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CANADA

Info about Canada

With 3.6 million square miles the largest country in land size in the western hemisphere, stretches 3,400 miles from east to west and extends from the North Pole to the US border. Population 32 million, density: 9 residents per square mile.

13 provinces (Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland & Labrador, Nova Scotia, Ontario, Prince Edward Island, Quebec, Saskatchewan, Northwest Territories, Yukon Territory, Nunavut)

Health

Life Expectancy in years: Male 76, female 83; Infant mortality per 1,000 live births: 5

www.canada.gc.ca

	Infection Control Guidance for Quarantine Officers at Canadian Airport - April 3, 2003

The Pattern B category means that the disease is spread among people who have had known contact with probable SARS cases.
Pattern C means that there are cases among people who were not previously identified as known contacts of SARS cases and who therefore raise new questions about whether the disease has been contained.

The classification is a technical device to help epidemiologists keep track of the virus.

Health officials in Toronto said today they may have found the link between the city's first and second SARS outbreaks. A nurse contracted the illness from her heart-patient mother at one hospital and passed it on to a man at another hospital where she worked.

The nurse's illness links Scarborough Grace Hospital where the Toronto outbreak began in early March and North York General Hospital where the second outbreak in May had been traced to a 96-year-old American man.

The U.S. Centers for Disease Control diagnosed the American with SARS on Monday, June 9 and placed him under quarantine with his family near Raleigh, N.C. In North Carolina two men who worked in the same building as the SARS patient came down with pneumonia, and one of them died today of heart failure and pneumonia. Both men tested negative for SARS and follow-up testing is being done.

WHO was concerned because nobody had previously been aware in Canada that the geriatric facility in question was linked to the SARS outbreak. Under new Canadian regulations, airlines would be required to distribute SARS information cards and questionnaires on incoming flights, a practice that is now voluntary, he said.

With 33 deaths and 238 cases, Canada is the hardest-hit country outside of Asia.

April 7:

Health Canada has received reports of 217 probable or suspect cases of SARS. There have been 9 deaths in Canada. All Canadian cases have occurred in persons who have traveled to Asia or had contact with SARS cases in the household or in a health-care setting. The largest outbreak has occurred in Ontario, where 87 probable and 92 suspect cases have been reported. British Columbia is reporting 3 probable and 23 suspect cases, New Brunswick is reporting 2 suspect cases, Saskatchewan is reporting 1 suspect case, Alberta is reporting 5 suspect cases, and Prince Edward Island is reporting 4 suspect cases.
These reports account for the 90 probable cases included in the WHO cumulative table of cases and deaths for today.

The couple's trip had originated in Beijing, China, on another plane, Air Canada flight AC030 with 148 passengers and 10 crew members aboard.

Although they were wearing protective face masks during the flight from Vancouver, they didn't tell anyone they were sick until the jet carrying 189 people had arrived in Calgary.

By that time, most of the other passengers had picked up their luggage and left. If SARS is confirmed, health officials will contact the passengers on both planes.

Crews sanitized the Calgary aircraft following the incident, using a standard
procedure when passengers have been ill.

Bill McComb, Calgary EMS spokesman
Ron Stir, Calgary Fire Department district chief
Veronica Scott, Calgary Health Region

April 2: Update from Toronto Pearson International Airport.

As of 0900 hours this day there are 151 cases in Canada up from 123 yesterday and 81 on Monday. The province of Ontario (read Toronto), has 56 probable and 68 suspected (124). All 6 Canadian deaths have occurred in Toronto, representing 12% of the worldwide deaths. Quarantines are around hospitals, clear and concise guidelines are being disseminated through a very proactive public health education campaign.
The Province's lead investigator/microbiologist, Dr. Don Low and his five team members are now under quarantine as well. The University of Toronto Medical School has postponed exams for third and fourth year clerks to prevent them from coming together in one location after being out at the city's hospitals for their clinical clerkships.

Those who have or are suspected are being treated aggressively through quarantine and the message to all others is that the risk is low.

A little bit of panic is arising from communities 100 miles north of the city. Again good public education is quelling those fears. General consensus is that further outbreaks will continue for a couple more days but that most under quarantine will not develop the syndrome. Attached the memo issued by the GTAA. It summarizes the info from Health Canada and The Ontario Provincial Commissioners of Public Health and Public Safety.

April 1: Greater Toronto Airport Authority Memorandum

March 31, Measures by Health Canada:

For incoming travelers currently on the ground at Vancouver and Pearson International Airports:

• Quarantine Officers meeting direct flights from Hong Kong, Singapore and Beijing and actively passing out Health Alert Notices to incoming passengers (yellow cards). These Health Alert Notices ask passengers to see a physician if they begin to have any symptoms related to SARS.
• Health Alert Notices with accompanying posters in all terminals for distribution to all other non-USA international flights.
• Active participation of Quarantine Officers on Airport Authority Emergency Protocols as required.
• Several thousand Health Alert Notices and Health Canada posters have been sent to terminals at the airports in Halifax, St John's, Montreal (Dorval and Mirabel), Ottawa, Toronto, Winnipeg, Edmonton, Calgary and Vancouver.
• As of the week of March 24, Health Canada has deployed personnel to Dorval International Airport (same roles and tasks as Vancouver and Pearson). Dorval does not receive direct flights from Hong Kong, Singapore and Beijing.

For departing domestic and international travelers (from Pearson International Airport)

• Effective April 1, 2003, Health Canada will launch an initiative to inform all departing travelers from Pearson International Airport about symptoms and contact with persons with SARS through the Health Alert Notice (cherry cards).
• The local airport authorities will place the Health Alert Notices and posters at strategic locations at Pearson International Airport, informing travelers who meet certain criteria to defer their flights. These criteria include: having SARS symptoms (fever, cough, shortness of breath and difficulty breathing); having been in contact with a SARS-affected person in the last 10 days; and, having visited a health facility that has been identified by public health officials as being affected by SARS.
• If passengers have symptoms, they are instructed to call their personal physician and when they see their physician, they are instructed to give them the Health Alert Notice and explain why they have deferred their travel.
• If passengers have visited a SARS-affected facility or have had contact with a SARS-affected patient, they are instructed to call their local health department.
• A Health Canada SARS Team of physicians and nurses will be deployed to Pearson to provide information to airline and airport staff. In very limited cases, this team will assist the individual traveler and, if necessary, arrange for the transportation of individuals to local medical facilities.
• Passengers seeking further information related to postponing their travel are advised to call the Health Canada SARS Info Line at 1-800-454-8302.
• Health Canada will be continually monitoring the situation on the ground at Pearson International Airport to evaluate the efficacy of the measures being implemented.

Health Canada is asking for the cooperation of local public health officials, the airline industry and the traveling public on this plan.

 

March 31, 2003

TORONTO, March 31: Canadian health officials reported 31 new cases of the SARS on Monday, March 31. The latest figures bring the number of probable and suspect cases of severe acute respiratory syndrome (SARS) to 129, one of the largest outside Asia.

Hospital access across Ontario, the country's most populous province, was restricted in bid to contain the outbreak. Ontario health officials said restrictive hospital measures put in place in Toronto, such as discouraging visitors and screening patients, would be extended to every hospital in the province or more than 11 million people. According to health officials the virus has been contained largely to medical staff and others who came into close contact with a handful of SARS victims who traveled from Hong Kong.

The death of a fourth Toronto-area patient over the weekend has prompted some residents of the country's largest city to don masks on the subway and avoid public places.

The Federal Health Minister told Parliament that Ottawa would step up the fight against SARS by sending health ministry staff to Toronto, Vancouver and Montreal airports to check on the health of some arriving passengers to help monitor passengers arriving on direct flights from Beijing, Hong Kong and Singapore for flu-like symptoms and to assist those who appear to be ill.

The passengers in question would be given "health alert notices" advising them to see a doctor if they fell ill.

Every incoming passenger identified as possibly having SARS had agreed to be isolated. If anyone with symptoms did not co-operate, Ottawa would, if necessary, invoke the Quarantine Act to ensure they were isolated.

The Canadian government has advised citizens to avoid traveling to China, Hong Kong, Singapore, Taiwan and the Vietnamese city of Hanoi.

Canadian health officials also said that starting April 1, airport authorities will place the health alert notices and posters in highly visible areas at Toronto's Pearson airport, informing departing passengers who meet certain criteria to defer their flights.

GLOBAL TOLL RISES

At least two more people died from the SARS virus in Hong Kong on Monday, taking the global death toll to 61. The virus has infected almost 1,700 worldwide.

Dr. Sheela Basrur, Toronto's medical officer of health.
Anne McLellan, Federal Health Minister

 March 28, 2003

·         How is SARS spread?

It is believed the illness is spread via droplets from coughing and sneezing, or from direct face-to-face contact with an ill person.

·         Who is being quarantined?

Anyone who visited Scarborough Grace Hospital in Toronto on or after March 16 and did not wear a protective mask. As well, individuals who have cared for, lived with or had direct contact with the body fluids of a person with SARS without wearing a protective mask are being quarantined, or asked to stay at home, for 10 days even if they have no symptoms. Other family members can continue with their normal routines.

·         What should people in quarantine do?

They should remain at home, with no visitors, for 10 days after their last exposure to SARS. They are advised to sleep in separate rooms and wear a mask when they are in the same room with another member of the household. The mask should be changed twice a day. They should not share personal items, such as towels, drinking cups or cutlery. Hands should be washed frequently. They should take their temperature twice a day. If anyone in the household develops fever or any of the other symptoms, public health authorities should be called.

·         Do family members of healthy people who are in isolation stay home too?

Family members of healthy people who are quarantined do not need to stay home because there is no risk they can transmit SARS. If the person in quarantine develops signs of SARS, the entire household will be quarantined.

·         What is being done to contain the spread of SARS?

Health authorities are monitoring the status of all probable, suspect and indeterminate cases. They are calling people who were exposed to others with SARS to monitor themselves for symptoms. They are supplying masks and thermometers to quarantined families. They have set up hotlines to provide information to the public.

·         What safeguards should travelers take?

Anyone who traveled to the affected places listed above should monitor themselves for symptoms for 10 days after returning. If they experience symptoms, they are asked to isolate themselves and call health authorities.

·         How to get further information?

As of 28 March 2003, Health Canada has received reports of 37 individuals who have become ill with SARS in Ontario, British Columbia and Manitoba. Three deaths have occurred due to SARS in Canada. All Canadian cases have occurred in persons who have traveled to Asia or had contact with SARS cases in the household or in a health-care setting.

• Ontario: 35 total cases
  To date, all cases have occurred in persons returning from Asia or having had contact with SARS cases in the household or in a health-care setting.
• British Columbia: total of 1 case
  The one person hospitalized with SARS was a traveler from Hong Kong.
• Manitoba: total of 1 case
  The one person hospitalized with SARS was a traveler from Beijing.

At this time, the cause of the illness remains unknown, however national and international laboratory testing and collaboration are ongoing.

No link has been established between cases of SARS in Canada and cases of H5N1 influenza in Hong Kong.

Recommendations

Due to the mounting concern about transmission of the SARS agent in non-hospital and community settings in the City of Hanoi, Vietnam; the People's Republic of China including the Hong Kong Special Administrative Region; Singapore and Taiwan, Health Canada recommends that persons planning to travel to these areas should defer all travel until further notice.

Also, Health Canada recommends alternate routing be considered, when possible, if a traveler is transiting through City of Hanoi, Vietnam; the People's Republic of China including the Hong Kong Special Administrative Region; Singapore or Taiwan.

Health Canada is aware that health authorities in these affected areas are making concerted efforts to contain the spread of SARS in their populations. Given the uncertainties of the current situation, Health Canada believes it is prudent to await the outcome of national and international control measures before undertaking travel to these destinations.

Travelers are advised that they will have to depend upon the local medical services in the countries where they reside or visit and are reminded that the health care services may be inadequate for the appropriate management of SARS. For example, Health Canada has been informed that adequate hospital care for a traveler who develops SARS in the City of Hanoi may not be available due to closure of the only adequate hospital in that City. In addition, medical evacuation of a patient with SARS may be very difficult. Canadian Missions may not be able to assist Canadians with SARS with medical transportation out of the region or back to Canada.

Persons who are traveling or have traveled to these areas should monitor their health for 10 days following their departure from these areas. Should a fever and one or more of the following respiratory symptoms - cough, shortness of breath or difficulty breathing - occur, Health Canada recommends that medical advice be sought as soon as possible. Ill persons should call ahead to their personal physician. Travelers should inform their personal physician when and where they traveled, and indicate whether there was contact with someone who had these symptoms.

Independent of the current international SARS outbreak, Health Canada routinely recommends that Canadian travelers seek an individual risk assessment consultation with their personal physician or a travel medicine clinic to determine their individual risks for illness.

Canadian travelers are reminded to practice good personal hygiene (e.g., good hand-washing practices) while traveling. Disease-causing micro-organisms can frequently be found on the hands. Hand-washing is the single most important procedure for preventing infections.

March 28, 2003

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