Canada

An epidemic of epidemics

SHEILA GORMELY September 6 1976
Canada

An epidemic of epidemics

SHEILA GORMELY September 6 1976

An epidemic of epidemics

ONTARIO

The chart for Olga Kamckey, a 56-year-old St. Catharines, Ontario, woman who was suspected to be Canada’s first victim of a deadly virus disease called Lassa fever, now carries the instruction: “Treat as a regular patient.” She was treated as anything but a regular patient during the two weeks after she flew into Toronto from a European holiday on August 2 and fell suddenly and critically ill. She set off the scare of an epidemic after Canadian and American medical scientists eliminated all

the likely causes of her disease and diagnosed her as having a case of Lassa. An unprecedented health protection move resulted in the first closing of an Ontario hospital, Etobicoke General, and a fiveday round-the-clock search for about 400 fellow British Airways passengers who might have been infected.

The scare is over—Mrs. Kamckey is in satisfactory condition and her disease is not infectious. But she still is considered to have suffered Lassa fever at some point. In the aftermath, decisions will be made that will increase protection against infectious diseases for all Canadians. The case of Olga Kamckey served to drive home the point that even a medically advanced country like Canada can be vulnerable.

In the last four months, an alarm about infectious diseases has been raised six times—suddenly there is Lassa fever, the Legionnaires’ disease, swine flu, St. Louis encephalitis, polio and diphtheria. In a mobile world population, no country can consider itself immune. A country can take steps to control infectious diseases in the

domestic population by immunization programs, water purification and constant vigilance over the food service industry. Because of the Kamckey case, Ontario and Ottawa will initiate two further measures against widespread infection. Health Minister Marc Lalonde will be asked to order international travelers arriving in Canada to fill out disembarkation cards telling where they have been and giving their home addresses. This will enable authorities to track down infected contacts in the event of an outbreak. The Ontario government will speed up plans for an emergency isolation unit with no fewer than 10 beds. As it stands now, all hospitals in Metro Toronto are able to isolate at least one room for the more common infectious illnesses but only the newer hospitals, such as Etobicoke General, have separate ventilation systems crucial to the control of toxic airborne diseases. Since Toronto International Airport is a major transfer point for travelers, an isolation unit would not benefit just the residents of Toronto and Ontario.

These two possible benefits of the Lassa fever scare await the political process, but the immediate result has been an increase in public awareness of infectious diseases and the need for everyone to be immunized on a regular basis. Frequent travelers know about regulations for smallpox and other vaccinations before setting out for exotic destinations, but not many adults realize that they should be immunized or receive a booster shot every five years for tetanus and polio. “There is a lack of awareness and a sense of complacency,” says Toronto epidemiologist Dr. J. Stewart Bell. “We now have parents who haven’t heard of diphtheria and young parents who don’t remember when polio was a serious problem. Doctors, generally, have a low index of suspicion when it comes to contagious diseases, and these diseases are very under-reported.”

Dr. Andrew Rhodes, an internationally recognized virologist who, as medical director of the laboratory services branch of the Ontario health ministry, is one of the medical detectives on the currently cold trail of the nature and cause of Olga Kamckey’s mysterious disease, said there always have been and always will be serious outbreaks of contagious diseases. Last year, five Ontario residents died from St. Louis encephalitis which had never appeared before in Canada. Two confirmed but recovering, victims have been identified so far this year. Dr. Barbara Blake, director of the community health protection branch for the Ontario health ministry, acknowledges that, while the St. Louis strain has been around in the southern United States since the 1930s and could be anticipated, “I don’t like to see a new virus take hold here.” In the Canadian St. Louis cases, the disease was carried by birds who were bitten by mosquitos who, in turn, infected people. Just as you can’t stop birds and insects, she says, it would be wrong to start clamping down on immigration because immigration controls have always been careful about health screening. “The whole thing is rapid travel,” she said. “Look at the number of flights we have in a 24-hour period. It’s staggering and some or all of the passengers could be breeding something. We’re vulnerable because of this.”

Dr. Bruce Dull, assistant director of the Centre for Disease Control in Atlanta, Georgia, which is the only one in North America capable of diagnosing Lassa fever, has been involved not only with the case of Olga Kamckey but also with the Philadelphia Legionnaires’ disease which, so far, has killed 28 persons and infected 177. Says Dr. Dull: “There has been a developing pattern over the years. We have had a cluster of events but they are not unexpected.” Even the Legionnaires’ disease.

In the mid-1960s, he said, there was an outbreak in a Washington hospital of 100 cases of pneumonia which killed about 18 | people. It was a situation similar to LeS gionnaires’ disease and, as in Philadel-

phia, the reason was never discovered.

Toronto successfully met its first fullscale emergency exercise dealing with a potentially dangerous ánd spreadable disease, but there is a price tag. The eight-day closure of Etobicoke General, with the accompanying loss of patients and the continuance of staff salaries, could cost as much as $500,000. No one has yet estimated the loss of income to the 36 doctors whose offices—on the top floor of the hospital—were closed and to surgeons whose scheduled operations were canceled. Whatever the price, it stands as minuscule when compared with the cost in human lives had a deadly disease been allowed to spread.

SHEILA GORMELY