SARS Scare Hit Hard In Canada

Karen Green still gets weepy when she talks about severe acute respiratory syndrome.

"The analogy that I kept saying to people is: If somebody had dropped a bomb in the middle of Toronto, that was the level of intensity that we were experiencing in the hospitals.

"Day in, day out. Day in, day out. It was one bomb after another," says Green, 46, who months after the SARS outbreak ended confesses the stress of the battle has left her feeling "very fragile."

Another health-care worker, Jean, admits colleagues worried about the possibility SARS will return this winter flinch whenever it is mentioned.

"We try not to use that word. It's a four-letter word," adds Jean, an infection control practitioner who asked that her real name not be used.

Like most people caught up in the battle, Green remembers the details of the long weeks in crystalline detail, particularly those of the night of her introduction to the disease.

A former infection control practitioner at Mount Sinai Hospital who now works in infectious disease research there, she was in the office of colleague Dr. Allison McGeer, an expert in the field. McGeer took a frantic call from Scarborough Grace Hospital in the east end of the city.

"Life as we knew it stopped at that moment. There was nothing else," Green says.

That night, March 13, marked the point at which it became apparent a new, as yet unnamed disease that was ravaging parts of China, that would soon be called "a worldwide health threat" by the World Health Organization, had found its way to Toronto's hospitals.

Scarborough Grace was worried the family of a man who had died that day was showing suspicious symptoms.

Agnes Wong, the hospital's patient care manager for intensive care, had seen reports in Toronto's Chinese community newspapers of a respiratory illness in mainland China. She urged a nurse to ask if anyone in the family had recently traveled to China. Yes was the answer.

As McGeer gathered information, Green sat down at a computer and discovered the WHO had issued an alert the previous day. A quick call to Dr. Danuta Skowronski, an influenza expert at the British Columbia Centre for Disease Control, revealed the stunning news that Vancouver too had what it believed to be a case of the new disease.

SARS made its way to two of Canada's biggest centers at the same time by freak chance. Travelers from each city stayed in a Hong Kong hotel near a Chinese doctor who was dying of the disease. A man from Vancouver and an elderly woman from Toronto became unwitting international disease couriers.

Vancouver officials, nervous about reports of avian influenza in Hong Kong, had been on the lookout for sick travelers returning from Asia. When their first SARS case turned up in hospital he was quickly isolated. The rapid response may have saved the city from a SARS disaster.

But in Toronto, Kwan Sui-chu never went to hospital. She died at home, tended by her family. She never knew she was the first Canadian to succumb to a new disease that would wreak panic and economic chaos and push the city's health-care system to the brink of collapse.

In the long weeks of SARS's hegemony in the Toronto area, 44 people died and 375 people were diagnosed with probable or suspect SARS. A staggering 169 of those people, 45%, were health-care workers. Three of them died.

It quickly became evident the place SARS loved best was a hospital. A crowded hospital with lots of sick people and vulnerable lungs and health-care workers inured to the dangers of being in very close contact with very sick patients.

The disease's highest toll was on those health-care workers, who paid - and continue to pay - in the currency of ill health, lost colleagues and shattered confidence.

"Nobody ever thought that this kind of job they could potentially die from," says Pat Tamlin, 43, an ICU nurse who caught SARS in the early days at Scarborough Grace and was off work until mid-June.

"I was never afraid to go back in the door. It never even entered my head until people asked me about it after," Tamlin admits.

"But I'm not going to lie to you.... There's a lot of people who were less sick than I was, and I don't want to compare sicknesses, but emotionally they couldn't handle going back to work. And some people still are not back at work fully."

To understand the forces behind that fact, one needs to know what it was truly like in hospitals during the outbreaks. But cameras and journalists were barred from entering. Only the people who lived it bore witness to the panic, the chaos, the heroism, the pain.

"People just can't understand ... exactly what happened and the magnitude of it," says Dr. Donald Low, an infectious disease expert who emerged as a leader in the fight to contain SARS.

For many, fear was a constant. Fear they would catch it. Fear they'd spread it. Fear they'd bring it home to their loved ones. Most dealt with it by putting up barriers between themselves and those they wanted to protect.

"You cannot appreciate, I don't believe, what the feeling of isolation was. Physical isolation," says Green, who works with McGeer and Low at Mount Sinai and deep in the fray during the first outbreak.

"You're talking about people who are working to their maximum. Beyond their maximum. Pushing themselves to their absolute physical and mental and emotional limits while going around in a mask, unable to touch anyone. No physical comfort whatsoever.

"You see nothing but people's eyes for days on end."

Tamlin and 13 other ill Scarborough Grace workers were cared for at West Park Health Care Centre, a respiratory hospital where a mothballed tuberculosis ward was turned into a SARS unit in six whirlwind hours.

The hospital's chief of staff, Dr. Peter Derkach, felt he needed to set an example. He volunteered to work the SARS unit.

"It was frightening when these patients - well, health-care workers - were coming in there. And of course, I was gowned and masked and gloved. And they were looking at me and saying: `But you know what? So was I. And I still got it.'

"That didn't make me feel very confident," Derkach admits.

Being able to send those patients to West Park lifted a particularly onerous burden for those who remained healthy at Scarborough Grace.

"How terrible it is if you need to have to look after your own colleague," Wong explains. When word came that several children of the sick health-care workers had come down with the disease, "it broke people's hearts."

Even as knowledge about the disease grew, health-care workers continued to fall ill, often as they helped with the risky task of inserting a breathing tube into a SARS patient's overcome lungs. Each new admission of a health-care worker devastated morale.

"Emerg would just kind of fall apart because `Oh, no, it's a staff member,"' says Jean.

McGeer started experiencing symptoms of SARS on the day Carlo Urbani, the WHO doctor who first alerted the world to the new disease, died. Hearing of his death and her illness on the same day petrified her colleagues.

To make matters worse, people who worked closely with her, including Low, were placed in quarantine. An army with too few troops temporarily lost several of its key generals.

Dr. Monica Avendano was working at West Park with Derkach when they heard the news.

"And I think that at that point we both said a few bad words," admits Avendano, a respirologist. "That was a bit of a shock."

There was too much work to do and too few people to do it. And some would not help.

"Some people just refused. You saw doctors refuse to come — period," Low recalls.

Others did, hurrying in from across the country to help. Margie Foster, an infection control practitioner at Grand River Hospital in Kitchener, Ont., was one who answered the call.

Foster, who slaved long hours to ensure her own hospital and its staff were ready for SARS if it hit Kitchener, came to Toronto during the second outbreak in late May at McGeer's request. She was stunned by what she saw.

"Everyone around the table was just utterly exhausted. I mean utterly exhausted."

Fear still reigned, a fact driven home to Foster when she spotted an oddly garbed technician taking blood from patients.

"She had on way more gear than she needed. Way, way more protective gear than she needed. Two hair nets, two isolation gowns, two pairs of gloves, a mask and a face shield."

The soft-spoken Foster gently tried to dissuade the technician from wearing such excessive apparel; the woman wasn't working anywhere near a SARS unit.

"Her look to me was like: `You can tell me anything you want. This is what I'm doing to protect myself."'

Stress melted weight off some health-care workers. Others packed on pounds. Tears were never very far away.

"I cried in every senior administration office one day. In one day," Jean notes. "I think by the end of it (the outbreak) that wasn't a record."

She also fell asleep one day making her bed. "All I did was lay down to get the corner done and I was asleep."

For most, though, sleep was much more elusive. And for many of the shell-shocked health-care workers who saw Toronto hospitals through this period of intense crisis, it remains so.

"I haven't been not tired since the 13th of March," Green admits. "I do sleep now. It doesn't quite make you feel rested."