Registered nurses Ruth Heeran, left, and Clayton Wilbur don personal protective equipment (PPE) during the Special Pathogens Fundamentals course at Toronto Western Hospital in Toronto, on Monday.EDUARDO LIMA/The Globe and Mail
Inside a downtown Toronto hospital is a six-room, highly specialized unit that can treat patients with rare and dangerous infectious diseases. This includes Ebola, a deadly illness that has caused global concern with a growing outbreak in the Democratic Republic of Congo and Uganda.
The unit at Toronto Western Hospital is the only site in Ontario – and one of only a few in Canada – designated to test and treat patients with special pathogens, which are highly contagious agents that can cause severe disease in humans.
What it’s like on the front lines of the Ebola outbreak
While there are no confirmed cases of Ebola in Canada, staff who are trained to work inside this “special pathogen unit” are on standby, should the outbreak driven by the rare Bundibugyo strain extend its reach into the country.
Justin Smith, director of the University Health Network’s special pathogen program, said his team has been monitoring the Ebola outbreak closely and has taken necessary measures to be able to house suspected or confirmed cases at a moment’s notice.
“In the unlikely event that something like this does pop up, there is a system and people in place to be able to handle it,” said Mr. Smith.
Justin Smith, director of the University Health Network's Special Pathogen Program at Toronto Western Hospital.EDUARDO LIMA/The Globe and Mail
The World Health Organization has confirmed nearly 400 cases and 65 deaths in connection to the Bundibugyo outbreak. This strain is particularly concerning because there are no targeted treatments or vaccines against it.
The outbreak was first disclosed by the WHO on May 15 after it circulated undetected for weeks in the war-ravaged Ituri province in eastern DRC. It is third-largest Ebola outbreak on record. The largest occurred in West Africa in 2014 to 2016, killing more than 11,000 people.
For 90 days, Canada has suspended electronic travel authorizations, as well as temporary and permanent resident visas for people currently in the DRC, Uganda and South Sudan. Enhanced screening measures are also in place at the country’s borders.
Public health experts have stressed that the overall risk of Ebola spreading to Canada remains low, but that the country is prepared to take action if needed.
In Toronto, the special pathogens unit is regularly used for standard intensive care operations, but two rooms have been taken offline and prepped for potential patients.
Mr. Smith said on Friday that ICU nurses and laboratory staff were conducting simulations to ensure they are “up to snuff” on the specialized protocols, including the use of advanced personal protective equipment and specialized waste removal.
What makes this unit unique is that it is a double negative pressure facility, meaning both the entryway and the individual patient rooms draw clean air while ensuring contaminated air is unable to escape. This prevents dangerous pathogens from spreading.
Registered nurse Sydney Kenney, right, assists registered nurses Ruth Heeran and Clayton Wilbur, left.EDUARDO LIMA/The Globe and Mail
“Whether it’s a novel strain of a virus that maybe we’ve never heard of before, whether it’s a complicated strain of Ebola like we’re currently dealing with, or it’s the Andes hantavirus, our approach to special pathogens remains the same,” said Mr. Smith.
“If the time comes where we have to activate, everybody is prepared.”
The specialized unit was formalized early last year, but provincial special pathogen protocols have been in place much longer, rooted in learnings from the early 2000s SARS outbreak in Toronto and the 2014 Ebola outbreak.
In addition to the Ontario site, there is the British Columbia Biocontainment Treatment Centre at Surrey Memorial Hospital.
Susy Hota, UHN’s medical director for infection prevention and control, said specialized spaces in Toronto have previously been used for symptomatic patients and those who failed screenings because of travel history, requiring further assessment for certain infectious diseases.
“Sometimes, the best thing to do is bring patients to our special pathogens unit and contain all activity to this one area,” said Dr. Hota.
Toronto Western Hospital’s special pathogen unit is one of only a few in Canada.EDUARDO LIMA/The Globe and Mail
This decision is based on the patient’s history, risk of infection and where care would be best provided. Testing for rare diseases also takes time and it’s best to keep potential cases contained until the results are known.
Canada’s primary facility for the testing of emerging or rare pathogens is the National Microbiology Laboratory in Winnipeg.
Despite the Toronto unit having six rooms, the special pathogen program has been created for a maximum of two patients at a time. This is because some of the space must be used to safely don PPE, conduct lab work, for storage and to contain waste.
Any waste from the area is considered highly infectious and must be stored in large drums, explained Dr. Hota. Those drums are then handled and transported under strict biohazard regulations.
While there are no confirmed cases of Ebola in Canada, staff who are trained to work inside this 'special pathogen unit' are on standby should the outbreak reach the country.EDUARDO LIMA/The Globe and Mail
Resources, such as staffing, are another reason for the patient cap.
Earlier this week, Ontario Health Minister Sylvia Jones said the province has asked the federal government to fund two additional special pathogen beds that could be used by anyone in Canada. Details on which hospital will house the beds have not been made public.
Dr. Hota said the Toronto team is mindful that adjustments may need to be made if an entire family required hospital care after a potential exposure. But, generally speaking, the likelihood of more than one room being required for use in the region is “incredibly low,” especially in the context of Ebola.
“It’s overall a very low risk for us as it is, but then multiple cases would be even a lower risk,” Dr. Hota said.