Nobody knows how many Canadian children have been infected by EV-D68 or how rapidly the deadly virus is spreading — despite public health officials claiming to be closely monitoring the disease.
The first death linked to Enterovirus D68 (EV-D68) was announced in Rhode Island on Wednesday.
The virus has also recently been linked to polio-like symptoms, with some infected children suffering from paralysis.
The threat of EV-D68 sparked a national public health alert in Canada two weeks ago, yet the prevalence of the rare respiratory virus remains a mystery.
This is not because the information isn’t available, it’s because EV-D68 is not a notifiable disease, according to the law.
Hospitals are not obliged to notify provincial public health departments of positive test results, making it impossible to monitor the reach of the virus.
EV-D68 is related to the common cold and has crept across the continent since early August, hospitalizing thousands of kids in at least 41 states and four provinces.
More than 100 Ontario children have been infected, with some rushed into emergency departments turning blue from a lack of oxygen and dozens requiring intensive care treatment.
When the Star asked Public Health Ontario’s (PHO) head of infectious diseases, Dr. Natasha Crowcroft, how the federal government could find out how many children had been infected, she said: “Well, this is where Canada gets tricky. The feds would have to ask each province what they are observing and most of the provinces would say, in the heat of the moment, they don’t know.”
This apparent hole in the public health system could be putting Canadians at risk, health experts told the Star.
Dr. Niranjan Kissoon, vice president of medical affairs at B.C. Children’s Hospital and Sunny Hill Health Centre for Children, said all hospitals should be reporting positive test results to health authorities to ensure other provinces were prepared for a potential outbreak on their turf.
“If there is any public health alert across the country, there should be some central body monitoring the situation,” he said.
Provincial medical officers of health have the legislative power to declare an unusual outbreak of disease reportable, but only if it is deemed to be a threat to the public.
The Star has found EV-D68 is considered to be more of a threat on the West Coast than it is on the East.
In British Columbia, eight children or teenagers have been infected and the virus was declared a reportable disease on Sept. 16.
Two victims have suffered from polio-like symptoms, with one still on a breathing machine a month after being admitted to hospital and the other with arm weakness that has not improved in nearly a month.
All suspected cases of the virus are now reported to the B.C Centre for Disease Control (CDC) and specimens are tested at its laboratory, similar to the United States, CDC physician epidemiologist Dr. Danuta Skowronski said.
“This is an emerging virus associated with severe complications, both respiratory and neurological. If we want to understand this illness then we have to have surveillance in place,” she said.
In contrast, Ontario has had 104 children infected, yet the virus has not been declared reportable.
And, Ontario’s Ministry of Health and Long-Term Care said there was no plan in place to change that.
“Under the current circumstances, this situation is not considered to be an outbreak,” ministry spokesman David Jensen said.
Public health officials do not believe EV-D68 is any worse than influenza, Crowcroft said.
Advice for parents was the same as all other enterovirus seasons.
“I think it would be very hard to make the case that we have a major public health threat,” she said.
Public Health Agency of Canada (PHAC) director general of immunization and respiratory infectious disease, Dr. John Spika, said if the illness became more severe and was sending significant numbers of children to intensive care or causing death, things would change.
The Star contacted health departments from all 10 provinces and three territories to try to find out how many kids had been infected to date.
From the latest information available, EV-D68 was confirmed in four provinces; Alberta reported 50 cases, B.C. eight, Saskatchewan 13 and Ontario 104.
Aside from calling every hospital in Canada, it is impossible to know if there are other confirmed cases out there.
What you need to know about Enterovirus D68
What is EV-D68?
EV-D68 is one of about 100 enteroviruses and is related to the common cold. The virus is fairly widespread, but the vast majority of children only suffer from mild symptoms. Children with a history of asthma or breathing problems are the most vulnerable. The D68 strain is rare and this is its biggest outbreak on record.
How widespread is the virus?
EV-D68 has infected 472 people in 41 states since mid-August, according to CDC. The virus has been reported in four Canadian provinces since September: Alberta, B.C., Ontario and Saskatchewan.
When did the outbreak begin?
The first hospital in North America that was hit with EV-D68 was the Children’s Mercy Hospital in Kansas City, Mo. Over a four week period, the hospital was flooded with an unprecedented number of children – up to 40 a day.
Advice for parents:
No vaccines exist to treat EV-D68, so the primary strategy for curbing the spread of infection is normal preventive measures such as hand-washing and coughing directly into a Kleenex. If your child falls ill or begins to wheeze or cough, seek medical care. If parents have any concerns, call Telehealth Ontario toll free at 1-866-797-0000.
- With files from The Canadian Press