The World Health Organization has deemed H7N9 bird flu to be “unusually dangerous” because of its high mortality rate and its potential to spread widely because humans have no immunity.
So far, H7N9 has sickened 109 people and killed 22, almost all of them in the Jiangsu region of China. Only one case has been reported outside China, in Taiwan, but officials in Hong Kong have dramatically stepped up their prevention efforts, ordering screening of all travelers from mainland and scrubbing down public markets in preparation for a massive influx visitors for the Labour Day holiday.
The spread and evolution of the new bird flu is being watched closely by public health authorities around the world, including Canada.
Dr. Vivek Goel, president and chief executive officer of Public Health Ontario, discussed the challenges posed by H7N9 with Globe and Mail public health reporter André Picard.
Q: Why should Canadians care about a few cases of the flu half a world away?
Dr. Goel: We should care about any changes in the flu virus that have the potential to turn into a pandemic. Right now, this is obviously not something that has a significant direct impact – the number of documented cases is still small – but the potential is there because it appears this avian-origin virus passes easily to humans. It doesn’t appear to transmit well from humans to other humans. It also has a relatively high mortality rate. Of the hundred or so people infected there are a couple of dozen deaths. So you have to watch it. Second, we live in a very globalized world and Canada is at the centre of travel. We have a few thousand landings a week from China in Canada, most of them in Vancouver and Toronto. The potential for a case to come over is there so we have to pay attention.
Q: Are we doing anything special to monitor those flights to ensure H7N9 doesn’t come into Canada?
Dr. Goel: There are no recommendations from the World Health Organization to do any sort of special screening. Through SARS and other experiences it has been shown that that approach is largely futile. Trying to screen thousands of people isn’t going to work: You have an incubation period (where people are infected but not sick) and people can have all kinds of respiratory symptoms that are unrelated. It’s like trying to find a needle in a haystack. Really the most important thing is ensuring increased vigilance among healthcare workers. Emergency rooms and hospitals have to be on the lookout for patients with severe respiratory illness and verify if they have any travel history to that region. If that is the case we have to take appropriate precautions for both healthcare workers and people around them to ensure we don’t transmission and we have time to confirm a diagnosis. If this virus comes into Canada want to catch it as early as possible. In Canada, the work on the ground is largely around ensuring that our frontline healthcare workers are aware and protected and we have a surveillance system ready to pick up any cases.
Q: The healthcare workers are key because, as you know, with SARS, there was a nurse who astutely spotted the first case because she had read about this virus in a Chinese newspaper.
Dr. Goel: That’s right but we don’t want to have to rely on luck, on healthcare workers reading Chinese newspapers for example. What SARS taught is that it is very important to communicate clearly to frontline healthcare workers and, with the assistance of the Public Health Agency of Canada, those communications have been getting out over the last few weeks.
Q: Does Canada’s experience with SARS and H1N1 leave us more prepared to deal with H7N9?
Dr. Goel: You learn from every one of those experiences so we’re much better prepared than we were 10 years ago. We have better protocols for sharing information and communication between health authorities at the federal, provincial and local levels. We have much better laboratory capacity in this country and we have a better information system. I’m not going to say it’s perfect but we have improved a lot and we’re in a much better position to detect cases and act on them quickly.
Q: You’ve talked about what governments and health workers are doing. What should members of the public do to protect themselves?
Dr. Goel: There are no specific restrictions on the travel side. People just need to take all the normal precautions for avoiding infection, the most important one being washing your hands regularly. If you’re travelling in China, you need to have a heightened awareness of your surroundings, and certainly avoid live-bird markets. But, overall, this is something we have to be alert for as a system but I don’t think the public needs to be worried about this at this stage.