SARS - Terrible Tuesday
In Toronto
From A Toronto Resident

Ontario Health Minister Tony Clement, Dr. Colin D'Cunha and Dr. Barbara Yaffe are in Europe today to convince the World Health Organization to drop its travel advisory on Toronto over SARS. Though the advisory has created much anger and bluster in the Toronto business community, I'm hoping Clement felt nervous and used a private plane. One reason for the travel advisory is that Toronto has no effective screening for SARS at the airport.

Britain is bringing in airport screening, yet Toronto, with a larger SARS caseload is still doing relatively nothing at the airport. The Feds are talking about thermal screening, but it does not promise to be successful as it is in effect elsewhere and hasn't caught one SARS case.

The sad news is that until Toronto gets effective screening SARS can come and go at the airport. To make up for our deficit of common sense we have the WHO travel advisory. Once it is removed we will have almost nothing blocking the virus. All we do now is give orange information cards to travelers.

Clement's evidence in Europe will be that as of Tuesday April 29, 20 days - or two full incubation periods - will have elapsed since the last reported case of community spread of SARS. Since April 9, the only new cases have been among health-care workers who tend SARS patients and their close contacts.

As Clement is presenting that evidence a story will be appearing in the Guardian in Britain. It is billed as a diary on the battle against the virus by Paul Caulford, a doctor at the Scarborough hospital, epicentre of Toronto's Sar's outbreak.

Here are a couple excerpts from that diary which is online at,13036,945490,00.html

From the week of April 21

"Later the same day I was informed that three family doctors in a four-man community practice just down the road - colleagues I would see at educational events or medical dinners - had become ill with Sars after treating a patient with the disease who came to their office. The patient had broken quarantine. Two of the doctors have young children. Unfortunately, we have learned that with Sars almost 100% of household contacts become infected themselves. Only one of the doctors treated the Sars patient, the other two simply worked in the same office. We have learned that the virus is highly virulent and some patients are "super shedders". The three doctors remain critically ill and on respirators in intensive care. Sars is challenging all of us, asking something new of us. It is asking us to put the needs of others ahead of our own. It is reminding us that this is what we signed up for, even if we never imagined it could really happen.

That evening I was on duty in the refugee health clinic. A few family doctors throw in some time to volunteer at a medical clinic for new arrivals to Canada who have no health insurance. The war in Iraq had made it a very busy place lately. Many immigrants - more than usual - were arriving from the United States. One, a young nurse, was halfway through her first pregnancy. She had arrived from Guangdong province in China in March. Contrary to the official line, she told me thousands were ill there. The outbreak there had begun as long as nine months to a year ago. She told me it had become impossible to quarantine all those who were ill, and many were dying. It made me worry a bit more."

Perhaps I'm paranoid, but that excerpt from Paul Caulford's diary convinces me that patients breaking quarantine could have put SARS back out in the community. Even that one man who broke quarantine could have started the incubation of new cases.

I hadn't heard before that some patients are super-shedders of the virus. Before yesterday there weren't any reports I saw about how bad the disease is. A Monday report in the SUN describes it in terms that make it look like a fate worse than death. Terrible muscle ache, you can't get comfortable, can't breathe, sleep or eat and it goes on and on for weeks with long excruciating periods where it feels like your joints and limbs are on fire. One struggling patient infected 15 doctors and nurses in Toronto. And that's why you see images of distraught nurses, including the one in Taiwan that tried to jump from a hospital window. Seeing the effects of SARS and knowing you might get it yourself is traumatic.

Clement and the province and news reports here tell us that SARS is tailing off. But Paul Caulford's diary tells us how it has hung on and grown for nearly a year in China. Since the province now only tells us of probable cases - not suspect - in Toronto, it will appear as if SARS is fading fast.
Yet it is still possible that Clement and friends are playing with fire. SARS is the real danger and not a minor travel advisory from the World Health Organization. If they make any more mistakes in containing it here large numbers of us are going to burn with the disease. Tony Clement's wonderful Tuesday and the lifting of the travel advisory may be an illusion, hiding a terrible Tuesday waiting up the road.



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