Ontario Declares SARS Health Emergency

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
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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