Speaking of the increasingly worrisome spread of coronavirus to dozens of countries around the world, Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, used the dreaded p-word.
“This virus has pandemic potential,” he said on Thursday.
So what is a pandemic? More importantly, is the world, and Canada, ready to deal with a pandemic?
The definition of pandemic is frustratingly vague – basically it refers to a new disease that has spread globally. Some would add that there needs to be intensive community spread in multiple regions of the world, which we have not seen with SARS-CoV-2 (the official name for the coronavirus that causes COVID-19).
At least not yet. But, as Dr. Tedros said, “No country should assume it won’t get cases.”
“Pandemic” refers to geographic spread, not severity of an illness. In the public mind, however, pandemic often invokes the feeling that “we’re all going to die a gruesome death,” which is why public-health officials are often reluctant to use the p-word.
Semantics aside, what really matters is whether we can handle the arrival of a novel disease on our shores. Newness matters because it means no one has immunity.
SARS-CoV-2 has been circulating in China for a couple of months, and there have been almost 80,000 recorded cases. We’ve learned that coronavirus is moderately infectious and not especially lethal (more deadly than the flu, but less so than SARS).
About 80 per cent of those infected and tested in China had mild symptoms, like a bad cold; 14 per cent of cases were severe, with lung problems such as severe shortness of breath; 5 per cent of cases were critical, meaning respiratory failure or septic shock, and 2.3 per cent of cases were fatal, a not-insignificant number.
So if the spread of coronavirus can’t be contained (which is looking increasingly likely), could Canada’s health system handle a China-like outbreak? On paper, certainly.
Because of Canada’s not-so-glorious handling of SARS in 2003 and, to a lesser extent, H1N1 in 2009, we now have all sorts of pandemic-preparedness plans, featuring everything from promoting “social distancing” (encouraging the public to avoid gatherings to minimize disease spread) to closing schools and borders, and shutting down public transit.
Legislation actually gives public-health officials quite sweeping powers to respond to an epidemic, both provincially and federally, but these laws have never been broadly applied in modern times, other than during SARS, when more than 20,000 people were quarantined by legal order.
It makes for pretty mirthless reading, but Canada even has a plan for the “management of mass fatalities” during a pandemic.
It includes a lengthy list of measures required for a “more rapid processing of human remains,” up to and including using hockey arenas and curling rinks as temporary morgues.
This is fascinating stuff for the morbidly inclined (such as journalists and coroners), but we’re not even remotely close to this type of movie-of-the-week horror scenario.
Most concerning for Canada in the present is that our hospitals are in a state of chronic overcrowding, meaning even a few thousand cases of COVID-19 could seriously overwhelm the system. Increasingly frequent outbreaks of infectious disease should force us to take the notion of surge capacity seriously.
The other reality is that pandemic illnesses such as COVID-19 pose the greatest risk to health-care workers such as personal support workers, nurses and physicians, because they are in the closest and most-sustained contact with infected patients.
In Canada, SARS was principally a nosocomial (hospital-based) outbreak; half of those infected were front-line workers, and three died.
COVID-19 poses a very similar risk, so protecting workers must be a priority.
In fact, preparing for a pandemic requires doing a whole bunch of little things well: stepping up testing, aggressive follow-up when cases are detected, equipping health workers with protective equipment and good communication with the public on how to protect themselves (mostly boring stuff such as washing their hands).
When containment has failed, we must rely on mitigation. As much as the public might want a fearful response, the old adage, “an ounce of prevention is worth a pound of cure,” holds true.
Vigilance, not hysteria, is what we need.
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