Bug could `broaden’: MD
Fourth GTA victim dies; toddler is a suspected case

Health officials are warning more cases of the mystery illness SARS may spread throughout Ontario.

Dr. James Young, Ontario commissioner of public security, warned that the spread of SARS could “broaden across Ontario” and urged all staff in Ontario hospitals to be on guard for potential cases. Officials are considering whether to impose visitor restrictions on hospitals throughout the province.

The warning came as the death of a fourth Toronto-area resident was announced and a “suspect” case of a 21-month-old toddler was revealed.

The latest patient to die from Severe Acute Respiratory Syndrome contracted the pneumonia-like illness from the first SARS patient to die at Scarborough Grace hospital, officials said yesterday.

Public health officials estimate Ontario has about 100 cases of SARS and said that 42 are “probable” and 39 “suspect” cases, including the toddler.

Health officials have already said that police officers and security guards should be used to enforce strict visitation rules in Toronto-area hospitals.

In other developments:

New Brunswick reported the first suspected case of SARS in Atlantic Canada. A teacher of a school in Miramichi developed symptoms before returning from a trip to China last Monday. A second probable case was found in British Columbia.

Singapore Health Minister Lim Hng Kiang said airplane passengers could infect people two rows ahead and two rows behind them. He said officials have discovered some SARS patients are “super infectors,” able to transmit the illness to as many as 30 or 40 others.

The Ontario Nurses Association complained about a shortage of supplies at Toronto-area hospitals, including N-95 masks needed to protect nurses the public from SARS. “We have not run out of masks,” Young said. Authorities have ordered more.

The International Ice Hockey Federation cancelled the women’s world hockey championship in Beijing. The Canadian team was to fly there today.

Dr. James Hughes, of the U.S. Centers for Disease Control and Prevention, said, “SARS is a global problem that emerged over a few months, results in a severe illness, has no effective therapy and cannot now be prevented by vaccine. It is as good an example as you will ever see of an emerging infectious disease.”

Health officials said the effectiveness of the quarantine would not be compromised by doctors, nurses and hospital workers being allowed to enter and leave Scarborough Grace and York Central hospitals.

They said there are strict safety measures in place both inside hospitals and after work for hospital workers to follow, including mandatory use of surgical masks, gloves, goggles and other equipment, and after-shift disinfection requirements.

The latest victim died Saturday at York Central Hospital in Richmond Hill after transferring there from Scarborough Grace on March 16. Health officials closed York Central Friday night after determining — 13 days after admission — that the patient had brought SARS from Scarborough Grace, also ordered shut last week.

“The person went to (Scarborough Grace) hospital as a patient,” Young said yesterday. “That person came into contact with … one of the first cases.”

Officials confirmed the victim is the second person to die after having contact with Chi Kwai Tse, a 44-year-old man who died March 13 at Scarborough Grace. A 76-year-old man who shared a hospital room with Tse died of SARS on March 21.

Tse was the son of Sui-chu Kwan, the first person in Toronto to die of the disease after returning from a trip to Hong Kong, which is also in the grip of a SARS crisis. Yesterday, health officials there reported 60 more people had fallen ill — more than half of them in one apartment complex. The latest fatality in Toronto brings the global death toll to 59.

Kwan, who was 78, died at her home in the east end of Toronto on March 5. She, along with other visitors to Hong Kong’s Metropole Hotel, was infected by an ailing doctor from Guangdong, China’s south province, which recorded the first case of the illness now known as SARS.

At their daily press briefing yesterday, Young, Dr. Colin D’Cunha, Ontario’s chief medical officer of health, and Dr. Hanif Kassam, acting medical officer of health for York Region, cited patient confidentiality in declining to give any more details about the latest death.

Nor would they say where the patient stayed while at York Central, which has three other probable cases of SARS. It’s known the person was not kept in isolation. Some family members who visited a patient in ICU over the past two weeks and are now under quarantine fear they may have been contaminated by an elderly male patient with a severe cough. Young declined to say if that was the latest victim.

York Region public health plans to open a SARS assessment clinic in the next few days similar to the one operating at Sunnybrook and Women’s College Health Sciences Centre’s downtown (Grenville St.) site, Kassam said.

Young said he wanted to assure Ontarians that all known SARS cases in Ontario can be traced either to people who became infected while travelling in Southeast Asia or having “close or direct contact with SARS.”

He also announced that visitor restrictions, already in place at Toronto-area hospitals, are now being imposed on jails. Many seniors and nursing homes across the city are also taking precautions by denying or limiting visitor access.

Many have posted signs on front doors outlining a variety of actions ranging from denying access to suggesting visitors voluntarily refrain from visiting loved ones or friends until further notice.

Peel Region yesterday reported two probable and three suspected cases.

Peel spokesperson Cynthia Ulba said yesterday the two probable cases — health-care workers who contracted the disease through their work in Toronto — are quarantined, one at home and one in hospital. Of the three suspected cases, two were discharged from hospital and are recovering at home after a period of quarantine and the other is quarantined at home.

At Highbourne Lifecare Centre on The East Mall, Etobicoke, two signs tell visitors to stay away. “The exception will be those family members who choose to attend to loved ones in critical or palliative care situations,” reads one sign.

Asked about new data out of China suggesting the incubation period could be as long as 14 days, Dr. Don Low, chief microbiologist at Mount Sinai Hospital, said the evidence collected here shows most people develop symptoms within four or five days of infection and that the 10 day-period is probably safe.

Thousands of Toronto residents who visited Scarborough Grace and York Central on or after March 16 have been advised to stay at home for 10 days, the maximum time public health authorities believe it takes SARS-symptoms, such as a high fever, coughing and breathing difficulty, to develop.

D’Cunha and Low also played down concerns expressed by the director of the U.S. Centers for Disease Control and Prevention about airborne transmission.

While it can’t be ruled out, “we have no epidemiological evidence to suggest this is airborne,” said Low. “That doesn’t mean you might not have an occasional case that you see occur or that might explain something, but 99 per cent of the cases we have seen to date we feel confident that we can focus on contact transmission.”

Young emphasized that the best way to combat the spread of SARS is for everyone in Ontario to be on the lookout for it. Even people experiencing headaches or malaise should be alert that it could signal the onset of SARS.

“We believe by the time the symptoms reach the fever stage, the person in fact may be contagious and so it is with that in mind that we urge those who are experiencing headache and malaise to take them seriously and begin to isolate themselves while they try and discover what they’re dealing with.”

D’Cunha and Low clarified who must remain in isolation.

If someone has had close contact with SARS but is not showing symptoms, “that is the person that we think in public health is at greater risk to come down with infection. His or her contacts are not likely to come down with infection.”

Data also suggests patients are probably most infectious probably in the first 24 hours of symptoms, said Low.

David Lewis Public School will reopen to staff and students today. The school closed last week after three students developed fevers in the same classroom. The illnesses were not SARS.