B.C. health officer provides hantavirus update

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[00:04:24]Good morning. Apologies for being a few minutes late.

[00:04:34]Good morning and thank you all for being here. I'm Dr. Bonnie Henry. I serve as BC's provincial health officer. And today I'd like to give an update on what's happened over the last 24 hours um with uh the four Canadians who returned here from the MV Hondas.

[00:04:52]I want to acknowledge that we're joining today from the traditional territories of the Lungan speaking peoples and I'm very grateful to the Songis and Isquamalt nations for their stewardship of these lands since time immemorial.

[00:05:06]So yesterday evening I can confirm that the four Canadians who had remained aboard the MV Hondas at the time the WHO recognized that this was an outbreak of Hunter virus. They arrived safely at Victoria International Airport last night. Their arrival went very smoothly and I'm very grateful for all of the support that we had and they are all now isolating in the Island Health region. I want to express my appreciation for the teams from the public health agency of Canada, from the quarantine service, the Canadian Armed Forces, and of course our very strong island health teams for making it seamless and smooth.

[00:05:49]I will say that uh I was reticent to say that they were due to or the plan was for them to come into uh Victoria last yesterday when we talked. The flight was still on route as we know to Quebec to Bagotville and we had a number of contingency plans along the place along the the route just in case something happened. So I'm very grateful nothing did and it all went very smoothly last evening. On arrival uh each individual was screened and thoroughly assessed by the Island Health public health teams and uh we were there in a very controlled conditions wearing appropriate PPE.

[00:06:29]All four were and continue to be well and have no symptoms. This is reassuring but as uh we talked about yesterday um we are in uh a very critical phase of the incubation period and in keeping with the established protocols that we're following here and around the world. Um the people who arrived here yesterday were transferred directly from the airport to the secure pre-arranged lodgings where they have begun a minimum of 21day period of of isolation under direction and with ongoing contact of our island health public health team. And I will get back to the why I stress minimum in a minute.

[00:07:19]After talking to each of the individuals, I can confirm that uh two are a couple in their 70s who live in Yukon Territory. One is a person in their 70s who resides here in the island health region and one is a person in their 50s from British Columbia who is currently living abroad.

[00:07:42]We are working closely, as you can imagine, with the Yukon where um the concern was that they do not have the capacity to test or the facilities to care for somebody should they develop the severe symptoms that we're seeing have been associated with this this antivirus outbreak.

[00:08:01]During this time, each of these individuals will be receiving daily monitoring by our public health teams, including regular symptom checks, wellness assessments, and clear guidance on what to do should their health status change.

[00:08:18]And again, these Canadians have been through a very difficult number of weeks. and it showed last night um they were tired and I would say exhausted but very relieved and grateful to be back here in Canada.

[00:08:33]I want to provide assurance as well that at no point during their arrival or transfer have did any of them come in contact with the public and the healthare workers that were involved were all wearing appropriate PPE at all times. We now have daily monitoring in place and they will remain fully isolated for the duration of their monitoring period.

[00:08:56]In u understanding uh what happened on board that cruise ship and discussions, none of the Canadians had known direct contact with ill people on board that ship. Having said that, in a closed environment like a cruise ship, it's very difficult to know for certain. We do know that the uh European Center for Disease Control had people on board the cruise ship who did an assessment of all passengers um who were on board and we consider globally that all of the people who were on board that cruise ship are what we call higher risk contacts. But within that context, the four Canadians were in the lower risk spectrum in terms of where they uh their location of their cabins were and the types of activities that happened on board that cruise ship.

[00:09:44]So that is again something that is reassuring but um doesn't rule out entirely that um somebody may have been exposed and may be incubating.

[00:09:56]As I said, these people are uh right now not showing any symptoms. their inappropriate isolation and monitoring measures in place and we will assure that the situation will be managed carefully every step of the way.

[00:10:13]We've all seen the news and we've had some uh ongoing calls with our uh colleagues at the public health agency and globally about some of the other passengers developing symptoms and developing posit uh testing positive in particularly. It's very concerning and and tragic about a person uh who returned to France and is has tested positive and is quite ill. We are all hoping that the four people who are here with us um will remain well through this incubation period. But this is exactly why we are taking the precautions and why plans are in place should their conditions change.

[00:10:52]We have been discussing uh across the country um as well as globally about um testing and what type of testing might be helpful or might not. Um this is a challenge because there's very little known about how tests can be helpful or not in the management of habirus and particularly the Andy strain of hivirus.

[00:11:16]Um we know that there's little benefit for some tests in uh people who are not showing any symptoms but we're going to reassess that as we see what happens globally. We do have the ability to do appropriate testing for haunt virus including for this strain of hunter virus here in BC and we will be uh monitoring and checking with our colleagues globally about when and what types of tests might be helpful.

[00:11:45]Should any of the four people who are here with us develop symptoms, we have established protocols in place to ensure they can be properly and safely assessed, tested and care for without risk to the public and with all the appropriate precautions for healthare workers in the healthcare setting. So this includes safe medical transport. We have protocols with the BC EMS, strict infection prevention and control measures in uh in all of the health facilities. We have the ability to do the diagnostic uh testing here in British Columbia through the BC CDC and of course access to specialized clinical care should it be needed.

[00:12:28]So my office, the BC Center for Disease Control, Island Health, and federal partners, including the Public Health Agency of Canada, Global Affairs Canada, and others continue to work closely together to coordinate monitoring to understand what's happening with the other uh people who are were on that cruise ship globally. And there's a a strong community who's sharing all the information that we can and to coordinate assessment and care if needed. And I do want to again stress uh how uh grateful I am for the teams at Island Health. Dr. Rake Augustusen is the chief medical officer and her team were fantastic last night and I know that these people are in good hands and will be followed up rigorously. I also want to mention, you know, that it reminds us again of the importance of the WH in coordinating this type of of global uh outbreak implications of an outbreak that have global implications.

[00:13:27]And I'm uh you know just knowing um the challenges that the WHO has been facing it's uh I want to remind people how important it is to have that expertise at the global level to support all of us in sharing information and being able to get determine the best possible ways of action.

[00:13:50]Um I did mention that we have said a minimum of 21 days and we've also um been thinking about you know when does that clock start and uh prior yesterday I had said the clock we thought would start on the 6th of May when the last known uh case was taken off the cruise ship. we've re relooking at that in the face of what we're seeing particularly with the case uh who develop symptoms quite quickly uh in France and so we are agreed and uh we've been talking to the four people who are here that the the clock will start uh yesterday when they arrived here in Canada and there has been uh concerns about you know 21 days versus 42 versus 45. So the known incubation period is about 6 weeks. So that's 42 days. And I can reassure you that these individuals, the four people who are here now will be followed daily for the 42 days of the risk period.

[00:14:57]What we're talking about when I say a minimum of 21 days, that's a complete isolation with no contact with anybody.

[00:15:04]um making sure that they are um safely able to manage. That's the highest risk period for somebody to develop symptoms and that is the minimum that we're going to as we see the situation evolve globally and here um that might be extended it might be extended as far as the full 42 days but uh as you can imagine that's quite a burden on people and it's challenging to stay in one place for that period of time um especially as the risk diminishes over time. So we'll be reassessing that on an ongoing basis depending on how people are feeling, depending on whether anybody develops symptoms and depending on what's happening globally. So the I think we are all aligned globally in that uh all of these individuals will need monitoring at least daily and uh uh plans in place to support them for the full 42 days.

[00:16:02]I know this news again can be unsettling to people in British Columbia and certainly um I I also have felt unsettled as we've been watching what's been happening in the last few weeks especially in the light of course of all that we went through due co 19 pandemic but I want to again reassure everybody that hivirus is a very different disease and it's not spread in the same way that we saw with the corona virus uh with uh influenza, measles and other diseases.

[00:16:37]So we are seeing this in the limited spread so far.

[00:16:42]This is a virus that we know we have had cases here in British Columbia. They're rare and that's why we're learning about uh the transmission particularly persontoerson transmission which is even more rare.

[00:16:57]um it's not highly transmissible and we know that too and it's not what we would consider a disease of pandemic potential.

[00:17:07]It is however a very serious illness. So I think of it as a serious and important disease that we need to understand and we need to understand the risk to these individuals but it's limited in terms of we don't expect to see transmission now that people are safely in isolation and being monitored um to people outside of those who were exposed on that cruise ship.

[00:17:36]If there is a change in the condition of the the four people that we're monitoring here in BC, we will provide further updates as soon as we know. Our priority and my priority continues to be to support the health of these four people who are now home while maintaining our strong safeguards for the people of British Columbia.

[00:17:57]And I want people to be reassured and confident that this response is guided by established public health planning.

[00:18:05]Our teams have had a lot of experience on case monitoring, managing people, knowing how to support them through these very difficult times on evidence-based measures that are continuing to evolve and we will continue in close coordination with our colleagues across the country and globally. And these measures will be applied steadily and carefully as we go through this next few weeks. Thank you very much. I'm happy to take questions.

[00:18:36]Thank you. A reminder to reporters on the line, if you'd like to ask a question, please make sure you are not on speaker phone or mute and press star one to enter the queue. Reporters will be limited to one question and one follow-up.

[00:18:50]And we'll start here in the room with Keith Baldry, Global News.

[00:18:54]>> Uh, thanks uh Dr. Henry. Just to your last point about this not being like co, many people watching this no doubt are going to have flashbacks. you being in this room at that podium against those flags, more than 250 briefings here by you on COVID. Can you again articulate and and explain the fundamental differences between what we're experiencing now and what the corona virus was >> happy to do that I will note it is a different podium so which makes me feel a little better too. Um you know corona virus the SARS Kovv2 virus is one that causes infection in the upper respiratory system first and so people shed quite a lot of the virus in their secretions when they talk or sneeze or cough sing um and it spread through the air and we know that especially the omccron strain of the the corona virus it uh can last in the air for some time and spread quite rapidly um to people especially in closed environments. with poor ventilation. So when we think of corona virus and we think of the cruise ship that happened in 2020, that virus spread very quick quickly through the ship. People were affected even if they hadn't been in contact with somebody because it likely spread through the ventilation system and other areas.

[00:20:15]We're not seeing that pattern of spread with this very serious illness. What we're seeing is people getting very seriously ill and those who provided care to them, those who lived with them, those were their partners who had that strong close contact over a period of time were the people who seem to be getting infected now. So that's very different. It's a very different scenario when I look at it from my perspective knowing how these outbreaks evolve over time. We don't see the same pattern of spread that we would see if it was transmissible in the same way as corona virus or measles or influenza.

[00:20:55]The other one that we see quite commonly spread very rapidly in cruise ships is uh neuroirus which can cause vomiting and diarrhea and you know that can spread very uh quickly and affect people. So that's a completely different pattern than what we're seeing happen and emerge now. And so far there's nothing that makes me concerned that that's going to change. So now that all of the individuals have um been taken back to their countries and and the four Canadians who are here, we know who has been in contact with whom. We know how to manage them, how to make sure that if they develop any symptoms at all that they won't be in contact with anybody other than health care professionals who are wearing PPE and can do it in a safe way. So I think that reassures me that we're dealing with a very different thing right now.

[00:21:49]>> Um I'm sure most most people up until now had never heard of antivirus. Do we have enough scientific data and experience with this virus to make a number of conclusions as we did with the corona virus?

[00:22:02]>> Yeah, we probably know more about haunt virus than we did about the corona virus prior to the pandemic. So haunt virus is something that has been uh in Canada globally. There's European strains, there's strains and South American strains. I believe our first case was in the uh early 90s here in the Canadian case here in British Columbia actually um acquired in a different part of the country. Um so we do know about hav virus. It's a rare disease in that it doesn't happen very commonly but we do have a good test for it. Uh we do know how it spread. So the synombre uh strain of the virus that we see here in North America doesn't has not been known to spread from person to person. Never say never but it has not been known. Um we do know that it's spread by uh rodent droppings, rodent urine, saliva that dries and then can be aerosolized when we do things like cleaning out the cottage before opening it up for the summer. So every year around this time, public health we would put out messages to remind people of the safe way to clean up those dusty places where there might be rodents and rodent droppings.

[00:23:16]And so I would refer people to uh the BCC CDC website to health link and there's lots of detailed information on how to protect yourself from that. We know um in Chile in Argentina they've been dealing with this and strain of the haunt virus for a number of years as well. Um and there is some data. It is limited but there's been published reports about uh clusters of people who have had close contact where it's been transmitted from one person to another person. So that's why it's within the realm of possibility for this strain of virus and that's what we're seeing play out. I think there's global consensus now that it was very likely that the first case or cases the two of them may have been exposed in an area where this strain of the virus is known to be to exist where we know uh where Argentina has reported a dramatic increase in numbers of people with the disease over a hundred in the last little while. So it's likely that that's where these people picked it up and then because it has such a long incubation period um they develop symptoms on board the cruise ship. So we do know quite a bit.

[00:24:31]I think it's really useful to know um we were able to do uh globally they're able to do whole genome sequencing and that's way we could tell that it was the Andi strain um not the synoma strain. It hasn't changed a whole lot so that's something that is quite different. um that's important. Uh that tells us that it's not the the virus isn't mutating and causing different sources becoming more infectious or anything like that.

[00:24:58]So that's also reassuring unlike the corona virus as we remember SARS KV2 it changed quite a lot very rapidly over time. So those are two things that uh we know a lot more about and we're going to learn a lot more with these uh 160some people who have been exposed um over the next few weeks and months.

[00:25:19]>> Our next question comes from Katie D.

[00:25:21]Rosa, CBC.

[00:25:22]>> Dr. Henry, when you talked about the the individuals isolating at an island health location without, you know, I'm sure you can't say the address, but is it a hospital facility or a clinic like and they're all being held together? I yeah I guess can you give us an idea of where this monitoring and where this isolation is happening?

[00:25:41]>> Um yes it's not in a healthcare facility. It's not in a secure facility.

[00:25:46]Um they're being monitored in appropriate places separately. So uh one person lives in this uh region and they will be monitored at home. They live on their own which is makes it easier um more comfortable for them. Uh the other two are in facilities that Island Health has uh procured and that we'll be monitoring um over the next number of weeks as we know but the couple are from uh the Yukon are together and the other individual is on their own.

[00:26:18]>> Just um when you're talking about the difference in in terms of the pandemic um is there almost is there an overcorrection because of how quickly the pandemic the corona virus spread and that it was too late? Is there a um o overcautiousness with this or the right amount of cautiousness? How would you assess how this is being handled both here and globally?

[00:26:39]>> I you know I I don't know if we can be overcautious given the trauma that we've all been through. Um but I I think it is appropriate. It's appropriate uh that because it's such a severe illness.

[00:26:54]That's the thing that that worries me.

[00:26:56]Um it's rare but we've now seen um eight people now nine if you include the person from France who have tested positive uh three people have died.

[00:27:08]That's a very high case fatality rate.

[00:27:11]Um they've become quite ill very quickly. We now have uh one person still in hospital in South Africa, two people in hospital in the Netherlands, one in Switzerland, uh one in France right now and a probable case you may have heard of uh interest in Duna which is a remote island. So it the impact of it even though the risk is relatively low and certainly the risk to anybody outside of those who are on that cruise ship or on one of the flights is is infantismally low. Um and we want to keep it that way.

[00:27:45]But the risk to those individuals is quite high. And because they come from many countries around the world, that means we really needed a a strong coordinated response to make sure we weren't exposing anybody else to potential of of being uh exposed to this very serious virus. So as I say, you know, it's serious but limited. So I think the uh the coordination and the approach that we've had is proportionate to the seriousness of the disease.

[00:28:14]Our next question comes from Rob Buffam, CTV News. Oh, >> hi Dr. Henry. Uh, nice to see you. Maybe not in this setting, but um, I just wanted to understand is the operating theory that everybody who got well that the antivirus in this instance that spread through the cruise ship to a certain extent originated with two people who got it in Argentina and then they spread it through human contact. My basic understanding is that hand virus typically comes from rat feces. But that's not how how everybody here got it. They got it from other people. Is that is that correct?

[00:28:50]>> Correct. And that's the the global hypothesis that makes the most sense given the investigations. I know many people were thinking, oh, rats on board a cruise ship, but it has been thoroughly inspected and there was no evidence of rodents on board the cruise ship. So that uh gives us some pieces of information. And if we look at when the initial case uh so a gentleman from the Netherlands became ill, it's consistent with an exposure before they joined the cruise ship and they were known to have gone on a um into a more remote area where this virus does exist in in rats and other rodents. And so it is very likely, I think the global hypothesis is that the in the the infection um the exposure to the the rat feces or whatever in the dry uh area that they were in happened before they arrived on the cruise ship. And that means that it's hard to say because it was a couple from the Netherlands and they both became ill. Whether they both had the initial exposure or whether the the wife was exposed to her husband once he became ill. But yes, the other people on the cruise ship had uh direct exposure over a prolonged period from in the most part with uh those two individuals when they were sick. So that's important.

[00:30:09]>> Um in the spirit of these pressers, I'm going to try and do a doublebarreled question. Um just wanted to be clear for myself anyways. How many Canadians be currently are impacted by this? I thought I saw something this morning talking about three people in Ontario.

[00:30:24]um is it three or four in BC? I I guess I'm trying to if you know what what the total number of Canadians who are on the cruise ship or who are isolating. And also I'm just curious um Keith asked you a question, Katie did as well about divining the or you know separating this from COVID but you must be feeling some almost I don't know if it's you know PTSD but it must be a a strange feeling for you. I'm curious to get inside your perspective as you've spoken to other global experts as you try and address what is a very worrisome situation.

[00:30:56]>> Yeah. Well, let me address the first one. Um what we know uh as of now there are um six people who are back in Canada who were on board that cruise ship. So four who are now here in British Columbia, two in Ontario.

[00:31:15]There were two other uh events where people were potentially exposed.

[00:31:21]One of them was the flight from Saint Elena to South Africa to Johannesburg where uh the wife of the initial case was on board that flight and was starting to show symptoms. When that flight landed in South Africa, it was they uh were on boarding a flight from Johannesburg to Amsterdam. And so the wife was notably quite ill and was on that flight uh for a period of less than an hour. They were medically assessed.

[00:31:54]The flight was delayed, didn't take off.

[00:31:57]Um and they were taken off the the flight and taken to hospital and died the next day in South Africa. So incredibly tragic. There are people who in Canada who are on the flight from St. Elena to Johannesburg and they are being monitored. They're in Ontario uh one in Quebec and there are people who are on the the flight from uh Johannesburg to uh Amsterdam who were within a uh very close proximity to the individual who was sick for the short period of time that they were on board that flight um or that airplane. and they are also being monitored um in Alberta and Ontario.

[00:32:43]>> Next question comes from Wolf Gang Deer.

[00:32:45]>> Whoops, sorry.

[00:32:47]>> One other uh group of people that we don't consider uh to be at risk and that's people who were the other people who were on that flight from Johannesburg to Amsterdam who were not in the close proximity of where this individual was sitting. So, um, KLM, I understand, has sent letters to those people. We will follow up with them, um, and make sure that they know what to do should they develop symptoms or if they have any questions.

[00:33:19]second question you um I think I've I've talked before about how um I was very concerned in late uh 2019 about what I was hearing about uh infections that were happening in China and our global community of people who follow these things. We were all quite anxious about that and sadly it did turn out to be um you know the tremendous impact it had on all of us and people around the world and yes I probably have as much uh traumatic um stress from that as anybody else in this province in this country.

[00:34:05]Um when I first heard about uh what was happening on board this cruise ship I did have a bit of a sinking feeling but once it was identified as hav virus and once we were very confident that that what was causing it at first you know I was a little incredulous because I hadn't heard much about the strain that could um pass from person to person but again you know globally with the infectious disease specialist uh with public health and ID colleagues around the globe, we all have a very similar approach to this and we calmed each other down. Um, so it is, you know, very different, important, serious and we need to take all those measures to make sure there's no opportunity for others to be exposed to this very, very unfortunate and tragic situation. So that's where I am now been behind this podium, but there you go.

[00:35:01]>> Thank you. Next question is from Wolf Gang Deer, Canadian Press.

[00:35:05]>> Yeah, good morning Dr. Henry. Thank you for taking my question. Uh earlier you mentioned that health officials are assessing whether uh whether there should be testing for uh for antivirus.

[00:35:15]Uh what would that uh testing look like?

[00:35:18]Um I'm talking we're talking we're looking at 5 million people in this province alone. And um how can you be sure or how can health officials be sure uh that this testing will indeed be successful? because uh one of the individuals uh in the US that has tested positive was also asymptomatic beforehand. So I was hoping that you could sort of clarify that.

[00:35:38]>> I'm not talking about testing of people in the province. What I'm we're talking about is the individuals who were exposed. So the four people um two in Ontario, four people here. Um we do have a plan. If any of them develop any symptoms that could be this um even as much as a headache, then we have testing available and a protocol to be able to do that. But globally there's some uh looking at you know what can we learn and can it help us in managing people.

[00:36:08]So there's two types of tests that happen. Both of them are done on blood.

[00:36:12]So it would be taking a blood sample.

[00:36:14]One of them is looking for antibodies in the blood that happen after somebody's been infected. So we do what's called a before and after sample. Takes time for your body to develop those antibodies, several weeks. So it would be taking a blood sample now and then testing again perhaps at the end of 42 days and that will give us a sense if anybody um developed antibodies without showing any symptoms. So those are one of the big unknowns. So that's something we're talking about. Is that worth doing? Does that help us in any way? The second test is what we call a PCR test. So it's able to detect the virus itself. It can't tell if the virus is live or dead, but it can tech detect the the RNA or the DNA in the virus. And that is also done on a blood sample. So, it looks for what we call vymia, virus in the blood. Um, and that was the one that's a little more fraught. For example, my understanding and it's yet to be confirmed from the US is that the the testing was equivocal that there was a positive and a negative and a weak positive and it and the person is asymptomatic. And so there's unclear what that actually means. So that's another one that we're wrestling with.

[00:37:31]If we do these tests, if it's negative, it doesn't tell you anything. It tells you that they don't have the virus in the blood at this minute. But if it's positive, how do we know whether it's truly positive or whether So it it just um those are questions that we're wrestling with in the lab community globally. Um so trying to understand it better.

[00:37:53]>> Thank you for that answer. Um earlier you gave a little nodu uh to the Canadian Armed Forces and you also said that um Island Health has uh secured facilities uh for two at least two two individuals uh to isolate there. Um just putting one and one together here. Um are we to understand uh that these individuals are isolating on one of the Canadian uh armed forces bases that are on the island? Thank you. Actually, no.

[00:38:23]My nod to uh to uh the Canadian Armed Forces was to specifically to 443 Squadron out at the airport who were very helpful um open the facility so that we had a a secure safe place um to safely assess and monitor the four individuals when they arrived last night. So once again, you know, 443 squad squadron was fantastic. They were very supportive and helped us do it in a way that was safe and that nobody was exposed.

[00:38:53]>> Our next question is from McKenzie Reid, Czech News.

[00:38:57]>> Hi, thank you so much for uh coming and speaking to us again today. Uh wondering why bring them to Vancouver Island and to isolate here, especially when yesterday you had talked about the bioontainment center in Siri Memorial Hospital. So why not isolate them closer to that facility rather than having them on the island?

[00:39:16]Yeah, we talked a lot about that, you know, whether they should go to a closed facility somewhere in another part of the country. Um, as I mentioned, two of them have strong connections to British Columbia, including one person who's able to isolate at home, which makes a big difference in somebody's life. Um, and the two the couple from the Yukon, we have a very strong relationship with Yukon. We do the testing for them.

[00:39:42]people with very serious uh illnesses like this um often uh receive treatment here in British Columbia. So it made sense for them to come here. Um the discussion about Lower Mainland versus here um we just felt we had the capacity and the ability to better u manage them in a safer way. Um here we have strong protocols should somebody become ill to be able to test them and care for them here. Um if they become seriously ill and there's any concerns, we have a protocol to be able to take them uh through BC ambulance to uh BC Emergency Medical Services uh to Siri Memorial should it be needed. So they're just on standby, but Siri, as you know, is a very busy hospital. we don't want to take up extra space if we don't need to and it was um logistically worked better to have people here >> and for those people who are isolating together what are some of those protocols to ensure that if one develops symptoms that they're not then giving it to the other person that they are isolating with what is some of that risk and what are some of those concerns around that as well?

[00:40:54]>> Yeah, so this is a couple and they were together on the cruise ship. they were isolating together on the cruise ship.

[00:41:01]Um there makes no sense at this point in time for to separate them especially for the length of time that we're talking about. So they are um considered as a unit. Should one of them become ill clearly that means the risk for the other is much higher and that we would need to assess and manage that as well.

[00:41:19]Um but uh we did this uh in in consultation with them and they are very comfortable being together and really if you think about 42 days you know 6 weeks away from your partner there's not much logic to that given that they've been together for the last number of weeks anyway >> and now we will go to the phones for questions and our first one from the phones is from Julie Laundry Cladio Canada >> Dr. Good afternoon. Thank you for taking my question. Are you looking at how the USA is dealing with their cases and what are what's your level of confidence there? Should Canadians be worried?

[00:41:57]>> Um yes, we're in contact with our colleagues, I should say, um primarily through the the public health agency of Canada who are meeting regularly with contacts from the US, uh from the UK, France. Um we're sharing what we know globally. Um I know that uh I have full confidence in in my public health colleagues in the US to understand the risks and to manage them. Um and I understand that's uh the protocols that they're using. Um so I don't have any concerns. Uh I think we're all looking and talking with each other so we understand what everybody's doing and what we can learn from this to best protect those people who've been exposed.

[00:42:43]Julie, do you have a follow-up?

[00:42:45]>> Yeah, second question. If I understood correctly, the people in Ontario um are not it's not a mandatory isolation. Uh they are encouraged to stay isolated. Is that are you okay with that way to do or should they be uh completely isolated?

[00:43:04]So the people in Ontario, the people here, um we don't do we don't issue an order to require people to do things unless um they're not complying with what we've asked them to do. So it's a last resort. We do have the legal authorities as they do in Ontario um to require people to isolate in a in a facility that we deem appropriate. Um, so we have the the legal capacity to require people to adhere to the measures that we've recommended because this is a serious infectious disease. Um, and I have the authorities, the local MHO has the authorities to do that, but we don't do that unless we absolutely need to. So uh we know that the quarantine service for example uh will uh has provided the four people who arrived with a notice that they are required to report to local public health and then we take over the management and the support over the period of time. So the legal things are there. We use them if we need to the legal tools. Um but for the most part, as long as we tell people what we need them to do and why and give people the means to do it, um people are concerned enough uh about their own health and safety and work with us to make sure we do it in the best way possible.

[00:44:27]>> And our next question comes from Lauren Collins, Black Press Media.

[00:44:32]>> Hello.

[00:44:34]>> Hi, Dr. Henry. Uh thank you for taking my question. Um so based on your uh last response are the four people technically allowed to leave their isolation?

[00:44:47]>> No. So we have asked them to remain isolated. I mean they can go out for a walk but not in go around other people.

[00:44:56]there's, you know, there's parameters that we've put in place and we'll be following up with them daily to make sure that they're doing that and they have um, you know, these are very reasonable people who understand the risks and understand what is happening and are very concerned themselves. So, I have no concerns that people are going to uh run off and go to a party or something.

[00:45:20]>> Lauren, do you have a follow-up?

[00:45:23]>> Yes. Um, so what what are those parameters? If you could explain that, please.

[00:45:28]>> Well, it varies by where people are, but what we've asked them to do at least for the next 21 days is to be selfisolating at home, which means we will support them to get or at home or at the place of lodging that um they've been uh provided with. We'll support them to get any medications to I know there's things like medical appointments and how to do that safely and where uh support them to get groceries and food. So, we're asking them and so far everybody's complied to to stay within the lodging that they're in and not have people come over to visit. They can certainly talk with people and I I think access to the internet was something people were very happy to have to be able to call family and friends and let them know that they're okay. Um but we're asking them to stay within the lodging and around the lodging that they're in. If uh somebody comes to the door, they need to wear a mask um and make sure that they don't have close contact that nobody else comes into the premise during this period of time.

[00:46:36]>> And that's all the time we have for today. Thank you all for joining us.

[00:46:39]That concludes today's event.

[00:46:41]>> Thank you.