TORONTO - As Ontario health officials braced for a wider outbreak of SARS around Toronto in the coming days, criticism was beginning to increase yesterday that political and health care leaders have made some critical miscalculations in their attempts to avert a broader epidemic.
For two weeks, the tone of health care officials and local media coverage had been increasingly upbeat that the disease was largely contained to a fixed number of people linked to a single chain of exposures beginning at one hospital.
But in recent days, reports have emerged that officials were slow to isolate a new cluster of patients in a Roman Catholic prayer group and that several of the stricken patients were inexplicably turned away at several hospitals while they potentially infected many others.
The 29 new cases of severe acute respiratory syndrome were not identified, and action was not taken to quarantine the group of 500, for more than a week after the initial exposure - leaving sufficient time for the disease potentially to have spread into the general population. There is already evidence of possible spreading, in a condominium outside Toronto and as far away as Montreal.
The second-guessing is now blooming faster than the disease, and it is beginning to jeopardize business confidence and become a rancorous political issue in the Ontario provincial legislature.
"Where's Rudy Giuliani when he's needed?" said The Globe and Mail in an editorial on SARS yesterday. "Toronto could use that kind of leadership now."
As the city most seriously stricken with the epidemic outside of Asia, Toronto has emerged as a test case of whether mass quarantines can be effective in containing the virus. Thirteen people have died from the disease here, and 251 of Canada's 306 probable and suspected cases have been reported in the greater Toronto metropolitan area.
Health officials say they are considering tougher measures, including the use of electronic bracelets to keep track of people in quarantine who are considered at risk to leave their homes.
With large church congregations gathering for Easter, this weekend is considered a crucial hurdle. Medical and religious leaders are urging anyone with the slightest temperature, body aches or other symptoms to stay home.
Meanwhile, in China, leaders have been facing similar criticisms about their handling and reporting of cases of the disease.
Seeking to quell an international uproar over the credibility of their medical reports and to halt the spread of SARS, officials have issued their strongest warning yet and have explicitly told officials not to withhold information.
With large front-page headlines yesterday morning, The People's Daily and other newspapers described an urgent meeting on the disease that was held Thursday by the country's supreme ruling body, the nine-member Standing Committee of the Politburo.
In the symbolic forms of Chinese politics, the message could hardly have been delivered with more force or fanfare, and the word to officials down the line was stern.
"The meeting explicitly warned against the covering-up of SARS cases and demanded the accurate, timely and honest reporting of the SARS situation," said the account issued by the New China News Agency.
The top leaders called the spread of the new disease a serious threat to "China's reform, development and stability," and said party and government leaders around the country "will be held accountable for the overall situation in their jurisdictions."
Many of the recommendations made by the World Health Organization and other international experts - such as guaranteeing care for impoverished SARS patients so they will not avoid hospitalization, and adopting swift, daily, nationwide reporting on new cases - were fully endorsed in the ruling body's statement Thursday.
Chinese credibility on SARS was first questioned in February and last month, as it became evident that the virus had spread quickly in the southeastern province of Guangdong. That is where the disease apparently originated and where more than 1,300 cases, of China's current official total of 1,457 cumulative cases, have been reported.