An increasing number of SARS cases in Canada's largest city is worrying the World Health Organization, which discussed the possibility of re-imposing a travel advisory on Toronto, a spokeswoman said Tuesday.
Health officials have reported 62 probable cases of severe acute respiratory syndrome in a new cluster that became known after the initial outbreak in March and April was believed under control.
The biggest outbreak of SARS outside Asia has killed 32 people in the Toronto area, including a 60-year-old man who died May 20. His case was reported Monday.
"We've been concerned by the increasing number of cases in Toronto," said Maria Cheng, a spokeswoman for the WHO communicable diseases division, from the Geneva headquarters. "Our epidemiological team is still looking for a bit more information."
She said the Toronto situation was discussed at a meeting Tuesday to review travel advisories that have been issued or were under consideration. No change was made because the new SARS cluster in the city appeared limited to hospitals, Cheng said.
"We are optimistic that Toronto is able to contain this outbreak," she said. "To us, it still looks very much like the transmission of SARS is confined to the hospital setting and there is no general public transmission of SARS."
The second cluster of SARS cases landed Toronto back on a WHO list of SARS-affected cities or regions. The U.N. agency previously issued a travel advisory for Toronto, but rescinded it a week later after Canadian officials complained it was unwarranted and promised better screening of international travelers for SARS.
The U.S. Centers for Disease Control and Prevention has reinstated a travel alert for Toronto, informing travelers of a health concern there.
A new WHO travel advisory would devastate the city already reeling from the SARS outbreak, which has overwhelmed the health care system and hurt the vital convention and tourism industry.
On Monday, the Dixie Chicks postponed a June 12 show until August, and theater producers announced they will close "The Lion King" in September after 1,300 performances seen by 2.3 million people over more than three years.
Complaints by nurses that their warnings in mid-May of a new cluster went unheeded caused Ontario officials to announce a review of the situation Monday.
The 62 cases reported Monday were an increase of 10 over the previous day, and health officials also said 6,800 people were under home quarantine because of possible exposure to SARS.
Dr. Colin D'Cunha, the Ontario commissioner of public health, said 5,000 health care workers were in working quarantine, which means they continue working but must wear mask, gown and gloves inside and outside of hospitals and isolate themselves at home.
D'Cunha said the latest death turned up when officials went back to check an unexplained respiratory illness in the case. The victim's wife also is a SARS patient.
"This is not an easy diagnosis. This diagnosis mimics just about everything else," said Dr. James Young, the Ontario commissioner of public safety. "It is proving to be extremely difficult."
Young urged people to avoid hospitals unless absolutely necessary to ease the burden on a system coping with the illness.
Health officials thought they had the illness under control after the initial cluster appeared in March and April, but an undiagnosed case at North York General Hospital led to a further spread among other patients, family members and health care workers.