““Surveillance and the sharing of information are the two biggest advances that we’ve made.” Dr. Donald Low Mount Sinai’s chief microbiologist and a member of the SARS containment team

It was just after 5 a.m. on a bleak winter morning a decade ago when Susan Sorrenti, a 39-year-old nurse and mother of two, woke from a restless sleep to grab a thermometer from her beside table.

Sorrenti was confined to a room on the second floor of her Peterborough home, a zone off-limits to her husband and girls. She hadn’t seen her little ones in days, not since the hospital phoned to tell her she had been exposed to the mysterious pneumonia-like disease that was killing people around the world.

Terrified, Sorrenti had been taking her own temperature every few hours since she got the call.

For days it sat at a normal 36.7 C, holding steady as she obsessively checked and rechecked. But on that Friday morning before dawn, when she pulled the thermometer out from under her tongue, the reading nearly knocked the wind out of her: 38.1 C.

Sorrenti’s temperature had spiked into the danger zone.

OK , she thought, as her breath quickened and her heart beat rapidly. This is it.

Sorrenti packed a bag and woke her husband. Greg Smith begged his wife to call an ambulance, but she refused. No point in exposing others, she told him. She’d already put her family at risk.

Sorrenti put on a mask, walked out the door and climbed into her dusty old Kia. The girls, 8-year-old Samantha and 6-year-old Angela, waved goodbye to their mother from a bedroom window. Sorrenti waved back. Then she took a deep breath, started the car, gripped the steering wheel and drove herself to Mount Sinai Hospital, where a medical test would confirm she had the deadly disease that would come to be known as SARS.

It started with one man's fever.

Four months earlier, in November 2002, a 40-year-old businessman in China’s Guangdong province was hospitalized with a high temperature and a dry, rapid cough. This was case No. 1, though it would not be identified as such until much later.

Hundreds fell ill across China that winter, but no one connected the dots. It would be months before health authorities took notice. Severe acute respiratory syndrome would catch the world off guard and become a defining event for the woefully underprepared province of Ontario.

The painful lessons learned would ultimately lead to a transformation of our public health system. The recent emergence of a SARS-like novel coronavirus that originated in the Middle East and has so far killed half of those known to be infected worldwide — 7 of 13 — is a stark reminder of the importance of the lessons learned locally and internationally.

SARS went global in February 2003. Late that month, Dr. Liu Jianlun, a 64-year-old medical doctor, travelled from his home in Guangdong province to Hong Kong, where he checked into a room on the ninth floor of the Metropole Hotel. The next day, he went into respiratory failure. Liu had been treating people with atypical pneumonia in the weeks leading up to his trip. At a Hong Kong hospital, he told medical staff he feared he’d been exposed to a “very virulent disease.”

The doctor infected at least 12 people at the hotel, who would fan out across the world and trigger outbreaks in at least five other countries. Liu would later be identified as a “super spreader” — a person whose body becomes hyper-infectious.

As Liu languished in hospital, Sui-Chu Kwan, a 78-year-old Scarborough grandmother visiting China, checked out of the Metropole Hotel and began her journey home to Toronto, landing on Feb. 23. She fell ill two days later and died on March 5. Kwan was Toronto’s first victim, though no one knew it at the time. Her death was declared a heart attack.

On March 7 , the 43-year-old son of Toronto’s first SARS case showed up at the Scarborough Grace emergency room with a fever and severe cough. The son, Tse Chi Kwai, was not put under quarantine because medical staff had not identified his condition. Few in Canada even knew that a virus had hit China at this time, let alone that it had already made its way to Toronto.

Only on March 12 did the World Health Organization issue an unprecedented global alert about cases of a “severe atypical pneumonia” that had spread beyond national borders. The disease had been identified in China, Hong Kong and Vietnam, the alert said.

Two days later, Canadian health authorities alerted Ontario doctors and public health units that there were four SARS cases and two deaths in Toronto, all in the same family. Unfortunately, they were several steps behind the virus. No one knew it yet, but the son of the Scarborough grandmother had already spread the disease beyond his family.

Kwai infected at least two people before he died in hospital on March 13. One was Joe Pollack, a 76-year-old Toronto man being treated for an irregular heartbeat. When he returned to Scarborough Grace a week later, Pollack was put under quarantine, but his wife was not. She spread the virus to 13 others in the hospital’s emergency room. The disease would eventually kill the elderly couple.

By this time, health officials were scrambling to figure out who had been exposed, but SARS was moving more quickly than anyone knew.

The second person who came into contact with the son of the Scarborough grandmother was an elderly man with a history of congestive heart failure. When that patient returned to Scarborough Grace a few days later, medical staff mistakenly attributed his symptoms to the heart condition and he was placed in the cardiology ward, where he would infect 21 people.

That day, a transplant patient happened to walk through the third-floor ward on his way to the foot clinic. He didn’t stop or linger, just passed through. When he fell ill near the end of March, the transplant patient returned to Scarborough Grace and was diagnosed with pneumonia. The hospital didn’t have room for him, so arrangements were made to send him to Mount Sinai.

Doctors said they were certain he didn’t have SARS.

Sorrenti was doing paperwork at a desk in the intensive-care unit when the transplant patient came through the double doors on a stretcher, coughing and hacking. The nurse froze, noting with alarm that he was not wearing a mask.

Mount Sinai had been buzzing for days with news that SARS had reached Toronto. Tensions had been high since March 15, when the WHO issued a rare travel alert and declared SARS a “worldwide health threat.” The information coming out of China was that health-care workers were the hardest hit.

Nurses had been told that a Scarborough Grace transplant patient with pneumonia was coming, but that quarantine measures weren’t necessary. Sorrenti and others questioned this approach. Wouldn’t it make sense to take precautions, just in case? They were told there was no record of the man having come into contact with infected patients. Isolation gear was in short supply and had to be conserved. Plus, it was March and the man was a transplant patient; pneumonia made sense.

“We made a mistake,” Dr. Donald Low, Mount Sinai’s chief microbiologist and a member of the SARS containment team, would say later.

In six hours, the transplant patient infected seven people at Mount Sinai. Sorrenti was one of them.

The hospital looked like a scene out of a bad science fiction movie — corridors taped off, everything wrapped in plastic, hallways silent and empty. The skeleton staff that remained was dressed in head-to-toe gear: gowns, goggles, gloves, masks, face shields.

Sorrenti was placed in isolation. Over the next few days, her fever intensified and she developed a sharp, persistent cough that left her gasping for breath. Then came the body aches, so severe she couldn’t wiggle her toes. The fever sucked away her energy and the sweating kept her awake at night. She was given experimental medication that made her lose control of her bowels. She developed psychosis and felt suicidal. One night, Sorrenti took off her oxygen mask to go to the bathroom and collapsed.

“I don’t think I’m going to make it,” she said to her husband on the phone.

The physical pain was one thing, but Sorrenti also had to deal with the emotional pain of knowing she had exposed her family to the virus. What if the girls fell ill? The guilt chewed away at the bit of sanity she had left.

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On a small television in the corner of her room, Sorrenti watched the world go into panic mode and the death toll rise. She would turn the TV off, then turn it back on again, not wanting to watch but unable to stop.

She didn’t know it at the time, but one of the dead in Toronto was the man who had infected her.

Greg Smith couldn’t stop scrubbing. At home in Peterborough, under quarantine with his two small girls, uncertain whether he would ever see his wife again, Smith focused on the only thing that made him feel in control.

“Just clean, clean, clean is all I did,” he recalled recently, a trace of residual panic in his brown eyes. “I couldn’t get things clean enough. I was wiping things down and then re-wiping things down. I was just in that state of mind. Is everything clean enough? It just couldn’t get clean enough, that’s the way my mind was working.”

Smith and his wife had recently moved the kids from Scarborough to Peterborough, where they bought a pretty two-storey house on a quiet street near a school. Sorrenti was the family’s breadwinner and commuted to work each day; Smith was “Mr. Mom.” They had a nice, quiet life.

After his wife left for the hospital, Smith ordered Samantha and Angela to stay in their rooms, separated in case one had been exposed to the virus and the other had not. Smith took the girls’ temperatures three times a day and recorded them in a notebook. One evening, Angela developed a slight fever. Over the phone, a public health worker told Smith to monitor her condition for a few hours and go directly to the hospital if it continued to rise. Smith sat up the whole night at the kitchen table, shaking with worry.

The next morning, Angela was back to normal. The father cried with relief. Then he went on scrubbing.

After 10 days in hospital, Sorrenti’s fever broke. A week later, she was sent home to her husband and children, who had made it through quarantine without developing symptoms. They were all OK.

SARS would ultimately claim 44 lives in Toronto and 800 around the world. Scientists later determined the coronavirus was most likely transferred to humans from civet cats, a raccoon-like animal that is a delicacy in some parts of China. Nearly one in 10 of the nearly 8,100 probable SARS patients worldwide died — a very high rate for a disease.

In Ontario, a scathing report by Justice Archie Campbell, who was charged with investigating the response to SARS, would affirm what had become brutally obvious through the winter and spring of 2003: the province’s health system was unprepared, fragmented, poorly led and inadequately resourced. Only the heroic efforts of front-line health workers prevented the virus from causing further damage.

A lot has changed since then, both locally and globally. One of the most important things, according to Dr. Low of Mount Sinai, is the ability — provincially, nationally, internationally — to recognize when there is a problem at the doorstep.

“Surveillance and the sharing of information are the two biggest advances that we’ve made,” says Low, who worked around the clock for months during the crisis and was hailed as one of the heroes of the outbreak.

Vigilance, Low and others stress, is critical. That’s because scientists believe it isn’t a matter of if the world will see another outbreak like SARS, but when.

In retrospect, Sorrenti remembers SARS as a really bad flu. She recognizes now that she was probably never as close to death as she felt at the time, though the heavy weight of uncertainty played on her mind. None of the people infected by the transplant patient sent from Scarborough Grace to Mount Sinai died — a relief to those who decided not to quarantine him.

For awhile, Sorrenti felt bitter, particularly when she thought about the danger her family had been in. She was part of a group of nurses who sued the province unsuccessfully, through their union, alleging the government put economic interests ahead of public safety during the outbreak. Over time, she has let go of the resentment — forgetting, but not quite forgiving. Risk, she says, is part of the job, and she continues to face it regularly at Peterborough Regional Health Centre and Mount Sinai, where she still works as an intensive-care nurse.

“As a health-care professional, every time you go into work you think, ‘What am I going to be seeing? What am I going to be exposed to?’ It’s always in the back of your mind,” she says.

“I feel that what we learned from the experience was invaluable in preparing us for what could happen in the future.”

“It was the turning point in our health-care system,” the nurse says. “The wake-up call.”

About this story

The scenes in this story were reconstructed from interviews with Susan Sorrenti and members of her family. Details that involved third parties, such as the scene in which Sorrenti contracts SARS from a patient in the intensive care unit, were confirmed with hospital staff.