Coping with SARS in Canada
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RAY SUAREZ: Today’s announcement by the World Health Organization drew a strong negative response from Canadian officials this afternoon.
To hear more on all this we’re joined from Toronto by Case Ootes, that city’s deputy mayor, and from Paris by Denis Aitken, chief of staff for the director general at the World Health Organization.
Denis Aitken, the WHO has added Toronto to a list that includes Chinese provinces and the Chinese capital Beijing. Why?
DENIS AITKEN: Because Toronto now meets the three criteria that we have for ensuring that we try to keep down the international spread of the disease.
The three criteria are that there’s a large number of cases, that secondly there’s evidence of transmission now unfortunately outside of the hospital community and the local family of those into the wider community, and finally that we have had a case of an exportation of the disease from Canada.
RAY SUAREZ: Deputy Mayor Ootes, given those criteria what was Toronto’s reaction to the WHO’s announcement of a travel warning.
CASE OOTES: Well, we were obviously very upset and have launched a protest through our federal minister of health that the action by the World Health Organization is not justified given the situation in Toronto which is completely different from the situation in China.
Our health organizations have taken strong measures to contain the SARS virus, the problem.
It is not throughout the community. It is focused in the hospitals primarily.
RAY SUAREZ: What about the third criterion Mr. Aitken mentioned, that now there is evidence that cases have been exported from Canada to other countries?
CASE OOTES: I think he’s talking about two cases, and to issue a warning based simply on that, that has the economic impact on the lives of people in this city, seems to be an action that doesn’t… isn’t merited by the facts.
RAY SUAREZ: Mr. Aitken, Toronto is a metropolitan area of approximately five million people.
Where does a disease new on the scene like SARS cross the line and become something that, for your organization’s purposes, is established in the community and in danger of being passed on in such a large area with such a small number of cases?
DENIS AITKEN: The two criteria I mentioned, namely the fact that it’s moving outside the hospital community and secondly this criteria for moving abroad.
Let me say that one case was enough to start this thing in Canada. It came from Hong Kong. In Hong Kong one case was enough from Guangdong to start the case in Hong Kong, the whole outbreak in Hong Kong.
So we have to be extremely careful in terms of avoiding to the maximum possible extent the further international spread of this disease beyond the 25 or so countries that are currently battling with it.
RAY SUAREZ: If you really clamp down, is there any hope that you can sort of put a roadblock, make a dead end on a city the size of Toronto and limit the spread of a disease like SARS?
DENIS AITKEN: I think we can ensure to the maximum possible extent that when it arrives in another country that the sufficient forewarning, the sufficient preparation for the country concerned to be able to take the kind of action that some countries have been able to take now to hold the disease when it arises. Some of the European countries have managed this to date. Vietnam has managed this to date.
Toronto has done a good job. I don’t want to be negative at all about Toronto doing a solid job in terms of handling it, in terms of giving the right advice. It just so happens that these two things have happened, and now in the interest of international public health, we’ve had to take the action we did this morning.
RAY SUAREZ: Well, Deputy Mayor Ootes, what are some of the tools at your disposal to try to stop the spread of this disease either through your public health authorities or through civil authorities like yourself?
CASE OOTES: Well, what took place in Toronto as soon as the virus was identified by a carrier that carrier was placed in quarantine. Every incidence of SARS since then has been traceable back to that individual. In other words, the virus is not through the community. Even the last instance of SARS was traced back to a previous carrier.
So our medical system has contained the problem. It’s not in the community.
When the virus was identified, our health people issued the appropriate caution to the public to wash their hands, created a great awareness of the symptoms, and it seems to me that the action by the World Health Organization is a cure worse than the virus by basically shutting down the city in terms of people coming to the city and impacting thousands of people in the tourist industry that depend for their livelihood on tourists.
And, you know, we’ve treated this first and foremost as a health issue in Toronto right from the beginning. We still treat it that way.
And this action by the World Health Organization I think fails to recognize that.
RAY SUAREZ: Well, the travel advisory has a life span of three weeks. Isn’t it better in one way to clamp down a little bit and maybe take this hit and then get a clean bill of health from the WHO?
CASE OOTES: Well, I think, you know, the Center for Disease Control took the appropriate approach. They advised people that it’s perfectly safe to travel to Toronto.
The problem with the three weeks is that, you know, the world now views us as a place not to come, unlike the advisory by the CDC, which still said that it’s safe to come to Toronto.
And I’d like to know who from the World Health Organization contacted our health people. No one that I know of has contacted our minister of health or certainly not our local medical office of health or the provincial officer of health.
RAY SUAREZ: Denis Aitken, was that decision made in consultation with Canadian authorities?
DENIS AITKEN: In consultation I would say no. What happened was our office in Washington, the Pan-American Health Organization yesterday contacted the Canadian federal authorities. But we don’t act in consultation with. If we did so, you would see what would happen. We would not actually take the action because every time we take the action people naturally are concerned about it. We act after talking to but not in consultation with.
RAY SUAREZ: But are you… do you appreciate Toronto’s concern over the travel warning and why it is very worried about getting out from under it once it runs its course?
DENIS AITKEN: I think that’s right. But in your piece as you built up to this, you explained the measures that Toronto was already worried about with individuals taking their own personal decisions about not traveling to Toronto.
What we’ve done now is simply add to that by ensuring that there’s a global alert on the situation. So that people share the same information globally rather than have to rely on their individual country advice. It’s true to say though that in three weeks’ time we will be reviewing this. We also review it on a daily basis to continue to monitor the situation.
RAY SUAREZ: Deputy Mayor, how is the warning put in place by the American Centers for Disease Control different from the one from the World Health Organization?
CASE OOTES: Well, it’s simply advised that people, when they come to Toronto should stay away from hospitals but that they should feel free to move around the rest of the city without fear of contracting the disease.
And I can assure you that the situation here is totally different than it is in the East, in the Far East. You don’t see people in Toronto walking around with masks. You only see that in the hospital environment. People in Toronto are going about their business as usual and taking the hygienic measures that we should all normally take.
RAY SUAREZ: And, finally, Mr. Aitken, do we know enough yet about the spread of SARS to know when a community becomes safer, when the risk is lowered?
DENIS AITKEN: We don’t know fully yet but our normal judgment in the case of previous unknown diseases was that two periods of incubation, namely twenty, twenty-one days of no cases arising is significant enough in this case for us to be able to lift the potential travel restrictions that we’ve imposed.
RAY SUAREZ: Denis Aitken and Deputy Mayor Ootes, gentlemen, thank you both.
DENIS AITKEN: Thank you.