SARS lessons useful for virus

Epidemic showed need for communication, doctors say 71 of 250 nursing home residents ill in mystery outbreak

Toronto’s experience with SARS in 2003 has helped it deal more effectively with a mysterious respiratory virus that has killed four residents of a Scarborough nursing home, doctors and public health officials say. SARS — severe acute respiratory syndrome — taught the city, public health officials, hospitals and the province the importance of co- operation and communication, said Dr. David ButlerJones, Canada’s chief public health officer.

“ It’s nice to see how things can happen when people come together and are more worried about solving the problem than who gets credit,” said ButlerJones, who specializes in public health and preventative medicine.

“ The co- operation, the transparency, the focus of who can do what. Toronto Public Health and the province are focusing on what they need to do.”

Since Sept. 25, four people have died from the respiratory outbreak at Seven Oaks Home for the Aged in Scarborough.

Seventy- one of the home’s 250 residents have now become ill from the virus, according to Dr. David McKeown, Toronto’s medical officer of health.

That’s three more cases than were first reported by health officials on Saturday. Seventeen residents have been admitted to hospital — two more cases than initially reported.

Six staff have become ill — that’s one more than first reported, and three have been hospitalized. Those who suffer from the illness have a cough, fever and general malaise.

“ There have been some new cases, but not that many, and that is the good news,” said McKeown. “And the other bit of good news is that many, if not most, of

those who have been ill are showing signs of improvement and there haven’t been any other deaths associated with the outbreak.

“ We’re monitoring the situation very closely and many of those who are ill are very frail and elderly, so there is always a risk of a more serious illness. This is a very vulnerable population.” SARS was very much on the mind of family members and friends outside Seven Oaks yesterday as they watched paramedics, in sterile gowns and masks, come and go from the building. Two years ago, SARS killed 44 people in Toronto. Hundreds of hospital workers and residents of the city were quarantined, and many others fell ill from the disease.

“ Many of these people went through the SARS outbreak and they are aware of the need for precautions,” said ambulance supervisor George Kislashko.

Inside Seven Oaks, paramedics observed stringent sterile techniques, including vigorous hand washing and sanitizing, to prevent further transmission.

Staff at the nursing home wore masks and gowns.

Asign on the door prohibited visitors, leading to frustration among many who wanted to see residents. Some were concerned about the lack of information regarding the health of their family members.

“ My mother is in there but I have no idea how she is doing or if she has come down with the flu,” said a woman who would not give her name.

After making several attempts to catch someone’s eye inside the locked front doors, the woman picked up a telephone and finally was given a number to call to check on her mother.

“ All they told me was that she is not on the list of those who came down with it,” she said.

Meanwhile, another death, unrelated to the outbreak, brought the coroner back to the nursing home.

Coroner Alex Jones said the 82- yearold man was not exhibiting typical symptoms of the virus and he attributed the death to heart failure. McKeown says the SARS outbreak has influenced the way officials and doctors are handling the virus at Seven Oaks.

“ We have much better protocols for dealing with respiratory outbreaks that have benefited from our experience with SARS. They’ve been rewritten and work better from what we learned from SARS.

“ Secondly we have much better working relationships with hospitals and nursing homes.

“ We are working together more closely.

“ In this outbreak we’re working more closely with Seven Oaks and hospitals where patients from Seven Oaks have been admitted, and with the ministry of health and ambulance services . . . and the coroner’s office.”

Dr. Allison McGeer, head of infection control at Mount Sinai Hospital, not only battled SARS but suffered from it. She also believes that the lessons learned from the SARS epidemic helped tighten up infection control and made the way the city copes with an outbreak “ faster and more effective.”

“ SARS also gave everyone in hospitals and nursing homes a new respect for respiratory viruses,” McGeer said.

“ And now we do better with our control measures, understanding when an outbreak has happened and implementing the response to it across all levels, knowing what to say to the community and what we’re doing in the hospitals and in nursing homes,” she said.

Federal Public Health Minister Carolyn Bennett, who was briefed yesterday about the outbreak, said she is impressed with the way officials have handled the case. A federal government report into the SARS crisis suggested that there was a breakdown during that crisis because of a lack of co- operation, collaboration, communication and clarity, Bennett said. But that was nowhere to be seen this weekend, she said.

This time around, she said, everybody was working together to contain the virus and figure out what it is.