Episode 4 – Novel Coronavirus – Dr. Vera Etches

In December 2019, cluster of cases of pneumonia was reported in Wuhan, China and the cause of this cluster was a new coronavirus not previously found in humans. Though early, it is thought that this new coronavirus originated in another animal (possibly of bat origin).

Coronaviruses are a large group of viruses, that are shaped like a crown. Crown in Latin is “corona”, hence the name coronavirus, and they have been around for decades. Generally, symptoms tend to be mild, and in fact coronaviruses are one of the main causes of the common cold. Every once in a while, we see a more severe strain of the virus, such as SARS (severe acute respiratory syndrome) which arose from civet cats in China in 2003, and MERS (Middle East respiratory syndrome), which was identified in Saudi Arabia in 2012, which are also coronavirus.

Dr. Vera Etches is the Medical Officer of Health for Ottawa Public Health (OPH). From a small town in northern British Columbia, her specialty training in public health and preventive medicine brought her to Toronto. Prior to joining OPH in 2009, she served as an Associate Medical Officer of Health, Acting Medical Officer of Health and Director of Clinical Services at the Sudbury & District Health Unit. In her work as Associate Medical of Health at OPH, she has led and supported work across the breadth of public health practice – from clinical services and outbreak management, health promotion and disease prevention, to surveillance, program evaluation, and evidence generation and dissemination. Appointed Medical Officer of Health in May 2018, Dr. Etches remains committed to addressing rural, Indigenous, and urban health issues and is passionate about building bridges between government, business, community and academic sectors to promote and protect health.

Coronaviruses are a large group of viruses, that are shaped like a crown. Crown in Latin is “corona”, hence the name coronavirus, and they have been around for decades. Generally, symptoms tend to be mild, and in fact coronaviruses are one of the main causes of the common cold. Every once in a while, we see a more severe strain of the virus, such as SARS (severe acute respiratory syndrome) which arose from civet cats in China in 2003, and MERS (Middle East respiratory syndrome), which was identified in Saudi Arabia in 2012, which are also coronavirus’.

An epidemic is an event in which a disease is actively spreading in a community at a particular time, whereas a pandemic relates to a geographic spread, and could describe a disease that affects an entire country or several countries. At this time, we are not on a pandemic.

In December 2019, cluster of cases of pneumonia was reported in Wuhan, China and the cause of this cluster was a new coronavirus not previously found in humans. Though early, it is thought that this new coronavirus originated in another animal (possibly of bat origin).

People infected with COVID-19 infection, the flu, or cold typically develop respiratory symptoms such as fever, cough, and runny nose. Even though many symptoms are alike, they are caused by different viruses. Because of their similarities, it can be difficult to identify the disease bases on symptoms alone. That’s why laboratory tests are required to confirm if someone has 2019-nCoV.

COVID-19 causes respiratory disease, and can be transmitted from person to person, usually after close contact with an infected patient, for example, in a household, workplace, or health care centre. To reduce the spread of germs, including the flu and novel coronavirus, we recommend:

Wash your hands often with soap and water, or use hand sanitizer
Avoid touching your eyes, nose, and mouth unless you have just washed your hands with soap
Cover your cough and sneeze with a tissue or into your arm, not your hand
If possible, stay home if you’re sick
Avoid visiting people in hospitals or long-term-centres if you’re sick
It is still recommended to get your flu shot if you haven’t already, as the flu is still circulating in the community

As with other respiratory illnesses, infection with COVID-19 can cause mild symptoms, but it can be more sever for some persons. Generally, it’s not the “young and healthy” that are at risk, but rather the elderly, those that are immunocompromised, or those with other medical comorbidities

As of Feb 12 2020, there’s been just over 45 171 confirmed cases, accounting for 1114 deaths. Likely this is an underrepresentation as many who are sick likely stay at home and don’t get lab confirmation.

Importantly, of the 45 k confirmed cases, only 441 are outside of China. Outside of China, Hong Kong (1 death) and the Philippines (1 death), there have been 0 deaths. In fact, there are only 20 confirmed cases in North America.

In the US alone this year, there have been 22 million flu illnesses, 12,000 deaths and 210k hospitalized by influenza. In Canada, there have already been 38 flu related deaths 29 023 laboratory confirmed flu illnesses. To date, there have been no reported, confirmed or presumptive cases of novel coronavirus in Ottawa. The risk to Canadians is still low, but it never hurts to be prepared.

Looking at some of the epidemiology, there’s something called a R0 value or the basic reproductive number. To simplify it, a mathematical term that indicates how contagious an infectious disease is, and it can be thought of as the expected number of cases directly generated by one case. the R0 value is ~2.2 (though some literature is saying it’s as high as 3.5). This means that on average, each patient has been spreading the virus to 2.2 people. For context, the R0 value of SARS was 2-5, 2-5 for HIV, and 12-18 for measles.

Comparing this to SARS, we’re better prepared in 2020 than we were in 2003 and the preliminary good news is that this appears to be different than SARS – overall there’s less mortality than SARS and there appears to be less human-to-human transmission than SARS. But this is a dynamic and quickly changing process, we’ve already seen the case definition change from screening for patients just from Wuhan, to screening patients from all of mainland China.

It’s well known that during the SARS outbreak, health care providers (including paramedics) were major vectors that helped quickly spread the virus. Not only is this due to simple exposure, but also due to performing some “high risk” procedures.

In the stable patient, we should be very diligent and deliberate in our PPE use and our risk assessment. Where this becomes a challenge, obviously, is with the critically ill patient. Not only do they likely have a higher viral load, they can be hypoxic and combative, which will only lead to a further spread of the illness.

Unfortunately, many of our airway management tools can aerosolize the virus. As such, the Ontario Base Hospital Medical Advisory Committee Group released a memorandum surrounding considerations that paramedics should undertake when managing patients with possible COVID-19. Refer to this document (attached at bottom) for further information.

The Public Health Agency of Canada is continuing to collaborate with partners internationally as well as to share information and work with federal, provincial and territorial partners and public health authorities and to maintain Canada’s preparedness to rapidly identify, treat and prevent the spread of this emerging disease.

Ottawa Public Health continues to actively monitor this situation in collaboration with our provincial and national health colleagues, and stakeholders that include local hospitals and community agencies.

Cases and potential suspect cases of COVID-19 are now reportable to local health authorities under the Health Protection and Promotion Act.

If there were potential cases of which public health has been notified, they would immediately follow-up with those individuals that they may have been exposed to a potential health risk, what signs and symptoms they should look out for, and when and what type of medical treatment should be sought out, if that becomes necessary. This work is part of routine public health follow-up of a case of an infectious disease.

Canada has a number of standard border measures in place to prevent communicable diseases from being introduced to or spreading in Canada.

Additional measures have been implemented including messaging on arrivals screens at the Toronto, Montreal and Vancouver international airports reminding travelers from Wuhan to inform a Border Services Officer if they are experiencing flu-like symptoms.

In addition, a health screening question has been added to electronic kiosks.

Entry screening alone is not a guarantee against the possible importation of this new virus but is an important public health tool and part of a larger response strategy.

Ottawa Public Health is following the lead of the Ontario Ministry of Health, Public Health Ontario, and the Public Health Agency of Canada in responding to the novel coronavirus.

They have a strong partnership with local hospitals who have put measures in place to screen individuals who are suspected of being infected by the novel coronavirus.

Ottawa Public Health and our local health-care partners recently reviewed and signed off on what is known as the Ottawa Interagency Influenza Pandemic Plan.

That plan outlines roles and responsibilities of OPH and partners when influenza activity creates a demand that exceeds the capacity of the health care system.

If a suspected or confirmed case of novel coronavirus were to be identified in our community, Ottawa Public Health would work with the Ministry of Health, Public Health Ontario Laboratory, and local hospitals in the management of the case and any contacts to reduce the spread of the virus in Ottawa.