- 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
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
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
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
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.