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Medisina at Politika by Dr. Rey Pagtakhan  

COVID-19 pandemic: Canada & around the world

by Dr. Rey Pagtakhan

World Health Organization (WHO) Director-General Dr. Tedros announced on March 11 that the outbreak of the coronavirus disease of 2019 (COVID-19) is officially a global pandemic. It is both a public health and a socio-economic global crisis.

Affecting over 100,000 patients and causing over 4000 deaths in 100 days, its geographic spread has reached all regions of the U.N. health agency, six continents and 114 countries. Indeed, COVID-19 is very contagious and rapidly transmissible from patient-to-patient, and has exacted a heavy toll on human lives.

Canadians and people around the world are all in this together. We shall all hope for both a curative drug and a preventive vaccine. In their absence, we shall all affirm to slow the spread of the disease and to mitigate its impact on life and living.

Understanding pandemics

Historically, COVID-19 is the world’s sixth pandemic and the first one to involve a member of the coronavirus family. Scientifically, there is no precise set of criteria that defines the title of “pandemic.” The SARS epidemic, caused by a different coronavirus, was not considered a pandemic.

There are three characteristics that COVID-19 has met:

1. Human-to-human spread occurs in at least two countries in one of the WHO’s six health regions;

2. Community-level outbreaks occur in at least one other country in a different WHO region; and

3. Waves of infection-activity are spread over months.

With COVID-19, the WHO made the declaration because of “the alarming levels of spread and severity, and the alarming levels of inaction” by some countries. The organization also pointed to the 13-fold increase in patients and the 25-fold rise in deaths outside China, and the three-fold increase in countries affected.

As of this writing, (March 14, 2020) COVID-19 has sickened over 156,000 patients and claimed 5,821 lives, and counting, since it started barely three months ago in early December 2019.

Magnitude before the pandemic declaration

During the two-week period before the official announcement, there were over 40,000 new patients and over 1,800 new deaths added worldwide. That translates to about 3,000 new patients and 130 lives lost per day. Italy and Iran were increasingly affected with Italy reporting many more deaths.

The United States showed over 1,000-fold rise to 1,280 new patients. The clusters likely reflect the nation’s slow rollout of testing, despite more requests from symptomatic patients. Therefore, many more Americans are already infected.

The Philippines showed a significant 50-fold increase in new patients, but their absolute number of 52 was also low. Each test costs 5,000 to 8,000 pesos (US$99 to US$160) and may explain the small number of cases diagnosed. The actual burden of the disease is likely underestimated.

Canada experienced a 150-fold increase in new patients during the two-week period, distributed as follows: British Columbia, 53; Alberta, 23; Saskatchewan, 0 (+ 1 probable); Manitoba, 1 (+ 2 probable); Ontario, 60; Quebec, 13; New Brunswick, 1; and repatriated 1. The absolute number of 152 reflects a releatively low risk for Canadians since Canada has been doing substantial testing nationwide.

Clinical warning signs & high-risk groups

The early symptoms and signs of the disease to watch for include a feeling of being unwell – fever, sore throat, headache and shortness of breath. A history of contact, particularly if close, to a known patient is important to report to your doctor. When presenting with any of these early manifestations and history of exposure, call first (do not visit without notice) your family doctor for health advice on what to do and where to go for evaluation, testing and treatment.

At highest risk of being ill when exposed to the infection and being critically ill requiring intensive care are seniors 70 years old and over and those with existing heart and/or lung disease. They and their families should pay attention to the basics of everyday life and living. This said, most patients – about 80% – do recover.

Incubation period & spread of virus

On average, it takes five days after exposure to develop the symptoms and signs, rarely more than 12 days, and almost always before the end of the 14th day. This is what is called the incubation period and it is the basis for the 14-day quarantine period.

Realize, however, that the incubation period relates to symptoms caused by, not to the transmissibility of, the virus. It is probable that people may be able to transmit before symptoms appear and without feeling ill.

A controllable pandemic

“In the days and weeks ahead, we expect to see the number of cases, the number of deaths, and the number of affected countries climb even higher,” the WHO has stated. At the same time, the Director-General conveyed a sense of measured optimism: “This is a controllable pandemic,” and he shared the following two key observations in support of his determination:

1. There are still 77 countries and territories with no reported cases, and 55 that have reported 10 cases or fewer; and

2. More than 90 per cent of cases are in just four countries, and two of those – China and South Korea – have seen significantly declining epidemics. These countries could make containment the central pillar of their response, even as the focus shifts to mitigation – to slow the spread and impact of the virus on communities in Canada, the US and around the world where it is already spreading. The choice ought not to be containment or mitigation, but applying the appropriate balance between the two approaches.

Canada’s response

On the day the WHO made the announcement, Prime Minister Justin Trudeau announced Canada’s response to the disease “by establishing a more than $1 billion COVID-19 response fund.” He reiterated this message yesterday when he briefed the media from his home, where he and his wife, Mrs. Sophie Gregoire Trudeau, are self-quarantined following the infection of his wife. The fund is to assure “new investments to limit the spread of the virus in Canada and prepare for its possible broader impacts,” he said. A week earlier, the prime minister struck a new cabinet committee, chaired by Deputy Prime Minister Chrystia Freeland, to co-ordinate Canada’s response.

Back to the basics & everyday life

In the absence of an anti-viral drug or vaccine, respiratory hygiene is the best preventive action against COVID-19. This includes frequent hand washing with soap and water (not merely rinsing) for at least 20 seconds (the length of one “Happy Birthday”) and drying with a single-use towel. Washing with hand sanitizers is also a substitute. Cough etiquette must also be observed.

Avoid handshakes, hugs or kisses; avoid touching the eyes, nose and mouth; and regularly disinfect surfaces at homes. Avoid non-essential travel and cruise ships. Everyone over 70 and those with compromised immune systems or underlying heart or lung disease should, in particular, practice social distancing. That is avoiding crowds and community parties to reduce close contact.

Canadians from all walks of life can help slow the epidemic – “flatten the peak curve” as they say – by diligently exercising basic personal and community preventive measures. This can help to prevent new clusters of patients and ensure those needing care are provided for by our health care system.

A Canadian research breakthrough

“A group of Canadian scientists has successfully isolated and grown copies of the novel coronavirus responsible for the COVID-19 pandemic, paving the way for a potential vaccine,” reported Nicole Bogart of CTV News on March 13. The team members are research scientists from Sunnybrook Hospital, McMaster University and the University of Toronto. They used samples taken from two Canadian COVID-19 patients.

“We need key tools to develop solutions to this pandemic before the outbreak peaks in Canada,” said Dr. Samira Mubarek. While the immediate response is crucial, longer-term solutions come from essential research into this novel virus. It is anticipated the research breakthrough “will help researchers in Canada and across the world develop better diagnostic testing, treatments and vaccines, and gain a better understanding” of the COVID-19 virus, including how it is shed and transmitted.

Hon. Dr. Rey D. Pagtakhan, P.C, O.M., LL.D., Sc.D., M.D., M.Sc., is a retired lung specialist and professor of pediatrics and child health from the Children’s Hospital of Winnipeg and the University of Manitoba Faculty of Medicine. As Canada’s former Secretary of State for Science, Research and Development, he made a presentation on “The Global Threat of Infectious Diseases” at the G-8 Countries’ Science Ministers and Advisors Group Meeting held on June 13-15, 2003 in Berlin, Germany.

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