A confidential memo circulated to Toronto hotels instructs officials on how to deal with the media in light of the unknown respiratory outbreak at a seniors' home in the city:

Subject: GTHA-Respiratory Outbreak Comments - PRIVATE & CONFIDENTIAL
Importance: High

The media may try to re-create the unfortunate events at the nursing home as it relates to the respiratory outbreak. We are not issuing any official statements and if inquiries are made, we are referencing them to Andrew Weer at Tourism Toronto. Andrew will use the story line enclosed.

Please do not circulate this document outside your office. This is for your information only and is to ensure you have a response if needed and that all the responses are in line.

CONFIDENTIAL - FOR INTERNAL USE ONLY

The following is an update on the respiratory outbreak at a Toronto long-term-care facility, and its implications. The purpose of this note is to ensure we are all informed and are speaking consistently when responding to inquiries, when asked.

Bottom line:

This is a typical outbreak for a long-term care facility. These happen hundreds of times a year in Ontario (and elsewhere, of course) and this one is being handled in exactly the same way. Health officials say the outbreak is "winding down" and is following the same course as most other outbreaks in similar facilities.

More detail:

• 6 deaths and 30 admitted to hospital so far. Officials say there could be more deaths as the illness progresses in people who have already contracted it. (In other words, more deaths is not a sign of the outbreak getting worse.)
• The outbreak appears to be "winding down". There were fewer new cases on the weekend and no new cases today.
• The facility is not quarantined. It is closed to visitors. The closure is a routine response. Facilities typically stay closed for two incubation periods after the last new case, so 8-14 days.
• It is normal that they have not yet identified the cause of the illness. There have been 39 respiratory illness outbreaks in Ontario long-term care facilities SINCE SEPT 1 (!), which is fairly normal. In 36 of those officials have not yet identified the cause.
• SARS, Avian Flu and Influenza have been ruled out.
• This illness is different from SARS. SARS had an unusually long incubation period before symptoms appeared, which enabled it to spread quickly. It also affected young, healthy people more acutely. The six deaths in this case have all been elderly people who all have other health complications.

Implications:

• The temptation of media to bring in comparisons to SARS will be high, and many will make exactly that comparison. Obviously the city is on high alert for anything that could be "the next SARS". Beyond the local media the worry is that clients, visitors and foreign media will pick up on the story and make similar SARS comparisons.
• The Chief of Public Health at one point was asked what advice he has for people in Toronto. He responded that if you have symptoms, stay home. And everyone should wash their hands. He emphasized that those are normal recommendations he would give anyone that has a respiratory infection. The concern is that those recommendations will become a big part of the story, "Health officials are telling people to stay home and wash their hands often - just like the darkest days of SARS." From a visitor standpoint right now - this one off-hand remark could become the story and we can't let it.

Recommendations:

• Public Health officials say this is "garden variety"and normal. We should not do anything that makes it seem like we are treating it like anything more than that. For us to speak out on the issue would appear very defensive and would signal that the issue is a more serious threat to tourism. The only threat here is if people get carried away with hysteria (or if the outbreak escalates significantly, but there appears no reason to suspect it will).
• We can inform anyone who asks that we are monitoring the situation closely. Of course we can't appear to be dismissing it out of hand. But the biggest threat to tourism is not a respiratory outbreak, it's a hysteria outbreak. That's what we need to contain.
• We certainly do not want to make any comments that refer to SARS or "last time". Such comments would imply that this is just like SARS, which officials assure it is not.
• Limit any comment to the theme: "Toronto is one of the safest cities in the world, and that's as true today as ever."