Unfortunately, little attention is being paid by the media to the most important infectious epidemic that WILL affect us in Canada – the seasonal flu! Based on data from the last decade, I feel confident to predict that in the next year, more Canadians will die of influenza in one day than will ever contract Ebola in Canada.
First, some basic facts about Ebola virus infection. Its mortality rate truly is horrific, between 50 and 80%. There is no current antibiotic that treats Ebola. Survival occurs with successful management of the severe dehydration that comes from the severe vomiting, diarrhea and uncontrolled bleeding that characterizes its infectious stage. Patients often have liver, kidney and blood clotting failure, all of which may require very specialized medical treatment.
Unlike the SARS virus, which was airborne (spread by coughing and sneezing), the Ebola virus is not airborne but is spread by direct contact with the body fluids that come from vomiting, diarrhea and bleeding. And make no mistake about the severity of these symptoms – they are very severe with Ebola, making it virtually impossible to avoid infection for those in West Africa who have to care for loved ones or patients without the benefit of superior protective gear. And as was seen in Dallas, even with the best PPE, small errors in the use of the gear can result in Ebola spreading. As a physician who was trained to wear PPE during SARS, I can tell you that the gear is very hot, very uncomfortable and very prone to seemingly insignificant mistakes, especially when the suits and masks are removed after touching a patient. The slightest brush of the back of a sleeve against your profusely sweating brow would allow the Ebola virus to spread. Even the Centers for Disease Control apologized to the nursing community when it reported the “breach of protocol” that caused patient Duncan's nurses to become infected as an error that could have been easily avoided. It is not so easy to deal with the protective clothing and masks. That is why a “buddy system” has been implemented with a checklist to assist with the use of PPE.
Will airport screening be our savior? Regrettably, a great deal of money will be spent on this effort, but to little avail. The fundamental assumption about such screening is that the person being screened will be truthful. As was illustrated by patient Duncan in Dallas, this will not always be the case. Travellers will have a strong bias toward getting to their destination, whether it for business or for personal reasons. Either by lack of knowledge or by a flagrant disregard for the importance of the screening questions, they may not tell the truth.
So which Estonian-Canadians, living here in Canada, should be worried about Ebola infection? (If you choose to travel to West Africa and interact with those dying from Ebola, with or without protective gear, you should be worried.) It is possible that Canadian humanitarian workers may contract Ebola while in West Africa and return to Canada to be treated. If one of those workers is a friend or colleague, you will likely be restricted from visiting until the infection has cleared. If you are a Canadian front-line health care professional, such as a paramedic, emergency room staff or family physician, you may deal with a potential Ebola patient who has slipped through screening, but even then, at the “influenza-like” stage (which includes fever, sore throat, fatigue, muscle and joint pain), the chances of personally contracting Ebola are virtually zero unless you have direct contact with the body fluids mentioned earlier.
In summary, we can pray for the victims of Ebola, but our own actions here in Canada should focus on the flu shot in the next few weeks. The influenza virus poses a very real threat to ourselves, our family, friends and co-workers, especially those who have weakened immune systems and the elderly who we visit at home and in nursing and retirement homes. Thousands will die in the next few months in Canada of influenza. Let us hope that Estonian Canadians do not contribute to that sad statistic.
Peeter Põldre MD, EdD, FRCPC
Professor, Faculty of Medicine, University of Toronto
Staff Hematologist and retired Vice President Medical Affairs, Sunnybrook Hospital.
