Inside quarantine: from SARS in Toronto to coronavirus in Wuhan

As we brace for a possible global pandemic of COVID-19, individuals are left wondering what this means and how it will affect their lives. Should we cancel travel plans?  Should we send our kids to school? Do we need to stock up on food and medication? Is everyone over-reacting?

Wuhan Hubei China

Canadians experienced an H1N1 flu pandemic in 2009, but COVID-19 has a higher mortality rate, no vaccine, and no treatment. As we try to prepare for what’s to come, both health officials and the public can learn from what people are living through in Wuhan, China, where the COVID-19 virus first emerged, and can also look back on Canada’s own experience during the 2003 SARS outbreak.

Mr. Y is a 56-year-old retired chemist who lives with his wife in a gated community in Wuhan. The Chinese government placed extensive domestic bans on media coverage of the novel coronavirus.

Healthy Debate spoke to Mr. Y on the condition that his voice not be recorded and his identity remain anonymous, as he is concerned about repercussions from government officials.

Mr. Y’s comments reflect his impression of the outbreak trajectory from inside Wuhan, but we are unable to independently verify some of his comments. Please read with discretion.

Mr. Y describes the grim circumstances of the neighbourhood where he has been quarantined for over a month. All grocery stores are still closed, citizens are constantly monitored by security guards, and strict quarantine regulations control the daily activities of community members.

At one point, at least 150 million people in China were living under government restrictions on how often they could leave their homes.

Mr. Y tells us the central government in China allocated approximately 10 per cent of all Chinese health care officials — roughly 30,000 doctors and nurses — to Wuhan care facilities. He says at the height of the outbreak, doctors and nurses were working 15 to 18 hour shifts and treating hundreds of patients every hour.

In early January, Chinese officials built 16 specialized hospitals in Wuhan in a matter of weeks to treat infected patients. Officials recently closed one of the first of the hospitals to open after the last patients were discharged.

This is because, according to the World Health Organization, the number of cases in China are decreasing. But globally, public health workers are still attempting to control transmission and scientists are trying to develop vaccines, as 79 countries have reported COVID-19 cases, bringing the global total to over 95,000 with almost 3,300 deaths.

Mr. Y says many people in Wuhan are still incredibly fearful of getting infected, especially people like him, who are not in great health.

“I can leave my home, but I don’t want to leave…this is very distressing and gives us a lot of pressure with daily life,” he says.

“I have friends who have gotten the virus, I feel so sorry for them. They die by suffocation, they drown in their own lungs. There are still new cases every day despite all these measures. There are people who are in good health and won’t exhibit any symptoms despite being infected, so you don’t know who to hide from out there.”

The Chinese government has developed an app which allows citizens to order food and have it delivered to the front office of their neighbourhood. If other necessities, such as medication, are required, people may leave their homes, but under strict regulations, according to Mr. Y.

“The rumours you heard are true,” he says.

“There are officers at the exit who can grant you permission to leave. They check your temperature every time you leave or return to your community. They want to know the details of where you go and set a time limit for when you must return. If you are caught outside without permission or not wearing a mask, you will be punished.”

Chinese officials visited Wuhan in mid-January and declared there was no evidence of human-to-human transmission of COVID-19. As we now know, this was inaccurate, and genomic sequencing of the virus shows it had likely been circulating undetected since November.

“They missed the opportunity to take aggressive measures during the most early, vital stage. The result of this was once the outbreak hit, our system was completely overwhelmed. No one was prepared for what happened. None of the hospitals could handle this many people and there were massive bed shortages,” Mr. Y says.

Despite the delayed start from the Chinese government, Mr. Y says things are finally starting to improve.

“Through all of this, we have really come to appreciate all the doctors and nurses. While all of us can hide at home, they must continue to work on the front lines.”

Government officials in Wuhan are responsible for managing the outbreak, from medical supply distribution to quarantine protocols. The military stepped in on operations, which Mr. Y sees as as a good thing. There have even been factories in Wuhan funded by the government to produce their own masks to prevent risk of shortages.

Mr. Y recalls seeing videos on social media about a politician who disobeyed his quarantine instructions, who was then stripped of his political ranking, and another individual who left home after being diagnosed to purchase something, and was then arrested by police.

“The stricter the better, because it is safer for us. I feel we are much more in control than we were in January,” he says.

Mr. Y will remain in self-imposed quarantine until the outbreak in Wuhan is under control, and says he will only leave home if he runs out of food or medication.

To Canadians, China is quite literally a world away. While stories of city lockdowns and travel bans command our attention, it’s hard to imagine a pandemic can affect our communities in the same way.

But some are feeling a sense of déjà vu. Toronto was an epicentre of the SARS outbreak back in 2003 with 438 cases resulting in 44 deaths. Health care workers made up 43 per cent of Canadian SARS cases.

Toronto, Canada – Sunnybrook hospital sign at entrance.

Dr. Andreas Laupacis has spent most of his career as a general internist at various hospitals throughout the Greater Toronto Area. In 2003, he was working at Sunnybrook hospital in Toronto where physicians were caring for patients in designated wards, and recalls how he ended up becoming a SARS patient himself.

After attending an NHL game in Ottawa, Laupacis and his wife and children were driving home when he felt increasingly unwell. A voicemail on his machine when he arrived home in Toronto informed him that a colleague of his had been admitted to hospital with SARS.

Laupacis was never severely ill, but quarantined himself at home and sent his family away for nearly two weeks while he was monitored via phone by infectious disease experts.

He recalls his children asking if he was going to die, colleagues and friends leaving take-out food on his back porch, and a small teddy bear a friend gifted him that he still has to this day.

The doctor monitoring Laupacis from afar became infected and quarantined and was unable to continue working, and his new doctor was previously infected with SARS and had just been released from quarantine to work on other cases.

“That was a ‘holy’ moment, realizing how much we were on the knife edge of this whole thing,” he says.

“I never thought as I went to bed every night that I was going to die. But it was a scary thing to see the number of people who were dying from this that were pretty young, and that differentiated it from influenza where it’s often the older population…it made a difference seeing it hit younger folks.”

Before his quarantine, Laupacis says he remembers attending a world-class theatre production in Toronto, expecting to see a nearly sold-out performance.

“The place was empty, there were maybe 10 other people in the audience. I don’t see that happening right now. [SARS] really affected the city and the way people reacted and socialized. We are way more aware and prepared about this particular situation, but we never really know what it will be like,” he says.

Laupacis says the SARS outbreak completely transformed public communication protocols within health care.

“It sounds really strange to say, but something that was great that came from SARS was the brilliant Dr. Donald Low and Dr. Sheela Basrur,” he says.

Now both deceased, Low, chief microbiologist at Mount Sinai Hospital, and Basrur, Toronto’s chief medical officer of health, held daily press conferences with updates about SARS.

“Every single day they would get up and have a press conference, and were totally honest and open to the public and media. They told people the facts and didn’t try to diminish anxiety,” he says.

Dr. Allison McGeer, an infectious diseases physician, who helped develop Canada’s Pandemic Preparedness plans after SARS, said an important lesson health care providers learned was how to cope with uncertainty and normalize change to the public.

“When officials begin changing instructions on how to do things, there’s a sense that people don’t know what is happening, or that things haven’t been done properly, which can be unnerving for everyone,” she says.

“The important message to understand about outbreaks with new pathogens is that you learn about those new pathogens every day. When you learn things about them, you can change and do better, or stop doing things you don’t need to do. That shouldn’t be seen as a problem…uncertainty happens and it’s normal.”

In addition to our past experience, Canada has tools like digital and telehealth, pandemic preparedness protocols and better infection control procedures in place.

With universal health care and the option for many citizens to take paid sick leave, Canada may be the perfect country to watch to see whether COVID-19 can be contained or not. So far, all Canadian cases are linked to travel and none have resulted in death.

But despite extensive preparation, the reality of a possible pandemic is bracing for the unknown – an unfortunate and inevitable part of the experience.

 

With files from Serina Dai and Seema Marwaha