SARS Hits Home
Doctors are scrambling to figure out what the mystery germ is and how to fight it
Coughs and sneezes. So far, 18 people have died in Ontario, and 138 appear to have been infected. One quarter of the victims have been healthcare workers. "It has some similarities to the time when we had the first AIDS patients," says Doris Grinspun, director of the Registered Nurses Association of Ontario, "with one big exception: Here, healthcare workers are getting hit big-time."
Several Toronto hospitals remain closed completely, and others are offering only urgent care. Last week, three hospital-infection experts from the CDC in Atlanta arrived in Toronto to help figure out why some healthcare workers have continued to become infected, despite wearing masks, gloves, and goggles all day. Their report is expected this week. In the meantime, many patients, like Andrew Rankin, have come to realize that the houses of healing have become threats in themselves. "Some people have refused to come in," even if they really need treatment, says Ronald Laxer, vice president for clinical and academic affairs at the Hospital for Sick Children. "Usually our emergency room visits are running 125 to 150 a day. We're seeing one third of that."
The fact that almost all of the victims worldwide have been either healthcare workers or family members of SARS patients has led researchers to believe that the bug is spread by droplets of saliva, generated when someone coughs or sneezes. This is why health authorities urge SARS patients, and those who come in close contact with them, to wear masks. Yet several outbreaks raise the disturbing possibility that there are other means of transmission and that close contact may not be required to become infected. "There are a couple of key situations that we don't understand," says Stephen Ostroff, deputy director of the National Center for Infectious Diseases at CDC. One is the Bukas Loob Sa Diyos Covenant Community, a Catholic group based in Toronto. In mid-March, an elderly member of the group was treated at Scarborough Grace Hospital and came in close contact with a SARS patient there. Both men died. Toronto health officials urged everyone who had attended the first man's April 3 funeral to go into quarantine. But it wasn't until later that they realized the BLD group had sponsored a retreat with 500 participants the week before, where the germ appears to have spread. Since then, two doctors and 29 congregants have fallen ill, including the Pennsylvania man. The Pennsylvania health department is now investigating eight suspect cases of people who had contact with him. WHO officials also say that cases in the Philippines and Australia trace back to the BLD cluster. "It may be explainable with close contact, shaking hands, hugging," Ostroff says. "But there may be some other means of transmission that we don't understand yet as well."
Other cases that have epidemiologists still puzzled, and alarmed, are the outbreak in the Amoy Gardens apartment complex in Hong Kong in early April and a second later in the month at a Singapore produce market. At the Amoy Gardens, more than 300 people fell ill within a few days. Most of them lived in the same tier of apartments. As a result, investigators have been trying to figure out if people could have become infected while waiting for elevators. It's still unclear how long the SARS virus can survive on surfaces such as elevator buttons--theories have ranged from a few hours to an entire day. Cockroaches and rats have been accused, too, but there's no proof that they are the culprits. Another theory holds that the coronavirus, which has been found in feces, was spread by sewage backups into apartment toilets, where it became aerosolized. About 60 percent of the ill people from Amoy Gardens had diarrhea, more than twice what's been seen in other outbreaks.