The 911 call came in on January 23, 2020. A 56-year-old man had just returned from a trip to Wuhan, China, where a new illness was spreading like wildfire. He had a fever and a cough.
It was easy to draw one conclusion: The virus causing the sickness that would become known as COVID-19 was now in Canada.
Emergency Medical Services dispatched an ambulance and sent word to Sunnybrook Health Sciences Centre in Toronto. Front-line health workers at the hospital immediately reviewed protocols for personal protective equipment (PPE), carefully donning gloves, gowns, masks and face visors to reduce the risk of infection.
“We were anticipating the worst,” recalls emergency department nurse Shauna Tavernier.
What would unfold over the next few days marked the beginning of Canada’s long struggle with the novel coronavirus. It revealed the grim isolation that many patients and their families would be forced to confront, and the difficulties medical staff would face. But it would also provide valuable insights into asymptomatic spread, help scientists isolate the virus and foreshadow the importance of masks.
Soon after Sunnybrook received the heads up, the ambulance paramedics – also covered in PPE – wheeled the patient into a “negative pressure” isolation room with a separate ventilation system designed to contain any air-borne pathogens.
Ms. Tavernier entered the room first without a moment’s hesitation despite the potential risk to her own safety. “In situations like this, your adrenaline kicks in,” she says.
As she assessed the patient’s vital signs and performed a nasal swab for analysis, another nurse, Natacha Hainzelin, drew blood samples and inserted an IV line to provide fluids. A chest X-ray revealed the man had pneumonia, a common finding reported in the Wuhan cases. Two days later – on January 25 – the results of a newly developed diagnostic test confirmed what doctors had suspected: This was Canada’s first case of COVID-19.
Once the patient was transferred to an isolation room for care and observation, Dr. Samira Mubareka, an infectious diseases physician and virologist, collected a nasal swab, which would later be used to isolate the virus.
When she entered the room after donning PPE, she was struck by how alone the man was, especially since he spoke mainly Mandarin.
“People like me couldn’t communicate with him apart from gesturing. You can’t even show a smile behind a mask. It made me think of how scared he must have been.”
Fortunately, one of the nurses assigned to his care was fluent in his own language. “Otherwise, the man was in there by himself – no family, no friends,” Dr. Mubareka says.
Before the patient was admitted to hospital, Ms. Hainzelin recalls thinking that the novel coronavirus could have truly serious consequences: “To the best of our knowledge, the virus had a high potential of being fatal.”
But the man improved. He never required additional oxygen, and after a week he was discharged home for the rest of his recovery.
Although his case was rather uneventful, the doctors were determined to use it to learn as much as they could about the new pathogen.
Additional information was gleaned from the man’s wife, who had travelled with him to Wuhan. She was also diagnosed with COVID-19, becoming Canada’s second confirmed case, but did not need to be hospitalized.
“There was a lot we didn’t know about COVID-19 at that period of time,” says Dr. Jerome Leis, medical director of infection prevention and control at Sunnybrook. The original reports from China tended to focus on people who fell extremely ill and often needed life-saving medical intervention; the first two Canadian patients didn’t experience such severe complications.
“We didn’t have a full picture of the spectrum of presentations of this illness,” Dr. Leis says. “Now we know many people have very mild symptoms, or no symptoms. And some have non-respiratory symptoms. But that was definitely not appreciated by the scientific community in those early days.”
Just weeks after the patient was discharged, Dr. Leis and his research colleagues outlined their findings in a study published by The Lancet medical journal.
One of the main messages, he says, “was that not all patients with pneumonia will go on to respiratory failure.”
What’s more, patients with mild symptoms could be safely managed at home in self isolation.
The study was welcome news for hospital administrators trying to figure out how best to manage limited health care resources. They could now reserve beds for those who needed them the most.
But the positive message raised a troubling possibility: There was a risk that people with mild symptoms might go undiagnosed and unwittingly spread the virus.
Testing for COVID-19 was originally restricted to people with obvious signs of illness or those who had recently travelled to an outbreak hotspot. That meant the results could represent a gross underestimation of the true number of cases.
In Italy, one of the first European nations hit hard by the virus, authorities weren’t aware of the extent of infections circulating in the community until their hospitals were flooded with patients.
“It was very clear that we needed to test, test, test but, unfortunately, we didn’t have the ability to get community testing off the ground fast enough,” Dr. Leis says.
As testing lagged, Canada’s first two cases helped reveal the protective power of wearing masks when accompanied by other measures such as frequent hand washing and physical distancing.
Officials were concerned that the couple might have spread the virus to other passengers on the plane. The husband was already experiencing mild symptoms, such as a dry cough, when he boarded their flight home.
So, Toronto Public Health contacted 25 individuals: crew members, plus people seated within three rows of the man and wife. These contact-tracing efforts, along with 14 days of monitoring, revealed that not one had contracted COVID-19.
Infectious diseases experts speculate that the passengers may have been partly safeguarded by the extremely efficient air infiltration systems used in commercial jets. But is also highly possible that they were protected by the masks worn by the couple during the flight.
Simply put, masks can help block the virus at its source – and the actions of the two Canadians helped drive home that lesson.
But, even more important, their cases triggered a host of research that lead to a “seismic shift” in our understanding of COVID-19, Dr. Mubareka says. Since she collected that first sample, others have been taken from subsequent Sunnybrook patients, permitting the virus to be isolated and multiplied again and again. That enabled scientists to study the virus in a lab. They could now learn its characteristics, develop new diagnostic tests, and determine how it will react to medications and vaccines.
“We had enough material that we could share it with a whole community of researchers including biomedical engineers, molecular biologists and immunologists.”
Looking back to January 2020, Dr. Leis remembers it as “a very intense time.” The initial cases “provoked a lot of concern and anxiety among the general public,” he says, and busy Canadian cities soon resembled ghost towns because so many people were staying at home.
But, as the months passed, many succumbed to “pandemic fatigue” and let down their guard. Cases are surging again in many places.
“If you asked me a year ago where I thought we would be today, I would never have guessed the situation would be this dire,” Dr. Leis says.
Paul Taylor was a patient navigation advisor at Sunnybrook Health Sciences Centre at the time of these events. He has since retired.
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