‘A sinking feeling’: Canadian experts on when coronavirus first felt like a serious risk

WATCH ABOVE: The World Health Organization has officially declared the COVID-19 outbreak a pandemic. What began as a handful of cases in Wuhan, China nearly two and a half months ago has evolved into a global outbreak, with the virus spreading to over 100 countries with over 100,000 cases and 4,000 deaths confirmed. But how many people could actually get infected by the novel coronavirus disease?

For many Canadian infectious disease experts, the first inkling of the new coronavirus came in a New Year’s Eve email from the Program for Monitoring Emerging Diseases.

The program, called ProMED for short, usually sends out multiple daily alerts, with updates on infections impacting humans, animals and agriculture.

The email blast in question had a line about pneumonia patients in Wuhan, China. There was, as Dr. Zain Chagla remembers it, “eerie references to SARS,” but also some suggestion that it might be Legionnaires — a severe type of pneumonia you can get from bacteria in water or soil.

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Even after it was clearly a coronavirus, Chagla says there was “initial fear but calm given this seemed localized.”

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We know now, it’s not.

Cases of COVID-19, the disease caused by the new coronavirus, have topped one million worldwide. For those who went from their normal routine to being isolated indoors within weeks, it might seem out of the blue.

It wasn’t for those in the field. Here are 14 Canadian experts on how they first heard about the new coronavirus and the moment they knew it was serious. Their answers have been edited and condensed.

Skip ahead to an expert:

Matthew Oughton, Infectious diseases doctor Jason Kindrachuk, Canada Research Chair in emerging viruses at the University of ManitobaSaverio Stranges, Epidemiology chair at Western UniversityZain Chagla, infectious diseases doctorClaire Cupples, Professor Emerita of molecular biology and biochemistry at Simon Fraser University Stephen Barr, Molecular virologist, professor at Western UniversityCraig Janes, Director of the School of Public Health and Health Systems at the University of WaterlooTom Koch, Medical geography professor at the University of British ColumbiaHoracio Bach, Manager of the Antibody Engineering and Proteomics Facility at the University of British ColumbiaIrene Pang, Assistant professor at Simon Fraser UniversityZahid Butt, Public health and health systems professor at the University of WaterlooSamantha Price, PhD Candidate in Anthropology at McMaster UniversityPriyanka Mishra, Postdoctoral Scientist at Simon Fraser UniversityCynthia Carr, EpidemiologistMatthew OughtonI was first made aware there was a cluster of severe pneumonia cases in Wuhan on Jan. 7, due to the extraordinary surveillance and reporting provided by the GeoSentinel Program, a worldwide network for collecting and communicating data on emerging infectious diseases operated by the International Society of Travel Medicine.Later in January, it became evident that this novel coronavirus infection had the potential for not only causing severe disease but also for sustainable transmission between humans, which were worrisome features.[readmore label="READ MORE: " link="" /]I cannot think of a stronger example than COVID-19 to underscore how important real-time syndromic surveillance and data gathering are, and why it is in the interests of developed countries everywhere to support public health and epidemiologic monitoring efforts around the world.[tp_video_miniplayer ids="6771885,6765308,6760087"]I also hope this teaches us the critical importance of a national strategy for manufacturing and distribution of essential equipment, including personal protective equipment and laboratory reagents, to enable our healthcare systems to accurately and rapidly diagnose disease, and to keep our front-line workers safe at all times.Jason KindrachukI was introduced to SARS-CoV-2, the virus that causes COVID-19, rather nonchalantly on New Year’s Eve 2019, when RTHK English News tweeted out a report of a potential SARS outbreak in Wuhan, China. This resulted in a Twitter thread between myself and Dr. Meghan May discussing our thoughts on whether this was indeed a re-emergence of SARS-CoV after 15 years of dormancy, H7N9 influenza or, possibly, a newly emerged virus.It is certainly hard to comprehend that my and Dr. May’s social media exchange occurred only three months ago as it certainly feels like a lifetime given the events of the past 12 weeks.Saw via primed last night as well. Description of cxr sounds SARSish but my only hesitation is that #sars (or #flu) seems like it would have been confirmed by now. Many rapid dx methods are available….— Meghan May (@DrMay5) December 31, 2019I spent three weeks in Nairobi, Kenya in the latter half of January and start of February leading a science outreach program focused on emerging viruses for students at the University of Nairobi. My recollection of my first concerns regarding this outbreak turning into a much larger epidemic or pandemic came when random people in Nairobi began to ask me questions or express their concerns regarding the “novel coronavirus” that they were hearing about in the local media.[readmore label="READ MORE: " link="" /]This would often occur with inquisitive drivers who thought I might have some insight during Uber rides to and from Kenyatta hospital at the university. My concerns were borne out of the vulnerability of many regions of Africa to infectious diseases such as COVID-19 and from my past experience in West Africa in 2014 during the Ebola virus disease epidemic.I did not appreciate at the time that in a very short period of time I would be concerned about our own vulnerabilities here in Canada to this virus.Saverio StrangesFor those of us doing research in public health and epidemiology, it was quite obvious at an early stage the potential global public health impacts of this virus in a highly interconnected world where people travel all over the place.We actually organized a forum here at Western University in early February to discuss the potential implications of COVID-19 in the western world. The take-home message was what’s happening in Huhan, Hubei province may be relevant to everywhere in the world including obviously London, Ontario, Canada.And then, the outbreak started in Italy, so I’ve been fully immersed in the situation for the last several weeks, mostly because I have family living in the Lombardy region.[readmore label="READ MORE: " link="" text="Triage and lies await Italy’s critical coronavirus patients" /]It was a struggle at first, within local communities, to take it seriously. I wouldn’t even blame (the average person for not taking it seriously) because not everyone understands epidemics or new viruses or the technical aspects of a pandemic.Even among physicians and some colleagues (in the field) there was a kind of underestimation of the potential impacts of COVID-19 at the very early stage. Someone could have thought that I was paranoid during that period because I was raising concerns.I think it’s a human feeling that people try to deny until they really see the signs and potential impact of what we are experiencing now.Zain ChaglaI first learned of something happening in Wuhan on New Year’s Eve. Many people in the field subscribe to a listserv called ProMed, which sends multiple daily updates on infections in humans, animals, and agriculture, and I usually skim through the subject line to see if there is anything of interest.They noted a cluster of pneumonia patients in Wuhan associated with the seafood, and made eerie references to SARS, but suggested it could be something [such] as Legionnaire’s, which made sense as it was associated with water and sprinklers.[tp_video id=6710955]Once this was identified as a coronavirus, there was an initial fear but calm given this seemed localized, and there have been many other small outbreaks in China that ended with quarantine and infection control.As things progressed, I think we all remained fairly calm that the global impact would be low, and most of the travel related disease would be focused in Southeast Asia and Australia.However, when the first community acquired case in the USA was discovered at the end of February, this was when the concern started kicking in.[readmore label="READ MORE: " link="" text="65% of reported COVID-19 cases in Canada related to community transmission" /]Some of the genetic data showed it was very similar to a case that had come to the USA weeks prior, and was very suggestive of spread through the communities.  Within a week of that we started seeing cases show up from the USA, which is a reflection of a very high burden, and because of the number of travellers we have going across the border, this was the time it became apparent this was going to come to Canada and spread.For now, people need to treat everyone else and themselves as infectious as it is spreading in our communities.We need to mobilize health care resources as well as our research capacity, in order to ensure patients have access to the best care and we understand what interventions can change this disease.Claire CupplesI first became aware of the virus about New Year’s when I read a minor article in the news about a small outbreak of pneumonia of unknown origin in Wuhan. This was just about the time that China first reported the information to the WHO.I was alarmed because a novel respiratory disease originating in China has always been one of the scenarios among microbiologists for a new pandemic — as indeed it has proven to be.[tp_video id=6774271]Of course, I expected it to be a false alarm since, at that time, there was no evidence for person-to-person transmission. Once this transmission was shown, it seemed likely to me that the estimated transmissibility of the virus would assure a pandemic in the short term, and continued annual cases in the long term.I suppose that is when, as a scientist, I started to worry, although I was reassured that the mortality rate was lower than for the related MERS and SARS viruses. That being said, I still went abroad for a holiday in early March — unfortunately for a much shorter period than we had planned — am now in isolation for 14 days as a consequence.[readmore label="READ MORE: " link="" /]Stephen BarrI first became aware of the new coronavirus back in late 2019 when media reports came out about a highly infectious virus circulating in Wuhan, China. As a molecular virologist studying HIV and other emerging viruses like Ebola virus, I always have my finger on the pulse of viral outbreaks and that specific report immediately caught my attention.Personally, I first started to worry about the impact of COVID-19 when I read about how China was trying to build a hospital in six days when the number of reported cases reached 10,000.[tp_video id=6499614]This was a sign to the world that local health services and hospitals were over-run and that this disease was not going to be easily contained. Viral outbreaks are unique and often unpredictable. Some outbreaks are contained and disappear as quickly as they emerge, whereas others like COVID-19 spread uncontrollably. This depends a lot on the properties of the virus itself and the response of local and global health authorities.Ideally, being able to quickly mobilize vast resources to contain every single outbreak that occurs around the world would go a long way in greatly reducing the risk of epidemics and pandemics. Currently, this is not feasible or sustainable without significant ongoing financial commitment from countries around the world.[readmore label="READ MORE: " link="" text="Flatten the curve — How one chart became a rallying cry against coronavirus" /]Moreover, and perhaps even more challenging, countries would have to know when to ask for help before it gets out of hand. I am hopeful that we will learn a lot from this current pandemic, its impact on health, the economy and our livelihood, and band together as a human race to put measures in place to stop pandemics like this from happening in the future. It is possible. We just need to want to do it bad enough.Craig JanesI first became aware of the new coronavirus in late December. I have been involved over the years with infectious disease researchers who are interested in the interrelationship of environmental change, social factors, and the emergence of zoonotic diseases (of which COVID is one), and have an academic interest in understanding the configuration of circumstances that lead to microbes jumping from one species to another and then mutating to become capable of human-to-human transmission.[readmore label="READ MORE: " link="" /]As a medical anthropologist, the main focus of this interest is in understanding the social factors that facilitate this. So, when it was first noted that a cluster of a novel pneumonia-like disease had emerged in Wuhan, and associated with a particular food market, I immediately paid attention.This is the kind of thing that my colleagues and I had been thinking might happen.Like many, I suppose, my interest was initially very academic, wanting to understand how the disease first emerged (or was first noted) in these market workers. My thoughts in December and January were that this might be like MERS or SARS and could hopefully be contained without widespread disruption to social and health systems.It was not until China declared an emergency and began extraordinary efforts to contain the virus that I began to be concerned about its global spread. And as an anthropologist who had worked in China, I was also intrigued with and impressed by the speed and ability of Chinese authorities to quarantine millions of people. This would have been in late January. Here at home I continued to be optimistic that COVID would not become a global pandemic.[tp_video id=6757452]My real worry and anxiety began on March 2, when I hosted a meeting of our external advisory board, many of whom are public health experts. They were certainly not yet in emergency mode, but the conversation, and the constantly chiming cell phones with urgent messages from home offices, made all of us aware that things were about to change. This change ramped up very rapidly the following week when WHO identified COVID-19 as a pandemic.Things happened very, very rapidly, and I think in retrospect (and hindsight is always 20-20 as they say) we moved a bit too slowly, both as an institution as well as a country. I am, however, gratified and heartened to see Canadian leadership, particularly in public health (which is often neglected until it is needed, it seems), step forward and make the right decisions.[readmore label="READ MORE: " link="" text="‘All it takes is one slip’ — Impassioned pleas from the coronavirus front lines" /]Messaging seems to be largely consistent, on point, and (mostly) apolitical. Public health scientists have taken center stage, which is — and let this not be forgotten — where they belong in matters such as this.Tom KochFor more than two years I have been lecturing to medical groups, and others, on The Next Pandemic. At the beginning I said it would be within 10 years but in the last iteration, Grand Rounds (formal physician meetings) for hospitals in Portland, Oregon, I had lowered it to eight years.More generally I’ve said the same thing at conferences on “disaster preparedness” where Americans were focused on bioterrorism, Fukushima, and earthquakes. So the arrival of SARS-Cov-2 was no surprise.[tp_video id=6614746]I saw early reports on an influenza-type disease when they were first reported to the WHO in late December or early January. Once the virus was identified in mid-January I was aware of it. As the Chinese epidemic expanded in mid-January and cruise ships became infected, I paid close attention.Since I expected a virus something like this I began worrying some years ago. And as our knowledge of this virus expanded, I watched carefully.All our expectations, from the start, were wrong.The virus is distinct in critical ways from its coronavirus cousins. Its rate of infection is greater than we assumed, it’s transmissibility broader but its mortality lower.Our medical systems are based on a business model that favours full capacity in the hospitals and a model of medical care that does not favour the specialists in infectious disease. ERs are not capacitated for epidemics like this.We learned a lot from SARS but the current epidemic is stretching resources in a thoroughly predictable way. We should not be surprised.We saw this before in the polio epidemic of 1951-1953.[readmore label="READ MORE: " link="" text="One will live, one will die — How Canada is preparing for tough coronavirus choices" /]Horacio BachAs a member of the Division of the Infectious Diseases, Faculty of Medicine, I learned at an early stage about the outbreak of the disease. As the disease spread quickly around the world, I was sure that I could help develop a therapy against the virus. Shortly after, the federal government, through the Canadian Institutes of Health Research, called for proposals to fight the disease from different angles and fields of expertise.[tp_video id=6765215]As a researcher working for more than 20 years in antibody engineering, I believe that my antibodies could be very useful for therapy. Antibodies are part of our body’s defense system against viruses and bacteria, and I proposed to create synthetic antibodies that could block the entrance of the virus into our body’s cells. My proposal was awarded, and we hope to have preliminary results in one to two months.Irene PangI first became aware of the Covid-19 outbreak around the second week of January, through reports surfacing in Hong Kong. At this point, mainland Chinese authorities were still pushing a narrative that the outbreak in Wuhan was under control. As someone who had lived through the SARS outbreak in Hong Kong, I was deeply skeptical about this narrative and official statistics coming out of mainland China.[readmore label="READ MORE: " link="" /]I was worried enough by mid-January to source and ship face masks to my parents, who still live in Hong Kong. In my capacity as a professor, I began sharing and analyzing Covid-19 data with my students in class starting the third week of January. I saw the need to prepare my students for what was to come.But for all of January until early March, I struggled to convince many around me – even those closest to me – that I was not simply freaking out irrationally.The public discussion on the Covid-19 outbreak in many parts of the world has been framed through an Orientalist discourse. That is, the experience of Asia has been questioned and challenged, and interpreted as an exception to North American and European norms.[tp_video id=6647401]This is made clear in the debate over face masks: the advice of public health experts in China, Hong Kong, and Taiwan – all having experienced SARS – advocating for wide-spread mask wearing is only slowly beginning to gain traction in North America and Europe because the outbreak is now no longer exceptionally Asian, but universal.The fact that certain bodies of (Asian) knowledge do not get recognized as useful and legitimate until it is articulated through the authoritative voices of North American or European experts is as unfair as it is costly.[readmore label="READ MORE: " link="" /]There were many valuable public health lessons learned very painfully through the SARS outbreak in Asia, and it is a mistake to have dismissed these lessons as inapplicable to North America or Europe, or to have relegated these to a category of “Asian hysteria”.Zahid ButtI had first heard about the new coronavirus in December 2019. I started worrying about the virus in February 2020 when it became clear that there was an international spread of the virus.I would think the key take home message would be to strictly practice physical distancing. Another thing to consider is that elderly, people with diabetes, cardiovascular disease, chronic respiratory disease, hypertension, and cancer are at an increased risk of death if they get infected from coronavirus. Therefore, extra precautions/care is necessary to prevent coronavirus transmission in these populations.[readmore label="READ MORE: " link="" /]Samantha PriceI first became aware of the new coronavirus from some of the early news reports after it had been reported to the WHO.I first started to worry about the impact of COVID-19 when the number of cases began to increase and the larger discussions to avoid travel to China were happening near the Lunar New Year.[readmore label="READ MORE: " link="" /]That holiday has great cultural significance to Chinese people and is a time to gather with family and I was afraid that the warnings coming out around that time would result in blaming the virus and it’s spread on China.It’s very important to remember that this is not a Chinese disease, this is a worldwide problem that can affect anyone.Priyanka MishraI first heard about coronavirus at the start of January when my colleagues from China told me about the lockdown happening there. I started following the news on TV and reading more about this virus.I first started to worry about the impact of COVID-19 because of how quickly it spread within a short time, overwhelming communities. The most dangerous aspect of this virus is the spread without symptoms.[tp_video id=6763656]The fact that so many new infections are showing up suddenly means the real number of infections is many times higher due to a lack of symptoms.A quarantine is, so far, one of the most effective weapons we have to stop the spread of the epidemic as we have not yet developed a vaccine.Cynthia CarrAs an epidemiologist, my ear is always responsive to words such as “outbreak”, “epidemic” so the news coverage caught my attention early — but, to be totally honest, in the beginning it was mostly in the context of “when will China get this under control?”I am an epidemiologist with years of experience but I am also human, and at the beginning I did not foresee the scale of public health emergency it has become.The personal experience and impact hit my heart in mid-March right at the beginning of the social distancing directives. I happened to be in Ottawa for a meeting and everything downtown was empty. I had never seen anything like it.  I walked into a restaurant and was one of three tables in the middle of a weekday. I saw a waitress crying and asked her if she was ok. She said she was a university student and had only been at work an hour and was being told to go home. She makes $12 an hour and counts on tips. That day she didn’t even make enough money to cover her transportation to and from work.I felt a sinking feeling in my stomach as the extent of the economic impact to come was right in front of me. I wondered how many students, parents, hard-working people would be hit hard financially, how we all would handle the stress and what we can do to help each other get through it.[readmore label="READ MORE: " link="" text="Your coronavirus questions answered" /]Although things are tough, I am more proud than ever of our public health system and the planning that clearly occurred prior to this pandemic. No pandemic plan can be prepared within a week or few months, and clearly cannot occur during the height of the emergency.This is why we invest in public health and why the messages about smoking cessation, seasonal flu shots, infant immunization schedules and taking care of ourselves matter. We need to be as healthy as possible as community members and a health system to be able to react when an unanticipated event like this occurs.


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