Spread to other countries and regions

The epidemic reached the public spotlight in February 2003, when an American businessman traveling from China became afflicted with pneumonia-like symptoms while on a flight to Singapore. The plane stopped in Hanoi, Vietnam, where the victim died in The French Hospital of Hanoi. Several of the medical staff who treated him soon developed the same disease despite basic hospital procedures. Italian doctor Carlo Urbani identified the threat and communicated it to WHO and the Vietnamese government; he later succumbed to the disease.^[23]
The severity of the symptoms and the infection among hospital staff alarmed global health authorities, who were fearful of another emergent pneumonia epidemic. On 12 March 2003, the WHO issued a global alert, followed by a health alert by the United States Centers for Disease Control and Prevention (CDC). Local transmission of SARS took place in Toronto, Ottawa, San Francisco, Ulaanbaatar, Manila, Singapore, Taiwan, Hanoi and Hong Kong whereas within China it spread to Guangdong, Jilin, Hebei, Hubei, Shaanxi, Jiangsu, Shanxi, Tianjin, and Inner Mongolia.

Hong Kong

9th floor layout of the Hotel Metropole in Hong Kong, showing where superspreading event of severe acute respiratory syndrome (SARS) occurred

In Hong Kong, the first cohort of affected people were discharged from the hospital on 29 March 2003.^[24] The disease spread in Hong Kong from a mainland doctor who arrived in February and stayed on the ninth floor of the Metropole Hotel in Kowloon, infecting 16 of the hotel visitors. Those visitors traveled to Canada, Singapore, Taiwan, and Vietnam, spreading SARS to those locations.^[25]
Another larger cluster of cases in Hong Kong centred on the Amoy Gardens housing estate. Its spread is suspected to have been facilitated by defects in its drainage system. Concerned citizens in Hong Kong worried that information was not reaching people quickly enough and created a website called sosick.org, which eventually forced the Hong Kong government to provide information related to SARS in a timely manner.^[26]

Toronto

The first case of SARS in Toronto, Canada was identified on February 23, 2003.^[27] Beginning with a woman returning from a trip to Hong Kong, the virus eventually infected 257 individuals in the province of Ontario. The trajectory of this outbreak is typically divided into two phases, with the second major wave of cases clustered around accidental exposure among patients, visitors, and staff within a major Toronto hospital. The WHO officially removed Toronto from its list of infected areas by the end of June, 2003.
The Canadian State’s official response has been widely criticized in the years following the outbreak. Brian Schwartz, vice-chair of the Ontario's SARS Scientific Advisory Committee, described public health officials’ preparedness and emergency response at the time of the outbreak as “very, very basic and minimal at best”.^[28] Critics of the response often cite poorly outlined and enforced protocol for protecting healthcare workers and identifying infected patients as a major contributing factor to the continued spread of the virus. The atmosphere of fear and uncertainty surrounding the outbreak resulted in staffing issues in area hospitals when healthcare workers elected to resign rather than risk exposure to SARS.