Toronto Fears New SARS Outbreak

Less than a month after the World Health Organization rescinded its warning about unnecessary travel to Toronto, city health officials said Friday that they were investigating a new cluster of at least 20 potential SARS cases.

The disclosure came hours after the U.S. Centers for Disease Control and Prevention reissued a warning about travel to the city.

The CDC based its warning on the report by Toronto officials late Thursday evening that they had discovered four new SARS cases in the suburb of North York. The disclosure of at least 16 more suspected cases late Friday represents a major escalation of the SARS outbreak in a city that had thought the disease was contained.

“We’re assuming the worst,” Dr. Donald Low of Toronto’s Mt. Sinai Hospital said during a news conference Friday. “There has likely been transmission to health-care workers. There has been transmission to family members. And there has probably been transmission to other patients.”

If the disease has spread to health-care workers, that means the infection control procedures instituted in the wake of the earlier outbreak have failed in at least one hospital. That could represent a sharp setback to the city’s efforts to control the disease, which had already killed 24 Canadians.

The CDC alert, which warns travelers about a potential health hazard and suggests precautions, is expected to be a blow to Canada’s economy, already reeling from an earlier outbreak of severe acute respiratory syndrome and this week’s report of at least one case of “mad cow” disease in the province of Alberta. The vast majority of visitors to Canada come from the United States.

Word of Toronto’s new outbreak came as the WHO announced that it was rescinding its travel advisory for Hong Kong and Guangdong province in China, where the disease first appeared late last year.

But despite the decline of the disease in those areas, Asia has remained the focus of the outbreak because of sharp increases in the number of SARS victims in Taiwan. The new announcement in Toronto will shift much attention back to this continent.

Before the escalation in Taiwan, the Toronto outbreak represented the largest number of cases outside mainland China and Hong Kong. Canada was also the only country outside Asia where people had died of SARS. But Toronto physicians seemed to have contained the outbreak, and the WHO had lifted its travel advisory for Toronto on April 29, less than a week after it was imposed. The CDC lifted its alert Tuesday.

In light of the new developments, some experts expect the WHO to reinstate its advisory against unnecessary travel to the city. Such a decision by WHO would not be made before Tuesday, however, according to Paul Gully of Health Canada.

At the Friday news conference, Low said he could not give precise figures for the number of patients being investigated. “It’s so fluid right now,” he said. “I think that it’s unfair to put a number on it, but we’re talking low 20s.”

Low also said authorities were investigating two deaths as possibly SARS-related.

Canada had not announced a new SARS case since April 18.

Joe Mihevc, chairman of the Toronto Board of Health, told The Times on Friday that many of the cases under investigation were technically not classified as “suspected” SARS cases, according to both the WHO and CDC definitions, because the patients cannot be linked to any SARS victim and have not traveled to SARS-affected areas.

Although such links have not yet been identified, officials are confident that at least five of the cases are probable SARS infections because a lung biopsy on one patient revealed the presence of the coronavirus that causes the disease.

“Clinically, we think this is SARS,” Low said.

The cluster of suspicious cases originated at North York General Hospital with a woman who was undergoing a hip replacement, Mihevc said. She infected her physiotherapist and her neighbor in the hospital room. The neighbor was transferred to St. John’s Rehabilitation Center, also in North York, and infected three others there.

Meanwhile, the original patient or the physiotherapist apparently infected others at the hospital.

Two of the St. John’s victims are in critical condition and two are hospitalized in stable condition. Officials did not provide any information about the condition of the other patients.

Health authorities called on everybody who had visited St. John’s between May 1 and May 20 and North York between May 13 and Friday to isolate themselves for a period of 10 days after their visit to prevent further spread of the disease. That could involve thousands of people.

Despite the grim news, some Toronto residents were not alarmed by the news. Jennifer Laplante, a market research consultant, said: “The new developments really don’t concern me. I think health officials will be able to contain it.”

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Times staff writer Kim Murphy in Fairview, Canada, and correspondent Andrew Van Velzen of The Times’ Toronto Bureau contributed to this report.