For the past four months, Toronto has been in the grips of a new disease that terrified the world, brought some of Canada's biggest hospitals to a virtual standstill and siphoned billions from the once burgeoning hospitality and movie-making businesses.

But the tale of Toronto's battle against SARS isn't only about its macro-level impact.

It's really a tapestry of stories, most of which never came to the public eye because travel advisories or hospital closings, quarantine orders or surging case numbers bumped them from the nation's news agenda.

Many are tragic, some ironic. Some are silly, others perplexing. Some are tales of heroism and sacrifice, others of unspeakable loss. One cannot fully appreciate the impact of SARS without examining the fine detail.

Here is a small sampling of those stories:

At about 9 p.m. on Thursday, May 22, a clutch of ashen-faced public health officials filed into a small room in the headquarters of Toronto Public Health for a hastily called news conference. Their grim message: SARS was back.

Four cases - the minuscule tip of the eventual iceberg - had been found at a rehabilitation hospital in the north end. The source of infection was unclear, they said, though there was a possibility the cluster had been triggered by an imported case.

That was wishful thinking, hinged on an astonishing coincidence.

One of the first four cases was a woman, 66, who had travelled in April to Hong Kong and China - areas where SARS infections were also raging out of control. Fearful that she might have been exposed to SARS, the woman quarantined herself at home for 12 days following her return.

Public health didn't ask her to. She simply wanted to make sure she posed no risk to others.

After her self-imposed quarantine was over, the woman went to visit her son, a patient at St. John's Hospital. And there she became infected with the virus she'd managed to evade in two of the world's hottest SARS hot zones.

"It's truly one of the great ironies," says Dr. James Young, Ontario's commissioner of public security. "Because for days everybody thought: 'Oh, well, she must have brought it back.' Then it turned out she didn't."

On June 7, the woman became the 34th person in Ontario to die from SARS.

Medical intern infected

News that SARS was back broke on a Thursday. That fact didn't surprise the experts fighting SARS. Bad news almost always cropped up on Thursdays during the SARS outbreak. The people trying to combat the insidious virus took to calling it SARSday - and holding their breath till it passed.

Public health officials first realized Toronto had a case of SARS on Thursday, March 13. That's when Chi Kwai Tse - the son of Toronto's index case, Kwan Sui-chu - died. The following Thursday, the first health-care workers in the city to come down with the disease developed symptoms.

The Thursday before the Easter weekend was a particularly gruesome SARSday. That's the day it became apparent hospital workers who were using recommended barrier precautions had nonetheless been infected during the intubation of a SARS patient at Sunnybrook Hospital.

The news horrified the SARS containment experts, who for a time worried there might be no way to keep workers looking after SARS patients safe.

And it was a Thursday when officials at Mount Sinai Hospital learned a medical student who had worked a shift on the hospital's obstetrics ward came down with SARS hours after finishing his shift. Five women and their infants were forced into quarantine and scores of hospital staff were forced into home or working quarantine. Fortunately, none developed SARS.

An estimated 27,000 people in the greater Toronto area were quarantined over the course of the city's two outbreaks. For many, the experience was stressful, inconvenient, isolating. For some, it involved lost wages.

But not everyone minded being ordered to stay home alone.
Syd Pell and Lesley Matthews had their first child, a daughter, at Mount Sinai on June 4.

The medical student who came down with SARS had been present at Allie's birth and had been in Matthew's room earlier in the day. They went home two days later to go into quarantine.

A few days later, Pell was raving about the experience.

"We're actually very happy in a strange way . . . that we're in quarantine, just that we get to spend time together and get to bond without all the usual circus of visitors and everything. So it's nice," he said in a telephone interview.

Pell and Matthews even sent the med student a card. "We have absolutely no anger against him - and really no anger against anybody. The doctors have been super great with us."

The only drawback: Pell had to wear a mask around his wife and his new daughter. "She's got the sweetest little toes and I'm dying to kiss them," he gushed.

SARS containment in Paris

Others found quarantine less rewarding. Dr. Richard Schabas was walking through Paris on March 29 when his wife's cell phone rang.

The couple was heading to the bateaux-mouches, the tour boats that display the City of Lights' magnificent sights from the vantage point of the world famous Seine.

When they'd left home two days earlier, Toronto had 28 probable and 10 suspect cases of SARS, all clustered among patients, staff and visitors of Scarborough Grace Hospital.
The couple planned to spend three days in Paris before travelling to London. Then the cell phone rang.

It was Schabas's daughter, who informed him the morning paper said York Central Hospital - where Schabas is chief of staff - was closed because of SARS and all staff had been ordered into quarantine.

Schabas, a former chief medical officer of health for Ontario, quickly called the acting medical officer of health for York Region, Dr. Hanif Kassam.

"I'm actually on the deck of the bateau-mouche waiting for it to leave on the tour of the Seine when I get a hold of Hanif and he says: 'No, Richard, you should go into quarantine.' "

Schabas, who has since publicly criticized the mass quarantine policy, followed orders. He thought to himself: "I don't think I have SARS, but I don't want to be the guy who brings SARS to Paris. That's just not how I want to be remembered.

"So I said goodbye to my wife. I jumped over the turnstile and walked back through Paris."

His three days in Paris stretched to eight, all confined to a rented apartment.

"It was the most frustrating and disappointing holiday of my life," he says.

"I had the triple whammy of being quarantined literally all by myself most of the time, having a wasted vacation and then furthermore I couldn't help out the hospital at the time when they needed me the most.

"It was totally bizarre and incredible bad luck."

Luck and strange coincidences

The stories of SARS abound with luck, bad and good, as well as strange coincidences.

Consider Kowloon's Metropole Hotel. What were the odds that one Chinese doctor - who would later die of SARS - could during a one-night stay in the hotel infect 16 other guests who then sparked outbreaks that ravaged hospitals, economies and lives in Hong Kong, Hanoi, Singapore and Toronto?

It seems the stuff of science fiction. But the confluence of bad luck runs deeper. Kwan Sui-chu, Toronto's 78-year-old index case, didn't need to stay in the hotel at all. She was in Hong Kong visiting family. But the hotel stay was part of a package deal and she couldn't resist the freebie.

In fact, 52 Canadians stayed at the Metropole between Feb. 20 and 22, Health Canada has since learned. (The Chinese doctor, Liu Jianlun, was there one night - Feb. 21.) Kwan wasn't the only Canadian to contract SARS.

Another man brought the disease to Vancouver, but officials there quickly realized he might have the atypical pneumonia that appeared to be sweeping parts of China and Hong Kong. He was placed in isolation and did not spread the disease.

In an almost freakish twist of fate, Dr. Donald Low was also in Hong Kong on Feb. 21.

Low, who emerged as a leader among the medical experts fighting SARS in Toronto, was on his way home from Cambodia, where he'd given a talk. While Low was also staying in Kowloon, across the harbour from Hong Kong, he was staying a few kilometres away at the Marco Polo.

There was no way you could describe it as anything other than the worst of luck.

A 76-year-old man - known in the medical literature as Patient 8 - went to the emergency department of Scarborough Grace Hospital on March 7. He was suffering from arrhythmia, an abnormal heart rhythm.

At this point, SARS didn't even have a name, but it was lurking in Emergency at Scarborough Grace. The man spent the night in a room with a 43-year-old man named Chi Kwai Tse - the son of Mrs. Kwan. Tse had SARS and he gave it to his roommate.

The next day, the 76-year-old man went home. A few days later, he was back in hospital in intensive care, fighting for every breath. On March 21, he became Toronto's third SARS fatality. Before he died, he infected his wife, who also succumbed to SARS.

Between them, the couple infected 33 other people, most of them health-care workers.

Equally tragic was the case of an 82-year-old man who went to Scarborough Grace on March 16 because he'd injured his knee. He and two members of his family contracted SARS while at the hospital; he died on April 1.

That injured knee led to one of the most frightening developments in Toronto's SARS battle, the spread of infection to a Catholic charismatic group known as the BLD, short for Bukas Loob Sa Diyos Covenant Community. The man and several members of his family belonged to the group.

For a time it appeared the virus was about to start spreading in an untraceable and uncontrollable fashion because of this incident. It did not. But by the time this cluster was contained, 14 members of 82-year-old man's family had come down with SARS; 14 members of the BLD and three health-care workers were also infected.

Another mystery surfaces

Diagnosing SARS, especially when there was no clear epidemiological link to existing cases, was often incredibly difficult. Getting the call wrong - as evidenced by the second outbreak at North York General Hospital - could and did have disastrous consequences.

Yet at times it seemed like Nature itself was conspiring to give the virus an unfair advantage. The mystery of the psychiatric patients at North York is a perfect case in point.

Low was called to North York on Monday, April 28, to assess a couple of psychiatric patients who looked like SARS cases but for whom no epi link could be found. It had been nine days since a new case of SARS had been diagnosed in the city and folks like Low were beginning to believe - and were fervently hoping - the outbreak was over.

Low took with him two other experts, Dr. Bonnie Henry of Toronto Public Health and Dr. Tony Mazzulli, a microbiologist from Mount Sinai. Mazzulli and Henry thought the psych patients had SARS; Low did not. Nonetheless, they were put in respiratory isolation as insurance.

A few days later, a lab test showed one of the two had mycoplasma, a pathogen that is a common cause of pneumonia. SARS is a definition of exclusion, meaning if you can find another explanation for the symptoms you can rule out SARS. And they did.

But weeks later, blood work showed the same patient had developed antibodies to the SARS coronavirus, which is about the clearest evidence available that he had been a SARS case. But that wasn't the end of the story.

A stool sample from the same patient tested positive for the SARS coronavirus, using PCR or polymerase chain reaction testing. A second test was negative.

"Somebody help me! Please!" Low said in a mock wail when outlining the complexities of the case later. "Could somebody please make something straightforward here?"

Investigators scouring North York General's records still have no clear picture of how the psych ward patients - there may have been as many as four infected - contracted SARS.

By now most people know the symptoms of SARS - the racking cough, the high fever, the muscle aches. What they may not know, however, is that for many SARS patients, eating becomes a highly unsavoury experience.

Dr. Alan Tallmeister, an anesthetist at Scarborough Grace Hospital, contracted the virus in mid-March while treating one of the city's first SARS patients.

Tallmeister, 48, says he's never been as sick in his life. While he wasn't weighing himself, he thinks he dropped about 20 pounds at the peak of his illness. "It just melted down."

That's because he could not bring himself to eat. Something - either the disease or the anti-viral drugs he was on - distorted his sense of taste and smell.

"It seemed to either taste extremely salty or extremely sweet," Tallmeister says. "It seemed to be very hard to chew. Everything seemed to just crumble and dry up in your mouth."

A coffee drinker, Tallmeister had to switch to tea. Toothpaste seemed to burn his mouth.

"Things smelled funny," he adds. "They'd bring us from the cafeteria these food plates. And you'd lift the steam hood and it smelled like you were opening up a hot, damp gym bag."

He remembers another meal - ham and potatoes - where the meat "may as well have been some sort of salted pemmican, the way it tasted."

The doctors fighting to contain SARS also dropped weight during the crisis. They called it "the SARSdale diet."

"There was no time to eat," says Low, whose weight loss was so apparent perfect strangers who regularly saw him on television e-mailed him to express concern about his health.

For all involved with SARS, the months of crisis were a time of very little food and very little sleep.

When SARS first hit the world's radar screens, the World Health Organization was ill-prepared for the demands it would face. For one thing, the organization didn't have communications staff in Hanoi, Hong Kong or Beijing, three of the cities hit first and hardest.

So reporters from those cities turned to the Geneva-based press office of the WHO's communicable diseases division and its director of communications, Dick Thompson.

"I would start getting press inquiries at 3:30 in the morning," Thompson explains. "And they would continue until about 6:30 a.m., when I left for the office on my bicycle. Then I would have a device that would plug into my ear so I could continue to do interviews while I was riding in."

The long days involved back-to-back meetings and fruitless attempts to return thousands of reporters' calls, which wouldn't stop coming in until American news outlets stopped calling, at about midnight Geneva time.

"This was like a daily occurrence," Thompson says.
This was also before March 15 - in other words, in the early days of SARS. As outbreaks exploded in Toronto, Taiwan and Singapore, and individual cases popped up elsewhere around the globe, the pace picked up.

The voice mail boxes on Thompson's two cell phones would fill up every half hour. That's at least 40 messages every half hour.

"I had somebody who didn't do anything but empty my voice mail. Because we were worried. We didn't want people to think that we weren't responsive - although we weren't responsive. We wanted them to at least be able to leave a message."

Eventually extra people were hired, both in Geneva and in SARS hot spots in Asia. Daily teleconferences were organized. But still communications was a challenge.

"The problem was from the beginning we thought we had to be as transparent as we were asking countries to be and yet we couldn't do it."