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Column originally published Apr 29, 2003
Column last revised/updated on Sep 8, 2018

SARS: Severe Acute Respiratory Syndrome Epidemic

Question: Our daughter just delivered a baby girl, our first granddaughter. They live in Toronto. I want to go and see our granddaughter, but my husband is very nervous about the SARS epidemic in Toronto. We want to know whether it is safe to go and visit now, or delay our trip until it is over. We have planned this for a long time, it would be a big disappointment for me and our daughter if we have to delay this trip.


Severe Acute Respiratory Syndrome, commonly known as SARS, has become a major health problem around the world. Before giving you my advice, I think it is useful to walk through the short history of SARS over the last two months.

SARS was recognized by the World Health Organization (WHO) on March 12, 2003 when it issued the first global alert following reports of patients with unusually severe pneumonia in several countries almost simultaneously, including Vietnam, Hong Kong, and Guangdong Province of China. Initially nobody recognize that these patients were somehow related.

On March 15, WHO released its second global alert and named this new condition as SARS. Within a few days, detective work by a group of doctors and public health specialists in Hong Kong was able to piece together the picture by tracking a number of patients, literally around the world.

The epidemic of SARS actually dated back to November 2002, when an outbreak of atypical pneumonia occurred in southern China. About 30% of infected patients were health-care workers. This epidemic was reported to WHO in early February, but no concern was raised until sick patients started showing up around the world.

The first known case of SARS happened after a 64-year-old nephrologist (a doctor specialized in kidney disease) from Guangzhou China visited Hong Kong in late February, and stayed in Room 911 (what a coincidence!) of the Metropole Hotel. He was sick before he arrived in Hong Kong. For reasons still unknown, he infected six hotel guests staying on the same floor, as well as one visitor to the hotel.

Two of these infected people were from Toronto. When they returned home a few days later, they became seriously ill and were admitted to Scarborough Grace Hospital, where the first outbreak of SARS occurred in Canada.

Another hotel guest on that floor went to Hanoi Vietnam and became sick. He was admitted to the hospital and sparked a large epidemic there. Dr. Carlo Urbani, an infectious disease specialist working for WHO in Vietnam, recognized the unusual nature of the outbreak among health-care workers and their families. He informed WHO officials on March 11, triggering the first global alert. Unfortunately Dr. Urbani contracted the disease and later died in Thailand.

When this hotel guest became seriously ill in Hanoi, he was transferred to Hong Kong for further treatment. He subsequently died on March 13. However, as a result of exposure to this man before strict isolation technique was instituted, many health-care workers in Hanoi and Hong Kong, including doctors, nurses, as well as medical students, contracted the virus while taking care of this patient.

Once the epidemic was recognized, WHO coordinated specialists around the world to identify the killer germ and to develop effective tests. By March 26, just two weeks after announcing the outbreak, a team of scientists in Hong Kong was able to grow the virus from infected patients and identified it as a new Coronavirus. Previously identified Coronaviruses only cause mild cold-like illness. This new virus (still without a name) is clearly different: it is highly infectious and causes serious to fatal pneumonia.

With the virus identified, different teams around the world were able to put together the first generation of tests that is capable of rapidly identifying the virus from sick individuals. These tests are extremely accurate, although they are not sensitive enough as yet. That means some sick patients can have false negative test results. Further refinement of these tests are in progress, thanks to the dedication of these scientists with the coordination of WHO.

On April 11 scientists from British Columbia announced the identification of the full genetic code of the virus. This is a major step towards future test development, as well as potential medication and vaccine production. At the present time, doctors are treating many of these patients with anti-viral medications and steroids, although the effectiveness of this treatment is still unknown.

Once it was recognized that SARS was a highly contagious illness, strict isolation was put in place for hospitalized patients. Unfortunately it is not always effective. As a result, health-care workers continue to be infected at an alarming rate. In Hong Kong, a fund-raising event was recently initiated to purchase full-body protective suits for frontline health workers, who are overburdened by the heavy workload of looking after many extremely sick patients, and the psychological pressure of seeing many of their colleagues getting sick.

Another important aspect of SARS control is tracking contacts of patients. This is being done around the world by public health professionals. These contacts are quarantined at their homes in most cases. With these intensive efforts, many countries are able to avoid further spread of the SARS virus. Vietnam has no new patient for more than two weeks, and may be declared ‘SARS free’ by WHO very soon. Even Hong Kong and Toronto have seen significant decrease in the number of new patients. The spread of SARS in China, however, is far worse. This is partly due to the country’s initial denial of the epidemic, as well as a lack of good health care system.

The early symptoms of SARS is similar to influenza. These include fever (usually over 38o), malaise, chills, headache, muscle ache, dizziness, running nose, and sore throat. After a few days, evidence of pneumonia will begin, with cough and shortness of breath. Most patients require hospitalization, with 10-20% developing serious pneumonia that can lead to death. Overall, the mortality rate is around 4-6%. Most of those who died have underlying medical conditions, although as the epidemic spread, younger and previously healthy individuals have also died.

In Canada, the greatest concentration of SARS patients are in Toronto, where the epidemic started before it was even recognized around the world. Naturally more people became infected, and the virus was able to spread much further than in other provinces. With intensive effort by a great team of health-care workers, most of the infected patients have recovered, and fewer new ones were identified in recent days. There is hope that the virus can be contained and eradicated in Canada, although with air travel, it can be reintroduced from other parts of the world.

The vast majority of SARS patients in Toronto are front-line health workers, and those who have direct contact with SARS patients. The risk to general public is very low, although not completely nil. Therefore, it is reasonably safe for you and your husband to visit Toronto. However, if your daughter or her husband works at the hospital, they would be at higher risk because of potential contact with patients carrying the SARS virus.

There are a few precautions that you should take while visiting Toronto: try to avoid excessively crowded places, especially if the ventilation is poor. You should wash your hands with soap and water frequently, because this is the easiest way for the virus to spread. You should also wash your hands before picking up your granddaughter. This has nothing to do with SARS, it is just a good measure of precaution so that you won’t pass any harmful germs to her.

At this point, I don’t think there is any need to wear a surgical mask around Toronto. You should try to avoid going to the hospital, and if you do, the hospital may require you to wear a mask. You should keep track of current recommendations from health authorities by tuning to the radio or television. You can also find these at Health Canada website ( or WHO website (

While you are in Toronto, you can still go out for shopping or have dinner. Just exercise normal caution, and stay away from those who are sick or coughing. However, one should not be overly paranoid either, people can still have common cold, asthma or allergies, all of them can have symptoms like stuffy nose, sneezing and cough.

I would like to discuss here about our civil responsibility as Canadians, and for that matter, as citizens of this world, since we are becoming more and more a global society. Anyone who was in contact with someone known to have SARS (either suspected or probable case) should follow the quarantine requirement to prevent further spread of the virus. Those who are sick, whether because of SARS or not, should not travel. At this point, it is not possible to detect the SARS virus reliably, those suffering from SARS can have negative test results. Many countries are beginning to check travellers with thermo-detectors and thermometers to identify those with fever, and detain them for further evaluation.

With global effort and individual cooperation, we hope that SARS can be eradicated like smallpox virus. This will depend on each and everyone of us. If you are so unfortunate and get sick after returning from Toronto, it is most important for you to phone your doctor or local health authority, and inform them about your recent travel history. They will arrange to ensure that if you were truly infected with the SARS virus, you will receive proper medical care while health-care workers are adequately protected.

I hope my answer is useful for you in deciding your travel plan. It is important to remember that we need to act cautiously, but life should continue in spite of this present epidemic.

[Note to Readers: SARS has been eradicated for a long time already. Many in the public may have forgotten about this terrifying epidemic. I have some schoolmates from University of Hong Kong who died or got very sick from SARS, after contracting it from their patients. My older son was in Hong Kong at the beginning of this epidemic, doing an elective in his final year of medical school. He was told to see a patient with pneumonia one evening, but was too busy and didn’t get the chance to do that. The next day, I was able to arrange for him to fly back to Canada, because I knew there was a serious epidemic. That hospital was the centre of SARS epidemic in Hong Kong, and that patient most likely had SARS. After our son came home, we kept him isolated in his room for two weeks. Fortunately, he did not get sick, and he is now a successful orthopaedic surgeon in Halifax. We would never know what would have happened if he had seen that patient with pneumonia, and contracted SARS….]