Toronto sees setbacks in SARS battle

Some refusing to comply with quarantine orders

April 14, 2003|By Erika Niedowski | Erika Niedowski,SUN STAFF

TORONTO - Just when health officials think they're close to controlling the SARS outbreak here, leaks have developed in their containment plan. In recent days, they've scrambled to track down more than 100 mourners at the funeral of an elderly man who infected his family. They had to shut down three schools because two students may have come into contact with SARS patients.

And, most exasperating of all in this civil nation, they had to order a dozen people into quarantine who refused to go voluntarily.

One "break-out," as such miscreants are termed, is now hospitalized under police guard. Disregarding his quarantine, he had ventured to work at a suburban Hewlett-Packard office, where he infected one co-worker and forced nearly 200 others to go into isolation.

That behavior prompted a public plea from Dr. Colin D'Cunha, Ontario's health commissioner. "For heaven's sakes, if you are asked to go into isolation, please do so," he said last week. A local newspaper columnist explained to readers that use of the expression "for heaven's sake" by the mild-mannered doctor was a signal of profound frustration, showing a measure of his anger and a glimpse of his fear.

Those leading the complex effort to contain severe acute respiratory syndrome in the province say they have the right plan in place to eventually outpace the disease - despite the recent setbacks, a case count that continues to climb and the likelihood that more overseas travelers will return infected.

"I believe and I feel firmly: We can control this outbreak," stressed D'Cunha. "Every time you find a case, you throw the ring [around it] - and tight. The science is clear about infection control."

Advising Hong Kong

But noncompliance threatens to undermine the effort, he and others warn. "The big problems are solved," said Dr. James Young, Ontario's commissioner of public security. "It's the break-outs right now that we're dealing with."

Canada has been dealing with SARS for more than a month, ever since a Toronto woman was sickened at a hotel in Hong Kong. With 283 probable cases and 13 deaths, the outbreak is troubling, but it is far from the epidemic in China and Hong Kong, where cases are mounting at an alarming pace.

Toronto's seeming success in controlling the illness has prompted doctors in Hong Kong to e-mail D'Cunha for advice on preventing hospital workers from becoming sick. A military physician from the United States is planning to visit him and Young this week.

Shutdowns and quarantines aside, Toronto is less a city in hysterics than it is simply on edge. For the most part, masks aren't flying off the shelves in drugstores and virtually no one wears them while walking down the street. Nobody seems to be equipping themselves with protective gloves or baby wipes, as has become common in Hong Kong.

Streets are busy and stores are filled; the only noticeable change at movie theaters, one local observed, is that it's dead quiet because people are afraid to cough. In fact, the most prevalent disease here is spring fever. Warm weather arrived last week after a harsh winter, and residents were thrilled.

There are a few disruptions: Thousands of elective surgeries have been postponed because of tighter restrictions on hospitals, which have temporarily barred visitors. Chinatown has suffered economically because people think it may be an incubator for SARS. Prime Minister Jean Chretien visited Thursday - he ate at Luen Fat Seafood & BBQ Restaurant - in hopes of boosting public confidence. Bus ridership was down about 3 percent, authorities reported, and more people are working from home.

The message that the city is safe may not be getting out, though: A major cancer research conference has been canceled, Wal-Mart told its employees last week not to travel here, and singer Lisa Marie Presley cited SARS in postponing her concert appearances here.

`Quite the virus'

Those leading the public health effort have discovered that there is much they don't yet understand about the illness, which has sickened at least 3,000 people around the world and scared thousands more.

"This is amazing. This breaks all the rules," said Dr. Donald Low, chief microbiologist at Toronto's Mount Sinai Hospital, who has treated about 30 SARS patients. "It is really quite the virus."

Experts aren't sure, for example, whether infected people who don't yet have SARS symptoms - fever, coughing, shortness of breath - may be capable of passing the disease on to others. They also don't know how long after someone has recovered he or she might still be contagious.

And not everyone here has had the same symptoms - or severity of symptoms. Some elderly patients have progressed quickly from hardly feeling sick at all to becoming seriously ill. Others have had only mild symptoms; not suspecting they had SARS, they might have spread the virus that causes it.

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