Posted on 06/13/2003 5:25:45 AM PDT by Lorenb420
Toronto — The World Health Organization has criticized Canadian health authorities for failing to notify people properly that they may have been exposed to SARS.
A senior United Nations official also raised questions yesterday about how well provincial and federal authorities are working together to tackle the virus.
Canadian officials say the criticisms are unfounded. But the WHO is still downgrading Toronto on its list of areas of local transmission today to a so-called Level C status, Health Canada said.
This means that health officials in Toronto are not doing a good enough job, according to WHO, of tracing people who may have been exposed to SARS.
"What it is telling us is that, in their judgment, there have been one or more individuals who were not identified as contacts, who under their assessment should have been identified as contacts of cases," said Paul Gully of Health Canada.
The change in status came about because a North Carolina man's exposure to severe acute respiratory syndrome in Toronto was identified only after the fact.
The man, who visited his father at Toronto's Baycrest Centre for Geriatric Care on May 16 and 17, developed SARS-like symptoms only after returning home.
For days, there have been rumblings that the Geneva-based health agency would reissue a travel advisory, warning against visits to Toronto because of the risk of contracting SARS.
The WHO's senior management committee will meet today and Toronto is part of the agenda. A WHO spokeswoman said that an advisory on Toronto cannot be ruled out.
Dr. Gully stressed the Level-C assessment does not necessarily mean that Toronto will be hit with another travel advisory, which the WHO cannot issue without first giving 24 hours notice to health authorities. He did indicate, however, that the status may be a factor in the WHO's decision.
This setback — yet another in Toronto's fight against SARS — developed as the WHO criticized Canada for the lack of co-ordination between Ottawa and the provinces.
David Heymann, the WHO's chief infectious-disease expert, said the conflicts between Canada's federal and provincial health agencies were as bad as or worse than those in other countries.
"SARS has shown us that relationships between federal, or central, and provincial or state governments are very important in public health, and very difficult to establish," Dr. Heymann told a press conference in Beijing yesterday.
"We understand that this has been a problem in China. It certainly has been a problem in Canada, where there have been difficulties between Health Canada and the provincial government."
Colin D'Cunha, Ontario's chief medical officer of health, immediately dismissed the criticism. "It's much ado about nothing," he said, adding that Health Canada has been informed of the situation every step of the way.
But a doctor who did not want to be identified agreed with Dr. Heymann's statements, saying it is a "totally unco-ordinated effort," lacking any leadership, with some people not co-operating or sharing information.
Maria Cheng, a WHO spokeswoman, said there are more questions than answers to Toronto's most recent wave of SARS. "I think it's definitely a concern that we don't have answers to a lot of questions in terms of how this second outbreak has progressed."
Allison McGeer, a key member of the SARS containment team, said it is "very odd" that the WHO downgraded Toronto to a Level C based on the single North Carolina case.
However, yesterday it was reported that two of the man's work colleagues are suffering from respiratory symptoms and are in isolation.
Exported clusters of SARS could vastly increase Toronto's chances of another travel advisory from the organization.
The traveller most likely caught the disease on one of two visits to the geriatric-care facility — but no one at the facility was showing symptoms at the time, she said.
Health officials say the man is now recuperating at home.
The WHO is concerned because officials did not contact the man to warn him that he had been exposed to SARS. This shows, according to the health body, that contact tracing is not necessarily identifying everyone who needs to go into quarantine.
But Canadian officials say this was a special case, and it is still not known exactly how the man contracted the illness.
A patient in the room the man was visiting had already come in contact with SARS at North York General Hospital — the epicentre of Toronto's latest outbreak — but displayed no symptoms until May 23. He was transferred to Baycrest's rehabilitation wing on May 15.
The patient's wife, who visited him regularly at both facilities, also developed symptoms of SARS. But doctors pegged her date of onset as May 21.
Since it is believed a person has to be symptomatic in order to spread SARS, health officials are stumped as to how the North Carolina man could develop SARS from two people who didn't show symptoms until a few days later.
"We're stuck with a circumstance that is very difficult to explain," Dr. McGeer said. "It appears to involve transmission from someone who was asymptomatic or very close to it."
Meanwhile, federal health officials amended the Quarantine Act to include SARS yesterday. Under the act, officials have the authority to ask anyone suspected of having the disease to undergo a medical examination and can detain the person if necessary. Dr. Gully said this was not the result of the WHO'S Level-C listing.
While the act prescribes an incubation period of 20 days, Dr. Gully said officials will stick to the 10-day quarantine period for SARS for "public-health-management purposes."
This is a very dubious and IMHO untrue belief.
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