Here is a quick history of SARS in Vancouver. Prior to the outbreak at the Kinsman Place Lodge nursing home in Surrey, BC there had been 4 probable SARS cases in British Columbia. Compared to Toronto, the Vancouver outbreak had been mild, based on almost any parameter. There were 4 probable and 44 suspect cases in contrast to 247 probable and 127 suspect cases in Toronto. Toronto had 44 SARS deaths while Vancouver had 0 and almost all Toronto deaths were of probable cases.
The 4 probable SARS cases in Vancouver not only had been in an affected area prior to developing symptoms, but had also been in an infected area. The first case was a 55-year old male who had been at the Metropole Hotel Feb 20-24 before being admitted to the Vancouver General Hospital emergency room on March 7. His treatment included being placed on a ventilator in the ICU. The second case was a 64 year old female who returned from a visit to Hong Kong on March 20. One of the relatives she had been staying with in Hong Kong developed SARS. She was admitted to Royal Columbian Hospital on March 28 and was transferred to Surrey Memorial Hospital on April 1. Her treatment also included being placed on a ventilator in the ICU. The 3rd case was a 48 year old male who was admitted April 3 to University of British Columbia. Prior to returning to Canada, he had been in Hong Kong's Amoy Gardens. However, he was not placed on a ventilator nor was he placed in intensive care. The 4th probable case was a 44 year old female health care worker who cared for the 2nd probable case. She was admitted to St Paul's hospital on April 19.
Thus, all 4 of the probable SARS cases in Vancouver developed symptoms after travel to buildings with known probable SARS cases and the only documented transmission within Vancouver was from probable case #2 to probable case #4. Probable case #2 was at Surrey Memorial Hospital from April 1 to April 22.
All 4 of the probable cases have tested positive for SARS CoV. None of the suspect cases have tested positive. Three of the four probable cases developed symptoms after returning from Hong Kong. Only one acquired the virus locally. That health care worker had cared for probable case #2, who was at Surrey Memorial Hospital from April 1 to April 22. Thus, the only documented transmission of SARS CoV in Vancouver was at Surrey Memorial Hospital, located approximately 4 miles from the Kinsman Place Lodge nursing home.
The outbreak at the nursing home is much more severe than the spring cases. In the spring there were only 4 positive cases for SARS CoV, no deaths, and one documented case of transmission. In contrast at the nursing home there have been three fatalities associated with pneumonia and at least one of the three has tested positive for SARS CoV. The attack rate has been very high, with 97 of 142 residents developing symptoms as well as 46 of 160 health care workers. The first cases at the nursing home were of health care workers. At least one of the PCR positive patients was seen at Surrey Memorial Hospital and at least 19 from the hospital have been quarantined. Fraser Health is managing the nursing home outbreak and is also affiliated with Surrey Memorial Hospital. 19 affiliated with the nursing home have been tested for SARS CoV and 10 have been positive. In addition, 4 of 7 tested for antibodies to SARS CoV have been positive. PCR testing of probable SARS cases in Toronto yielded only 40% positives.
Positive results for both the SARS CoV and SARS CoV antibodies clearly indicates that the outbreak at the nursing home is a re-emergence of SARS, which is markedly more severe than the earlier Vancouver cases by any of the common parameters used to monitor the outbreak. |
