Travel Advisory:
The World Health Organisation (WHO) has recommended that people avoid non-essential travel to Toronto, Canada. The Canadian situation is reviewed by Reuters, in this article. Public health officials and politicians in Toronto reacted strongly against the WHO action.

BBC coverage of the WHO travel advisory notes that WHO has added Toronto, Shanxi, and Beijing to the areas where non-essential travel is not recommended. Hong Kong, and China's Guangdong province have been under the same travel advisory for weeks. The WHO advisory is here.

The WHO cited Toronto because cases had been 'exported' to other countries, including the US where secondary SARS cases occurred, and a case that was exported to the Philippines. WHO was also concerned about the large numbers under quarantine in Toronto, and that city's difficulty keeping people within quarantine.

Ribavirin is ineffective against SARS virus:
There is no known cure, and no drug to treat SARS. Various drugs have been tried, but none have any proven value.

Here is some advice for doctors on the management of SARS, from WHO, on April 11.

Scientists at the SARS conference in Taiwan, on April 21 said ribavirin is ineffective against SARS, according to the Taipei Times. "Dr Joseph Sun, a pathologist from the University of Hong Kong, and Hsueh Po-jen, a doctor at National Taiwan University (NTU) Hospital, said that ribavirin cannot effectively contain the cell-to-cell spread of the SARS virus in the bodies of patients."

The United States agrees that ribavirin is dangerous and likely not helpful. Yahoo! News reports that:

"The drug ribavirin is being used by doctors in Hong Kong and Toronto who are convinced it helps many SARS patients. But U.S. researchers, who have been skeptical all along, shelved a plan to formally test the drug with a careful experiment in people... Dr. Catherine Laughlin, virology chief at the [United States] National Institute of Allergy and Infectious Diseases, said there was simply no evidence it worked. "It has significant toxicity, and there was a real chance you could do more harm than good." Dr. Michael Lai, ofthe Univerity of Southern California said that ribavirin might be tested in monkeys.”

At the April 22, press briefing, the Director of the US CDC, Dr. Julie Gerberding said, "...Ribavirin is a drug that does have some serious side effects, including hemolytic anemia and other complications. We also know from the early results of the viral testing studies that there doesn't seem to be any activity of ribavirin in the methods that are being tested right now against this particular Coronavirus."

Clearly, the United States has shelved plans to test the anti-viral drug, ribavirin, in human trials.

Although unproven, ribavirin is used routinely both in Hong Kong and in Canada, which has the world's highest death rate for SARS.

The full April 23 SARS Update is here.