Travelers given SARS advisory

WASHINGTON — The World Health Organization (WHO) warned travelers yesterday to avoid China's capital city of Beijing and Canada's financial center, Toronto, saying the step was needed to halt the spread of severe acute respiratory syndrome, or SARS.

"We're doing this to try to stop this disease from becoming endemic," said David Heymann, executive director of WHO's communicable-diseases program.

The advisory, which says any unnecessary travel to those locations should be postponed, will be reviewed in three weeks, he said.

The warning, which also added the Chinese province of Shanxi to the WHO's list of places to avoid, was denounced by officials in Toronto, which has suffered a sharp drop in tourism because of a SARS outbreak. It was received as another blow in Beijing, where thousands of people yesterday rushed train stations in a frantic attempt to flee the city even before the announcement. Chinese officials closed all public schools in the city for two weeks starting today. In addition, a major hospital, the People's Hospital of Peking University, was closed today and more than 2,000 employees were placed under observation while the hospital is being disinfected.

Canadian officials said the outbreak is under control. Dr. Paul Gully, director general of Health Canada, said he would challenge WHO's assertion in a letter. "Toronto continues to be a safe place," he said.

Mayor Mel Lastman said, "I've never been so angry in all my life." He added that he was "shocked" because "the medical evidence that we have before us does not support this."

Donald Low, an infectious-disease expert at Mount Sinai Hospital in Toronto, also disputed the WHO decision. "I don't understand the rationale," he said.

Colin D'Cunha, Ontario's commissioner of public health, accused the WHO of "overreaction." He said that "Toronto continues to be a safe place ... There are 5 million people in greater Toronto and the risk continues to be low."

As of yesterday, 16 people in Toronto had died from the pneumonialike disease, making it the worst SARS hot spot outside Asia, and 342 suspected or probable cases of SARS had been identified in the country, most in Ontario.

Within hours of the WHO notice, the Britain issued a similar warning to its citizens and the health minister of Nova Scotia issued a similar advisory to residents of that Canadian province.

The U.S. Centers for Disease Control and Prevention (CDC) has not issued such an advisory, however, suggesting only that travelers take precautions — such as not visiting hospitals — when traveling to Toronto. An estimated 9 million Americans and 6.8 million overseas visitors pass through the Toronto airport every year.

The WHO had previously warned travelers to avoid unnecessary visits to Hong Kong and the southern Chinese province of Guangdong, where the outbreak first appeared in November.

The immediate cause of the WHO action, Heymann said, was the export of SARS from Canada to a country, which he refused to identify, where a cluster of five cases emerged. Other sources said a Toronto medical assistant had infected five people in Manila before dying of the disease.

In addition, Pennsylvania and U.S. health officials are monitoring 24 people in that state who had contact with a man who is believed to have caught SARS at a conference in Toronto.

A 40-year-old doctor from Baltimore, meanwhile, was isolated at Johns Hopkins Hospital yesterday when he developed symptoms of SARS after visiting Toronto, Maryland health officials said.

SARS is caused by a previously unknown virus related to germs that cause the common cold. The virus spreads most commonly in large droplets spewed out when an infected person coughs or sneezes. But there is also evidence it may spread in other ways and may be able to survive on objects for up to 24 hours.

Early symptoms resemble the flu: high fever, dry cough, shortness of breath. There is no treatment. Most people recover after about 10 days. About 6 percent of patients are estimated to die. As of yesterday, according to WHO, there were 4,288 cases of SARS worldwide and 251 deaths. There are 37 confirmed SARS cases in 36 states in the United States, with no deaths.

Information from The Associated Press and the Los Angeles Times is included in this report.