Toronto succumbs to SARS a second time

Toronto is back on the World Health Organization's list of areas with local transmission of SARS after Canada's federal health department reported new clusters of 26 suspected and eight probable cases of the disease linked to four Toronto hospitals.

But WHO is not recommending any restrictions on travel to the city, because the new cases can all be traced back to the original outbreak and are not linked to travel.

WHO spokesman Dick Thompson said it was extremely unlikely that WHO would be issuing a new warning against non-essential travel, because of the city's experience in dealing with and controlling outbreaks. On 30 April WHO removed its warning on travel to Toronto, and on 14 May the city was removed from the agency's SARS list.

The health department said that as of 26 May 351 probable or suspected cases of SARS had been reported in Canada, with 27 deaths. By that date transmission was limited to specific locations such as particular households, hospitals, and community settings. A total of 111 people with probable SARS and 161 people with suspected SARS had been discharged or were at home.

To be considered for a WHO travel advisory an area must have more than 60 cases of SARS, report more than five new cases daily for an extended period, and show evidence of transmission beyond healthcare workers and their close contacts. Toronto does not meet those criteria today, said Mr Thompson.

The new outbreak spread from the SARS ward on the eighth floor of North York General Hospital, where a 96 year old man undergoing surgery for a fractured pelvis on 19 April is believed to have contracted the disease. The man developed pneumonia-like symptoms after his surgery but was not suspected of having SARS because pneumonia is relatively common among elderly patients. He died on 1 May.

Investigators now believe that the man may have been infected by someone else in the ward who also went unrecognised as having SARS. Several members of his family have shown pneumonia-like symptoms and are part of the new SARS cluster.

A woman from the hospital's orthopaedic ward who was transferred to St John's Rehabilitation Hospital on 28 April was later recognised as having a mild case of SARS, and five other SARS cases then appeared at St John's Hospital. The woman has recovered, but three of the other patients are in critical condition, and a 90 year old woman has died.