White Coat, Black Art·THE DOSE

COVID-19: The latest guidance for Canadians on travel, quarantines and what to do if you have symptoms

As Canada faces a rising number of coronavirus cases, public health experts and the public alike are dealing with confusion and uncertainty as the situation changes daily. Here are some answers — and key questions experts are still working on.

'We're in this really unstable phase of the pandemic,' Canadian infectious disease expert says

As COVID-19 cases continue to rise in Canada, experts are trying to slow the spread and prevent the health-care system from becoming overwhelmed. (Christinne Muschi/Reuters)

This story has been updated to reflect a new travel warning by the Canadian government. 

With a deluge of news about cancelled events together with conflicting information about what to do — or not do — the worldwide COVID-19 pandemic is causing confusion, uncertainty and worry among many Canadians. 

Health workers themselves are trying to navigate a virus they've never seen before and deal with constantly evolving information too, said Dr. Allison McGeer, a microbiologist and infectious disease expert at Sinai Health in Toronto, and a researcher funded by the federal government to study how the coronavirus that causes COVID-19 spreads. 

"The problem is that we're in this really unstable phase of the pandemic where new cases are appearing, public health officials are uncertain about what the right interventions are to try to slow this down and spread this out so that we can manage health care," McGeer told Dr. Brian Goldman, host of CBC health podcast The Dose.

"Things are changing so quickly [that] ... the right decision today and the right decision tomorrow might be two different things."

Microbiologist and infectious disease specialist Dr. Allison McGeer is pleading with Canadians to be vigilant about the 'boring stuff' — such as handwashing, staying home when they're sick and coughing into their elbows. (Evan Mitsui/CBC)

At this moment, though, here are the answers McGeer and other health experts have for some of the top questions on people's minds:

It's March Break next week. Should Canadians travel?

Not outside of Canada.

In a news conference on Friday, the federal government warned against all international travel and is limiting inbound flights as part of a series of measures to limit the spread of COVID-19.  

What about travel to the U.S.?

The federal government's advisory includes the U.S. 

Travel to the U.S. is currently "unpredictable," McGeer said. 

"They still aren't doing much testing, so it is hard to tell what is going on," she said. 

At a time when health authorities are trying to slow the rise of coronavirus in Canada, people bringing back any new infections during a peak travel period is a worry. 

If 50,000 people travel for March Break and 0.5 per cent of them become infected, that would add up to 250 new cases in Canada, McGeer said. 

What about travel within Canada?

"We still don't have much community transmission in Canada," McGeer said, so the risk of getting COVID-19 is still relatively low. She doesn't think people need to worry too much about travelling within Canada right now — but that may  change as the case numbers rise.     

Dr. Allison McGeer, one of Canada's top infectious disease specialists, joins host Dr. Brian Goldman to give you the most up-to-date information on the new coronavirus, a reality check on travel bans and quarantines and what you can do to protect yourself and the most vulnerable people around you. 30:54

But because the COVID-19 situation is changing daily, people also need to think beyond the actual risk of infection — because no matter where you travel, there's still always a chance you could be told to go into quarantine as a precaution, whether by another country's government or by your employer upon your return, McGeer said.   

"You have to think to yourself: If I got there and got quarantined, how bad would that be? If I came back and somebody said, 'We don't want you at work for 14 days,' how bad would that be? And then make your decision on travel based on that."

What does the scientific evidence say about travel bans and quarantines?

The evidence says that travel bans and quarantines won't stop the disease, but they can delay it, McGeer said. 

The harsh quarantine in China, where the new coronavirus was first detected and became an epidemic, bought much of the rest of the world, including Canada, about three weeks to a month to prepare for the virus's arrival, she said. 

 "That month is very valuable," she said, but it also came at a "tremendous cost to the people in quarantine in China."

That's why decisions about whether to enact quarantines and travel bans are difficult to make.

"How much economic loss — and health losses because [of] the economic loss — are you willing to tolerate in order to delay or slow down the spread of this virus?"

What should you do if you have fever, cough or shortness of breath?

Fever, cough and shortness of breath can be symptoms of COVID-19 — but they're also symptoms of seasonal flu and other respiratory illnesses that are common at this time of year. 

Call your local public health unit if:

  • You have even mild symptoms and you have travelled anywhere
  • You have been exposed to someone known to be infected

"Generally, it is individuals who have travelled or are a known contact of a case, with respiratory symptoms that are new, who are recommended to be tested," Dr. Vinita Dubey, Toronto's associate medical officer of health, said in an email to CBC News.

If you have symptoms and are concerned for any other reason that you may have COVID-19, you can call public health, but you could also call your provincial or territorial telehealth service, or call your doctor to talk about your risk.  

If you have travelled or been exposed to someone with COVID-19 and need immediate medical attention — for example, if you're having difficulty breathing — go to your doctor or the Emergency Department, but call them or Public Health in advance so they can prepare and put infection control precautions in place. 

On Thursday, the government of Ontario — the province that currently has the highest number of COVID-19 cases — announced it is opening dedicated assessment centres at some hospitals in the Greater Toronto Area and Ottawa to do coronavirus testing, and will add more across the province in the coming weeks. 

That's expected to take the load off emergency departments that have seen a jump in people coming in for COVID-19 testing — and also help separate possibly infected people from other patients. 

You should self-isolate while waiting for test results. If you do test positive for COVID-19, you'll need to be quarantined for 14 days.  

It's important remember that the majority of people who get COVID-19 will only have mild to moderate symptoms, health experts say. For others, especially people who are elderly or have compromised immune systems, COVID-19 is life-threatening. 

That's why it's critical that anyone with a cough, fever, shortness of breath — or anyone feeling unwell — stay home and not go to work until they are feeling better, McGeer said, and avoid taking any chances of spreading COVID-19.

Spreading out infections that require hospitalization is also vital to ensuring patients requiring intensive care — whether they have COVID-19 or something else — are able to get it. 

"This outbreak is going to be very hard on our health care system," she said. "It's intensive care unit beds and ventilators that are the real challenge for Canada because we don't run with a lot of spares of either."

The impact on long-term care homes is also a big area of concern, she said, because that's where an outbreak could be "catastrophic" 

As of Thursday, Canada's only COVID-19 death to date was an elderly man who lived in a British Columbia long-term care home.  

B.C. provincial health officer Dr. Bonnie Henry has asked people to practice so-called social distancing to help slow the spread of COVID-19, emphasizing that it's 'not forever.' (Maggie MacPherson/CBC)

On Wednesday, B.C.'s Henry said there have also been positive outcomes where seniors who became infected have recovered.

But she also emphasized the need to ramp up protection for people living in long-term care facilities — including measures such as restricting visitors and screening workers in the facility to make sure they're not ill.   

Should you wear a mask to protect yourself?

If you're not sick, the answer is no, McGeer said. There's no evidence that wearing a mask will protect you from becoming infected. 

But if you are sick, there is some evidence that wearing a mask will help reduce the amount of virus around you, potentially offering a measure of protection to others, she said. 

What should you do if you are infected and live with someone?

Influenza studies have shown that people living together can reduce transmission if they stay at least two metres away from each other and wash their hands carefully, and if the sick person wears a mask, McGeer said. 

But if it's a really small space with a shared bathroom, the non-infected person should consider moving out for a while if they can, McGeer said. It could take up to three weeks for the infected person's test results to come back clear. 

How long is someone with COVID-19 contagious?

That's an area under study, McGeer said. It will likely be another month before experts are able to answer that question with confidence. 

Can a person transmit coronavirus if they don't have symptoms?

Globally, "we have some descriptions of circumstances in which people who were asymptomatic appear to have passed on the virus," McGeer said. 

But it's not yet clear whether that's important, she said, because there's a key question researchers are working to answer: How many people actually have infections without symptoms? If it's an extremely low percentage of the total number of people who have COVID-19, then it may not be worth worrying too much about. 

"The fact that an asymptomatic person has passed on the virus is not the critical issue. The critical issue is whether asymptomatic people fairly routinely pass on the virus," McGeer said. 

Can the virus live on surfaces outside the body? 

This is one of the areas McGeer is researching. 

Unlike bacteria, viruses don't continue to grow outside the body. But they do survive.

They usually survive on a surface longer if they're surrounded by a bodily fluid, such as saliva, McGeer said. 

But to infect you, the virus has to get from the surface inside your body — which means touching it and then putting your hand to your eyes, nose or mouth.  

Contact with infected people, rather than objects, is likely more of a risk, McGeer said. 

"It's really about the people you touch, probably not the things you touch," she said. 

Is banning large gatherings the right move?

The NBA has suspended its season after a Utah Jazz player tested positive for COVID-19. Concerts and events — including this weekend's Juno Awards — have been cancelled. And some businesses are telling employees to work from home — even when there hasn't been an infection. 

How much that will help slow the spread of the virus is unclear at this point, McGeer said. 

"We haven't had COVID-19 before," she said.

So these efforts are "by necessity based on uncertainty, because this is a new virus."

"It's this balancing act," McGeer said. People are trying to make responsible decisions to do whatever they can that might help, while weighing the downsides of what they have to give up. 

"I think the answer is we're going to know afterwards," she said. "I don't think we have enough information to be really confident about which measures are most important and how effective they are."

The Public Health Agency of Canada has issued guidelines to help people make "risk-informed" decisions about group events.   

How long will this last?

COVID-19 could become a new reality — like influenza — experts say.

But it's likely to come in rounds, McGeer said, and this first one will likely be at least four months. 

Infectious disease specialists are hoping COVID-19 will behave like other respiratory illnesses and decline during the summer — so it's possible we may get a reprieve, but no one knows for sure.  

"We do not know how this is going to play out," McGeer said. 

What's the bottom-line advice on COVID-19 in Canada right now?

"You need to recognize that disruptions are coming," McGeer said. 

Over the next weeks and months, it's critical to take prevention measures that people tend to "roll their eyes" at, she said. 

B.C.'s Henry and many other public health experts have recommended Canadians start practicing "social distancing" — increasing the physical distance between people at gatherings, and considering not going to places that are crowded. 

That especially applies if people are feeling even mildly unwell, she said.

"Stay away from others, even if you have the sniffles right now," Henry said. "This is not forever. This is for the coming weeks. The coming weeks where we know we have to do everything we can to prevent transmission of infection in our communities, to protect those people who are more likely to have severe illness, and particularly our seniors and elders." 

It's also the "boring stuff," that's important, McGeer said, including washing your hands, staying home when you're sick and coughing into your elbow. 

It's important to remember that this isn't just about whether you get sick but also protecting those who are vulnerable around you, she said. 

"Just for the next three months, don't roll your eyes," McGeer said. "[Just] do it."

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About the Author

Nicole Ireland is a CBC News journalist with a special interest in health and social justice stories. Based in Toronto, she has lived and worked in Thunder Bay, Ont.; Iqaluit, Nunavut; and Beirut, Lebanon.

With files from Dr. Brian Goldman, Dawna Dingwall, Kathleen Harris, Bethany Lindsay and CBC News

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