looks like it is spreading around the lake
Posted on 06/09/2003 5:24:31 PM PDT by IYAAYAS
New SARS outbreak feared at Whitby hospital Fifteen dialysis patients have respiratory symptoms
HELEN BRANSWELL CANADIAN PRESS
An unexplained cluster of respiratory illnesses at a hospital east of Toronto has Ontario's SARS containment team worried about the possibility of a new outbreak of the disease. Fifteen dialysis patients of the Whitby site of the Lakeridge Health Centre have pneumonia or respiratory symptoms and are under investigation as possible SARS patients, Dr. James Young, Ontario's commissioner of public security, said today.
In addition, "there have been some staff reports of illness today which we are looking into," said Dr. Donna Reynolds, from the Durham Region public health department.
The ages of those who are sick range from 28 to patients into their 80s.
"We will not know whether they are SARS or not until we have seen them go through this clinical course over the next 10 days," said Dr. David Ross, Lakeridge's SARS consultant and chief respirologist.
"They are all in isolation."
The first person became sick June 1. By Thursday, as more patients fell ill, management of the facility ordered staff to don full gown and glove protection. On Friday, the local public health authorities were called. By Saturday, officials realized they had ``around 10" people who were ill.
Dr. Don Atkinson, the chief of staff, said the first person to come down with a respiratory illness had received dialysis at one of the hospital's 27 satellite sites, so it wasn't immediately apparent there might be a problem. Atkinson added that they cannot, at this point, link the first patient to the other 14.
"(But) 14 patients over three days does raise the flags," he said.
Of the 15 dialysis patients with respiratory illness, 11 were outpatients and four were in "continuing care."
Young, who only learned of the possible cluster on Saturday, said doctors are performing tests to see if there might be another cause for the illnesses. But in the meantime, all are being treated like SARS cases. They are in respiratory isolation; public health is tracing their contacts and ordering them into quarantine.
"It's SARS until proven otherwise," he said.
"Hopefully it isn't and hopefully it's something that's eminently treatable with all of the people. But there's no other way in this day and age that you can treat it other than to say it's SARS until proven otherwise."
Neither officials at Lakeridge nor leaders of the provincial SARS containment team had any clues today about how the patients - if they are SARS cases - contracted the disease.
Despite the lack of that crucial piece of information, one of Toronto's leading SARS authorities had little doubt that this was the province's latest bout with the pernicious disease.
"It's hard to imagine what else it could be," said Dr. Donald Low, the senior medical member of the SARS containment team.
"It doesn't bode well for the number of cases that we'll expect to see (in coming days)."
The hospital has been effectively moved to a Level 3 designation, indicating the highest level of SARS contamination. That designation puts all sorts of restrictions on admissions and transfers of patients as well as the ability of staff to work at other facilities.
Lakeridge officials told an afternoon news conference that two brothers - not linked to the Whitby cluster - arrived at their Oshawa site nine days ago and were being treated for SARS. They're in critical and deteriorating condition.
The pair had visited their ailing mother at North York General Hospital during an outbreak of severe acute respiratory syndrome at that facility.
But there is no known link between those two cases and the unexplained illnesses in Whitby.
Low suggested that if the Whitby patients do have SARS, then the outbreak has been under way for awhile. It's unlikely that so many people were all infected by the same person, he said.
"This number of people suggests that one person has infected three or four and those three or four have infected another three and four," said Low, chief microbiologist at Toronto's Mount Sinai Hospital.
"So when you're getting out to a second and third generation, then you're concerned about people that have already left and gone to other places," he said, referring to the possibility undetected SARS patients could slip into other area hospitals and spark new waves of infection.
Young said he hopes the pneumonia cases prove not to be SARS-related, but admits he's concerned.
"Oh course I'm worried. Any time I hear the word `cluster' and a group now, of course I get worried. I hope to be relieved of that worry soon."
Efforts are under way to determine how the patients could have contracted SARS, if indeed they have the disease. No epidemiologic or "epi" link to known SARS cases has yet been identified for the group.
An epi link is needed to officially diagnose a probable or suspect case of SARS.
But the experience in Toronto's second SARS outbreak showed officials the early lack of an epi link is no guarantee a case isn't SARS.
The current outbreak was sparked after officials at North York General Hospital, who were alerted to suspicious pneumonias by worried nurses, decided the patients couldn't be suffering from SARS because they couldn't discover a link to prior cases.
As a consequence, the disease festered among patients in the orthopedic ward for weeks before eventually infecting staff. Infected patients transferred from the facility took the disease to several other hospitals in Toronto.
Ontario currently has 66 active probable cases of SARS, and nine active suspect cases. Thirty-three people have died since the outbreak began about three months ago.
Young acknowledged today that he and provincial medical officer of health Dr. Colin D'Cunha sent a memorandum to all acute care hospitals in the area over the weekend reminding them to comply with provincial directives aimed at stopping the spread of SARS within health-care settings.
The memo followed on the heels of Friday's announcement of a potential exposure of newborns, their mothers and roughly 100 health-care workers on Mount Sinai Hospital's obstetrics unit when a medical student came down with SARS hours after finishing a shift last Wednesday.
The Ontario Nurses' Association complained the hospital had breached provincial directives requiring staff in all patient care areas to be suited up in protective gowns and masks.
Low defended his hospital, saying the directives issued May 31 provided some leeway for staff working in low risk areas such as obstetrics.
But Young said the purpose of the memo was to clarify that as far as the province is concerned, there is no room for hospital-by-hospital interpretation of the rules. The directives are to be applied across the board.
I think you are right, again.
U.S. confirms Toronto has exported a SARS case
Canadian Press
TORONTO — U.S. officials confirmed Monday that Toronto has exported a case of SARS to the United States. To make matters worse, figuring out how the man caught the disease in the first place is stumping local SARS experts.
The man, a 47-year-old from North Carolina, 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 the man's visit.
The situation doesn't add up, said Dr. 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 McGeer would not name, is not Mount Sinai. Nor is it North York General, the epicentre of Toronto's second SARS outbreak and a place where, on selective wards, many people were falling ill at the time when the North Carolina man visited the city.
Confirmation of the case came from tests run by the U.S. Centers for Disease Control, said Carol Schriber, a spokeswoman for North Carolina's department of health and human services.
The man is recuperating at home in isolation. None of his family members, who are also quarantined, has shown any symptoms of the disease.
"He is doing fine," Schriber said. "His symptoms are abating. ... He was never hospitalized -- he was never that ill."
While that is reassuring, the circumstances surrounding how he contracted SARS are not.
The man visited the Toronto facility in question on May 16 and 17. The patient he visited never contracted SARS. But two other people who shared the room later came down with the disease.
The dates of onset of symptoms for the two were May 21 and either May 22 or May 23 respectively, McGeer said.
"They give very clear stories of developing illness -- there is no reason to doubt them,'' she said. "And their illness developed five and seven days after this patient in North Carolina was exposed."
People who come down with SARS aren't believed to be infectious until they are suffering symptoms of the disease. To be on the safe side, though, public health officials consider the 24 hours before symptoms set in as part of the infectious period when they are determining who has been exposed and who must go into quarantine.
Even that window wouldn't explain how the North Carolinan contracted SARS.
The two patients who went on to develop the disease had been exposed to it at another health-care centre before they transferred into the unnamed facility, McGeer said. So they were incubating the disease when the North Carolina man visited their room.
McGeer said the scenarios she can envisage don't explain this case:
"But now we're talking about him having to have it (the prodrome) for days and days -- and to be infectious," McGeer said.
"Again, a little unlikely."
looks like it is spreading around the lake
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