AARON DERFEL
Gazette Health Reporter

Montreal public health authorities took the extraordinary step yesterday of urging anyone with flu symptoms who shows up in an emergency room or doctor's office to don a surgical mask.

The measure is aimed not only at containing the spread of influenza as it reaches its peak in Montreal in the next three weeks. The Public Health Department is also being very prudent to prevent even the remote possibility of SARS hitting the city, or the transmission of a new human virus that might originate from Asia's bird-flu epidemic.

ER doctors and nurses are being advised once again to ask anyone with a fever or a nagging cough whether they have recently travelled from southeast Asia, the source of last year's outbreak of severe acute respiratory syndrome.

Get used to it: the surgical-mask measure is part of the new cultural phenomenon of "respiratory etiquette," officials said yesterday. That includes repeated hand washing with an antiseptic gel like Purell for those with flu-like symptoms.

"More and more, this is going to become the norm," said Dr. Richard Lessard, director of the Public Health Department.

"People who cough and who have fever will be offered a mask and will be asked to clean their hands and, if at all possible, to stay away from the rest of the patients in the waiting room."

These measures have already been adopted by Montreal hospitals and CLSC clinics, and are mandatory. In private doctors' offices, however, they are voluntary - for now, because there is no sign of an epidemic.

"We're becoming more aware that viruses change around the world," Lessard said. "The SARS epidemic of last year that touched Toronto so much increased our awareness that the preparation that we have toward these epidemics is not what it should be."

The Public Health Department has three concerns:

The seasonal flu epidemic, which has proved to be nastier this year than last.

On average, flu causes 15,000 hospitalizations in Quebec each year and kills up to 1,500 people, mostly the elderly.

This year, the vaccine offers only partial protection against the Fujian strain sweeping across North America. Thus, surgical masks, tissues and hand gels provide additional protection.

SARS. The World Health Organization reported yesterday a second confirmed case of SARS and a third probable case - all confined to China.

Dr. John Carsley, director of infectious diseases at the Public Health Department, said SARS is posing much less of a risk than it did last year.

"For the time being, the risk of SARS importation is extraordinarily low," Carsley said. "All the same procedures, however, are still in effect in terms of travel questions."

The bird flu epidemic. The spread of highly contagious avian influenza in Vietnam and Thailand poses a major threat to human health and a disaster for agricultural production in the region, the WHO and two other international bodies said in a joint statement yesterday.

"With SARS, we learned that only by working together can we control emerging global public health threats," said Dr. Lee Jong-wook, WHO director-general. "Now, we confront another threat to human health and we must reaffirm existing collaboration and form new ones."

The human death toll rose by one yesterday to eight. In all cases, the individuals had been in close proximity to infected fowl.

Carsley emphasized the avian-flu virus is contagious only between birds. But he warned it could mix with a human virus - potentially sparking a pandemic.

The risk of a new strain stemming from avian flu poses more of a threat today than SARS, he said.

aderfel@thegazette.canwest.com