In December 2019, a novel coronavirus (2019-nCoV) was identified as the cause of an outbreak of pneumonia originating in Wuhan, China. As of January 30, 2020, approximately 8,000 cases had been confirmed in China, and it has quickly spread around the globe. In Ontario, Canada, there were two confirmed cases of 2019-n-CoV; another 19 are under investigation. There is also a confirmed case in British Columbia, and at the time of this post, there were five in the United States, with another 73 under investigation. The situation is rapidly evolving, and it is expected that new cases will continue to be identified globally.
Coronaviruses are a family of viruses that include milder strains causing the common cold, but also more virulent strains, like 2019-nCoV, resulting in acute respiratory tract infections such as pneumonia.
This outbreak is not the first in recent history. In 2002, an outbreak of Severe Acute Respiratory Syndrome (SARS) caused by a novel coronavirus named SARS-CoV emerged in China and spread rapidly across the world. In total, approximately 8,273 cases and 775 deaths were reported globally. Canada had the fourth highest number of cases in the world, with 251 cases and 44 deaths reported. SARS was a wake-up call for the international community, demonstrating just how quickly diseases can emerge and spread around the world.
Middle East Respiratory Syndrome (MERS), another novel coronavirus, has been causing concern in the Middle East. From 2012 through November 30, 2019, a total of 2,494 laboratory-confirmed cases of MERS-CoV and 858 associated deaths were reported globally to the World Health Organization (WHO) under the International Health regulations (IHR 2005). The total number of deaths includes the deaths that WHO is aware of to date through follow-up with affected member states.
In Canada, SARS put public health agencies at every level of government to the test. And evidence in the form of numerous reports, inquiries and research published post-SARS has shown that our public health system was caught off guard by SARS. Canada’s public health system was simply not adequately resourced to deal with a national outbreak of a new communicable disease. The Naylor Report, Learning from SARS: Renewal of Public Health in Canada, a seminal report published by the National Advisory Committee on SARS and Public Health, highlighted specific systemic gaps and deficiencies in the public health system in Canada in response to SARS, and concrete recommendations to strengthen public health capacity to deal with future threats.
“The SARS story as it unfolded in Canada had both tragic and heroic elements. The toll of the epidemic was substantial, but thousands in the health field rose to the occasion and ultimately contained the SARS outbreak in this country. The Committee emphasizes that in drawing lessons from the SARS outbreak, our intent has been not to 'name, shame, and blame' individuals, but rather to move and improve systems that were suboptimal. The challenge now is to ensure not only that we are better prepared for the next epidemic, but that public health in Canada is broadly renewed so as to protect and promote the health of all our citizens." -- The National Advisory Committee on SARS, 2003
Since that report was published in 2003, the capability of public health agencies in Canada, from local health units to ministries of health to provincial and federal agencies, to detect and respond to outbreaks of communicable disease has improved significantly. Many of the recommendations outlined in Naylor’s report have been actioned. For example, pre-SARS, there was no federal public health agency in Canada. In 2004, the Public Health Agency of Canada (PHAC) was created as a direct result of deficiencies identified in the Naylor Report. By comparison, the U.S. Centers for Disease Control and Prevention, the national public health agency of the United States, has been around since 1946.
Many of us at Gevity have been involved in public health information system projects across Canada undertaken as a direct result of the recommendations that emerged post-SARS. At the time of SARS, local and provincial public health agencies across Canada were relying on paper, standalone databases and Excel spreadsheets for surveillance, monitoring, analysis and reporting of communicable disease case, contact and outbreak data. Timely access to comprehensive, good-quality data is key in effective disease surveillance and response. SARS highlighted the need for centralized public health data, and since 2003 there has been steady momentum in Canada to modernize public health data collection, management and reporting systems. In 2004, the Integrated Public Health Information System (iPHIS) outbreak management module was very quickly developed by Ontario, supported by the Canadian Integrated Public Health Surveillance Collaborative within PHAC for the reporting and surveillance of infectious diseases. iPHIS, which is provincially mandated in Ontario, provides a centralized case, contact and outbreak application and database for use by all regional public health offices across the province. The availability of the information supports surveillance and activities to help minimize the spread of the disease.
In Ontario, all 36 local public health units began implementing iPHIS in 2005. B.C., Manitoba and Saskatchewan also implemented selected iPHIS functionality in their Regional Health Authorities.
SARS highlighted a number of systemic deficiencies, including a marked lack of public health information technology infrastructure. We had to manage that outbreak with sticky notes, email, and simple spreadsheets. iPHIS substantially improved local and provincial public health capacity for case, contact, and outbreak management and reporting for surveillance of communicable diseases. Digital investments have made us much more prepared to respond to novel pathogens like the Wuhan coronavirus.
There is more proof that we have come a long way since 2003: Toronto Public Health daily reports on case and contact status used to be delivered to the Ministry of Health and WHO on CD-ROM. The custom-developed database to track the investigated individuals needed to be enhanced almost every day to capture additional signs and symptoms as more was known about the disease. Fortunately, we now have the ability to manage and report the cases and contacts and their exposures in a provincial shared system. Additional tools are also available to map the data and support the contact tracing effort.
With the support of Canada Health Infoway, iPHIS has been replaced in most jurisdictions in Canada by the IBM Public Health Solution for Disease Surveillance and Management (PHSDSM), or Panorama. Many Gevity team members were involved in the early requirements for developing the solution and today provide the solution implementation services worldwide as an IBM partner.
The new coronavirus outbreak will provide an opportunity to once again test the capacity of public health agencies to respond to a novel disease threat. It is still early days in the outbreak, and the extent to Canada will be impacted is unknown, but there is the reassurance in that Canadian public health agencies at all levels of government are primed and prepared.