US embassy cable - 05TORONTO2614

UNCLAS SECTION 01 OF 02 TORONTO 002614 
 
SIPDIS 
 
STATE FOR WHA/CAN, CA/OCS, M/MED, and M/DASHO 
HHS FOR OFFICE OF THE SECRETARY, OFFICE OF 
INTERNATIONAL AFFAIRS (STEIGER), CDC FOR GLOBAL HEALTH 
OFFICE (COX) 
 
SENSITIVE 
 
E.O. 12958: N/A 
TAGS: AMED, SOCI, TBIO, ECON, CASC, CA, KPAO, Health 
SUBJECT: 16 Dead in Toronto "Mystery" Flu Illness 
 
Ref:  (A) Toronto 0153  (B) Toronto 2602 
 
Sensitive But Unclassified - Please protect 
accordingly. 
 
1.  (SBU) SUMMARY: On October 6, the reported death 
count in a "mystery" flu-like virus outbreak in a 
Toronto-area nursing home climbed to 16, making it the 
city's worst respiratory outbreak since SARS killed 44 
Canadians in the spring of 2003.  Public health 
officials emphasize that they have ruled out SARS, 
avian flu, and influenza as possible causes.  They also 
claim that the outbreak has been contained among 
residents, staff, and visitors of the nursing home, 
with no reported cases outside of those groups and no 
new cases in almost 48 hours.  However, medical health 
professionals in Toronto say the City is not providing 
adequate information to medical professionals.  The 
Toronto economy lost C$1 billion during the 2003 SARS 
outbreak, creating the current impression of a possible 
conflict of interest when public officials are 
confidently proclaiming that the outbreak has been 
contained before they can exactly identify the virus. 
END SUMMARY. 
 
Death Toll Rises to Sixteen 
--------------------------- 
 
2.  (U) On October 6, Torontonians woke up to the grim 
news that 16 residents of a nursing house in the 
Toronto suburb of Scarborough had died from an 
unexplained respiratory illness, making this outbreak 
the worst since SARS killed 44 people in the spring of 
2003.  Six nursing home residents died on October 5 -- 
three women (aged 85, 92, and 96) and three men (aged 
75, 84, and 89).  Since the illness was discovered on 
September 25, five visitors, 13 employees, and 70 
residents have been affected. 
 
Official Line Calms the Nerves 
------------------------------ 
 
3.  (U) Toronto's Chief Medical officers continue to 
emphasize that the disease is in several critical 
respects different from SARS and that it has likely 
been contained.  In their words, the outbreak does not 
pose a public health risk.  Their reasoning is based on 
the following facts: 
 
--all 16 fatalities were elderly men and women with 
additional medical conditions that made them 
particularly susceptible to any disease (NOTE: a large 
proportion of SARS cases was among much younger health 
care professionals. END NOTE); 
 
--all reported cases are confined to residents, staff 
and visitors of the nursing home, all have been 
accounted for and, if necessary, quarantined in Toronto 
area hospitals; 
 
--Toronto's statistics demonstrate that there are 200 
respiratory outbreaks in long-term care facilities 
every year.  Per outbreak, there was one fatality on 
average, and the highest previous number of deaths was 
15; 
 
--there have been no new cases for almost 48 hours and 
the number of new cases per day has declined over the 
last seven days.  These numbers indicate that the 
disease has been contained.  While more deaths among 
those already infected is possible, all eyes will be on 
whether the total number of infections remains stable; 
 
--Toronto area medical labs have been able to determine 
that the disease is a febrile (characterized by a 
fever) respiratory virus that is not/not SARS, avian 
flu, or influenza; 
 
--the building that houses the nursing home also 
accommodates a day care center for children, which 
remains open for parents to drop off their children. 
No virus cases have been reported at the childcare 
center. 
 
Medical Professional: "Anything is Possible" 
-------------------------------------------- 
 
4.  (SBU) Dr. Howard Seiden, the Consulate's Medical 
Advisor, expressed frustration that the City of Toronto 
has not been more forthcoming with information about 
the virus.  Medical professionals know no more than 
what is in the newspapers and they get the info no 
earlier.  He argued that 16 deaths with no explanation 
raises questions.  His bottom line: If you don't know 
what you are dealing with, anything is possible.  He 
expressed concern that public health officials are not 
reacting as conservatively as they should while 
important questions about the virus remain unanswered. 
 
5.  (U) Media reports note that Toronto lost C$1 
billion in the 2003 SARS outbreak, so city and 
provincial officials have a very material interest in 
treading as softly as possible.  These reports quote 
the previous Tourism Minister, who advised the current 
government to closely monitor its tone to avoid 
economic losses. 
 
Comment: A Fine Balancing Act 
----------------------------- 
 
6.  (SBU) Clearly, Ontario is walking a fine line in 
trying to avoid an overreaction that could have severe 
economic consequences and prompt unnecessary public 
alarm, while still taking every measure to contain the 
disease.  Understandably, Ontario's Health Minister, 
George Smitherman, emphasizes that there is "no 
evidence" that the disease has spread outside the 
nursing home.  At the same time, given the expectation 
of worldwide pandemic, it is unsurprising that medical 
professionals are frustrated that they are not getting 
more scientifically based information that would enable 
them to quickly diagnose possibly linked cases.  This 
outbreak, which likely is contained, should be taken as 
opportunity to rehearse with the medical community for 
the real thing (NOTE: Ref (A) contains ConGen Toronto's 
"Lessons Learned" from the 2003 Toronto SARS outbreak. 
END NOTE). 
 
LECROY