Ebola: Is Canada Ready?

Ebola has killed nearly a thousand people in West Africa, and health care workers around the world are on high alert. This past weekend there were concerns the disease had arrived in Canada. A man in Ontario was hospitalized with flu-like symptoms after returning from Nigeria but has  reportedly tested negative..  I give my take on how ready Canada is to face Ebola and other deadly infections.

As expected, the Ontario patient tested negative for the virus. In general, it's unlikely that we'll see many cases of Ebola here in Canada. There are no direct flights from West African countries affected by the outbreak such as Liberia and Sierra Leone that could carry people with Ebola to Canada. Still, with an incubation period of up to 21 days, we need to be vigilant. A case or two could just show up here. The other factor that makes it unlikely to wind up here is that Ebola is not spread by casual contact with an infected person. You need direct contact with bodily fluids to get infected. That's what puts health care workers at much higher risk.  

The likely scenario is that a Canadian health care worker gets infected in the hot zone and is airlifted back to Canada. I can't imagine an infected health care worker arriving in Canada unannounced.

Were that to happen, I am very encouraged by the quick response of doctors at Brampton Civic Hospital. The man had been in Nigeria, which is now one of the countries home to the Ebola outbreak in Africa. After returning home, he developed a fever and flu-like symptoms and went to the ER at Brampton Civic Hospital. He was placed in isolation and admitted to hospital, where he was tested for Ebola and other infectious diseases. 

Likewise, earlier this year, a man returned to Saskatchewan from Liberia near the start of the outbreak. At the time, he had no symptoms and was permitted to enter the country. Several days later, he got a fever and went to the ER, where he was isolated and tested for Ebola. Authorities interviewed his contacts for symptoms. The World Health Organization was notified. The man tested negative for Ebola, and none of his contacts became ill. Once again, the hospital and authorities handled him appropriately.

In other words, in both instances, the system of vigilance and prompt action worked perfectly. It wasn't always that way. As an ER doctor, I was on the front lines during the SARS outbreak more than ten years ago. Severe Acute Respiratory Syndrome or SARS was a wake up call for authorities and for the people who run hospitals. The outbreak in Canada began in part because patients weren't isolated so they were able to spread the disease.  

The hospital I work at and many others learned from that experience by building additional hospital rooms that isolate the patient from others at risk of being infected. As well, the public health computer system for tracking cases was upgraded.  

But the biggest factor was not technology. It was getting front line health care workers and Canadian Border Services agents to be more vigilant about asking travellers who arrive from infection hot spots if they have a fever and, if so, taking immediate steps to contain the infection by advising the patient to seek medical care and by preventing the patient from infecting others.

 

This week, the World Health Organization convened an ethics panel to explore the use of an experimental treatments for Ebola - at least one of which was developed with Canadian help. 

One treatment that has been in the news is a serum made up of monoclonal antibodies derived from mice exposed to Ebola DNA .You may have heard that two American aid workers who were airlifted to the U.S. are receiving the treatment. 

The accelerated use of experimental treatment creates an ethical quandary.  The fact that the two Americans being treated are doing well does not mean the treatment is working. A lot more research is needed before its approved for patients with Ebola. Should we unleash untested and unproven treatments on patients with life threatening infections?  With Ebola and its 90 percent death rate, the answer is probably yes. But I might not think so were the infection to carry a death rate of 10-20 percent.  

The  other reason why the WHO convened the ethics panel is to address concerns regarding access to experimental therapies. While the treatment was given to the two American missionaries, it seems unlikely that people who live in the hot zones of West Africa will have the same access.

Ebola is not the only emerging infection worth keeping an eye on. Another one that I've been watching the most is Middle East Respiratory Syndrome (or MERS) - the virus that comes from the same family as SARS. The outbreak has centred in Saudi Arabia, which has reported 721 confirmed cases and 298 deaths. There were fears that there would be huge outbreaks during the annual pilgrimage to Mecca during Ramadan; only 10 new cases were reported during that time. I think MERS may be on its way to disappearing - just as SARS did. I think we need to keep an eye on the H5N1 or bird flu virus. And you never know when we'll have another pandemic strain of influenza.

Vigilance is the watchword.

Dr. Brian Goldman is an ER physician and host of White Coat, Black Art, which returns with new episodes this fall.  His latest book The Secret Language of Doctors is published by HarperCollins Canada.