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Officials concerned rumours spreading after Canada’s third case of coronavirus

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VANCOUVER — A third case of a new coronavirus that’s behind deaths in China has been confirmed in Canada by health officials in British Columbia, who say a man in his 40s tested presumptively positive after a business trip to the Chinese city of Wuhan.

Dr. Bonnie Henry, provincial health officer, said the man who lives in the Vancouver area returned last week and had symptoms about 24 hours later, when he voluntarily isolated himself at his home and called a clinic.

The man is doing well at home and no members of his family have shown any symptoms as they are being monitored by health officials, Henry added.

A second test will be done at the National Microbiology Laboratory in Winnipeg and results are expected in the next two days, Henry told a news conference Tuesday.

“Given the history of travel and the contact that this person had in Wuhan city, and they were showing symptoms, we are confident that this is truly a case of this novel coronavirus,” she said.

The patient spent most of his time in the port city of Guangzhou and visited Wuhan, the city at the centre of an outbreak in that country, where millions of people have been quarantined and the number of cases has increased to at least 4,500 across China.

Chinese authorities report at least 106 people have died there of the novel virus that is believed to have originated at a market in Wuhan, where meat was sold alongside live animals.

The man who returned to Vancouver contacted a primary health-care provider on Sunday to say he had travelled to Wuhan. He had no symptoms on the plane back to Vancouver, said Henry, who expects more people in B.C. to test positive for the virus.

Several people have been assessed in the province and the risk of the virus spreading remains low, she said.

“We need to be very careful about listening to rumours and third- and fourth-hand information,” she said, adding people should rely on credible sources for information.

“It’s very challenging and what’s concerning to me, having been in the city of Toronto during the SARS outbreak and being one of the people responding there, is how easily those rumours can lead to discrimination, inappropriate discrimination against people, and I think we need to take all those rumours with a grain of salt and recognize they are just that — rumours.”

B.C. Health Minister Adrian Dix said the province will provide ongoing information to the public and all the necessary precautions are being taken, adding social media has allowed rumours to spread quickly, something that didn’t happen during the SARS outbreak in 2003, when 44 Canadians died.

“We are determined to provide the information that the public needs,” he said.

Multiple systems are in place to prepare for, detect and respond to infectious diseases, Dix said.

The BC Centre for Disease Control has developed a diagnostic test for the new coronavirus and is working to ensure potential cases can be detected quickly and accurately.

Several countries have flown their citizens out of China as the novel virus spreads in that country and beyond to countries including Cambodia, Japan, Thailand, South Korea, Sri Lanka, Taiwan, Singapore, Malaysia, Vietnam, Nepal, Australia, France, Germany, the United States and Canada.

Unlike some other countries including the U.S., Canada has not repatriated any citizens.

Federal Health Minister Patty Hajdu said Foreign Affairs Minister Francois-Philippe Champagne is considering ways to bring Canadians back if they wish to return.

“Not all residents or visitors in the area that are Canadians do want to come back. And so we’re working through some of those details about what that might look like,” she said in Ottawa.

Canadians considering a trip to China should adhere to travel advisories, she said.

“There are increased advisories for the area of Hubei, the province of Hubei, to let travellers know that non-essential travel should not be considered at this time,” she said.

“That’s not so much about, by the way, contracting the illness. It’s because of the significant quarantine making it very difficult to move around the region. There is no transportation in and out of 18 cities in China. That number may grow.”

Hajdu echoed Henry’s concerns about misinformation sparking fears and said people should rely on government sources to ensure they are not unnecessary being fearful of a virus that remains at a low risk to spread in Canada.

The federal government will be putting additional public health officials at airports to meet passengers from Chinese flights and ensure they have written information and can speak with someone who can explain the steps they need to take if they end up developing symptoms, she said.

This report by The Canadian Press was first published Jan. 28, 2020.

Camille Bains, The Canadian Press

Note to readers: This is a corrected story.
An earlier story said man spent the majority of his time in Wuhan.

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How prepared is Canada for a possible Coronavirus outbreak? – OttawaMatters.com

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OTTAWA — Canadian medical experts say the country’s already overstretched emergency rooms would find it difficult to cope if a true outbreak of the novel coronavirus, or COVID-19, were to take hold in Canada.

So far, the virus has been relatively contained to mainland China, thanks in part to one of the largest quarantines in modern history.

“We must not look back and regret that we failed to take advantage of the window of opportunity that we have now,” Dr. Tedros Adhanom Ghebreyesus, director general of the World Health Organization, said in a message to all the world’s countries Friday.

The risk of contracting the virus in Canada right now is extremely low, and public health officials have been lauded for their efforts to detect and isolate the nine cases confirmed in the country so far.

The hundreds of patients across the country who have tested negative for the virus are also a sign that containment efforts are working as they should.

But Canada’s most recent case in British Columbia has raised fears about where and how the disease is being transmitted abroad. Unlike others who’ve imported the virus from China or from people who have recently been to China, the woman in her 30s contracted the illness while in Iran.

“Any imported cases linked to Iran could be an indicator that there is more widespread transmission than we know about,” said Canada’s chief medical officer Dr. Theresa Tam Friday.

Canada has taken major steps to prevent the kind of shock that befell Ontario during the outbreak of the coronavirus known as SARS in 2003 that led to 44 deaths. Creating the Public Health Agency of Canada, which Tam heads, is one of them.

The country is now better co-ordinated, has increased its lab-testing capabilities and is prepared to trace people’s contacts to find people who might have caught a contagious illness without knowing it.

But once the number of incoming cases reaches a critical mass, the approach must change, according to infectious-diseases physician Dr. Isaac Bogoch of Toronto’s University Health Network.

He likens the response to trying to catch fly balls in the outfield: as the number of balls in the air increases, they become harder and harder to snag.

“Every health care system has limits,” Bogoch says. “The question is, if we start getting inundated with cases, how stretched can we get?”

Many emergency-room doctors argue Canada’s ERs are already as stretched as they can get and are worried about what would happen if they suddenly had to start treating COVID-19 cases en masse.

From the public-health perspective, the greatest challenge may be as simple communicating across all parts of the health system across the country, said Dr. Jasmine Pawa, president of the Public Health Physicians of Canada.

“We cover a very wide geographic area,” she said, though she added that Canada has made great strides over the course of the SARS experience and the H1N1 flu outbreak in 2009.

Dr. Alan Drummond of the Canadian Association of Emergency Physicians, who works at the hospital in Perth, Ont., says he doesn’t want to fearmonger, especially considering all the lessons Canada has learned from past outbreaks, but the reality of life in the ER gives him pause.

“Our day-to-day experience in crowded hospitals, unable to get the right patient in the right bed on a day-to-day basis … makes us really question what the integrity of our health-care system would be like in a major severe pandemic,” Drummond says.

He envisions that a disease like COVID-19, if it spread widely, would have a major impact, including the possibility of cancelled surgeries and moving stable patients out of hospitals who would otherwise stay.

“I think there would have to be hard decisions made about who lives and who dies, given our limited availability by both speciality and (intensive-care) beds and we would probably see some degree of health-care rationing,” he says.

The problem may be even more pronounced because of Canada’s aging population, he said. The virus tends to hit older people harder, according to observations made in China and abroad, and is also particularly dangerous for people with other health problems.

Older people also tend to stay admitted in hospital beds even when they are in relatively stable condition because of a lack of long-term-care beds across the country.

That keeps emergency rooms from being able to move acute patients out of the ER and into those beds, limiting hospitals’ capacity to handle new cases.

Tam agreed Friday that hospital capacity is a “critical aspect” of Canada’s preparedness for a potential coronavirus outbreak, but said even very bad flu seasons can have a similar effect on emergency rooms.

“If we can delay the impact of the coronavirus until a certain period, when there’s less influenza for example, that would also be very helpful,” she said.

She also suggested people who are concerned about the possibility that they’re developing COVID-19 symptoms should call ahead to a hospital so they can make proper arrangements for containment and isolation.

Canada is doing its best, along with every other country in the world, to seize this time of relative containment and plan ahead, Tam said.

This report by The Canadian Press was first published Feb. 22, 2020.

Laura Osman, The Canadian Press

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Coronavirus: How does Covid-19 spread? These new studies offer clues. – Vox.com

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How does the new coronavirus disease, Covid-19, spread? That’s just one of many basic, unanswered questions about this latest pandemic threat.

The virus that causes Covid-19 — known as SARS-CoV-2 — has already infected more than 75,000 people in two months. (Of them, 2,130 have died.) And the best explanation for this rapid spread is that it’s being passed through droplets from coughing or sneezing. When these virus-laden droplets from an infected person reach the nose, eyes, or mouth of another, they can transmit the disease.

But are there other ways SARS-CoV-2 moves between people? And what do they tell us about why this disease seems to be even more contagious than SARS and MERS? The latest science on the virus offers possible answers to these questions — and why Covid-19 might be particularly difficult to stop. Here’s what we know so far.

Respiratory illnesses generally fall into two categories: upper respiratory — infections in the nose, pharynx, or larynx, like the common cold and seasonal influenza; and lower respiratory illnesses, like pneumonia, which infect the lungs.

The original SARS virus that spread around the world in 2003 was thought to be a lower respiratory infection: It replicated in the cells deep within the lungs and caused the pneumonia. People also seemed to only spread the virus days into their illness, when it was already clear they were sick. This made SARS more difficult to pass on to others and the job of containing it relatively easy.

The new virus that causes Covid-19 disease appears to be a different beast: While it also can eventually lead to pneumonia, the virus does a great job of replicating in the upper respiratory tract, even when people don’t have any symptoms or just begin to feel sick.

Check out this new New England Journal of Medicine paper. Chinese researchers monitored how much virus could be found in the upper respiratory tracts — noses and throats — of 18 patients in Guangdong, China. One of the 18 never had any symptoms.

The big finding? The way people shed this virus, potentially exposing others, looked a lot more like the flu than the first SARS, which might help explain why Covid-19 appears to be more infectious. You can see why in this chart from the study, focused on the patients who experienced symptoms: Just as they were starting to feel ill, they had the highest concentrations of virus in their noses:

New England Journal of Medicine

What’s more, the one person who was asymptomatic carried a similar amount of virus as the symptomatic patients, “which suggests the transmission potential of asymptomatic or minimally symptomatic patients,” the researchers wrote.

In a separate, newly published New England Journal of Medicine paper, researchers in Germany were also able to isolate the virus from patients’ upper respiratory tract even before they showed any symptoms or were very mildly symptomatic — more evidence of the potential for spread of the virus from the nose and throat when people barely know they’re sick.

So what does this imply about the contagiousness of Covid-19 and stopping the outbreak? “For a virus pretty closely related to SARS, it shows very effective person-to-person transmission, something nobody really expected,” Stephen Morse, a professor of epidemiology at Columbia University Mailman School of Public Health, told Vox. Researchers currently believe one infected person generally infects two to more than three others, which would make the new coronavirus more contagious than seasonal flu, SARS and MERS.

Javier Zarracina and Christina Animashaun/Vox

Second, it means stopping the outbreak might be more difficult, since people start to become infectious early on in their disease or may even spread the virus when they’re asymptomatic.

But to confirm these two findings, we’ll need more science, said Jennifer Nuzzo, an infectious disease expert and senior scholar at the Johns Hopkins Center for Health Security. “We still don’t know to what extent people without symptoms can infect,” she pointed out.

It’s also possible that transmission early in the illness or from asymptomatic people won’t end up being important contributors to the outbreak, said Marion Koopmans, who studies emerging infectious diseases and heads the department of virology at the Erasmus Medical Center in Rotterdam, Netherlands. In most parts of the world where travelers with Covid-19 turned up, she added, the spread of the disease has been contained by only testing people with symptoms. But, she added, “both of these statements can coexist: Asymptomatic shedders could spread the virus, but it probably is not the main driver of this epidemic.”

Another way viruses can spread is through poop. Think of the norovirus, the extremely contagious bug that can be passed along by ingesting the stool of an infected person, often through food or touching a contaminated surface. This is known as the “fecal-oral” route of disease transmission.

Now there’s some suggestion in the emerging literature that Covid-19 could be passed through exposure to virus-laden feces, too.

In this new paper from the Chinese Center for Disease Control and Prevention, researchers managed to isolate live virus from stool samples of Covid-19 patients. And they’re not the first to find the virus in stool.

As with norovirus, this means the disease could be passed around when there’s less than optimal hygiene. “If true, it would not be surprising,” Morse said. “A number of other coronavirus are excreted from the intestines, and infectious virus can be found in stool.”

That’s why the China CDC recommended taking measures to stop the spread of the virus this way, including:

maintaining environmental health and personal hygiene; drinking boiled water, avoiding raw food consumption, and implementing separate meal systems in epidemic areas; frequently washing hands and disinfecting of surfaces of objects in households, toilets, public places, and transportation vehicles; and disinfecting the excreta and environment of patients in medical facilities to prevent water and food contamination from patients’ stool samples.

But just because the virus is found in stool doesn’t mean that’s how it’s transmitting. And, again, more research is needed to figure out how important the fecal-oral route is in the spread of this disease.

Poop was also implicated in the first SARS outbreak, when a large housing estate in Hong Kong called Amoy Gardens became ground zero of a public health nightmare. More than 300 people were infected with the disease through yet another viral transmission route: airborne transmission of virus-ridden feces aerosols.

Airborne spread happens when the residue from evaporated, infected droplets gets suspended in the air and indirectly infects those who breathe it in. It’s different from droplet transmission, since droplets are too large to float through the air and need to get sprayed directly on someone’s eye, nose, or mouth in order to infect them.

In the case of Amoy Gardens, researchers learned SARS was capable of going airborne, spreading through the building’s faulty plumbing and ventilation systems to the people who lived on the estate. “The infections [were] officially attributed to faulty toilet traps which were thought to have aerosolized patients’ virus when the toilet was flushed, allowing dispersal of the virus to other residents,” Morse explained. “This has been demonstrated with SARS and MERS and others, and therefore is plausible, although we currently lack good evidence.”

So researchers and doctors are looking into whether the news SARS virus spreads this way — and taking precautions in case it can. Vito Iacoviello, chief of the division of infectious diseases at Mount Auburn Hospital in Cambridge, Massachusetts, and an editor at Dynamed, noted that the US Centers for Disease Control and Prevention is recommending people admitted to hospitals with Covid-19 be put in an airborne isolation room. “That’s the precaution we use for TB, measles, and chickenpox,” he said, and it suggests health officials are preparing for the possibility that this virus is capable of airborne spread.

But again, for now, there’s no good evidence of Covid-19’s airborne transmission. It’s just another thing to watch out for as our understanding of this virus, and how it moves through populations, evolves.

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COVID-19: Canadian hospital space a concern despite lessons from SARS, experts say – Global News

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Canadian medical experts say the country’s already overstretched emergency rooms would find it difficult to cope if a true outbreak of the novel coronavirus, or COVID-19, were to take hold in Canada.

So far, the virus has been relatively contained to mainland China, thanks in part to one of the largest quarantines in modern history.

“We must not look back and regret that we failed to take advantage of the window of opportunity that we have now,” Dr. Tedros Adhanom Ghebreyesus, director general of the World Health Organization, said in a message to all the world’s countries Friday.


READ MORE:
COVID-19: Coronavirus multiplies eight-fold in South Korea as cases jump to 433

The risk of contracting the virus in Canada right now is extremely low, and public health officials have been lauded for their efforts to detect and isolate the nine cases confirmed in the country so far.

Story continues below advertisement

The hundreds of patients across the country who have tested negative for the virus are also a sign that containment efforts are working as they should.

But Canada’s most recent case in British Columbia has raised fears about where and how the disease is being transmitted abroad. Unlike others who’ve imported the virus from China or from people who have recently been to China, the woman in her 30s contracted the illness while in Iran.






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Coronavirus outbreak: China reports significant drop in daily cases, down to 397

“Any imported cases linked to Iran could be an indicator that there is more widespread transmission than we know about,” said Canada’s chief medical officer Dr. Theresa Tam Friday.

Canada has taken major steps to prevent the kind of shock that befell Ontario during the outbreak of the coronavirus known as SARS in 2003 that led to 44 deaths. Creating the Public Health Agency of Canada, which Tam heads, is one of them.

The country is now better co-ordinated, has increased its lab-testing capabilities and is prepared to trace people’s contacts to find people who might have caught a contagious illness without knowing it.


READ MORE:
COVID-19 and the Tokyo Olympics: What you need to know

But once the number of incoming cases reaches a critical mass, the approach must change, according to infectious-diseases physician Dr. Isaac Bogoch of Toronto’s University Health Network.

Story continues below advertisement

He likens the response to trying to catch fly balls in the outfield: as the number of balls in the air increases, they become harder and harder to snag.

“Every health care system has limits,” Bogoch says. “The question is, if we start getting inundated with cases, how stretched can we get?”


READ MORE:
With COVID-19 emerging in new countries, health officials worry about untraceable clusters

Many emergency-room doctors argue Canada’s ERs are already as stretched as they can get and are worried about what would happen if they suddenly had to start treating COVID-19 cases en masse.

From the public-health perspective, the greatest challenge may be as simple communicating across all parts of the health system across the country, said Dr. Jasmine Pawa, president of the Public Health Physicians of Canada.

“We cover a very wide geographic area,” she said, though she added that Canada has made great strides over the course of the SARS experience and the H1N1 flu outbreak in 2009.






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Coronavirus outbreak: British passengers disembark Diamond Princess cruise ship


Coronavirus outbreak: British passengers disembark Diamond Princess cruise ship

Dr. Alan Drummond of the Canadian Association of Emergency Physicians, who works at the hospital in Perth, Ont., says he doesn’t want to fearmonger, especially considering all the lessons Canada has learned from past outbreaks, but the reality of life in the ER gives him pause.

“Our day-to-day experience in crowded hospitals, unable to get the right patient in the right bed on a day-to-day basis ? makes us really question what the integrity of our health-care system would be like in a major severe pandemic,” Drummond says.

Story continues below advertisement

He envisions that a disease like COVID-19, if it spread widely, would have a major impact, including the possibility of cancelled surgeries and moving stable patients out of hospitals who would otherwise stay.


READ MORE:
Italy reports 1st death from COVID-19 as cases more than quadruple to 19

“I think there would have to be hard decisions made about who lives and who dies, given our limited availability by both speciality and (intensive-care) beds and we would probably see some degree of health-care rationing,” he says.

The problem may be even more pronounced because of Canada’s aging population, he said. The virus tends to hit older people harder, according to observations made in China and abroad, and is also particularly dangerous for people with other health problems.

Older people also tend to stay admitted in hospital beds even when they are in relatively stable condition because of a lack of long-term-care beds across the country.

That keeps emergency rooms from being able to move acute patients out of the ER and into those beds, limiting hospitals’ capacity to handle new cases.






0:36
Repatriated Canadians from Japan to be treated individually if diagnosed with COVID-19


Repatriated Canadians from Japan to be treated individually if diagnosed with COVID-19

Tam agreed Friday that hospital capacity is a “critical aspect” of Canada’s preparedness for a potential coronavirus outbreak, but said even very bad flu seasons can have a similar effect on emergency rooms.

“If we can delay the impact of the coronavirus until a certain period, when there’s less influenza for example, that would also be very helpful,” she said.

Story continues below advertisement

She also suggested people who are concerned about the possibility that they’re developing COVID-19 symptoms should call ahead to a hospital so they can make proper arrangements for containment and isolation.

Canada is doing its best, along with every other country in the world, to seize this time of relative containment and plan ahead, Tam said.

© 2020 The Canadian Press

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