Looking back: Toronto’s 2003 SARS outbreak

A new coronavirus, which emerged in December from China, has drawn comparison to the 2003 outbreak of SARS.

Here, Global News looks at how SARS affected Torontonians nearly 20 years ago:

What is SARS?

The SARS coronavirus, or Severe Acute Respiratory Syndrome, is thought to be a virus from an animal reservoir that spread to other animals and first infected humans in Guangdong, China in 2002, according to the World Health Organization.

The epidemic resulted in more than 8,000 cases in 2003 and affected 26 countries, one of which was Canada.

In Canada, there were 438 probable and suspect SARS cases reported, which included 44 deaths.

Start of the virus and its transmission to Toronto

SARS first infected humans in the Guangdong province in southern China in 2002.

A 65-year-old doctor, who had treated atypical pneumonia patients in Guangdong, travelled to Hong Kong to attend his nephew’s wedding. When he checked into the hotel he was staying at, he didn’t feel well. The doctor ended up infecting at least 12 others from several different countries, including a 78-year-old Canadian woman.

The woman returned to Toronto from Hong Kong on Feb. 23, 2003. Two days after she got back home, she developed a high fever. She visited her family doctor five days later, and by that time, she was also complaining of muscle aches and a dry cough.

The woman’s condition continued to deteriorate, and she died at home on March 5, 2003. Two days later, her 44-year-old son went to the Scarborough Hospital, Grace Division’s emergency department to complain of a high fever, a severe cough and difficulty breathing.

The man was kept in the open observation ward of the emergency department for 18 to 20 hours, but by the next day, his condition had deteriorated significantly, and he was admitted to intensive care.

The woman’s son died on March 13, 2003, and by this time, several other family members were also sick.

“It was then clear that there was a cluster of illness in that family, and at about the same time, the outbreak was recognized in Hong Kong,” said Allison McGeer, an infectious disease consultant at Sinai Health System, who was at the forefront of the Toronto outbreak.

On March 12, 2003, the World Health Organization issued a global alert about “cases of atypical pneumonia.”

In Toronto, the virus continued to spread to others, including hospital staff

Public health response

On March 13, 2003, Health Canada was notified of the Toronto cluster.

SARS continued to spread throughout the Scarborough Hospital, which led to it closing its emergency and intensive care services on March 23 and to refusing new patients and transfers from other hospitals. Anyone who entered the hospital after March 16 was asked to adhere to a 10-day home quarantine.

On March 25, 2003, the Ontario government designated SARS as a reportable, communicable and virulent disease under the Health Protection and Promotion Act, which allowed public health officials to track infected people and issue orders to prevent them from engaging in activities that might transmit the illness.

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One day later, Ontario’s then-premier Ernie Eves declared SARS a provincial emergency. Overnight, the province’s ministry of health and long-term care required all hospitals to create units to care for SARS patients. The province also activated its multi-ministry provincial operations centre for emergency response.

All hospitals in the Greater Toronto Area and Simcoe County were instructed to activate “Code Orange” emergency plans, which meant that the involved hospitals suspend non-essential services.

They were also required to limit visitors, create isolation units for possible SARS patients and to implement protective clothing for exposed staff. Four days later, officials implemented the access restrictions on all hospitals in Ontario.

Looking back and forward

Looking at Toronto’s 2003 SARS outbreak, McGeer said officials got a lot of things right in the sense that they were able to control it.

“They clearly did enough right things to control the outbreak,” McGeer said. “Some of the things that were done were not necessary, but there was no way of knowing at the time that they were not necessary.”

According to the doctor, one thing that wasn’t necessary was quarantine.

“When we learned more about the disease, it turns out that SARS is among the unusual infections that was not infectious before people got sick,” McGeer said.

“Retrospectively, we needn’t have quarantined all of those people who were exposed.”

McGeer said officials could have just told people who exhibited SARS symptoms to separate themselves from others.

Another thing that was unnecessary, according to the doctor, was the extent of hospital closures. If officials had data on likely patterns of spread between hospitals, they probably could have managed a different system that would’ve resulted in less hospitals being closed, causing less of a disruption to general care, McGeer said.

“These are not things where I would say the government should not have done them, but with the wisdom of hindsight, now that we’ve had the chance to look at it afterwards, you can say we didn’t need to do them,” McGeer added.

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