Ontario’s measles outbreak through the eyes of front-line workers

Health-care workers battling measles in southern Ontario say they think about the outbreak from the moment they wake until the moment they sleep.

They say treating and tamping down the surge of a disease most have never seen in their lifetime is constant.

Some have even been infected by patients who unwittingly spread the highly infectious illness while seeking help for early but general symptoms — fevers and coughs are common before the telltale rash appears days later.

Measles has spread to more than 3,000 people in Canada this year. More than 2,000 of those infected are in Ontario.

Here’s a look at caregivers on the front lines of an outbreak that has particularly struck a region south and east of London.

“THE UNLUCKY ONES”

Carly Simpson considers herself one of the “unlucky ones.”

Five days after developing a sore throat, body aches and fever, the nurse practitioner gazed at her reflection in the bathroom mirror, stunned to see red splotches all over her body.

“Oh my gosh this is measles,” Simpson gasped.

She said measles never crossed her mind when she first fell ill mid-March, suspecting a more likely cause was her autoimmune disease, ankylosing spondylitis, which leads to chronic pain and inflammation.

After all, the vast majority of cases had been among the unvaccinated and Simpson said she had been inoculated three times — including a booster in 2015 after a test revealed her previous two shots didn’t lend full immunity.

Simpson said she had been assured at the beginning of the outbreak that three shots would be enough to protect her. She still got sick and was essentially bedridden for days, only mustering enough energy to walk to the bathroom. But she said the rash only lasted a day and never spread to her husband or kids.

“I had a mild case because I’ve been vaccinated,” said Simpson, among five per cent of the outbreak’s cases to involve vaccinated people.

She suspected she was infected by a patient who came to her clinic with virus symptoms a couple of weeks earlier.

Early symptoms can seem like other illnesses until the rash appears, leaving health-care workers who examine them vulnerable to exposure.

“Is this just a common cold? Is it just some viral infection?” she said of the questions that dog caregivers.

Shawn Cowley was unlucky, too. He noticed white spots inside his cheeks in late April, and then a red blotchy rash on his forehead that migrated down his face, and onto his shoulders and arms.

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“Fortunately for me, because I was fully vaccinated I didn’t get the full brunt of measles,” he said, explaining that the rash otherwise would have covered his whole body. Still, it took about a week for his body to recover from the exhaustion.

Cowley is a key player in measles containment as head of emergency management and preparedness at the local health unit, Southwestern Public Health. His case was traced to his son’s hockey tournament.

He eventually told his colleagues that he contracted measles but noted there is “a stigma” associated with the illness.

Cowley also felt guilty for going to the grocery store and filling up on gas before he was symptomatic, potentially spreading it to others.

“When you find out you do potentially have measles, and the number of people I’ve exposed, understanding how virulent measles is, that’s a really hard thing to deal with personally because you put other people at risk.”

“SLOW BURN” 

Dr. Erica Van Daalen calls the outbreak a “slow burn” but one that has required close collaboration among local hospitals to safely treat and isolate measles patients.

The chief of staff at St. Thomas Elgin General Hospital said she might see one to three patients in the emergency department on an average day, and often they are children.

As of late May, three infected pregnant women had delivered babies and 15 kids had been admitted. Those include young patients transferred from hospitals in Woodstock and Tillsonburg, which don’t have pediatric units.

“It’s a lot of one-on-one bedside nursing,” Van Daalen said in an interview earlier this spring. “When the days are busy, it wears on the nurses.”

Less than seven per cent of Ontario’s cases have ended up in hospital. But the logistics of safely admitting a measles patient is like expert-level Tetris.

Masked patients are ushered through back doors to negative pressure rooms that keep contaminated air from escaping into other areas of the hospital and infecting more people. The room is sealed and has a system that filters and exchanges the air.

Exposure risks are avoided as much as possible, even trips to the bathroom, said Sangavi Thangeswaran, a registered nurse and an infection control practitioner at both Alexandra Hospital Ingersoll and Tillsonburg District Memorial Hospital.

“We ask the patient to stay in there. If they need anything like using the washroom, we try to give them commodes or urinals, just to lessen the exposures,” Thangeswaran said.

There are five negative pressure rooms at Woodstock Hospital. When they’re full, patients are assessed in the ambulance garage, said David Lambie, a charge nurse in Woodstock’s emergency department.

It is an extra layer of logistics to navigate, said Lambie, whose hospital has cared for 108 measles patients since January, 55 of them kids.

Once a patient is well enough for discharge, their negative pressure room is left empty for half-an-hour while contaminated air is expunged. Then it’s deep cleaned for the next patient, said Thangeswaran.

She said each of her Oxford County hospitals initially had just one negative pressure room in each emergency department but as cases swelled they created three more.

As of June 12, her team had cared for 14 measles patients in Ingersoll and 64 in Tillsonburg.

“INHERENT CHALLENGE” 

Van Daalen, of the hospital in St. Thomas, said deciding whether to discharge a kid sick with measles sometimes keeps her up at night.

“You hesitate to send them home because you’re not quite sure how they’re going to land,” she said.

“There are some later-term consequences for kids who have measles. It’s a very rare complication, but we’ll have to keep our surveillance up.”

Dr. Ninh Tran said he felt like he was approaching burnout in late February.

Ontario’s weekly case count had nearly doubled to 177 over a two-week period ending Feb. 27, with almost half of the overall cases located in his southwestern public health unit.

Pressure was high to trace cases, halt community spread and stop infections. Measles was on his mind every moment of the day and night.

“You could sense a bit of tension and anxiety in all this discussion,” Tran recalled in late May.

“It’s always like a temporary feeling of doubt, fear, anxiety when we see numbers go up and there’s just a lot of things coming right at you,” Tran said of the outbreak’s early days.

“And then you have to step back and say, ‘OK, it’s not going to be helpful if I get stressed because I need to — and other leaders have to — figure out a way to move forward.”

The spread of measles has ebbed and flowed, but Tran noted a steady decline of new cases mid-June.

“While it’s still early to confirm a persistent pattern, the consistency of the decrease does suggest a potential shift in the trajectory of the outbreak,” said Tran.

“We are cautiously encouraged.”