It seemed like the typical viral ''summer cold'' as it began spreading through a nursing home in the Vancouver area in early July. Then in August, test results from the Canadian National Microbiology Laboratory suggested that the ''cold'' might be from a mutated SARS coronavirus.

Just the hint created deep concerns in a country that had already been hobbled by an outbreak in Toronto last spring. British Columbia officials temporarily imposed infection control and quarantine measures that had contained the Toronto outbreak.

The disruptive and costly actions turned out to be excessive. British Columbia officials have since determined that the SARS coronavirus did not cause the outbreak. Rather, they said, its virological cousin, the OC43 coronavirus, which commonly causes colds, was the probable culprit.

Disputes among Canadian officials over the virological findings have exposed deep flaws in the systems available to detect and monitor any potential outbreak in Canada and elsewhere. Not only did they underscore the need for more uniform laboratory testing, but also prompted health officials to renew calls for reliable tests to detect SARS, or severe acute respiratory syndrome, in its earliest stages of infection.

''The safety net for detecting the possible return of SARS is pretty fragile,'' said Dick Thompson, a spokesman for the World Health Organization, the United Nations agency in Geneva with responsibility for controlling the disease. ''It holds together, but it is spit and luck.''

Examination of the disputed findings in Canada is also occurring as the world is bracing for the possible resurfacing of SARS. A recent report from the United States National Intelligence Council -- which consists of experts from the academic and private sectors and which reports to the director of central intelligence, George J. Tenet -- lays out three bleak possible situations for the virus's re-emergence. Surprisingly, the intelligence report does not consider an instance in which the disease does not reappear.

The three situations outlined in the report are disconcerting. One is a resurgence in countries with major trade centers as international travelers spread SARS the way they did this year. A second is that SARS cases will occur sporadically but will be detected before the disease can spread, creating more of a public health nuisance than a crisis. The third unfolds in developing countries with weak public health systems.

All make early detection a priority. Canadian and United States health officials and SARS experts are expected to discuss what steps may reliably be taken to identify possible new SARS cases, among other topics, at a two-day closed meeting in Ottawa that begins tomorrow.

To some health officials, the outbreak at the Kinsmen Place Lodge nursing home in Surrey, British Columbia, has not only revealed important gaps that need to be addressed, but it may also provide lessons that can be used in the face of a recurrence of SARS.

''In a way, it was lucky that this outbreak happened before the influenza season because it is better to learn about the problems now than then,'' said Dr. Katrin Leitmeyer, a W.H.O. epidemiologist and virologist who went to the National Microbiology Laboratory in Winnipeg to review its findings.

One of the most glaring problems uncovered by the nursing home outbreak was the absence of a formal agreement among scientists about precisely what steps and laboratory methods should be used to make a definitive diagnosis of SARS.

For example, many test results remain in dispute, largely because the scientists involved in different laboratories did not use the same methods to test each specimen to try to identify the virus and to determine whether the patients' immune systems had produced antibodies against it. And partly because little is left of the specimens collected from the nursing home patients, it will take weeks more to prove that the suspected OC43 coronavirus, is the cause.

The conflicting laboratory results have led Canadian scientists and officials to clash over the validity and meaning of the tests performed on the lodge residents and staff members.

''We're at loggerheads with the National Microbiology Laboratory,'' said Dr. Mel Krajden, the chief virologist at the British Columbia Center for Disease Control.

The center's chief epidemiologist, Dr. David Patrick, said that from July 1 through August, 95 of the 142 lodge residents, or 67 percent, developed the summer cold and that 8 deaths were related to the outbreak. Of the 160 health workers there, 53, or 33 percent, developed the summer flu.

Initially, Dr. Krajden's team found no evidence of viruses like influenza, parainfluenza and respiratory syncytial virus that are common causes of upper respiratory illness.

SARS was low on the candidate list because the death rate among lodge residents was 8 percent, far lower than the rate of 50 percent or more found among people 60 and older in the SARS epidemic last spring.

But when a second wave struck the nursing home and the center still could not identify a virus, health officials reconsidered SARS. ''So, having come up empty-handed, we said why not send some of the very limited remaining materials to'' the national laboratory, Dr. Krajden said.

It was a step that many laboratories less concerned about the threat of SARS might not have taken under the same circumstances, health officials said.

The surprise came when [Francis Allan Plummer (born 1952)], the director of the National Microbiology Laboratory, said that his team had found tentative evidence of what might be a mutant SARS virus.

Then on Aug. 22, provincial officials said the latest findings from the British Columbia Center for Disease Control and the British Columbia Cancer Agency's Genome Sciences Center ''provide conclusive evidence'' that the virus responsible for the nursing home outbreak was not the SARS coronavirus, but probably its cousin, OC43.

''We have clearly found large sequences of the virus that are not present in the SARS coronavirus,'' Dr. Patrick said.

Last week, Dr. Larry J. Anderson, an expert on respiratory diseases at the Centers for Disease Control and Prevention in Atlanta, said his team had completed tests to detect antibodies to the SARS virus in the blood specimens sent by Dr. Plummer. The C.D.C. tests did not confirm the Canadian National Microbiology Laboratory findings that SARS antibodies were present.

Dr. Plummer said he agreed that the virus was not the classic SARS virus, but that his team had found no evidence of OC43.

''We do not dispute their results, but we also believe our results,'' Dr. Plummer said. ''Now what produced them is a puzzle.''

Among the possible explanations for the conflicting results is that two or more viruses were simultaneously affecting the nursing home. Another possibility is that the specimens from the lodge were inadvertently contaminated with SARS virus in the Winnipeg laboratory. Dr. Plummer said he considered that unlikely because of the pattern of his test findings. ''All these diagnostic tests are new and every laboratory has developed its own test,'' he said.

''We have a limited understanding of their performance, so comparing what one laboratory is talking about to another is problematic,'' Dr. Plummer said. ''This is obviously new territory for all of us. We are probably at a normal state of development for a disease that has been around for a few months, and we will be learning every time one of these things happen.''

The Canadian laboratories have not succeeded in growing the nursing home virus and then fully mapping its genome -- two findings that would provide the most definitive evidence of the causative agent. But virologists say that growing the coronavirus apparently involved in the nursing home outbreak is more difficult than growing the SARS virus in the laboratory.

The threat of SARS may prompt several changes in laboratory practices, virologists said. For example, diagnostic laboratories rarely include coronaviruses in screening tests for the cause of outbreaks of respiratory illness because they generally cause mild illness and because budgets preclude searching for every virus.

''No one ever cared that much,'' said Dr. Kathryn V. Holmes, a professor of microbiology at the University of Colorado Health Sciences Center in Denver who has studied coronaviruses for 20 years. She was not involved in the Canadian investigation.

And the nursing home developments raise questions about how research is conducted in a public health crisis, said Dr. Roland Guasparini, chief medical health officer of the Fraser Health Authority near Vancouver, which had jurisdiction over the nursing home outbreak.

[Dr. John S. MacKenzie (born 1943(est.))], an Australian virologist who is temporarily helping W.H.O. deal with the threat of SARS and other emerging diseases, said the nursing home episode pointed out three major worries about laboratory testing for SARS that an advisory panel of W.H.O. would need to address in October.

One is the lack of quality assurance. The various methods have not been tested in different laboratories under different conditions, Dr. MacKenzie said, and ''this is a big concern.''

Second, there is no internationally accepted standardization of the biological materials known as reagents used in testing in different laboratories. Dr. MacKenzie said he was particularly concerned about the lack of standardization of the control tests, which play a routine part in laboratory testing.

Third, Dr. MacKenzie said, ''we need to look very carefully at what we do if we have a positive case.''

''What's crucial is that a second laboratory, preferably an international reference laboratory outside the country that found the positive, confirms the tests,'' Dr. MacKenzie said. ''Some countries are not keen on this,'' he added, yet ''it is a major issue.''

At the October meeting, he said, ''We're going to go into detail about what is known, what isn't known, what needs to be done, and then prioritize some things that need to be looked at.''

But because the W.H.O. meeting will not be held until late October, it may be too late to be effective, Mr. Thompson, the agency spokesman, acknowledged.

By then the Northern Hemisphere may be experiencing the usual seasonal outbreaks of influenza and other respiratory illnesses. Under such circumstances, the continuing lack of a reliable diagnostic test for SARS could create chaos from the continuing inability to distinguish SARS from other illnesses that, by coincidence, were producing similar symptoms like fever, headache and cough.

Plummer, 67, was in Kenya, where he was a keynote speaker at the annual meeting of the University of Nairobi's collaborative centre for research and training in HIV/AIDS/STIs.

Dr. Larry Gelmon, who helped set up that meeting, said Plummer collapsed and was taken to hospital in Nairobi, where he was pronounced dead on arrival.

No confirmed cause of death has yet been released.

Plummer was born and raised in Winnipeg, where he headed up Canada's National Microbiology Laboratory for several years.

He was also involved in an innovative research partnership between the University of Manitoba and the University of Nairobi, established before the world was very aware of HIV/AIDS. 

"He helped to identify a lot of the key factors that are involved in HIV transmission in the early days," said Keith Fowke, a professor in the medical microbiology and infectious diseases department at the University of Manitoba. 

Before that partnership, scientists didn't know HIV could be passed on to women or to babies through breast milk.

"He developed a lot of interventions that helped save hundreds of thousands of lives across the world," Fowke added. "Frank was definitely a brilliant mind."

As a specialist in infectious diseases, Plummer's work influenced international public health policies.

"Frank dedicated decades of his time to Africa and led world-changing breakthroughs in HIV prevention," Matthew Gilmour, director general of the National Microbiology Lab, wrote in an internal email to staff of the Public Health Agency of Canada on Tuesday. 

"Of course, the most noteworthy breakthrough that he and his team made was the finding of female sex-workers who were resistant to HIV. The gift these women have given science in the years since has been unparalleled.

"Frank had just had a joyful reunion with many of them a couple days before his passing."

Another colleague, Dr. Allan Ronald, said Plummer's death is tragic and a loss for science.

"He was so hopeful that he was on the path that would end with discovery of the HIV vaccine — the road he had started down almost 30 years ago," Ronald said.

University of Manitoba president and vice-chancellor Dr. David Barnard said Plummer had a great impact on global public health.

"He was admired and regarded highly by academics and researchers around the world, and his legacy of seeking to develop an HIV vaccine remains one of the landmarks of infectious disease prevention," Barnard said.

Dr. Theresa Tam, Canada's chief public health officer, took to Twitter to remember Plummer.

Plummer was most recently living in Toronto, where he underwent experimental brain surgery to fight alcohol addiction.

He was believed to be the first person in North America to undergo deep brain stimulation for that purpose.

"Frank was bigger than life. His physical presence and intelligence contradicted the fact that he was actually a fairly quiet and shy guy," Gilmour's memo says.

"Science will continue to build on his accomplishments and improve public health in the world for many years to come."

Plummer was in Kenya with his wife, Jo Kennelly, and his stepdaughter Imogen, and the family had just enjoyed time on safari, Gilmour's memo says.

TORONTO -- Like millions of Canadians, Dr. Frank Plummer used alcohol simply to relax after work. Or so he told himself.

Only after he became ill with liver failure was he forced to confront a painful reality: he suffered from alcohol-use disorder.

“I guess I was in denial,” Plummer told CTV News. “It’s pretty obvious now that I look back that I had a problem.”

Plummer had an illustrious career as a physician, researcher and the scientific director of Canada’s National Microbiology Lab in Winnipeg. He worked on the front lines of medical crises such as the AIDS epidemic. His groundbreaking work studying HIV/AIDS in Nairobi revealed that the disease did not only affect gay men, as was thought at the time, but could impact heterosexuals and women. He guided Canadian public health through Ebola scares, SARS and the arrival of the pandemic swine flu strain, H1N1, in 2009. As a result of his decades of work the 67 year old has won multiple awards, including the Order of Canada.

But while he was working tirelessly to improve the lives of others, Plummer was also using whiskey -- up to 20 ounces a night -- to deal with the resulting stress.

“I used to think about alcohol all the time,” he said, admitting that part of his brain used to be constantly planning how he’d get more. He thought he was managing it because he never drank on the job.

“I think I was a high-functioning person with a problem with alcohol,” he said.

In 2012, he suddenly became sick: “My belly blew up, and I found I had cirrhosis and end-stage liver disease.”

He was given a liver transplant in 2014. The new organ was “magical,” he said, but the then-retired scientist soon discovered that without “that adrenaline from responding to some pandemic somewhere,” to distract him, he couldn’t stop himself from returning to drinking. And the problem simply became worse and worse from there.

His wife Jo Kennely told CTV News that at first she couldn’t comprehend it.

“I kept on thinking as we went through this, you know, he’s the smartest man in Canada,” she said. “He’ll be able to figure this out, we’ll get through this, he’ll want to survive, he’ll want to stop, he’ll want to do these things.”

Eventually, she realized “it doesn’t matter how smart you are, doesn’t matter how educated you are. It affects everyone. No one is immune from this disease.”

Plummer underwent therapy, alcohol treatment programs, AA meetings. Nothing, he says, worked for long, and he was not a candidate for a second liver.

“If I didn’t get the drinking under control, I was going to die,” Plummer said. “And I didn’t want to die.”

With his options running out, Plummer agreed to be the first person in North America to test an entirely new way of stopping alcohol addiction -- by treating it with deep brain stimulation.

THE TREATMENT

In December of 2018, doctors at Sunnybrook Health Sciences Centre implanted two electrodes into Plummer’s brain while he was still awake. He was able to talk and answer questions during the surgery.

The electrodes are connected to a device similar to a pacemaker in the upper right side of his chest. It sends electrical impulses deep into the brain to an area called the nucleus accumbens, which is linked to addiction and alcoholism and plays a central role in the brain's reward circuitry.

“So we’re inserting electrodes directly into that region of the brain in an effort to reset its activity, to recalibrate it in some way,” Lipsman said. The device is controlled by an external monitor that Plummer and his doctors can adjust and turn on and off.

The study’s goal, Lipsman says, is to raise awareness of the disease, and to validate the growing awareness that alcohol addiction is likely “a brain-based illness.

“And there should be no better way to treat a brain-based illness than a brain-based intervention.”

According to Lipsman, the pilot study now underway will test six patients like Plummer who have treatment resistant alcohol-use disorder, and for whom all other therapies have failed. [...]

It’s also the top cause for hospitalization linked to substance abuse across the entire country, accounting for more than half of hospital stays caused by substance abuse. Ten Canadians die in hospitals per day due to substance abuse -- and three out of four of those deaths are due to alcohol, according to figures from the Canadian Institute for Health Information.

For Plummer, this new trial didn’t just mean a chance to get help for himself, but a chance to contribute to the science aimed at minimizing those deaths.

“I spent my whole life doing research, and here’s a different way of doing research,” he said. “Be a participant, rather than the study director.”

THE IMPACT

A year later, the stimulator is on 24-7 and Plummer reports that he no longer is obsessed with thoughts of drinking.

“It’s given me my life back,” he said.

His wife said that while the treatment may not be a “cure,” it has acted as one for the family as a whole.

“It’s a cure for us,” she said.

Before, she said, the need for alcohol was like “an itch,” that Plummer was compelled to scratch at, and had to address before he could think about anything else, but “now … that itch is gone.

“It’s like night and day.”

Lipsman said that their test trial only sought out subjects whose alcohol addiction had gotten so bad that it was verging on fatal.

“Frank is really a typical example,” he said. “Somebody that has been through a transplant, been through medical treatment and despite that is still affected by his addiction. So those are the kind of patients that we enroll for this particular trial.”

There are risks of infection and bleeding with brain surgery, but so far researchers say the treatment seems to be relatively safe and the first three patients treated are doing well.

“There are encouraging signs that we’re having a meaningful impact on their drinking behavior and on their mood as well,” Lipsman said.

Currently, Sunnybrook is the only centre in the world actively performing deep brain stimulation on patients with treatment-resistant alcohol-use disorder. As the study continues, researchers will also be monitoring changes in brain structures and activity. The study is currently being funded by philanthropic grants, which cover the cost of medical care and follow-up as well as the cost of the equipment. The stimulator alone can run anywhere from $15,000 to $20,000.

Deep brain stimulation is widely used to treat Parkinson’s disease and also depression. It’s also being tested for eating disorders, obsessive compulsive disorders and Alzheimers. Dr. Lipsman says there may soon be attempts to try DBS as a treatment for other forms of addiction outside of alcohol use disorder.

Plummer is a prime example that addiction can strike anywhere -- it targets not only those who are visibly struggling, but also those who appear to be successful in all avenues of their lives. The misconceptions surrounding who is affected by addiction are just one of the reasons that Plummer says “it’s important to talk about alcohol-use disorder.”

He told CTV News that there is “a stigma,” surrounding the illness.

“Training as a medical doctor, I didn’t think much of people that had problems with alcohol,” he said. “And I never thought of myself like that.”

Although he admitted to judging those who struggled with addiction in the past, he said his experience was eye-opening.

“[Alcohol addiction] will ultimately kill you if you don’t deal with it,” he said. “It just about killed me.” He added that he thought long and hard about taking his story public, but decided to talk about his struggle with alcohol-use disorder, “to try to destigmatize it.”

These days, Plummer, who now lives in Toronto, says he has a new zest for life. He has reconnected with family and -- most importantly -- is diving back into his passion: infectious diseases.

He is preparing to push ahead with an experimental vaccine against HIV infection, and is working on writing a memoir.

“I’m happier than I’ve been in many, many years,” he said.