Two suspected SARS cases turned up in British Columbia Thursday just as a key official on Toronto's SARS containment team suggested the city's second outbreak may have peaked and officials presented stunning new figures revealing just how big the problem actually is.
They reported 33 probable cases and 29 suspect cases of SARS. In addition, 107 other people are showing symptoms of the disease and are under investigation, they revealed.
"I think a large number of them will eventually be suspect or probable cases," said Dr. Donald Low, chief microbiologist at Toronto's Mount Sinai Hospital and the main medical adviser to the team.
In British Columbia, meanwhile, two new suspected cases were reported.
Prime Minister Jean Chrétien responds to questions on the SARS crisis in Canada at a news conference in Athens on Thursday. (Tom Hanson/CP)
Health Planning Minister Sindi Hawkins said both people are in quarantine — one in hospital in stable condition and the other at home. Hawkins did not give their locations.
Ms. Hawkins said the patient in hospital had travelled from Hong Kong and the individual now quarantined at home travelled from India through Singapore, where he waited for five hours.
"He presented in the country a couple of days ago, did not show symptoms while he was at the airport but went to visit his family doctor and the family doctor identified the symptoms as a suspect case," said Hawkins.
The suspected SARS case who came from Hong Kong also showed no symptoms until after arriving in Canada, she said.
Ms. Hawkins said the cases were picked up because B.C. health workers are being "hyper-vigilant" about SARS.
The Toronto numbers, though large, do not surpass those racked up during the city's first go-round with SARS, when 136 probable and 121 suspect cases were recorded.
But the new numbers are stark proof of how contagious this virus can be in certain settings — particularly hospitals — and how critical it is to contain the disease.
Most of those infections would have occurred in the past 10 days or so.
The disease had been spreading, undetected, among patients in a couple of city hospitals since at least mid-April. When hospital staff working in non-SARS wards were given the all-clear to remove their protective face masks in mid-May, a huge wave of infection was touched off.
Faced with large numbers of health-care workers falling ill with SARS-like symptoms, public health officials realized SARS was again wreaking havoc in health-care facilities and among the families of health-care workers and patients in the affected hospitals.
Altogether, 7,026 people are in quarantine after having been exposed to someone with the disease, including 396 health-care workers. "A slew" of other health-care workers are on working quarantine, said Dr. Colin D'Cunha, Ontario's chief medical officer of health. That means they are asked to continue working but to isolate themselves from their families in their off hours.
A sharp jump in the number of probable cases had been expected after Ontario officials announced Wednesday they would revert to using the World Health Organization's criteria for defining a probable case. Probable cases are the ones the WHO watches to assess how severe an outbreak is and whether world travellers should be warned away from an affected area.
The number of probable cases attributed to the new cluster was 11. Four people infected in the second outbreak have died, bringing the city's SARS death toll to 29. Thirteen people, spanning both outbreaks, are in critical condition.
The move to the WHO standard was made after Dr. Low publicly criticized the decision to use Health Canada's probable case definition, saying it set the bar too high and therefore painted a false picture of the magnitude of the outbreak. On Thursday, Health Canada announced it was adopting the WHO definition.
The pertinent difference between the two — for the present, at least — is that the WHO says anyone who has been exposed to the disease, has symptoms and has a chest X-ray showing signs of a new pneumonia is a probable SARS case. The old Health Canada definition did not include the X-ray evidence, requiring signs of severe progressive respiratory illness.
Critics said that requirement was simply too subjective.
Health Canada's point man on SARS said the decision was made in the interest of being as open as possible about the scope of Toronto's SARS problem.
"We think it will help us in terms of clarity and WHO, because it's really important to keep their confidence," said Dr. Paul Gully, head of the department's population and public health branch.
Whether Toronto becomes the subject of another WHO advisory may depend on it, said Dr. Gully, who noted while the organization has criteria for triggering a travel advisory, numbers aren't the only factors involved.
"Behind that, the decision of a travel advisory is taken at a higher level. And that would depend on confidence."
Doctors treat probable and suspect SARS cases in the same manner, because they believe both can spread the disease. Many, like Dr. Low, believe when a good diagnostic test is discovered, retrospective testing will show that both groups had SARS, but one had a milder form.
Both are put in respiratory isolation and their close contacts are traced to ensure they are go into isolation and monitor themselves for symptoms.
Dr. Low, who is one of Canada's leading infectious disease experts, said he believes the spread of SARS in this outbreak may have peaked.
He said there was a sharp increase in the number of health-care workers showing up sick at emergency departments on Friday, Saturday and Sunday night "and that has dropped off quite dramatically in the last two days."
"The wave that we've experienced this weekend and including Monday night, that wave is behind us."
But he warned there will still be transmission within families and there may be other cases such as visitors to hospitals and transferred patients.
Dr. D'Cunha revealed that among the probable cases in Ontario in this second round of SARS, one patient is under the age of 16 and 14 are 65 and older. The bulk are aged 18 to 64, he said.
The latest outbreak appears to have started at North York General Hospital, in the orthopedic ward. The first or index patient was a 96-year-old man who had undergone surgery for a fractured pelvis. When he developed pneumonia, his doctors put it down to post-operative pneumonia, which is common, particularly among the aged.
Three patients on the hospital's locked psychiatric ward also are believed to have suffered from the disease.
Dr. Low and a team of people trying to figure out how the disease first entered these non-SARS wards have so far been stumped. They learned Thursday that a team of experts from the U.S. Centers for Disease Control will travel to the city Friday to help puzzle out that mystery.
The disease spread to St. John's Rehabilitation Hospital when a patient who was incubating the disease was transferred there from North York. She touched off a round of infection that has resulted in six other cases.
Three other city hospitals — Toronto General, St. Michael's and Scarborough General — received undetected infected patients in transfers from those two facilities. That led to the quarantining of staff in all three and the infection of staff in one and possibly two of those hospitals.
