OTTAWA—Up to four Canadians remain in hospital in Japan and are “quite sick” with COVID-19 while only a handful of patients diagnosed in Canada has been hospitalized for treatment, say federal health officials who downplayed the need to scale up border measures or hospital responses.

Most Canadian cases are patients who are being “cared for” at home, said chief public health officer Dr. Theresa Tam, who declined to provide further details about the most seriously ill, saying things can change on an “hourly” basis.

That point was underlined Wednesday, as federal officials reported 33 cases in the afternoon, and the number changed within three hours as another B.C. case was confirmed, bringing the Canadian total to 34.

A woman in her 80s, who travelled to Canada via India and Hong Kong was in intensive care Wednesday night in a Vancouver hospital. Older people and those with underlying medical conditions are most at risk for contracting the virus.

Those Canadians hospitalized in Japan were among 59 who had remained in that country after being taken off the Diamond Princess cruise ship.

“At least three to four Canadians,” Tam said, are “in a serious condition” while the rest have been treated and left hospital, after testing twice as negative for the virus, many of whom have returned to Canada.

Tam, Health Minister Patty Hajdu and Deputy Prime Minister Chrystia Freeland sought to reassure Canadians that Canada’s health system is adjusting pandemic plans and is ready to deal with a surge in cases, should it happen here.

“We do have battle plans,” said Hajdu.

Freeland said a cabinet committee struck to monitor the situation has reviewed detailed “scenario plans” prepared by the federal public service.

“At the same time it’s important for us in terms of public health and in terms of our economic response to seek what I would call the Goldilocks response,” said Freeland. “Not too hot, not too cold. It’s important for our response to be adequate to, and appropriate to, the situation in which we find ourselves. We can’t be slow in responding but neither should we overreact.”

There has been no community transmission, as the experts call it, and so government officials repeatedly assure Canadians the outbreak can be contained with common-sense advice such as washing hands, monitoring symptoms, staying home if sick and reporting any COVID-19 symptoms to public health authorities.

But that advice has failed to reassure Canadian frontline health workers, particularly the Canadian Federation of Nurses’ Unions. It says national guidance for provincial health systems are failing to keep pace with Europe, United Kingdom, United States, and since Monday, the province of Ontario — all of which are taking a more precautionary approach, assuming that it is possible the COVID-19 virus might yet be found to be capable of transmission via airborne means.

Linda Silas, president of the nurses’ federation, said in an interview that the lessons learned in the SARS, H1N1 and Ebola outbreaks still aren’t being heeded. Nurses are demanding health authorities use the “precautionary principle” for the workplace. “When the evidence is not clear, you protect for all methods of transmission — contact, droplets and airborne — and why today are we still in the same situation?” she asked.

Silas is angry at suggestions by the Public Health Agency of Canada that high-level protection must be only be used in certain settings and procedures lest the system risk shortages.

“All due respect,” said Silas, “we’re not about to run out today. If we get into a situation where we’re running out, we’ll work with the governments and the employers about what we do next, but right now we’re trying to contain a virus, and the powers that be (say), ‘oh we do not want to give you proper protection in case we run out?’ ”

“So what is it? — the first 100, we’re going to let you get sick and after that we’ll say ‘oh we’ll protect the rest?’ It’s nonsense. We’re talking about a handful of health care workers, nurses doctors, the majority working in large centres which are well equipped . . . that will be dealing with these patients face-to-face.”

Though Tam repeatedly said the situation is “evolving rapidly,” she insisted the scientific evidence says transmission is via droplets that come out of an infected person’s nose and mouth, and contaminates other people or surfaces, not via so-called airborne transmission. She added that certain health facilities and procedures (such as a bronchoscopy) might expose workers to aerosolized virus and thus more risk. But she said those workers have access to adequate personal protective equipment and other resources.

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Tam said health authorities are currently adapting pandemic plans that were designed for a widespread national influenza outbreak to address “the specific challenges of a COVID-19 outbreak.” She said they recognize the two are different respiratory infections but believe there are “enough similarities for this plan to provide us a solid foundation and advanced starting point for a comprehensive response.”

However, Hajdu conceded the federal government is investigating to ascertain if there is enough adequate personal protective equipment for frontline workers, and whether there are additional ventilators “should people get to point where they need to be intensively cared for if they have a severe expression of the illness.”

The officials defended Ottawa’s decision not to close borders to travellers from infected countries, even as they said as the virus sprawls across the globe, it’s harder and harder to do that, especially when it has an incubation period of 14 days during which people might not show any symptoms or be sick.

“The border is never a specific spot where you pick up cases, or diagnose cases,” said Tam. “It is the spot where you provide people information as to what they should be watching out for and what they should do if they get sick, particularly a number where they can call if they are concerned because this virus has an incubation period . . . of 14 days.

She insisted that so far the Canadian approach has worked, as travellers from Iran and Egypt who got sick reported to Canadian authorities before outbreaks in those countries were widely recognized.

“I think calibrating is important,” said Tam. “This is an actual marathon that we’re on, right now we’re at a pace which is . . . commensurate with the requirements of where we are now, and we have flexibility to escalate as we need.”

Hajdu also said she believes it’s only a matter of time before there is a community outbreak, however the intent of the government’s strategy now is to “delay” its onset.

“If we can delay obviously community transmission to beyond the normal typical flu season then we can actually provide some slack in the health care system to address things like shortages of beds, and the burden on health care systems that oftentimes flu season exacerbates.”

At Queen’s Park, Ontario Health Minister Christine Elliott said the provincial government is ready to move decisively should the number of cases become a serious concern by spreading beyond travel-related infections that have spiked recently but remain under control with no unexplained person-to-person transmission.

That could result in increased expense for the government with a provincial budget looming March 25.

For the first time in days, Ontario did not report any new confirmed cases of COVID-19 by Wednesday dinnertime but was awaiting test results on 102 people. The province has had 20 cases, three of which have been cleared of the virus after testing negative on two sets of nose and throat swabs more than 24 hours apart.

Ontario Finance Minister Rod Phillips, who was with provincial counterparts on a conference call about the novel coronavirus with federal Finance Minister Bill Morneau, said it’s too soon to say what economic aid the business community might need if COVID-19 takes hold widely in Canada as it has in other countries like Iran, Italy, China and South Korea.

“It’s important first of all that we deal with the public health aspects . . . but we’ll look at whatever the economic impacts are,” he said, pledging Elliott will be given “the resources that she needs to protect the health and safety of the people of Ontario.”

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