- The Washington Times - Tuesday, May 27, 2003

The outbreak of several new possible SARS cases in Toronto has some scientists worried that the respiratory illness may be harder to eradicate than hoped, with some SARS cases slipping under the radar if health care workers are not constantly vigilant.

“It’s an indication that it may be more difficult than people were hoping,” said Dr. Ken McIntosh, emeritus chief of infectious diseases at Children’s Hospital in Boston.

“It does show that we need to continue the vigilance for a fairly lengthy period of time and that it’s going to be difficult,” said Dr. Ruth Berkelman, director of the Center for Public Health Preparedness and Research at the Rollins School of Public Health at Emory University in Atlanta.

Canada had had no new cases of severe acute respiratory syndrome since April, but a new possible cluster of cases was discovered late last week. There are now nine new probable cases of SARS and 23 new suspected cases, Dr. Colin D’Cunha, Canada commissioner of public health said yesterday, adding that he expects a spike in probable cases in the coming days. Toronto is taking strict containment precautions and more than 3,400 people are in quarantine at home, he said.

The World Health Organization placed Toronto back on its list of affected areas Monday, after removing the city on May 14. The WHO has not reissued the advisory against travel to that area, however. The travel ban was lifted on April 30.

“We need to find out what happened,” said the WHO’s Dick Thompson. He said the new outbreak could be an indication that there are people who have SARS, but do not display SARS symptoms, or it could have been an environmental factor in the hospital itself. “This may be a new expression of the disease,” he said.

The new cluster, which is linked to four Toronto hospitals, has been traced to a 96-year-old man who had been in the hospital for hip-replacement surgery, who apparently developed pneumonia and died May 1. Officials did not link him to SARS at that time, but now there has been a link established.

Officials are not sure how the man got SARS, but they believe he spread it to others. Dr. D’Cunha could not say whether the man caught SARS in the hospital from another patient, unknowingly from a staff worker, from a family member, or from some other person, but would only say that the investigation is continuing.

Dr. D’Cunha said he did not believe hospitals had “dropped their guard,” enabling this second outbreak to occur. But he did say the case of the elderly man “was sitting there … and already infected a few before the situation came to light.”

Dr. McIntosh said this could have happened because staffers were not as thorough as they should have been, or because SARS came back into the hospitals through people who were displaying few or no symptoms.

Along those lines, a WHO official yesterday said some workers who had handled animals in a market in southern China had SARS antibodies in their systems, but had never become severely ill with SARS. Late last week, the WHO said evidence of SARS had been found in three species of animals sold at the market in China. A WHO official said yesterday that Hong Kong researchers now have found five workers at that market had at one time been ill with SARS and developed the antibodies against it, but apparently never developed the severe symptoms.

“If this is true, that might also point in the direction that this virus may be harder to control than thought,” said Dr. Arthur Reingold, head of epidemiology at the University of California at Berkeley.

Globally, SARS has infected 8,221 persons and claimed 735 lives, hitting hardest in Asia. China yesterday, however, reported only nine new cases of SARS in Beijing — the first time there were no new cases in the rest of China. And while Taiwan reported 13 new probable cases and four new deaths yesterday, the WHO said it expects the situation there to “improve gradually in the coming days and weeks,” because of the strict containment measures being taken.

In other SARS news:

• Chinese media praised 72-year-old military doctor Jiang Yanyong as a hero in the campaign against SARS. He is credited with breaking government secrecy to reveal the true scale of Beijing’s SARS outbreak. However, the doctor is not allowed to give interviews and is not invited to ceremonies or news conferences.

• Hong Kong and Chinese researchers hope to be able to have results in six months on whether a SARS vaccine works in animals, Chinese state media reported yesterday.

• A zoo in China has been unable to afford all the food necessary to feed its animals because of lack of paying visitors amidst SARS fears.

• This article is based in part on wire service reports.

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