The Globe and Mail - 11.03.2020

WEDNESDAY, MARCH 11, 2020 | THEGLOBEANDMAIL O NEWS | A1 1

Doyouhaveanyofthesymptoms?

It can take up to 14 days for symptoms to appear after

you’ve been exposed to the virus. These symptoms in-

clude fever, cough, difficulty breathing and pneumonia

in both lungs, according to the Public Health Authority

of Canada website. It can be tricky for people to recog-

nize they are infected because the symptoms can re-

semble a cold or flu, and some individuals experience

little to no symptoms. To self-monitor, watch for any

symptoms of fever, coughing or difficulty breathing for

14 days after exposure and avoid public places, Ontario’s

Ministry of Health says. If you do develop symptoms,

isolate yourself immediately.

Wheredoyougoforhelp?

If you are experiencing symptoms, shy of a severe short-

ness of breath, call your local health authority, or your

health-care provider. (See below for health authority

phone numbers for each province.)

Be sure to call your family doctor, and let them know

you’re worried you may be infected, before you show up

at their office, Dr. Heilman says.

In Alberta, residents are advised to visit their doctor

as a last resort, says Stephanie Smith, director of infec-

tion prevention and control at the University of Alberta.

Instead, she says, they’re advised to call 811, the pro-

vincial health-link number. Those manning the phone

lines can go through your medical and travel history

with you, and determine the next step to take. They can

either direct you to a testing centre, recommend that

you be brought to the hospital in an ambulance if you’re

very ill or have emergency medical service providers

come test you in your home, Dr. Smith says.

Shouldyouonlyseekhelpifyou’ve

recentlytravelled?

Your risk of having COVID-19 is certainly lower if you

haven’t left the country than if you’ve recently travelled

to an affected area, Dr. Smith says. But don’t assume

you’re free of infection. In Alberta, she says, all testing

currently done to look for any respiratory pathogens

will also include testing for COVID-19.

In British Columbia, health providers are also screen-

ing for the disease among everyone who has flu-like

symptoms, Dr. Heilman says.

Whatifyouneedtobetested?

Some places are setting up special units specifically to

test people for COVID-19. This helps avoid having poten-

tially infected individuals come in contact with those

not infected.

I

f you think you may be infected with the new
coronavirus, isolate yourself quickly and call
your doctor or public-health authority, health
officials say.
As long as you’re not experiencing a severe
shortness of breath, don’t go to the hospital emer-
gency department because that could put other pa-
tients at risk, says James Heilman, an emergency
physician in Cranbrook, B.C. “If you come to the
emergency department, you come into a crowded
waiting room, that’s just a recipe for disaster,” he
says.
Here’s what to do instead:

It’s best not to show up at one of these centres with-

out making that initial phone call to your doctor or local

health authority first. You don’t want to be around po-

tentially infected individuals needlessly, Dr. Smith says.

The test itself involves having someone stick a little

cotton swab at the back of your throat and another

swab up your nose, Dr. Heilman says.

“It’s a little uncomfortable, but it’s a pretty simple

process,” he says, but the results can take days or weeks,

depending on courier times and the wait at the lab.

Whatdoyouneedtodoto

self-isolate?

Stay home, limit the number of visitors to your home,

stay in a separate room and away from others as much

as possible and use a separate bathroom if you have

one, Ontario’s Ministry of Health says. If you do have to

be in the same room as someone else, keep a distance of

two metres and wear a mask that covers your nose and

mouth, it says. Like everyone else, make sure you prac-

tice hand hygiene and cover your mouth and nose when

you sneeze.

Howdoyoucareforyourself?

There isn’t any specific treatment for COVID-19. As such,

Dr. Heilman says as long as they don’t need in-hospital

care, patients at his hospital would likely be isolated,

assessed and sent on their way.

“If your vital signs are reasonable ... we’ll just recom-

mend that you self-isolate at home,” he says.

Most people who become sick from coronaviruses

get better on their own, Ontario’s Ministry of Health

says. Drink plenty of fluids, rest and get as much sleep as

possible, and use a humidifier or take a hot shower to

soothe a sore throat or cough, Ontario’s Ministry of

Health advises.

Emergencynumberstocall

Here are the local numbers for public-health authorities

across Canada.

British Columbia: 811

Alberta: 811

Saskatchewan: 811

Manitoba: 1-888-315-

Ontario: 1-866-797-

Quebec: 811

New Brunswick: 811

Nova Scotia: 811

Prince Edward Island: 811

Newfoundland and Labrador: 811 or 1-888-709-

Nunavut: 867-975-

Northwest Territories: 911

Yukon: 811

WENCY LEUNG
HEALTHREPORTER

IthinkImightbe

infectedwiththe

newcoronavirus.

Whatarethenext

stepsIshouldtake?

Above left: A medical official with protective gear
takes the body temperature of passengers in a plane
as a preventive measure against the coronavirus at
the Boryspil International Airport near Kyiv on
Tuesday.

Above right: Medical staff clean a negative pressure
room inside North York General Hospital’s emergency
room on March 2, donning full personal protective
equipment for potential droplet contact.
ABOVE LEFT: GLEB GARANICH/REUTERS;
ABOVE RIGHT: TIJANA MARTIN/THE GLOBE AND MAIL

fected but not realize it – al-
though Dr. Colijn acknowledged
that such measures are among
the most disruptive to daily rou-
tines.
“It can feel like ‘Oh, that’s too
much’ before the problem, and
then after the problem it can feel
like ‘Oh, that wasn’t enough’ ”
she said.
An important caveat is that
the study, which is available on-
line, has been submitted for pub-
lication but has not yet under-
gone peer review. However, the
result is supported by at least
one report published last month
that documented the case of a
five-member family group in
China in which four of the family
members appear to have been
infected by another who showed
no symptoms of COVID-19.
The analysis conducted by Dr.
Colijn and her colleagues offers a
broader and more statistical look
at the question of asymptomatic
transmission. It is based on data
from 135 confirmed cases in Tian-
jin, China, and an additional 93
cases in Singapore. In both loca-
tions, the researchers drew on
details in case reports related to
contact history and the appear-
ance of symptoms. These were
used to mathematically deter-
mine two key numbers that are
important for predicting the
spread of an epidemic.
The first number is incubation
period: the time between con-

tracting the virus and the devel-

opment of symptoms.

In their analysis of the com-

bined data, the researchers

found that the average incuba-

tion period for COVID-19 falls be-

tween six and 10 days. (It can al-

so last longer in some cases,

which is why a 14-day quarantine

period has become standard

practice for those who may have

been exposed to the coronavi-

rus).

Their result is similar, al-

though slightly longer than an

average incubation period of five

days, which was calculated by a

team from Johns Hopkins Uni-

versity that published its result

on Monday.

Dr. Colijn and her colleagues

then determined a second num-

ber, know as the serial interval –

the average time it takes to com-

municate the virus from person

to person in a chain of infection.

This worked out to be about 4.

days, with about a day and half

of uncertainty on either side.

Although the two numbers

are close, with uncertainty rang-

es that slightly overlap depend-

ing on location, a key takeaway

from the study is that the serial

interval for COVID-19 appears to

be shorter than the incubation

period. Such a result would vir-

tually guarantee that the virus

can sometimes spread between

individuals before symptoms

show up.

While such a situation would

compound the challenge of con-

taining the virus, it also comes

with one small bit of good news,

Dr. Colijn said. If the virus can

spread asymptomatically it

means that it is probably some-

what less contagious than cur-

rent estimates suggest. Other-

wise, asymptomatic transmis-

sion would have already pro-

duced a higher case count and

more rapid spread of COVID-

than has been seen so far.

Justin Lessler, an epidemiolo-

gist and co-author of the Johns

Hopkins study, said that the fig-

ure that Dr. Colijn and her col-

leagues obtained for the serial in-

terval of COVID-19 “seems a little

short ... but not completely im-

plausible.”

He added that determining

with certainty if people who

show no symptoms can transmit

the virus is among the most im-

portant details that still need to

be understood about COVID-19.

This is not the first time re-

searchers have raised the possi-

bility of asymptomatic transmis-

sion. In late January, as the coro-

navirus epidemic was rapidly es-

calating in China, German

researchers concluded that four

cases of what is now known as

COVID-19 that appeared in the

Munich area had been caused by

contact with a Chinese colleague

who showed no signs of illness.

That study proved to be a red

herring. It later emerged that the

individual who had triggered the

mini-outbreak was already feel-

ing unwell while en route to Ger-

many.

Since then, the stealthy and

sometimes rapid progress of the

coronavirus beyond China’s bor-

ders has once again raised con-

cerns about the possibility of

asymptomatic transmission and

created an urgent need to pin

down the basic characteristics of

the developing epidemic.

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JOHNSOPINSKI/THE GLOBEANDMAIL, SOURCE: FONDAZIONEGIMBE

(VIAM.W.FONGETAL, CDC, EMERGINGINFECTIOUS DISEASES)

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WithmeasuPes

TheauthoPs ofastudy, publishedin EmePgingInfectious Diseases, conducted

asystematic Peviewoftheeffectiveness ofsix social-distancing measuPes

duPing pastflupandemics. They concludedthateaPly implementationdelayed

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systems by spPeading outthecases ovePalongeP pePiodoftime.

In their analysis of

the combined data,

the researchers

found that the

average incubation

period for COVID-

falls between

six and 10 days.