Amid recent concerns that avian influenza could enter the lower United States via birds traveling from the North, just what is neighboring Canada doing to prevent and prepare for a possible outbreak?
Canadian officials are tracking and testing migratory birds to find out if any are infected with the deadly strain of the avian influenza virus that's been spreading across Asia and into Europe. In October, fears were raised when ducks were identified to have influenza but preliminary tests indicated the strain was non-deadly.
Canada also has been preparing for years for the possibility of a flu pandemic in people, such as one that could occur if the deadly H5N1 virus hit North America and mutated into a form that's easily transmissible among humans.
Some scientists say it could only be a matter of time before the killer virus comes to American soil. One theoretical possibility is that infected migratory birds could travel to Siberia, and then cross the Bering Strait to Alaska and Canada and then the lower 48 states.
Vigilance is essential
British Columbia’s chief veterinary officer, Ron Lewis, said the sampling of migratory birds that found non-lethal strains of bird flu in 33 wild ducks in Quebec and Manitoba is essential if health officials are to understand what avian viruses are out there and which ones are potential threats.
While American and Canadian scientists launched a migratory bird study in Alaska last summer, and American officials hope to expand their efforts to the lower 48 states, Canadian officials are already sampling birds in six of its 10 provinces. Lewis said this bird virus database will keep them ahead of the curve.
It’s “standard operating procedure” to inform the U.S. Department of Agriculture and other American agencies any time a potentially harmful virus is found, Lewis said, but the U.S. plan is centered on reacting to an outbreak rather than a widespread program of monitoring bird health before a pandemic begins.
Indeed, when the non-deadly form of bird flu was found in Canada, officials at the Canadian Food Inspection Agency notified their counterparts at the U.S. Department of Agriculture before announcing their discovery to the public.
While the U.S. government unveiled pandemic plans just this week, Canada has been preparing for a potential outbreak for a decade. Canada’s federal, provincial, territorial and local governments have all completed or are near completion of pandemic plans for contingencies from vaccinating the homeless to surging hospital lines and mass casualties.
Canada’s largest city, Toronto, bore most of the human and economic toll from the outbreak of the SARS virus in 2003 when 44 people died and the city lost billions of dollars in cancelled conventions, tourism and other reduced activity.
Lessons from SARS
“We learned a lot of lessons from SARS,” explained Dr. Barbara Yaffe, the city’s associate medical officer of health, and “lesson No. 1 was: no matter how prepared you are, it’s not enough. You have to keep working on it.”
In contrast, Yaffe said, the U.S. plan shifts a big burden of payment and organization to local authorities and most of them haven’t even begun to prepare.
Canada’s pandemic plan is based on two main principles — taking care of the ill and containing the disease, and maintaining security. As a result, the national plan calls for vaccines and treatment to go first to health care and essential workers such as police, fire fighters and transit operators.
Some Canadian businesses already have plans in place to deal with a soaring absentee rate, and pandemic planners are warning others to not make things worse by forcing sick workers to come in.
Canadian plans include consistent messaging on how to “keep their families as healthy as possible” (wash your hands!) and where to get help if they need it (plans for mass vaccination sites and hospital triage programs are in the works), Yaffe said.
There are plans for multi-language communications, when to close schools and day care centers, and how to assist health care workers, hospitals and businesses.
While Canada’s system of universal public health insurance means people will likely get help — and free vaccines — rather than wait if they can’t afford treatment, governments that finance the provincial and territorial health care systems know a pandemic could mean a surge in demand of unprecedented proportions.
The world’s worst flu pandemic, the Spanish flu of 1918-19, killed up to 50 million people, including more than 500,000 Americans and 60,000 Canadians. But even modeling on the less severe “Hong Kong flu” pandemic of 1968-69, the U.S. Centers for Disease Control and Prevention have estimated a human outbreak of the current avian flu could kill more than 200,000 Americans and cost the U.S. economy between $71 and $166 billion.
Dr. David Butler-Jones, Canada’s chief public health officer, said Canada is working closely with its U.S. counterparts at the CDC, and that in the event of an outbreak the two countries would coordinate their efforts to control the spread.
While some fear a severe pandemic could force the closure of the U.S.-Canada border, Butler-Jones said this is unlikely, unnecessary (since flu victims do not show symptoms immediately and therefore could be contagious without knowing it) and would add to confusion and panic.
Hopefully, all this preparedness won't be necessary. Dr. Michael Gardam, director of infection prevention and control for Toronto's University Health Network, said while it’s impossible to full contain the avian flu if the virus mutates to a human contagion, “there’s no guarantee it will.”
But as with all emergency planning, he added, “you have to plan for the worst and hope for the best.”