Outraged Toronto Seeks End to SARS Warning

In an effort to stave off economic disaster, Canadian officials launched a campaign Thursday to repudiate the World Health Organization’s warning that it is potentially dangerous to travel to Toronto because of an outbreak of SARS.

Local officials met Thursday morning to plot strategies to restore tourism in this normally bustling city, dispatching Canadian diplomats to WHO headquarters in Geneva to plead for the warning to be rescinded.

“Fortress Toronto” and “Boo WHO” read banner headlines in local newspapers, as the mayor and other officials made high-profile public appearances to dispel what they consider misguided perceptions about the city, the financial capital of Canada. A prominent cartoon showed a surgical mask on the 1,815-foot-tall CN Tower, a symbol of the city.

Toronto officials argued that, despite the WHO warning, they were making major progress in controlling severe acute respiratory syndrome. Dr. Sheela Basrur, the city’s chief medical officer, said Toronto had not had a new case for seven days. “The outbreak will be over when 20 days have elapsed with no new cases,” she said. “It’s been about a week so far, at least.”

The WHO’s warning against unnecessary travel, issued Wednesday, was quickly echoed by the governments of Britain, France, Ireland, Australia, Venezuela and Jamaica. Local hotels, convention centers and theaters already were experiencing the effects of canceled reservations.

One of the few pieces of good news came from the province of Nova Scotia, which had issued a similar warning Wednesday, then withdrew it overnight.

U.S. officials were reluctant to criticize the WHO’s decision to issue the warning, but they went out of their way to support Toronto’s position.

“U.S. citizens traveling to Canada are not at risk for SARS if they avoid hospitals and take common-sense precautions,” said Dr. Julie L. Gerberding, director of the federal Centers for Disease Control and Prevention.

The United States is by far the largest source of foreign visitors to Canada, with more than 62 million border crossings each year. Gerberding said the CDC expects to begin issuing travel alerts today to people crossing into the United States from Canada by car and plane. The cards, already issued to people arriving by plane from Asia, explain the symptoms of SARS and what to do if symptoms occur.

But Gerberding did not seem unduly concerned about the risks to U.S. travelers. The original cases of SARS in Canada occurred among people returning from Asia, and most of the subsequent spread has been among health-care workers exposed in hospitals, she said. There have been no unexplained cases developing in the community, as has been the case in Hong Kong and China.

“We understand the patterns of transmission [in Canada], and they make sense,” Gerberding said. “The epidemiological picture is complete.”

In a bit of wry humor, Emile Therien, president of the Canada Safety Council, declared that “your chances of dying in a plane crash coming to Toronto are greater than your chances of acquiring SARS.”

To date, Canada has had 342 probable and suspected cases of SARS and 16 deaths, the only fatalities from the disease outside Asia. The CDC said the U.S. has 39 probable SARS cases, with the most recent one identified Saturday. There have been no SARS deaths in the U.S.

“The optimistic view is that we are beginning to see the benefits of containment measures,” Gerberding said.

Toronto officials feel much the same way, but they also feel a strong sense of outrage. “They [WHO officials] have quarantined an entire city,” Mayor Mel Lastman said. “I demand that WHO come to Toronto and see for themselves that Toronto is safe to visit, safe to work in, and safe to play in.”

Traffic on Toronto’s streets may be a little lighter than normal, but people are, in fact, going about their business pretty much normally. “It is perfectly safe to walk down the street in Toronto,” said Dr. James Young, Ontario’s commissioner of public security. “And all of us walk down the street every day, without masks.”

Indeed, masks are rarely sighted on Toronto streets. Lastman made a highly publicized visit to Toronto’s Chinatown on Wednesday evening, shaking hands all around and even persuading 34-year-old David Song to remove the mask he had been wearing.

Bus and subway drivers have been ordered not to wear masks, even though some reportedly would like to do so. There have been no cases of infection on public transportation, officials said, so there is no need for the masks.

The Canadian government’s effort to rescind the WHO travel warning probably will do no good, however.

The warning will remain in force for a full three weeks, WHO spokesman Jon Linden said Thursday. “To say that Toronto has a very good health service and that the likelihood is not high of getting the disease if you get to Toronto is fine, but it does not change the basic criteria of our travel advice,” he said.

The warning was issued, he noted, because there had been an increase in cases, there had been a geographic spread in cases, and there had been an export of cases.

WHO officials also expressed optimism Thursday about the ultimate fate of the SARS outbreak, noting that it has been contained in Vietnam, one of the first countries to be stricken.

“In Vietnam, certainly, the disease has been brought under control,” said Dr. Julie Hall, a coordinator for the WHO’s global outbreak alert and response unit. “We have not had any new cases ... for over 10 days.”

The key to success, she said, was aggressive hospital control measures and early identification of cases “If we can detect and isolate cases early enough, an outbreak can be brought under control,” Hall said.

According to the WHO’s latest tally, there are 4,439 SARS cases around the world. The current death toll stands at 263.