University of Toronto faculty are at the forefront of a global health response to the Ebola outbreak that has killed over 4,400 people.
On October 14, the World Health Organization (WHO) said that the death rate of West African patients reached 70 per cent and that the number of new cases may soon reach 10,000 per week.
Though there are no confirmed Canadian cases, a number of Canadians who recently took trips to West Africa have been kept in isolation after reporting Ebola-like symptoms. So far, all have tested negative for the disease.
“We know how to deal with this”
According to Dr. Eleanor Fish, associate chair of international collaborations and initiatives and professor of immunology, it is unlikely that Ebola will become a pandemic in Toronto.
Toronto previously dealt with the outbreak of an infectious disease in 2003, when a tourist who visited Hong Kong brought severe acute respiratory syndrome (SARS) to Toronto. Forty-four Canadians died of the disease, and 400 became ill.
During this previous event, a number of faculty played important roles in containing the outbreak, including David Naylor, past–U of T president and former chair of the national advisory committee on SARS and public health; Sheela Basrur, former Ontario chief medical officer of health; and Allison McGeer, a microbiologist and infectious disease consultant.
Ross Upshur, clinical public health division head at the Dalla Lana School of Public Health, said that the SARS outbreak identified numerous flaws in Canada’s healthcare system that were subsequently addressed.
Upshur is now leading the Dalla Lana School of Public Health’s Ebola Working Group, which has highlighted the importance of rapid response to a viral outbreak.
The working group consists of both professors and public health students.
“Communication between Public Health Ontario, the Public Health Agency of Canada and the WHO has been improved,” the working group said.
Fish echoed the working group’s findings. “I don’t want to say we’ve set the standards, but from our experience with SARS, we know how to deal with this,” she said.
“We identified hospitals, we identified teams, we have all the personal protection equipment,” she added.
University administration is also taking a proactive approach to the health threat posed by Ebola. A notice released by the university through Blackboard provided information on the virus, as well as contact information for university health resources.
Althea Blackburn-Evans, director of media relations, said that the university is committed to supporting faculty, staff, and students through a potential public health threat. “The university relies on the information provided from the relevant Ministry and health agencies, and will follow any recommendations from these agencies,” she said.
Similarly, the university’s Health and Safety Policy, published by Angela Hildyard, vice-president, human resources and equity, makes an exhaustive commitment to high health and safety standards. “The University will strive to exceed the legislated requirements by adopting the best practices available to protect the University community,” the policy says.
The risk of potential outbreak has nonetheless caused students to think seriously about their own medical security.
Mary Githumbi, a third-year international student, said that her University Health Insurance Plan (UHIP) would afford the same treatment as the Ontario Health Insurance Plan (OHIP), but expressed concern that administrative burdens associated with the plan could cause issues.
Ontario disqualified international students from OHIP in 1994, leaving international students to pay private health insurance fees through UHIP.
“This is a barrier to healthcare since the student may not have the finances to pay upfront,” Githumbi said.
Fish expressed concern that Canadian discourse on the Ebola outbreak in West Africa only recently became more urgent, and said that the slow international response played a key factor in the virus’ migration from West Africa to other parts of the world.
Although the outbreak began in fall 2013, Fish said that Canada has yet to contribute certain basic tools, such as personal protection equipment, medication, and hydration equipment.
“Where are our priorities?” Fish said.
In the meantime, Fish is committed to using her research to help quell the outbreak in West Africa.
Her research focuses on using synthetic interferon, a substance naturally released by the body’s immune system, to reduce replication of viruses.
Fish said that the Ebola virus, like SARS, blocks interferon to evade immune response. By producing interferon, Fish added, it is possible to boost the immune system and inhibit virus replication.
Though there is no human trial evidence that the drug is effective for treatment of Ebola, Fish said that studies of interferon’s effectiveness in primates are encouraging. Interferon also has the advantage of being currently available, unlike many study drugs currently being developed for Ebola.
“Time-wise, there’s some imperative to do something urgently. Interferon is available, we’ve drafted a protocol, there are individuals in Guinea who are interested in implementing this as soon as possible,” Fish said.
The Ebola Working Group at the Dalla Lana School of Public Health is mobilizing research to help curb the outbreak.
“As a top-rate research institution, we have the capacity to conduct research to gain a comprehensive outlook on the biological, epidemiological, ethical, and social components of the Ebola outbreak,” the group said.
The group emphasized the importance of using the large-scale outbreak as a learning opportunity for future outbreaks. “Due to the scale of this outbreak, it provides us with an opportunity to understand the disease better and how to treat it,” the group said.
Meanwhile, some students described the need to be involved in broader discussions of public health.
Victoria Banderob, third-year health and disease and anthropology student, said the outbreak provides a real-time case study for students and faculty from every discipline at U of T.
“This institution is [full] of minds that have this ability, and those at the helm of organizations will have no one interjecting or criticizing their decisions unless questions are asked,” Banderob said.
Fish said that the university’s Beyond Sciences initiative, where undergraduate and graduate students come together to look at ways to improve global health outcomes, is one example of student engagement in public health issues.
“There are many ways that you can get involved in public health … We have First Nations communities that would benefit from social justice. We have marginalized communities … that cannot access [public health] easily,” Fish added.