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

Toronto's Dance With SARS

By Paul Webber

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

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

Seeking relief at a local hospital, he laycoughing on an ER gurney for 12 hours, exposing more than 200 patients, nursesand doctors to this unknown pathogen. Patients who shared the hospital ER withKwai were transferred to other hospitals all over the city, transferred byemergency response personnel who didnt know to take precautions and who oftencarried more than one patient at a time. Cautious about overstating the risk andcausing panic, the Toronto Public Health Department issued an underwhelmingstatement that SARS was confined to a family who had recently traveled toHong Kong. One day after this lukewarm warning, Tsi Chi Kwai died.

As the magnitude of the problem becameunavoidable, waves of e-mails and faxes with updated (sometimes contradictory)information crashed into healthcare facilities from every direction. Everyhospital in Ontario a land mass more than twice the size of Texaswasordered to bar all visitors, volunteers and non-critical appointments. Hospitalsscreened everyone as they entered even staff members who just steppedoutside for a smoke. Double gloves, double gowns, masks and face shields weremandatory for contacts. First responders were gowned, gloved and masked for alltransfers and were instructed to clean their equipment and vehicles with aspecial accelerated hydrogen peroxide disinfectant. Alcohol handsanitizers and N95 respirators became hot commodities and were quickly in veryshort supply.

In the media, news of SARS pushed the pendingassault on Baghdad off the front pages. Thousands of people, includinghealthcare workers, were quarantined in their homes, and many peopleself-quarantined after suspected or known exposure. Toronto nurses were oftenavoided by friends and family, afraid of what might be incubating in theirlungs. One Hewlett-Packard employee went to work with SARS-like symptoms afterhaving been warned to stay home. Consequently the entire HP plant was shut downand 300 of his workmates quarantined. As a travel destination, for business orpleasure, Toronto was a pariah. Huge conferences were cancelled, as were manyflights into Torontos Pearson International Airport. Community functions andsporting events were postponed.

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

No one in Toronto was unaffected by the spring2003 SARS outbreak. Dozens died (all traceable to the index cases).Paranoia-like fear of infectious disease ran rampant. The direct and indirectcosts to Canadian government, business and society will never be fully knowncertainlybillions of dollars.

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