Toronto Under SARS: A Media Fever

In a chop-suey mood the other day, I was nonplussed to learn that my chosen restaurant was eerily vacant, its owners having fled and closed shop for an early summer. Blame the specter of SARS, which has cast a patina of panic over this generally stoic city of 2.5 million people. The Mexican restaurant next door was bustling, mind you. Mexican and other ethnic restaurants are sopping up business from the General-Tso-chicken crowd, a major constituency here in Toronto, which boasts the second-largest Chinatown in North America.

The World Health Organization, having fired off an incendiary SARS warning — its advisory counsels against non-essential travel to Toronto, Canada’s business capital — has soiled this city’s signature reputation for hygiene and wreaked unforgivable havoc on business. The hotel industry has been devastated. In the weeks since SARS hit the city, tourism has been chopped by 23 percent, according to the local commissioner of development. Retail sales are down by anywhere from 20-30 percent.

The WHO’s advisory has been compounded by sometimes histrionic media coverage around the world. Reuters says the city is limping into leper status. London’s Independent newspaper has reported that Toronto is in quasi-quarantine. The New York Times called local public health-management a leaky dike.

As a consequence, economic tremors are rippling through the city. Major League Baseball has even advised players to refrain from signing autographs.

An analysis by J. P. Securities Canada Inc. on Tuesday estimated that the epidemic will cost Canada $30 million a day; the firm then reversed its forecast to 1 percent from the 2-2.5 percent national economic growth rate in the current economic quarter, which, pre-SARS, had been reason for economists here to herald Canada’s impending emergence as an economic powerhouse.

Responding to the WHO’s travel warning, an exasperated Dr. Donald Low, one of the world’s leading infectious-disease experts and a member of the SARS containment team here, called it a bunch of bulls**t. There’s some rationale for the doctor’s exasperation, which has been echoed by the mayor and by other civic and business leaders. At the same time, it is irresponsible to dismiss the panic as simple hysteria. There is much we don’t know about the etiology of the disease and its mutation patterns.

On the positive side of the ledger, there is no evidence of casual transmission of SARS in Toronto — transmission appears to be by respiratory droplets, not airborne spread — and every case can be linked back to the original index case, a 78-year-old grandmother and immigrant from Hong Kong. Almost half the patients who have been afflicted with presumed SARS in Toronto have recovered and gone home. Tragically, there have been 16 deaths from SARS in Toronto (at the time of writing); but the weekly increase in the number of cases is dipping, and has not manifested the exponential growth seen with uncontrolled epidemics of the past. The deceased suffered from other underlying health problems, such as congestive heart failure. Many of those who have recovered from SARS in Toronto are out of quarantine and there are no reported cases of post-recovery transmission to their families and co-workers.

Whatever the facts, the SARS epidemic will always be more about psychology than epidemiology. If we live in a global village when it comes to the dissemination of news information, then we live in a global cocoon when it comes to the dissemination of fear and rhetoric. The media have a role to play here, and must take it very seriously.

The essential problem is shoddy reporting. In order to make the illness appear more widespread, journalists seldom report on the attack rate within discrete, at-risk populations — SARS in Toronto is a disease affecting health-care workers and elderly patients within hospital settings, and with underlying illness. In the province of Ontario, doctors estimate that the case-fatality rate for those who actually contract SARS is less than one percent for patients under 50.

Journalists habitually lump together probable and suspected cases, without ever explaining why. Lumping the two categories together can make the picture of SARS appear bleaker than it might otherwise seem, since, at this stage in the outbreak, many suspected cases may be excluded after investigation and follow-up.

Just as disturbing, most media reporting has succumbed to political correctness. Canadians are clueless as to the ethnicity and country of origin of the victims.

Nor do journalists recognize that the rate of new cases is what really matters in measuring an epidemic. The rate of new cases in Toronto seems to be slowing. This is good news and suggests that local transmission in the Toronto area is on the wane — assuming the successful containment of so-called super transmitters.

Context and sobriety are crucial in the public-health response to SARS. In a city of 2.5 million, 16 people have died thus far. Lung cancer, heart disease, and automobile crashes have all exacted a far, far heavier toll on human life in the city.

Even so, this is a fast-breaking epidemic that doesn’t lend itself to 24-hour punditry. Some commentators have been quick to suggest that SARS is an example of juvenile media scare-mongering, while others, notably Dr. Patrick Dixon, a trends expert at London Business School, reportedly predicted SARS could be more dangerous than AIDS, with up to a billion cases in the next year.

While journalists may be tempted to cite these extremist predictions to craft a colorful story, doing so suggests that we know enough now to make concrete epidemiological predictions about the progression of the disease. But this is a new virus in humans; it could spiral out of control or could mutate such that humans can no longer get it (i.e. SARS may be insufficiently contagious to sustain transmission in the environment).

Since we don’t know what proportion of those exposed to SARS will become infected, it is difficult to fully assess risk at this stage. That is cold comfort to media pundits, who earn their trade on predictions and, in some cases, the serial debunking of health-care scares. It’s certainly true that all the available empirical evidence shows that visitors to Toronto — even if they are in a high-risk category for SARS (i.e., elderly, history of respiratory illness) have, statistically speaking, much bigger things to worry about than SARS, including run-of-the-mill traffic accidents. But that may change rapidly, and it is wrong and disingenuous to suggest otherwise.