Toronto was the only city outside of Asia to suffer from a serious outbreak of SARS. Its experience with SARS came in two stages. It was during the first outbreak that the world learned how deadly this virus was. The world community panicked over the virus and the World Health Organization issued a travel ban to Toronto for all but essential travel. Just as Toronto appeared to have recovered from SARS, it experienced a second outbreak which crippled the city once again. SARS held centre stage in world headlines with the crisis in Toronto being detailed in every report.
Toronto's outbreak, however, was confined to hospitals. It was there where people were diagnosed. It was there where SARS patients were treated. It was there where many SARS patients slowly recovered and it was there where many SARS patients died.
Even though SARS patients were placed in isolation units, away from a panicked community, they were not isolated from frontline healthcare workers. Nurses working in shifts around the clock had the duty to screen suspect SARS cases arriving at the hospital. Nurses also had the duty to work in the very isolation units containing the SARS virus. They had the obligation to treat and care for these patients. The nurses who risked their lives to this unknown virus were not only caring for the patients; they were also caring for the entire community of Toronto. Their brave actions saved Toronto from the spread of the deadly virus. Thanks, to their professional work, SARS did not spread throughout the community.
Timeline
On Feb. 15, 2003, China reports 305 cases of atypical pneumonia, later classified as Severe Acute Respiratory Syndrome or SARS. On Feb. 28, Sui-Chu Kwan, aged 78 of Toronto, seeks medical advice complaining of fever, cough and muscle tenderness. She has just returned from a trip to Hong Kong. She is prescribed antibiotics and sent home. Less than one week later, she dies. About one week after her death, her also son dies of SARS at Scarborough Hospital, Grace Division.
On March 17, Health Canada reports nine suspected cases of SARS in Ontario. A few days later, health officials in Hong Kong announce that epidemiologists had traced the illness back to a professor from China who was staying at the Metropole Hotel in Hong Kong. Since Sui-Chu Kwan had stayed at that hotel, the contagious link for Toronto has been established. Toronto's Chinatown becomes a ghost town due to the linkages made by panicked citizens.
The World Health Organization announces on March 22 that Toronto is an area of recent local transmission. The next day, Scarborough Hospital, Grace Division closes. On March 26, Ontario declares a public health emergency and orders thousands of people to quarantine themselves in their homes. A number of those quarantined for the mandatory 10 days are nurses. Their families are increasingly shunned by the community fearing an early link in a seemingly inevitable community outbreak. By now, there were 27 probable cases of SARS in the province and visitors are barred from Toronto hospitals.
On March 29, the Canadian government announces plans for screening all departing passengers at Toronto's Pearson International Airport. The next day, Public Health officials say that protective clothing should be worn by all hospital workers and this is followed by a further order from the province to extend its SARS-related restrictions on Toronto hospitals to hospitals across the province.
By April 1, the Canadian death toll reaches six and Ontario health officials begin to announce mandatory quarantine orders. Within a week, four more people die in Toronto. Over the next two weeks four more people die.
Several health-care workers at Sunnybrook Hospital show syptoms of SARS. The hospital closes its critical care, cardiovascular intensive care and SARS units for 10 days. Ontario's chief medical officer of health requests nurses to wear full face shields, double gowns and double gloves as a precaution. The changes come after as many as 15 staff contract SARS while intubating a patient with the disease.
On April 23, the World Health Organization issues a travel ban to Toronto for all but essential travel. By April 26, the Toronto death toll reaches 21. Thankfully, however, there is an interval of 20 days where there are no new cases of local transmission of SARS in Toronto. The World Health Organization lifts its travel ban. To all, it appears that Toronto has won the battle against this deadly disease.
The sense of victory was short lived when on May 24, 500 people are ordered into quarantine. Public health authorities confirm that they are looking at up to 33 new infections. By May 26, approximately 2,200 people are quarantined in the Toronto region. There are now 11 active probable cases and more than 24 suspected cases of SARS. By June 1, the death toll in Canada is at 30 - all in the Toronto area.
On June 13, Ontario health officials announce that they have discovered a the link between the first and second outbreaks of SARS in Toronto. Apparently, a woman was exposed to SARS on March 17 at Scarborough Hospital, Grace Division, the site of the original outbreak, passed it on to her daughter, a health-care worker at North York General. Officials believe the daughter passed it on to a 96-year-old patient while they were both on the same floor of the North York hospital. Within 10 days, the death toll rises to 38.
On, June 30 a 51-year-old nurse, Nelia Laroza dies from the infection. She is the first Ontario healthcare worker to die of the virus. She worked at North York General Hospital, one of the hospitals hit by an outbreak of SARS. Then on July 19, a 58 year old Toronto nurse, Tecla Lin dies of SARS that she had contracted while treating SARS patients.
A number of healthcare workers who contracted SARS are still struggling with the impact the virus had on them. For the City of Toronto, the SARS crisis has changed the meaning of being a nurse. Fortunately, there have been no new reported cases of SARS in Toronto since the death of these two nurses. Will SARS return? Even if it doesn't, nurses across Canada are more aware of the serious risks that they encounter while on healthcare's frontlines in their efforts to keep Toronto healthy.
Conclusion
Why did nurses risk their lives to care for these patients? Why did they not panic like the rest of the world? It may be because of a professional character represented by a pledge similar to one they first made when they entered the profession. The portrait titled I PROMISE is a reflection of the events which took place in Toronto in the first half of 2003. The words contained in the portrait are taken from the pledge of the International Council of Nurses founded in 1899 in Geneva affirming the common goals of all nurses around the world.
This 15" by 20" poster is available for purchase by sending $35.00 (includes taxes, shipping and handling) to the artist, Don Mayne, 49 Gloucester Street, Toronto, Ontario, M4Y 1L8.
Further information can be obtained by email to donmayne@gmail.com
