Infectious disease specialist Dr. Allison McGeer at Sinai Health System joined us Jan. 28, 2020 to answer some of Toronto Star readers’ most pressing questions about coronavirus.

McGeer was the lead investigator in the hospital section of the 2003 SARS outbreak in Toronto, and investigated the initial hospital outbreaks of MERS in Saudi Arabia. She is a professor in the Dalla Lana School of Public Health at the University of Toronto. Her research group studies the prevention and management of serious bacterial and viral infections.

Due to an overwhelming number of questions from readers, Dr. McGeer ran out of available time and wasn’t able to answer all of the questions from readers. The Star sent the remaining questions to Steven Hoffman, professor of global health, law and political science at York University and scientific director at the Canadian Institutes of Health Research’s Institute of Population and Public Health, for him to answer.

Reader questions were condensed and combined for clarity and to avoid duplication.

Answers provided by Dr. Allison McGeer

From Ina via email: As a senior of 71, is there more concern dining at a Chinese buffet restaurant as opposed to other kinds of restaurants? They are usually very busy. I live in Barrie, Ont., and have not yet heard of anyone with the virus but it is a concern.

A: Thanks for the question. There is absolute no reason to worry about being exposed to this virus anywhere in Canada. You should not be in the least concerned about eating out anywhere.

From Michael via thestar.com: Is the heightened concern about coronavirus over the common cold or flu due to the severity of the virus to our bodies once infected, or that it’s more contagious to pass from human to human (or both)? It’s my understanding that there’s no cure for the coronavirus, but there isn’t one for the regular cold/flu either, so I don’t fully understand why we’d need to be more worried as there are annually thousands of deaths from the flu.

A: Great questions. Two things about the coronavirus — first, it is new and if we can get rid of it before it becomes widespread, that would definitely be of great benefit, even if disease is mild. Secondly, we don’t yet know how severe the disease is — it is still possible that it will be severe enough to cause a great deal of illness and disruption if it spreads effectively outside of currently affected areas. But you are correct that we don’t pay enough attention to preventing influenza!

From Michael via thestar.com: When a person is being tested for coronavirus, do they have to show symptoms, or can the test confirm a person has the virus before showing symptoms since it is now believed someone could have been infected for up to two weeks before showing signs of sickness?

A: Because testing is limited, it has to be saved for the most critical circumstances at the moment; we don’t know if there are asymptomatic infections — studies to identify this need to be done, but they involve a lot of testing and take time. I think that the 14 days you are referring to is the incubation period — the time from exposure until you get sick. People with viral respiratory illnesses do not pose a risk of transmitting infection to others until either just before or after they get sick. They won’t be infectious for the entire 14 days.

From Holly via thestar.com: Is there anything I can start doing now, example to help my immune system etc. so that in the off chance I were to contract coronavirus I would increase my chance of survival?

A: Hi Holly — great question. Unfortunately, there isn’t much anyone can do to improve their immune system (despite what you can read on the internet) — there is some evidence that serious life stress (eg. caring for someone with cancer or dementia) can reduce your immune response to infections, but there isn’t much you can do about that. And a bit of evidence that getting enough sleep may be important. Other than that, your best protection is making sure you clean your hands at least 5 times a day, and keep your hands away from your face. That has been shown in numerous studies to reduce risk.

From Mark via email: Ontario officials are saying that the risk to the public to this coronavirus is “low.” But wouldn’t it be more accurate and transparent to say that the risk is “unknown?” If the goal of public health is to maintain public trust, won’t you jeopardize that if the virus becomes more severe than currently described?

A: I think it depends on what your time frame is. Ontario public health folk are completely correct that our risk of becoming infected with this virus in Ontario this week is vanishingly small, and not something to be worried about. But there is a concern that the virus might eventually spread from China and then the risk level would change.

From Johan via thestar.com: Are there areas I should avoid?

A: You don’t need to worry about anywhere in Canada. There are obviously alerts about travel to some areas of China, although China has quarantined most of these cities anyway, preventing any travel.

From Jeff via email: Hello, We are travelling with a 4-year-old and a 2-year-old from Mexico to Toronto this week and have to fly into Terminal 3 at Pearson. Should we be making alternate arrangements to fly into Hamilton or another airport instead? Our concern is that Terminal 3 is quite busy and usually has the international flights come in.

A: No, you do not need to worry. Transmission of this virus has not occurred with the kind of exposure you get in airports. So far, there has not been any detected transmission on any airplanes, and that is of course much higher risk than crossing paths in the airport. I know how scary this feels, but you are really at greater risk of being in a serious car accident on the drive home than being exposed to this virus at the airport.

From Karen via thestar.com: My daughter is 11 years old, in a competitive dance program and one of her teammates left last week for China for three weeks. I’m nervous for when she returns being around my daughter during the incubation period. How long is the incubation period and should I ask that upon her return she does not attend dance for 2 weeks? My daughter was born a premie at 28 weeks so respiratory issues are a concern for me even though my daughter is doing well now. Do I keep my daughter home if this child still goes to classes upon return from China?

A: It is important to remember that there are now about 4,000 infections in a billion residents of China — over the last three weeks, that is about a 4 per million risk for any one person getting sick. In most areas of China, it is much lower than that. This is a risk that is just too small to be worried about. In addition, there is not yet evidence that this virus is transmitted before people get sick (MERS and SARS, the other coronaviruses, were not). Certainly if any child is sick, they should not be at classes.

From Darryl via email: The current coronavirus has already been labelled by a few experts as growing to become an eventual worldwide, pandemic, due to the millions in China already subject to the spread of the virus. Do you agree that at this stage with so many people affected it is something the world will be contending with for some time yet? If so, and many more cases are found and spread within Canada, can you give us an idea of what societal changes are envisioned for Canadians to weather this event?

A: Great question. Yes, if China succeeds in controlling the outbreak, it may take months. There is a lot of concern that this event has the potential to cause a pandemic. But we don’t know what that would look like — for instance, this virus may be seasonal like influenza or RSV, and we might not see infections until next winter. We also still don’t have a good sense of how severe it will be — it might be much milder than we think. All possibilities are speculative. Governments and health care have done a lot of planning (not enough, but there is never enough) for pandemics, and all of that will be used, but is difficult to predict what is coming. We’ll all need to work really hard to get people to listen and act on the simple messages about hand hygiene and staying home while sick.

From Bruce via email:

— Should we not have a suspected coronavirus clinic? Instructing patients to call 911 or to go to the emergency department will most certainly have an adverse effect on the functioning of both services.

— Public Health suggestion’s “call your doctor” I don’t think is practical advice. Most doctors do not return calls these days as it is . . . and their responses may not be “on message”. A dedicated hotline (multilingual) + web-page of Q and As (multilingual) would seem to be a sensible means of messaging.

— What measures should a workplace adopt viz a viz a symptomatic suspected patient (confirmed or not)?

— All three levels of Public Health are putting their spin on the current situation...at times not always in sync with each other. Rather than having a single go-to informed involved trust worthy MD ie a Dr. Don Low.

A: Hi Bruce! You make several good points. I think the issue at the moment is that there are still pretty small numbers of patients. Setting up one clinic in Toronto may mean that some patients couldn’t get there, which would also cause problems. But I do know that public health, paramedic organizations and hospitals are having this discussion as I type, trying to create a system that will work. When information is uncertain and changing quickly, and public health is trying to be transparent, it is very difficult to be as consistent as is needed, so I have sympathy with every level of public health.

From SC via thestar.com: What is the chance this virus will mutate into something more dangerous?

A: Doesn’t seem very likely at the moment. This is because the sequencing of the virus so far suggests very little change in the first 6 weeks — this is in contrast to the SARS virus, which changed rapidly. Obviously something people are watching very carefully.

From Leo Kleiss via thestar.com: How many people per thousand will die if infected? How long will an infected person be sick for and what is the current remedy?

A: I wish we knew the answer to this — as I said in response to another question, the risk of death in people who have been diagnosed in China is currently about 3%, but it is likely that many less ill people have not been tested (we’ve only had a test for about 2 weeks, so the Chinese will be focusing their testing on more severely ill people first). We just have to wait and see. The same uncertainty is true for how long illness lasts. There is no specific treatment for this infection although there are some now being tested.

From NB via email / From Alex via email: Should extra precautions be taken if you’re travelling internationally in the next month? What about for pregnant women?

A: No, there is no need to worry about travel anywhere except to affected cities in China, no matter who you are.

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From Barbara via email: Could you please provide comparative data on number of cases and mortality rates of the flu vs. the coronavirus in Canada and worldwide. Is the coronavirus something to be feared more than the flu? Are there any differences in ways we should take protective measures?

A: Every flu season, between 5 and 20% of the population get influenza, and about 2,500 Canadians die. If this coronavirus stays in China, obviously the number of cases and mortality in Canada will be very low. If the coronavirus spreads too easily to be contained and becomes a pandemic, then the impact will depend on how quickly it spreads and what the risk that a person who develops infection will die. The risk of death is estimated at about 3% now, which seems low, but would still be very serious in a pandemic. However, as the Chinese likely can’t yet test people with mild symptoms, the risk of death may actually be much lower. Then the impact of a pandemic might be small.

From Ehud via thestar.com How long will the virus stay active for on a surface (a table, chair or a door handle) if not being disinfected?

A: We don’t yet know for this virus. However, it is important to recognize that transmission is usually by people, not surfaces. And even if you get it on your hands from a surface, you won’t get infected unless you transfer the virus to your face with your hands — washing your hands and not touching your face is important, and more effective, because your hands can also become contaminated from droplets from the person next to you.

Answers provided by Steven Hoffman

From Sharon via thestar.com: What have we learned from the SARS crisis that can inform good health policy / travel policy that should be rolled out right now and during the development of this new crisis?

We learned a lot from SARS and are already applying many of those lessons in this current outbreak. For example, we learned that maintaining open lines of communication is a top priority and that proactive measures are needed to make sure new information reaches those who need it including public health authorities, health-care providers, and the public. Two years after SARS, the world also revised the International Health Regulations – which is the legally binding treaty that governs how 195 countries respond to health emergencies. We are benefiting now from those revisions which facilitate greater cooperation across countries and promote faster information sharing.

From Vishal via thestar.com: How can I differentiate between the common cold and Coronavirus? When should I seek professional medical attention and how should I do so?

At this point in time, if someone has not recently visited an affected area in China, the likelihood of having the coronavirus is extremely, extremely low. Anyone with flu-like symptoms who has recently traveled to an affected area in China should consult their primary health-care provider and should call ahead of time so that infection prevention precautions can be taken. Health-care providers may refer their patients directly to hospital emergency rooms; if so, people should call ahead to again allow hospital staff to prepare accordingly.

From Pat via email: How did the SARS epidemic end? Did it just peter out or was there a vaccine that stopped it?

The SARS outbreak ran its natural course and was contained through public health measures such as quarantine and isolation. There is no vaccine to prevent SARS and the available antiviral medicines were only minimally effective. This highlights the importance of investing in public health infrastructure and investing in science ahead of outbreaks so that medical and social countermeasures are ready for use when future inevitable outbreaks emerge. Today we are much better equipped to address an outbreak than we were during SARS in 2003. For example, this is the first time the world has had a diagnostic test so early in an outbreak. This diagnostic test is already allowing public health authorities to quickly identify cases and pursue appropriate containment measures. In Canada, it takes only 24 hours to confirm a potential case of this novel coronavirus. This technology is a game-changer for the public health response to outbreaks.

From Gus via email: How effective are masks and which kinds are the best to use?

Masks are not recommended for use by the public at this time. Most people have not been trained to use masks correctly, which means that using a mask may not provide any protection and could actually inadvertently encourage people to touch their faces more frequently which would be counterproductive. The best measures to take at this time are the same measures that everyone should always take during the winter time: washing hands frequently, coughing/sneezing into elbows, and staying home if sick.

From Martha via email: We see clips online where frontline care workers are boarding landing planes in full hazmat suits and taking the temperature of the people on the plane. Why are we not doing that here in Toronto?

Experience has shown that mass temperature screenings do not work. For example, during SARS, millions of people were screened for their body temperature at Canadian airports and not a single case of SARS was identified through that process. It has been impressive to watch the way that the Canadian government has been responding to this particular coronavirus outbreak with an evidence-based approach. The response we are seeing in Canada now is exactly the kind of response we want to be seeing.

From Christopher via email: If people are contagious before symptoms appear, is this likely to be for a day, or for multiple days before the onset of symptoms? Will stopping air travel from China help to curtail H to H transmission in Canada? Are there any medical treatments that worked during the SARS outbreak?

There is still a lot we do not yet know about this novel coronavirus. For example, we do not yet know the exact incubation period or the exact point when people become contagious. The good news is that we are learning more every day and that new information is immediately being shared internationally and with the public. Based on past outbreaks, we also know that travel bans do not typically work because people find ways of circumventing these restrictions which then makes it more difficult for public health authorities to identify cases and undertake contact-tracing. Furthermore, travel bans actually disincentivize countries from reporting when they have cases in their territory out of fear of being slapped with punishing trade and travel restrictions that do not typically help in any event. The World Health Organization has not recommended any trade or travel restrictions; it is best for everyone if all countries follow this good, evidence-based advice.

From Shaun via thestar.com: Is this virus more deadly than any other flu virus? It’s just a flu virus correct? Is the media hyping this out of proportion?

We do not yet know the exact severity of this virus, but it appears to be much less severe than either MERS or SARS (two other coronaviruses). As we identify more cases, we are starting to see that initial reports of severity were probably overestimated. Such overestimation in severity is normal because it is people with serious symptoms who are more likely to seek medical attention and thus get included in reports. This is partly why public health authorities have been emphasizing that the risk posed to Canadians by this novel coronavirus is low. We in Canada also benefit from an excellent public health system and access to health care such that this virus will not spread as much or be as severe in Canada as we might see in other countries. There is certainly more media attention on this virus than the risk it poses, especially in Canada where we benefit from a great public health system and access to health care.

From Shean via email: How many days or weeks will it be before we start to see massive numbers of Canadians presenting with the virus?

Hopefully we never see many Canadians affected by this virus. The most likely situation is that we will see some additional cases in Canada and that each case will be contained quickly. It is important to remember that the risk currently posed by this novel coronavirus is far less than the risk Canadians face every year from the regular seasonal flu.

From Linda via thestar.com: Will the regular flu shot decrease the severity of coronavirus?

If anyone has not yet gone to get their flu shot to lower their risk of getting the seasonal flu, it is not too late to do so! While this is unlikely to offer any protection against the novel coronavirus, it is likely to offer protection against something that is currently a greater health risk.