Battle against mystery ailment widens

Battle against mystery ailment widens

www.ocanada.ca...

By CAROLYN ABRAHAM

MEDICAL REPORTER

Wednesday, March 26, 2003 � Print Edition, Page A1


Health officials have taken extraordinary measures to contain the spread of a strange pneumonia outbreak as one school closed, dozens of people were quarantined in their homes and a wide-ranging search was launched for others exposed to the disease.

At least 25 Toronto nurses, paramedics, clerks, and lab workers are now in hospital isolation rooms, thought to have severe acute respiratory syndrome, and the members of their 25 households are under strict quarantine. They're obliged to wear face masks indoors while interacting with other family members, and are forbidden to leave.

Sheela Basrur, Toronto's medical officer of health, said yesterday her office is racing to track other patients or friends who came in contact with those sick health workers, an effort that includes local school boards.

"The number of people to be quarantined has yet to be determined," Dr. Basrur said. "But we expect that this number could reach into the hundreds."

David Lewis Public School in Scarborough announced yesterday it would close today and not reopen until next Monday as a "precautionary measure" after three junior kindergarten students developed high fevers, one of the symptoms of SARS.

Other schools have sent notes home urging parents to watch for symptoms of the atypical pneumonia, such as dry coughs and soaring temperatures, and to keep sick children at home.

Ontario Health Minister Tony Clement said SARS will be included as a reportable, communicable and virulent disease under the Health Protection and Promotion Act, which lets officials quarantine people against their will.

That measure most often is applied in cases of tuberculosis.

Quarantines are to run 10 days from the last contact a person has had with a SARS patient, the outer range of the known incubation period of the illness.

"We have gone beyond the standard outbreak measures," said Colin D'Cunha, Ontario's commissioner of public health. "We are taking steps to contain the spread of SARS and to make sure people who have been exposed are safely isolated where they can be cared for."

Dr. D'Cunha stressed that the risk to the general public of developing SARS is still very small. Only those who have been in close contact with people known to have the disease, or those who have recently travelled to Southeast Asia, the suspected starting point of SARS, need be concerned, he said.

Vancouver and Edmonton have reported one suspected SARS case each. But Ontario now reports 48 suspected or probable cases, including those of the Scarborough health workers, and three deaths.

The Toronto situation has taken on an eerie resemblance to the one unfolding in Asia. Some schools have closed in Hong Kong, and the government of Singapore has already ordered 740 people under house quarantine. They could face fines of about $4,400 if they disobey.

The Asian experience prompted Health Canada to upgrade its travel advisory yesterday, saying "Canadians should defer all travel until further notice" to Hong Kong, Singapore, Vietnam, and China's south province of Guangdong, where an atypical pneumonia first broke out last November.

Internationally, labs continue to come up with different answers about the agent behind SARS. Both a coronavirus, which is linked to the common cold, and a human metapneumovirus, associated with mild respiratory ailments, have been identified by several labs.

"It is not very easy to fight against an infectious disease when we don't know what the cause is," said Atilla Turgay, chief of staff at Scarborough Grace Hospital, which has closed its emergency department and restricted admissions and visitors.

Health workers at Scarborough Grace took no precautions when they dealt with a SARS patient in early March, since they knew nothing of the disease at that point. The patient had contracted the illness from his mother, who had recently returned from Hong Kong. He died March 13.

From March 15 to March 21, health workers began falling ill. Not realizing their symptoms signified more than a routine respiratory bug, some of the 25 health workers continued to work last week, health officials confirmed.

Their families are now being confined to their homes. Public-health officials are phoning them twice daily to ensure they remain at home and to record their temperatures.

Protective face masks are to be worn around other family members and changed three times a day, since SARS is thought to spread through respiratory droplets.

The health office suggests these households have friends or family leave food on the doorstep, or order it through the Internet.