US embassy cable - 03OTTAWA899

UNCLAS SECTION 01 OF 03 OTTAWA 000899 
 
SIPDIS 
 
STATE PLEASE PASS TO CDC 
 
STATE FOR WHA/CAN, CA/OSC and M/MED 
 
E.O. 12958: N/A 
TAGS: AMED, SOCI, TBIO, CASC, CA 
SUBJECT: Ontario Declares SARS Health Emergency 
 
Ref: State 072824 
 
1.  Summary:  Late on March 26, the province of 
Ontario, faced with growing numbers of cases of 
Severe Acute Respiratory Syndrome (SARS), 
officially declared a "provincial emergency." 
This represents a dramatic upgrade of measures to 
contain the potential spread of SARS in the 
greater Toronto area, the epicenter of Canada's 
SARS cases.  In the last several days, "probable" 
case numbers have jumped to 62, according to 
March 27 "Globe and Mail" reports, making Ontario 
the largest disease site outside Asia. 
Provincial emergency responses and powers include 
(so far voluntary) quarantine orders, potentially 
for thousands of residents and scores of 
emergency medical workers - which could slow 
responses to `911' calls; the closing of critical 
care units in two major hospitals; round-the- 
clock monitoring by a new Provincial Operations 
Center; and an intense effort to track workers 
and visitors to Scarborough Grace, the hospital 
where Toronto's three SARS fatalities were 
treated.  Post will send proposed Public 
Announcement text via Septel. End summary. 
 
Multi-ethnic Metropolis Potentially Vulnerable 
--------------------------------------------- - 
 
2.  Toronto, Canada's most populous urban center 
with the nation's largest and most diverse ethnic 
and immigrant populations - including one of the 
largest Chinese populations outside Asia - has 
been hit with the majority of the country's 
Severe Acute Respiratory Syndrome (SARS) cases, 
including its three fatalities to date.  With 
high travel rates to and from Asia's vulnerable 
areas - the March 26 "Toronto Star" reports 
outbound travel from Toronto's Pearson 
International Airport to southeast Asia at more 
than 1,000 passengers daily - the SARS risk 
potential is clear.  The Toronto district of 
Scarborough, with notable concentrations of Asian 
populations, is the focal point of concern and 
attention.  Scarborough Grace Hospital, where the 
three SARS fatalities were treated, was 
completely closed on March 26, while a near-by 
elementary school has also closed as a 
precautionary measure. 
 
Current Profile - A Four-fold Jump in "Probable 
or Suspect" Cases 
--------------------------------------------- -- 
 
3.  According to the City of Toronto's March 25 
SARS Backgrounder, prominently posted on 
Toronto's government website, health officials 
report that, of the three fatalities, two were 
related and had traveled to Hong Kong, while the 
third, according to the "Star," had shared the 
same hospital observation room with the one of 
the two family victims.  As of March 25, the city 
backgrounder referred to 15 "probable" and five 
"suspect" cases.  Two days later, the March 27 
"Globe and Mail" and the CBC report an increase 
of "probable cases" to at least 62 persons, 
including a number of health care workers from 
Scarborough Hospital. 
 
Multi-front Response: Institutional Closings and 
Quarantine Orders; Could Slow `911' Response 
--------------------------------------------- --- 
 
4. Under Ontario's emergency powers stemming from 
its "Health Protection and Promotion Act" invoked 
on March 26, an extensive quarantine search and 
order is underway, targeting the potentially 
"thousands of people" who visited, worked, or 
were treated at Scarborough Grace Hospital from 
March 16 onward.  In addition, the province's 
"Emergency Plan Act," also invoked, authorizes 
the use of emergency funds for disaster response, 
if needed.  With SARS now designated a 
"reportable, virulent, communicable disease," 
this designation empowers public health officials 
to prohibit those suspected of SARS from 
"engaging in activities that may transmit" the 
disease.  According to media, individuals must 
voluntarily place themselves under a 10-day home 
quarantine and wear a protective mask when 
interacting with family members. 
 
5. The quarantine includes, according to CBC 
reports, an estimated 50 ambulance staff and 
paramedics who either had contact with victims, 
or have exhibited possible symptoms of SARS. 
Provincial emergency officials advised residents 
to continue to use the "911" number but indicated 
that response times may be slow. 
 
6. Two major hospitals have been closed or 
restricted in the past 24-48 hours.  Scarborough 
Grace Hospital staff told us that the facility is 
completely closed, with access barred by masked 
security personnel.  In downtown Toronto, Mount 
Sinai, the city's premier medical facility, 
closed its intensive care unit and emergency room 
services, according to a hospital public affairs 
officer.  The precautionary closure stems from 
the fact as reported in the March 27 "Globe and 
Mail" that a possible SARS patient was 
transferred to Mount Sinai's acute care unit from 
Scarborough over the weekend. 
 
7.  Working with Canadian federal and Toronto 
municipal health personnel, Ontario's Ministry of 
Health and Long-Term Care announced March 26 
additional tracking and containment measures 
including: 
 
-- Planning to increase Ontario's isolation bed 
capacity, potentially using new, unopened 
facilities as a way to isolate patients with 
symptoms; and 
 
-- Partnering with the City of Toronto in efforts 
to identify a "broad sweep of people" who 
may have come into contact with SARS sufferers. 
 
Canada Issues Health Travel Advisory while 
Ontario Implements Health Protection and 
Promotion Act Powers 
----------------------------------------- 
 
8.  Health Canada, the nation's federal health 
ministry, issued a March 25 travel advisory which 
recommends that persons "defer all travel until 
further notice to Hanoi, Hong Kong, Guangdong, 
and Singapore."  In addition, federal health 
officers are distributing SARS information cards 
to passengers arriving at Toronto's Pearson 
International Airport from Asian ports of 
embarkation.  According to a pre-clearance 
contact at Pearson International Airport, airport 
personnel, including U.S. and Canadian inspection 
officers, are not yet receiving protective gear 
or working under special handling rules, although 
individual services have counseled staff on SARS 
characteristics. 
 
Multiple Info Sites and Free Clinics 
------------------------------------ 
 
9. Area residents or travelers concerned about 
SARS can contact a variety of information 
resources sponsored by all three levels of 
government.  The public can call the province's 
Telehealth Ontario hotline, 1-866-979-0000 and 
Toronto Public health Hotline, 416-338-7600 for 
clinical information and advice.  In addition, a 
downtown Toronto clinic affiliated with the 
respected Sunnybrook and Women's College Health 
Sciences Center opened today offering assessments 
on a walk-in basis to any individuals worried 
about the disease. 
 
Comment:  Province, City Taking SARS Very 
Seriously 
----------------------------------------- 
 
10.  Far from minimizing SARS concerns that could 
potentially affect business or tourist travel to 
Canada's leading city, health authorities are 
using whatever legal, research, and public 
outreach tools they have to educate the public, 
isolate symptomatics, and respond to this 
unfolding disease profile.  But given a 
metropolitan population close to five million and 
strong Asian ties and travel patterns, the 
difficulty of enforcing extensive quarantine 
orders, as well as medical uncertainty over the 
disease's etiology and clinical transmission 
specifics, it is too soon to know whether Toronto 
is over the worst. 
 
11. MINIMIZE considered. 
CELLUCCI