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Canada's Probable SARS Cases Rise, Could Reach 70
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May 29, 2003

By Rajiv Sekhri

TORONTO (Reuters) - Toronto's probable SARS (news - web sites) cases more than doubled on Thursday as the city changed how it counts cases of the deadly disease in line with World Health Organization (news - web sites) recommendations, and doctors warned the number could go as high as 70 in coming days.

Provincial medical officials reported 29 probable cases of Severe Acute Respiratory Syndrome. The number, revised to conform with WHO guidelines, is up from 12 on Wednesday, when there also were 20 suspect cases. Doctors are monitoring 107 patients for infection, up from 50 people.

Under the WHO definition, Toronto will now include patients with pneumonia whose cause cannot be adequately explained. The previous Health Canada recommendation on how to define probable SARS cases included only patients with a worsening respiratory illness.

Dr. Jim Young, Ontario's commissioner of public safety, said it would have been better to classify cases as severe, moderate and mild.

"I think most of us would say that would be a whole lot easier than probable and suspect, which are probably about the two worst ways of describing this illness," he said.

Dr. Donald Low, chief of microbiology at Mount Sinai Hospital in Toronto, said the city could see probable case "numbers up in the 60s, 70s."

The flu-like illness, whose symptoms include high fever, dry cough and difficulty breathing, has killed 29 people in the Toronto area, the only place outside Asia to report deaths from SARS.

Low said he thinks the current outbreak of the deadly disease seems to have peaked. However, more than 7,000 people are in quarantine and 13 patients are in critical condition.

Canadian and U.S. health authorities are investigating reports that visitors from Toronto may have spread the disease to the United States, said Dr. Colin D'Cunha, Ontario's chief medical officer of health. He did not give details.

D'Cunha said there was no evidence of transmission of the disease in the Toronto community and said he hoped the WHO would not recommend that travelers stay away from Toronto.

The number of SARS cases is one element examined by both the WHO and the U.S. Centers for Disease Control when they decide whether to issue travel advisories.

Among the factors that can trigger a WHO advisory are a large and rising number of cases -- 60 infectious cases plus five new cases a day -- coupled with a spread of SARS outside a hospital setting and the risk it is being exported to other countries.

"Hopefully, the WHO will not change our status. We have a problem that is identifiable. We can account for all the cases that we find, and I hope the WHO will look at that and give us credit for that," Low said.

The WHO put Toronto back on its list of SARS-affected areas earlier this week, after taking it off for 12 days, but stopped short of issuing a travel advisory.

Worldwide, there are about 8,300 SARS cases. The virus, which originated in southern China and has spread to 30 countries by travelers, has killed nearly 750 people.

In the Toronto area, a high school was shut on Wednesday sending 2,000 staff and students into quarantine after a student there showed SARS symptoms. A liquor store has also been shut down and its employees are in quarantine.

In Vancouver, British Columbia, health officials said on Thursday they had put two people into quarantine who had recently traveled to Asia and were displaying SARS-like symptoms.