Infection Control Today - 07/2003: Toronto's Dance With SARS

July 1, 2003

Toronto's Dance With SARS

By Paul Webber

days after her Continental Airlines flight from Hong Kong touched down in
Toronto, family matriarch Kwan Sui-Chu died quietly from flu-like symptoms at
her suburban home. She had not been to a hospital, and once symptomatic, she had
not circulated in the general population her cause of death was listed as
heart attack. Nobody knew about SARS at the time; her death did not
trigger anything in the coroners mind, said Dr. Jim Cairns, Ontarios
deputy chief coroner. If SARS had been limited to Sui-Chu, Torontos first
SARS outbreak might never have happened. Unfortunately, it wasnt limited, and
through a series of events, it was about to get legs.

By the time Tsi Chi Kwai buried his mother, he
too was symptomatic, and a highly infectious super-spreader.

Seeking relief at a local hospital, he lay
coughing on an ER gurney for 12 hours, exposing more than 200 patients, nurses
and doctors to this unknown pathogen. Patients who shared the hospital ER with
Kwai were transferred to other hospitals all over the city, transferred by
emergency response personnel who didnt know to take precautions and who often
carried more than one patient at a time. Cautious about overstating the risk and
causing panic, the Toronto Public Health Department issued an underwhelming
statement that SARS was confined to a family who had recently traveled to
Hong Kong. One day after this lukewarm warning, Tsi Chi Kwai died.

As the magnitude of the problem became
unavoidable, waves of e-mails and faxes with updated (sometimes contradictory)
information crashed into healthcare facilities from every direction. Every
hospital in Ontario a land mass more than twice the size of Texaswas
ordered to bar all visitors, volunteers and non-critical appointments. Hospitals
screened everyone as they entered even staff members who just stepped
outside for a smoke. Double gloves, double gowns, masks and face shields were
mandatory for contacts. First responders were gowned, gloved and masked for all
transfers and were instructed to clean their equipment and vehicles with a
special accelerated hydrogen peroxide disinfectant. Alcohol hand
sanitizers and N95 respirators became hot commodities and were quickly in very
short supply.

In the media, news of SARS pushed the pending
assault on Baghdad off the front pages. Thousands of people, including
healthcare workers, were quarantined in their homes, and many people
self-quarantined after suspected or known exposure. Toronto nurses were often
avoided by friends and family, afraid of what might be incubating in their
lungs. One Hewlett-Packard employee went to work with SARS-like symptoms after
having been warned to stay home. Consequently the entire HP plant was shut down
and 300 of his workmates quarantined. As a travel destination, for business or
pleasure, Toronto was a pariah. Huge conferences were cancelled, as were many
flights into Torontos Pearson International Airport. Community functions and
sporting events were postponed.

Chinese restaurants closed and the Asian
districts of Toronto and other major cities looked abandoned.

No one in Toronto was unaffected by the spring
2003 SARS outbreak. Dozens died (all traceable to the index cases).
Paranoia-like fear of infectious disease ran rampant. The direct and indirect
costs to Canadian government, business and society will never be fully knowncertainly
billions of dollars.

As with most outbreaks though, some good things
came out of the SARS experience. Canadian health officials at all levels are
better prepared and aware of what level of coordinated effort will be required
to battle SARS again, an influenza pandemic or biological terrorism. Dramatic
budget cuts to public health agencies in recent years were exposed and reversed.
Proper hand hygiene was advertised so widely and aggressively during the
outbreak that it evolved into a societal norm. And as Canadian hospitals settle
into the new normal, infection control practitioners will continue to reap
the rewards of their deservedly higher profilea very good thing indeed.