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Toronto traces SARS cases to 96-year-old patient

How hospitalized man caught disease remains unclear

A worker offers hand cleaner to a visitor at a Toronto hospital.
A worker offers hand cleaner to a visitor at a Toronto hospital.

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The World Health Organization has returned Toronto to its list of areas where there is local transmission of the SARS virus.
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Taiwan health authorities insist the SARS epidemic is easing despite recent deaths.
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TORONTO, Canada (CNN) -- The World Health Organization returned Toronto to its list of areas where there is local transmission of SARS, a spokesman for the health agency said Monday.

Officials made their decision after receiving reports of eight more probable cases of severe acute respiratory syndrome in Toronto -- two of which were fatal. All the cases have been traced to a 96-year-old man who died May 1 after two bouts with pneumonia that hospital officials did not link to SARS until the new cases emerged.

In addition to the probable cases of SARS, 26 others have been classified as suspect, a WHO spokesman said. (Full story)

In both probable and suspect cases, the patients have respiratory symptoms and fever. A case is deemed probable if the patient also has lung illness confirmed by an X-ray.

Canadian health officials underscored to reporters that no travel advisory has been reinstated.

Toronto "will be a SARS-affected area, but there is no travel advisory," said Dr. Paul Gully of Health Canada.

The difference is critical. Early this month, the WHO imposed a travel advisory urging delay of all but essential travel to Ontario. Although the WHO lifted the advisory a week later, it resulted in a sharp drop in business and tourist travel to the area, and stirred the wrath of Canadian health officials and politicians, who called it an overreaction.

Toronto's reinstatement to the list of SARS-affected areas means that screening efforts at airports will resume and that doctors will raise their index of suspicion when treating people with respiratory disease -- one of the hallmarks of SARS.

Canada thought it had contained SARS and declared itself free of the disease a week ago but has found itself struggling with the largest outbreak outside Asia.

Monday's announcement does not mean that the general public in Toronto is at risk, Gully said. "The conclusion was reached that that individual acquired it somehow or other in a hospital situation. There's no other explanation."

Still, he acknowledged, questions about how the 96-year-old got the disease while a patient in North York General remain unanswered. The patient was on a different floor from where SARS patients were being treated in isolation.

Health officials: SARS cases could grow

The other hospitals are St. John's Rehabilitation, St. Michael's and Scarborough General. All are in Toronto's business district.

Dr. Colin D'Cunha, Ontario's commissioner for public health, predicted that the number of possible SARS cases could grow as officials investigate each hospital further.

Doctors have said the overwhelming body of evidence indicates that the disease is spread primarily through close contact with droplets from a SARS-infected person, something that does not appear to have been possible in that case.

"Any case that cannot be explained readily by immediate close contact would raise those questions about whether there are other modes of transmission," Gully acknowledged.

Asked whether there is a risk that people outside hospitals could contract SARS in Toronto, he said, "For people coming to Toronto, there is not a risk. There is not a risk unless you are going to a hospital. Those hospitals where there was a risk would not be open to you anyway."

The disease has profoundly affected health care workers, who are at higher risk for the disease. A total of 141 asymptomatic Toronto paramedics and health care workers who might have come into contact with probable SARS-infected patients have been put into "working quarantine," D'Cunha said. That means they may continue to work around patients but must not take public transportation to their jobs and must wear gloves, gowns, masks and eyewear protection on the job -- changing them each time they see a new patient.

At home, the health workers have been directed to isolate themselves from friends and family, sleeping and eating alone. At times when they must be around others, they are to wear a mask.

As of Monday, about 2,200 people in Toronto who show no symptoms of SARS were in quarantine, up from 500 Saturday.

Cases increasing in Asia

The global death toll from SARS pushed past 700 on Sunday.

Taiwan reported 15 new SARS cases Monday, raising its total to 585 and prompting Taipei's Health Bureau chief, Chiou Shu-ti, to quit. She is the third official to resign over SARS.

So far, 72 people have died on the island from SARS, but Taiwan's center for disease control said the updated figures suggest the epidemic is coming under control after a record rise of 65 cases Thursday.

China, the hardest-hit area in the world, reported its smallest one-day rise in new SARS cases since it began tallying figures. It counted two more deaths and another eight infections Monday.

One of the deaths and five of the new cases were in hard-hit Beijing.

While noting the falling number of new cases, Gao Qiang, China's executive vice minister of health, told local officials that the situation "remains grave," with prevention and treatment still "enormous and difficult," the state-run Xinhua news agency reported.

Gao warned of a possible relapse, citing the large number of patients still in the hospital and suspected cases in quarantine, as well as weaknesses in rural prevention, as reasons to remain vigilant.

Although the World Health Organization lifted an advisory against travel to Hong Kong and the southern province of Guangdong on Friday, the health body still advises against nonessential travel to Beijing and Hebei, Inner Mongolia, Shanxi and Tianjin, as well as to Taiwan.

After marking its first day with no new cases on Saturday, Hong Kong said Monday that SARS had killed one person in the city and infected another.

Just days after the lifting of the WHO's travel warning, the airport authority in the SARS-scarred territory of 6.8 million people said it would halve its landing fees for airlines during the next six months. (Full story)

Hong Kong is one of the world's busiest airports, but many airlines have cut flights to the territory amid a drop in travel linked to the SARS outbreak.

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