Be informed

There is a lot of misinformation circulating which can escalate stress and anxiety, so make sure you are getting your news and health updates from trusted, verified sources. Keep important phone numbers and web links close at hand, so if something happens, you know who to reach out to. Visit sunnybrook.ca/coronavirus for information and links from trusted sources.

Don’t panic

Arm yourself with trusted information, as this will help you adjust your level of concern to appropriately fit the situation. And while it’s important to stay informed with reliable information, know that overwhelming yourself with difficult news and headlines can increase stress and anxiety, and lead to unnecessary worry.

Take reasonable precautions

Be appropriately prepared rather than stockpiling or overbuying. That in turn can shortchange the supply for others and intensify feelings of panic.

It can help to remember that there are many things that are in your control, like practicing good hand hygiene and not touching your face, to minimize the risk of getting sick. Social distancing can reduce your risk of catching the virus.

Think about others

Call, message or email friends, family, neighbours and loved ones. Even if we are physically isolated, we are fortunate to have access to technologies that can virtually connect us so we don’t feel alone.

Practice good self care

In times of heightened stress, we all need extra rest and relaxation. Everyone will have their own favourite activity to unwind, so make that a priority over the days and weeks ahead. Try to maintain a healthy diet, get enough rest, and be physically active (even at home), as these factors can significantly impact overall mood and quality of sleep.

The post Has COVID-19 affected your mental health? Here are some tips that could help appeared first on Your Health Matters.

The infectious diseases physician and microbiologist is one of the key leaders in Sunnybrook’s response to COVID-19, the novel coronavirus. She is also a member of a local working group of scientists who are researching the virus and finding ways to better combat it.

Along with her colleagues, Dr. Mubareka recently received a grant that will allow the group to use next generation sequencing technologies to capture COVID-19 from patient samples and generate whole genome sequences in real-time.

“We want to develop a sensitive, real-time advanced sequencing approaches to help hospital labs better detect and characterize the virus.”

Faster generation of additional and accurate genomic data will improve diagnostics and help researchers better understand COVID-19, including how much virus is shed and whether this relates to disease severity or poor outcomes. This will then allow researchers to further explore key questions that are relevant to front-line healthcare providers and the public, like how the virus transmits, and for how long.

As all eyes are on the world’s infectious diseases experts and infection prevention and control teams as they try to learn more about this new pathogen and control its spread, Dr. Mubareka says she draws upon her own curiosity and uses that to drive her forward, for patients and the community.

“We are performing real-time science,” said Dr. Mubareka. “By leveraging existing projects and technologies, Canada’s microbiology, infectious diseases and genomics experts are all working together to improve our understanding of this emerging pathogen.”

For accurate and up-to-date information about COVID-19 please visit sunnybrook.ca/coronavirus.

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Dr. Samira Mubareka, infectious diseases physician and microbiologist, and Dr. Jerome Leis, infectious diseases physician and medical director of infection prevention and control, answer some questions about this novel coronavirus below.

What is a coronavirus?

Dr. Samira Mubareka (S.M.): The term corona actually describes what the virus looks like under an electron microscope. There are proteins on the surface that people think look like a crown [corona is Latin for crown].

The group of viruses is actually quite diverse. These viruses can infect birds, animals and, of course, humans.

A number of coronaviruses that infect humans every year, and there are four in particular that cause the common cold. So, most of us would have been infected with one of these coronaviruses, if not all of them, at some point in our lives. These are coronaviruses that are fairly well-characterized. Obviously, there’s a spectrum of illness associated with them, like the common cold – most cases are mild, but for some patients, even a common cold can lead to a more severe illness.

In addition to those four common strains, up until now there were two strains associated more with severe illness: SARS and MERS.

I’ve heard people compare this novel coronavirus to SARS. Is it really that similar?

Dr. Jerome Leis (J.L.): While you may have seen some comparisons being made to the SARS virus that we saw in 2003, there are a few important differences.

1. The improvements in diagnostics have allowed scientists to rapidly identify the cause of this infection as a coronavirus – with improved communication and surveillance compared to what happened in 2003. This can really help limit spread of the infection.
2. Although we are still learning about this virus, the infection that it causes does not appear to be as severe.
3. Our public health and infection control programs in Canada have improved significantly compared to 2003, which allows us to rapidly respond and limit spread of this infection.

How has the response to this outbreak been so far?

S.M.: From the outset of this outbreak, there’s been a lot more transparency and communication. That’s very different from SARS back in 2003, where information was guarded, was not being shared openly, or there were conflicting pieces of information coming out. What we’re seeing right now [from authorities in China] is more consistent reporting, more transparency and much clearer communication.

The other thing is that we know what we’re dealing with this time. With SARS, it was a very long time before they identified the causative agent as a coronavirus. At one point they even thought it was bacteria that was responsible.

This time – partly because of history and learning from that, and also because we have better tools now than we did 15 years ago – they were able to identify the causative agent as a coronavirus and then sequence it really early on. Not only does that help reassure people as to what’s going on, but it also helps scientists, microbiologists and virologists to develop diagnostic tests. It’s a lot easier to develop an assay if you know what the sequence is.

Since SARS, our public health and infection control programs have been strengthened. That has a huge impact, probably more than anything, in terms of actually controlling the spread of these viruses.

What are the symptoms of this novel coronavirus?

S.M.: So far, it does sound like a lot of the cases can be mild. There are definitely more severe cases like pneumonia, or they can lead to respiratory failure, and there have been a few deaths. But the symptoms are really non-specific, so they’re a lot like what we would see with the influenza virus, things like fever, dry cough, sore throat, muscle aches, headaches, those kinds of things. Unfortunately, there’s no specific symptom associated with this particular virus.

Is Sunnybrook doing any additional screening for this novel coronavirus?

S.M.: Since it happens to be flu season right now, as part of our protocols, people are being screened at the majority of healthcare centres for these symptoms. We’ll be using protocols that we’re already using on an annual basis for the influenza virus.

J.L.: It’s helpful that it’s flu season, because healthcare workers already know to be on alert for respiratory symptoms. There are already a number of cold and flu viruses circulating around the country, which you can track on Health Canada’s FluWatch. We also use a variety of screening tools all year round for respiratory illnesses in general, so this is no different.

What’s the best way to prevent transmission of respiratory illnesses like this?

J.L.: Most respiratory viruses are transmitted by droplets, but there are simple things you can do to prevent transmitting it to others: clean your hands; avoid touching your face; stay home if you feel like you’re getting sick; and cover your cough/sneeze with a tissue or your sleeve, rather than your hands.

Is there anything else I can do to protect myself?

J.L.: It’s important to remember that the greatest risk to Canadians remains the respiratory viruses that circulate here, and not those that could be imported from abroad. In particular, influenza remains the greatest risk to our staff and patients right now, killing over 3,500 Canadians every year. In spite of those numbers, influenza vaccination rates continue to hover around 40% for the general public. If you haven’t had your flu shot yet, it’s not too late to get it from your family physician or at a pharmacy. Protect yourself from the respiratory illness you are most likely to get – the flu.

Updated March 9, 2020

Get answers to frequently asked questions and more at sunnybrook.ca/coronavirus

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As I go through yet another box of tissues, I thought I’d reach out to Dr. Lisa Del Giudice, family doctor at Sunnybrook, to check if I’m just unlucky on the germ front this year, or something else is wrong with me. (Learn about the difference between colds and the flu)

“First off, nothing is wrong with you,” she assured me. “Some years, there seem to be more viruses going around. Sometimes our exposure to these cold viruses go up due our environment — our kids bring them home from school or daycare, our jobs in healthcare or education put us in close proximity to lots of viruses, or we just need to be out and about in public places. Often times we get re-exposed just as we are getting over one cold when our immunity is down from trying to fight the first cold.”

That sounds familiar. And makes sense. But why do some people (ie. me) catch more colds than others (ie. my husband)? Dr. Del Giudice says there’s a number of factors.

“Some people just don’t have the same exposures – no visits with young kids, they don’t ride public transit, they avoid other people with colds,” she said. “Some people have built up a good immune system from previous colds. And, some people are very good at taking care of themselves when they feel a cold coming on: they stop and rest so things don’t escalate.”

Dr. Del Giudice says some people have a tendency to get longer or harsher colds, for example those who smoke or vape, and people with lung conditions like asthma, emphysema or chronic bronchitis.

To help avoid these nasty viruses, wash your hands. Wipe the grocery cart with the disinfectants at the entrance to the store. Open doors with your sleeve. Stay home. If you have to be around people, avoid physical contact (don’t shake hands, hug or kiss). Cough, sneeze and blow your nose away from people or objects people will touch. If you have to do these things around people, cough or sneeze into your sleeve. Wash your hands after.

“Try not to touch your face as your hands get dirty fast. Wash your face when you get home to get all those germs off,” Dr. Del Giudice said.

If possible, separate infected family members from the well family members – don’t share a bed if someone has a cold and you want to avoid it, Dr. Del Giudice added.

While most people don’t need to see their family doctor for a cold, you should see a doctor if you have a fever lasting more than five days, have trouble breathing, chest pain, or your symptoms worsen after seven to 10 day. Also, keep an eye on your snot.

“We expect to see discoloured mucous in the first five to seven days but if that worsens or changes from clear or white to dark yellow, orange, brown, green mucous on day six or seven, then you should see a doctor.”

Other reasons to see a doctor include coughing up blood or a post-viral cough lasting longer than four to six weeks.

“Older adults often don’t get measurable fevers so just checking their temperature may not be enough,” Dr. Del Giudice added. “Older adults with pneumonia might hallucinate, say or do odd things and get very weak. These patients should see a doctor.”

Dr. Del Giudice said while antibiotics won’t help the common cold, over-the-counter medications can help ease some of the symptoms that come with a cold, but they should be only used for a short time. Salt water nasal rinses can help get rid of mucous in the sinuses (always follow the instructions on the package).

And, don’t hesitate to put the kettle on.

“Warm water with lemon and honey is the safest and most natural thing to take to break down mucous that drips down from the sinuses and collects in the throat,” she said.

Dr. Del Giudice’s final pieces of advice:

“Rest and take care of yourself. We all have a tendency to push through our colds. Be patient, take it easy, and give it time. Get your flu shot to help avoid the respiratory flu. And if you smoke or vape, please consider quitting. I promise you will tolerate your colds better.”

The post How to avoid (and find relief from) the common cold appeared first on Your Health Matters.

Well, I’ll give you the bad news first: these types of viruses are typically very highly contagious and spread very easily through families and households.

The good news is if it’s been over three days since your exposure, you have likely dodged this one (knock on wood).

“Winter vomiting bugs” (also referred to as the stomach flu) that cause quick onset vomiting and/or diarrhea are typically noroviruses. They usually take one to three days to incubate (but can strike even faster) and often seem to come out of nowhere, and usually only last about 24 hours.

These viruses are spread in droplet form, most often on the fecal-oral route (think someone goes to the washroom and doesn’t wash their hands properly and then touches a shared surface, which you later touch and then touch your mouth). The viruses can also spread through airborne particles of vomit, and in the vomit itself. And, as you describe, this can get everywhere. If you are the person cleaning up the mess, it’s really hard not to get it. If you are cleaning up, touching the laundry, changing diapers, or comforting a sick little one, wash your hands…wash your hands a lot.

Routine handwashing is the number one way to prevent these types of illnesses from spreading. People, especially little kids, can carry and pass along the virus even if they don’t themselves have symptoms. Be a vigilant handwasher at all times of year, but it’s particularly important if the “vomiting bug” is in your home or going around your child’s school. Some research suggests alcohol-based hand sanitizers don’t kill these viruses so go for good ol’ fashioned soap and water whenever possible.

These kinds of viruses also survive on surfaces for a long time. Let’s say the infected person uses the washroom, touches the tap to turn it on and then you touch the tap, then you put in your contact lenses or floss your teeth, you are likely exposing yourself to the virus. Wipe everywhere the affected person may have touched – door handles, light switches, toilet seat and flusher, taps, toys, phones, your kitchen. Many household cleaners aren’t great at killing the viruses, so look for something that’s bleach-based.

Once the virus enter your body, there’s nothing that you can do to stop it from materializing; no magic pill that will suppress it. If it strikes, be sure to rest, drink lots of water and avoid dairy if you’ve got diarrhea. Wash your hands with soap and water every time you use the washroom or touch your mouth or nose, and wipe down the surfaces in your home.

One last thing, a common misconception is that the “flu shot” should protect against this nasty bug. Just a reminder, the flu shot offers protection against influenza, the respiratory flu – which hits with fever, aches, cough, sore throat, congestion, headache. Learn more about that here. There’s no vaccine for the norovirus – the best way we can stop its spread is by handwashing!

(Written as told to Alexis Dobranowski)

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Over the past century, access to effective antibiotics has saved millions of lives, and enabled major medical and surgical breakthroughs. The misuse and overuse of antibiotics, however, has contributed to a phenomenon known as antibiotic resistance.

“Antibiotic resistance is rising to dangerously high levels in all parts of the world, including Canada. It threatens our ability to treat common infectious diseases, resulting in prolonged illness, disability and death,” says Christine Peragine, Pharmacist and Clinical Research Fellow in Antimicrobial Stewardship and Infectious Diseases at Sunnybrook.

Antibiotic resistance is increasing the overall cost of health care, by contributing to lengthier hospital stays for patients and more intensive care unit admissions.

It’s also impacting many of the medical advancements we take for granted, like organ transplants, chemotherapy for cancer treatment, diabetes management and major surgeries. To be successful, these conditions and procedures require effective antibiotics, because they have a high risk of infection. If current trends continue, it will become more difficult to achieve good outcomes for patients.

Here’s what you need to know about antibiotic resistance:

What is antibiotic resistance?

Resistance develops when potentially harmful bacteria change in a way that makes them immune to antibiotics. Resistant bacteria survive, multiply and spread, causing more harm.

How does antibiotic resistance happen?

Drug resistance is a natural evolutionary phenomenon. When people take antibiotics for a bacterial infection, the antibiotic kills off the “weaker” organisms. However, there may be some organisms that are resistant to the antibiotic, so they aren’t killed off. This allows them to multiply and spread, meaning that the next generation of the bacterial infection will no longer respond to (or be killed off by) that antibiotic.

Why is antibiotic resistance a problem?

Antibiotic resistance is a problem because standard treatments become ineffective. An antibiotic that used to work on certain infections no longer does. People are unable to recover from infections, and may then spread those infections to others.

In Canada, the prevalence of resistant- and multi-drug resistant bacteria (also known as ‘superbugs’) is increasing. We are one step away from creating a superbug resistant to all commercially available antibiotics that would be capable of defeating every antibiotic in the medicine cabinet.

What can you do to reduce antibiotic resistance?

If you’ve been prescribed antibiotics, there are a few easy steps you can take to prevent antibiotic resistance:

1. Only take antibiotics in the way they have been prescribed to you

2. Don’t ask for antibiotics to treat viral infections like colds and the flu. Antibiotics have no effect on viruses, and won’t speed up your recovery from viral infections

3. Clean your hands often! It is possible to pass on antibiotic resistant bacteria to others, so prevent the spread of germs by practicing good hygiene

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“Zika virus comes from the same family of viruses as Dengue fever and West Nile virus. It’s predominantly spread by the Aedes mosquito, although it is not circulating here in Canada so there’s no risk of contracting Zika by mosquito bite here,” says Dr. Andrew Simor, head, Department of Microbiology and Infectious Diseases consultant at Sunnybrook Health Sciences Centre.

There are, however, other ways the virus can be transmitted. And while most people who get Zika will never experience any symptoms, women who are pregnant or trying to get pregnant are at much greater risk. Here are three things you need to know about Zika virus:

1) Most people don’t even know they have it

Only about 20% of people who are infected with Zika actually experience any symptoms. The rest have no idea they were ever infected with it at all. “If you do have symptoms, it will feel like having a mild flu,” says Dr. Simor. Fever, rash, nausea, joint and muscle pain, headaches and redness of the eyes are all signs of a Zika infection. The only way to know for sure, though, is by getting a blood test.

“There have been instances of people developing Guillain-Barre syndrome several weeks after a Zika infection, but it is rare,” says Dr. Simor. The overwhelming majority of people will fully recover from Zika.

2) Zika can be transmitted through sexual contact

Mosquitos are transmitting the Zika virus in other parts of the world, but not in Canada. So how else can someone get the virus? “The Zika virus stays in the blood for no more than a week, but it may persist in men’s semen for much longer- at least 60 days,” says Dr. Simor. The virus can then be transmitted to the man’s sexual partners.

So, if a man has traveled to a Zika affected part of the world, is bitten by a Zika-carrying mosquito, and contracts the virus (and he often won’t have any symptoms, so he won’t know he had Zika), he may transmit it to his sexual partner for months afterward. It is recommended that men who travel to or live in an area with Zika virus transmission and their non-pregnant sex partners should either abstain from (or use condoms during) sex, in order to reduce the risk of Zika virus transmission.

3) Women who are pregnant, or trying to get pregnant, are at highest risk

For healthy adults, contracting Zika is not serious- most will never even experience symptoms. However, the risk is much greater for women who are pregnant or trying to get pregnant. “There is a confirmed link between a women contracting Zika virus during pregnancy and microcephaly, which means the baby’s brain does not fully form, leading to cognitive impairment,” says Dr. Simor. It’s still unknown how often this happens, or at what point in the pregnancy the risk is highest, but it is important that women who are pregnant or planning to become pregnant take precautions:

• Avoid travel to Zika affected areas
• If travel is unavoidable, take measures to avoid mosquito bites, such as using a mosquito repellant with DEET, using mosquito nets at night, and wearing long pants and long sleeved shirts
• Men from who have traveled from a Zika affected area should either avoid having sex, or use condoms during sex with their pregnant partners, for the duration of the pregnancy

As always, if you have any questions or concerns about Zika virus, discuss them with your doctor.

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