More than 7,000 in quarantine from SARS
BY HELEN BRANSWELLCANADIAN PRESS
More than 7,000 people were in quarantine in Ontario today because of possible exposure to SARS and the number of probable cases rose to 33 in the second cluster of the disease that was recognized last week. The number of suspect cases in the new cluster is 29, said Dr. Colin D'Cunha, Ontario's chief medical officer of health. The new tallies were released as the leading doctor on the containment team said the city's second outbreak may have peaked and Health Canada moved to adopt a new definition of probable SARS that will more accurately reflect the scope of the problem. A spike in the numbers was expected as Ontario moved to the new definition, which is back in line with how the province was reporting figures during the first outbreak of the disease starting in mid-March. D'Cunha said there are currently 29 active probable cases in hospital, including five from the old cluster and 24 in the new cluster. Yesterday, using the old definition, there were 12 active probable SARS cases. At least a couple of Section 22 orders have been issued to force people to obey isolation orders, officials said. Students and staff of a high school in Markham are among those in quarantine. Dr. Donald Low, one of Canada's leading infectious disease experts, says the spread of the disease may have peaked earlier this week. "The sense we get is the wave is behind us. What's shaking out now are the numbers," Low said. "The sense is that we probably peaked on Monday, Tuesday." In Ottawa, Health Minister Anne McLellan explained that Health Canada's first definition of probable SARS was devised in the early days of the initial SARS outbreak in consultation with provincial and territorial chief medical officers. "That definition was in place before the WHO had finalized their definition," she said in the House of Commons. "However, because of recent discussions with the WHO, it is very likely that we will move to their definition of probable cases." A few minutes later, her department's point man on SARS said Health Canada would align its definition with the WHO's, in the interest of ease and transparency. It's crucial that Canada provide the world — and the WHO — with as complete and accurate a picture as possible, said Dr. Paul Gully, head of the department's population and public health branch. "We think it will help us in terms of clarity and WHO, because it's really important to keep their confidence." Whether Toronto becomes the subject of another WHO advisory may depend on it, said Gully, who noted while the organization has criteria for triggering a travel advisory, numbers aren't the only factors involved. "Behind that, the decision of a travel advisory is taken at a higher level. And that would depend on confidence." Low sparked a firestorm yesterday when he criticized the use of the Health Canada definition, saying it had the effect of artificially deflating the number of probable cases by moving more people into the less problematic suspect category. Ontario officials had originally used the WHO definition, but switched to the Health Canada one in early to mid April. The clinicians were not informed of the switch at that time. It only came to light last weekend, as doctors were scrambling to assess large numbers of patients from the new cluster, creating the impression that the switch may have been made in a bid to make the outbreak look less serious than it was. Doctors treat probable and suspect SARS cases in the same manner, because they believe both can spread the disease. Many, like Low, believe when a good diagnostic test is discovered, retrospective testing will show that both groups had SARS, but one had a milder form. But probable cases are crucial from a public relations point of view, because it is the number of probable cases that the World Health Organization uses to determine whether a travel advisory urging international travellers to steer clear of a SARS-affected area is warranted. Toronto's latest bout with SARS — SARS 2 as it's being called locally — had been spreading, undetected, through several area hospitals for the past five weeks. It only broke on the radar screens of public health officials when large numbers of health-care workers began to get sick. That started occurring after May 15, when hospital workers in non-SARS wards were told they did not need to be masked at all times. The outbreak appears to have begun at North York General Hospital, where it spread in the orthopedic and psychiatric wards. A patient transferred from the orthopedic ward to St. John's Rehabilitation Hospital took the disease along with her, infecting up to six others there. Three other city hospitals — Toronto General, St. Michael's and Scarborough General — received undetected infected patients in transfers from those two facilities. That led to the quarantining of staff in all three and the infection of staff in one and possibly two of those hospitals. In the days that followed, scores of sick health-care workers and family members of sick patients started showing up in emergency rooms with SARS-like symptoms. But that flow appears to be petering off, Low said. "When you're looking at the epi curve, the wave started to rise on Friday, Saturday, Sunday and it crested on Sunday and Monday night. And now we're on the downside," Low said. An epi curve charts when people began to get sick and shows retrospectively when an outbreak began, peaked and ended. "Today I think maybe only two people have come in as opposed to five, six days ago when you had like 10, 12 people in Emerg," he said, using the Canadian shorthand for an emergency room. "And I think that's the same sense I get from Scarborough General. The same feeling is that the wave has crested." CP 1628ES 29-05-03 Taken from www.star.com | 
