In the spring of 2003, the World Health Organization identified a worldwide epidemic of severe acute respiratory syndrome (SARS) that had started in China and spread to the rest of the world, with early cases reported in Toronto and Vancouver. Little was known about the disease, which meant that symptoms were often misdiagnosed as simple flu, and the infection spread rapidly. After the third SARS-related death occurred in Ontario in mid-March, the provincial premier declared a state of emergency, which was finally lifted on May 17 when it appeared the outbreak had ended. A week later, on May 23, four new cases were reported at Toronto's North York General Hospital. The lack of public health infrastructure in Ontario combined with its hospitals' noncompliance with following existing policies concerning infection control and especially the lack of communication between hospitals, health organizations and levels of governments, with numerous spokespersons making uncoordinated and sometimes contradictory announcements, all led to the public perception that the government and health care authorities did not know what they were doing or were lying about the severity of the outbreak. Before the next provincial election, the premier must examine and address what could have been prevented, how public health interventions were managed and the differences between public health responses in Toronto and Vancouver.