TORONTO - Just when health officials think they're close to controlling the SARS outbreak here, leaks have developed in their containment plan. In recent days, they've scrambled to track down more than 100 mourners at the funeral of an elderly man who infected his family. They had to shut down three schools because two students may have come into contact with SARS patients.
And, most exasperating of all in this civil nation, they had to order a dozen people into quarantine who refused to go voluntarily.
One "break-out," as such miscreants are termed, is now hospitalized under police guard. Disregarding his quarantine, he had ventured to work at a suburban Hewlett-Packard office, where he infected one co-worker and forced nearly 200 others to go into isolation.
That behavior prompted a public plea from Dr. Colin D'Cunha, Ontario's health commissioner. "For heaven's sakes, if you are asked to go into isolation, please do so," he said last week. A local newspaper columnist explained to readers that use of the expression "for heaven's sake" by the mild-mannered doctor was a signal of profound frustration, showing a measure of his anger and a glimpse of his fear.
Those leading the complex effort to contain severe acute respiratory syndrome in the province say they have the right plan in place to eventually outpace the disease - despite the recent setbacks, a case count that continues to climb and the likelihood that more overseas travelers will return infected.
"I believe and I feel firmly: We can control this outbreak," stressed D'Cunha. "Every time you find a case, you throw the ring [around it] - and tight. The science is clear about infection control."
Advising Hong Kong
But noncompliance threatens to undermine the effort, he and others warn. "The big problems are solved," said Dr. James Young, Ontario's commissioner of public security. "It's the break-outs right now that we're dealing with."
Canada has been dealing with SARS for more than a month, ever since a Toronto woman was sickened at a hotel in Hong Kong. With 283 probable cases and 13 deaths, the outbreak is troubling, but it is far from the epidemic in China and Hong Kong, where cases are mounting at an alarming pace.
Toronto's seeming success in controlling the illness has prompted doctors in Hong Kong to e-mail D'Cunha for advice on preventing hospital workers from becoming sick. A military physician from the United States is planning to visit him and Young this week.
Shutdowns and quarantines aside, Toronto is less a city in hysterics than it is simply on edge. For the most part, masks aren't flying off the shelves in drugstores and virtually no one wears them while walking down the street. Nobody seems to be equipping themselves with protective gloves or baby wipes, as has become common in Hong Kong.
Streets are busy and stores are filled; the only noticeable change at movie theaters, one local observed, is that it's dead quiet because people are afraid to cough. In fact, the most prevalent disease here is spring fever. Warm weather arrived last week after a harsh winter, and residents were thrilled.
There are a few disruptions: Thousands of elective surgeries have been postponed because of tighter restrictions on hospitals, which have temporarily barred visitors. Chinatown has suffered economically because people think it may be an incubator for SARS. Prime Minister Jean Chretien visited Thursday - he ate at Luen Fat Seafood & BBQ Restaurant - in hopes of boosting public confidence. Bus ridership was down about 3 percent, authorities reported, and more people are working from home.
The message that the city is safe may not be getting out, though: A major cancer research conference has been canceled, Wal-Mart told its employees last week not to travel here, and singer Lisa Marie Presley cited SARS in postponing her concert appearances here.
'Quite the virus'
Those leading the public health effort have discovered that there is much they don't yet understand about the illness, which has sickened at least 3,000 people around the world and scared thousands more.
"This is amazing. This breaks all the rules," said Dr. Donald Low, chief microbiologist at Toronto's Mount Sinai Hospital, who has treated about 30 SARS patients. "It is really quite the virus."
Experts aren't sure, for example, whether infected people who don't yet have SARS symptoms - fever, coughing, shortness of breath - may be capable of passing the disease on to others. They also don't know how long after someone has recovered he or she might still be contagious.
And not everyone here has had the same symptoms - or severity of symptoms. Some elderly patients have progressed quickly from hardly feeling sick at all to becoming seriously ill. Others have had only mild symptoms; not suspecting they had SARS, they might have spread the virus that causes it.
"That's dangerous," said Low, who spent 10 days in quarantine after a co-worker, one of the top doctors on the SARS team, fell ill. "That's a worry, because if we have a subset of people who are infectious, then there's the weak link, because they don't come to our attention. And they go about their daily work and they infect others."
Case in point: An 82-year-old man who died April 1 wasn't diagnosed as a SARS case until several days later. He had never had the characteristic fever.
When members of his family got sick, Toronto officials worried that they in turn may have infected others at the funeral home. All those who visited or worked there on the day in question are now supposed to be in isolation.
"We're trying to do the detective work, we're trying to contain the thing and we're just running like blazes," said D'Cunha.
The epicenter of the Canadian outbreak is Scarborough Grace Hospital, a modern-looking brick building on Toronto's east side. Officials say, with great relief, that all of the SARS cases not related to travel overseas can somehow be traced back here, where Tse Chi-kwai, 43, infected a number of patients and health-care workers last month before stepped-up infection-control measures were put in place.
Tse contracted the disease from his 78-year-old mother, Kwan Sui-chu, who was infected by a Chinese doctor while staying at the Metropole hotel in Hong Kong. Both Tse and Kwan died.
Scarborough Grace has been closed for two weeks, save for the patients infected there and the staff members caring for them. A blue tarp has been wrapped around a sign that normally directs visitors and patients where to park, and the lot is eerily empty.
Just down the street, Stephen Leacock Collegiate Institute, a high school of more than 1,000 students, has been shut down as well. Everyone there was sent into isolation after a girl attended classes while showing symptoms of SARS on April 4.
One youth's tale
One Leacock student, Timothy Benson, hasn't found quarantine nearly as exciting as he imagined. As part of a Web diary of his activities, viewers can see pictures of him taking his temperature, wearing his mask, eating popcorn and generally looking bored.
"And I would have thought I'd be loving it - No class, no tests, just sitting here surfing, as I usually do ... but NO! I'm going insane!!" he wrote in an entry titled, "THIS IS GOING TO BE THE END OF ME."
Meanwhile, anyone who thinks he or she may have been exposed to the disease can visit one of several city-run clinics. Six women and two men wearing masks sat Friday in the waiting area of one such clinic at Sunnybrook & Women's College Health Sciences Centre downtown. Signs outside warned visitors not to enter without a mask, boxes of which were available outside.
All staff members in the hospital's regular units have been wearing goggles, gloves, gowns and masks while working in patient areas, even though no one with SARS has been admitted. "We're [taking] full precautions, and we haven't had one patient with us," said a nurse, who had taken off her mask for a cigarette break outside. "It's better to be safe than sorry."
That's the message being stressed over and over by top health officials in the province: Be overly cautious now, rule out cases later.
"As we know more, we can back off certain things," said D'Cunha, the public health commissioner.
As for those who don't respect their quarantines, they may face tougher measures in the days ahead. Police are investigating whether the Hewlett-Packard employee committed a criminal offense by going out. The man, who officials have said led public health workers to believe he was at home, is now hospitalized in serious condition.
Dr. Hanif Kassam, acting medical officer of health in York Region, said he will take "whatever steps necessary" to ensure compliance from everyone who should be in isolation.
While some people have complained about not getting paid or abandoning work, health officials are confident that most residents understand that public safety is at stake and have no tolerance for rule-breakers.
"I think they are highly irresponsible," said Gurmeet Bambrah, a Red Cross volunteer, of those who refuse to stay isolated. "The only thing they have to do is stay in for 10 days."
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