16 Dead in Toronto "Mystery" Flu Illness

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
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