Widespread community transmission of COVID-19 is likely underway in Canada, experts say, warning that Canadians need to heed advice from public health officials and do their part to prevent it from getting out of control.
Community transmission is the spread of an illness with no known link to travel or previously confirmed cases, which can signal a growing number of cases going unreported across the country.
Dr. Allison McGeer, an infectious diseases specialist at Toronto’s Mount Sinai Hospital who worked on the front lines of the SARS epidemic in 2003, believes there is no doubt it is already happening in Canada.
“I don’t think there’s any question,” she said.
Ontario announced 42 new cases of COVID-19 as of 5:30 p.m. ET Sunday. So far, only five of those have been definitively linked to travel or previously confirmed cases, while 37 are marked as “pending” as officials investigate further.
Ottawa’s medical officer of health confirmed community transmission is likely happening in the city, with up to 1,000 cases going unreported, and instructed all residents not to leave their homes for “non-essential reasons.”
Ottawa Medical officer of Health says could be 200-1000 cases in Ottawa- calling on all people to stay home, social distancing.
And Alberta’s medical officer said the province is “likely seeing community transmission” and announced 17 new cases Sunday, two of which had no known link to travel or other cases. Calgary has also declared a state of local emergency due to a spike in cases and concerns of growing community transmission.
Canada’s Chief Medical Officer of Health Dr. Theresa Tam said Sunday that 25,000 COVID-19 tests have been done across the country to date and there has been a “rapidly increasing” number of cases, particularly in Ontario, B.C. and Alberta.
“Our window to flatten the curve of the epidemic is narrow,” Tam said. “We all need to act now. COVID-19 is a serious public health threat.”
Tam urged Canadians to embrace social distancing in an effort to slow the spread of the outbreak, but did not say whether she believed there is widespread community transmission of COVID-19 in Canada.
Social distancing is an approach to limiting the spread of an illness in the population by creating physical space between people and reducing the size of large gatherings, or avoiding them altogether.
‘I think it’s clearly here’
Dr. David Fisman, an epidemiologist with the University of Toronto’s Dalla Lana School of Public Health, says the exponential growth of COVID-19 cases in Canada indicates community transmission is already underway.
“Either it’s already here or it’s coming, because we’re just importing so many damn cases that we can’t keep up with it,” he said. “I think it’s clearly here.”
Dr. Isaac Bogoch, an infectious disease physician at Toronto General Hospital, said Canadian health officials have been bracing for community transmission of COVID-19 for months.
“It’s expected that this would happen and the whole purpose was to get prepared for this scenario,” he said.
“The time is now to act so that we can mitigate the spread of this infection in Canada. We’re not going to eliminate the spread in Canada, but we can certainly dampen the effects.”
Bogoch said this is the reason why public health officials are asking Canadians to avoid all non-essential travel outside of the country, return to Canada if they are travelling abroad and embrace social distancing on a massive scale in an effort to flatten the epidemic curve of the outbreak.
Matthew Miller, an associate professor of biochemistry and biomedical sciences at McMaster University, said the virus can have a relatively long incubation time — anywhere from three to 14 days.
“So there’s going to be a lag time between when the community-based transmission actually starts to occur and when it’s detected,” he said.
“Once it’s here, it’s almost already too late.”
Growing community transmission in the U.S.
Jason Kindrachuk, an assistant professor and Canada Research Chair in emerging viruses at the University of Manitoba, said Canada is moving into a new phase of the outbreak that would see increased community transmission likely.
“We can’t be overly surprised that that is going to happen if it hasn’t already, based on the fact of what we’ve seen in the United States in particular,” he said. “We are seeing obvious community transmission in multiple regions of the U.S. now.”
Bogoch said that widespread community transmission in areas like Washington state could be fuelling the increasing number of confirmed cases in Canada.
“We’re likely importing cases from a growing number of countries, not just European, but also an increasing number from the United States,” he said.
“As time goes on, without travel restrictions in place, we will continue to import cases.”
Social distancing may be key to curbing spread
McGeer said that when many Canadians first heard messaging from public health officials encouraging social distancing, she suspects they may not have taken them seriously.
“Maybe the first time you hear the messages, it doesn’t feel like it’s that important. It doesn’t feel like what you can do as an individual makes that much difference. So I’m not sure people have been listening to them,” she said.
“As we see more cases people will perhaps listen better, but one of the important messages about social distancing is that the earlier you start it, the more effective it is.”
McGeer said the two most important aspects of social distancing to stop the spread of COVID-19 are staying home when you’re sick and limiting contact with as many people as possible.
“People have a tendency to think that what I as an individual do is not important,” she said. “But when you sum what each of 35 million individuals do, it’s critically important.”
Not all experts are as optimistic that social distancing will be effective in this outbreak, however, now that community transmission has likely begun in Canada.
Fisman said Canada “squandered” opportunities to learn from countries such as China, South Korea, Singapore and Taiwan in proactively curbing the outbreak as opposed to countries like Italy that have seen an “explosion” in new cases and deaths.
“We’ve chosen to go the route of Italy and I think unfortunately at this point the die is cast,” he said.
“Hopefully I’m wrong about that.”
Coronavirus: Trudeau says he’s ‘proud’ of Canada’s COVID-19 response as U.S. cases soar – Global News
As U.S. President Donald Trump slowly comes to grips with his country’s grim prognosis for the novel coronavirus, Prime Minister Justin Trudeau conceded Monday he’s taking a measure of comfort from early signs that the caseload in Canada is on a different trajectory than the United States.
Trudeau said he’s proud that Canadians appear to be taking seriously the importance of staying home and keeping their distance from others — the one measure public health officials say is paramount to slowing the spread of COVID-19.
And while the success or failure of those efforts won’t become clear for at least another week, Trudeau said, there’s little doubt that Canada is doing better than its southern neighbour at limiting the scope of the illness.
“I think I would say we’re not necessarily on the same trajectory,” Trudeau said in French during the daily fresh-air briefing outside his Rideau Cottage residence. “We were quicker to get the screening done, and I think we have had more success in getting people to self-isolate.”
The U.S., however, has hardly set a high bar.
There were more than 156,000 cases by midday, nearly 13,000 more than the day before, and the number of deaths was hurtling towards 3,000. A shortage of beds, ventilators and masks had hospitals in hard-hit New York City operating well past the breaking point, using refrigerator trucks as makeshift morgues. The USNS Comfort, a hospital ship, docked at Manhattan’s Pier 90 to help with the overflow.
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Alarming spikes in the caseloads in New Jersey, Florida, Pennsylvania and Louisiana had officials in those states bracing for the worst, well aware they might be ill-equipped to handle it. In New Orleans, home to America’s worst per-capita COVID-19 death rate, the mayor said she’d have cancelled Mardi Gras last month if only the federal government had warned her.
Dr. Anthony Fauci, the lead voice of medical reason on the White House coronavirus task force, has warned the U.S. death toll could land between 100,000 and 200,000 — and that’s after Trump abandoned his “aspirational” target of April 12 for reopening parts of the country, extending stay-at-home measures until the end of the month instead.
“By very vigorously following these guidelines, we could save one million American lives,” Trump said Monday during a Rose Garden news conference as he spelled out the need to keep the country shuttered for another month.
“This is our shared patriotic duty; challenging times are ahead for the next 30 days. We’re sort of putting it all on the line, this 30 days.”
Live updates: Coronavirus in Canada
To the horror of public health experts, Trump had been musing about a celebratory Easter long weekend marked by packed churches, open shops and an accelerated return to American normalcy, insisting he didn’t want the “cure” to be worse than the “problem.” But early indications from Washington state, which reported the first known U.S. case, suggest the social-distancing strategy is having an impact.
A joint online survey released Monday by polling firm Leger and the Association for Canadian Studies suggested, among other things, a difference in attitudes between the two countries when it comes to modifying behaviour to curb the spread of the virus.
Only 86 per cent of 1,004 U.S. respondents said they were keeping the requisite two-metre distance between themselves and others, compared with 95 per cent of the 1,590 Canadians surveyed, while 85 per cent of the American survey group said they had stopped going out for necessities — nine percentage points less than their northern neighbours.
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And while 86 per cent of the Canadians polled said they had asked friends and family to keep their social distance, only 72 per cent of the U.S. respondents could say the same.
“Everything depends on the choices that people have made and continue to make,” Trudeau said.
“I’m very proud of the way that Canadians have rallied and continue to abide by the guidelines. I think they understand that we all have an opportunity to have a direct impact on Canada’s ability to come out of this.”
When confronted with the failings of the American response, Trump frequently claims that things would have been far worse had the U.S. not slammed the door back in late January on travellers from China, where the outbreak originated. Most major airlines by that point had already suspended flights to China.
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Canada, however, didn’t take significant steps to restrict international travellers until mid-March. On Monday, Trudeau — asked whether that should have happened earlier — seemed to acknowledge that with the benefit of hindsight, more could have been done.
“We’re obviously not, in an unprecedented situation, always going to get things perfectly right,” he said.
“We’re going to continue to be committed to doing the right things as best as we can and figuring out what works, what doesn’t work, and moving forward in a way that is both nimble and focused on helping Canadians, insomuch as a government can be nimble and agile.”
Canada and the U.S. agreed to close their shared border to non-essential travel two weeks ago while still allowing two-way trade, supply lines and commercial interests to continue, including workers who live in one country but commute to the other. The U.S. has also banned foreign nationals from China, Iran and parts of Europe.
Given U.S. social-distancing restrictions will remain in place through April, those existing travel bans would likely be extended as well, Trump said — “maybe even toughened up a little bit.”
© 2020 The Canadian Press
This week ‘critical’ for Canada’s fight against coronavirus, officials say. Here’s why – Global News
As Canada continues to grapple with the coronavirus pandemic, officials say this week will be “critical” in the country’s fight against the outbreak.
“This is a really critical week in our fight against the coronavirus,” Canada’s deputy prime minister, Chrystia Freeland, said at a press conference on Monday, urging Canadians to continue physical distancing.
“I know that it is hard, but we all must stay strong and stay at home unless we are doing essential work like stocking the shelves in our grocery stores, like working on the frontlines of our health-care system.”
Freeland’s remarks echoed those from Canada’s chief public health officer, who on Sunday said this week would be “very, very important” to understand trends in the pandemic and to determine whether physical distancing has been effective.
Dr. Theresa Tam said she would be keeping an eye on what’s happening in Quebec, Ontario and Alberta — where there has been community transmission of COVID-19 — to see if there has been a drop in new cases, like what has been reported in B.C.
Across the country, federal and provincial health officials have banned large gatherings, closed non-essential businesses and advised Canadians to practise physical distancing to limit the spread of COVID-19.
On Friday, health officials in B.C. released modelling that showed the province’s rate of increase in cases had dropped from about 24 per cent to 12 per cent.
B.C.’s health officer, Dr. Bonnie Henry, said the results left her feeling “cautiously optimistic” about the future.
Tam noted, though, that Canada is a “big country” and different regions are experiencing different timing of the pandemic, with different periods of acceleration and deceleration.
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Dr. Suzanne Sicchia, an associate professor at the Interdisciplinary Centre for Health and Society at the University of Toronto Scarborough, said this week and next are important because they will give health officials a “better sense of whether the measures we’ve taken to flatten the curve have been effective and to what degree.”
“To these ends, the experts will be watching to see if there is a decrease in the rate of new, confirmed cases,” Sicchia wrote in an email to Global News.
She said health officials will “no doubt” use this evidence to inform the ongoing public health and health-care responses to the virus.
Dr. Jeff Kwong, an infectious disease specialist and associate professor in the department of family and community medicine at the University of Toronto, told Global News that based on mathematical models and what we know about the virus’s incubation period, this would be the week many may begin having symptoms.
“It’s going to be this week or the next week that we’re going to see a wave of people who are really sick,“ Kwong said.
Kwong said this has already begun, with hospitals across the country already treating patients infected with COVID-19.
But he said what we have seen so far is just the “tip of the iceberg.”
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“We know there’s lots cases out there — most are mild — but how many of all these cases are going to be severe?” he said. “That’s what we’re going to start to see this week.”
On Monday, Tam said 6,671 cases of COVID-19 had been confirmed in Canada.
Of those cases, Tam said approximately seven per cent require hospitalization, three per cent are critically ill and one per cent of cases have been fatal.
Tam cautioned, though, that these rates could fluctuate as more cases are reported.
According to Kwong, this week will also provide important insight into whether Canada needs to implement more stringent physical distancing measures.
He said if Canada sees fewer cases of COVID-19 than modelling has predicted, it will show that Canadians have done a good job.
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If there is a dramatic spike in cases this week, Kwong said more stringent measures may be justified in order to prevent the health system from “collapsing in another three to four weeks.”
“I hope it does doesn’t come to pass, but, you know, it’s hard to say,” he said. “I mean, who knows what’s going to happen?”
Asked about the data from B.C., Sicchia said it is “promising,” but that we need to be “very cautious in making any definitive claims and even more so when it comes to generalizing these findings to other provinces.”
She said, though, that if the trend continues in B.C., we will know that we have been effective in flattening the curve in that province, and “that bodes well for us all.”
But Kwong said regardless of whether the rest of Canada sees encouraging results, the country “can’t afford to let up on physical distancing.”
He said it is likely the measures will need to stay in place “for months.”
© 2020 Global News, a division of Corus Entertainment Inc.
In Canada and abroad, COVID-19 super-spreaders could be anywhere – CTV News
You may have heard of “patient 31” in South Korea, a woman who was thought to be the source of thousands of COVID-19 infections in that country. Or more recently, a man in India who had returned from Europe and reportedly infected people in more than a dozen villages. They are known as “super-spreaders” – individuals who can infect a large number of people easily.
The World Health Organization estimates someone with COVID-19 can infect between 2 and 2.5 individuals, but super-spreaders infect a large number of people, often in a crowded and busy environment like a church or a conference.
“In a weird way, that seems to be the pattern for this disease. It’s not just that it spreads universally across the landscape,” said CTV News’ science and technology specialist Dan Riskin.
“You get these hot spots where a whole bunch of people get infected at once, and when that happens you can call that person a super-spreader.”
In Canada, while no specific individual has yet been identified as super-spreader, there have been clusters, or hot spots, from coast-to-coast involving a significant number of people.
More than 60 cases of the 135 cases identified in Newfoundland and Labrador are tied to two wakes held at a funeral home on March 15. The funeral home has since been closed as the investigation continues.
“Many of our numbers right now are related to this one cluster, either directly or indirectly, and that will have an influence on what we see,” Dr. Janice Fitzerald, the province’s chief medical officer of health told reporters over the weekend, when asked when she might expect to see cases peak in the province.
On the other side of the country, up to 32 people infected with the virus could be tied directly or indirectly to the Pacific Dental Conference held in Vancouver earlier this month, according to the province’s medical health officer, Dr. Bonnie Henry. One of those attendees has since died.
Some of the factors that can make a patient a super spreader may be related to biology – if they produce more of a virus, for example, or if they take longer to recover from an infection and spread the virus over a longer period, according to experts.
Historic research showed that Mary Mallon, a cook in New York City infamously known as “Typhoid Mary”, was the source of a typhoid fever outbreak in the early 1900s that infected thousands, despite never having any symptoms herself. Scientists are researching how much of a role silent carriers of COVID-19 – those who exhibit no symptoms – play in unknowingly spreading the disease.
This is why self-isolation is important, Riskin said.
“It’s a reminder that for Canadians, we all have to take this seriously, because you don’t know if you’re that one person who unknowingly could infect thousands.”
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