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For Canadians who remember the face masks, quarantines and airport screenings of the SARS epidemic, a mysterious outbreak of pneumonia in China likely caused by the same family of viruses may be raising concern.
Since Dec. 12, 59 people have been hospitalized with viral pneumonia in the city of Wuhan, in the central Chinese province of Hubei. Wuhan health officials on Saturday reported that one person has died, and seven were in critical condition.
Health officials in China have reportedly identified and genetically sequenced the previously unknown virus from an infected patient in Wuhan and found remnants of it in 15 others, state-run media agency Xinhua announced Thursday.
The illness has been identified as a new coronavirus, a large family of viruses that can make the jump from animals to humans and range from the common cold to much more serious illnesses, such as SARS or MERS.
Chinese officials have traced the outbreak back to a seafood market in Wuhan, which was shut down and disinfected on Dec. 31. But it’s not yet known how it made a species jump from animals to humans, or if it is transmissible from person to person.
Diseases such as SARS, MERS, influenza and avian influenza have also reportedly been ruled out in tests, World Health Organization representative to China Dr. Gauden Galea said in a statement.
“According to Chinese authorities, the virus in question can cause severe illness in some patients and does not transmit readily between people,” he said.
“In the coming weeks, more comprehensive information is required to understand the current status and epidemiology of the outbreak, and the clinical picture.”
How does this outbreak compare to SARS?
Given the fact that both SARS and the Wuhan outbreak both originated in open-air markets that sold both live and dead animals, the similar origins of the viruses are hard to ignore.
“Certainly there are some parallels, if we’re thinking back to SARS,” said Dr. Kamran Khan, an infectious disease physician and scientist at St. Michael’s Hospital in Toronto.
“We know that in today’s world, diseases spread incredibly quickly and we don’t actually even know what this is just yet.”
More than 400 Canadians were diagnosed with SARS and 44 died as a result of the 2002-2003 epidemic that killed 774 worldwide. So the current outbreak is something health officials who lived through it are watching closely.
“I think given when it presented, how it presented, it certainly did raise eyebrows and serious concerns,” Dr. Marjorie Pollack, deputy editor of the Program for Monitoring Emerging Diseases (ProMED), said of the current outbreak.
“People who want to be sensationalist and want to blame are throwing stones at China, saying they’re not being transparent enough.… They are being transparent with what they know. They’re not being transparent for speculations.”
Information was hard to come by in the early days of the SARS epidemic, too, and health officials in Canada were caught off guard when the virus was confirmed to have landed in Toronto in March 2003.
“This went on for months before, really, the world kind of knew what was happening. And it really started to build up quite a bit of momentum before it started to disperse in different parts of the world,” Khan said.
“We’re getting this information, certainly earlier [in this outbreak], … but I still take all of the information as being preliminary at this point.”
For its part, WHO said in a statement that the identification of a new coronavirus in a short period of time is a “notable achievement” that “demonstrates China’s increased capacity to manage new outbreaks.”
Dr. Allison McGeer, an infectious diseases specialist at Mount Sinai Hospital in Toronto, who herself was diagnosed with SARS in 2003, said she’s encouraged by the amount of information released by China so far.
“The fact that we know about it, that we’re talking about it, this is a marker of just how much better things are,” she said.
“A challenge with SARS was when it started, we didn’t know anything about it.”
Could Canada be at risk?
The Public Health Agency of Canada recently updated its website, warning travellers to Wuhan to avoid contact with animals and to report any symptoms to health-care workers.
But assessing the level of risk in Canada for an outbreak like this is largely based on two key factors: whether the virus will spread from person to person and whether health-care workers will be affected on the front lines.
“In the last 15 years, the volume of people travelling through commercial flights has doubled. We’ve become vectors that are moving these diseases very, very rapidly around the world,” said Khan, who is also the co-founder of the app BlueDot, which uses various types of data to study how infectious diseases spread around the world.
“We are not there yet. We are still moving too slow. If we want to get in front of these threats, we are literally going to have to spread knowledge faster than the diseases themselves. And they move quick.”
His data shows that of all the travellers projected to depart from Wuhan on commercial flights from January to March of this year, 4,000 of them are heading to Canada — and the majority to cities such as Toronto and Vancouver.
“Thirty years ago, when somebody turned up in the emergency department in hospital, you didn’t have to worry about where they’d been because air travel was much less common,” said McGeer.
“Now when somebody turns up in your emergency department, they could have been anywhere four days ago. And so SARS was us catching up with the globalization of humans.”
McGeer says that while she can’t guarantee there would be no risk of transmission of a virus like this in Canada if it were to spread overseas, she’s confident health-care workers could do a better job of containing it than they did with SARS.
It can be hard to recognize new viruses early on, she added, which is why airports in Hong Kong, Singapore and cities around Wuhan will likely be screening travellers in the meantime.
But a comprehensive 234-page report into the outbreak of SARS in Canada released by Dr. David Naylor in October 2003 found WHO-ordered airport screening to be completely ineffective.
More than 6.5 million travellers were screened at Canadian airports for SARS by August 2003, with 9,100 passengers isolated for further assessment by nurses or quarantine officers. None had SARS.
A thermal scanner project was also piloted, with 2.4 million passengers screened and 832 requiring further assessment. None of them were found to have SARS either.
So it’s likely not a virus that will easily be detected until health-care workers can test for it based on its genetic sequencing.
“If somebody comes from Wuhan with pneumonia, and we don’t know they came from Wuhan, we’re not looking for it. And if it happens to be transmissible, we’re not going to make the diagnosis,” McGeer said. “So until we have a test for it, it can be very difficult.”
Khan thinks that even with the technological innovations in health care since SARS, the biggest risk related to an outbreak spreading to Canada is the fact that we’re far too “reactive.”
“We spring into action with incredible vigour during an emergency, but then forget about the emergency almost immediately after it is over,” he said.
“The current events in Wuhan are a reminder about what happened in Toronto and around the world 17 years ago, and are foreshadowing what we will no doubt face again. Will we pay attention, and if so, for how long?”
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