West Nile Virus-Misinformation in Canada-needs Action

[Guest guest]

Ontario's Health Minister is avoiding spraying and coming under pressure to

" do something " --ANYTHING.He needs support. More people are made sick from

the

spray than avoid the WNV, that most people hangle with a healthy immune

system.

arnold

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Ontario hit hard in initial West Nile outbreak

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/1046402858512_45///?hub=

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Saturday, Mar. 1, 2003

 

The Globe and Mail

 

How top public health officials underestimated the threat of West Nile

virus while 12 died and 1,000 others were treated for the disease

 

By AVIS FAVARO AND ANDRÉ PICARD

 

 

Dino Perissinotti was a bull of a man, powerfully built and tireless, able

to put in a 12-hour shift as a manager at DaimlerChrysler, come home, swim

with the kids, take them to their soccer matches, then toil for a few more

hours in the vineyards.

 

" They called me the raging bull at work. I was strong. To me, it wasn't

work, it was enjoyment that you would work like a mule, " he said.

 

That all changed late last summer when Mr. Perissinotti learned that

mosquitoes could be killers. He was infected with West Nile virus, and he

has not yet fully recovered.

 

As they realize how hard West Nile hit southern Ontario last summer,

public-health officials and other front-line health workers are warning

that there will be many more cases like Mr. Perissinotti's.

 

A wide-ranging investigation by the CTV newsmagazine W-Five that was

broadcast last night reveals that their cries of alarm are being stifled by

senior provincial-government officials, who continue to play down the

breadth and the impact of the outbreak.

 

Mr. Perissinotti's temperature soared to a life-threatening 42.2 C (108

degrees F), and he spent 10 days in intensive care. Today, the 43-year-old

is sapped of energy, barely able to walk around the block and plagued by

recurring fevers.

 

Mr. Perissinotti, of Windsor, Ont., knows that he survived only because he

was young and healthy; he fears that when the mosquitoes return in spring,

others will not be so lucky.

 

" If we have a summer next year, a traditional summer that's hot and humid,

watch out. Those mosquitoes are going to be out there. Watch out, watch out

for your kids, watch out for the older people, watch out for those who

aren't as strong, " Mr. Perissinotti said.

 

According to Colin D'Cunha, Ontario's chief medical officer of health,

there were 373 human cases of West Nile in Ontario last summer.

 

But data provided to W-Five that will be presented next week at the

Canadian Infectious Disease Society conference in Quebec City reveal that

at least 1,000 people required medical attention for West Nile -- and that

does not include the undiagnosed cases. (Although the disparity is largely

a technical, scientific debate, infectious-disease researchers say Ontario

should use the same definition of a probable West Nile case that the United

States does.)

 

There were at least 12 deaths caused by the West Nile virus in Ontario, and

one in Quebec. One death is being investigated in Alberta, but in that

case, the disease almost certainly was contracted in the United States. A

Canadian died during the first outbreak of West Nile in New York in 1999.

 

Researchers believe that as many as one in 500 people in southern Ontario

was bitten by a mosquito carrying the West Nile virus. (Most infections are

harmless, but one in 150 lead to neurological complications.) Dead birds

have been found in five provinces and, by this summer, the disease likely

will migrate to the West Coast.

 

Front-line health workers are angered that many of the infections and the

deaths from West Nile could have been prevented had action been taken

earlier. Instead, the government spent its time and energy trying to dampen

public concern.

 

" As a template for how to deal with a new, emerging disease, this is not a

very good example, " said Dr. Neil Rau, an infectious-diseases consultant at

Credit Valley Hospital in Mississauga. " We had all this environmental data

that was crying out for action, and it was treated with grand indifference. "

 

Ontario officials counter that they acted swiftly on the data they had but

blame Ottawa for a lengthy backlog in testing. They also point the finger

at individual health units for not being more outspoken at the time.

 

" We remain confident that appropriate measures were undertaken, " Dr.

D'Cunha said in a written response to questions. (Although he is the face

of public health in Ontario, he declined a request for an on-camera

interview with W-Five.)

 

He rejected criticisms that Ontario should have shown more leadership,

saying it used the " most current science to support public-health actions "

that include the monitoring, prevention and control of West Nile.

 

Dr. D'Cunha disagreed with the view the province should have ordered

spraying, saying " spraying represents merely one component of the

'phased-response' approach " that was adopted.

 

Some patients and their family members believe this is bureaucratic bumpf:

They equate Ontario's response to West Nile to the bungling that led to the

tainted-blood tragedy, and they are considering a class-action lawsuit.

 

" I think it's pretty obvious the Ontario government fell well short of the

mark in responding to this situation, " said Douglas Elliott, a lawyer

investigating the issue. He criticized the government for failing to draft

a plan and act swiftly to mitigate the spread of the deadly disease.

 

West Nile virus is spread to a human through the bite of a mosquito that

fed on the blood of a bird infected with the virus. The disease was first

identified in 1937 in Uganda.

 

How the tropical disease jumped the Atlantic Ocean is a mystery, but an

infected bird likely was caught in a jet stream.

 

New York was the first place in North America hit by West Nile. The virus

was identified within a month, and spraying with larvicide began after only

four cases of encephalitis (swelling of the brain). Notably, the city

remains the only place in North America where incidence of the disease is

falling. Last year, there were almost 4,000 confirmed cases and 254 deaths

in the United States.

 

Despite the warning signs, Ontario officials essentially shrugged off the

surveillance data.

 

In early August, the number of dead crows reached a threshold of 1.5 per

square mile (a powerful indicator that the disease was a threat to humans)

in parts of Southern Ontario. Dr. Rau said this should have led to a series

of public-health measures, such as spraying and public education.

 

People were getting sick and dying within two weeks of the bird die-off.

All 1,000 cases occurred within six weeks, from Aug. 10 to Sept. 20.

 

The number was large enough to describe the situation as an epidemic.

 

Manitoba sprayed as a precaution. But the Ontario government was beset by

West Nile denial syndrome. The official line was that the disease was rare

and relatively benign, posing a risk only to the frail elderly and the

immuno-compromised -- people, it was implied, who were going to die anyway.

 

Dr. D'Cunha said that people should worry more about riding the subway

beside someone with the sniffles than they should about West Nile virus.

 

The data told a different story. One West Nile victim had cancer, and

another was a recent organ-transplant recipient, but most were young and

healthy until they were bitten by mosquitos. In Credit Valley Hospital

alone, there were more West Nile cases in a single weekend than in New York

when the outbreak made international headlines.

 

Scientists had learned a lot about West Nile since those early days. The

median age of those infected was 50. The vast majority of those infected

were not frail; one day, they were perfectly healthy, the next, they were

struggling with encephalitis or meningitis (swelling of the lining of the

brain). A single bite from an infected mosquito is enough.

 

Nicole Noble was 18 when she was infected late last summer. She contracted

meningitis and spent seven days in hospital. The teenager was so sick she

missed a semester at school; she still struggles with chronic fatigue.

 

Ms. Noble did not learn of her diagnosis until four months after she became

sick. The backlog of tests was another major problem for front-line doctors.

 

Ontario announced this week that it will set up its own lab, so tests no

longer have to go to the federal lab in Winnipeg.

 

But there is still no rapid test for West Nile, no way to test blood

donations, for example.

 

Joyce Kimmel of Kitchener, Ont., died of West Nile in November; she was

receiving blood transfusions as part of her cancer treatments. Four cases

of suspected blood-borne transmission are being investigated, three in

Ontario and one in Quebec.

 

Canadian Blood Services is worried that until a test is developed, it may

have to discontinue blood collections in areas affected by West Nile, which

include the most populous and the source of much of Canada's blood.

 

If there is one benefit of Ontario's fumbling of the West Nile outbreak,

front-line health-care workers say that other jurisdictions can learn from

the mistakes and, hopefully, keep their infection and death rates lower.

 

Mel Krajden, associate director of laboratory services at the B.C. Centre

for Disease Control, said he would give Ontario a failing grade for its

handling of the West Nile epidemic.

 

" I think that the ball was dropped, " he said. Dr. Krajden said the large

number of infections in Ontario show that surveillance, such as tracking

bird deaths, is essential and must be acted upon quickly.

 

Test results for suspected cases should be available within a day or two,

not months later, he said. And as soon as it is clear that there is a

threat to people, " abatement measures, " such as spraying and screening

blood donors, need to kick in. Education programs are required to inform

the public that they should routinely use mosquito repellent with DEET.

 

West Nile disease cost Ludwig Mayer his life.

 

On the evening of Sept. 8, he was sitting on the porch of his west-end

Toronto home when a mosquito bit him on the shoulder.

 

Ten days after the bite, Mr. Mayer was admitted to hospital with a fever

and a headache. He lapsed into a coma, a prelude to a host of health

problems linked to West Nile, including kidney failure, pneumonia, bladder

infection and a polio-like paralysis that put him on a respirator.

 

After six months in intensive care, Mr. Mayer died. Before the mosquito

bite, the 72-year-old was in excellent health; he had just returned from

holiday.

 

Aurelia Mayer, his wife of 45 years, had never heard of West Nile before

the ordeal, and never imagined mosquito bites could be anything but a

nuisance.

 

For Mrs. Mayer, the arrival of West Nile means Canadian summers will never

be the same.

 

" I'm scared for next summer . . . " she said, her voice trailing off. Avis

Favaro is medical reporter for CTV News. André Picard is public- health

reporter at The Globe and Mail. Reducing the risk

 

Human illness from West Nile virus remains relatively rare, even in areas

where the virus has been reported, but the chances of becoming ill can be

reduced by taking precautions:

 

Apply insect repellent containing DEET (N,N-diethyl-meta-toluamide) when

outdoors.

 

When possible, wear long-sleeved clothes and long pants treated with

repellents containing permethrin or DEET since mosquitoes may bite through

thin clothing. Do not apply repellents containing permethrin directly to

skin.

 

Consider staying indoors at dawn, dusk, and in the early evening, which are

peak mosquito-biting times.

 

Limit the number of places available for mosquitoes to lay their eggs by

eliminating standing-water sources.

 

Check whether there is an organized mosquito-control program in the area.

If no program exists, work with local authorities to establish one.

 

Source: U.S. Centers for Disease Control and Prevention

 

© 2003 Bell Globemedia Interactive Inc. .

 

 

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Quote of the Day

 

Friday, Feb. 28, 2003

 

 

'We had a number of healthy, gainfully employed people turned into

dependent people by a mosquito bite.' James Brunton, lead author of a study

on the effects of the West Nile virus.

 

Page A1

 

© 2003 Bell Globemedia Interactive Inc. .

 

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Friday, Feb. 28, 2003

 

The Globe and Mail

 

West Nile virus effects far worse than thought

 

By ANDRÉ PICARD Globe and Mail Update

 

 

The outbreak of West Nile virus disease in Southern Ontario last summer was

far more deadly, disabling and costly than anyone imagined, according to

yet-to-be-published research.

 

A study obtained by the CTV newsmagazine W-Five as part of a wide-ranging

investigation that will be broadcast Friday night reveals that one in six

people admitted to hospital for treatment of West Nile died. Among those

who left hospital alive, four in five have lasting physical and

neurological damage.

 

" People just don't understand how deadly and incapacitating this disease

can be, " said James Brunton, director of the infectious-diseases division

at the University Health Network in Toronto and lead author of the study.

 

The research was made available before publication in the hope that it

would help public authorities plan for the return of West Nile in the

spring, when the disease is expected to spread much further afield, perhaps

as far as the West Coast.

 

The study, conducted in seven Toronto-area hospitals, is a detailed

analysis of 64 patients who were left seriously ill by West Nile, a

mosquito-borne illness that made its way to North America in 1999.

 

According to another study to be presented to the Canadian Infectious

Disease Society next week, about 1,000 people in Ontario sought medical

treatment for the illness last summer, and at least 12 died. The official

Ontario government count is 373 cases with 11 confirmed deaths.

 

The unpublished research contradicts the commonly held belief that West

Nile strikes only the frail and others with compromised immune systems.

Only seven of the 64 cases studied were among immunosuppressed patients.

Although the median age of those infected was 61, doctors reported that the

vast majority of patients, even the older ones, were in good health before

the infection.

 

" We had a number of healthy, gainfully employed people turned into

dependent people by a mosquito bite, " Dr. Brunton said.

 

The researcher said he has been frustrated by the approach of public-health

authorities and politicians who " keep saying West Nile isn't such a big

deal because most people don't get sick. . . . I want them to understand

just what the burden is to the medical system and to society in general. "

 

Although Dr. Brunton and his team have not completed an analysis of

treatment costs, the amount is substantial.

 

The research shows, for example, that the average hospital stay was 29 days

and that almost one-third of patients were in intensive-care units, where

treatment costs thousands of dollars a day. After their hospital stays, the

majority of West Nile sufferers needed additional aid, from home care to

admission to long-term treatment facilities.

 

The West Nile virus is spread by the bites of mosquitoes that have feasted

on the blood of infected birds. Symptoms usually appear 10 to 14 days after

a victim is bitten. Although most people fight off the virus, about one in

150 suffer serious illness, principally meningitis (swelling of the lining

of the brain) or encephalitis (swelling of the brain).

 

The study, however, details a host of complications, the most frightening

of which is a polio-like paralysis that primarily affects the limbs and

breathing. One in four patients had to be placed on a ventilator. A number

of patients also suffered heart attacks and kidney failure.

 

Neil Rau, an infectious-disease consultant at Credit Valley Hospital in

Mississauga and a physician who last summer treated many of the most

serious West Nile cases, said the " study confirms my suspicion that this

disease had a much more staggering impact than we ever imagined. "

 

He said that though the data in the study are troubling, they represent

only the tip of the iceberg because they come from only seven hospitals.

 

Dr. Rau has been frustrated by the tendency of public officials to downplay

the risk rather than informing people how to protect themselves against

mosquitoes and bites.

 

" Even this little snapshot flies in the face of what public health has been

saying, " he said. " The public has been misled about the severity of West

Nile. "

 

With a report from CTV medical reporter Avis Favaro

 

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Mar. 1, 2003. 01:00 AM

 

Toronto Star

 

West Nile virus downplayed, MD says Ontario said to have 1,000 cases

Healthy adults suffer severe symptoms

 

PETER SMALL

STAFF REPORTER

 

More than a thousand people in Ontario - far more than the number listed

in government statistics - have likely been hit with the West Nile virus,

says Dr. James Brunton, the director of the infectious disease division at

the University Health Network.

 

The government's count for probable and confirmed West Nile victims is 373,

with 11 confirmed deaths.

 

But an unpublished study of seven hospitals in the Greater Toronto Area,

co-authored by Brunton, found 10 fatalities.

 

Dr. Neil Rau, an infectious diseases specialist at Credit Valley Hospital

and Halton Healthcare Services and one of the study's co-authors, said he

believes the number of probable cases is at least 1,000 and that the number

of deaths could exceed 11. He accused provincial authorities of downplaying

the issue.

 

The study examined records of 64 patients with a median age of 61 who were

 

hospitalized in Peel, Halton and Toronto. It found that West Nile hits far

more than just the frail elderly and people with weakened immune systems.

It also strikes active, healthy people, leaving them with crippling

symptoms that last for months.

 

Symptoms ranged from nerve damage, temporary loss of consciousness,

paralysis and severe weakness lasting for months. " It can be so severe that

the person cannot breathe for themselves, " Brunton said. Four in five of

the patients had lasting damage. Most needed additional assistance, such as

home care.

 

One of the patients, a labourer, could not raise his hands above his waist,

and has not yet recovered. A 30-year-old hiker and kayaker ended up needing

a walker. A Toronto dentist with a large periodontology practice was

incapacitated for months and is in rehab.

 

The study, with research led by Dr. Caitlin Pepperell, has been submitted

for publication in the Canadian Medical Association Journal, but Brunton

and Rau decided to release their results early to alert the public. " The

findings are so disparate from what was publicly disseminated, " Rau said.

 

West Nile is spread from mosquitoes to birds, often crows, which are in

turn bitten by other mosquitoes that spread the infection to humans.

 

Symptoms include mild fever, headache, stiff neck, muscle weakness, rash

and swollen lymph glands. In rare cases, it can cause inflammation of the

brain.

 

One man who went through the illness last year described after-effects that

lingered for months.

 

Dave Nelson, a 44-year-old London, Ont., landscaper and avid volleyball

player who had " never been sick a day in my life " was felled with intense

headaches, neck stiffness, dizziness and vomiting after he was bitten by a

mosquito.

 

" The first doctor that saw me said I had the flu and sent me home with

Tylenol, " he told the Star.

 

Nelson worked through last summer's hot, humid weather. By the end of

August the symptoms faded but so had his energy.

 

In September, the symptoms resurfaced, this time with a stubborn migraine

that would linger for days.

 

His wife, Mary, forced him to see the doctor filling in for their family

physician, who was on vacation.

 

" The first thing she said was `I can assure you he hasn't got West Nile

virus,' " Mary recalled. She also insisted there was no available test for

the disease.

 

But when two dead crows were found beside the tree where Dave had been

working, Mary insisted on a blood test for West Nile virus. It came back

positive.

 

" When you're down for a whole week at a time, it really turns your whole

life around, " he said.

 

He took the winter off work to rest, instead of taking other jobs, and

hopes to recover before landscaping season begins.

 

" I hope that our medical society starts taking a much more serious attitude

when dealing with people who have symptoms of West Nile, " he said.

" Something needs to be done. "

 

Study co-author Rau accused the government yesterday of keeping

tight-lipped about suspect cases beyond the 373 it acknowledges.

 

Dr. Colin D'Cunha, Ontario's medical officer of health, said the province

uses the national definition for confirmed and probable cases, which has

been adopted by all provinces and territories.

 

It is not dissimilar from the definition used by the Centers for Disease

Control and Prevention in Atlanta, he said.

 

" I accept that the diagnosis is a changing one and the science is changing

but there has to be an element of national and provincial consistency, "

D'Cunha said. He added that he encourages clinical doctors to tell the

province about their disagreements with national definitions and those

issues will be raised in federal-provincial forums.

 

But Rau also accused provincial health authorities of downplaying the

extent of West Nile infection last summer.

 

" By doing so the debate about whether to intervene in spraying was kept

from the public eye, " Rau said.

 

D'Cunha said that the province was actively alerting and educating the

public and doctors about the dangers of West Nile as early as 2000. " I

don't find the allegation worthy of taking note of. "

 

with files from Elaine Carey

 

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Feb. 28, 2003. 01:00 AM

 

Toronto Star

 

West Nile attack plans laid

Virus killed 11 in Ontario last year Health units target mosquito larvae

 

KAREN PALMER AND MIKE FUNSTON

STAFF REPORTERS

 

West Nile virus killed 11 people and sickened more than 370 in Ontario last

summer - and experts fear there will be even more human cases this year.

 

Public health units in southern Ontario are making plans to squelch the

mosquitoes that carry the virus while researchers struggle to understand

how it made such a sudden and successful leap to humans.

 

Yesterday, Peel Region announced it will spend $2.7 million on a mosquito

control plan that uses two types of larvicide to kill the virus-carrying

bugs before they grow into adults.

 

Hamilton has set aside $500,000 for mosquito control and Halton Region is

expecting to budget the same amount. Pellets of larvicide, which dissolve

in water and kill only mosquito larvae, will be tossed into 26,000 storm

water catch basins and 60 ponds.

 

Toronto also plans to use a larvicide program and will resort to spraying

malathion - a toxic chemical linked to increased asthma rates - if

necessary, but formal budget approval hasn't been given yet.

 

Researchers working on how to contain the virus have spent the winter

reconstructing the virus' movements to help understand how it got a

foothold in the province last summer.

 

The answer, surprisingly, is probably found in the cool, dark sewer pipes

of Windsor and Peel Region. Last winter, field researcher Robbin Lindsay

pulled 10,000 pools of hibernating mosquitoes from the pipes - an

experiment he is expected to repeat in March - and quickly realized the

slumbering bugs were full of virus, replicating as though it was untouched

by the cold weather.

 

" (The virus) didn't have to be reintroduced, it had a much larger time to

build up and that made it a bigger risk, " said Harvey Artsob, head of the

federal microbiology lab.

 

" With all the virus seeding this year, what are we going to face in 2003?

Looking ahead - and we want to be careful what we predict - but we think it

will get to the West Coast, " he added.

 

Canadian Blood Services is investigating three cases of West Nile virus

likely contracted by Ontario residents through blood transfusions,

including a Kitchener woman who died of the virus in November. Tests point

to a transfusion of tainted blood in the death of Joyce Kimmel, 57,

although the investigation is ongoing, the executive medical director of

Canadian Blood Services said yesterday.

 

With files from Kitchener-Waterloo record

 

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Mike Christie

(613) 228-7499 / bus.

(613) 228-7487 / fax.

mikechristie / e-mail