Posted on 06/10/2003 4:23:11 AM PDT by Lorenb420
Toronto — Doctors are anxiously trying to determine whether 15 patients who developed SARS-like symptoms after attending a dialysis clinic in Whitby actually have the disease — a finding that would represent a huge setback in the fight against the virus.
As worried health officials sort out the situation, hundreds of people who came in contact with the patients or attended the clinic are being put in isolation and officials are scrambling to determine whether there is a link to known cases.
"We have to, in these times, assume that they may be SARS and we have to take those kinds of precautions," James Young, Ontario's public safety commissioner, said yesterday.
"Hopefully, in the next few days we'll have the answer and find that we've done it for naught. But it's one of those situations where we have to take extra precaution."
Donald Low, head of microbiology at Mount Sinai Hospital, said he and his colleagues are very anxious about these new cases.
"To see this occurring in a closed unit, especially a dialysis unit, has to be of grave concern that we're witnessing another cluster of SARS," he said.
If the illness were caused by the deadly virus, the situation could quickly escalate. Dr. Low said the number of people infected suggests that it is in its third or fourth generation in this particular cluster and could have been transmitted to many other people.
Meanwhile, U.S. officials confirmed yesterday that a North Carolina man who visited Toronto has exported a case of SARS. Experts in Toronto are having a difficult time figuring out how the man caught the disease.
The 47-year-old developed fever and pneumonia late last month after a stay in Toronto during which he visited a patient in a health-care facility.
Two people who shared the room with the person he visited came down with SARS — but only several days after his visit.
The situation doesn't add up, said Allison McGeer, head of infection control at Mount Sinai Hospital and a key member of the SARS containment team.
"This story, at the moment, remains a bit of a mystery," she said.
The health-care facility, which Dr. McGeer would not name, is not Mount Sinai. Nor is it North York General, the epicentre of Toronto's second wave of SARS and a place where, on selective wards, many people were falling ill at the time when the North Carolina man visited the city.
He is recuperating at home in isolation. None of his family members, who are also quarantined, have shown any symptoms of the disease.
The suspicious group of potential new cases attracted the attention of staff last Thursday at the Lakeridge Health facility in Whitby, where the clinic is located. "As soon as we realized that there were a few respiratory cases," staff were told to don full infection gear including masks, gloves and gowns, said Donald Atkinson, Lakeridge's chief of staff.
Public-health officials were told about the potential cluster on Friday afternoon when the number of illnesses continued to mount.
A dialysis patient who also appears to have severe acute respiratory syndrome was treated at another Lakeridge location in Oshawa on June 1, Dr. Atkinson said. But "we have not been able to establish at this time any link between that patient and the ones at the Whitby site," he said.
Dr. Atkinson said all of the patients under investigation had developed respiratory problems and a fever, two of the main signs of SARS. Some have pneumonia and could well have the virus, he said, but others will likely be diagnosed with something else.
The number of active probable cases of SARS fell by three in Ontario yesterday to 66 while the number of active suspect cases remained steady at nine. That's good news for those who have been struggling to contain a second wave that occurred when a case went unnoticed at North York General Hospital for more than a month.
But health officials know better than to exude optimism.
Last Friday, it was announced that a medical student at Dr. Low's own hospital had fallen ill with the disease 12 days after being exposed to the virus, two days after his quarantine ended and a few hours after he helped deliver twins in the hospital's obstetrical ward.
That, in turn, allowed for the potential exposure of other babies, their mothers and roughly 100 health-care workers. None of them had come down with the disease by yesterday.
"We're at Day 5 now, so it's a little early to say that we're out of the woods, obviously," Dr. Low said, "but we haven't seen any evidence of illness."
Meanwhile, Premier Ernie Eves promised yesterday to establish a "public investigative process" to study how Ontario's hospitals, its public-health system and the provincial government reacted to the SARS outbreak.
The inquiry is expected to have powers to subpoena witness, command the production of records and protect witnesses from reprisals.
The establishment of the investigative process would follow a demand made earlier yesterday by the Registered Nurses Association of Ontario for a Walkerton-style judicial inquiry into how the health-care system and the government handled the SARS outbreak.
Adeline Falk-Rafael, president of the association, argued that a full judicial inquiry is essential to determine the failings of the health-care system and whether these failings contributed to the spread of the outbreak and to the number of deaths.
"If it had been contained earlier, then it wouldn't have spread as far as rapidly and, ostensibly, then there would have been less morbidity and mortality as well," Ms. Falk-Rafael told a news conference at Queen's Park.
The SARS outbreak has caused untold economic damage to Toronto and caused travellers to shun the city. One of those was Portuguese Prime Minister Jose Manuel Durao Barroso, who cancelled an invitation to attend a dinner here in his honour last week.
Mr. Durao Barroso tried yesterday to limit damage caused by that decision, taking pains during a visit to Ottawa to express confidence in Canada's handling of the crisis.
"It's a very unfortunate event, but the government of Canada and all Canadian authorities are very much respected abroad by the transparent way in which they are managing this very difficult issue," Mr. Durao Barroso told reporters after meeting with Prime Minister Jean Chrétien.
"We have full confidence in the way Canadian authorities are dealing with this very, very difficult situation."
AMERICAN-STATESMAN STAFF
Tuesday, June 10, 2003
The first probable case of severe acute respiratory syndrome in Texas has been reported in a Travis County man who traveled to Toronto in mid-May and became ill later that month after returning home.
The man was not hospitalized and is in isolation at home, where he is recovering well, state and local health officials said.
"He doesn't have any fever, and he doesn't have any cough left," said Bob Flocke, a spokesman for the Austin/Travis County Health and Human Services Department. "He's got to stay home 10 days after the symptoms go away" so he doesn't infect others.
Flocke said the man is 38 but declined to release any other identifying information.
The U.S. Centers for Disease Control and Prevention classified the case as probable Friday evening, Flocke said.
Eight other possible SARS cases in Texas during the past three months have been classified as suspect, including that of a Travis County man who traveled to China. The key difference is that in probable cases, the victims also develop pneumonia and are believed to be more likely to have SARS.
The eight suspected victims have recovered, state health officials said.
"The most important thing is to get these people isolated quickly," Flocke said. The man with the probable case is cooperative and has not infected anyone else, he said.
As of Friday, the CDC had identified 68 probable cases in the United States and 311 suspect cases. No one has died of SARS in the United States, but worldwide, 784 people have died, according to the World Health Organization. The health organization reported 8,421 probable SARS cases worldwide Monday.
The CDC reinstated a travel alert for Toronto on May 23 after reports of five new probable SARS cases. It had lifted the alert on May 20 because more than 30 days had elapsed since the date of symptom onset in the last case. An alert does not advise against travel but tells travelers a health concern exists and they should take precautions.
maroser@statesman.com; 445-3619
Does that mean 10 days later or 18 days later or 21 days later?!
I wonder what your file looks like?! LOL
You and me both. A nice spell of warm weather would certainly go along way, I think, alas, it's been as cold as a donkey's b*lls up here this spring....
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