May 28, 2003	Wednesday	Rabi-ul-Awwal 25,1424

TORONTO, May 27: Medical staff at some Toronto hospitals, dealing with a new SARS outbreak, have strapped back face masks and donned two layers of gloves, fearing they let their guard down a few weeks ago and let SARS back into a city that thought the battle was over.

The World Health Organization on Monday put Toronto back on its list of SARS-affected areas, just 12 days after it was taken off.

Masks first came off in mid-May in all hospital departments except SARS wards, because officials thought that Severe Acute Respiratory Syndrome had stopped spreading.

But doctors now think the mystery virus had not left, and it lingered in at least one hospital ward for weeks, infecting patients, nurses and visitors.

“I think it’s true that some hospitals around the city perhaps eased up on either screening or surveillance, or some of the precautions.” said Dr. Andrew Simor, chief of microbiology at Toronto’s Sunnybrook and Women’s College Health Sciences Centre.

The latest outbreak started with a 96-year-old man, who died on May 1. Doctors never suspected SARS. Now they think he had the disease and spread it to other people, one of whom may have infected staff at a rehabilitation hospital.

Simor said the first patient’s case was “very difficult to recognize. I’m not sure the failure to recognize this case was related to easing up on any of the precautions,” he said.

Twenty seven people have died from SARS, in the Toronto area, the only place outside Asia where the virus has killed people. About 2,200 people are in quarantine and doctors fear there could be up to 45 new infections.

The outbreak means all hospitals around Toronto are working under a “new normal,” under which masked and gloved hospital staff check all visitors for symptoms of respiratory illness before they enter.

Dr. Colin D’Cunha, Ontario’s chief officer of medical health, said patients with symptoms of respiratory illness, will be monitored, regardless of whether they are in an infection unit or an orthopedic ward.

If more than a month passes without any new infections in Toronto, “you won’t see everybody wearing a mask. But the expectation is that if you are dealing with a respiratory patient, you should practice infection control. That’s the new normal,” he said.

But doctors are still baffled about how the 96-year-old man contracted the virus in an orthopedic ward.

Some suspect he might have been infected by someone who entered the hospital in late March, when the SARS outbreak was at its peak. Others say nurses and doctors from the hospital’s SARS ward may have spread the disease to the orthopedic ward.

Almost all agree the link will be hard to find.—Reuters