SARS in Toronto! - page 15

Hey I just saw on the news that a thousand people have been quarentined at a hospital in Toronto! Do you all know anything about this? I hope our Toronto members are alright. Is this virus... Read More

  1. by   Scotty
    Travel can spread SARS.

    That is how it moved from China to Hong Kong and so on. It has also probably been spread from Toronto to the Philipines and the USA. The vast majority of travellers in the world today are not carrying SARS but a few of them may be. The majority of travellers won't contract SARS but a few unlucky ones might.

    Sometimes SARS transmits easily (the people who caught it in the hotel in Hong Kong despite absolutely minimal contact with the index case) and sometimes it doesn't.

    I love Toronto and if I had a ticket to visit right now I think I'd still come. My most realistic fears would be getting mugged for being a tourist, or perhaps getting stuck in quarantine with people who do have SARS when I came home, if the epidemic and the panic worsen. [The British fee paying schools sent a lot of children from Hong Kong etc into quarantine together when they returned to the UK after their holidays, to protect the British children. This wasn't the British Government, it was the organisation that supposedly looks after the welfare of these children when they are in the UK. What if one of those children had been a so called super spreader and had transmitted The SARS virus(es) to the healthy children who were quarantined along with him or her? Then again it wouldn't be very nice for a child in a foreign country to spend ten days in solitary confinement.]

    I honestly don't know if the WHO are right to issue travel advisories or not. Time will tell. Maybe they should just continue to issue the facts and let people make up their own minds. But we know only too well that some people will knowingly put others at risk.

    Will a travel advisory stop the spread of SARS? SARS may be with us for good and we can't close our borders for ever or we'll have an economic disaster.

    There are so many dilemmas.

    Anyway, best wishes to you all. I really appreciate your stories and views. I'm sorry some of you are actually dealing with this nightmare.
  2. by   RN4ev'r
    Can someone refresh my tired brain?

    Did the nurse that travelled to the Phillipines have symptoms before she left? Same question for the children in Australia? I do remember it was around this time that one of the doctors involved with looking at the virus went to Paris and then quarantined himself there in an apartment. If the above happened before sars became the problem it is, and there has only been the doctor that travelled to the US since, then isn't the WHO a little late to be showing their concern about coming to Toronto?
  3. by   Scotty
    RN4ev'r, maybe no-one knows whether the nursing assitant who travelled to the Phillipines had symptoms or not, but her linked SARS contact WAS in Toronto. And yes, I agree with you the WHO may be a bit too late with their concern about spread of SARS from Toronto.

    [My husband is grabbing the computer mouse here (he is a journalist who worked in public relations for a state health authority) and he wants to have his say. He wants to say it is ridiculous to pick on Canada in the face of a pandemic which, by definition, is already beyond national boundaries. That's his view.]

    I have a question. Do people think that the infection control advice given by the WHO on their website on 24th April is adequate?
  4. by   toronto rn
    SARS is defined by exemption since there is no definative test for it. The woman who died in the Philipines had been ruled out for SARS initially, however the Canadian Gov't, acting cautiously ruled her in so as not to allow any case to slip through the cracks. 50 plus healthcare workers and family contacts were quarantined since 11 days ago---no further cases have arised from those quarantined. Same with australia, the three children were quarantined because they couldn't rule out SARS--again no further spread. Reviewing the symptoms-headache cough fever achiness, fatigue-many other illnesses including the common cold have the same symptoms but because SARS has no definative test everyone is included until they recover or the illness progresses with x-ray changes, and shortness of breath. No one can say with any certainty that the cases in the Philipines and Austrailia were SARS or just a cold/other virus. I think it is irresponsible of the WHO to use these cases as a basis for the travel alert- accusing Toronto of exporting the illness when it was never confirmed as SARS. The ramifications of that alert will harm Toronto indefinately, especially since the community transmission of the virus has been contained.
    Last edit by toronto rn on Apr 24, '03
  5. by   sixes
    Good morning. TorontoRN thank you for posting. I am happy to hear from someone actually working with the SARS clients. Please keep us well informed. Unfortunately the only paper I can find is the SUN and because I am not from the area besides this board and the CDC it is my only source of info. Do you recommend that I stop posting the links to the Sun?
    On the news last night they say there has been no new cases in the last 17 days in the community. Are there new cases arising in the Hopitals?
    Also there was a bus load of university students that were turned back from the states they were not allowed to play soccer as the university they were going to feared the spread of SARS. I believe they were going to get scolarships. Will they not be allowed to go to the states to get their education?
    Until I hear from you I will continue to post the links to the SUN. Don't worry I won't be offended if you advise me not to post these links! I don't want to help in the spread of the hysteria aver SARS
    My hats go off to all who are working with SARS. Keep up the good work and my God bless you all
  6. by   toronto rn
    Hi Sixes, keep up the posts, there are some wonderful stories in there just bear in mind that the Sun can be a little lopsided in their views and may contradict themselves, confusing the reader. I'm impressed with your ability to send the links - I'm just a computer novice myself but I would appreciate any tips. Things are looking up here in Toronto.
  7. by   oramar
    torontorn, I am confused about there being no test for sars. On tv I saw someone talking about it and they said there WAS a test but unfortunately there were a certain percentage of false negatives.
  8. by   a-rose
    HOPE THAT THERE IS NO SARS
    Last edit by a-rose on Apr 25, '03
  9. by   toronto rn
    I heard that there was a test being developed as well, but not yet widely in use because of false negatives and false positives. As far as I know they are not widely using it and still erring on the side of caution so as not to miss anyone.
    ?? a-rose, what do you mean?
  10. by   fergus51
    Even in probable cases of SARS about 50% of people are not getting a positive for this new test. It is basically useless in the clinical setting.

    Again, it is only certain people who should not be travelling: those at risk of contracting SARS through their occupation or their family. Normal tourists are not a threat.
  11. by   Trishrpn
    The three cases (children) that we apparently exported to Australia have turned out NOT to be SARS at all, and it was reported yesterday that the case of in the philipinnes has not been proved to be SARS as of yet either.

    So far the only case that has definitely been SARS that we've "exported" was the doctor who went to Phillidelphia. (excuse spelling) I haven't heard any reports as to how this dr travelled to the US ... it's not inconceivable that he drove (hopefully alone!).

    It's true that our Airports should have had a screening process both for people coming into the airport from other countries as well as for Canadians outward bound. Information sheets and self screening are definitely not enough.

    We certainly do not want more cases here, and we definitely don't want any cases to spread from Toronto elsewhere. But look at the numbers at http://www.hc-sc.gc.ca/pphb-dgspsp/s...as/prof_e.html probable cases are not really going up. Suspect cases have gone up but we are basically treating anyone with a respiratory ailment that turns out to be phneumonia as a suspect case at this point. Now look at the numbers today for China (125), and Hong Kong (30). The number of probable cases are still increasing by large amounts. Even Singapore, where Sars might finally be becoming under control (LIKE TORONTO) is still reporting a fair amount of new cases each day, although there numbers have steadily been dropping (just like Toronto's!).

    As others have been saying we don't have any new cases out in the community that can't be traced back to a hospital setting ie the initial cases. And there have been no new cases in the community for 16 or more days. It's contained.

    The CDC is apparently in our hospital today. We'll see what they have to say about how we are doing. As all the Canadians on this board have said- the CDC have not put out a travel advisory for Toronto and I trust the CDC- they are here, WHO hasn't been here to see what's happening.

    I've checked many of the Airport sites and the CDC site and I don't see any recommended screening proceedures for airline passengers (ie screening for all passengers, just recommendations if someone appears to be ill from a resp. ailment). Some of the actual airlines have posted that they will screen passengers from certain flights ie
    http://www.cathaypacific.com/intl/news/0,,78347,00.html And some airports (Denver for one) have instituted screening proceedures for passengers travelling through their airport ... but overall it appears that there is no major screening proceedure for airport travellers in the US. Am I missing something or are the majority of your airports not screening passengers? If we should be doing it- then I think the USA should as well.

    I'm still so tired. I hope we clear things up here soon. I have Crohns and I had a major flare in February and March and missed a lot of work during that time period ... and I had just started back at work when we had to start wearing gloves, gowns, masks and goggles (and doubling up when seeing isolation patients) and as many of you know the work is exhausting when wearing all these additional items (now face shields, hairnets, double masks, and disposable scrubs). I noticed that in one of Toronto_Rn's post she mentioned that people with certain illnesses etc might be exempt from working with SARS patients in her hospital ... that doesn't seem to be the case in ours. Many people in my dept know that I was very sick in Feb and March yet I'm still often put to work in our isolation area. All of my last 6 shifts had several hours of work in the isolation area. oh well, even exposure to a cold or a flu bug could set off a flare for me ... at least with the masks and everything I'm protected from most of those germs these days ... so I'm not too worried about working in the isolation area ... but I do find that it's making me excessively tired (haven't worked since Monday night and I'm still tired!) perhaps it's because I'm still getting over my illness.

    Anyway ... walking the streets of Toronto you really wouldn't know that we are having a health crisis here ... it's only when you see the news or go into a health care setting that you know something is up. Toronto is still a beautiful place to visit with many many interesting things for tourists to do. People are not walking the streets wearing masks or cowering in fear, people are out enjoying the beautiful spring weather, just like I plan to do later this afternoon.

    Trish
  12. by   Scotty
    I don't know how accurate the information on this web page is but have a look at it yourselves.

    www.abc.net.au/news/newsitems/s840512.htm

    Good news about Vietnam

    Regards
  13. by   epaminondas
    << "Am I sick? You're darn right I'm sick... I have never been more sick because I've never been so angry in my life."

    "What I'm doing right here, right now, is sending out a message to this CDC group, whoever the hell they are," he said.

    "Who? WHO, sorry. Well, who's the CDC? Oh. OK. The WHO. And the message I'm sure will reach them through you (is) that I dare them, I dare them, to be here tomorrow."

    - Toronto Mayor Mel Lastman at a news conference, reacting to the WHO decision to impose a travel advisory on Toronto; April 23. >>


    I suppose that the above plays well in Canada, but I doubt that it inspires a tremendous amount of confidence in the rest of the world.

    The mayor who's city is in the center of this health crisis - I believe that the count is three dead and eight new cases today, alone (4/25/03) - does not even know the difference between the CDC and the WHO.

    To me his words sound more like the bluster of a boxer prior to the big match than it sounds like the thoughtful and measured wisdom of a man to whom a traveller or tourist would wish to entrust his health.

    Mel Lastman is not hurting the WHO by intemperate statements. Not one little bit.

    He is only increasing the WHO's stature, if only in contrast.

    The worse he makes himself look, the more he makes the WHO look good - while he further damages the reputation of Toronto in the eyes of the world in the process.


    But I guess it must play well in Toronto.

    ________________________________


    << "WHO has a duty and a responsibility to all countries to provide the best advice for public health possible. We never compromise that."

    - WHO director-general Gro Harlem Brundtland, after telling Canada's Health Minister Anne McLellan the organization will not lift a travel advisory against non-essential travel to Toronto; April 24, 2003. >>


    The above statement sounds like it actually comes from an adult.


    I think again of Mayor Lastman's inflammatory statements.

    This is the man who is leading Toronto?

    Can you imagine the two of these men - Lastman and Brundtland - talking to each other on the telephone and trying to come to some sort of reasoned agreement about the WHO travel advisory?

    One can almost overhear the indignant shouting and shoe pounding from the Canadian end -

    And the long but terribly meaningful silence from Vienna side of the call.

    ________________________________


    There now appear to be two definite cases of SARS exportation from Canada to other countries: the U.S. and The Philippines.

    Exportation of SARS remains one of the three rationales for the WHO travel advisory in regard to Toronto.


    From inside the fence in Toronto there does seem to be a tendency for the WHO travel advisory to be treated in much of the Canadian press as an egregious outrage - the WHO is viewed as politicized, incompetent, and totally uninformed. Toronto the innocent victim of the WHO. What were they thinking, those WHO idiots? Who does the WHO think they are? Uh - who is the WHO, anyway?

    Here on the outside of the fence, however - particularly from those of us who would prefer not to become an integral part of the "new normal" in the delivery of health care - the WHO advisory may look a bit different than it does in Toronto. A bit calmer. Even prudent. Sensible. Wise.

    Both points of view are easy to understand. Neither is necessarily right or wrong - a whole lot just depends where you are standing.

    If I were a native of Toronto I'd probably be outraged at the WHO, as well.

    But here I am - back from work - where I wore no mask, no goggles, and had no particular fear of breaking protocol - and I'd like to keep things that way, if it is at all possible.

    If a travel advisory in regard to Toronto may help - I am all for it.


    The dedication of Toronto's front line health care workers has been exemplary.

    The actions of the politicians may leave something to be desired.

    __________________________________________________

    Sotty,

    It looks like the Philippines case has been confirmed as SARS. The report you quote was originally a Reuters feed posted directly from Manila, 4/25/03:

    Philippines confirms first deaths from SARS
    By John O'Callaghan
    MANILA, April 25 (Reuters)

    http://reuters.com/newsArticle.jhtml...toryID=2630284

    _______________________________________________

    Another version of the Philippine SARS story:

    SARS Virus Spreads in Asia, Canada's Toll Climbs
    By Russell Blinch and Benjamin Kang Lim
    TORONTO/BEIJING, April 25 (Reuters)

    http://reuters.com/newsArticle.jhtml...toryID=2633925

    __________________________________________________ __________

    Case report on another Toronto export - the Pennsylvania SARS patient - as per the CDC:

    << . . . In the ED, he was identified as a suspect SARS patient approximately 2.5 hours after arrival. He was subsequently admitted to the hospital with a diagnosis of atypical pneumonia and possible SARS, and was placed in an isolation room with negative pressure. Serum samples collected on April 15 (day 12 of illness) demonstrated SARS-CoV antibodies . . .

    . . . The patient had traveled to Toronto, Canada, for a religious retreat during March 29--30; the event has been linked to subsequent SARS cases among the attendees . . . >>

    MMWR
    April 25, 2003 / 52(16);357-360:

    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5216a1.htm

    __________________________________________________ __________

    Canadian commentary:

    WHO made us take disease seriously
    The Toronto Star
    THOMAS WALKOM
    Apr. 25, 2003.

    http://www.thestar.com/NASApp/cs/Con...l=968793972154


    WHO knows what's happening
    The Toronto Star
    JUDY GERSTEL
    Apr. 25, 2003

    http://www.thestar.com/NASApp/cs/Con...=1051125555475


    Canadian Prime Minister responds to the SARS crisis by pledging $10 million for marketing (I'm not kidding - E.):

    Apr. 25, 2003. 12:21 PM
    The Toronto Star
    RENE JOHNSTON
    Prime Minister Jean Chrtien breaks SARS silence, pledges $10M

    http://www.thestar.com/NASApp/cs/Con...l=968793972154


    The man who is running Toronto:

    Mayor's gaffe-ridden CNN appearance draws ridicule
    FROM CANADIAN PRESS
    Apr. 25, 2003. 06:27 PM

    http://thestar.com/NASApp/cs/Content...=1051265660049

    ______________________________________________


    People in Clinical Care are trained to be patient advocates. The patient comes first.

    People in Public Health are trained to place society first, not the individual patient: the needs of the many outweigh the needs of the one.

    These are very different approaches. They can come into conflict.


    The WHO, of course, bears the mantle of the Public Health approach.

    You try placing someone into forced quarantine and see how he likes it.

    Just stay out of spitting distance.

    I've never been involved in STD contact tracing - but I always thought that that would be quite a trip.

    Public health workers who are involved in forced quarantine work are used to having to be the heavy. To being unpopular. To being vilified. To being hated.

    No problem.

    It's just part of the job description.


    Toronto has taken on the WHO. Direct attack - all guns blaring. But the WHO is way ahead of that curve.

    By hundreds and hundreds of years.

    Such attacks are a lot of what public health work is all about.

    They are expected.

    That is basic Public Health 101.

    No surprises, there.

    Lastman is in way over his head.


    The WHO has much bigger fish to fry than the folks in Toronto.

    (1) China. People say it's a big place.

    (2) What is going to get really interesting is if the WHO eventually has to lay down a travel advisory on the good ol' U.S. of A.

    I wonder if Bush would actually bomb Geneva?

    I wonder if Bush could find Geneva on a map?

    He just might, ya know.


    Last I heard, despite all the ruckus, Toronto is still not screening airline passengers.

    The result? Well:

    http://www.cbc.ca/news/indepth/backg...lwarnings.html

    Simple as that.


    Maybe Canadian politicians should try just cooperating with the WHO.

    You know - like the rest of the world.


    To your health -

    Epaminondas

    ______________________________________


    Bangladesh is ready:

    http://news.bbc.co.uk/2/hi/south_asia/2946277.stm

close