SARS Claims Fourth Canadian Life

TORONTO (CP) — A fourth Toronto-area resident died of SARS on the weekend, and a 21-month-old child joined the growing list of probable and suspected Canadian cases of the rapidly spreading disease.

Swamped public health officials estimated Ontario has roughly 100 cases of severe acute respiratory syndrome, but admitted they had only been able to analyse data for 81 — 42 probable and 39 suspect cases.

“There are very many more individuals provincewide who are cases that are under investigation,” said Dr. Colin D’Cunha, Ontario’s chief medical officer of health.

Dr. Jim Young, the province’s commissioner of public safety, urged hospitals and health-care workers around the province to be vigilant for potential SARS cases, saying they fear that as time goes on the ripples from the Toronto cases will move further afield.

Meanwhile, officials in New Brunswick revealed they are watching a school principal in the Miramichi region who had recently returned from China. The woman, they said, had gone into voluntary quarantine in her home and the school at which she teaches was to be closed until April 8.

Vancouver has one probable SARS case and a number of people under surveillance for the disease. But health officials in Manitoba said Sunday a patient who had been listed as a probable SARS case in Winnipeg does not have the disease.

The Ontario officials confirmed the latest person to die had become infected while receiving treatment in the intensive care unit of Scarborough Grace Hospital — the nexus of Toronto’s growing cluster of SARS cases.

One of the original Canadian SARS patients was treated at Scarborough Grace in early March before health-care workers realized they were facing a highly contagious and potentially deadly new disease that required high level infection containment measures: gowns, gloves, goggles and masks at all times. Waves of cases have emanated from that first patient.

The latest person to succumb to SARS was transferred to York Central Hospital on March 16 — long before he began showing signs of SARS. As a result, staff there did not impose the stringent infection control measures needed to contain the disease. The patient died Saturday night.

At least two nurses from York Central have come down with SARS. Both York Central and Scarborough Grace are now closed to new patients. Staff from the two facilities are barred from working elsewhere for the time being.

Anyone who worked at, visited or was a patient of either hospital from March 16 onwards has been asked to go into quarantine for a period of 10 days from the last exposure to the hospitals.

While no one has a good handle on how many people are holed up in their homes, public health officials have estimated the numbers would reach into the thousands.

Even less clear is how many people have ignored the request to quarantine themselves. To date, D’Cunha said Sunday, no mandatory quarantine orders have been issued, but he and others have threatened the province will go that route if necessary.

D’Cunha and Young insisted that all known SARS cases on Ontario can be traced either to people who became infected while travelling in Southeast Asia or the Scarborough Grace cluster.

That’s crucial, from a containment point of view. If public health officials know who might have been exposed to the disease, they can apply containment measures to try to keep them from giving it to others.

If sporadic cases — meaning not linked to any known SARS case — begin to appear, it will be a sign that containment efforts have not worked and the disease is at large in the community.

That would be a public health nightmare.

“There is concern when you can’t trace cases. That’s very worrisome,” said Dick Thompson, a spokesman for the World Health Organization.

In a new bid to contain the spread of the disease, Young announced that visitor restrictions would also be placed on jails.

“Like hospitals, we want to be sure that we don’t bring the spread of SARS inadvertently again into what’s an institution,” Young said.

On Saturday, nursing homes, chronic care facilities and other group care operations were told to restrict visitors.

Hospitals in the Toronto area were told to close their doors to all but a selected few visitors — family members visiting the dying and parent visiting young children — last week.

Those restrictions may be extended to hospitals throughout the province soon, Young said, saying hospitals elsewhere have been warned to be ready for the move.

Health Canada continued to work Sunday with officials at Pearson Airport in an attempt to devise a program to screen people getting on international flights leaving Toronto.

The WHO recommended departure screening in a bid to keep Canadians from exporting the disease. While Health Canada hasn’t said what form the screening might take, it has ruled out a person-by-person check of all passengers, saying that would be impractical.

Spokeswoman Tara Madigan said the department hoped to have something in place “after the weekend.”

In other developments Sunday, the International Ice Hockey Federation cancelled the women’s world hockey championship in Beijing due to SARS. Several teams, including Canada’s, had delayed leaving for Beijing over concerns about SARS.

Last week, Health Canada urged Canadians not to travel to or through China, Singapore, Hanoi, Vietnam, Hong Kong and Taiwan if such travel could be avoided.