Front Burner - How to fight a viral disease outbreak

Episode Date: January 27, 2020

The coronavirus outbreak has come to Canada. A man in his 50s who’d recently been to Wuhan, China is Canada’s first “presumptive case,” and is being treated in a Toronto hospital. Today, on Front Burner, we speak to infectious disease specialist Dr. Isaac Bogoch to learn what’s happening in this country and around the world to combat the 2019-nCoV coronavirus. He explains everything from front-line measures being taken by health professionals, to the co-ordination of international public health authorities, to the lab research being done to help us better understand and better fight this virus.

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. This is a CBC Podcast. Hello, I'm Jamie Poisson. It's a battle happening on many, many fronts now, in an increasing number of countries. I'm talking about the fight to stop the outbreak of the 2019 coronavirus. In Wuhan, China, where the outbreak originated and in neighboring areas,

tens of millions of people have effectively been placed on lockdown. This is a city with a population bigger than London, and yet there is no one on the street. And here in Canada, public health officials are racing to identify who might have come into contact with our first presumptive case. We're looking at a two metre radius. So of course we'll be looking at the plane and its seating plan and where that patient was actually seated. It all has me wondering exactly how you fight an outbreak like this once it's already here.

Dr Isaac Bogosh is joining me. He's an infectious disease specialist with Toronto General Hospital and the University of Toronto. And we're going to talk about exactly that. This is FrontBurner. Dr. Isaac Bogosh, thank you so much for being with me today. Thanks for having me on. So I'm hoping that we can start with a quick status update here. You and I are talking on Sunday afternoon.

Five cases of the novel coronavirus have been identified in the United States. Meantime, the latest from China is that there are now more than 2,700 cases and 76 people have died. There doesn't seem right now to be updated numbers on worldwide cases, but we know that the virus is spreading to countries around the globe, including Canada now. And I know last week, two big unknowns were how contagious is this and how deadly is this? SARS, for example, had roughly a 10% fatality rate. And so what do we know about this now? I think it's so important that you put the timestamp on this conversation, because things have changed very rapidly over the

last days, and certainly over the last week. And if we think about this virus a week ago, and we think about it now, we're in a completely different universe. There's certainly been numerous exported cases to international settings, and we know that there's been way more cases reported in China. Unverified pictures appear to show hospital wards overwhelmed, patients filling the corridors. In others, doctors seem at breaking point. And then in terms of, you know, more focused answers looking at, you know,

how transmissible is this from person to person? You know, it's interesting. We still don't know the efficiency at which this virus can be transmitted from person to person. China's health minister told reporters that the virus's ability to spread is getting stronger. From our observation, the disease can be spread during the incubation period. The period lasts for 10 days. The shortest is one day, the longest is 14 days. This is very different from SARS. You know, I think the other good point you raised was,

you know, how, you know, what's the case fatality rate? Right, how deadly is this? Yeah, exactly. How deadly is this? And, you know, I think we still have to be weary about this 3% number that's floating around. Maybe it'll be true. It might be a lot less than that.

And what really will factor into this is looking at the total number of people infected, which we don't know. We don't know that answer. So there are emerging reports of people who have no symptoms whatsoever or who have very mild symptoms as well. And certainly those individuals need to be factored into the fatality rate of this because if there's a large proportion of those individuals, then the fatality rate will be far, far, far lower. Okay. I want to talk to you today about how you fight an outbreak like this on a bunch of different levels, because I know this is super complex, but I'm hoping we can start with China,

with Wuhan, the epicenter of all of of this there's now unprecedented travel bans with authorities halting most forms of transportation in Wuhan and neighboring cities. They're essentially on lockdown. But the governor of Hubei province where Wuhan is says he hopes people understand the enormous challenge. It was a tough decision he says but the outbreak had reached a critical stage. That sense of urgency now shrouds all of China. Disneyland in Shanghai is closed to crowds, as is Beijing's Forbidden City. And how could that help? Yeah, it's really interesting because in the past,

travel bans haven't really been that effective in preventing the spread of infectious diseases. And there's been a few recent examples. I mean, for example, in the 2014 Ebola virus epidemic, there was a similar stay-at-home policy for some neighborhoods in Liberia. stay-at-home policy for some neighborhoods in Liberia. A few years before that with H1N1, there were some limited travel restrictions as well. And those didn't seem to work out. But I just think the world has never seen a travel ban on this scale ever before.

It's extraordinary. Exactly. I mean, there's about 40 million people affected by this. I spoke to Ben Kavanagh, who's from Ireland and working as a teacher in Wuhan. If you were to look outside now, you would have no idea it's Chinese New Year. It's like a ghost town out there. It's as if I'm in a dystopian movie. It's hard. Like there's 10 million people in the city and there's no one on the streets. We've just never seen something to this magnitude before. So, you know, I think it will be very difficult to extrapolate from existing data whether or not this type of travel ban will work. But my gut is that it might not be that effective. It may slow things down a bit, but it might not be that effective.

But, you know, I think the real question here is, if there are ongoing chains of transmission outside of the areas with the travel ban, it's probably going to be, you know, still a little more difficult to get this epidemic under control. Essentially, is it too late? Yeah, it might have been. It might have been. Yeah. China has also been criticized in recent days for, you know, not acting soon enough here. Reports that the first patient was actually admitted on December 16th,

and the doctors were told to keep quiet and that the WHO wasn't notified until December 31st. On Chinese media and social media there were a lot of criticism. There are days here when the official government newspaper People's Daily doesn't have a single word about this epidemic. They're very suspicious that this is actually much worse than what they're being told and that the numbers for this epidemic are only going to be going up. And how important is the open sharing of information to this fight, especially from the very beginning? Yeah, openness and transparency with medical updates and with public health

updates is just essential in getting epidemics and outbreaks like this under control faster. You know, I think it's really interesting with this example, because, you know, it's hard to make broad strokes generalizations over a country of 1.4 billion people. And certainly early on, we did have some very valuable information transmitted to the world. early on, we did have some very valuable information transmitted to the world. So after there was, you know, this, we heard of grumblings of this outbreak in Wuhan, within two weeks of that, the genetic sequence of the virus was made publicly available to the world. And this is something that didn't happen with SARS. Oh, not even close. I mean, this is unprecedented, having, you know, isolated the causative virus and having

that made publicly available to the global community in that short amount of time is just, to my knowledge, that's never happened before. And in addition to that, you know, there are lots of different players in this giant country. And we certainly were getting updates from Wuhan public health authorities. We were getting a few updates from certain Chinese centers for disease control, public health authorities. So, you know, on the one hand, there are likely many actors in this moving scene here.

And I think we're probably getting different degrees of transparency from different actors here. How significant is it though, that there was that, there seems to be that lag? If that's the case, and I think we're still too early to know exactly what the exact details were and who knew what at what time. But of course, if that is the case, you know, that's upsetting because, you know, if the earlier you can jump on these epidemics, the far more likely you are to get them under control. And these are, you know, far less likely to spread as quickly and as far as they do. So now I want to talk to you about what's happening in other places in the world.

So this virus has now spread to several other countries. As of Sunday afternoon, we're talking at least 10 other countries. The U.S., Japan, France, Nepal, Singapore, Malaysia, Australia, and of course, the first presumptive case in Toronto. The patient currently remains in a stable condition. Dr. Jerome Lees is head of infection control and prevention at Sunnybrook Health Sciences Centre. He says the man is in a special isolation room in the hospital. And the patient will not be discharged until we can be assured they have fully recovered.

And what is the protocol being put in place when this starts to happen? Can we start at the airports, for example, the Toronto International Airport? Absolutely. So getting these epidemics under control and really bracing for these epidemics is a multi-pronged approach. And certainly if we're talking about Canada and many countries that have the resources available to them, screening at the ports of entry is vital. I mean, this is one of many approaches that are taken simultaneously. So, you know, at Toronto Pearson International Airport and Vancouver and Montreal as well, there's screening in place and passengers arriving from China are given questionnaires and screen for symptoms. And, you know, we've seen it elsewhere in the world, like, for example, in the United

States, they're using thermography, where they're measuring people's temperatures as they're arriving. You know, there's a lot of different approaches. Of course, if we're looking explicitly for symptoms, you know, you got to get lucky, right? There's an incubation period of this virus. And of course, if we're looking just for symptoms, you have to have a person with the right symptoms at the right place at the right time. And of course, it's not going to be a perfect system. Of course, we're going to get a few that slip past the goalie here. But the key thing for airport interventions is education. And that is the essential component because, you know, just looking for symptoms, whether you're taking a history or measuring a

temperature, you're going to miss lots of cases. And then in addition to that, you're going to get a lot of false positive cases as well. It's the flu season in the Northern Hemisphere. There's a ton of people that don't have the coronavirus that have influenza or another related infection. a ton of people that don't have the coronavirus that have influenza or another related infection. But arming people with information saying, look, you have traveled to China or you have a potential contact with someone who has this infection. And if you come down with fever, cough, or shortness of breath within a couple of weeks, here's what you should think about. Here's what you should do.

And here's what you should, where you should go and really arm people with information. And like, this is what happened with this case in Toronto. I mean, this is exactly what happened. The person was armed with information, recognized that he had some appropriate symptoms, sought appropriate medical care. You know, the system worked. The message today from Federal Health Minister Patty Hajdu,

remain calm. The patient, when he became ill, more ill, that he realized he needed medical support, in fact, followed all of the information provided at the airport. For me, that is a sign that the information at the border did actually percolate through to the patient and his family. Right. And let's talk about that for a second. So this gentleman, this man is in his 50s. He came from Wuhan via Guangzhou on January 22nd. And apparently he was picked up by a family member at the airport. He drove in a private car. And when he started not feeling well, he called 911. Paramedics were able to come with proper masks. He's taken to the hospital. What happens at the hospital? an influenza-like illness or an ILI, you know, there's appropriate screening measures that are enacted. And that's basically, you know, have you been to China in the last two weeks, or do you have a potential contact with someone who might have this illness? And of course, in this case, this gentleman was in Wuhan, which is the epicenter of this epidemic. So if people have

that immediately, they're isolated, they have a mask placed on them, they're put into a special isolation room. Right. Negative pressure. A negative pressure room, yeah. Explain that to me. What is a negative pressure room? Oh, essentially, imagine if you open the door to a room, a lot of the air inside that room can come out. And what a negative pressure room is, is it basically has a vacuum in the ceiling of the roof and it just sucks all the air out through a vacuum and it's filtered. So if there are infectious particles floating around in the air, they will not come out of

the front door and possibly infect other people. They get filtered through this vacuum and they're neutralized so that they don't infect other people. I'm an infectious disease physician. I'm a general internist. I work at the Toronto General Hospital. I'll be walking into negative pressure rooms several times a day without this coronavirus outbreak happening. So these are, you know, common infrastructure within hospitals. Right. It's not like just this one room that exists in Sunnybrook.

That's good to know. I don't know why I thought that. No, but it's a great question because I don't think the general public would know what that means either. And it's just like we use these rooms all the time for lots of different infections. And so the medical attention that this man is getting right now, is he receiving any medicine that would make him feel better, that would help his symptoms? Right. So there actually is no real treatment for these coronaviruses.

And the medical care for people is really what we call supportive care. We ensure that they have the appropriate fluids and electrolyte balance. We treat fevers. But usually it's just waiting until their immune system really fights off this infection. There are some experimental treatments, and there is some, you know, emerging data that's current. There's some antivirals that we don't really use that much anymore may have some effectiveness. And I heard some grumblings of the start of some clinical trials in China to look at the utility of these for this infection. But really, as of now, we don't have an antiviral for this infection. I know now there is a test to test for this virus. Right now, it's a presumptive case in

Toronto because there's a local test, and then it has to go to this lab in Winnipeg. What is the Winnipeg lab doing? So there's two tests, right? There's the test that is going to be done at the provincial health lab, which is like, I mean, just to be clear, obviously my microbiology colleagues are going to rake me over the coals for this, but like in all fairness, if the test of the provincial health lab is positive, you've probably got a positive case. I mean, the provincial health lab testing is fantastic, but there are confirmatory tests that will be done at the national lab that is based in Winnipeg. The reason that we can test for this, am I right to say it's because China released the genetic sequencing of this virus?

Yes. Yes and no. So yes, in the sense that that genetic sequence is extremely helpful in developing diagnostic tests. But before that, there were other coronavirus diagnostic tests available for general coronaviruses and different types of coronaviruses as well, such as MERS, the Middle Eastern Respiratory Syndrome, and of course SARS. So I'm not entirely sure if they're using the sequence for the test that we have here, but I definitely know that that sequence has been helpful in developing diagnostic tests.

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. You know, I know that this is being fought on the front lines, obviously, in China at the epicenter and then where these cases are popping up all over the world. But this is also being fought, you know, it seems to me, in laboratories and boardrooms around the world, right? And what steps are labs going through to try and find some sort of antiviral or a vaccine? There has been a lot of research on this because of the prior SARS and MERS outbreaks, and there has already been some work looking into developing coronavirus vaccines.

You know, is this going to be available for this epidemic? Most certainly not. But certainly there is work on this front. And, you know, if anything, an outbreak like this will certainly raise the eyebrows of people who are in positions of who are the funders for these and say, you know, this is this should be a priority. To be fair, haven't officials been saying this for a very long time? Yeah. Yeah. I mean, funding is always a contentious issue because there's always limited funds and a million competing priorities. But I think now this will be a top priority. you think, if anything, individuals could be doing? So, for example, I took public transit on my way to work today and I saw people wearing masks. Is that helpful?

If you're in Toronto or Canada, currently there's no interventions, there's no reason to change your day-to-day behavior. I mean, we have one case at Sunnybrook Hospital that's getting the appropriate care. And authorities here at Sunnybrook saying that they are prepared to continue to handle this case. I think the general public needs to understand that again the risk remains low but the fact that we have identified this first case again is a marker of success of the system that we have in place and all the progress that we've made since SARS.

We have the appropriate public health response to this to ensure that there's no further transmission in the community. And if there is, that people are identified early. There's just no reason to change anyone's, to change one's behavior. Having said that, you know, this is clearly a very dynamic situation and there's a lot of fluidity and we see changes day by day. I think it would be helpful for the general public to be aware of what's going on in their community and pay attention because we might hear, you know, different updates from different public health authorities. But currently, I don't think there's any reason to change anything. Perfect, Dr. Isaac Bogosh. Thank you so much. Anytime. Some shocking news on Sunday.

Retired NBA superstar Kobe Bryant died in a helicopter crash in Calabasas, California. Eight other people died in the crash, including his 13-year-old daughter Gianna. Kobe's 20-year career with the Lakers was marked by five NBA championships. He is regarded as one of the greatest basketball players of all time. In a statement Sunday night Michael Jordan said that he was like a little brother to him and called him a fierce competitor and one of the greats of the game. Kobe also leaves behind a complicated legacy in the MeToo era. He was accused of sexual assault in 2003 but the criminal charges were dropped

after his accuser refused to testify in court. He was 41 years old. That's all for today. I'm Jamie Poisson. Thanks so much for listening to FrontBurner, and talk to you tomorrow. For more CBC Podcasts, go to cbc.ca slash podcasts.