Front Burner - As Wuhan virus spreads, fears about pandemic readiness

Episode Date: January 22, 2020

A new virus spreading out of China has caught the attention of infectious disease experts around the world. That's because it bears some strong similarities to SARS, the respiratory disease that killed hundreds of people including 44 Canadians in 2003. Whether this new coronavirus turns out to be more or less dangerous than SARS, experts say we need to better prepare for pandemics because they are coming for us — ready or not. Today on Front Burner, we talk to Dr. Kamran Khan, who heads up a medical data analytics firm that's trying to set up an early warning system for infectious diseases so doctors like him can spread information about pandemics faster than diseases can spread themselves.

This is a CBC Podcast. We'll just type in Wuhan over here. Okay, this is where the virus originated from. This is where the virus originated from. That's Dr. Cameron Kahn. He spends a lot of time studying global pandemics. Seoul and South Korea confirmed. Tokyo also confirmed.

He's showing me this app that he's developed. It's taking in data on climate patterns, demographics, and flight paths. And it's trying to predict the outbreak of the new coronavirus. You're essentially trying to predict the hotspots. We're really trying to anticipate, well, where's going to be the next jump? Dr. Khan's computer screen is lighting up with these blue circles, big and small, all over this map of the world. Some of the key places would be Toronto and Vancouver, San Francisco, Los Angeles. Bigger dots there. Bigger dots there. And with a few more clicks, he's showing me the direct connections that could carry the virus around the globe. You can see

nonstop flights into places like San Francisco and New York. Today, the World Health Organization convenes an emergency meeting to talk about whether this outbreak should be declared an international public health emergency. We now have confirmation of a case in the United States and there are fears that this might develop the way SARS did in 2003, another coronavirus that began in China. We'll talk to Dr. Khan about whether these fears are warranted and why we might be

more vulnerable to global pandemics than ever before. This is Front Burner. Dr. Khan, thank you so much for being with me today. My pleasure. So as of Tuesday afternoon, and I know that this is moving very quickly, there are more than 300 cases, reported six deaths. The virus we're talking about is known as the coronavirus. And can you tell me a little bit more about what that means? Coronaviruses are just a fairly common virus.

People, when they get colds, those are often from coronaviruses. They're called coronaviruses because they actually look under a microscope, an electron microscope, a bit like the sun. So they have a bit of that appearance. But there are these novel coronaviruses that we have seen in the last couple of decades that have spread from animals to humans. The one that we're most familiar with, of course, in Canada is SARS, back in 2003. More than 30% of the Guangdong victims had some connection to the food trade.

That led investigators here to the markets. The scientists found the SARS coronavirus in six Himalayan palm civets, a member of the cat family. There's another one, the Middle East Respiratory Syndrome, which emerged in the Middle East around 2012. No one knows exactly how it spread, but in about one-third of cases, it's fatal. MERS also infects camels, which scientists believe is more likely to be the source of infection in humans. And then, of course, now we have this new coronavirus that is emerging in the area of Wuhan in China. And these types of coronaviruses tend to be much more deadly.

We're still learning about how virulent, how dangerous this is. I'm joined now by Chief Public Health Officer of Canada, Dr. Theresa Tam. Initially in China, they thought that the majority of the cases were connected to an animal market. And so the hypothesis at the time is animal to human transmission. Now there's increasing evidence that there's limited human to human transmission. But certainly there are far more deadly and produce severe illness more so than the kind of common coronaviruses that we would see just circulating in the public. Why so? What's different about these? Well, first of all, they're not human viruses. So whenever you have a new microbe that humans

have never seen before, we really lack the appropriate immune response to it. So, you know, common colds and these other types of respiratory viruses, generally speaking, the public has mounted some kind of immunity to this. So when you have this brand new virus, the host immune system doesn't really recognize it. And in some instances, it can just produce a severe illness. In other instances, it's actually the host immune system that actually can really cause a lot of inflammation in the host, which can then lead to complications and even death. We know that there is human to human transmission here, but we don't know for sure if it is sustained human transmission. And why is that a big deal?

When you start to have multiple chains of transmission that the person who was at the market then spread it to someone in their family and did it stop there? Or did that person now spread it to the next person and so on and so forth? It becomes very, very challenging when you're trying to do the appropriate tracing of, well, where did this come from? And if you're a healthcare worker and this virus is spreading from person to person to person and they're no longer associated with the market, this becomes really challenging. So just imagine, for instance, now you're a healthcare worker in the Northern Hemisphere during the season when respiratory viruses are

very common, and your patient has no connection to the market. Do you think about this coronavirus, or do you just assume that it's, you know, a common cold? It becomes more and more challenging to really control this type of outbreak and understand exactly where it is. So sustained transmission indicates that this is efficiently moving from person to person and that the outbreak is going to be, you know, a real challenge to control. You mentioned it's flu season. How would you be able to tell if it was the coronavirus versus the flu? Well, often what we do is this is done more as a process of elimination. So, you know, when we see someone first who's got a serious respiratory illness, we kind of test for the common suspects, if you will, influenza and so forth. If those tests are negative, then we may pursue additional testing. We'd also want to, again, go back to,

is there an epidemiological history? If the person had some, was traveling in Wuhan, we might think about this and do the appropriate testing. So right now, some of these tests, again, when we have a brand new virus that the world has never seen before, the tests themselves have to be manufactured and produced and so forth. And so all of those efforts and activities are currently underway. Okay. And airports are screening. The U.S. started screening at various airports. So has Vancouver, Toronto, Montreal. Still the biggest concern is here in China itself,

where the Chinese New Year's holiday is set to begin in just a few days. Hundreds of millions of people traveling across the country and abroad. The largest annual human migration. And how well do these screening processes work, especially if they don't yet have the mechanism to test for this specific virus? When a person gets infected with a particular disease, there is a time between their exposure and the time at which they actually develop symptoms, and that's known as the incubation period. Now, for coronaviruses, you know, typically they're five or six days before someone would manifest symptoms if they're exposed. We do know with some of these novel coronaviruses like SARS and MERS that that period can go up as long as two weeks. that that period can go up as long as two weeks.

So as you imagine, if a individual is infected and they get on a plane, and it could be up to two weeks before they manifest symptoms, I mean, today's world, you could literally go around the earth before you start to develop illness. So we need to kind of think about that in the context of how airport screening works. The value of airport screening and engagement with travelers, if you will, is more about giving them the information they need so that if they do become sick after they've left the airport, they know what to do. They know who to contact. The likelihood of an individual being picked up literally at the moment that they arrive at the airport, it's not zero, but it's relatively low. You know, our borders are very permeable when it comes to these types of diseases. Setting up an infrared

scanner isn't going to help you if the person doesn't have a fever? 300 cases are now reported. Is it possible that the number is larger than that? Yeah, I think it's almost certainly larger than that. So whenever you're dealing with a new infectious disease, you're often just seeing the tip of the iceberg. And that is because what presents to the healthcare system are those who have the most severe illness. So it's fairly common when you have a new emerging disease that you see kind of the tip of the iceberg. And then as the outbreak evolves and as you learn more, you start to realize that, in fact, the scope of the infection is larger than maybe you initially anticipated. The U.S. Centers for Disease Control and Prevention is saying on Tuesday afternoon that the first case of this virus has been reported in the United States,

in Washington state. If I can just say at this moment as governor of the state of Washington, the good news is, is the CDC and we also agree that the risk is low to residents of the state of Washington. And this is certainly not a moment for panic or high anxiety. It is a moment for vigilance. And what does that tell you? Well, I think what it says is that, you know, this virus is going through different stages and it's going through different frontiers. So, you know, first frontier was Wuhan and the seafood market there. The second was starting to see some regional spread across mainland China. The third really is starting to see other cities, international cities in the region, in Thailand and Japan and Korea and now Taiwan.

And I think what this has really indicated today is that this really has a global reach now. And it is really spreading not just just within the region, but across continents. Health Minister Patti Hajdu says so far there are no cases in Canada. Our Chief Medical Officer of Health has been working very closely with our international partners to make sure we're tracking the spread of the disease and understanding its particular characteristics. We have measures in place to alert travelers and also are looking at the suite of measures that we will take if, in fact, the virus is moving.

In the Dragon's Den, a simple pitch can lead to a life-changing connection. Watch new episodes of Dragon's Den free on CBC Gem. Brought to you in part by National Angel Capital Organization. Empowering Canada's entrepreneurs through angel investment and industry connections. So, I lived in Toronto during the SARS outbreak. I'm not sure if you were here as well. It was a scary time. 44 people died.

Hospitals closed. Key health care workers stricken. Thousands of people exposed to the disease quarantined in their homes. She is the daughter and sister of the first two people in Canada to die of SARS, known as patient three. In my life, I've never been in a separated room like that and so sick that I need to depend on people for everything. I cannot survive without an oxygen mask. It took us so long to recover and to stand back up again. This virus, how similar is it to the SARS virus? Is it just as dangerous? You know, I'm from Toronto as well.

And, you know, I went to medical school at U of T. But I did my infectious disease and public health training in the U.S. and moved back to Toronto just before SARS arrived. So the beginning of my career was watching this virus cripple our city, watching my colleagues get infected with SARS, and you know seeing the city really kind of just paralyzed by this virus. Ontario's Minister of Health has given public health officials the right to force symptomatic people into isolation. To make SARS a reportable, communicable and virulent disease. We know the economic implications were massive

and the psychological effects to the health care workforce I think were also very profound. Fifteen health care workers worked four hours in very close confines trying to put a breathing tube down the throat of a SARS patient. Now they too are suspected of having SARS. In the end, 45% of the 375 people infected with SARS were health care workers. That was in many ways kind of my own inspiration and calling to really get involved in this type of work. To your question about is this as severe as SARS,

I think there are so many parallels here, but there are still some unknowns. So the parallels, of course, are started in a market with live animals, made the leap over to humans, spreads from human to humans across the region, across continents. I think the big unknown right now is, is this as deadly as SARS was? And SARS had roughly a 10% mortality rate. Of concern is coronaviruses. People often ask, well, do we have any antibiotics or a vaccine? Well, we don't have any antivirals. This is a virus against coronaviruses. And it's 17 years since SARS, and we don't have a vaccine. So unlike an influenza pandemic where we could develop a vaccine, I think we're unlikely to have a vaccine available anytime in the foreseeable future. Okay.

I suppose the question I have then is, did we learn anything from SARS? Why do we not have some sort of vaccine ready? I suppose the question I have then is, did we learn anything from SARS? Why do we not have some sort of vaccine ready? It's my belief that our biggest failure is that we are reactive beings and that we cannot focus on threats that are slow moving and even if they're imminent. You hear this argument with climate change all the time. Exactly. We're dealing with the exact same issue. What we really need to be doing is we need to be focusing on prevention with the same level of rigor that we are during an emergency. And that is very difficult. It requires a tremendous amount of leadership for people to say, no, no, we need to keep our eye on this and we need to focus on it during peacetime because we know inevitably that next threat is coming. I can't help but think of this report that was released last year, the WHO affiliated report, which essentially warned that there is a very real threat of a pandemic,

not necessarily this coronavirus. It could be something else entirely that could sweep 80 million people off the planet. The board warned that the world is woefully unprepared. If this had been the defense preparations in our country, it would not only have been the defense minister, but the whole government and the prime minister or president responsible. This has to be the same in global health security. And yet, we still haven't moved. We're talking about existential risks here, But it is surprisingly difficult to have that kind of focus maintained after an emergency is over. And again, I think really the limitations are no longer technology and science and innovation.

I think it's really just human behavior and focus. human behavior and focus. You're saying essentially we have the know-how to properly deal with these issues, but just not the will? This is not to say that there are not unforeseen challenges. I mean, I think one thing about microbes is that, you know, they will do lots of unexpected things and we'll just have to accommodate. But I think in general, I think we're just far too reactive. So we try and deal with and develop a solution during the middle of an emergency when we should have spent the time planning for it, preparing for it, and making the appropriate investments in advance. Is there any part of human activity that's making these outbreaks more common, more serious? Is

there anything that we could do to reverse the trend here? First of all, population growth. There's seven and a half billion people on the planet. It took all of human history to reach a billion somewhere, I think, in around the 18th century. And now every 12 years, there are an additional billion people on the planet. More than 50% of the world's population now lives in cities. You know, that has so many benefits, but it's the perfect place for a virus to rapidly spread. We are dealing with climatic changes. We are dealing with billions of us boarding commercial flights and traveling around the world. It's liberating,

and it makes a more for a more interconnected world, but it also creates a more interdependent world. You know, we often focus on things like, well, what should we do in an airport and, you know, those kinds of things. But if we need to be thinking further upstream, what was the spark, the catalyst that got this all started? And if we just look back to SARS, it started in a market with wild animals being consumed. If we fast forward 17 years, here we are again, a market with wild animals being consumed. I think it is extremely important for us to recognize that human health and security is very interdependent with the health and well-being of other living systems on our planet. with the health and well-being of other living systems on our planet.

So, and I'm not speaking about this from a moral perspective about, you know, consumption of animals or even environmental perspective. But as we consume wild animals, we are encountering microbes that are very dangerous, as we can see. That is a very important lesson as we think about the industrialization of agriculture. Swine flu, avian flu, these are viruses that start in animals and find their way into human populations. When we disrupt wildlife ecosystems, those wildlife come in contact, in closer contact with humans. We get infected with viruses and then the whole cycle starts again. So if we really want to look upstream

and talk about real prevention, we have to be looking at that issue and having real discussions about how we interact with other living systems on our planet. Just to loop back to the coronavirus, before we end this conversation, the World Health Organization is meeting today. They're going to decide whether or not this should be declared a global emergency. At what point for you does this become incredibly concerning maybe you're already there I think I'm already seeing it so it was probably about three days ago when the market was closed on January 1st and we saw cases that were occurring after that that was it was very plausible to say okay this is what we call a common source

exposure or a point exposure. So the people who were close to the market got infected with this virus, and then they developed an illness. But when the market was closed on January 1st, that exposure was now gone. And so we waited for a period of time thinking about the incubation period. So, you know, if 14 days is the outer limit, as you started to approach January 14, we shouldn't be seeing people developing new infections at that point in time. And really over just this past weekend, a few days ago, you know, we saw, I can't remember the numbers, in 48 hours. 139 new cases in 48 hours. In a span of just 72 hours, more than 150 cases have been reported in China. And the onset of illness was approaching up to January 18th. So to me, that basically said,

okay, the outbreak has moved into a new phase. It's no longer animals to humans. It's now humans to humans. And so for me, that was the point of this is kind of the real deal here. I think one of the other questions we have is something called a reproduction number. You may have heard the term R-naught is sometimes discussed in kind of epidemiology, which is, The term R-naught is sometimes discussed in kind of epidemiology, which is, will each case generate one case or more? And if the R-naught is above one, those are outbreaks that start to grow. If the R-naught is less than one, these are things that kind of peter out and just fizzle out over time. So we're at that point right now where, you know, some of those estimations and calculations are being performed.

But the indications seem to be that this is rapidly propagating person to person, the dispersion to other parts of mainland China. And then, of course, now hearing about not only regional dispersion, but dispersion across continents. I think kind of the cat's out of the bag. Okay. Dr. Cameron Kahn, thank you so much for taking me through this today. Thank you. So before I let you go today, some news about the conservative leadership race that I want to tell you about. We did an episode on this last week with Maclean's writer Paul Wells, and one of the possible contenders we talked about was former Quebec Premier Jean Charest. You can find that episode in our feed. Well, Mr. Charest told our colleagues at Radio Canada on Tuesday

that he will not be running after all. He said that the party has changed and that the rules of the race were really not meant for an outside candidate. Mr. Charest has made headlines in recent weeks for advising Huawei on the Meng Wanzhou case and for ongoing investigations by Quebec's anti-corruption squad on his years in power. There were also reports last week that former Conservative Prime Minister Stephen Harper was very much opposed to the idea of Charest running and was going to be actively blocking his candidacy. That's all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner and see you all tomorrow.