It was Jan. 23, 2020, when a 56-year-old man, who had just arrived back in the Toronto area from Wuhan, China, became Canada’s first case of COVID-19 — though the illness wasn’t yet called that, and it would take the medical team a few days to confirm it was indeed a case of the disease caused by the novel coronavirus.
“I remember receiving the call. … My immediate reaction was, I want to see the chest X-ray,” recalled Dr. Jerome Leis, medical director of infection prevention and control at Sunnybrook Health Sciences Centre.
“We got the chest X-ray and I looked at it. And certainly, at that point in time onward, we were very suspicious that that is what we were dealing with.”
Dr. Leis had been following the news out of Wuhan, China, since December 2019.
“As soon as it was determined that it was a novel coronavirus and it was spreading, we added that region to our areas, our countries of concern. … We worked with our emergency teams to make sure that the screening was in place,” he said.
Dr. Leis explained, in January 2020, the laboratory was still completing “validation of the test” for COVID-19 and had yet to confirm the virus in any individual.
“And so that was a lot of work on their end to scramble, to some extent, to be able to come up with a reliable answer about whether (the patient) did or didn’t have the infection,” he said.
Ultimately, the answer would come two days after the patient presented with COVID-19 symptoms, and the 56-year-old man became Patient One, the country’s first confirmed case of the virus.
The medical team cared for the patient, who was placed in an isolation room, and remained in hospital for only a week before he was well enough to be discharged home to continue his recovery.
“We didn’t really know much about … the spectrum of severity. … We had reports that suggested that these patients could develop respiratory failure and this particular first case had pneumonia,” he explained, adding, “We were concerned about that possibility and yet that never really developed in this case.”
Those first few days with that very first patient would “pave the way” for how the hospital would manage COVID-19 patients during the first wave, Dr. Leis said.
Early on, he noted that many patients with COVID-19 would only have mild symptoms and could be managed and supported in the community, with virtual visits from medical staff.
Patient One’s wife also became ill with COVID-19 but was able to self-isolate at home.
“We’re in a pandemic … because it has continued to spread through the community very widely among people who have mild to no symptoms at all,” he explained, adding, “We’ve been able to learn from this first case onward that the best overall strategy is to keep most people at home and manage them in their home environment.”
Sunnybrook has seen cared for more than 4,000 COVID-19 patients.
Registered nurse Kathryn Rego still remembers the hospital’s first case, and can hardly believe a full year has passed.
“When I came to work, there was just sort of talk — there’s a patient who may or may not have coronavirus. We’re not really sure. We’re just kind of waiting. We don’t know how long we’re going to wait to find out and just kind of waiting,” she recalled.
Up until that moment, for Rego, this was an outbreak happening a world away, not here in Canada.
“It wasn’t until we actually found out the person was positive that you kind of went, ‘Oh!’ and the fear of the unknown really set in. … What does this mean? how does this affect us?” she said.
Rego said there were protocols already in place so not much changed at first for the frontline healthcare workers, but there was a sense of concern among them.
“It was just, sort of, how do we keep ourselves safe and make sure we don’t take this home? because we don’t know what it is, because we don’t know what may or may not happen,” she recalled.
A year later, that worry remains for Rego, a mother of two.
“There’s just always that fear in the back of your mind that you have come into contact, or you will come into contact with someone. And did you put on the mask? Did you put on the shield right? Is there a risk that I’m taking this home to my family, to my parents, to anyone? It’s just always there,” she said.
Both Rego and Dr. Leis said Patient One was cooperative and wanted to help the healthcare team.
“The patient was very willing to work with us and very accommodating. … The patient would step back if we were doing something that didn’t need to be directly in contact with him,” Rego said.
Despite the concern of what this mysterious virus could do, and how it could be transmitted in those early days, Rego felt comforted knowing the hospital had protocols for staff to follow.
Dr. Leis credits the team at Sunnybrook and Toronto Public Health.
“The system really worked very well. And I think that speaks to how prepared we were for the possibility of an epidemic. We have protocols in place that had been built really since SARS One and were refined and put into practice multiple times over the last nearly 20 years,” he said.
Overall, as Dr. Leis reflected back on that very first case, he recalled, “Our experience around this first case was actually very positive and it really helped to build confidence that those systems work.”
He acknowledged, however, since then much has changed, including the sheer burden of the number of cases relative. to those early days. “That’s of course presented additional complexities that, of course, our hospital and frankly, the health care system at large, have not faced until COVID-19.”