The first case of novel coronavirus in Canada has now been confirmed in Toronto and the patient is being treated at Sunnybrook hospital.
The country’s chief public health officer Dr. Theresa Tam stressed on Sunday that the risk of onward spread is low, but “it would not be unexpected” if more cases were imported to Canada given global travel patterns.
Even as authorities continue to disperse as much information as possible while quelling growing panic, questions still abound about the virus, its spread and what authorities are or should be doing about it.
CityNews asked online followers about their concerns and Dr.Brett Belchetz, Toronto emergency-room physician who was training and exposed to SARS during that crisis in 2003, has the answers to some of them:
Q: Should you avoid using public transit?
A: I don’t think we’re at that stage yet. I think the vast majority of people on public transit are just fine — they don’t have this virus, its very unlikely that they’re going to have this virus.
The greater risk using public transit this time of year is that you’re going to get the flu and most of the time you’ll get the flu because you put your hands on one of the poles in a subway car that somebody with the flu touched.
I think we want to use common sense: so don’t touch surfaces if you can avoid it. It’s winter —wear gloves. That’ll really help your chances of not actually touching surfaces and picking up infection. Use hand sanitizer after riding public transit.
I think if we get to a point where we’re starting to see mass outbreaks of symptoms in the community, a better answer might be to wear an n95 type mask if you’re on public transit — but we’re nowhere near that yet. I think that would be a hysterical response and certainly not anything anybody needs to be doing in this point in time.
Q: Why aren’t authorities being proactive and locking down airports and other entry points where travellers from infected areas are arriving for at least 48 hours?
A: It probably wouldn’t be practical for us to be doing a lockdown of all travellers coming from those areas for 48 hours.
I think we probably should be thinking about stopping travel from affected areas in the first place. It’s much easier to just keep somebody on hold where they’re coming from versus allowing them to come here and then setting up some sort of quarantine zone in our airports.
Back during the SARS outbreak we implemented thermal scanners at a lot airports so we could pick up people who actually had fevers as they were trying to come through immigration. It would have been effective in this case that we have here in Toronto because this is somebody who was already symptomatic when they were on the aircraft. So one of the issues that I see at our airports right now is that we are relying on patients to admit that they came from this part of the world and admit that they have a fever.
If we can proactively track where people are coming from, proactively potentially avoid travel coming in from affected parts of the world, but also proactively scan for fever — I think these are the more effective steps for us to identify potential cases and isolate them, rather than trying to quarantine incredibly large amounts of people which just practically could not be done.
Q: Is it inevitable to contract the new virus if its airborne?
A: It’s definitely not inevitable … (it depends on) infectivity rates of different viruses.
If we were talking about something like measles … which is probably one of the most infectious viruses out there — if you’re not vaccinated and you’re in a room with someone with measles who is symptomatic, it is pretty much inevitable you will get measles.
We don’t know that yet about this virus. Maybe it has the same level of infectivity as measles and if you are in a room with somebody who is coughing, it’s pretty inevitable you’re going to get it. Maybe it’s only 10 per cent chance you’re going to get it — we don’t know.
We also don’t know if you getting infected means its inevitable you’re going to have any symptoms at all or serious symptoms. There’s a very good chance that you could be in the room with somebody who has this illness, you could get infected and you may have no symptoms at all — because we just don’t know what percentage of people who are infected actually even get sick.
So the answer here is that there’s much more that we don’t know than what we do know. But I certainly don’t think anything is inevitable at this point in time and its certainly not inevitable that this is going to be an outbreak or inevitable that you will get sick if you’re exposed.
Q: If the patient in Toronto showed symptoms on the flight, why wasn’t he quarantined immediately upon landing?
A: What we’re doing right now is asking people “have you been to the affected part of the world?” and “have you had a fever? if so please tell us and then we will consider quarantining you.”
That is just not an effective method because people aren’t honest.
I was working during SARS and I was exposed to SARS and I was actually quarantined as a result of an exposure to SARS.
The reason why I was exposed is that the patient that I saw who had SARS lied about all of his exposure history. So we thought that we were safe and we went into a room with him unprotected and next thing we found out a couple days later is he had SARS and we were all exposed. By the time we found out (the patient was) critically ill and unable to breathe and on a respirator.
The learning that I took away from that is that people, in outbreak scenario, tend to not be completely honest because they have their own motivations. Somebody who is coming off an airplane after a long flight — their motivation is they just want to get where they’re trying to go and they’re not going to admit to something that might land them in quarantine.
So we need to be proactively, at immigration, tracking where people have come from and proactively screening for fever. I think that will make a big difference and that would have possibly stopped this case from coming into our community.
Q: Is Canada doing any research to find a cure?
A: I don’t know if there are any specific efforts happening in Canada. Canada has been active in many other outbreaks in doing research in terms of understanding viruses better and looking for how to manage or treat them.
One thing to be clear about when we’re looking at this particular virus is coronaviruses are one of those most difficult strains of viruses to treat. It’s the same family of viruses that causes the common cold, the same family of viruses that caused SARS.
We have never really had any effective treatments for the common cold or any effective vaccines. The reason being this particular family of viruses is just incredibly adaptable and incredibly difficult to target.
When we try to actually research this virus what we really need to understand is how does it get transmitted? how do people get sick? … how long are you infectious? These are the kinds of things that allow us to know effectively who should be quarantined, how long they should be quarantined for. This is how we set up an effective public health strategy to contain this.
That’s the kind of research we’re all much more interested in right now rather than trying to find a cure.
Q: What behaviours should people observe on public transit in order to reduce the spread of this virus and other infectious diseases?
A: We don’t know the incubation period with certainty at this point – our guess is it’s about a couple of days. The other thing we don’t know is whether patients are infectious during that incubation period or whether they only become infectious when they have symptoms.
So exercise common sense — which is the same as what you would want to do during flu. season.
If your’e on transit and somebody is actively coughing and clearly unwell — this is probably not the person you want to sit next to or be withing a six-foot radius of. For the most part, most of the infectious viruses that are airborne, when you get at least six to 10 feet away, your chance of being infected goes down dramatically. So you probably want to move down to another car or get off the train — that would probably be my best advice.
If you happen to be near that person when they start coughing, try to tell them they shouldn’t be there. Nobody (who is sick) should be on public transit without wearing some sort of surgical mask, so that they don’t cough and spread virus around the train.
It’s just a matter of good decision making — you don’t want to get an entire train full of people sick even with the flu, let alone coronavirus.
Q: What are the odds the virus becomes severe enough to cause death in a patient with the sickness?
A: We don’t really know the odds that it will kill any particular patient, we don’t even know the odds that you will even develop symptoms.
What we’re starting to see is that of those patients that develop symptoms, we’re seeing a fatality rate that’s somewhere just above 10 per cent. It certainly is quite a deadly illness —to put that in perspective, that’s not far off of what we were seeing with SARS. So once you have symptoms, this is certainly a very concerning illness.
I think what is a little bit different between this and SARS — and again this is preliminary — is that once people had symptoms of SARS there were very few people that had mild symptoms. Most people who were infected. it was quite severe.
What we’re seeing with this illness is that many people who do have symptoms actually never have major symptoms. There are a small percentage of people who have very serious symptoms and of those, we’re seeing a fairly high fatality rate.
There’s lots we have to figure out about those rates and also who are the patients who are getting sick. In the early days the thought was that only people with underlying medical conditions could get very sick or potentially die from this, but we have had a couple of recent reports of younger patients with no underlying heath conditions dying from this illness.
We’re really reevaluating things as we go, but overall to the average person out there — if you’re exposed to this, your likelihood that this is going to be fatal to you is quite low.
A small percentage of people, as far as we know, will die if they have symptoms and there’s a very good likelihood that a certain percentage of people will never have symptoms whatsoever.