March 29, 2006

SARS prepares Toronto for bird flu

By Jonathan Spicer

TORONTO (Reuters) - Toronto's deadly brush with the SARS
virus three years ago has uniquely prepared the city for the
possibility of a bird flu pandemic, health officials say.

Drawing on lessons from the 2003 outbreak of Severe Acute
Respiratory Syndrome, city and provincial experts promise new
screening measures, emergency plans to treat patients from home
and tough laws detailing what health workers must do.

Rules still under government debate could ban travel, fix
prices and order health-care professionals to provide necessary
services in the event of a pandemic.

"I think what puts us ahead of folks who haven't dealt with
SARS is that it really has made the potential pandemic more
real. We at least have a framework for what we might see with
pandemic flu," says Dr. Susan Poutanen, primary author of the
first two scientific papers on SARS, published in The New
England Journal of Medicine during the Canadian outbreak.

Toronto was the only city outside Asia where people died of
SARS. The disease infected 375 people in the city, Canada's
largest, and killed 44, prompting a scathing public inquiry and
angry lawsuits.

And it could be only a matter of time before Toronto has to
cope with bird flu too, as the H5N1 avian influenza virus
spreads out of Asia to infect birds in Europe and Africa.
Experts agree it will one day reach North America too.

The virus does not easily infect humans -- it has killed
just over 100 people in three years -- but scientists fear it
could mutate into a pandemic strain that could kill tens of


Ontario's influenza plan aims to free up overwhelmed
hospitals by providing telephone and Internet home care to less
vulnerable patients.

Late last year, the provincial government proposed
legislation that would broaden its power to ban travel and
order health workers to provide services if a pandemic struck.

But Ontario's Bill 56, which is still being debated, has
drawn criticism from doctors who fear they will be jailed or
fined if they refuse to work.

"My initial response when I think about (avian influenza)
is that I'd like to run away from it all and protect my family,
and that's the sense I get from my colleagues," said Connie
Leroux, a nurse who contracted SARS from a patient at a Toronto

"However, I also have a very strong sense of responsibility
to our community and our patients, so I'm not sure how many of
us would actually leave -- including myself."

Poutanen, an infectious disease consultant at Toronto's
Mount Sinai Hospital, named surveillance and diagnosis as key
areas where Toronto learned from SARS.

"Surveillance for fever and respiratory illnesses ... has
gone from essentially nothing to an Ontario-wide suggestion
that all hospitals search (them) out," she said.

Hospitals in the province of 12.5 million will question
anyone who arrives with a respiratory illness, even isolate
them until the symptoms are deemed noninfectious.

In 2003, hospitals overlooked a single case of SARS,
setting off a second deadly wave of the disease and landing
thousands in quarantine.

One of those quarantined was Leroux. Now 35 and diagnosed
with depression, anxiety and post-traumatic stress, Leroux says
she followed guidelines for both protective attire and contact
with her family.

"It was very clear to me that (my husband) and two children
were at high risk of contracting it as well because I had just
seen them and was quite contagious at the time," she said in an

Leroux's family did not contract SARS, but they spent 10
days in isolation, while she was quarantined for a month. The
nurse is now one of 53 suing the provincial government for
negligence during the crisis.


A public inquiry blamed a "broken" public health care
system in its interim report, calling it "unprepared,
fragmented, poorly led ... inadequately resourced."

"SARS was contained only by the heroic efforts of dedicated
front line health care and public health workers and the
assistance of extraordinary managers and medical advisers,"
Justice Archie Campbell wrote in 2004.

Ontario that year committed C$2.4 million ($2 million) in
new health spending and created an emergency management unit to
coordinate the province's response to crises like SARS.

"The fundamental problem with SARS was that we took for
granted our ability to trump Mother Nature," said Allison
Stuart, the unit's director. "We don't have a pill for
everything, and we learned that lesson very quickly."