On May 14, 2003 the World Health Organization (WHO) removed Toronto, Canada from the list of areas with recent local transmission. Toronto has also been removed from the list of areas for which WHO has issued recommendations pertaining to international travel.
The decision was made following a teleconference between Toronto and Health Canada officials and WHO. The teleconference, which was requested by Health Canada, reviewed the adequacy of data on the SARS situation in Canada and summarized the criteria and procedures used by WHO when making decisions about which areas should be included in the list.
The most important WHO consideration is whether 20 days have passed since the last locally acquired case was isolated or died. If no further cases have occurred for 20 days, which is twice the maximum incubation period for SARS, the chain of transmission is considered broken. The last locally acquired case in Canada was isolated on 20 April.
The greatest number of Canadian cases are in Toronto, and are traceable solely to people returning from Asia, members of their households and health-care workers who were in contact with these patients. The spread of the virus occurred during the early stages of the outbreak, before the world had been alerted to the severity of the disease, and before precautionary steps were taken by the Ontario health system. Since the situation was properly assessed, contacts and health care workers have been appropriately quarantined in order to contain the spread.
Based on the Ontario experience, Québec has taken preemptive measures, screening potential victims and quarantining people who might have been in contact with SARS patients. The result is that no cases whatever have been confirmed in the province as of this date, and the health system and the population are alerted to take action should suspected cases arise.
A number of people attended a business conference in Pointe Claire, and a man from Toronto who also attended was diagnosed with SARS after returning home. None of these people, all of whom were quarantined, displayed any symptoms. The quarantine period ended on Wednesday morning, April 23, 2003. None of the people in this group contracted SARS, or exhibited the symptoms.
The World Health Organization issued a travel advisory, including Toronto. The officials of the Canadian and the Ontario Governments were outraged at this, since they feel the spread of SARS has been contained and they are being aggressive in keeping it that way.
The Center for Disease Control in Atlanta on April 24, 2003, at a nationally broadcast news conference, said that it is NOT putting Toronto nor Canada on a "travel alert" or even a "travel advisory" status at this point in time. They have investigated the outbreak in Toronto (several hundred miles from Montreal) and are able to pinpoint every single reported case of SARS to one specific family or group that had traveled to China. Once the SARS was identified, there has been no spreading of the disease from normal everyday contact in Toronto.
WHO lifts travel advice for Toronto, effective April 30, 2003.
WHO Director-General Dr Gro Harlem Brundtland announced the evening of April 29, 2003, that the travel advisory for Toronto will be lifted, effective tomorrow.
Travel advisories for Beijing, Hong Kong SAR, and Guangdong and Shanxi provinces, China, remain in effect.
Travel advisories are issued following consideration of several factors, including the magnitude of probable SARS cases, the last dates of cases of community transmission, and the last dates of export of cases.
Dr Brundtland cited three changes in Toronto over the last week. The magnitude of probable SARS cases has decreased. Twenty days have passed since the last cases of community transmission occurred. No new confirmed exportation of cases has occurred.
WHO has also been assured by Canadian authorities that pro-active screening measures at airports will be implemented, as recommended by WHO.
There is no change in Toronto’s status as an “affected area.” Viet Nam, which is the first country to have contained its SARS outbreak, was removed from the list of affected areas yesterday.
For continuous updates, please check:
www.hc-sc.gc.ca/english/protection/warnings/sars/index.html
For answers to most questions you may have go to the FAQ from the Centres for Disease Control or to the FAQ from Health Canada.
The following is from the Health Canada Web Site: