SARS: The Toronto Experience

Phase 1 and Phase 2 SARS Cases by Status in Ontario as of June 26, 2003

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Date of Onset

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Phase 2 - Suspect

Phase 1 - Suspect

Phase 2 - Probable

Phase 1 - Probable

Notes: i) Phase 1 cases are based on Health Canada case definitions prior to May 29, 2003. Phase 2 cases are based on revised Health Canada definitions effective May 29, 2003. ii) A Probable case w ith an April 19, 2003, date of onset is under review .

SARS Toronto: Phase I & II

Age group

Phase I Phase II

N % N %

<18 18 7 2 2

18-35 71 28 20 17

36-64 132 51 70 59

>64 36 14 26 22

Total 257 100 118 100

Case Distribution by Age Group

Age group

Phase I Phase II

N % N %

<18 0 0 0 0

18-35 0 0 0 0

36-64 10 38 6 31

>64 16 62 11 69

Case Fatality by Age Group

SARS Toronto: Phase I & II

Exposure

Phase I II

No. (%) No. (%)

Hospital - worker - patient/visitor

91 (33%)49 (18%)

52 (42%)

64 (51%)

Other healthcare (clinic, EMS)

8 (2.9%)

2 (1.6%)

Household contact 76 (28%) 9 (7.2%)

“Community” Travel

16 (5.9%)12 (4.4%)

--

Under investigation 21 (7.7%)

-

The Problem:

The unrecognized patient

Index Case

(Mother)

Returns to Toronto and develops pneumonia that week

Sunday, February 23

Index Case

(Mother)

Dies at home

Wednesday, March 5th

Index Case

(Mother)

Cared for mother at home and develops pneumonia

Mr. T

(Son)

Index Case

(Mother)

Admitted to SGH

Mr. T

(Son)

SGH

Friday, March 7th

PPP

ATM

Outpatient

Entrance

Drug Store Emergency

EntranceSecurity Emergency

Registration

Emergency

Nurse

Admitting

Vending

Machines

Waiting Room

Trauma

Room

Room 1

Room 2

Room 3

Room 4

Room 5

Room 6

Stock

Room

Room 7

Room 8

Room 9

Eye Room

Fracture

Room

Soiled

Linen

Show er

W CW C

Observation Room

Nursing Station

Ante

Room

Bed 1

Bed 2

Bed 3

Bed 4

Bed 5

Bed 6

Bed 1 Bed 2 Bed 3

Bed 4 Bed 5

Bed 8 Bed 7 Bed 6

Bed 1

Bed 2Bed3

Grace DivisionEmergency Department

March 7

Morning of Thursday, March 13th

Intensive Care Unit SGH

Mr. T

PPP

ATM

Outpatient

Entrance

Drug Store Emergency

EntranceSecurity Emergency

Registration

Emergency

Nurse

Admitting

Vending

Machines

Waiting Room

Trauma

Room

Room 1

Room 2

Room 3

Room 4

Room 5

Room 6

Stock

Room

Room 7

Room 8

Room 9

Eye Room

Fracture

Room

Soiled

Linen

Show er

W CW C

Observation Room

Nursing Station

Ante

Room

Bed 1

Bed 2

Bed 3

Bed 4

Bed 5

Bed 6

Bed 1 Bed 2 Bed 3

Bed 4 Bed 5

Bed 8 Bed 7 Bed 6

Bed 1

Bed 2Bed3

Grace DivisionEmergency Department

March 16

Mr. P arrives in the emergency department with a LRTIOn respiratory precautions from time of admission

PPP

ATM

Outpatient

Entrance

Drug Store Emergency

EntranceSecurity Emergency

Registration

Emergency

Nurse

Admitting

Vending

Machines

Waiting Room

Trauma

Room

Room 1

Room 2

Room 3

Room 4

Room 5

Room 6

Stock

Room

Room 7

Room 8

Room 9

Eye Room

Fracture

Room

Soiled

Linen

Show er

W CW C

Observation Room

Nursing Station

Ante

Room

Bed 1

Bed 2

Bed 3

Bed 4

Bed 5

Bed 6

Bed 1 Bed 2 Bed 3

Bed 4 Bed 5

Bed 8 Bed 7 Bed 6

Bed 1

Bed 2Bed3

Grace DivisionEmergency Department

March 7

PPP

ATM

Outpatient

Entrance

Drug Store Emergency

EntranceSecurity Emergency

Registration

Emergency

Nurse

Admitting

Vending

Machines

Waiting Room

Trauma

Room

Room 1

Room 2

Room 3

Room 4

Room 5

Room 6

Stock

Room

Room 7

Room 8

Room 9

Eye Room

Fracture

Room

Soiled

Linen

Show er

W CW C

Observation Room

Nursing Station

Ante

Room

Bed 1

Bed 2

Bed 3

Bed 4

Bed 5

Bed 6

Bed 1 Bed 2 Bed 3

Bed 4 Bed 5

Bed 8 Bed 7 Bed 6

Bed 1

Bed 2Bed3

Grace DivisionEmergency Department

March 16

Mr. P arrives in the emergency department with a LRTIOn respiratory precautions from time of admission

PPP

ATM

Outpatient

Entrance

Drug Store Emergency

EntranceSecurity Emergency

Registration

Emergency

Nurse

Admitting

Vending

Machines

Waiting Room

Trauma

Room

Room 1

Room 2

Room 3

Room 4

Room 5

Room 6

Stock

Room

Room 7

Room 8

Room 9

Eye Room

Fracture

Room

Soiled

Linen

Show er

W CW C

Observation Room

Nursing Station

Ante

Room

Bed 1

Bed 2

Bed 3

Bed 4

Bed 5

Bed 6

Bed 1 Bed 2 Bed 3

Bed 4 Bed 5

Bed 8 Bed 7 Bed 6

Bed 1

Bed 2Bed3

Grace DivisionEmergency DepartmentMarch 16; 22:45-23:30

Index Case Case A

(Mother) (Son)

Mr. P

Mr. P’swife

Index Case Case A

(Mother) (Son)

Mr. P

Mr. P’swife

16 persons

9 persons

Index Case Case A

Mr. D

(Mother) (Son)

Mr. P

Mr. P’swife

16 persons

9 persons

PPP

ATM

Outpatient

Entrance

Drug Store Emergency

EntranceSecurity Emergency

Registration

Emergency

Nurse

Admitting

Vending

Machines

Waiting Room

Trauma

Room

Room 1

Room 2

Room 3

Room 4

Room 5

Room 6

Stock

Room

Room 7

Room 8

Room 9

Eye Room

Fracture

Room

Soiled

Linen

Show er

W CW C

Observation Room

Nursing Station

Ante

Room

Bed 1

Bed 2

Bed 3

Bed 4

Bed 5

Bed 6

Bed 1 Bed 2 Bed 3

Bed 4 Bed 5

Bed 8 Bed 7 Bed 6

Bed 1

Bed 2Bed3

Grace DivisionEmergency Department

March 7

Index Case Case A

Mr. D

(Mother) (Son)

Mr. P

Mr. P’swife

9 persons

21 persons

16 persons

Index Case Case A

Mr. D

(Mother) (Son)

Mr. P

Mr. P’swife

24 persons

9 persons

21 persons

Index Case Case A

Mr. D

(Mother) (Son)

Mr. P

Mr. P’swife

24 persons

9 persons

21 persons

15 persons

Index Case Case A

Mr. D

(Mother) (Son)

Mr. P

Mr. P’swife

Mr. R?

24 persons

9 persons

21 persons

15 persons

Index Case Case A

Mr. D

(Mother) (Son)

Mr. P

Mr. P’swife

Mr. R?

9 persons

21 persons

15 persons

16 persons

Index Case Case A

Mr. D

(Mother) (Son)

Mr. P

Mr. P’swife

Mr. R?

9 persons

21 persons

15 persons

7 persons

16 persons

Index Case Case A

Mr. D

(Mother) (Son)

Mr. P

Mr. P’swife

Mr. R?

9 persons

21 persons

15 persons

7 persons

16 persons

Wednesday March 26th

Provincial emergency declared Directives for all hospitals formulated

over weekend Stopped transfer of patients and staff

between health care centers Created SARS units in all hospitals Restricted access to hospitals including

visitors Screening of all persons accessing hospitals Institution of precautions