UNCLAS SECTION 01 OF 02 OTTAWA 001876

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)

E.O. 12958: N/A
TAGS: AMED SOCI TBIO ECON CASC CA
SUBJECT: Update 44 - Ontario SARS (July 2, 2003): WHO
Removes Toronto from List of SARS Affected Areas


TORONTO SENDS

Ref: Toronto 1816 and previous

World Health Organization (WHO) Removes Toronto from
List of "Areas with Recent Local Transmission"
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1.In a move anticipated with measured optimism by
Ontario Health Minister Tony Clement in a July 1
televised interview, the WHO on July 2 "removed
Toronto, Canada, from its list of areas with recent
local transmission." The WHO used as its measure the
fact that 20 days - double the known incubation period
for SARS - have passed since a new SARS case surfaced
in the Greater Toronto Area (GTA). Twenty-two active
probable cases remain in Toronto. The WHO, however,
according to spokesman Christine McNab, determined that
the disease's risk to people in the community is
"extremely low to zero."


2. During Toronto's second bout with SARS, locally
dubbed "SARS II," the WHO did not reinstate its earlier
travel advisory on Toronto. However, Toronto's
presence during May and June on the WHO's "local
transmission" list delayed public/private sector
marketing programs to bring travelers back to Canada's
largest city - programs which can now be launched with
confidence.

Keep up the Guard, Experts Caution
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3. Despite the good news, both the WHO and Toronto
experts such as Dr. Donald Low, Mount Sinai Hospital's
chief microbiologist, are urging continued vigilance.
The mechanisms of SARS' spread are still not fully
understood, and modern hospital settings appear to be
particularly vulnerable to SARS. Toronto's most recent
SARS fatality, for example, was a front-line nurse.
The WHO's statement notes that the efficient spread of
the virus in "sophisticated hospital settings may have
contributed to the severity of Toronto's outbreak ...
certain procedures, such as difficult intubation and
use of nebulizers that are more common in sophisticated
hospitals, also increas[e] the risk of infection."


4. A combination of the CDC and Health Canada's review
of hospital procedures, a just-underway Health Canada
expert committee examination of infectious disease
controls, and an Ontario provincial lessons-learned
exercise should help to fine-tune the "new normal" of
identifying, containing, and dealing with infectious
diseases, implemented by Ontario's Health Ministry last
month.

June 30 Case Statistics (Ontario Ministry of Health)
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5. Summary:

--22 active probable cases (hospitalized/under
investigation), compared with 37 on June 17. Of the 21
hospitalized cases, 11 are in critical/ deteriorating
condition.

--2 active suspect cases, compared with 4 on June 17.
Of the 2, both hospitalized, none are in
critical/deteriorating condition.

--316 cumulative discharges (probable and suspect),
compared with 299 on June 17.
--379 cumulative cases (probable/suspect/ fatalities)
compared with 375 on June 17.

Case Statistics:

Probable (Active):
21 hospitalized
1 under investigation
0 home
188 cumulative discharges to date.

Suspect (Active):
2 hospitalized
0 under investigation
0 home
128 cumulative discharges to date.

Fatalities: 39 cumulative fatalities to date, compared
with 33 on June 11.

MARWITZ