SARS in Toronto 2003 ● 78 year old women returned home to Toronto from Hong Kong ○ Primary care physician cared for her but passed away ● Her son became ill and went to Scarborough Hospital ○ Exposed to multiple staff ○ Physicians later isolated him ○ But too late ■ Too many people already exposed ● One of staff were transferred to York Central Hospital ○ Infected other ○ Cluster of 50 infection at this hospital ○ Resulted hospital closure ● Disease control measures brought outbreak under control ● Modeling studies later predicted even with SARS being only moderately transmissible to close contact ○ No action had been taken to prevent virus transmission ● Point of healthcare system must be better prepared ○ Lack of facilities for isolation of patients ○ Design of emergency room facilitate keeps people in close contact ○ Lack of adequate outbreak plans in hospitals ■ Cities ■ Provincial ■ Federal levels ○ Lack of coordination between hospitals ○ Lack of coordination between government Why is there two peak of outbreak in the graph? ● First peak ○ Primarily centered in Toronto, Ontario. ○ Late FEB to early MAR ○ Triggered by Hong Kong outbreak ○ Early control measures has reduced the impact slightly ● Second peak ○ After the first wave… ■ Public health measure became loose ○ Hidden chain infection may have occurred ○ Strict health measures were re-implemented Public health strategies ● Case identification and isolation ● Contact tracing ● Quarantine ● Healthcare settings ● Travel entry screening Similar to COVID-19 As a result… ● 44 deaths ● 375 estimated infection