Toronto Sick of Being a Pariah

Almost no one here is wearing masks.

In the city that has seen the biggest outbreak of the SARS virus outside of its epicenter in China, life on the street appears normal. Restaurants and streetcars are far from empty. And at a recent Stanley Cup playoff game, the beloved Maple Leafs played to a sold-out crowd.

But beneath it all is also a palpable sense of unease. Employees coming to work find hand sanitizer on their desks. Some people have stopped shaking hands. One sneeze is enough to startle a whole restaurant. And familiar objects, such as pay-phone receivers and subway straps, seem ominous in this city under the SARS cloud.

“You wonder if you should touch the taxicab handle or the elevator button,” said Louis Turpen, head of the Greater Toronto Airports Authority. “On the other hand, customs agents and airline passengers aren’t getting sick.”

This is what health officials call “the new normal” -- the strange but subtle ways residents are dealing with their newest resident: the SARS virus.

Many are comforting themselves with statistics published this week in the National Post showing the odds of dying of SARS in Greater Toronto (1 in 292,681) are less than dying after falling off a ladder (1 in 9,485), dying from a dog attack (1 in 142,279), or dying by accidental strangulation in bed (1 in 10,779.)

Public health officials have spent days reassuring residents and travelers that it is safe to be in the city and that only those in close contact with SARS patients are at any risk.

Despite those reassurances, the metropolitan area of 4.5 million is struggling to fight off an economic bust as convention and tourism traffic quickly evaporates. The residents are angrily adjusting to life as global pariahs.

With the SARS outbreak here now considered largely under control, the city is far from being a hot zone. Instead, it has entered an epidemiological gray zone, a place where people feel safe -- sort of.

“Everybody’s hands are chapped from washing them so much,” Ellen Vanstone said.

Many residents of this city known for its Canadian propriety and politeness are very angry that they’ve been labeled by the World Health Organization as a destination to be avoided for all but essential travel. They are fuming over the portrayal of Toronto as a “pestilential Third World cesspit,” as one columnist for the Globe and Mail newspaper put it.

Canadian Prime Minister Jean Chretien promised to sleep in Toronto on Monday to dispute the WHO’s travel alert. “We all believe that the World Health Organization came to the wrong conclusion,” he said. “We believe that Toronto is a good place to visit. It is a safe city.”

Hersh Goldin, an investment advisor who had booked a berth on an Alaska cruise for his summer, was stunned to get a letter this week from the luxury Crystal cruise line saying Toronto residents were no longer welcome aboard. “I feel as though we might be tarred and feathered and thrown off the ship,” he said.

Carnival and Royal Caribbean Cruise lines, still reeling from bouts of the intestinal Norwalk virus aboard their ships last year, said Friday they would bar passengers who are ill and have recently visited Toronto. Major League Baseball warned players from visiting teams to sign autographs only when using their own pens.

“Toronto the good, Toronto the clean, Toronto the safe, had become Toronto the contaminated,” popular Toronto Star columnist “Slinger” wrote after returning home from a trip to Hanoi via Hong Kong.

Canadians, used to living in the shadow of the United States and known for their self-effacing ways, are struggling to understand why this new plague took root in their fair city and not in such chaotic, festering places like Los Angeles.

At an emergency meeting held Thursday to respond to the epidemic, Toronto City Councilor Mario Silva asked: “What are we doing wrong? Why were we hit so hard?”

Dr. Sheela V. Basrur, the city’s medical officer, had a quick answer. “Bad luck,” she said. “And worse timing.” There is no evidence yet to suggest that Toronto was hit with a more virulent strain of SARS, formally known as severe acute respiratory syndrome.

Toronto was the home of Kwan Sui-Chu, 78, a woman who stayed on the ninth floor of the now-infamous Metropole Hotel in Hong Kong on Feb. 21.

Another resident of that floor was Dr. Liu Jianlun, 64, an expert on respiratory illness who had treated hundreds of SARS patients in southern China. He was in Hong Kong for a wedding and infected Kwan and several other ninth-floor guests, perhaps coughing on them while waiting for an elevator. Liu died in a Hong Kong hospital March 4.

Kwan returned to Toronto on Feb. 23, fell ill on the 25th and died at home March 5 after infecting her 44-year-old son, Tse Chi Kwai. The son entered Toronto’s Scarborough Grace Hospital on March 7. There, he started a chain of infection that spread through several of the city’s hospitals, one church group, a business meeting and to at least two foreign cities.

Officials here and with the U.S. Centers for Disease Control and Prevention in Atlanta agreed it was largely “misfortune” that the disease spread in Toronto and just good luck that the United States has had relatively few cases and no deaths.

But there were some mistakes in Toronto, according to several Canadian public health officials. Vancouver also saw an infected person return to the city from the Metropole Hotel, but when the 55-year-old businessman entered Vancouver General Hospital on March 13 with a flu-like illness, he was immediately masked and isolated and the disease was contained.

This was because British Columbia hospital workers had received several e-mails since mid-February telling them to be on the lookout for a strange Asian flu. The same warnings were not widely disseminated by Ontario health officials until mid-March.

Later in the epidemic, the son of one elderly victim in Toronto was not quarantined and, for reasons that are still not clear, was turned away from three hospitals when he became ill. The gaffe led to more infections and widespread quarantines of areas he had visited while ill.

But the overall handling of the epidemic since then has gained Toronto’s public health workers and its front-line medical workers praise. The infection control procedures developed here will be used in other cities with new cases.

In Toronto’s new normal, once-obscure public health bureaucrats have become household names and are recognized on the street. “It’s a notoriety I’d prefer not to have,” Ontario Minister of Health Colin D’Cuhna said.

D’Cuhna has spent each day insisting the city is safe and the SARS virus is not easily spread outside of a hospital setting. Nerves needed calming after a report that a nurse with the virus had ridden a commuter train while infected and possibly spread the disease to four or five people sitting near her.

People were also on edge after a person in a condominium complex was apparently infected by other residents of the complex. But that spread appears to have stopped as well.

Subway ridership was down just 5% after the scare, and many people say they have no problem riding trains, streetcars or buses. “What can you do?” asked Brett Shama, 28, a Toronto native who works in the film and television industry. “You can’t stop it. You just have to deal with it.”

The side effects of SARS are most obvious at Toronto’s Pearson International Airport, especially in the wing for Asian air carriers, where some 400-seat jets are landing with 30 or 40 people aboard. Some 20 million tourists visit the city each year, and the recent drop in visitors, even before the WHO advisory, is noticeable.

The cavernous lobby of Toronto’s historic Royal York hotel stood quiet most of the week. “I can get you ‘Lion King’ tickets very easily,” the concierge said. And the Cindy Sherman portraits hanging in the Old Masters wing of the Art Gallery of Ontario have little company these days. “It’s dead,” said the museum’s cashier. Hotels are reporting that occupancy rates are down 20% to 70%.

The lack of business from travelers is already starting to hurt businesses in Toronto. The area’s Chinese districts are particularly hard-hit. Barbecue ducks hanging in the window of the Garden Restaurant in the city’s old Chinatown aren’t moving quite as fast as usual, though diners from the nearby business district continue to lunch there.

“The disease won’t kill me, but the lack of money might,” said Peter Vlachos, who runs Bay Coins, a business near Chinatown. Vlachos has seen sales of rare coins and currency exchange drop by 90%. The only customers are those wanting to sell coins. “People need the money,” he said. “It shows something isn’t right.”

The most unsettling scenes in Toronto are inside hospitals, where employees, swathed in double gowns, double gloves, face masks and shiny plastic face guards screen everyone who enters. Only hospital employees and seriously ill patients are allowed in. Family members can enter only to visit the dying.

“Grandparents of newborns are the hardest to keep away,” said Walter Abrams, a security officer at St. Michael’s Hospital who had drawn a thick handlebar mustache on his mask.

Regular patients, even with serious diseases, are taking a back seat to SARS. One heart patient died after being turned away and is considered the city’s first death indirectly related to SARS.

Audrey Pankhurst, a 60-year-old shop employee, has been waiting since the end of March for the results of a biopsy that will reveal whether her swollen lymph nodes and hoarse throat are the result of thyroid cancer. Her doctor’s office has been off-limits for weeks.

Pankhurst has taken the delay in stride. “I have a lot of faith,” she said. “And I wash my hands a lot.”