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SARS: The Toronto Experience. SARS Toronto: Phase I & II. Case Distribution by Age Group. Case Fatality by Age Group. SARS Toronto: Phase I & II. The Problem:. The unrecognized patient. Sunday, February 23. Index Case. (Mother) Returns to Toronto and develops pneumonia that week. - PowerPoint PPT Presentation
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SARS: The Toronto Experience
Phase 1 and Phase 2 SARS Cases by Status in Ontario as of June 26, 2003
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Date of Onset
Nu
mb
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Ca
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Phase 2 - Suspect
Phase 1 - Suspect
Phase 2 - Probable
Phase 1 - Probable
Notes: i) Phase 1 cases are based on Health Canada case definitions prior to May 29, 2003. Phase 2 cases are based on revised Health Canada definitions effective May 29, 2003. ii) A Probable case w ith an April 19, 2003, date of onset is under review .
SARS Toronto: Phase I & II
Age group
Phase I Phase II
N % N %
<18 18 7 2 2
18-35 71 28 20 17
36-64 132 51 70 59
>64 36 14 26 22
Total 257 100 118 100
Case Distribution by Age Group
Age group
Phase I Phase II
N % N %
<18 0 0 0 0
18-35 0 0 0 0
36-64 10 38 6 31
>64 16 62 11 69
Case Fatality by Age Group
SARS Toronto: Phase I & II
Exposure
Phase I II
No. (%) No. (%)
Hospital - worker - patient/visitor
91 (33%)49 (18%)
52 (42%)
64 (51%)
Other healthcare (clinic, EMS)
8 (2.9%)
2 (1.6%)
Household contact 76 (28%) 9 (7.2%)
“Community” Travel
16 (5.9%)12 (4.4%)
--
Under investigation 21 (7.7%)
-
The Problem:
The unrecognized patient
Index Case
(Mother)
Returns to Toronto and develops pneumonia that week
Sunday, February 23
Index Case
(Mother)
Dies at home
Wednesday, March 5th
Index Case
(Mother)
Cared for mother at home and develops pneumonia
Mr. T
(Son)
Index Case
(Mother)
Admitted to SGH
Mr. T
(Son)
SGH
Friday, March 7th
PPP
ATM
Outpatient
Entrance
Drug Store Emergency
EntranceSecurity Emergency
Registration
Emergency
Nurse
Admitting
Vending
Machines
Waiting Room
Trauma
Room
Room 1
Room 2
Room 3
Room 4
Room 5
Room 6
Stock
Room
Room 7
Room 8
Room 9
Eye Room
Fracture
Room
Soiled
Linen
Show er
W CW C
Observation Room
Nursing Station
Ante
Room
Bed 1
Bed 2
Bed 3
Bed 4
Bed 5
Bed 6
Bed 1 Bed 2 Bed 3
Bed 4 Bed 5
Bed 8 Bed 7 Bed 6
Bed 1
Bed 2Bed3
Grace DivisionEmergency Department
March 7
Morning of Thursday, March 13th
Intensive Care Unit SGH
Mr. T
PPP
ATM
Outpatient
Entrance
Drug Store Emergency
EntranceSecurity Emergency
Registration
Emergency
Nurse
Admitting
Vending
Machines
Waiting Room
Trauma
Room
Room 1
Room 2
Room 3
Room 4
Room 5
Room 6
Stock
Room
Room 7
Room 8
Room 9
Eye Room
Fracture
Room
Soiled
Linen
Show er
W CW C
Observation Room
Nursing Station
Ante
Room
Bed 1
Bed 2
Bed 3
Bed 4
Bed 5
Bed 6
Bed 1 Bed 2 Bed 3
Bed 4 Bed 5
Bed 8 Bed 7 Bed 6
Bed 1
Bed 2Bed3
Grace DivisionEmergency Department
March 16
Mr. P arrives in the emergency department with a LRTIOn respiratory precautions from time of admission
PPP
ATM
Outpatient
Entrance
Drug Store Emergency
EntranceSecurity Emergency
Registration
Emergency
Nurse
Admitting
Vending
Machines
Waiting Room
Trauma
Room
Room 1
Room 2
Room 3
Room 4
Room 5
Room 6
Stock
Room
Room 7
Room 8
Room 9
Eye Room
Fracture
Room
Soiled
Linen
Show er
W CW C
Observation Room
Nursing Station
Ante
Room
Bed 1
Bed 2
Bed 3
Bed 4
Bed 5
Bed 6
Bed 1 Bed 2 Bed 3
Bed 4 Bed 5
Bed 8 Bed 7 Bed 6
Bed 1
Bed 2Bed3
Grace DivisionEmergency Department
March 7
PPP
ATM
Outpatient
Entrance
Drug Store Emergency
EntranceSecurity Emergency
Registration
Emergency
Nurse
Admitting
Vending
Machines
Waiting Room
Trauma
Room
Room 1
Room 2
Room 3
Room 4
Room 5
Room 6
Stock
Room
Room 7
Room 8
Room 9
Eye Room
Fracture
Room
Soiled
Linen
Show er
W CW C
Observation Room
Nursing Station
Ante
Room
Bed 1
Bed 2
Bed 3
Bed 4
Bed 5
Bed 6
Bed 1 Bed 2 Bed 3
Bed 4 Bed 5
Bed 8 Bed 7 Bed 6
Bed 1
Bed 2Bed3
Grace DivisionEmergency Department
March 16
Mr. P arrives in the emergency department with a LRTIOn respiratory precautions from time of admission
PPP
ATM
Outpatient
Entrance
Drug Store Emergency
EntranceSecurity Emergency
Registration
Emergency
Nurse
Admitting
Vending
Machines
Waiting Room
Trauma
Room
Room 1
Room 2
Room 3
Room 4
Room 5
Room 6
Stock
Room
Room 7
Room 8
Room 9
Eye Room
Fracture
Room
Soiled
Linen
Show er
W CW C
Observation Room
Nursing Station
Ante
Room
Bed 1
Bed 2
Bed 3
Bed 4
Bed 5
Bed 6
Bed 1 Bed 2 Bed 3
Bed 4 Bed 5
Bed 8 Bed 7 Bed 6
Bed 1
Bed 2Bed3
Grace DivisionEmergency DepartmentMarch 16; 22:45-23:30
Index Case Case A
(Mother) (Son)
Mr. P
Mr. P’swife
Index Case Case A
(Mother) (Son)
Mr. P
Mr. P’swife
16 persons
9 persons
Index Case Case A
Mr. D
(Mother) (Son)
Mr. P
Mr. P’swife
16 persons
9 persons
PPP
ATM
Outpatient
Entrance
Drug Store Emergency
EntranceSecurity Emergency
Registration
Emergency
Nurse
Admitting
Vending
Machines
Waiting Room
Trauma
Room
Room 1
Room 2
Room 3
Room 4
Room 5
Room 6
Stock
Room
Room 7
Room 8
Room 9
Eye Room
Fracture
Room
Soiled
Linen
Show er
W CW C
Observation Room
Nursing Station
Ante
Room
Bed 1
Bed 2
Bed 3
Bed 4
Bed 5
Bed 6
Bed 1 Bed 2 Bed 3
Bed 4 Bed 5
Bed 8 Bed 7 Bed 6
Bed 1
Bed 2Bed3
Grace DivisionEmergency Department
March 7
Index Case Case A
Mr. D
(Mother) (Son)
Mr. P
Mr. P’swife
9 persons
21 persons
16 persons
Index Case Case A
Mr. D
(Mother) (Son)
Mr. P
Mr. P’swife
24 persons
9 persons
21 persons
Index Case Case A
Mr. D
(Mother) (Son)
Mr. P
Mr. P’swife
24 persons
9 persons
21 persons
15 persons
Index Case Case A
Mr. D
(Mother) (Son)
Mr. P
Mr. P’swife
Mr. R?
24 persons
9 persons
21 persons
15 persons
Index Case Case A
Mr. D
(Mother) (Son)
Mr. P
Mr. P’swife
Mr. R?
9 persons
21 persons
15 persons
16 persons
Index Case Case A
Mr. D
(Mother) (Son)
Mr. P
Mr. P’swife
Mr. R?
9 persons
21 persons
15 persons
7 persons
16 persons
Index Case Case A
Mr. D
(Mother) (Son)
Mr. P
Mr. P’swife
Mr. R?
9 persons
21 persons
15 persons
7 persons
16 persons
Wednesday March 26th
Provincial emergency declared Directives for all hospitals formulated
over weekend Stopped transfer of patients and staff
between health care centers Created SARS units in all hospitals Restricted access to hospitals including
visitors Screening of all persons accessing hospitals Institution of precautions