SARS in Canada

April 16, 2003

Over the next 24 hours, the Canadian Medical Association Journal will publish online a series of early-release articles concerning the outbreak of severe acute respiratory syndrome (SARS) in Canada.

The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital
-- R. Maunder et al


The patient who became Canada's first probable case of SARS was hospitalized in Toronto Mar. 7, 2003. By Apr. 10 there were 253 probable and suspected cases in Canada, and 206 of these were in Ontario.

Dr. Robert Maunder and colleagues at Mount Sinai Hospital in Toronto relate the hospital's experience in managing its first 19 SARS patients between Mar. 7 and Apr. 10. This report describes the reorganization of care required because of the outbreak and the steps taken to help staff and patients cope with both the illness and the significant stress and fear generated by the disease.

The race to outpace severe acute respiratory syndrome
-- D.M. Patrick


The British Columbia Centre for Disease Control (BCCDC) has been monitoring the emergence of SARS in British Columbia since February, when first reports of a mysterious outbreak of atypical pneumonia emerged from China.

In this commentary, Dr. David Patrick of the BCCDC discusses why the number of cases in BC so far has been low, with only 3 cases of serious illness, 36 suspected SARS cases and no deaths.

He adds that almost all BC cases have involved travellers returning from Asia. Even though cases have been identified in all parts of the province, BC's experience is far different from Ontario's, where SARS has also affected health care workers and household contacts.

Patrick states "good fortune" likely played a role in limiting the initial impact in BC. He also warns that it will take global collaboration to devise better diagnostic tests, to understand the etiological role of the SARS-associated coronavirus and to develop the vaccines and drugs needed to overcome this disease.

Containing a new infection with new technology: a Web-based response to SARS
-- Elizabeth VanDenKerkhof


This spring, Toronto's SARS epidemic and the high probability that the disease could spread to other regions of Ontario and Canada led the Ontario Ministry of Health and Long-Term Care to implement strict controls on who could enter hospitals throughout the province. As part of these controls, staff and the public could enter hospitals only through a specific entrance and after screening for SARS symptoms and/or risk factors.

To facilitate this screening process, the Queen's University Anesthesiology Informatics Laboratory in Kingston, Ont., developed an electronic tool that was used to screen 5785 employees and produced 36 628 questionnaires between Apr. 3 and Apr. 14.

Given that all employees of health care institutions in Ontario are required to complete the same screening questionnaire, the authors suggest that this e-screening tool could be easily adopted to streamline screening at all hospitals.

Ribavarin in the treatment of SARS: A new trick for an old drug?
-- G. Koren et al


Initial management of patients with SARS, particularly those with pneumonia, involves treatment with antibiotics and ribavarin, an antiviral agent that is not yet available in Canada except under Health Canada's early-release program.

Clinical pharmacologist Gideon Koren and colleagues present a review of ribavarin and its contraindications and explain how physicians can obtain it. Koren and his colleagues also point out the drug's teratogenic potential during pregnancy.

"Clearly, the present experience with intravenous ribavarin is likely to result in much higher fetal exposure, and current recommendations include an avoidance of the drug during pregnancy."

CMAJ is also releasing early a Public Health page and Editorial dealing with SARS.
-end-
http://www.cma.ca/cmaj/press/pr_sars.pdf.

Canadian Medical Association Journal

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