After the Outbreak

When the Toronto epidemic was already thought to be over, an undiagnosed case at the North York General Hospital led to a second outbreak among other patients, family members and healthcare workers.

Infection control measures may have been lifted too early. During early and mid-May, as recommended by provincial SARS-control directives, hospitals discontinued SARS-expanded precautions (i.e., routine contact precautions with use of a N95 or equivalent respirator) for non-SARS patients without respiratory symptoms in all hospital areas other than the emergency department and the intensive care unit (ICU). In addition, staff were no longer required to wear masks or respirators routinely throughout the hospital or to maintain distance from one another while eating. In the hospital where the second outbreak originated, changes in policy were instituted on May 8; the number of persons allowed to visit a patient during a 4-hour period remained restricted to one, but the number of patients who were allowed to have visitors was increased (MMWR; 52:547-50).

Maintaining a high level of suspicion for SARS on the part of healthcare providers and infection-control staff is therefore critical, particularly after a decline in reported SARS cases. The prevention of healthcare-associated SARS infections must involve health care workers, patients, visitors, and the community (MMWR; 52:547-50).