2003-11
April 23, 2003
5 pm

Advisory

Update #37 - Severe Acute Respiratory Syndrome

New in this update:

• Latest Canadian Numbers on SARS
• Health Canada Reaction to WHO Travel Advisory

Latest Canadian Numbers on SARS

As of April 23, 2003, Health Canada has received reports of 330 probable or suspect cases of severe acute respiratory syndrome (SARS) in Canada. There have been 16 deaths in Canada. To date, transmission has been limited to specific transmission settings such as households, hospitals and specific community settings. The information contained in this update is based on the information available to Health Canada at this time.

The details of the cases to date are as follows:

• Ontario is reporting 136 probable and 131 suspect cases.
• British Columbia is reporting 4 probable and 47 suspect cases.
• New Brunswick is reporting 2 suspect cases.
• Saskatchewan is reporting 1 suspect case.
• Alberta is reporting 5 suspect cases.
• Prince Edward Island is reporting 4 suspect cases.

So far, 127 people have been discharged from hospitals in Ontario. These people were treated as suspect cases or as probable cases.

These numbers are accurate as of 1:00 pm. Eastern Daylight Saving Time, April 23, 2003. For specific information on the provincial numbers, please contact the appropriate provincial health department.

Health Canada Reaction to WHO Travel Advisory

On April 23, the World Health Organization (WHO) extended its recommendation to postpone non-essential travel to include Toronto.

Health Canada does not support the WHO's position; it is safe to travel to Toronto.

We have a clear understanding of the specific settings in which this virus has been transmitted in Canada and confidence in the steps being taken to manage infection control.

A CDC travel alert provides a more accurate assessment of the situation in Canada. It states that: "Currently, all cases in Toronto are linked to Toronto's original index case and spread has been through person-to-person contact. SARS transmission in Toronto has been limited to a small number of hospitals, households, and specific community settings."

Health Canada will be formally challenging the WHO's assertion that Toronto is an unsafe place to visit through a letter to be sent today to the WHO.

Health Canada Investigation with Officials from the U.S. Centers for Disease Control and Prevention

On April 20, Health Canada invited officials from the U.S. Centers for Disease Control and Prevention (CDC) to come to Canada to lend their expertise to a Health Canada-led investigation.

They will be assisting Health Canada officials as they spend time in hospitals in Toronto, gathering information in order to compare the circumstances surrounding those who were infected to those not infected.

Health Canada and the CDC will report as soon as possible, outlining the probable cause of the transmission among health-care workers and recommendations for additional measures that may be taken to prevent further spread.

Protecting Canada's Blood Supply

Health Canada issued formal direction to blood operators on April 10, 2003, as a precaution, to protect the blood supply in Canada and recipients from the possible threat of SARS. Although there is currently no evidence of transmission of SARS through blood and blood components, Health Canada has directed blood operators, to temporarily defer from donating blood (for a period of 10 days) from persons who have:

• traveled within the previous 10 days to an affected area outside Canada. The affected areas are currently: China, including the Hong Kong Special Administrative Region; Hanoi, Vietnam; Singapore and Taiwan;
• been a patient, worked in, or visited a facility that is under quarantine for SARS.

Health Canada has requested that provincial public health officials, when investigating possible SARS cases, ask whether the individual has donated blood. If the individual has donated blood within 10 days prior to the first day of symptoms such as fever, public health officials are asked to notify Canadian Blood Services and Héma-Québec. The donor's blood and blood products will be withdrawn from the inventory.

Information for Travelers Expanded

Since Thursday, April 10th, as an added precautionary measure, Health Canada has arranged for in-flight distribution of the yellow health alert card by flight attendants to passengers on all direct flights from Hong Kong, Singapore and Beijing.

Flight attendants will also ask passengers to fill out a traveller tracing form (also known as content information cards) that will enable health authorities to contact passengers over a two-week period after their arrival in Canada, if necessary. These forms must be filled out before clearing customs. This in-flight distribution will also be expanded to direct flights from other Asian destinations in the near future.

Most Recent Travel Advisory Information

For further information on Health Canada's travel advice, please see:
http://www.phac-aspc.gc.ca/tmp-pmv/2003/sars0423_e.html

Health Canada Support for Ontario

• At the request of Ontario, Health Canada shipped 10,000 masks to Toronto as a stop-gap measure until the province receives additional masks from its supplier. These masks are part of Health Canada's national emergency stockpile (National Emergency Stockpile System). Health Canada is also assisting to identify sources for masks in Canada and off-shore.
• Health Canada has deployed 14 staff to Ontario to assist Toronto's public health unit and the Ontario Ministry of Health with the investigation of the SARS cases. The department has also provided guidelines for infection control and recommendations on actions for public health settings.
• On March 31, 2003, Health Canada sent two mobile x-ray machines and processors to Toronto for two isolation units being set up in non-hospital facilities.
• Health Canada is ready to respond to additional requests for support from Ontario and other provinces and territories.

Health Canada's SARS Screening Initiative at Pearson Airport

• Since April 1, 2003, Health Canada has been informing all departing travellers from Pearson International Airport and Toronto Island Airport (since April 15) about SARS through the Health Alert Notice (cherry cards). Cards are also being distributed at Union Station in Toronto to people travelling by train.
• A Health Canada SARS Team of physicians and nurses have been deployed to Pearson to provide information to airline and airport staff.
• Passengers seeking further information are advised to call the Health Canada SARS Info Line at 1-800-454-8302.

Additional Key Health Canada Activities to date

• Continuous laboratory testing is underway at Health Canada's National Microbiology Laboratory in Winnipeg in a race to find the cause of SARS.
• Health Canada has expanded Health Alert Notice distribution at major airports in Canada. These Health Alert Notices ask passengers to see a physician if they begin to have any symptoms related to SARS. These symptoms include a fever over 38.0 degrees Celsius AND one or more of the following respiratory symptoms: cough, shortness of breath or difficulty breathing.
• Health Canada has sent staff to Pearson, Vancouver and Dorval International Airports to support airport staff.
• Health Canada's Workplace Health and Public Safety Programme (WPHSP) is providing advice to federal employers on occupational health and safety matters. Information sessions for federal employees are available, at the employer's request. To date, there have been more than 100 information sessions provided to federal staff at airports and workplaces. Such sessions continue to be available at the employer's request. The Programme issues updated advisories to provide federal departments with the most current information and advice available on SARS. Health Canada advises that the use of masks is not necessary in federal workplaces.
• Health Canada is collaborating and coordinating efforts with our counterparts across Canada, including the Chief Medical Officers of Health in each province and territory. Health Canada is chairing five Working Groups made up of experts dealing with such issues as infection control, treatment guidelines and public health measures.
• Health Canada is providing expertise, advice, personnel, and medical supplies and equipment to Ontario.
• Health Canada is also in daily contact with our partners worldwide, including the U.S. Centers for Disease Control and Prevention (CDC) as well the World Health Organization (WHO) in an effort to try and find the source and cure for this syndrome.
• Health Canada's collaboration is further facilitated with the presence of Health Canada staff at the WHO headquarters in Geneva. In addition, Health Canada and the CDC have exchanged staff members to work in each other's Emergency Response Centres.

Health Canada will continue to do everything it can to keep Canadians informed and will continue to work with the provinces and territories so that medical officers are fully informed and appropriate steps are taken to mitigate risk.

For additional information on SARS, please contact Health Canada's information line at: 1-800-454-8302.

For information on previous travel advisories to South East Asia issued by Health Canada and the World Health Organization, please see the following links:

World Health Organization issues emergency travel advisory (April 2, 2003)

Health Canada Travel Advisory (April 23, 2003)

For Media Enquiries:
Emmanuel Chabot
Health Canada
(613) 957-1803