The 2003 SARS outbreak in Toronto was the largest outside Asia: as of August 12, 2003, Canada had 438 probable and suspect cases of severe acute respiratory syndrome, including 44 deaths, and all the deaths occurred in Toronto, according to the National Advisory Committee on SARS and Public Health. The outbreak came in two waves, the first beginning in hospitals in March 2003 and the second announced on May 23, 2003. Ontario’s SARS Commission, led by Justice Archie Campbell, reported on it in detail.
This article sets out the timeline, the public health response, and the official inquiries, with each figure tied to its source and year. It gives no medical guidance. Another Toronto emergency of that summer is in the article on the August 2003 blackout.
What SARS was
The National Advisory Committee, chaired by Dr. David Naylor, then Dean of Medicine at the University of Toronto, described SARS in its October 2003 report as a droplet-spread viral illness apparently caused by a novel coronavirus. It emerged in China in November 2002. The committee reported about 8,500 people diagnosed worldwide with probable SARS and over 900 deaths. Outside Asia, it wrote, Canada was the country hardest hit.
First wave: March to May 2003
The Naylor report and MacDougall’s 2007 study of Toronto Public Health give the following sequence.
| Date (2003) | Event |
|---|---|
| March 5 | A woman who had stayed at a Hong Kong hotel dies at home in Toronto (MacDougall) |
| March 7 | Her son is seen in the emergency department of the Scarborough Hospital, Grace Division, and dies on March 13 |
| March 12 | The World Health Organization (WHO) issues a global alert |
| March 13 and 14 | Health Canada is notified of the Toronto cluster; Ontario’s health ministry and Toronto Public Health hold a press conference |
| March 23 | The Grace Division closes its emergency and intensive care services and stops admissions |
| March 25 | Ontario designates SARS a reportable, communicable, and virulent disease |
| March 26 | Premier Ernie Eves declares a provincial emergency; hospitals in the Greater Toronto Area are ordered to activate “Code Orange” plans |
| April 23 | WHO adds Toronto to its travel advisory list |
| April 30 | WHO lifts the Toronto advisory (WHO chronology; the Naylor report gives April 29 in one passage and April 30 in another) |
| May 14 | WHO removes Toronto from the list of areas with recent local transmission; the city returns to the list on May 26 and is removed again on July 2 (WHO) |
| May 17 | The provincial emergency is lifted |
The Naylor report says physicians and public health officials connected the family cluster to the Hong Kong illness around March 13, and that one early patient’s contact in an emergency department led to further infections among visitors, staff, and paramedics. A separate cluster that started with a transferred patient reached more than 50 people and closed York Central Hospital. For hospitals, “Code Orange” meant suspending non-essential services, limiting visitors, creating isolation units, and providing protective clothing for exposed staff. Four days after March 26, access restrictions were extended to all Ontario hospitals. The committee heard mixed opinions about whether Code Orange was justified.
Second wave: May 23 to June 30, 2003
A week after WHO removed Toronto from its list, health officials announced that SARS had not been defeated. On May 23 the province said five people were under investigation. Anyone who had visited St. John’s Rehabilitation Hospital between May 9 and 20, or North York General Hospital between May 13 and 23, was ordered into quarantine, and North York General closed to new admissions except SARS patients. By the end of May, 48 probable and 25 suspect cases had been identified in this second outbreak. The committee wrote that the chain of events behind it remained a mystery. Only four hospitals were designated as SARS facilities, a group called the SARS Alliance: North York General, the General site of the Scarborough Hospital, St. Michael’s Hospital, and Sir William Osler Health Centre in Etobicoke. The Scarborough sites are placed in context in the article on Scarborough’s history.
Quarantine and public health work
MacDougall reports from Toronto Public Health records that quarantine lasted ten days, that more than 23,300 people were identified as contacts, and that 13,374 people spent ten days isolated at home. Only 27 formal isolation orders were issued. The department’s SARS hotline received over 300,000 calls, including 47,567 on a single day, and its website carried information in 14 languages. The Medical Officer of Health, Dr. Sheela Basrur, led up to 700 staff. Case files were kept on paper with colored sticky notes because the provincial software was judged unsuitable; Dr. Basrur said Toronto was using “nineteenth century tools to fight a twenty-first century disease,” as the Naylor report records.
Counts and who was affected
Counts depend on the date, the area, and the case definition, so the sources are listed side by side.
- 438 probable and suspect cases in Canada, 44 deaths, as of August 12, 2003: National Advisory Committee on SARS and Public Health (October 2003).
- 375 cases in Ontario (247 probable, 128 suspect) and 44 deaths: figures used by the SARS Commission, from a Health Canada summary of September 3, 2003.
- 351 cases in Ontario (301 probable, 50 suspect): a retrospective review by the Ministry of Health and public health units in July 2006, as quoted by the SARS Commission.
The commission, which counted almost 375 Ontario cases, said that 72 percent of them were infected in a health care setting, that 45 percent of that group were health workers, and that two nurses and a doctor died. The Naylor committee likewise reported that more than 100 health care workers became ill and three died. MacDougall dates the deaths to June 30 (a nurse), July 19 (a second nurse), and August 13 (a family physician).
The inquiries
Three bodies reviewed the response. The Naylor committee, appointed by the federal government, published Learning from SARS in October 2003. A provincial expert panel chaired by Dr. David Walker, dean of medicine at Queen’s University, was announced after the first wave. Premier Eves named Justice Archie Campbell to head a judicial commission on June 10, 2003. It issued interim reports on April 15, 2004, and April 5, 2005, and its third and final report carries a letter of transmittal to the Minister of Health and Long-Term Care dated December 11, 2006. The Archives of Ontario, which hosts the report, gives January 4, 2007 for transmittal and January 9, 2007 for public release, so the sources differ on the dates. Its central finding was that SARS took hold because of a confluence of systemic weaknesses in worker safety, infection control, and public health. On the question of whether precautions were relaxed too soon in May 2003, it wrote that there was no easy answer: in hindsight the relaxation was a mistake because cases at North York General flared into the second outbreak, but the decision was made in good faith on the best medical advice available.
How many people died of SARS in Toronto?
Forty-four people died in Canada, and the Naylor committee states that all the deaths occurred in Toronto. The Ontario SARS Commission also puts the Ontario toll at 44.
Why did the WHO issue a travel advisory for Toronto?
On April 23, 2003, WHO advised against non-essential travel to Toronto, saying a small number of people with SARS in other countries appeared to have caught it in Toronto. Canadian health officials disputed the reasoning, and WHO lifted the advisory on April 30 (the Naylor report gives April 29 in one passage), after a delegation that included Ontario Health Minister Tony Clement and Dr. D’Cunha visited Geneva.
What was Code Orange?
It was an emergency plan activated in Toronto-area hospitals on March 26, 2003, under which non-essential services were suspended, visitors were limited, and isolation units were created. It was extended to all Ontario hospitals four days later and revoked after the first wave ended.
What did the Campbell commission conclude?
Its final report (letter of transmittal dated December 11, 2006; public release January 9, 2007 according to the Archives of Ontario), found a combination of weaknesses in worker safety, infection control, and public health, and called the relaxing of precautions in May 2003 a mistake in hindsight, made in good faith on the advice then available.
Sources
- National Advisory Committee on SARS and Public Health (chair David Naylor), Learning from SARS: Renewal of Public Health in Canada, Health Canada, October 2003
- Heather MacDougall, “Toronto’s Health Department in Action: Influenza in 1918 and SARS in 2003,” Journal of the History of Medicine and Allied Sciences 62(1), 2007
- Hon. Archie Campbell, SARS Commission, Executive Summary, Volume One: Spring of Fear, December 2006 (letter of transmittal dated December 11, 2006); copy hosted by Louisiana State University Law Center
- World Health Organization, “Update 95: SARS, Chronology of a serial killer,” July 4, 2003:
- Archives of Ontario, SARS Commission final report pages (release dates of the report).html (the site blocked automated access when checked, so the dates were read in search extracts only)
Related reading
- The 1918 influenza epidemic in Toronto
- The 1847 typhus epidemic and Irish immigration
- The August 2003 blackout
- Toronto in numbers, with year and source
- Overview of Toronto’s history
Last verified: October 2026
Cite this page
APA: History of Toronto. (2026, October 23). The 2003 SARS Outbreak in Toronto: Timeline and Inquiries. https://historyoftoronto.ca/blog/sars-outbreak-2003-toronto
MLA: “The 2003 SARS Outbreak in Toronto: Timeline and Inquiries.” History of Toronto, 23 Oct. 2026, https://historyoftoronto.ca/blog/sars-outbreak-2003-toronto. Accessed .
Chicago: History of Toronto. “The 2003 SARS Outbreak in Toronto: Timeline and Inquiries.” Last modified October 23, 2026. https://historyoftoronto.ca/blog/sars-outbreak-2003-toronto.
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