Posted on 06/10/2003 7:02:55 AM PDT by Brian S
CTV.ca News Staff
There is more bad news this morning for Canada in the battle against SARS. U.S. officials have confirmed that Toronto has exported a case of the pneumonia-like illness to North Carolina.
The 47-year-old man developed a fever and pneumonia after visiting the city. While he did visit a patient in a health care facility, exactly how he contracted SARS is a mystery.
The man visited the Baycrest Centre for Geriatric Care in north Toronto on May 16 and 17. Two people who shared the room with the person he visited came down with SARS, but five to seven days after his visit.
"This story, at the moment, remains a bit of a mystery," said Dr. Allison McGeer, head of infection control at Mount Sinai Hospital and a key member of the SARS containment team.
What is confusing health officials is that they believe people who come down with SARS don't become infectious until they are suffering symptoms of the disease.
McGeer said there are a number of possibilities that could help explain the situation: either the man doesn't have SARS, he was exposed somewhere else in Toronto or he was infected by someone who had SARS but had no symptoms.
There is also the possibility that one of the patients who went on to develop SARS had signs the illness was coming, such as a very mild malaise, before the full onset of the disease's prodrome.
New cluster?
Ontario's SARS containment team is investigating a group of 15 dialysis patients who are suffering from pneumonia after attending the Lakeridge Health facility in Whitby, east of Toronto.
Although they do not have test results, or an identified epidemiological link to a known SARS case, infectious diseases expert Dr. Lionel A. Mandell said given the situation in Toronto and globally, "I think you have to consider it's SARS until proven otherwise."
The facility has now been classified as a "Category 3" hospital -- defined as a site where transmission of SARS to other patients or staff has occurred.
There are a total of four category levels. "Category 2" refers to a hospital where there is a risk of exposure and "Category 1" is applied to a hospital that is treating SARS patients. "Category 0" is when there are no SARS cases or transmission.
The key medical adviser to Ontario's SARS containment team, Dr. Donald Low, believes the approach is appropriate.
"It's hard to believe it's not SARS," Low said. "When you see a bunch of pneumonias in this day and age, it's SARS until proven otherwise."
But when reporters pressed Low to label the cluster a "SARS outbreak," he stopped just short.
"In what we've lived through the last 12 weeks, to see this occurring in a closed unit, especially a dialysis unit, is a grave concern that we're witnessing another cluster of SARS. That would be my working assumption," Low said.
The ages of those who are sick range from 28 to their 80s. Some staff are also reporting illness, and those cases are also being investigated.
The possibility of a new cluster of SARS cases, along with an export case, could put Toronto back on the World Health Organization's travel advisory list.
WHO spokesman Dick Thompson said the organization is looking into the reports. For now, officials have decided not to change Toronto's status.
With reports from The Canadian Press
It is no mystery: There are people who poo-poo the idea of infectious disease and there are people who avoid touching public surfaces. We know which category he falls into.
That's gonna be a problem.
My neighbor who has had a fever for over 3 weeks and pnuemonia (whom they can't give a diagnosis) works in Geriatric care.
But, as far as I know his illness has not spread to anyone.
The latest outbreaks in Canada, as well as an exported case, are all being called "mysterious" and "unlikely" which goes along with the earlier data showing positive PCR data in sub-clinical cases. The PCR data was described as "weird".
It seems that what is most mysterious and weird is Toronto's failure to take a hard loom at what they have, instead of calling very expected results "weird" or "mysterious".
The PCR test is more likely to give false negatives (due to timing of sample collection) than false positives. That is why I thought it was weird that the characterization of 20% positives in patients with symptoms was called weird and cited as evidence that SARS CoV didn't cause SARS.
Now the "mysterious" label is being put on patients who have SARS, but no known contact.
There really is no reason to think that some patients will not develop sub-clinical infections and be infectious.
That is certainly the easiest way to generate a 20% positive PCR result in patients with sub-clinical disease. The explanation that "we haven't seen that" is correct, but only because the observer has not really looked or dismissed the data as "weird".
The data aren't weird and are expected. I suspect that the virus is quite widespread in the Toronto area by now, and occasionally shows up as SARS when hospital patients are exposed.
The only thing "weird" about the Toronto PCR data is the failure to recognize the data for what it is, a measurement of SARS CoV infections, which continue to silently spread as officials attempt to find excuses for "weird" results.
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