Toronto reports 25 possible new SARS cases
CDC reissues travel alert three days after lifting it
TORONTO, Ontario (CNN) -- Toronto health officials revealed Friday that they were looking into at least 25 possible new SARS cases involving a second hospital.
The first five suspected cases announced Thursday were all linked to St. John's hospital.
Now health officials say more than 20 patients are being evaluated for possible SARS at another Toronto-area hospital -- North York General. Two of the patients there have died -- one age 96 and another in his or her 80s, officials said.
Three of the St. John's patients were in critical condition after one worsened during the day, the health authorities said. There was no word on the condition of the other patients at North York.
"It's been a rough day," said Dr. Donald Low, a microbiologist helping with the investigation.
"We're assuming the worst, that there has been likely transmission to health care workers, that there has been transmission to families and that there has probably been transmission to other patients, and that it provides the link to St. John's Hospital that we didn't recognize last night," Low told reporters at a testy news conference Friday night.
"The investigation continues, and we hope to have more information, but there's obviously a lot we don't know," he added.
All the patients are being treated as if they have SARS, but the cases will not be confirmed until laboratory testing is complete. The first results, on the St. John's patients, might not be ready until Tuesday, Dr. Paul Gully, the director general of Health Canada, said Friday.
Thursday, Toronto officials urged anyone who had passed through St. John's Hospital between May 9 and Tuesday to isolate themselves and to call a Toronto Public Health hot line at 416-338-7600.
Friday night, that caution was expanded to anyone who had been at St. John's between May 1 and May 8, and anyone who was at North York between April 22 and May 13. Well over 1,000 people could fall into that category, Low said.
Those people are urged to monitor their temperature and watch for these signs and symptoms of SARS: sudden onset of fever greater than 38 degrees Celsius or 100.4 Fahrenheit; and respiratory symptoms including cough, shortness of breath or difficulty breathing.
"This is a setback," Tony Clement, Ontario's minister of health and long-term care, acknowledged Friday.
"We are taking every measure possible to implement strict infection control procedures," Clement said. "We have to hope for the best but prepare for the worst."
CDC issues travel alert for Toronto
Even before the announcement of the additional cases, the Centers for Disease Control and Prevention reinstated its travel alert for Toronto.
An alert does not advise against travel to an area, "but informs travelers of a health concern and provides advice about precautions they can take to reduce their risk of exposure," the CDC said in a statement.
The CDC had lifted a previous alert Tuesday because more than 30 days had elapsed since the onset of symptoms for the last reported SARS case.
As of Wednesday, 23 people in Canada had died of SARS -- primarily in the Toronto area -- according the World Health Organization Web site.
The new possible cases of SARS were announced several weeks after the last positive diagnosis in Toronto and just days after the WHO dropped Canada from its list of "hot zones" where the disease has been recently transmitted.
Travelers are urged to avoid settings such as hospitals and clinics where there has been evidence of SARS transmission.
Meanwhile, Taiwan's SARS crisis is threatening to deteriorate rapidly after more than 100 cases were reported in the past two days.
Highlighting the seriousness of the situation, a member of a U.S. team assessing SARS control procedures in Taiwan has developed symptoms of the disease. (Full story)
The WHO says Taiwan has the world's fastest-growing outbreak of SARS.
Guangdong travel advisory lifted
A travel advisory on Hong Kong and China's Guangdong province -- where the disease is believed to have originated -- was lifted Friday by the WHO.
"The outbreaks in those areas are being contained," WHO spokesman Dick Thompson told CNN. "There's still disease, but the disease is largely contained in hospitals."
China reported three deaths and 20 new cases of SARS on Friday, a slight rise after reporting fewer than 20 cases earlier this week.
The WHO is worried, however, that some patients in China with mild SARS symptoms are getting "false negative" diagnoses.
The number of cases and deaths hit single digits for the 20th day in a row in Hong Kong on Friday.
Earlier this week, health officials in Washington warned of overconfidence in the SARS fight, saying the disease could make a comeback this winter and spread throughout North America.
"I am convinced with the advent of an early winter in the Northern Hemisphere in just six short months, we will see a resurgence of SARS that could far exceed our experience to date," Michael Osterholm, director of the Center for Infectious Diseases at the University of Minnesota, testified to Congress.
"If this projection is correct, we have every reason to believe that this disease may show up in multiple U.S. cities as we continue to travel around the world in unprecedented numbers and speed," Osterholm said.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said he agreed.
"There is the possibility, if not likelihood, that we would not yet be finished with this, even with the cases no longer spread in this season or at this particular time," Fauci said. "So we must be prepared for serious consequences in future years."