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WKSU, our public radio partners in Ohio and across the region and NPR are all continuing to work on stories on the latest developments with the coronavirus and COVID-19 so that we can keep you informed.

Toronto's SARS Outbreak Provides a Cautionary Tale of Lifting a Lockdown Too Soon

city of toronto
Toronto, in 2003, was the only city outside of Asia to be hit by the SARS outbreak. The city was sent into lockdown to control its spread, but a second wave of infections showed how difficult it is to contain a killer virus.

Protestors outside the statehouse have called for Gov. Mike DeWine to fire Ohio Department of Health Director Dr. Amy Acton and to reopen all businesses.

A legislative task force is working out its own timeframe to restart Ohio’s economy.

All of this puts Governor Mike DeWine under increasing pressure to ease social distancing restrictions.

But the world’s first coronavirus outbreak provides a cautionary tale about the risks of lifting this lockdown too soon.

We’re being hit by a new coronavirus, but it’s not the first one to put parts of the world in lockdown.

Seventeen years ago SARS began killing people in China and then spread to other parts of the world.

It landed in Toronto in 2003 where Case Western Reserve University immunology professor Mark Cameron was a post-doc researcher.

“I was part of a rapid research response to SARS when it hit Toronto that year," says Cameron, "And we quickly mobilized to take a look at research specimens from SARS patients and to track their illness.”

SARS stands for Severe Acute Respiratory Syndrome. The virus that causes Covid-19 is called SARS-coronavirus-2.  

Mark Cameron, PhD studies immunology and emerging diseases at Case Western Reserve University. As a post-doc in Toronto in 2003 he was in the front lines of the fight against the deadly SARS virus.

SARS-1 was more deadly than our current SARS, and Cameron says, "that meant you could track and trace the patients easily because they got sick, and they got sick fast.”

The outbreak in Toronto began in late February, starting from one patient who returned from a hotspot in Hong Kong. 

Unfortunately, it spread to her family.

Her son went to the emergency room, where he infected four other people.

By late March dozens of staff and visitors in several hospitals had contracted the disease.

Toronto officials issued a state of emergency, and like today, Cameron says, “They started closing non-essential businesses and implementing social distancing measures.”

At its peak, more than 300 people in Toronto were confirmed or believed to have had the disease.

Two dozen people died.

Lifting the lockdown too soon
Twelve weeks after that first patient had come down with SARS, Toronto health officials felt it was time to return to normal.

But Cameron says it wasn’t just public health concerns that led them to lift the lockdown.

“The real driving force of letting some of these guidelines be relieved," he says, "was the economic pressure of having a city like Toronto almost shut down trying to deal with an infection like this.”

Credit CDC
A graph shows the initial wave of SARS infections in Toronto in 2003, and a second wave that surged weeks later.

They thought it was over.

Then a second wave of infections hit.

“They decided a little bit too early," says Cameron, "and it's been well documented, to relieve some of the PPE or personal protective equipment and social distancing guidelines.”

Another 118 people got sick and a hospital had to be closed for quarantine.

Instead of one peak in the pandemic, Toronto had two.

The lessons of SARS1
Cameron says health workers isolated every infected person and quarantined everyone they had come in contact with because, “even one person still carrying the virus is enough to start a pop up or another cluster of infection.”

By June, it was truly finished.

But Cameron says it was not because the weather got warmer, "it was because of this massive public health response.”

The virus that caused the deadly SARS outbreak of 2003 has not been seen again, but Cameron says the lessons of SARS1 remain.

“Because our lesson from Torontois the other side of the peak is just as lengthy as the rise to the peak."

The latest models show Covid-19 cases in Ohio peaking over the next two weeks, then slowly trailing off.

As to when to lift the lockdown, Cameron says the data should determine the date.

"We're not talking about April anymore," he says. "We're not talking about May anymore. We're talking about mid-summer.”

On the down side of the curve
There are important differences between the SARS1 and SARS2 outbreaks.

The new coronavirus is spread by non-symptomatic people, so it’s harder to track, and it’s not just in one city, it’s everywhere.

So when to lift the lockdown doesn’t just depend on where we are on the curve, it depends on whether we can test enough people to spot a second wave before it washes over us.

That’s one area where Cameron feels hopeful.

“Every week there is news of a new test to add to this arsenal.”

It’s going to be a long time before restaurants open, crowds can safely gather, or we even shake hands again.

But Cameron says as hard as social distancing is, the economic impact of a second wave of infections will be worse than what we’ve seen already.

Jeff St. Clair is the midday host for Ideastream Public Media.