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Dr. Donald Low, leading figure in Toronto's response to SARS, dies at 68

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Infectious disease expert Dr. Donald Low walks through his laboratory in Toronto's Mount Sinai hospital, Tuesday, February 19, 2008. Dr. Low, one of the key figures in Canada's battle against SARS has died at 68. THE CANADIAN PRESS/J.P. Moczulski

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Infectious disease expert Dr. Donald Low walks through his laboratory in Toronto's Mount Sinai hospital, Tuesday, February 19, 2008. Dr. Low, one of the key figures in Canada's battle against SARS has died at 68. THE CANADIAN PRESS/J.P. Moczulski

TORONTO - One of the key figures in Canada's battle against SARS has died.

Dr. Donald Low, who became a trusted face and voice of the response effort, died Wednesday. Low, 68, was diagnosed with a brain tumour earlier this year.

A native of Winnipeg, Low was credited by friends and colleagues for both his contribution to the SARS response and for advancing the practice of microbiology and infectious diseases across Canada.

He had a keen mind and loved to puzzle out intriguing new developments in infectious diseases. Over the course of his career he co-authored nearly 400 peer-reviewed articles for scientific journals, 41 book chapters and almost 100 invited articles.

Low was a global expert in flesh-eating disease — necrotizing fasciitis — caused by group A Streptococcus. He was also an early and passionate champion of the need to combat antibiotic resistance by prudent use of the precious drugs.

But it was through the 2003 SARS outbreak that he became a familiar face to Canadians. While he had no formal leadership role on the response team, his capacity to explain through the media to the public what was going on in the fast-moving outbreak made Low the face of Toronto's SARS response.

Treasury Board President Tony Clement, who was Ontario's health minister during the SARS outbreak, expressed his sorrow at hearing of Low's death.

"Saddened to hear the news of Dr Donald Low's passing. I worked extensively with him during the SARS outbreak. Wonderful guy," Clement said on Twitter.

At one point during the SARS outbreak, Low had to go into quarantine, because he'd been in contact with a colleague who came down with SARS. He worked from home and emerged, 14 days later, without developing the disease. He would later marvel that he never caught SARS, given the amount of exposure he had to cases throughout the outbreak.

Putting in long hours over many weeks, he visibly dropped weight during the outbreak, prompting concerned strangers who saw him on TV news reports to write to ask after his health.

While he was always cognizant of the fact that SARS ended 44 lives in Ontario and permanently altered others, for Low, a microbiologist, being at an epicentre of the outbreak of a new infectious disease was a career highlight.

In an interview in late February about the 10th anniversary of SARS, Low described the outbreak as "the most amazing experience ever."

"In the first week or so it was quite exciting," he said, his voice raspy from the drugs he was taking to try to shrink the tumour.

"We were dealing with something that was international. It was in Toronto. We thought we had a handle on it. We didn't think it was going to go crazy. You know, this was fun. And we got a call from the New England Journal of Medicine saying 'We want a manuscript.' What else could you ask for?"

It quickly became apparent, though, that SARS had spread far farther into the city's network of hospitals than Low and others initially realized. It would take four months to bring the disease under control. "It was a very, very, very tough time."

Low studied at the University of Manitoba, getting his science degree and his degree in medicine there. After doing his internship and working for several years in Los Angeles, he returned to Winnipeg in 1982 as microbiologist-in-chief at St. Boniface Hospital.

Long-time friend Dr. Allan Ronald, a giant in Canadian infectious diseases medicine, said Low transformed what was a typical community hospital laboratory into a very good lab.

"He was a natural leader and a very bright, fun-loving individual who made for good times in terms of the whole issue of looking after sick people and trying to be enthusiastic and doing a good job," said Ronald, a professor emeritus at the University of Manitoba.

"(He had) lots of energy. He really pursued things to get the answers.''

Low's work in Winnipeg garnered notice. In 1985 he was recruited to run the microbiology department at Toronto's Mount Sinai Hospital, a position he held till his death.

Dr. Lionel Mandell, Low's best friend, said he was a terrific role model.

"He was a tremendous educator and he was a fabulous researcher. But I think if you wanted to point to what's the high water mark in terms of what can somebody achieve in microbiology and ID (infectious diseases) as an academic, he would be it," said Mandell, professor emeritus of infectious diseases at McMaster University in Hamilton.

"He's the guy you would point to in terms of what's possible to achieve."

After commissions of inquiry criticized Ontario's response capacity during SARS and in particular the state of the province's long-neglected public health laboratory, Low was pressed to lead a revitalization of that facility. He served as medical director of public health laboratory of the Ontario Agency for Health Protection and Promotion (now Public Health Ontario) from 2005 to 2012 — all the while remaining microbiologist-in-chief at Mount Sinai.

"Don's lasting legacy for public health is a renewed and reinvigorated public health system ready to respond to infectious disease challenges. We are grateful for his passion, commitment and talent," said Vivek Goel, president of Public Health Ontario.The provincial lab operates under the agency's auspices.

For Dr. Allison McGeer, Low's friend and colleague, this contribution was more important than what Low did during SARS.

"He was stellar and amazing at what he did during SARS, but the amount of work and energy and effort that went into taking a moribund public health lab and turning it into a really useful lab ... is of enormous value," said McGeer, who worked under Low as head of infection control at Mount Sinai.

In the early 1990s, when flesh-eating disease made a resurgence after decades of only rare appearances, Low quickly grasped that something had changed about the pattern of infections group A Strep was causing. He organized an Ontario-wide surveillance system, publishing findings in the New England Journal. Later, work he did on intravenous immunoglobulin rewrote the treatment protocol for group A Strep, McGeer said.

In the mid-1990s Low led an investigation that showed that a bacteria seen in fish — Streptococcus iniae — could sicken humans, finding infections in people who had recently handled farmed tilapia. That too made it into the New England Journal.

"Don seemed to have almost sort of a sixth sense of what was going to be important," said Mandell, who also described Low as a kind friend and doctor, and a man with an impish sense of humour.

McGeer said Low's biggest contribution, though, was training and mentoring a large network of infectious disease specialists.

"I think the most important thing he leaves behind is an entire generation of people who he has supported to be bigger and better and to find the place in the world that was right for them where they were going to do things," she remarked, saying of her boss "they don't come better."

Low is survived by his wife, Maureen Taylor, and by three children from a previous marriage.

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