X-Message-Number: 21853
Date: Sun, 1 Jun 2003 07:20:02 -0700 (PDT)
From: Christine Gaspar <>
Subject: sars articles 

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Hi again. I thought it might be interesting to post the articles from the 
Toronto Star since yesterday. For your reading enjoyment, the following 3 
articles are related to the last message I sent, the update on SARS. The first 
article is the one I was referring to in my last message. I hope this message 
isn't too long to fit cryonet.
Christine Gaspar
May. 31, 2003. 08:31 AM RELATED LINKS >
More SARS coverage >
Opinion: More nurses needed (May 29) >
Dispute brews over numbers (May 29) >
City of Toronto: SARS facts >
CDC report on SARS among health workers >
Telehealth Ontario >
Health Canada: Public Health >
World Health Organization warning >
CDC: SARS warnings SARS alert ignored: Nurses
Doctors deny they failed to heed warnings about family 
`There was no link to any SARS patients:' North York MD


A family cluster of five people with SARS-like symptoms went undetected at North
York General Hospital in the weeks leading up to the announcement that a new 
wave of the deadly respiratory infection was sweeping through the hospital. 

Nurses say they raised serious concerns which were dismissed by doctors. Even a 
member of the exposed family pleaded with hospital staff: "Does anybody realize 
we all have this thing?" 

Still, not enough was done, charge two emergency room nurses who spoke to the 
Star yesterday on condition of anonymity, for fear of being fired. 

"There was a hurriedness to be done with SARS," said one. 

Dr. Glenn Berall, co-chair of the hospital's SARS management team, denied the 
accusations: "I don't have the same impression as the nurses. I respect their 
professional opinion, but I don't have the same impression." 

During this time, through patient transfers and walk-in traffic, SARS was 
spread, leading to the current outbreak at five health-care centres and 
thousands of people being quarantined in the community. 

Throughout the investigation, Toronto Public Health said it was not SARS because
there was no visible link to SARS cases. 

The investigation included an examination of suspicious cases in other parts of 
the hospital. 

"We sounded alarm bells, which were silenced, days before it became undeniable,"
said one of the nurses. 

They said they still have concerns about the way North York General is treating 
SARS. For example, the hospital's SARS unit is so overloaded with patients that 
some suspected SARS cases are being treated in emergency. The nurses say the 
only barrier protection provided are some hastily erected shower curtains, which
they say they had to fight to have installed. Typically, people with SARS 
symptoms are treated in isolation, in a negative-pressure hospital room if 

Staff concerns boiled up on May 20, just after the Victoria Day holiday weekend.
Staff say they told their superiors they feared a SARS outbreak in the hospital
because a family of patients had SARS-like symptoms. 

They say Berall, along with Dr. Barbara Mederski, the hospital's infectious 
disease specialist, dismissed their concerns. Mederski did not respond to calls 
from the Star over the past two days. A hospital spokesperson said she was 
having "some well-deserved rest." 

Hospital president Bonnie Adamson, a nurse, knew of the meeting, but did not 
attend. She was unavailable for comment yesterday. Nurses say she has been 
trying to advocate on their behalf. 

Berall said public health officials investigated the family cluster, but ruled 
out SARS, given what they knew about the virus at the time. 

"The original diagnosis of SARS required an epidemiological link. ... This 
particular family didn't have an epidemiological link. There was no link to any 
SARS patient or to travel in China and, therefore, the diagnosis of SARS 
couldn't be made," he said. 

Now public health officials say a SARS diagnosis may not require such a link. 

"There's an expression in English, hindsight is 20-20. All the experts are 
experiencing that along with us," Berall said. 

Here's how the outbreak developed at North York General, according to the 
nurses, public health officials, doctors and a hospital spokesperson. 

It took place in an atmosphere of increasingly relaxed restrictions on mask 
wearing and other protocols instituted as a result of Toronto's original SARS 
outbreak. Nurses interviewed include the media in a list of groups that they 
believe contributed to the relaxed vigilance. They note that, after the World 
Health Organization removed the travel advisory against Toronto on April 29, the
media dramatically scaled back coverage of the disease. 

At North York General Hospital, in mid-April, a 96-year-old man arrived at 
emergency with a fractured collarbone and pelvis. He had an operation April 19. 
The man was short of breath, which staff at the time attributed to his broken 
collarbone and post-operative atelectasis, or a partially collapsed lung. He 
died May 1, still without anyone thinking he had SARS. He had been treated on 
the fourth floor, in the orthopedic ward. 

`Hindsight is 20-20. All the experts are experiencing that along with us.' 

Dr. Glenn Berall, co-chair of North York General's SARS management team 


The following week, on May 10, the man's 90-year-old wife developed 
pneumonia-like symptoms and came to North York General Emergency. She was 
admitted. Doctors, nurses say, decided she got pneumonia due to exhaustion. She 
has since died. 

Then, on the May 17-18 weekend, the couple's 67-year-old daughter and her 
husband came to emergency with similar symptoms. They were both admitted. 

Later, either on May 18 or 19, that couple's daughter (the granddaughter of the 
96-year-old patient) came into the hospital with SARS-like symptoms. 

The nurses said chest x-rays of the family members showed some type of pneumonia
and were identical to x-rays of known SARS patients. 

Worried about the number of her relatives becoming ill, the 67-year-old woman 
contacted the hospital, according to the nurses, and asked a staff member, "Does
anybody realize we all have this thing?" 

The cluster of SARS-like cases in one family prompted the nurses to take action 
on May 20. They requested a meeting with Berall and Mederski, which was attended
by about 20 nurses, along with administration officials, a pharmacist and 

The nurses said they were sure there was an outbreak of SARS in the hospital. 
They said they were worried about colleagues in other parts of the hospital   
like those on the fourth-floor wing where the 96-year-old patient had been 
treated   who were not wearing protective garb like their ER counterparts. 

"It was too much to be a coincidence," said one nurse. She said some other 
doctors agreed with them and said the family cluster is either SARS or "the most
amazing coincidence." 

But the concerns fell on deaf ears, they charge. 

"(Berall and Mederski) were basically saying we don't need to (wear our masks), 
it's over, there's no SARS; he was saying you guys are overreacting," the nurses

Several people walked out of the meeting in disgust, they said. 

Berall recalls it differently: "They opted to spontaneously come and they all 
seemed to appreciate having the opportunity to have a conversation." 

Two days later   on May 22   public health officials went public with news of 
the new outbreak at North York General Hospital. 

"Staff are pouring in sick," the nurses now lament, certain that had their 
concerns been immediately heeded, the outbreak would not be as bad. 

Those sick with SARS include 15 nurses from the fourth floor orthopedic wing and
two doctors. 

A pharmacist and a hospital case manager are considered "under-investigation" 

One of the sick nurses is on a ventilator in the intensive care unit. She is the
mother of the student from Father Michael McGivney Catholic Academy in Markham 
that was recently closed after that student developed SARS symptoms. 

Berall said the five family members were officially diagnosed with SARS May 23 
after a meeting attended by him, Mederski, microbiologist Dr. Donald Low, and 
officials from Toronto Public Health. 

Berall insists that, knowing what he did at the time, the hospital went beyond 
the call of duty to protect staff. 

"What's really important here," he told the Star, "(is) we did it different than
almost every other emerg in the city by going more cautious." Others, he said, 
"completely de-masked and left the masking of their (ER) triage nurses, who 
first greet and evaluate the patients, at the call of the triage nurses. We did 

"The nurses in triage were masked and gowned and (wore) protective gear. For the
rest of the emerg, we had identified that for patients with any respiratory 
illness we would continue the masking and garbing policy. So we set up something
different than the majority of the rest of the city in order to be cautious and
conservative. I think that probably shows a lot of foresight and it shows a lot
of caution."

Jun. 1, 2003. 01:00 AMEndurance of nurses is more than heroic

SARS-weary nurses demand danger pay 

May 29. 

Our health-care workers richly deserve some added compensation, free beverages 
and more fluid breaks. Having worked many shifts in plastics, double plastics, 
double gloves, booties, glasses, etc., I take my hat off to these brave souls. 
After a 12-hour shift, working in their non-breathing getup, they go home 
feeling like a rag doll. To endure this for weeks on end is not just heroic, 
it's amazing! 

Dehydration is insidious. Covering your skin for many hours with rubber and 
plastic makes you sweat like a horse. Sweat drips in your glasses. How do you 
clean them without possible infection? Fluid breaks are missed because you're so
bushed you don't want to bother getting in and out of plastics except for 
nature calls and mealtimes. 

Dehydration sets in, causing headaches, irritability, frustration and severe 
fatigue. Ever try to handle pills or instruments with rubber gloves? 

Our media reporters and politicians should walk a mile in their shoes for one 
12-hour graveyard shift. I'd like to see their impressions, especially the last 
five hours. Then tell us who deserves generous "plastics pay" and free 
beverages. It's the least we can do. 

Scott Young, Port Hope, Ont. 


Jun. 1, 2003. 08:18 AM RELATED LINKS >
More SARS coverage >
Opinion: More nurses needed (May 29) >
Dispute brews over numbers (May 29) >
City of Toronto: SARS facts >
CDC report on SARS among health workers >
Telehealth Ontario >
Health Canada: Public Health >
World Health Organization warning >
Has outbreak peaked? >
Should I wear a mask? >
Will pools, saunas spread SARS? >
Difference between 'suspect' and 'probable' >
Will EI compensate victims? >
Virus spread by droplets Nurses demand SARS probe
Officials investigating four deaths feared linked to disease
Mourners at R.S. Kane Funeral Home urged into isolation


Ontario's nurses are calling for an independent review to determine why warnings
of Toronto's latest SARS outbreak went unheeded by senior North York hospital 

The demand for an inquiry by Doris Grinspun, executive director of the 
Registered Nurses Association of Ontario, came as public health officials 
confirmed that four recent deaths are being investigated in connection with 
SARS. The officials have also urged more people into isolation. 

Grinspun, whose organization represents 16,000 Ontario nurses, has called for a 
team of outside experts to launch a public inquiry, examining what she says were
repeated warnings from nurses that the virus had entered North York General 

"We are demanding an external, full review of this situation," Grinspun said 
yesterday in reaction to a story in the Saturday Star that detailed how, weeks 
before it was made public, nurses were warning that a new wave of the deadly 
respiratory infection was sweeping through the hospital. 

"We can't continue to allow nurses to ring the alarm bell and not be taken 
seriously," Grinspun said. 

"This is a systemic problem," she added, "nurses giving warning signs   and they
aren't listened to." 

Also yesterday, Dr. Barbara Yaffe, the city's associate medical officer of 
health, asked anyone who visited the R.S. Kane Funeral Home at 6150 Yonge St. on
May 22 for an afternoon or evening viewing, and anyone who attended a funeral 
at St. Mary's Armenian Church on May 23 at 11 a.m. and burial at York Cemetery 
to isolate themselves and contact city public health officials. 

Public health officials say the man likely died of SARS, although that wasn't 
known at the time of his death. Now a female member of his family is a suspect 

Funeral home owner John Kane said about five of his employees are in isolation, 
but Kane said the facility remains open. 

Although Yaffe would not release the name of the deceased person, she said the 
individual is not connected to the four deaths earlier this week at Scarborough 
Centenary Hospital that are now being investigated. 

As a result of that investigation, the emergency department and out-patient 
clinics at the east-end hospital have been closed. 

"We don't know if (the deaths) are SARS-related or not," Ontario's chief medical
officer of health Colin D'Cunha told reporters yesterday. 

"But we are approaching them as though they are." 

So far, no health-care workers or other patients at Scarborough Centenary appear
to be sick, he added. 

To date there have been 30 deaths related to SARS, not including the four now 
under investigation. 

As well, there are currently 45 probable cases being treated in hospital   14 in
critical or deteriorating condition. 

About 7,350 people and 466 health-care workers in the Toronto area are in 
quarantine due to the second SARS outbreak which is centred at North York 
General Hospital. 

The Saturday Star reported the concerns raised by two emergency room nurses in 
mid-May over a cluster of five family members with SARS-like symptoms. 

When nurses tried to tell doctors of their suspicions, they said, they were 

But Dr. Glenn Berall, co-chair of the SARS management team and chief of 
pediatrics at the hospital, said he got no such impression. 

Grinspun said it's "unfortunate" Berall and his colleagues didn't take the 
nurses more seriously. 

Ontario health officials could not be reached for comment on the nurses' demands
last night. 

The disease is taking its toll on the nursing profession: 

 A source said at least two nurses are critically ill with SARS and that one, at
 North York General, is the mother of a Markham student also sick with SARS. 
 The other, at Sunnybrook & Women's College Health Sciences Centre, provided 
 care for quarantined nurses; her husband has since died of SARS. 

 At least 20 nurses at North York General are patients sick with SARS. 

At least one nurse has quit for fear of contracting the disease. 

Marcia Taylor, the Ontario Nurses Association vice-president representing 18 
locals in the GTA, said Toronto-area nurses knew SARS never disappeared, adding:

"Our members were telling us of people with classic SARS symptoms coming into 
hospital. It appeared government was more focused on the protection of the 
Toronto tourist industry than the health of our health-care workers and members 
of the public." 

There are about 35 patients with SARS now at North York General, said Dr. Donald
Low, chief of microbiology at Mount Sinai Hospital. A leader in Toronto's SARS 
fight, Low believes the epidemic reached a peak at the beginning of the week, 
and he said: 

"The worst is behind us. ... Just because you are reporting people today, it 
doesn't mean they got the disease today." 

At yesterday's news conference, D'Cunha said public health officials are 
particularly concerned about students at Father McGivney Catholic Academy where 
students were forced into quarantine last week after a Grade 11 student 
developed SARS symptoms. 

A McGivney student was detained by police officers on Friday at the Markville 
Shopping Centre, Constable Kennedy Baker of the York Regional Police said. 

Police referred the problem to local health authorities, and the mall has since 
hired a police officer to monitor other violations of quarantine. 

Medical officials say the outbreak at North York General occurred in an 
atmosphere of relaxed restrictions on mask wearing and other infection control 
protocols instituted to deal with Toronto's original SARS outbreak. 

One puzzle, Low said, is determining how a 96-year-old man, admitted to North 
York for a pelvic operation, first caught SARS. 

What is known is that he seems to be the "index" or first identified case of 
SARS at the hospital. When the man died May 1 it was thought he had 
post-operative pneumonia. Members of his family are also ill. 

On May 10, the man's 79-year-old wife developed pneumonia-like symptoms 
resembling SARS and went to North York General. 

Doctors said she had pneumonia due to exhaustion. 

The following weekend the man's 67-year-old daughter and husband came to emerg 
with similar symptoms. Both were admitted. 

The granddaughter of the index case also suffered SARS-like symptoms and came 
into hospital. 

The nurses who noticed the family cluster requested a meeting with Berall and 
other hospital officials on May 20. 

The nurses say they were told they were overreacting; two days later, on May 22,
public health officials announced the outbreak at the hospital. 

With files from Gavin Taylor 





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