SARS claims two more victims

Globe & Mail ^ | 2003-05-28 | LUMA MUHTADIE

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Two more people who were part of the re-emergence of SARS in Toronto last week died in hospital overnight, bringing the nation's death toll to 29.

"It is with some regret that I wish to advise all of you that two individuals have passed away with SARS-like symptoms overnight," Ontario's Commissioner of Public Health, Colin D'Cunha, told a news conference Wednesday. He said both women were over the age of 65.

Meanwhile, nearly 2,000 people in a Toronto suburb have been asked to go into quarantine after a student attended an area high school with symptoms of SARS.

The teenager who attended Father Michael McGivney Catholic Academy in Markham, Ont., last week with SARS symptoms is the son of a health care worker at North York General Hospital, Dr. Murray McQuigge told a news conference on Wednesday.

Ontario currently has 12 active probable cases and 23 suspect cases in hospital and there are some 50 cases under investigation.

The Ontario Ministry of Health has adopted Health Canada's definition of probable SARS cases to deal with the new cases of the disease — a definition that officials are now saying is out of line with international standards.

"If we widen the definition to include a wider case of symptoms — such as a broader definition of pneumonia — it would change some of the suspect cases into probable cases," Health Canada's senior director of public health said Wednesday afternoon.

Ontario abandoned the World Health Organization's definition for probable SARS cases in early April and adopted Health Canada's definition instead.

Donald Low, Toronto's point man on SARS told reporters earlier in the day that if Ontario had stuck to the criteria it used during the first outbreak of the disease, the number of probable cases in the province would be "in the 30's" — not the 12 currently reported.

Health Canada defines a suspect case of SARS as someone who has had close contact with an affected person or area, shows signs of a fever and has respiratory problems.

A probable case is one in which the respiratory problems develop into a "severe respiratory pneumonia."

Unlike the World Health Organization's definition of a probable case, this does not refer to chest X-rays showing "infiltrates" or signs of pneumonia.

Dr. Gully said Health Canada officials had "at least two" conversations with the WHO on Wednesday. They were seeking input from the Geneva-based organization on making possible changes to the definition of SARS.

A WHO official advised Health Canada in a conference call that it would be prudent to have a more sensitive case definition than the one we have now, Dr. Gully said.

But he stressed that a revised definition of probable cases has no bearing on the way patients — be they suspect or probable cases — are isolated and treated in hospital.

Ontario and Toronto public health officials admitted at the conference that the definitions they are using to deal with new cluster of SARS cases are problematic.

"The difficulty with the health Canada definition is that it's a subjective definition, whereas the WHO definition [involving x-ray evidence of chest infiltrates] ... is less open to variation from centre to centre and is less open to interpretation," Dr. Low said.

Toronto's medical officer of health Barbara Yaffe also expressed regret about adopting Health Canada's more vague definition.

"As we are now in the second phase of the outbreak, it's obvious the WHO definition has more transparency and in applying the Health Canada definition it looks like we're trying to change the data."

Health Canada reports both suspect and probable cases to the WHO, but only probable cases are taken into account in decisions such as when to issue a travel advisory.

Still, Dr. Yaffe played down the difference between the way the two types of cases in a hospital setting.

"At the end of the day, probables and suspected are being treated the same way ... on the clinical side."