Local transmission of COVID-19 within Canada is inevitable, according to infectious disease experts who warn officials here are not moving fast enough to catch and control the spread of new cases.
“You can slow it down, but you can’t stop it,” said Michael Gardam, an infection prevention expert and chief of staff at Toronto’s Humber River Hospital. “Local transmission is coming.” Local transmission of the coronavirus is person-to-person spread within communities in Canada not related to travel to a part of the world experiencing an outbreak.
Dr. Gardam and others are sounding the alarm as officials in Washington State struggle to contain a COVID-19 outbreak that has so far killed six people after spreading undetected for weeks. The growing outbreak in the state is raising concerns about the ramifications for British Columbia, which is directly to the north. Researchers suggest COVID-19 has been circulating in Washington State for at least six weeks.
On Monday, B.C. Health Minister Adrian Dix said the situation in Washington State poses a serious challenge for the province.
The threat of local spread of COVID-19 in Canada is one of the key reasons why infectious disease experts are calling for more aggressive testing for the virus in communities.
Theresa Tam, Canada’s Chief Public Health Officer, said that some provinces, particularly B.C. and Ontario, are starting to test a wider sample of the population to detect possible community spread of the virus, including those who go to the hospital with flu-like symptoms even if they haven’t travelled outside of Canada recently.
It’s unclear which cities or hospitals are doing additional surveillance.
B.C. provincial health officer Bonnie Henry said Monday officials have added COVID-19 testing to the province’s existing influenza surveillance network, which means a broad array of patients will undergo screening for the coronavirus. B.C. is also checking all patients admitted to hospital with severe respiratory illness for COVID-19 if they have a negative flu test.
David Williams, Ontario’s chief medical officer of health, said Monday that some pilot sites in the province are testing patients with flu-like symptoms for COVID-19. Ontario is also testing patients admitted to some Toronto hospitals with severe respiratory illness for the coronavirus, officials said.
Ontario also announced Monday a new oversight structure to centralize communication and help with responses and planning related to COVID-19. A new provincial command group will be responsible for providing executive leadership and strategic direction to the province. Ontario is also creating other expert groups, including for regional planning and ethics table.
Janine McCready, an infectious diseases physician at Michael Garron Hospital in Toronto, said governments in Canada are still too focused on looking for COVID-19 in people who have travelled to a handful of countries experiencing outbreaks, such as China, Japan, South Korea and Italy. It’s time to widen that criteria to test patients who have any respiratory symptoms combined with any travel outside of Canada, she said.
“Every day we’re adding new countries,” Dr. McCready said. “It’s impossible and it’s also not practical to keep doing that. You’re going to miss cases.”
On Monday, the Public Health Agency of Canada announced that all Canadians should avoid non-essential travel to Iran. Anyone coming to Canada from Iran is being asked to identify themselves at airport screening checkpoints and check in with local health officials. They are also being instructed to monitor themselves for symptoms and enter a voluntary quarantine for 14 days.
Several people in Canada have tested positive for COVID-19 in recent days after travelling to Iran. There are 27 confirmed cases of COVID-19 in Canada: 18 in Ontario, eight in B.C. and one in Quebec.
Dr. Tam said officials are sending the message that any international travellers arriving in Canada should be aware of the virus and monitor themselves for signs of illness, such as fever or cough.
But the national criteria still direct clinicians to focus testing on people with symptoms who have travelled to one of seven countries experiencing an outbreak. Despite this, Dr. Tam said there is “some flexibility” and that clinicians should still order tests for patients who travelled to a country not on the list.
Dr. Gardam said officials must also aggressively look for COVID-19 cases in the community, given how quickly the virus is spreading in the United States as well as the rapid rise in cases in Ontario and B.C.
Dr. McCready said her hospital is one of the sites where additional tests are now taking place. But she said there’s a lack of transparency from the province about additional tests, which means clinicians are operating in the dark, not knowing what other hospitals are doing or whether any new cases are identified.
“I don’t really understand why we wouldn’t be sharing that information as rapidly and broadly as possible,” she said.
While there’s no evidence the disease is spreading locally in Canada yet, Dr. Tam said that could change and people should be prepared for unusual events, such as the cancellation of large gatherings and the closing of schools.
Toronto’s two biggest transit agencies are ramping up cleaning on buses and trains after a GO Transit passenger tested positive for COVID-19.
Metrolinx, the regional agency that oversees GO Transit, has been testing a new antimicrobial treatment and is now applying it to its vehicles. The treatment, which is intended to provide longer-lasting protection than regular disinfectant, should be completed on all buses and trains by Wednesday, according to agency spokeswoman Anne Marie Aikins.
The Toronto Transit Commission is looking at employing an antimicrobial treatment like the one Metrolinx is using. The agency, with nearly 1.7 million daily riders, has also stepped up its cleaning of vehicles and is doing more frequent wipe-downs of stair-rails and hand-holds, spokesman Stuart Green said.
With reports from Andrea Woo in Vancouver and Oliver Moore in Toronto