The new coronavirus is spreading in more countries and is likely to be declared a pandemic in the coming days, prompting infectious disease experts to say Canada must take immediate steps to ensure the country is ready to handle it.
Governments should issue clear directives to health-care institutions on all aspects of managing a pandemic, they say, from the appropriate use of isolation rooms and masks to the safe transfer of patients between hospitals to the guidance given to family health teams and walk-in clinics.
“We are trying to do as much as we can to try and prepare at the hospital level,” said Janine McCready, an infectious diseases physician at Michael Garron Hospital in Toronto. “That window is closing on us.”
Dr. McCready said officials need to begin immediately to do what is known as sentinel surveillance to detect COVID-19, the disease the virus causes.
This would involve testing a large number of people, such as patients who visit clinics in major cities, those who go to the hospital with unexplained severe respiratory illness, or those who test negative for the flu, Dr. McCready said. Doing that would help determine if and when COVID-19 starts spreading in Canada, and could help prevent the type of situations unfolding in Iran and Italy, where the disease is being widely transmitted and health officials are struggling to figure out how it started.
“We definitely want to be ahead of it and we don’t want to be playing catch up,” Dr. McCready said.
Currently, most COVID-19 tests are done on people who have a cough, fever or other symptoms who recently travelled to China or other affected countries, including Singapore, Iran, Italy and Japan.
Another crucial issue is a potential lack of ventilators, said David Fisman, an epidemiologist at the University of Toronto’s Dalla Lana School of Public Health. If the virus starts spreading freely in Canada, ventilators will be important in the treatment of patients, particularly those over the age of 65, who appear to experience the worst effects, he said.
“There aren’t enough,” said Dr. Fisman, who is also an attending physician at Toronto Western Hospital. “There’s not a lot of clarity and there’s not a lot of leadership and there’s not a strong voice … in terms of how do you prepare in hospitals.”
Dr. McCready said she believes hospitals may have enough ventilators, but need guidance on how to make difficult choices about how to assign priority to patients who are critically ill with COVID-19.
“We need to be thinking about these decisions now, before I have 10 people in my emergency department who range from 30 to 90 years old who all need a ventilator and we only have five ventilators,” she said.
Evidence shows the coronavirus spreads through droplets from such things as sneezes or coughs. Health professionals can protect themselves by wearing surgical masks, gowns, gloves and eye guards. Precautions against airborne transmission include disposable respirator masks, known as N95 masks, and isolation rooms.
Dr. McCready said Ontario health-care institutions should stop using airborne precautions against the virus and move to droplet precautions.
Without such a change, N95 masks and isolation rooms, which are needed in many areas of health care, could be in very short supply soon, which is why hospitals need to use them wisely, Dr. McCready said.
David Williams, Ontario’s chief medical officer of health, said the province is looking at increasing its testing capacity and whether it has enough supplies, such as protective equipment, ventilators and beds. Ontario announced its fifth case of the virus on Wednesday, in a traveller from Iran. It’s Canada’s 12th, and the third linked to Iran.
Federal Health Minister Patty Hajdu said on Wednesday that Canadians should prepare for a possible pandemic by ensuring they have an adequate supply of food and their prescription medications and follow advice about frequent hand washing and staying home when sick.
Isaac Bogoch, an infectious diseases physician at Toronto General Hospital, said it’s important to remember that, based on the existing data, most cases of COVID-19 will be mild.
“There’s reacting to this situation and then there’s overreacting to this situation,” he said. “We will have to live our lives, but we also have to be prepared for this as well and appreciate this might have some disruption in our day-to-day life.”
For Dr. Bogoch, preparing doesn’t mean stockpiling food. Rather, it means people with chronic conditions should ensure they have enough medication and are getting their health issues managed.
Health-care officials must also consider how they would handle an influx of new patients, considering most hospitals are already overcrowded, he said. The good news is that flu season is winding down, and that should free up some capacity, Dr. Bogoch said.
With a report from Kelly Grant
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