Is Canada ready if Ebola virus outbreak spreads to North America?

Canada has expressed measured confidence in the face of a growing outbreak of the Ebola virus, which has now spread to four African nations and sent other countries scrambling to prepare for its possible, and perhaps inevitable, arrival.

Prime Minister Stephen Harper told reporters this week that the Ebola virus outbreak, which has claimed more than 720 lives since it was first reported in March, is a major epidemic and while Canadian officials are concerned, the risk it spreading to Canada is low.

While that may be the case, other Western nations have mounted a more vigorous response to the threat of an Ebola spread and Canadian health officials have followed suit.

British Prime Minister David Cameron has said the Ebola virus was a "very serious threat" to the country, while Jeremy Hunt, the country's health secretary, stated they have put the necessary expertise and resources in place to "deal with anything." The Telegraph reports that a British emergency planning committee has readied itself to introduce additional precautions should the likeliness of Ebola reaching the country increase.

In America, the realities of an Ebola spread have already taken root. Two U.S. health care workers were infected by the virus while working in Liberia, though no cases have been reported on U.S. soil. Experts told ABC News that it was likely that at least one person infected with Ebola will travel to America during the outbreak. A spokesman for the Center of Disease Control and Prevention said that regardless of the likelihood of its arrival, health officials were prepared to stop it from spreading.

Dr. Jay Keystone, who works in the tropical diseases unit of Toronto General Hospital, said this Ebola outbreak is the worst the world has seen.

"It's different because it is crossing borders, it is because it is centre cities instead of villages," he told CBC News. "In a village you get an outbreak, it kills most of the patients, everybody leaves and it is over. Now we are in cities, it is now moving cross-border. People are hiding their cases."

The outbreak has so far been confined to Africa but continues to spread, with 122 new cases and 57 additional deaths being reported on Thursday. According to the latest information from the World Health Organization, there are now 1,323 infected patients and 729 casualties across four African nations.

Numbers released on Thursday place Guinea, Libera and Sierra Leone at the epicenter of the outbreak. Guinea has a total 460 suspected or confirmed cases and 339 deaths; Liberal has 329 reported cases and 156 deaths, and Sierra Leone has 533 cases and 233 deaths.

Nigeria also confirmed one fatal case of Ebola, in a civil servant who flew into the country after working in Liberia.

There is also some concern that the virus may have spread to Togo and Ghana, two countries where the civil servant spent brief airport layovers. So far no infections have been reported.

The WHO has launched a $100-million strategy to combat what they have called an "unprecedented" outbreak, in the hopes of containing its spread and limiting its impact.

“The scale of the Ebola outbreak, and the persistent threat it poses, requires WHO and Guinea, Liberia and Sierra Leone to take the response to a new level and this will require increased resources, in-country medical expertise, regional preparedness and coordination,” WHO Director-General Margaret Chan said, according to the Associated Press.

With all of this in mind, countries around the world have begun ramping up their own efforts against the spread of the disease. While Canada doesn't have any direct flights to affected countries, it is still taking precautions at its border entry points. According to the Public Health Agency of Canada, they have a number of systems in place to identify and quarantine sick travellers as they enter Canada.

Dr. Gregory Taylor, Canada’s deputy chief public health officer, says every point of entry into Canada is subject to quarantine inspection, via the Quarantine Act. Travellers are required to report any illness and airport authorities are ordered to identify any passengers they suspect of being sick.

"Quarantine officers are vigilant in their surveillance of travellers who are ill, including those showing signs of nausea, vomiting and diarrhea, or other indications of an infectious disease. These officers have authorities under the Act to take action to protect the public," Taylor said in a statement.

This plan is far from infallible, however. For one, it relies on visual identification of potential illness, as well a person's willingness, or ability to identify themselves as a potential case.

In 2007, Dr. Richard Schabas with the Hastings and Prince Edward Counties Health Unit in Bellville, Ont., published a commentary on the Quarantine Act in the Canadian Medical Association Journal that doubted the relevance of Canada’s Quarantine Act.

"It would be impossible to identify all people potentially exposed to a disease infecting hundreds of millions of people worldwide. In addition, people with asymptomatic infections would still slip through a quarantine net," he wrote.

He further noted that when SARS hit Toronto, compliance (those who willingly engaged in the quarantine process) was no higher than 57 per cent.

That is where our health system kicks in. According to the national public health agency, Canadian hospitals have sophisticated infection control system in place to limit the spread of infection.

In Ontario, that system was reviewed and improved following the 2003 SARS outbreak. Communicable diseases are now monitored by the Infection Prevention and Control team, which maintains a unit of infection control experts who are dispatched to hospitals when an outbreak is reported.

Keystone, the tropical disease expert at Toronto General Hospital, played down the likelihood of the Ebola virus reaching Canada, but said it was a possibility, and it would put first responders at the greatest risk.

He noted that in previous Canadian outbreaks of cases comparable to Ebola, most of the people infected are paramedics and emergency room doctors, who are subjected to an infected patient before the issue is clear. After that, Canada's impressive oversight network has been able to limit the spread.

"So far (the Ebola outbreak) has really been confined to Africa. Truly very few cases coming out of Africa, none of them have spread. Yes, a major problem in Africa right now, not a big problem for us at the moment, and I don't think it's going to be."

Canada’s health officials hope he’s right. But they are prepared for the chance that he is not.

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