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SARS FAQ's (Canadian Government)
Q. What is
severe acute respiratory syndrome (SARS)?
A. SARS is an
infection in which affected individuals develop a fever, followed by
respiratory symptoms such as cough, shortness of breath or difficulty
breathing. In some cases, the respiratory symptoms become increasingly severe,
and people require oxygen support and mechanical ventilation. Other symptoms
of SARS include muscle aches, headaches, and sore throat.
Currently, the
cause of SARS is unknown, and no specific agents have been identified.
Q. How is SARS
diagnosed?
A. In the
absence of a laboratory test, doctors are using the following criteria to
diagnose SARS:
-
people who
have recently travelled to affected countries in Asia or who have had close
contact with persons diagnosed with SARS; and
-
who develop
a fever (over 38.0 degrees Celsius); and
-
have one or
more of the following respiratory symptoms: cough, shortness of breath or
difficulty breathing.
Q. How is SARS
treated?
A. The cause of
SARS is currently unknown, so doctors are presently treating patients'
symptoms. With supportive care, several hospitalised individuals with SARS in
Canada are recovering and some have been discharged.
Q. Does the
drug Ribavirin cure SARS?
A. Health
Canada's Special Access Programme (SAP) provides access to drugs that are not
approved for sale in Canada for patients suffering from serious and
life-threatening conditions when other marketed therapies have either failed
or are unsuitable.
SAP is currently
providing access to intravenous and oral Ribavirin for use in SARS. These
products are not approved for sale in Canada. The efficacy of Ribavirin in
treating SARS is unknown, although it has been used to treat a variety of
viral illnesses including Respiratory Syncytial virus, Lassa fever, and Hanta
virus.
SAP is working
closely with health care professionals at each of the hospitals involved to
gather information on the use of Ribavirin for SARS, and potential adverse
effects.
Q. Which
countries have reported cases of SARS?
A. Please
consult the following link to the World Health Organization's web site for
current figures:
http://www.who.int/csr/don/en/
Q. What is the
difference between a "suspect" and a "probable" case?
A. A "suspect"
case of SARS is a person who fits into one of the following two categories:
-
a person who
develops fever and one or more respiratory symptoms, including cough,
shortness of breath or difficulty breathing, within 10 days of returning
from travel to areas in Asia where SARS cases are being reported; or
-
a person who
develops fever and one or more respiratory symptoms, including cough,
shortness of breath or difficulty breathing, within 10 days of having had
close contact with a "probable" case of SARS.
"Probable" cases
of SARS are similar to suspect cases, but often they have a more severe
illness, with progressive shortness of breath and difficulty breathing, and in
some cases, chest x-rays show signs of atypical pneumonia.
Q. Who is at
risk of developing SARS?
A. At this time,
the only risk factors identified are recent travel to affected countries in
Asia, or close contact with a person who has SARS. Close contact includes
living in the same household, providing health care to someone with SARS, or
having direct contact with respiratory secretions and body fluids of a person
with SARS.
Q Is there
anything that can be done to help prevent the spread of SARS?
A. Practising
good personal hygiene is a key to stopping the spread of this disease.
Thorough hand-washing - using hot, soapy water and lathering for at least 20
seconds - is the single most important procedure for preventing infections.
This is because disease-causing micro-organisms can frequently be found on the
hands.
Q. Are the
Canadian cases linked to the outbreak in Asia?
A. Yes. The
first cases of SARS identified in Canada are people who had travelled to Hong
Kong. Subsequent cases have been in their close contacts and travellers to
Asia.
Q. Is this
disease spreading through or being spread by the Asian community only?
A. While
identifying the cause of the disease has been difficult, time has shown that
its spread is not limited to any one geographic region, nor is it linked to a
particular ethnic group. SARS can be contracted and passed on by any
individual, regardless of their cultural identity or background. The only
requirement to becoming infected is by direct, close contact with a SARS
affected individual.
Q. Are the
people who travelled through Toronto and Vancouver airports at risk?
A. It is
unlikely that someone who has not had close contact with someone with SARS
will develop it. Being in the Toronto or Vancouver airports is not considered
to be an at risk activity. Measures have been put in place to identify
travellers with symptoms of SARS or travellers at risk of developing SARS.
Q. What should
I do if I develop symptoms of SARS?
A. If you have
recently travelled to Asia or have had close contact with someone who has
SARS, and develop symptoms within 10 days, you should call ahead to your
physician or your local public health unit/department. They can provide
information about the appropriate Emergency Department or established SARS
Centre you should visit for medical assessment. The symptoms for SARS are the
following:
-
a fever of
more than 38 degrees Celsius; and
-
a cough,
shortness of breath or difficulty breathing.
Q. What do we
know about the cause of SARS?
A. The National
Microbiology Laboratory (NML) in Winnipeg continues to do extensive research
into the cause of SARS. In many of the specimens from Canadian cases, there is
evidence of a previously unrecognized form of coronavirus. There is also some
evidence of human metapneumovirus. Although the cause of SARS is not certain,
there is a strong indication that it is linked to the coronavirus, with the
possibility that other factors also contribute.
Q. What can you
tell us about coronavirus?
A. Normally,
coronaviruses cause mild to moderate upper-respiratory illness such as the
common cold. When viewed under a microscope, the coronavirus has a halo or
crown-like appearance. Coronaviruses can also be found in animals.
Q. What can you
tell us about metapneumovirus?
A.
Metapneumovirus is part of the paramyxovirus family. Viruses in the paramyxo
family can be responsible for mumps, measles, pneumonia and the common cold.
The metapneumovirus was only recently identified in humans and has been proven
to be very common. It causes respiratory symptoms that are not usually as
severe as those evidenced in the current outbreak.
Q. What are the
next steps?
A. Research at
the NML is ongoing into the cause of SARS. In addition, researchers are
working on the development of an antibody test. This test detects whether the
patient has developed an antibody to SARS. The presence of this antibody could
indicate whether or not the patient has contracted SARS. It is not known,
however, whether this will be suitable for a screening test. Research is also
ongoing to determine the stage of the illness at which the antibody is
developed in the body.
Q. Is NML
working with other international labs?
A. Under the
direction of the World Health Organization, the NML continues to work in
collaboration with a network of laboratories from around the world. With the
hope that this collaboration will contribute to a more speedy determination of
the cause and more effective treatment of SARS, information is shared via
regular conference calls as well as a secure website.
Q. How close
are you to finding the cause of SARS?
A. It's
difficult to say how close we are to finding the cause. We feel we're on the
right track and that these findings will help pinpoint what we should be
focussing on, but it's impossible to say when we may have more answers.
Q Should
members of the general public wear a mask as protection against SARS?
A. At this
present time, masks are not recommended for use by the general public.
The only
exception would be under special circumstances, whereby a person has come into
close contact with a SARS affected individual.
Close contact means contact is close enough to have the person's respiratory
secretions or saliva on you. Close contact includes living in the same
household as a SARS affected person, providing care to someone who has SARS,
or having direct contact with respiratory secretions and body fluids of a
person with SARS.
To date, all evidence indicates that individuals affected by SARS are not
contagious until they begin to exhibit the symptoms associated with SARS,
including fever over 38.0 degrees Celsius and one or more of the following
symptoms: cough, shortness of breath or difficulty breathing.
Activities at
airports
Q. What is
Health Canada doing to monitor incoming passengers for SARS at
airports?
A. At the
Vancouver and Pearson airports, Quarantine Officers are meeting direct flights
from Hong Kong, Singapore and Beijing. Quarantine Officers are also present at
Montreal's Dorval airport. They are passing out Health Alert Notices (yellow
cards) to incoming passengers. These cards ask travellers to see a physician
if they begin to have any symptoms related to SARS.
In addition,
Health Canada has placed Health Alert Notices with accompanying posters in all
terminals for distribution to passengers from all other international flights
(i.e., those flights that do not arrive directly from Hong Kong, Singapore and
Beijing) who are not being met by a Quarantine Officer.
Several thousand
Health Alert Notices and Health Canada posters have been set up in airports in
Halifax, St. John's, Montreal (Mirabel), Toronto, Ottawa, Winnipeg, Edmonton,
Calgary and Vancouver.
Starting April
10, some airlines began a phased-in distribution of yellow Health Alert Notice
forms and traveller contact information on direct flights coming into Canada
from Hong Kong, Singapore and Beijing. More airlines are expected to follow
shortly.
There is active participation of Quarantine Officers on Airport Authority
Emergency Protocols as required.
Q. What is
Health Canada doing to monitor outgoing passengers for SARS at
airports?
A. On April 1,
2003, Health Canada began using Health Alert Notices (cherry cards) to inform
all passengers departing from Pearson International Airport about symptoms and
contact with persons with SARS.
The local
airport authorities have placed the Health Alert Notices and posters at
strategic locations at Pearson, informing travellers who meet certain criteria
(ie., they have SARS symptoms, they have been in contact with a SARS infected
person in the last 10 days) to defer their flights.
Airline staff
are also asking passengers checking in if they have seen and read the
information on the Health Alert Notices.
A Health Canada
SARS team of health professionals has been sent to Pearson to provide
information to airline and airport staff. In very limited cases, this team
will assist the individual traveller and, if necessary, arrange for the
transportation of individuals to local medical facilities.
These activities
meet the World Health Organization's recommendations on new measures to
prevent travel-related spread of SARS, which include screening of air
passengers departing from affected areas.
Health Canada
will be continually monitoring the situation at Pearson International Airport
to evaluate the efficacy of the measures being implemented. Health Canada is
asking for the cooperation of local public health officials, the airline
industry and the travelling public on this plan.
Q. Why is it so
difficult to get travel manifests?
A. All airlines
that have carried passengers who have become ill with SARS have been asked to
provide lists of passengers and contact information so that provincial and
territorial public health personnel can contact them to see if they have
become ill with the same disease. Although simple in concept, there is no
standardized, internationally accepted system for recording this information
by international airlines. Some airlines are better prepared to provide the
data than others. It is often difficult for a company to aggregate the data in
a timely fashion. The information is often a mixture of coded data that
requires considerable personnel time to decipher and organize.
To date, Health
Canada has completed 17 flights for which information was made available and
has forwarded this information to the provincial/territorial public health
authorities. Other passenger manifests are being forwarded by the involved
airlines
Travel
advisories:
Q. I have
planned an upcoming trip to Asia. Should I still go?
A. Due to the
mounting concern about transmission of the SARS agent in non-hospital and
community settings in the City of Hanoi, Vietnam; the People's Republic of
China including the Hong Kong Special Administrative Region; Singapore and
Taiwan, Health Canada recommends that persons planning to travel to these
areas should defer all travel until further notice.
Also, Health
Canada recommends alternate routing be considered, when possible, if a
traveller is transiting through City of Hanoi, Vietnam; the People's Republic
of China including the Hong Kong Special Administrative Region; Singapore or
Taiwan.
Health Canada is
monitoring the international situation and the most up-to-date information is
available at the Travel Medicine Program website.
http://www.hc-sc.gc.ca/pphb-dgspsp/tmp-pmv/index.html
Q. Earlier
advisories indicated that the risk to travellers was low. You seem to now be
saying that the risk is not low. What is the risk?
A. The risk is
probably still low, but we have increasing evidence for transmission of this
illness in the community, meaning outside the hospital and family setting. It
is a prudent public health measure to use the revised travel advisory.
Health Canada's
role:
Q. What is
Health Canada doing to protect Canadians?
A. The
Government of Canada is taking all the necessary precautions to protect the
health and safety of individuals in the fight against SARS. At Health Canada,
there is an unprecedented level of activity going on in six key areas -
investigation, laboratory diagnosis, infection control, treatment, travel and
emergency response. This includes 24/7 surveillance and monitoring, laboratory
testing to find the cause of SARS, emergency measures and support at Canadian
airports to stop the spread of SARS in Canada and abroad, epidemiological and
infection control and support, coordination and collaboration with
inter-governmental jurisdictions and non-governmental organizations, and
international consultation with partners including the World Health
Association (WHO) and the U.S. Centers for Disease Control and Prevention.
More
specifically:
Investigation: Health Canada has deployed 14
epidemiological experts to assist Toronto's public health unit and the Ontario
Ministry of Health with the investigation of the SARS cases. An outreach
investigation and response team in Ottawa is in constant contact with the
Toronto team.
Laboratory diagnosis: Health Canada staff -
including those in the National Microbiology Laboratory in Winnipeg, the
Centre for Emergency Preparedness and Response, the Centre for Infectious
Disease Prevention and Control, and the Workplace Health and Public Safety
Programme - are working around the clock in collaboration with our provincial
and international partners to address this worldwide issue.
Samples from
across the country have been sent to Health Canada's National Microbiology
Laboratory in Winnipeg to conduct tests in an effort to determine the cause of
the pneumonia-like cases. As results become available, the National
Microbiology Laboratory will convey the results to the attending physicians.
Infection control: Health Canada has directed blood operators
to temporarily defer from donating blood (for a period of 10 days) persons who
have:
-
travelled
within the previous 10 days to an affected area outside Canada (currently,
the affected areas are: China, including the Special Administrative Regions
of Hong Kong; Hanoi, Vietnam; Singapore and Taiwan);
-
been a
patient, worked in or visited a facility that is under quarantine for SARS.
Infection
control guidelines for, for example, airflight cabin crew, airport staff and
health care workers have been developed. You can find these guidelines at
http://www.hc-sc.gc.ca/pphb-dgspsp/sars-sras/prof_e.html
Treatment: Health Canada's Special Access
Program is currently providing access to intravenous and oral Ribavirin for
use in SARS. These products are not approved for sale in Canada. Ribavirin is
not indicated in the treatment of SARS, although it has been used to treat a
variety of viral illnesses including Respiratory Syncytial virus, Lassa fever,
and Hanta virus. SAP is working closely with health care professionals at each
of the hospitals involved to gather information on the use of Ribavirin for
SARS, and potential adverse effects.
Travel: On March 18, Health Canada sent two
Quarantine Officers to Pearson International Airport and three to Vancouver
International Airport. Another arrived at Dorval International Airport on
March 30. These health professionals are monitoring passengers arriving on
direct flights from Hong Kong, Singapore and Beijing; passing out Health Alert
Notices to incoming passengers; and supporting airport staff.
To date, Health
Canada Quarantine Officers have met approximately 90 flights and distributed
approximately 25,000 Health Alert Notices to passengers in Toronto and
Vancouver.
In addition,
several thousand Health Alert Notices and Health Canada posters have been sent
to terminals at the airports in Halifax, St John's, Montreal (Dorval and
Mirabel), Ottawa, Toronto, Winnipeg, Edmonton, Calgary and Vancouver.
On April 10,
some airlines began a phased-in distribution of yellow Health Alert Notice
forms and traveller contact information on direct flights coming into Canada
from Hong Kong, Singapore and Beijing. More airlines are expected to follow
shortly.
April 1, 2003,
Health Canada launched an initiative to inform all departing travellers from
Pearson International Airport about symptoms and contact with persons with
SARS through the Health Alert Notice.
The local
airport authorities will place the Health Alert Notices and posters at
strategic locations at Pearson International Airport, informing travellers who
meet certain criteria to defer their flights.
Emergency measures: On March 15, Health Canada
activated its Emergency Operation Centre. It is currently is being staffed by
approximately 30 employees and is operating at a Level 3, which means the
Department has activated its Emergency Response Plan.
The week of April 7, Health Canada sent Toronto health officials 10,000 masks
from the Department's national emergency stockpile system.
Finally, we and
many other partners fighting SARS are meeting Canadians' demand for up to date
information. Health Canada has answered thousands of enquiries through the
1-800 O Canada information line. Updates, fact sheets, Qs and As, and travel
advisories are posted regularly on Health Canada's website for the public and
health care providers.
Q. What is
Health Canada doing to assist Ontario?
A. Health Canada
has deployed six staff to assist Toronto's public health unit and the Ontario
Ministry of Health with the investigation of the SARS cases. The department
has also provided guidelines for infection control and recommendations on
actions for public health settings. Health Canada then deployed an additional
eight personnel to Ontario the week of March 31, and sent two mobile x-ray
machines and processors to Toronto for two isolation units being set up in
non-hospital facilities. The week of April 7, Health Canada sent Toronto
health officials 10,000 masks from the Department's national emergency
stockpile system.
Health Canada is
ready to respond to requests for support from provinces and territories on the
SARS issue.
Q. What kinds
of powers does Health Canada have under the Federal Quarantine Act?
A. Under the
Quarantine Act, Health Canada has the power to detain persons, goods or
conveyances on suspicion that the persons, goods and conveyances might
introduce a dangerous communicable disease into Canada. The authority permits
detention without due process for a period of 48 hours in order to undertake a
medical examination of persons, analysis of goods or inspection of
conveyances. If detention is required beyond 48 hours, Health Canada must
present evidence for a continuation of the detention in a federal court. These
powers also apply to persons and conveyances leaving Canada for another
country. This Act would only be invoked if necessary and Health Canada is not
considering that at this time.
Q. What is the
Emergency Operations Centre?
A. In a national
health emergency or disaster, Health Canada's Office of Emergency Services is
responsible for supporting emergency health and social services nationally and
in the provinces, territories or abroad. The office is responsible for the
Emergency Operations Centre (EOC) which responds to calls for emergency
assistance from provincial and territorial governments and from other parts of
the Government of Canada. The EOC can operate at four levels:
-
Level 1 - on
standby (the EOC generally operates on this level when there is no
emergency)
-
Level 2 - EOC
staff begin monitoring an evolving situation with a limited number of
personnel
-
Level 3 -
Health Canada's Emergency Response Plan is activated
-
Level 4 - the
number of staff in the EOC is expanded and provides 24/7 support
The EOC was
activated on March 15 in response to the SARS outbreak. It is currently being
staffed by approximately 30 employees and is operating at a Level 3, which
means the Department has activated its Emergency Response Plan.
Q. Where can I
find up to date information on SARS?
A. Health
Canada website
www.sars.gc.ca
Information for the public: 1-800-454-8302
Workplace
health
Q. How is
Health Canada supporting federal employees with respect to SARS?
A. Health
Canada's Workplace Health and Public Safety Programme is providing advice to
federal employers in Canada and abroad on occupational health and safety
matters. As of March 17, Health professionals from Health Canada's Workplace
Health and Public Safety Programme were on site at the Pearson, Vancouver and
Dorval airports to provide information sessions for federal employees. They
continue to provide information sessions to employers and employees at
workplaces across the country, and answer daily enquiries from employers.
The Workplace
Health and Safety Programme has issued advisories and Qs and As, and has
spoken to or met with representatives of a number of federal departments to
provide them with information and advice they can use in determining what
health and safety measures they deem appropriate for their employees. WHPSP
officials participated in a videoconference with employees working in seven
missions in affected areas overseas to provide information about respiratory
protection and to discuss other general health concerns about SARS.
Q. Why is
Health Canada not recommending the use of masks by federal workers, such as
Customs agents at Pearson and Vancouver airports?
A. The role of
Health Canada's Workplace Health and Public Safety Programme (WHPSP) is to
provide advice to federal employers on occupational health and safety matters.
It is Health
Canada's position that Government of Canada workers are unlikely to become ill
because employees' encounters with passengers/clients are of reasonably short
duration and not considered to be close contact. Therefore, Health Canada
advises that the use of masks is not necessary.
Employers can
use this information and advice in determining what health and safety measures
they deem appropriate for their employees.
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