Translation Google
Bird flu in a teenage girl: emails reveal "a widespread reaction"
Melinda Trochu
Published yesterday at 7:44 AM CST
On November 9, 2024, British Columbia announced the first presumptive case of H5 avian influenza contracted in Canada by a human . Media outlets worldwide quickly took notice, given the disease's pandemic potential .
With fatalities potentially reaching 50%, particularly among younger people, no country wants to be the epicenter of human-to-human transmission and a new pandemic.
British Columbia's chief medical officer of health, Bonnie Henry, remembers those early days, when there was inevitably a lot of concern .
We had prepared ourselves for the possibility of transmission to humans, particularly to people working on poultry farms. However, it was quite unusual to learn that it involved a young woman who, to our knowledge, did not live on a poultry farm.
A quote fromBonnie Henry, Chief Medical Officer of Health for British Columbia
Upon the arrival of a positive result from a flu screening test, excluding the usual H3 and H1, a process is triggered to inform people very quickly .
[It's] a general reaction. Absolutely.
A quote from Bonnie Henry, Chief Medical Officer of Health for British Columbia
Radio-Canada obtained, through an access to information request, 278 pages of emails from the provincial Ministry of Health. These reflect the coordination of the first few days, particularly while awaiting confirmation from the National Microbiology Laboratory in Winnipeg, which would be announced several days later .
Six days in the community
Although in the first few weeks the media only had access to certain information, we now know that the teenager infected in the Fraser Valley developed symptoms on November 2, went to Surrey Memorial Hospital on the 4th , was sent home, then returned there on November 7 in respiratory distress .
On November 8, she was transferred to a pediatric intensive care unit at BC Children's Hospital. A test that day revealed the presence of the H5 virus.
She has just spent six days in the community without a diagnosis, carrying a virus monitored globally for its pandemic potential.
Friday, November 8: All hands on deck in the evening
That same evening, the medical director of preventive clinical services at the British Columbia Centre for Disease Control sent a highly important email to arrange a conference call. The goal was to inform key individuals on that Friday evening, on the eve of a long weekend.
Several people are absent, so we may not have everyone available.
A quote from Email request for access to information
Another email mentions: It would appear that this is the first case in Canada.
That evening, doctors set about developing a plan, including what to tell the family regarding isolation and contacting the Chief Veterinarian's Office .
Public health officials will contact the family [Saturday] morning to determine who their contacts have been and who they should contact.
At 11:15 p.m., an email states that the Fraser Health Authority will contact the family's contacts, that nasopharyngeal swabs should be preferred, and that prophylaxis should be offered.
We will also follow up with [redacted part]; potential occupational exposure and exposure to other patients during admission and previous visits to the emergency department.
A quote from Email request for access to information
Information contained in the emails has not been made public due to, among other things, the risk of damaging disclosure:
to the application of the law;
to intergovernmental relations or negotiations;
to the financial or economic interests of a public body;
to individual or public safety;
to privacy.
Saturday, November 9: The media have been notified.
The following day, at 8:58 a.m., communications officials from the Pan-Canadian Public Health Network and Health Canada were alerted by British Columbia. A public health advisory was expected to be issued later, although details were still being finalized and numerous partners were involved .
Your case will be the first human-acquired case in Canada.
A quote from Email from the Director of the Public Affairs and Communications Branch, Health Canada
In the early afternoon, Health Canada advised British Columbia, after discussions with the Winnipeg Laboratory, to report that this was a confirmed case of H5 based on the test.PCR but that there will be a more in-depth analysis of a sample to be sent to Manitoba.
In Victoria, prior to the release of the press release, there was a debate about whether to mention the Fraser Health Authority , a choice that ultimately fell to the Chief Medical Officer of Health, Bonnie Henry .
The standard practice is to name the relevant authority to alleviate concerns from other parts of British Columbia . In this particular case, it was agreed not to go into too much detail given the concerns expressed by parents .
Minutes before the release of the press release, which finally does mention the Fraser region , the communications director of Bonnie Henry 's office is already anticipating media interest: "And then, my phone is not going to stop ringing
."
While Dr. Henry thought the media might take some time to react given that most media outlets don't have many staff working weekends , reporters were already requesting interviews as early as Saturday afternoon.
Sunday, November 10: The Special Access Program
On Sunday morning, we learned that contacts in the community are being monitored and have been offered prophylactic measures.
A problem with access to a medication seems to be emerging. Part of a sentence is not public, but it reads: always delayed due to problems related to SAP [sic] and where one can access the medication .
SAP refers to the Special Access Program (SAP) which allows health professionals to access drugs and medical devices that are not yet commercially available for sale in Canada.
It is reported that the BC Children's Hospital is in contact with the CDC American, then further on: We are working to get SAP [sic] from Health Canada to Roche.
In the afternoon, a reporter requests an interview about advice to give to worried parents who have been or are still at the Children's Hospital. Another wants to address the concerns of parents in the Fraser region as their children prepare to return to school the following Tuesday.
The director of media relations for the Provincial Health Services Authority (PHSA) then wrote: It is important, I think, to inform people of the security measures in place (as usual) and to remind them that it is always safe to go to the hospital.
We also learn that a problem accessing Tamiflu has been resolved for some contact cases and that recourse to the provincial reserve was not necessary.
However, a problem related to the fax machine was mentioned in the evening.
There are connection problems with the pharmacy: a prescription by fax is required. Can a verbal order be accepted?
A quote from Email request for access to information
At that time, 26 contact cases were mentioned, half of which had not yet been contacted .
Monday, November 11: a public holiday that's anything but restful
On Monday, one of the difficulties arising from the emails concerned the sample that was to be sent to the Winnipeg Laboratory to confirm the British Columbia test.
It was supposed to be sent on an Air Canada flight departing Vancouver at 8:10 a.m. and arriving in Winnipeg at 12:58 p.m. However, the sample did not make it onto that plane. It finally arrived at the Winnipeg laboratory on Tuesday at 9:00 a.m. on a Cargojet flight .
In the afternoon, there appeared to be communication problems between the different levels of government. British Columbia then requested that the federal government receive a copy of the comments from any other federal agency commenting on the matter, in order to ensure consistency in communications .
"Health Canada's statement surprised us somewhat."
Early in the evening, while awaiting results from Winnipeg, the director of communications for the Office of the Provincial Medical Officer of Health explained to a CNN reporter that it was a presumptive positive case of H5 .
In the evening, contact tracing became one of the problems.
Ongoing issue: notification and support of occupationally exposed individuals. Contact is difficult; the team is continuing its efforts.
A quote from Email request for access to information
At Surrey Hospital , approximately 18 people are affected. At the Children's Hospital, it's around 26. The team hopes to complete the contact tracing on Tuesday.
The source of the contamination is still unknown, but several teams are ready to contribute their resources if needed. At 4 p.m., it was understood that the interview with the family had concluded and that a site visit was being arranged.
Tuesday, November 12: a highly anticipated press conference
On Tuesday, as children returned to schools in the Fraser region , the head of provincial digital solutions for the PHSA questions whether the case and contact tracing system or the Panorama system needs to be adjusted .
Panorama is an integrated electronic public health record system. It is used in British Columbia by public health professionals to support the management of communicable diseases, outbreaks, immunizations, and vaccine stockpiles.
[There have been] some modifications to the CST Cerner software, given that this child's case is being treated at the Children's Hospital.
CST Cerner software is an electronic health record system.
Before the press conference, Dr. Bonnie Henry and Dr. Elizabeth Brodkin agreed to add to the advice for schools that visits to educational farms [...] should not be part of school activities at present .
At 11:30 a.m., Dr. Bonnie Henry held a press conference attended by international media outlets such as CNN , the Associated Press , and the Washington Post .
The main messages to be conveyed, which can be read in the emails, should allow for preparation for questions about Canada's pandemic preparedness and whether there is an emphasis on obtaining details about the patient .
At 3:52 p.m., a letter was sent to the superintendents. The only sentence in bold was: No cases of exposure have been identified in any school.
On the morning of November 13, more than 40 media requests were received. During the night, the Winnipeg Laboratory confirmed the contamination.H5N1.
Source unknown
To date, the source of the contamination remains unknown. No other people have been infected.
The teenager was no longer contagious from November 29th and no longer needed respiratory assistance from December 18th. She survived, but she nevertheless spent two months in the hospital .
I am really happy that she received such good care and survived, but it has been a very traumatic time for her family , says Dr. Bonnie Henry .
The public health officer assures that British Columbia detected this rare event , thanks in particular to the PCRMultiplex, a test that allows screening for 5 respiratory diseases.
She also congratulated the province for being able to sequence the entire genome of this virus and determine its relationship , which provided a relief by showing that the virus was actually much closer to certain wild birds .
The system we have put in place to monitor people with respiratory illnesses, particularly if their condition is serious enough that they seek medical help, is working.
However, even if this story has a happy ending, Dr. Bonnie Henry knows there will be another virus . In public health, she says, a balance must be struck so that people can go about their daily lives , while also emphasizing the importance of prevention and vaccination.
We have big events coming up, such as the FIFA World Cup next summer, and we need to make sure we are able to detect any potential problems.
A quote from Bonnie Henry, Chief Medical Officer of Health for British Columbia
According to data from the WHO from December 19th (new window)mortality due toH5N1over the past four years has amounted to 16.28%. These rates may reflect both the nature of the report [...] and the actual severity of the illness .
Even if the case fatality rate fluctuates, a pandemic of H5N1would wreak havoc, hence the vital importance of rapid detection of cases and mutations.
Nearly a century ago, the H1N1 pandemic, one of the deadliest in history, had a mortality rate of around 2% .
https://ici.radio-canada.ca/info/lo...cente-echanges-ministere-sante-grippe-aviaire
