaths in 13 countries.
International efforts to identify what is believed to be a viral agent behind the outbreak continue, with Hong Kong researchers suggesting the bug belongs to the coronavirus family, known for causing the common cold. But whether that's the culprit remained to be seen. Health Canada found that several patients were infected with the metapneumovirus, part of the paramyxoviridae family that normally causes mild respiratory infections. The two viruses could be working in tandem, suggested Singh, as the medical world battled an enemy it has trouble even identifying. In the absence of certainties, vigilance and valour will need do the trick.
Maclean's April 7, 2003