As Canada comes to grips with its first death from COVID-19, experts say it’s important not to give in to undue fear around the outbreak but instead to put the tragedy into context.
B.C. health officials confirmed Monday the patient, a man in his 80s with underlying health conditions, died Sunday night after becoming infected with the illness at the Lynn Valley Care Centre in North Vancouver.
While tragic for those close to the victim, the man’s death should not be used as a way to justify panic for the majority of Canadians who are not at risk of severe complications from COVID-19, experts say.
“More than 80 per cent of COVID-19 infections are estimated to be mild, meaning symptoms are manageable and not life-threatening, compared with 15 per cent that are severe and five per cent that are critical and require ventilation.
The percentage of people who die from the illness is currently estimated at upwards of 3.4 per cent, according to the World Health Organization, which is significantly higher than the seasonal flu at less than one per cent.
In patients aged 70 and up, that fatality rate increases to eight per cent, and for those above 80 years old, it rises to almost 15 per cent.
“The majority of people who get this infection have mild disease and recover,” said Dr. Jocelyn Srigley, a physician and clinical assistant professor with the department of pathology and lab medicine at the University of British Columbia.
“It’s not unexpected that we would see patients in those age groups dying of this disease and it’s similar with many other infections that with age your chance of dying from it goes up.”
Canadians need to understand that the vast majority of us are going to manage well if infected with the illness, with most not even requiring hospitalization, says infectious disease physician Dr. Isaac Bogoch at Toronto General Hospital.
“We know this COVID-19 infection can disproportionately make individuals who are elderly and individuals with chronic medical conditions more sick, but we also know that almost any infection or condition can make that population more ill as well,” he said.
“It’s not surprising, but it’s still sad, and I think people should be mindful that we can expect to see more cases like this — this is not going to be a unique case.”
First death still a wake-up call for Canadians
While many Canadians may feel uneasy about the first reported death from COVID-19 in the country, it unfortunately comes as no surprise to experts following the situation closely.
“I think that this was very, very expected,” said Dr. Michael Gardam, an infectious disease specialist and chief of staff at Humber River Hospital in Toronto.
“I think it just reinforces the fact that this virus is now very much on Canadian soil.”
Gardam, a veteran of SARS and H1N1 who is watching this outbreak closely, says while that panic is ill-advised, Canadians do need to be aware of what’s happening with COVID-19 worldwide.
“I think Canada has been living in a bubble the last two months thinking that this is something that’s happening elsewhere,” he said.
“We’re just at the beginning of now, this starting to really happen here. This isn’t the last death we’re going to hear about from this virus.”
Canada’s first COVID-19 death does not mean, however, that the illness is significantly widespread across the country, said Dr. Jerome Leis, medical director of infection prevention and control at Toronto’s Sunnybrook Hospital, who treated Canada’s first case of the illness.
“It’s not accurate to say that the virus is everywhere. Certainly, we’ve begun to see some communities spread in British Columbia. We still don’t have evidence of that here in Ontario and we’ve been looking and a number of other provinces are looking for community spread,” he said.
“But we do know that when community spread begins to increase, one of the consequences is that it can affect the most vulnerable people in our society and from that standpoint it was a matter of time until we would have the first deaths reported from this virus in Canada.”
Leis said when outbreaks of any respiratory viruses hit long-term care homes, there can be a disproportionately high risk of death, which is why health officials advocate so strongly for flu vaccines to spread immunity to the whole population.
“Unfortunately, this is a very vulnerable population,” he said. “The problem in this situation is we have no vaccine against COVID-19 — our whole population is susceptible. And so as it spreads in the community, it is certainly the most vulnerable patients that are at risk.”
Bogoch said it’s time to start considering implementing policies and behaviours that will mitigate the spread of the infection in the community. Visiting policies at long-term care homes should be examined closely, he added, especially given the outbreak in Washington state.
“Stay home if you’re sick. Even if you have the sniffles, a bit of a cold, your children are feeling a little bit under the weather — keep them home from school. Keep yourself home from work if you’re not feeling well,” B.C. chief medical officer of health Bonnie Henry said Monday.
“Even if you have no relationship to COVID-19, we want you to do that. We want you to clean your hands regularly, we want you to cough in your sleeve. Those are important issues all of us need to take right now.”
Henry referenced the concept of “social distancing” as a way of mitigating the effects on the most vulnerable populations in society. Social distancing will likely be rolled out in other provinces more formally if increased community transmission is seen outside of B.C.
“If people do limit their interaction and exposure with others, it does somewhat reduce the risk not just at an individual level, but at a population level as well,” Bogoch said, adding they were effective in limiting transmission in China and South Korea.
“So I think it’s time. I’m not sure to what extent these should be employed, but they certainly should be considered now.”
The next few months will be especially critical for preventing the spread of COVID-19 in long-term care facilities to protect the elderly, said Dr. Allison McGeer, an infectious diseases specialist at Toronto’s Mount Sinai Hospital who worked on the front lines of the SARS epidemic in 2003.
“So for any of us visiting those facilities, it’s a message about the critical importance of hand hygiene, of not visiting when you’re sick no matter what the circumstances are, of following the guidance from public health or from the nursing home,” she said.
“Because it’s really clear that as we have to deal with this outbreak, that long-term care facility residents are going to be one of the most vulnerable populations and it’s really important that we work together to try to protect them.
“They are a very different group of people than most of us in Canada and they badly need our protection during this outbreak.”