With Toronto in the global headlines over the Sars outbreaks, Fran Caygill, a nurse originally from Teesside and now living in the Canadian city, gives her perspective on the epidemic which is causing panic in some parts of the world

WE'VE been dealing with this crisis for more than seven weeks now. In fact, it's not a crisis in Toronto any more. The Sars deaths which occurred last weekend were of people who had been ill with the disease for a while.

On a positive note, there haven't been any new Sars cases in Toronto since April 9. The number of cases in Ontario is falling, and on Monday, 95 people were being treated in hospital compared with 106 last Friday. These facts indicate that the disease has been contained.

But when it was a crisis, when myself and my colleagues were filled with fear as the number of cases in Toronto increased, the world wasn't watching. The international media rightly focused its attention on Iraq.

Now, the war is over, and journalists from around the globe are camped outside Mount Sinai Hospital - three weeks too late. There are only four people in the hospital with Sars, compared to 16 about three weeks ago.

Still, despite the attention and all the bad press Toronto is receiving, we are slowly and thankfully putting our lives back together after weeks of stress and worry.

The first time I heard about Sars was on March 17. A memo arrived outlining a respiratory condition - the word Sars wasn't even used at that point. Staff weren't too concerned a few days later when we heard that a Sars patient was being cared for on a different floor. Infection control policies here are excellent and the patient was in a different part of the hospital, so I felt safe.

But things quickly became bleaker towards the end of March when the number of Sars cases increased, reaching 16 in early April. The seriousness of the situation hit home when a friend contracted the disease. He is an anaesthetist and apparently caught Sars at the end of March when he was putting a tube into a patient's throat. He was masked, gowned and gloved, although he was not wearing a high-protection mask.

He was taken into isolation, and has only just gone home after a long and painful illness. It was upsetting to know that we couldn't go and see him while he was quarantined. We put together a care package and sent it up to his room, and e-mailed him to help keep his spirits up.

At about the same time, a Sars nurse contracted Sars, even though she followed all policy and wore a high-filter mask at all times. She did not know that she had the disease and travelled to work on a local commuter train, despite having a mild headache and a slightly elevated temperature. She thought the symptoms were due to the stress of the growing crisis, but she was sent immediately to emergency. A CT scan revealed fluid on the lungs and confirmed that she had Sars. This poor nurse suffered a huge backlash in the local press and was severely criticised for travelling on a train, even though she had followed all procedures.

Normally, I work in post-anaesthetic care unit. But by the end of March, in a decision to better use hospital resources to deal with Sars, the hospital discontinued all surgery. Myself and my team were sent to other parts of the hospital.

In early April I had to work in intensive care, because 65 of the unit's staff had been quarantined due to Sars. This was the most difficult time for me, and I felt anxious and very worried. When I arrived at the unit, a Sars patient had been treated the previous day. I worried about my own health because we are still unsure about the transmission of Sars. And I was concerned about the air quality in the unit, or if the people around me had the disease.

By then, the hospital had instituted a strict Sars control policy and we were wearing masks and gowns. The stress was beginning to show as the whole situation took on a sense of unreality. I felt I was on a movie set, something like Dustin Hoffman's virus drama Outbreak, only this was for real. The growing sense of isolation was really difficult too, because colleagues could not eat together as this meant removing one's mask. We were also discouraged from socialising together outside work.

The stress was intensified by the introduction of a strict screening procedure for every staff member arriving for work. Our hands were cleaned with alcohol gel, we were masked, gowned, had our temperatures taken, and asked questions about our whereabouts and activity in the last 24 hours. This screening of hospital staff is still in place today, and we are still fully gowned and masked when caring for patients.

Those weeks through the end of March and early April were the most difficult for me, and my life outside work began to change too. A close friend decided not to visit my house because he had young children, one of whom had suffered a respiratory illness as a baby. Other friends stayed away at a time when I needed to be able to talk and receive support.

But the strict measures instituted by the hospital were having an effect. Case numbers were falling and new cases occurring less frequently. Slowly, life is starting to get better. Last week our hospital started performing elective surgery for the first time in three weeks. This week, staff who do not have direct patient contact, such as accountants and secretaries, will not have to be masked.

In Toronto, there is no fear or panic, although fewer people are going into Chinatown because of the China/Hong Kong connection. But the shopping malls are busy and the ice hockey arenas are full.

However, just as things have started to get better, the World Health Organisation (WHO) has issued a caution against travelling to Toronto, and this travel advisory will not be reassessed for some weeks. I believe this decision is one that has come two or three weeks too late; it is an extreme reaction to a situation which needs to be taken seriously but is no longer a crisis.

We are upset about this, but at the same time realise that our federal government hasn't helped the situation by not taking the Sars outbreak as seriously as it should have. Instead, it has been left to the province of Ontario and the City of Toronto to respond properly. So in effect, the United Nations body has quarantined Toronto because our own federal government was unwilling to take proper measures itself, such as airport screening.

It's been a stressful and traumatic time - but one that has brought rewards too. Our infection control policies have been tested and proven. Communication at my hospital is very good and I feel managers and staff have managed through this brilliantly. Another reward is that the stress and strain has meant that colleagues have had to work more closely and consequently bonds have been strengthened.

l Fran Caygill works at the Mount Sinai Hospital in Toronto, Ontario