SARS Just Going To Get Worse

C-FAR Summary

April 9, 2003

Probable/suspected cases in Canada, Wednesday : 242 Outside of Asia, Canada is the only country recording SARS deaths.

Of course hot zone Toronto is chock-a-block with slack jawed yokels stumped by sophist-im-icated concepts like quarantine. Thus, every time some anonymous knuckle-dragger breaks quarantine, hundreds more trudge into isolation.

Toronto: "Public health officials had to direct a class of [Albert Campbell Collegiate] high school students into quarantine after an [unidentified] classmate left isolation to write an exam, only to come down with SARS later that day." (National Post, April 9, 2003) "Another 197 people in the province have been ordered to go into isolation. They are all employees at one workplace where one [unidentified] worker did not follow isolation orders and continued to go to work. ... Ontario health officials discussed their exasperation with the public's inability to follow quarantine instructions, saying the failure of people to stay at home when told is putting all citizens at risk. 'It is extremely frustrating for public health officials. When we ask people to go into isolation, please respect it,' said Dr. Colin D'Cunha, Ontario's chief medical officer of health." (Globe and Mail, April 9, 2003, 9:36 PM EST)

Health officials "have asked anyone who was in the Highland Funeral Home in Toronto on Thursday evening to contact a public-health unit and go into quarantine for 10 days. Susan LeClair was upset at the news. Her father's wake was the other service held at the funeral home that day. Ms. LeClair and her family have been in quarantine after cremating her father on Friday, and the family has given health officials the names of those who attended the wake. 'This was all caused by one [unidentified] person who did not respect the signs at the door,' said Ms. LeClair, who expressed her frustration that a person exposed to the virus may have attended the funeral. Signs at the front of the funeral home say that those who show symptoms of SARS, such as a high fever or coughing, should stay out. ... Despite the obvious anguish it will cause, Dr. Basrur [Toronto's medical officer of health] said yesterday that anyone who is in quarantine must not leave isolation to attend the funeral of a friend or relative. Health officials and the funeral home would not release the man's name, even as Canada's leading privacy officials said that making that information public could be justified in the interest of public health.

Public-health laws allow for the release of the names of people infected with SARS -- dead or alive -- as well as those who violate quarantine orders, if doing so would help slow the spread of the disease, said George Radwanski, Canada's Privacy Commissioner. 'Privacy law is not an obstacle to protecting public health and public safety, nor should it ever be,' Mr. Radwanski said in an interview. He said that, federally, Health Canada 'has all the authority it needs to collect information and to disclose it in the public interest,' under the Health Act and the Quarantine Act. A similar view is shared by Ontario's Information and Privacy Commissioner. Bob Spence, a spokesman for the commissioner said yesterday that, under the provincial Public Health Act, information about infectious disease can be collected and it can be released publicly in the interest of public health or safety. 'There has to be a reasonableness of use but in this circumstance, obviously, names could be released, if it's going to help deal with the situation,' Mr. Spence said." (excerpt, Globe and Mail, April 8, 2003)

Why aren't names and photos published? Because SARS is increasingly about public relations not public health. Now children, close your eyes very, very tight and wish very, very hard. Maybe the magic microbe will be a great respecter of our "made in Canada" solution : get the perceptual containment part just right and hope the epidemiological containment part takes care of itself.

As a worried city waits for updates, "one or another of the experts at these daily briefings has offered another story, or caution, or both about what has come to be called the racialization of SARS. Yesterday, for instance, it was Public Health Commissioner Dr. Colin D'Cunha, who offered that last weekend, while filling up his car at a downtown Toronto station, someone suggested to him that SARS was being spread "by a particular community," and he snapped back that it certainly wasn't. I asked what seemed to be the logical question: What is the breakdown by age, sex and ethnicity of those who have died of SARS? In other words, we've had the anecdotal stories; how about the actual facts? "I think what you ask makes sense," Dr. D'Cunha said, then went on to add he was mindful of what happened to Toronto Police Chief Julian Fantino, years ago and long before he became chief, when he had released (at the request of a race relations committee) certain crime statistics by race and been vilified as a racist for doing it. Dr. D'Cunha indicated he didn't want a "Chief Fantino" inadvertently done on him and said he would consult the rest of the provincial team and make a decision. At no point did he indicate the information was not available, but rather that the only issue was the potential sensitivity of releasing it.

Yet by day's end, while his communications manager, Anne Matthews, was able to provide the age and gender breakdown of the so far 10 Ontario victims who had died -- she said that as it turned out, the ethnicity of the victims had not been noted and wasn't available. ... [But in a study of the first 10 Canadian cases] in the New England Journal of Medicine published just last week ... the researchers disclosed every bit of information they had, both on the disease and its victims. They noted, for instance, that of the then three deaths which occurred in the first 10 cases, all had a serious underlying disease -- type 2 diabetes -- which had left them in an immunocompromised state. They noted that of the four Canadians who had a history of smoking, all had required mechanical ventilation, which means they were hit more severely, as compared to only one of the six who had never smoked. They noted that all 10 patients had shown symptoms of fever and a dry cough, while seven had complained of a general malaise. They noted the ages of each patient and their sex. And they noted the ethnic background: Eight of the 10 patients were Asian; two were not -- one an elderly man who had been in the emergency department of Scarborough Grace hospital [near fatality # 2, Chi Kwai Tse] and the other a 62-year-old man who had just recently returned from a trip to Southeast Asia, where the disease is believed to have originated." (National Post, April 8, 2003)

According to the woman who is both daughter of fatality # 1, Sui-Chu Kwan, and sister of fatality # 2, Chi Kwai Tse: "'People treat us like monsters. They say we eat like rats and live like pigs,' said Ms. Tse, who agreed to an interview on her first day out of quarantine on condition she be identified only by her maiden name, Tse. ... [But note that for all the corrective news stories, no one has seriously suggested Canadians are potential thugs. At lunch in a Chinese restaurant] Ms. Tse selected a table far from others. 'I don't want people to hear me. They're going to kill me, said Ms. Tse, noting that other diners had stopped eating to watch a noontime television newscast about SARS. ... Health Canada notified [Tse's children's] schools, which are taking precautions but keeping their identities confidential. Even without being pinpointed, her children have suffered merely for the way they look. 'Chinese, go away,' some classmates taunt." (Globe and Mail, April 8, 2003)

Ah, the daily improvement lecture. Let's try to spare a little pity for a community that has selflessly planted itself squarely in harm's way - one with its own share of "horror stories: Nurses whose husbands were sent home from work, children of nurses shunned at school, nurses refused rides by taxi drivers, single parents unable to get a babysitter, pregnant and immuno-compromised nurses forced to go to work despite concerns or forced to use big chunks of sick leave, casual nurses who no longer have a means of income, nurses of Asian heritage subject to discrimination, routine life turned upside down by the fear and the unknown." (Globe and Mail, April 5, 2003) What was it the immigration department said when Dr. Maria Hugi complained she'd been infected with TB by an unscreened refugee? "So, who forced you to pursue a high-risk career?" That's the real face of Canada's vaunted compassion.

New agents suspected in SARS spread "Health officials in Hong Kong and Singapore warned their citizens on Tuesday that the agent that causes a mysterious respiratory disease had spread so far in their communities it would be hard to bring under control any time soon, if ever. 'Singaporeans must be psychologically prepared for the problem to stay with us for some time,' said Lee Hsien Loong, Singapore's deputy prime minister. Hong Kong and Singapore officials began emphasizing new measures to slow the spread of the disease, known as severe acute respiratory syndrome, or SARS. But they backed away from suggestions they may be able to get rid of it completely. Dr. Leung Pak-yin, Hong Kong's deputy director of health, said that residents should be concerned that the disease could be spread through contaminated objects, particularly if their apartment buildings developed large numbers of cases. 'We believe that every citizen could become a carrier of the virus,' especially if people do not follow practices such as handwashing and wearing face masks, he said. ...

Epidemiologists have traced most SARS cases to close person-to-person contact. That finding initially led officials to believe that they could break the SARS chain by isolating patients and their contacts, and by requiring health workers to use standard infection-control measures in caring for patients. Such measures, including frequent handwashing and wearing masks, gloves, gowns and goggles, have worked in most places. But in recent days epidemiologists have been unable to trace a number of SARS outbreaks in hotels, hospitals and apartment complexes in Hong Kong, Singapore and China to such person-to-person spread. Because of that, many health officials have become increasingly suspicious that the disease can be spread through contaminated objects such as door knobs, water and sewage, as well as by person-to-person contact. Hong Kong officials also have theorized that insects such as cockroaches could spread the disease, perhaps by tracking contaminated sewage from apartment to apartment. Hong Kong University researchers have found evidence suggesting that many people may come in contact with the virus and only become mildly ill and not meet the case definition. Also, officials are now suspicious that some people may be able to spread the disease even before they develop the first symptoms of SARS. If SARS can be spread by insects or objects or healthy human carriers, containing its spread would be much more difficult. The fear is that in a short time SARS could become yet another on the long list of diseases that are a fixture in many areas." (Edmonton Journal, April 9, 2003)

"Doctors in China – the country worst hit by Severe Acute Respiratory Syndrome – have found that the virus appears to be connected to chlamydia. The discovery suggests that those with the STD are more likely to develop or transmit SARS. 'SARS is one virus acting with other things and in China it happens to be chlamydia,' Chris Powell, of the World Health Organisation, said. In February this year, Queensland Health officials reported that chlamydia was the most commonly notified disease in the state, with the number of reported cases increasing by 60 per cent since 1997. Dr Robert Breiman, also of the WHO, said he feared people who already had chlamydia might be vulnerable to the flu-like bug and become highly contagious 'super-spreaders'. Health experts made the connection after an airborne form of chlamydia, which can leave women infertile, was found in the lungs of SARS victims. But the STD does not yet appear to be linked to SARS cases outside China." (The Courier Mail, April 7, 2003) Australia

The super infectors "Toronto's explosive SARS outbreak is being traced back to three 'hyper-infectors' who each gave as many as 20 people the deadly virus. Doctors believe that before they knew how contagious a disease they were dealing with, these SARS victims unknowingly infected a number of others. 'That helps explain why we saw such a rapid acceleration of cases,' said Dr. Don Low, chief microbiologist at Mount Sinai. Doctors also point to the hyper-infectors as a reason why Toronto has been hammered by the virus, while the U.S. -- with a number of cases but no hyper-infectors -- has no deaths from the illness so far. 'That's the problem with Toronto, there have been several super-infectors there,' said Harvard professor Dr. Henry Niman. 'It's giving a false sense of security in the U.S.' The problem doctors are facing is they don't know why someone is a hyper-infector. 'It could be severity,' Low said. 'It seems to be the patients who are sickest are more likely to result in secondary transmission.' All three hyper-infectors have died. One of them was Ontario's second SARS victim, the 43-year-old son of the woman who is believed to have brought SARS to Canada. The second was a 76-year-old man exposed to the 43-year-old in Scarborough Grace's emergency room. The third was also male, Low said." (Toronto Sun, April 9, 2003)

And more on the optics of protective masks At Scarborough Grace, when "an ailing elderly man in the bed next to [Chi Kwai Tse's] became the third fatality ... that got nurses and other staff talking about a serious, travel-related respiratory illness. But when they tried to take the precaution of wearing masks, it didn't go over well with hospital supervisors. An incident at Grace as late as March 22 illustrates the confusion and tension. By then, SARS had killed three people in Toronto. Twelve others were probable or suspected cases. ... According to two nurses who requested anonymity, a Grace staff member responsible for infection control told a physician that day that he didn't need to wear a mask. 'It was bad for public relations,' is how it was put, said one nurse. Added the other: 'And it wasn't just the infection-control people, it was management saying, 'You know, it's not good PR to be wearing the mask, you really don't need that mask, it's overkill.'" (Maclean's, April 14, 2003)

Finally, "Acadia University, in Wolfville, N.S., said students arriving from certain parts of Asia are being asked to enter voluntary quarantine for 10 days at the university's expense. The students are at Acadia for an English language program. The students are staying at an off-campus location for the 10-day period before boarding with local families in Wolfville, said Paula Cook, Acadia University Provost. ... Provincial medical officer Robert Strang called the move 'excessive and unwarranted.' ... Cook says officials at the university are disappointed with Strang's statement. She says they feel they're acting responsibly." (CBC, April 9, 2003)