This article was originally published in Maclean’s magazine on May 5, 2003. Partner content is not updated.
Messages don't get more mixed. Depending on who, or WHO, is doing the talking, Canada's biggest city is either a perfectly safe and fun place for a family vacation, or a no-go plague area. Two months after the first case of the flu-like severe acute respiratory syndrome arrived in Toronto, 19 people were dead, Ontario had 265 probable or suspect cases, and a worrying public health problem has suddenly morphed into a crisis with national implications.
Concerned that Canada may be exporting the mysterious illness to other nations, the Geneva-based World Health Organization issued an international advisory last week, warning travellers to stay away from Ontario's capital unless a visit is absolutely necessary. Local politicians and health officials were livid, claiming the SARS outbreak is almost under control. But that made little difference in the international media where Toronto, and the rest of Canada by association, have become synonymous with danger and death. Tour operators and hotels, already feeling the effects of SARS wariness, were flooded with cancellations. Major corporations, in Canada and abroad, are telling employees to avoid the city. Restaurants - especially Chinese restaurants - are suffering, conferences and concerts have been called off. And an increasingly worried public is left to wonder whether their city's on the cusp of containment or widespread contamination.
Masked men and women are still few and far between on the streets of Toronto, but in a world where bad news travels faster than ever, perception is reality. Lester B. Pearson International Airport, usually the busiest hub in the country, is eerily quiet, the dwindling ranks of visitors from out of town conspicuously unhappy to be there. Co-workers Joe Pekelsky and Sebastien Poirier disembarked from an Ottawa flight late last week wearing surgical masks to shield themselves from microbes. "Sixteen dead people are more than enough," said Pekelsky, a 22-year-old electronics salesman, citing the death toll at the time. "I don't want to be the guy that brings this back home. My buddy's a health inspector, and he told me there is no way I should come here without protection." Poirier was a little sheepish about having attracted the attention of the media, but no less apprehensive. "I thought there would be more people wearing these," he said. "But I'm doing it for my girlfriend and my family. They really didn't want me to come to Toronto."
Fear appears to be spreading faster than the disease itself. People from Toronto are no longer welcome aboard the ships of one major U.S. cruise line. Long-planned school trips to the region, including many for a high-school music festival, have been cancelled. International delegates backed out of conferences even as far away as Quebec. Vancouver, which is dealing with its own, far less serious SARS outbreak, is also feeling the economic pinch. A major pulp industry gathering scheduled for May 11-14 in Vancouver has been postponed for a year. Joey Ducharme, managing director of the Montreal-based Market Pulp Association, the conference organizer, says industry giants from Europe and the U.S. expressed concerns about their employees flying in the age of SARS. "We tried the rational route to say that it's a very minute chance of anything happening," says Ducharme, "but in the end we just couldn't argue with the emotions and the fear of something potentially happening."
Canada's swift descent to pariah status angered politicians in all levels of government, apparently catching them by surprise. Ernie Eves, Ontario's infamously low-key premier, was impassively aggressive, pledging $25 million in new funds to help Toronto's overworked hospitals through the crisis, $10 million to rehabilitate the city's battered international image, and unspecified money to compensate quarantined Ontarians for any lost wages. "The WHO took an unprecedented and, I think, totally unwarranted step," said Eves. "We were quite frankly sandbagged by the WHO."
Mel Lastman, Toronto's tiny, imperfect mayor, who has been battling his own health problems, surfaced after a prolonged absence to declare - not for the first time - that he "has never been so angry" in all his life. His inability to tell the difference between the Geneva-based WHO and the U.S. Centers for Disease Control - which doesn't endorse the travel warning - didn't inspire confidence, however. Nor did the mayor's subsequent appearance on CNN, where he was unable to answer such basic questions as just how many people in the city are suffering from the illness.
Officials at the WHO said they would give their travel advisory a formal review only after three weeks. But later they said they would look at new data from Toronto early this week. Public health officials argue that Toronto has been unjustly lumped in with Hong Kong, Beijing and China's Guangdong provinces - also under travel advisories - where SARS has spread into the community at large, and where official tallies almost certainly understate the real number of SARS cases. Almost all cases in Canada can be traced back to exposure to an ill hospital patient, they say, and by the time the WHO issued its warning, it had been 2 ½ weeks since a new case appeared outside a clinical setting.
"This has been a hospital outbreak, not a community one," says Dr. Richard Schabas, Ontario's former medical officer of health and now chief of staff at York Central Hospital, just north of Toronto. "The picture being given that this is a growing epidemic that is spreading across the community is simply not true. This outbreak peaked in late March." Schabas, who participated in a conference call in which WHO officials reached their decision about the travel advisory, says there are no scientific grounds for slapping the plague city label on Toronto. "This is an entirely political decision," he insists. "The WHO doesn't want to appear to just be singling out Asian cities. We're a sacrificial lamb."
Those who study the past, however, see some disturbing parallels with other devastating disease outbreaks in Canadian history. University of Toronto historian Michael Bliss wrote a book on the smallpox epidemic that killed some 5,900 Montrealers in 1885. "In Toronto now, just as in Montreal then, we're at the mercy of the least responsible, stupidest segment of the population," he says, referring to those who would break quarantine and endanger others. "We've already had problems with people not obeying the rules. That's just how the smallpox spread." As the death toll and international concerns rose, reluctant politicians in Montreal were eventually forced to take draconian public health measures to halt the disease, virtually shutting down the city. "These are grim struggles against microbes and you have to trust the generals you have," says Bliss. "But the lessons we've learned in the past also show that you can't rely on the public's good sense. There has to be a backup plan."
On more than one level now, the growing question is: if Toronto sneezes, does the rest of the country catch a cold? Southern Ontario is the engine of the Canadian economy, and any prolonged economic slowdown in the region is bound to touch other provinces. Armine Yalnizyan, an economist with the Canadian Centre for Policy Alternatives, says the traditional reckoning is that production and commerce in the Toronto area make up about 20 per cent of the national economy. The already apparent drop in tourism and business travel could have a significant short-term effect, as could any wide-reaching quarantine that shuts offices, schools and stores.
What's not clear, however, is how much the increased government spending on health care - a sector that accounts for 10 per cent of GDP and the labour market - might offset other losses. In the end, it will be consumer spending - the thing that has really been driving the Canadian economy in recent years - that will count. "There's really no way to soothsay about something like this," says Yalnizyan, who notes that Sept. 11 didn't have nearly the fallout in Canada that many experts predicted. "If consumers stop spending it's anybody's guess."
With the doom-and-gloom scenarios coming fast, perhaps the biggest surprise of the SARS crisis so far has been the stubborn refusal of Torontonians to panic. While newspaper stories suggest sales of hand-sanitizers and surgical masks, as well as the business of Internet grocery ordering services, are way up, it's hard to detect any evidence of changed behaviour on the streets. True, the subways, commuter trains, movie theatres, shopping malls and other gathering places are a little less crowded, but the bars remained full - at least until the Leafs flamed out in the first round of the playoffs. Foreign reporters who arrived expecting to find overflowing hospitals and plague wagons have barely been able to contain their disappointment.
Steven Taylor, a University of British Columbia psychologist and authority on health anxiety, says the people crowding SARS clinics in Vancouver, Toronto and elsewhere are often from the same small part of the population who obsess about every well-publicized outbreak, whether it's anthrax, West Nile virus or flesh-eating disease. The vast majority of people tend to be cautious but rational about the level of danger they're facing. "I think it's healthy in this case to have some level of apprehension - not to go into high-risk places like hospitals unless you have to," says Taylor. "But it shouldn't be interfering with people's day-to-day lives."
It's an outlook that most Torontonians seem to embrace, despite the relentless media coverage. They crowd onto buses, subways and trains without a mask in sight. They're puzzled when friends and relatives call from afar, asking if they're OK. On a beautiful spring evening, the crowds café-hopping and window-shopping along tony downtown Bloor Street look as big as ever. Rick Green, his wife, Pat, and their son Derek should have more to worry about than most families. Rick is a firefighter. Pat works as an administrative assistant at one of the affected downtown hospitals. Derek drives a bus for the Toronto Transit Commission. They've all been feeling the stress at work, but six weeks into the outbreak, they haven't seen any colleagues, friends or neighbours who fall ill.
The Greens aren't panicking or changing their lives until they see proof that there is something to worry about. "We're Canadians," Pat says by way of explanation. "When the medical officer of health gets on TV and says that everything is OK, we believe her." There's not much time to talk. The Greens are heading off to meet family and friends. "We're having dinner at a Chinese restaurant," Pat says with a laugh.
SARS HOT SPOTS
The five regions on the World Health Organization's list of places to avoid
Total probable cases % of world cases Reported deaths
Hong Kong 1,510 32 115
Guangdong province 1,374 30 50
Beijing 877 19 42
Shanxi province 173 4 8
Toronto 138 3 19
World 4,649 100 277
PUTTING SARS IN PERSPECTIVE
When a real epidemic hits, the casualties are far greater than what we've been seeing. Some of Canada's worst:
Smallpox - Quebec City 1702-03 3,000
Cholera - Upper and Lower Canada 1832-34 10,000+
Typhus - Grosse Île, Que. 1847 5,400
Smallpox among the Pacific coast Aboriginals 1862-64 20,000
Smallpox - Montreal 1885 5,900
Spanish influenza - across Canada 1918 40,000-50,000
Polio - across Canada 1952-53 413
Maclean's May 5, 2003