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A woman arrives at the COVID-19 assessment centre at Toronto's Michael Garron Hospital.
A pedestrian walks across Toronto’s Yonge Street and Dundas Street intersection, as a nearby billboard urges people to “Stop The Spread Of COVID-19.”
With COVID-19 outbreaks in Iran, Italy and South Korea, and new cases outside China exceeding those identified at the epicentre of the outbreak for the first time, a global pandemic is becoming increasingly likely. World Health Organization officials have repeatedly said that, while they’re still hopeful that the novel coronavirus can be contained, now is the time to prepare for the worst. Canada’s chief public health officer has said that it will get harder to contain the coronavirus as it spreads to more countries, and on Wednesday Toronto identified its first presumptive case of COVID-19 that originated in a country outside China, the third in Canada to be traced back to Iran, and the 12th case overall. In light of the growing spread of the virus, here’s what we know about how a pandemic response might unfold.
Do we have a plan?
Canada has a pandemic preparedness plan that was developed to deal with influenza, but would also be used as a foundation in the case of a COVID-19 outbreak, Chief Medical Officer of Health Dr. Theresa Tam has said. The Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (CPIP) is a guidance document “that outlines how jurisdictions will work together to ensure a co-ordinated and consistent health-sector approach to pandemic preparedness and response.” It was first published in 2004, updated in 2006 and was put to the test in 2009 during the H1N1 influenza pandemic. The latest version was approved in 2014 and updated in 2018. The plan aims to minimize serious illness and deaths, and minimize societal disruption among Canadians.
What can be done now?
Tam has said that Canada can prepare by expanding laboratory testing capabilities across the country; examining supplies and identifying any potential shortages; and accelerating research into treatments and potential vaccines. Now would also be the time to stockpile respiratory equipment and add hospital beds.
What about individuals?
Health Minister Patty Hajdu encouraged Canadians on Wednesday to stockpile food and medication in their homes in case they or a loved one falls ill with the novel coronavirus. “It’s good to be prepared because things can change quickly,” she said. The latest advice the government has given to people returning to Canada is to monitor themselves for potential symptoms, no matter where they travelled, and to contact local public-health units if they have concerns. Workplaces should also prepare policies to reduce the spread of illness among employees.
What happens if containment is no longer possible?
The next step is mitigation. This includes encouraging individuals to practice good hygiene and social distancing. Travel restrictions will become less effective as the virus spreads to more countries.
What about quarantines?
While China’s lockdown of at least 50 million people in Hubei has been credited with slowing the spread of the virus outside the country, it was also unprecedented. The large-scale quarantine of millions of people would be unlikely in Canada unless the spread of the virus was severe, but the government could ask people not to gather in large numbers. In certain cases, the government could decide to close schools, however its not yet known how the virus spreads among children.
Would Canada shut its borders?
Locking down borders would have severely detrimental effects on trade and the shipment of food and natural resources. While Canada could choose to implement highly restrictive border measures limiting the movement of people and goods, such policies may delay, but would not likely halt the eventual spread of disease during a pandemic, the
North American Plan For Animal and Pandemic Influenza concludes. And such measures could have “significant negative social, economic and foreign policy consequences.” The document, which is not legally binding, recommends less restrictive measures, including appropriate screening at airports and land borders and public health communications and education.
“During Pandemic (H1N1) 2009, mitigation measures employed for residents of border and non-border communities included keeping people educated, asking sick people to exercise voluntary personal preventive measures when attending large events or travelling, and to stay home when possible. Although these measures did not contain the pandemic, they may have mitigated its impact,” the document states. “The quick decision of Canada, Mexico, and the United States to keep the borders open and minimize travel restrictions limited disruptions of travel and trade, avoided panic, and saved resources.”
What’s possible under the quarantine act?
The federal government has already invoked powers granted under the Quarantine Act to isolate hundreds of Canadians, who were evacuated from Wuhan, at an Ontario military base for 14 days, which is the incubation period for the new coronavirus. The legislation gives the federal health minister sweeping powers to stop the spread of communicable diseases either in or out of Canada. It also technically empowers the government to make use of any building they see fit and designate it as a quarantine site, including private homes. Using a military facility limited the strain on potentially overtaxed health-care resources.
Can Canada’s health system handle a pandemic?
It’s hard to say. Tam has said that the goal is to get through the end of the influenza season without a serious outbreak. In spring the hospitals will have more capacity to deal with an influx of patients, should it come to that. Hajdu also suggested people should do what they can to ease the burden on the health-care system in the meantime by staying home if they’re sick, washing their hands and getting flu shots. The virus known as COVID-19 is different from influenza and the flu shot doesn’t provide protection against it, but the fewer people who are sick, the less strain on doctors and hospitals. 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.
Who is most at risk?
For most people, COVID-19 causes only mild illness, but some people become severely ill. The death rate is between two and four per cent in Wuhan, and 0.7 per cent elsewhere in China and around the world. It is most fatal in older people and those with preexisting medical conditions, with the death rate jumping to nearly 15 per cent for patients over 80. The death rate for the 2009 swine flu was 0.026 per cent.
How could a pandemic effect infrastructure?
While a pandemic would pose no risk of physical damage to infrastructure, worker absenteeism — due to illness or the need to stay home to care for children in the case of school closures — poses it’s own threat.
“For example, critical workers sustain the flow of electricity as well as natural gas and petroleum. These critical goods and services are part of a vast, interconnected system serving all of North America. Beyond energy and power, other critical infrastructure and key resource sectors, from manufacturing operations to transport, banking systems to food delivery service and the ability to provide trained medical personnel could also be affected. Moreover, a pandemic could significantly interrupt the ability of public and private sector entities to sustain critical infrastructure,” the North American Plan For Animal and Pandemic Influenza warns. “Underserved populations could be disproportionately affected by disruptions in critical infrastructure.”
What happens if we experience mass fatalities?
While Canada’s latest version of its pandemic plan refers to WHO, Pan American Health Organization and the International Red Cross for “the effective management of mass fatalities during a disaster,” it predicts that death services — funeral homes and mortuaries — could become overwhelmed. An archived 2009 version of the document estimates that the total number of fatalities resulting from a pandemic and other causes during a six- to eight-week period would be similar to the number of deaths typical during a six-month period. The document suggests that while cultural and religious preferences will have to be considered, cremations may be the most “expedient and efficient way of managing large numbers of deceased during a pandemic.” Volunteers may be required to dig graves and there will be increased demand for body bags and cheap coffins. Hockey arenas, refrigerated trucks, cold storage lockers could even be turned into temporary morgues if there isn’t enough storage at funeral homes, the document states.
How do we end a pandemic?
Either by stopping the spread of disease or identifying a vaccine, but the World Health Organization estimates that the earliest one could be ready is 18 months from now. Public health officials are hoping that warmer weather in the northern hemisphere could slow the spread of COVID-19.
— With files from The Canadian Press and Bloomberg
Copyright Postmedia Network Inc., 2020