Toronto Is Placed on SARS List

Struggling to stop the spread of the SARS virus, the World Health Organization issued a warning Wednesday urging travelers to avoid unnecessary visits to Toronto.

The Canadian city is the first outside Asia where WHO has advised against unnecessary travel. The world agency added Toronto, Beijing and Shanxi province in China Wednesday to a list that had previously included Hong Kong and Guangdong province, where the outbreak is thought to have originated.

The WHO’s advisory outraged Canadian officials, who argued that Toronto is safe and the outbreak under control.

“I’ve never been so angry in all my life,” said Mayor Mel Lastman. He added that he was “shocked” because “the medical evidence that we have before us does not support this.”

Sixteen people in Toronto, the sixth-largest metropolitan area in North America, have died from the pneumonia-like disease, officially called severe acute respiratory syndrome, and 342 suspected or probable cases of SARS have been identified in the country, most of them in Ontario. Canada is the only area outside Asia where SARS deaths have occurred.

As of Wednesday, according to WHO, there were 4,288 cases of SARS worldwide and 251 deaths. There are 37 confirmed SARS cases in the United States, but no deaths.

Within hours of the WHO notice, the British government issued a similar warning to its citizens. Closer to home, the health minister of Nova Scotia, Jane Purves, issued a similar advisory to residents of that Canadian province.

Officials in Alberta are also reported to be considering such a warning.

The U.S. Centers for Disease Control and Prevention has not issued such an advisory, however, suggesting only that travelers take precautions -- such as not visiting hospitals -- when traveling to Toronto.

An estimated 9 million Americans and 6.8 million overseas visitors pass through the Toronto airport every year.

The CDC said Tuesday that it would begin issuing travel alerts -- cards in various languages describing the symptoms of SARS and telling people what to do if they develop them -- to people traveling by automobile from Ontario to the United States. Such cards are currently being given to people arriving by air from Asian sites where the outbreak has occurred.

Major League Baseball on Wednesday said it was cautioning teams visiting Toronto to play the Blue Jays to avoid mingling with crowds and to stay away from public transportation and hospitals.

The National Hockey League, with franchises in the U.S. and Canada, has so far not issued any travel advisories.

Hockey’s Toronto Maple Leafs were eliminated from the playoffs Tuesday, but the NHL has a office in Toronto where many significant league operations are based.

Dr. David Heymann of WHO said the new warning was being given because “these areas now have quite a high magnitude of disease, a great risk of transmission locally ... and they have also been exporting cases to other countries.”

But Colin D’Cunha, Ontario’s commissioner of public health, accused WHO of “overreaction.” At a Wednesday news conference, he said “Toronto continues to be a safe place. There are 5 million people in greater Toronto and the risk continues to be low.”

Toronto’s medical officer, Dr. Sheela Basrur, conceded that the outbreak is serious, but argued that it “is contained -- largely in hospitals, which is, frankly, where it belongs. So we don’t have widespread community spread.”

The immediate cause of the WHO action, Heymann said, was the export of SARS from Canada to a country, which he refused to identify, where a cluster of five cases emerged. He added that the warning would be reviewed in three weeks to determine whether it would remain in force.

There have been at least three incidents in which a traveler has carried the disease from Toronto. In perhaps the most serious one, a Toronto medical assistant infected members of her family in Manila before succumbing to the disease.

A Philadelphia man who traveled to Toronto on business also contracted SARS, but has not spread it to any U.S. contacts.

In the third incident, an Australian who visited Toronto was also thought to have contracted the disease, but officials now believe he actually had something else.

D’Cunha said the Manila incident makes Toronto “an exporter of sorts,” but that the incident was not severe enough to warrant the WHO’s advisory.

Canadian officials fear the WHO warning will further exacerbate economic problems created by hysteria over SARS because of Toronto’s place as the country’s financial center. Before the outbreak, Canadian economists had predicted a 2.5% growth in the economy this year, but the figure has since been revised down to only 1% by some experts.

Airport traffic has not yet fallen off substantially, except on flights from Asia, according to Louis Turpen, head of the Greater Toronto Airport Authority. Flights from Asia that would normally have 300 or 400 people aboard now have 30 or 40, he said. “The Asian terminal is very quiet.”

WHO officials have expressed some concern that the apparent death rate from the outbreak is rising. Initially, authorities said that about 2.5% of those infected died from the disease, primarily those who were older or who had underlying diseases that left them more susceptible to the effects of the SARS virus.

Now, however, the official death rate is estimated to be about 6%.

Hong Kong officials said Wednesday that the death rate there has risen to 7.2% and experts predicted it could reach 10% before the outbreak ends. The death rate for influenza, in contrast, is less than 1%.

Some of the increase may be an illusion, however, according to Dr. Julie Gerberding, head of the CDC. She noted that the use of new tests to identify the coronavirus that most experts now believe causes SARS has eliminated many suspected cases. Thus, the number of people who actually have SARS has fallen in proportion to the number who have died, yielding a higher apparent death rate.

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New travel advisory

The World Health Organization extended the SARS travel advisory Wednesday to include China’s Shanxi province, Beijing, and Toronto in addition to China’s Guangdong province and Hong Kong.

Reported SARS cases

*--* Country Cases Deaths AFRICA South Africa 1 0 ASIA/SOUTH PACIFIC Australia 4 0 China 2,305 106 Hong Kong 1,458 105 India 1 0 Indonesia 1 0 Japan 2 0 Malaysia 5 2 Mongolia 3 0 Taiwan 37 0 Thailand 7 2 Philippines 2 1 Vietnam 63 5 Singapore 189 17 EUROPE Britain 6 0 France 5 0 Germany 7 0 Ireland 1 0 Italy 3 0 Romania 1 0 Spain 1 0 Sweden 3 0 Switzerland 1 0 MIDDLE EAST Kuwait 1 0 NORTH/SOUTH AMERICA Canada 140 13 Brazil 2 0 United States 39 0 TOTAL 4,288 251

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International figures as of April 23, 5 p.m. GMT

SOURCES: Associated Press; World Health Organization

Maugh reported from Los Angeles and McFarling from Toronto. Times staff writer Helene Elliott contributed to this report.