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A lot of people are losing sleep to stop novel coronavirus from getting a beachhead in Canada. Here’s what they’re doing.
It’s been 101 years since the Spanish Flu swept through Canada, killing 55,000, including an estimated 259 in Greater Victoria. Not only was that flu particularly deadly, but it was also able to benefit from a world without a coordinated global health infrastructure designed to halt pandemics; by the time doctors knew what the flu was or how to prevent its spread, it was already too late.
As of this writing, Canada is working to contain a new virus known as novel coronavirus (2019-nCoV). The virus appears to have jumped the species barrier last December at a seafood market in China’s Hubei province. As of Thursday morning, it has infected 28,000 people and killed 565, largely in Hubei.
Victoria is only a short ferry ride from one of two known Canadian regions hit by the outbreak, as well as the site of the first known U.S. case, which occurred just outside Seattle. With Canada having activated its official response plan for biological events and Victoria pharmacies already running out of face masks and hand sanitizer, The Capital assembled a picture of what the response to novel coronavirus is looking like at the local level.
When Southern Vancouver Island was struck by a measles outbreak in April, the response of the Vancouver Island Health Authority was an immunization drive. But novel coronavirus is so new (the first known cases showed up less than two months ago) that there is no vaccine and no known antiviral treatment. As a result, the only way to curb its spread is containment; identifying people with the virus and putting enough space around them so that they can’t spread it to others.
Containment is humanity’s oldest form of disease prevention, but that doesn’t necessarily mean it’s a primitive response. For instance, Canada sees only a few hundred cases of tuberculosis each year, as compared to the 10 million cases that annually occur around the world. One of the primary reasons for this is good old-fashioned containment – Canadian health officials are very good at isolating new tuberculosis cases before they can infect others.
When it comes to 2019-nCoV, Canadian researchers have joined the global hunt for a vaccine. But with a solution as much as three years away, local efforts for the time being are all focused on identifying people with the virus and stopping them from getting near anyone else.
The BC Centre for Disease Control, the agency coordinating the provincial response to coronavirus, is advising frontline healthcare officials to be on the lookout for the following symptoms of 2019-nCoV infection: Fever, cough and difficulty breathing. Unfortunately, these symptoms also describe dozens of other wintertime infections, from pneumonia to the common cold. The BC CDC’s lab would be overwhelmed if all of these cases were tested for 2019-nCoV. As a result, healthcare professionals across Canada are only testing patients who are showing these symptoms and also reporting that they’ve travelled to Hubei or have been in close contact with others who have.
BC’s first confirmed case was a Vancouver man who had just returned from a visit to Wuhan, the capital of Hubei province. The second, a woman in her 50s, caught the virus after being in close proximity to family from Wuhan.
The foot soldiers of an infectious disease outbreak are teams of public health nurses performing what is known as “contact tracing”; labouriously tracking down anyone who might have gotten infected by a confirmed case.
In Victoria, contact tracing was on prominent display during the city’s April measles outbreak, when the Vancouver Island Health Authority was trying to track down hundreds of people who may have ridden buses, attended classes or simply shared the same mall as a measles carrier. In large part due to contact tracing, that particular outbreak burned itself out before anybody was seriously injured or killed.
Contract tracing is a bit easier with 2019-nCoV because it’s not as infectious. So far as is known, it’s only possible get novel coronavirus by being within two meters of an infected patient; any further and you’re too far away to be hit by any infected water droplets emitted by a sneeze or cough. This is in contrast to the measles, which can leap across distances of up to 30 meters.
Still, contact tracing can be an incredibly daunting undertaking. In Snohomish County, WA, the site of the United States’ first confirmed case, staff at the Snohomish Health District poured an estimated 1,000 hours into tracking down every possible person the patient might have infected, including fellow guests at a group lunch the patient had attended, or the waiting room of a clinic where he had first sought medical attention.
Contact tracing is precisely what Vancouver Coastal Health is doing with its two 2019-nCoV cases. And should a confirmed or suspected case show up in Victoria, the Vancouver Island Health Authority would similarly be mobilizing teams to track down anyone who might have gotten within two metres of them.
Of course, contact tracing can only go so far. In Hubei, the virus has already spread so widely that Chinese authorities are needing to take much more drastic measures such as the locking down of entire cities and transportation networks. But in Canada’s case, public health authorities are still able to catch carriers of the virus when they’re only one or two degrees of separation from Wuhan. The singular goal of Canada’s public health response is to keep it that way.
B.C.’s only two confirmed cases of coronavirus were mild enough that both patients were able to self-isolate at home. However, if BC were to see a confirmed coronavirus case who was also in bad enough shape to require hospitalization, it would open up a whole other layer of complexity in keeping that patient isolated.
Any nurse or doctor treating the patient would need to don appropriate protective gear to shield themselves from infection. Any room holding the patient would need to be sealed off from the rest of the hospital and equipped with a special ventilation system to prevent airborne contamination with the rest of the building. There’s also the delicate issue of patients who refuse isolation. In those cases, Canadian public health authorities can indeed mobilize law enforcement to ensure that an infected patient does not leave quarantine.
The European Union guidelines for hospitalization of 2019-nCoV cases requires any attending healthcare staff to first don respirators, goggles, gloves and long-sleeved water-resistant gowns. What’s more, this protective clothing must be donned in its own isolation area under supervision by a “trained observer.” Any ambulance, equipment or furniture touched by the patient must be thoroughly disinfected, also by staff in head-to-toe protective clothing.
Of course, guidelines on isolating a patient aren’t unique to the novel coronavirus outbreak. Like all Canadian hospitals, BC hospitals have plans in place for a wide range of contingencies, from mass casualty events to bomb threats, and isolating an infectious patient is no different.
Canada, unlike most other countries in the Pacific Rim, has not implemented any mandatory restrictions on travel to China. Instead, the federal government has simply advised Canadians to cease all non-essential travel to China and not to travel at all to Hubei province. Federal authorities have also implemented control measures at points of entry.
Any traveller with flu-like symptoms is asked to present themselves to a border services officer, who will then direct them to an on-site Public Health Agency of Canada quarantine officer. If a traveller is visibly showing signs of possible 2019-nCoV infection, a quarantine officer could order them to seek medical treatment. Otherwise, the screening is largely voluntary.
For the time being, these quarantine measures are only being implemented at the country’s three largest airports: Toronto Pearson, Montreal’s Trudeau Airport and Vancouver International. These airports are the primary points of contact between China and Canada, but should the outbreak spread beyond patients who have had direct or secondary contact with Hubei province, however, similar quarantine measures could start to be implemented at a regional level, such as at transport hubs connecting Vancouver Island with the mainland or the United States.