As bird flu cases mount, a new tool for containing global outbreaks

Source: St. Michael's Hospital

Another day, another handful of new H7N9 cases, another death to report in eastern China.

The new bird flu strain continues to puzzle and alarm health officials in China and around the world. But thankfully, H7N9 isn't spreading easily between people -- yet.

Public health authorities are tightly crossing their fingers that the virus fails to mutate into a more dangerous form and will eventually just sputter out. The fear is that it will evolve into something more infectious -- like H1N1, which popped up in Mexico and caused a pandemic in 2009.

Luckily, H1N1 wound up being a pretty wimpy virus and caused mostly just mild disease -- but from the looks of it, an H7N9 pandemic would prove much more devastating.

You can bet public health officials worldwide are already preparing for that eventuality, which is why there is no better timing for this new paper, published in the Bulletin of the World Health Organization.

The paper comes from a group of scientists led by Dr. Kamran Khan, an infectious disease physician at St. Michael's Hospital and founder of BioDiaspora, a really interesting program that uses global flight patterns to predict the spread of new infectious diseases. (Khan spoke to the Toronto Star earlier this week about the likelihood of an H7N9-infected traveller from China coming to Canada -- for now, the chances of that are pretty low).

When outbreaks hit, public health officials have to make difficult but necessary decisions to prevent a virus from spreading further. They might consider airport screening, for instance -- but such measures should not be taken lightly, because they are hugely disruptive and require major resources.

So such actions need to have a strong scientific basis -- and that's where Khan's paper comes in. Looking at the 2009 H1N1 pandemic, Khan and his co-authors analyzed flight itineraries for more than 580,000 at-risk travellers who flew out of Mexico in May 2009.

They concluded it is much more efficient to screen passengers exiting an outbreak country than those arriving at their destination airports. According to Khan's estimates, all at-risk travellers during H1N1 could have been assessed with exit screening at Mexico's 36 international airports.

And 90 per cent of all at-risk travellers worldwide could have been captured by screening at just six of Mexico's largest international airports, coupled with targeted screening at two airports in Shanghai and Tokyo.

On the other hand, trying to screen those same travellers when they arrived at their destination airports would have required setting up checkpoints at 82 international airports in 26 countries.

And screening all international travellers at their arrival destinations would have been staggeringly difficult. During the H1N1 pandemic, this would have meant screening 67.3 million grumpy travellers at 1,111 airports -- and for every one person who actually had exposure to H1N1, 116 people would have been unnecessarily screened.

Using their findings, Khan and his co-authors developed a basic tool to help public health officials decide whether, and how, to set up airport screening. The tool takes three things into account: 1) whether there is effective exit screening at the source of the outbreak 2) whether a city receives direct flights from the outbreak country 3) the incubation period of the disease.

"One never waits for a fire to spread before putting it out," Khan said in a press release. For now, the H7N9 situation is just a few dozen sparks in eastern China -- let's hope it doesn't become a flame we have to snuff out.

Update: Canadian Press reporter Helen Branswell has written a great article about Khan's study, which has now been posted on the Toronto Star's website here.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar

In other bird flu news...

A bird flu strain called H7N9 has been dominating headlines lately, and with good reason. The strain, which has never been known to infect people before, has suddenly begun popping up in eastern China, where it has now killed eight people. So far, there have been 24 confirmed cases but the tally is steadily rising by the day. 

But yesterday, another bird flu strain was quietly in the news: H5N1, which — until H7N9 came along — was the most notorious of the bird flu strains.

This story came out of eastern Bangladesh, where a two-year-old baby died of H5N1 — making him the country's first known fatality from bird flu.

H5N1 made its world debut in 1996 when a poultry outbreak in Hong Kong wound up killing six people. The region's entire chicken population was slaughtered but that didn't stop the virus from spreading amongst birds — and infecting people in other parts of the world. Today, human cases have been recorded everywhere from Vietnam and Cambodia to Nigeria, Turkey, Egypt and, now, Bangladesh, which has seen six cases since 2008, five from the last two years. In a decade, 622 people have been infected with H5N1 and 371 have died — a fatality rate of about 60 per cent.

For infectious disease experts now watching H7N9, that other bird flu is likely haunting their thoughts. Even if H7N9 doesn't become easily transmissible between humans (the nightmare scenario), it may very well follow in H5N1's footsteps and continue spreading in bird populations — thus turning H7N1 into a global terror, always lurking and threatening to pop up. Or, even worse, mutate into a more dangerous form.

But there is one key difference between H7N9 and H5N1 that makes the former even more concerning —  unlike H5N1, which decimates entire chicken flocks, H7N9 doesn't seem to make birds sick, meaning it can spread undetected. If H7N9 does start flying around the world, we will have a hard time noticing — that is, until people in other corners of the world start getting sick.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar

H7N9 bird flu: is Canada ready for a bird flu outbreak?

Chinese health workers collect bags of dead chickens at the Huhuai wholesale agricultural market in Shanghai on April 5. (AFP/Getty Images)

As the world nervously watches the bird flu outbreak unfolding in China, two questions are likely at the top of everyone's minds:

1) Will H7N9 start spreading between humans?

2) Will it come here?

The WHO has confirmed 16 cases so far, including six deaths. They also announced today that any new H7N9 updates will be announced on their Twitter account first. It is important to note, however, that there is still no evidence of human-to-human transmission and the prevailing theory is that people are getting infected by poultry.

But now there are also a few suspected imported cases of H7N9 in Hong Kong and, according to Chinese reports, in Taiwan -- both involving people who have recently visited China. This is not altogether surprising, considering the close ties and proximity between those countries and China.

But could there be imported cases in Canada? It's hard to know but the possibility certainly cannot be ruled out. There is a huge Chinese population in Canada and during the SARS outbreak in 2003, we were among the countries hardest hit -- we were also completely caught off guard by the sudden appearance of a brand new virus (for a refresher, you can read my colleague Amy Dempsey's recent SARS anniversary stories here and here).

So if an H7N9-infected person were to arrive on our shores, is Canada ready to test for it? The Public Health Agency of Canada's National Microbiology Lab says yes. Here's what they told me by email: 

How is the Agency able to detect the H7N9 virus?

The Agency's National Microbiology Laboratory has access to the H7N9 whole genome sequence through the Global Initiative on Sharing Avian Influenza Data. With this information, the NML has the capability to rapidly detect the H7N9 virus.

Can the provincial laboratories detect the virus?

The NML is working closely with provincial laboratories to ensure they will soon be able to test for the H7N9 virus.

How is the Agency monitoring the situation in China?

An Agency medical expert is based in Beijing, and is liaising with the Chinese infectious disease prevention authorities on this outbreak. The Agency is also continually monitoring information on avian influenza H7N9 in poultry, as well as human cases in China and is working closely with its national and international partners, including the World Health Organization, to track all types of flu activity in Canada and around the world.   

It will be really important for provincial labs to acquire the capacity to test for the new bird flu strain, however -- as of now, any samples from a suspected case in Canada would have to be shipped to Winnipeg for testing and confirmation (although even after the provincial labs acquire the capacity to test, any positive cases would be doubly-confirmed by the Winnipeg lab, at least in the early stages).

A spokesperson with Ontario's public health lab tells me they currently have tests that can pick up Influenza A, which would flag the sample as a suspected H7N9 case. As of yet, however, they do not have specific tests to pick up H7N9 -- they're working on that right now.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar

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Bird flu: More cases, more rumours in China's spreading outbreak

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Will a $5.5B plan end polio?

This morning, senior officials from the Global Polio Eradication Initiative briefed reporters on their strategy to wipe out polio once and for all by 2018.

The world has been working towards this goal since 1988 -- and today, it finally looks within reach. Despite some significant setbacks (including the bloody attacks on immunization workers in Nigeria and Pakistan), 2012 proved to be a very good year for the polio eradication effort.

The virus is now endemic in just three countries: Afghanistan, Nigeria and Pakistan. In 2011, these countries saw 650 cases; in 2012, there were 223.

And India, once considered the most challenging country for overcoming polio, has not recorded a new case in more than two years.

"(Last year) had the fewest number of polio cases ever reported in recorded history, in the fewest places, fewest countries, fewest number of districts," Hamid Jafari, the World Health Organization's director of polio operations and research, told reporters.

"So it has really brought us to a very important and unique opportunity to actually complete polio eradication."

The initiative's strategy for polio eradication is outlined in a $5.5-billion plan called the "Polio Eradication and Endgame Strategic Plan." It has four main objectives:

1) To stop all natural transmission of the virus by the end of next year.

2) To strengthen routine immunization programs in high-risk countries and phase out oral polio vaccines.

3) To ensure that samples of polio virus are safely stored -- a requirement that must be met before a country can be certified as polio-free.

4) To ensure that the lessons learned (and infrastructure developed) can be applied towards future health campaigns and interventions.

There will be two major obstacles in seeing this plan through -- the first being that $5.5 billion.

"It’s absolutely essential to be able to fund these activities and continue through th entire period of six years in order to achieve the goal,"  said John Sever, vice-chair of Rotary International's committee to end polio. "We’re aiming to get that money committed up front so that the entire series of events can take place."

The other obstacle, of course, are the security risks. If immunization workers are unable to carry out their tasks safely, then the campaign is doomed to fail. Jafari said a "multi-pronged strategy" is being applied to combat this problem -- one that recognizes that every security threat is "highly contextual at the local level."

"Each of these areas, provinces and districts ... have found security coordination committees that are working very closely with the polio operational planning," Jafari said.

The campaign will also ramp up efforts to engage community members, particularly local and religious leaders, thus involving them in the eradication effort, he added.

"The vaccinators should be from the local communities and they are vaccinating their own children and their own communities," Jafari said.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar

Bird flu: More cases, more rumours in China's spreading outbreak

A woman at a chicken farm in Zouping, east China's Shandong province on Monday. (AFP/GETTY IMAGES)

Rumours have been coming fast and furious in the wake of Sunday's announcement that a new bird flu strain, H7N9, has infected humans for the first time (that we know of, that is). Two men in Shanghai have died; a woman in Anhui province, some 360 kilometres away, has also fallen ill and is now in critical condition.

Earlier Tuesday, a picture was making the rounds on Twitter and Chinese media, allegedly a patient's diagnosis sheet leaked by a hospital staffer in Nanjing, capital of Jiangsu province. The person posted the picture on Chinese social networking website Weibo and said the patient was a 45-year-old poultry butcher who was confirmed as having H7N9 on March 30.

That information remains unconfirmed but now it looks like we have official word of four more cases from four different cities in Jiangsu province -- including a 45-year-old poultry butcher. Jiangsu's health department has posted a Chinese-language press release on their website announcing the additional cases -- which have not yet been confirmed by the World Health Organization.

According to a machine-translated version of the Chinese announcement, the new patients are:

* A 45-year-old female from Jiangning District who worked with poultry. She developed symptoms (fever, dizziness, body aches, fatigue) on March 19; on March 27, she went into ICU. Currently in critical condition. The Chinese CDC tested her today and she was positive for H7N9. Officials are now monitoring 49 people who have come into contact with her; none are showing any symptoms yet.

* A 48-year-old woman who worked in "sheet metal processing." Developed symptoms on March 19 and was transferred to ICU on March 30 at Nanjing Hospital. Currently in critical condition. Was confirmed to have H7N9 today by the Chinese CDC. Officials are now tracing 60 people who have come into close contact with the patient; none have any symptoms.

*83-year-old male from Suzhou Wujiang District. Developed symptoms on March 20 and was transferred to hospital on March 29. Tested positive for H7N9 on April 1. Officials are now following 15 contacts of this patient; none have yet to show any symptoms.

* A 32-year-old unemplyed woman who lives in Wuxi city. Developed symptoms on March 21 and was transferred to a hospital on March 28. She was confirmed to have H7N9 on March 31 by Jiangsu health authorities, a diagnosis that was confirmed on April 2. Health officials are monitoring 43 people who've come into contact with the patient; none have respiratory symptoms.

There are apparently no epidemiological links between the four Jiangsu cases.

Update: Some information on what Chinese authorities are doing to step up their outbreak response, from an Associated Press report by Gillian Wong:

The provincial health bureau said it was strengthening measures to monitor suspicious cases and urged the public to stay calm, joining Beijing and China's financial capital, Shanghai, in rolling out new steps to respond to the relatively unknown virus.

The latest cases follow the three earlier ones reported Sunday, including two men who died in Shanghai, resulting in the city activating an emergency plan that calls for heightened monitoring of suspicious flu cases. Under the contingency plan, schools, hospitals and retirement facilities are to be on the alert for fevers, and administrators are to report to health authorities if there are more than five cases of flu in a week.

Cases of severe pneumonia with unclear causes are to be reported daily by hospitals to health bureaus, up from the weekly norm. The plan also called for stronger monitoring of people who work at poultry farms or are exposed to birds.

The level-3 response plan, the second-lowest in a four-stage scale, reflects higher concern after the H7N9 bird flu virus led to the deaths in Shanghai and seriously sickened a woman in the city of Chuzhou 360 kilometres west.

"The health bureau will take effective and powerful measures to prevent and control the disease, to make sure the flu epidemic is effectively guarded against and to safeguard the health of the city's residents," said Xu Jianguang, head of the Shanghai Health Bureau.

Health officials said this week there was no evidence that any of the three earlier cases, who were infected over the past two months, had contracted the disease from each other, and no sign of infection in the 88 people who had closest contact with them.

Health authorities in Beijing also upped the capital's state of readiness, ordering hospitals to monitor for cases of bird flu and pneumonia without clear causes, the official Xinhua News Agency reported.

The announcements, as lacking in details as they are, show that the government is mildly more transparent in handling health crises than it was a decade ago during the SARS pneumonia epidemic. Then, as rumours circulated for weeks of an outbreak of an unidentified disease in southern Guangdong province, government silence contributed to the spread of the virus to many parts of China and to two dozen other countries.

Scientists are closely monitoring these viruses for fear they could mutate into a strain that easy spreads among people, but there's no evidence of that occurring.

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar

PHOTOS: 2012 Military Photographer of the Year competition

 

When Lance Cpl. Chuck Sketch lost his sight and both his legs to cancer, he refused to let that get him down. Sketch, from Phoenix, Arizona, is now competing against other wounded warriors in the  2012 Marine Corps Trials. This photo placed first in the Portrait category in the 2012 Military Photographer of the Year photo competition. (Sgt. Mark Fayloga/USMC/MCT)

Polish and U.S. Air Force honour guards march during the Aviation Detachment Ceremony, Lask Air Base, Lask, Poland, Nov. 9, 2012. This photo placed honourable mention in the News category in the 2012 Military Photographer of the Year photo competition. (Tech Sgt. Araceli Alarcon/USAF/MCT)

A competitor stresses during CrossFit Integrity, the Integrity's Revenge Battle of Charleston CrossFit games Oct. 6, 2012 in Charleston, South Carolina. This photo placed honourable mention in the Portrait category in the 2012 Military Photographer of the Year photo competition. (SrA James Richardson/USAF/MCT)

 

A photo illustration created to raise domestic violence awareness for USS Theodore Roosevelt's (CVN 71) Coalition of Sailors Against Destructive Decisions. This photo placed second in the Illustration category in the 2012 Military Photographer of the Year competition. (Mass Communication Specialist 3rd Class Sean Hurt/U.S. Navy/MCT)

An Afghan National Army soldier poses with a poppy near the village of Karizonah, Khost province. This photo placed first in the Portrait category in the 2012 Military Photographer of the Year photo competition. (Joshua L. DeMotts/USAF/MCT)

The story of cancer, in pictures

All photos by Angelo Merendino (http://mywifesfightwithbreastcancer.com)

The above photo is from an incredibly moving photo essay that has been making the rounds online, entitled "The Battle We Did Not Choose: My Wife's Fight with Breast Cancer." Captured by Angelo Merendino, the photos document his wife Jennifer's journey from good health:

To cancer diagnosis:

To death.

The photo essay has been posted on Angelo Merendino's website and is a testament to how powerfully images can tell a story. Merendino writes:

"My photographs show this daily life. They humanize the face of cancer, on the face of my wife. They show the challenge, difficulty, fear, sadness and loneliness that we faced, that Jennifer faced, as she battled this disease. Most important of all, they show our Love.  These photographs do not define us, but they are us.

Cancer is in the news daily, and maybe, through these photographs, the next time a cancer patient is asked how he or she is doing, along with listening, the answer will be met with more knowledge, empathy, deeper understanding, sincere caring and heartfelt concern."

You can read press interviews with Merendino about his wife and photographs here.

Today, Susan Gubar, who writes the Living With Cancer column for the New York Times' Well blog, points out another poignant collection of photographs that also capture the ruinous effects of cancer. In The Scar Project, fashion photographer David Jay takes unflinching portraits of young women and the jagged scars left behind by their battles with breast cancer.

Gubar writes:

"Bravery resides there, beauty elsewhere, in these shots of topless women in their 20s and 30s — in a wary smile, a cocked hat and suspenders, the branching veins of an inner arm, a mystic tattoo on a lower back, resolute hands on hips, smudged make-up smeared by a tear, an abundantly pregnant belly. Often beauty radiates from the eyes of the subject whose proud gaze conveys a steadfast determination to confront a grotesque turn of events with fortitude.

The ones that grip me stare at the photographer — at me — defiant. They want to live. I want them to live."

Jennifer Yang is the Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar

Poop Strong's founder, who used crowdfunding to battle cancer, dies

Arijit Guha is seen in this undated photo. (Courtesy: Poopstrong.org)

When Arijit Guha found out he had stage four colon cancer and that his insurance company was balking at paying his bills, the 31-year-old turned to the Internet for help.

He used Twitter (@poop_strong) to publicly shame the insurance company that was refusing to cover his $11,000-per visit chemotherapy treatments. And he joined a legion of people who are turning to a new financing tool known as crowdfunding, which allows companies and individuals alike to connect with an audience and make an impassioned pitch for funding.

On the website Kickstarter, for instance, nearly three million people have raised a collective $300 million in pledges for 30,000 projects, The New York Times reports.

Guha, who died last Friday, had a modest ambition: staying alive.

In the months before his death, Guha used crowdfunding to find an inventive way to connect with new supporters.

A doctoral student at Arizona State University, Guha had health insurance that covered his medical expenses up to a lifetime limit of $300,000.

When Guha spent all of that, he started a website called Poop Strong, a not-so-subtle rip-off of Lance Armstrong’s well-known Live Strong cancer charity. Guha used his site to sell Poop Strong T-shirts and other donated items, using the money for his cancer treatment. In the first three days following the site's Feb. 15 startup, he raised more than $20,000.

“My friend once said what I’m doing seems like the world’s most important bake sale,” Guha told The Washington Post. “It sometimes feels like this weird joke, that I’m selling T-shirts to pay for chemotherapy.”

In July, Guha posted this comment on Twitter, taking a swipe at his insurance carrier, Aetna: “@Aetna’s 4th qtr profit up 73%: ‘it continued to benefit from low use of health care.’ Helps they can ensure low use.”

Within a day, Aetna’s chief executive Mark Bertolini had agreed to cover all of Guha’s outstanding medical bills.

After that, the money raised by Poop Strong was used to support local wellness initiatives, Salon.com reports.

As Salon.com reporter Mary Elizabeth Williams writes in a touching obituary, “Guha was, in many ways, one of the lucky ones. He had cleverness on his side – an appealing communication style that wed his wit with his outrage. It’s what earned him the attention of a major insurance company, and got action where another person could have easily fallen through the cracks.”

Guha’s wife Heather posted a note on Facebook on the weekend, commemorating her husband, an Internet pioneer.

“My heart is aching," she wrote, "but the pain is eased a bit knowing that he has the support of such an amazing community of people, so many of whom have never met him. I thank you all, from the bottom of my heart, for all you have done for him. He is truly an inspiration (though he hated being told so), and I will be eternally grateful to have had him in my life, and to have been able to share him with all of you."

Rick Westhead is a foreign affairs writer at the Star. He was based in India as the Star’s South Asia bureau chief from 2008 until 2011 and reports on international aid and development. Follow him on Twitter @rwesthead

Latest death from the novel coronavirus

Astute folks on Twitter have noticed a German-language newspaper article reporting the latest -- and now eleventh -- death from the novel coronavirus, or nCoV.

According to TZ Online, the latest victim is reportedly a 73-year-old man from the United Arab Emirates who fell sick in Abu Dhabi and was flown by private jet to Munich for treatment. Fifty people who came in contact with this patient are now being monitored for any symptoms of the disease.

German newspaper Bild reports that the victim was from a "ruling family" in Dubai and caught the infection at a camel race. There is strong evidence to suggest the virus comes from bats, which may be infecting another animal that more frequently comes into contact with humans.

This is Germany's second imported case of the novel coronavirus -- the first was a patient who fell sick in Qatar and recovered in November after being treated at a specialty clinic in Germany.

This latest fatality comes on the heels of another death from the novel coronavirus, this one in the United Kingdom. The Birmingham Mail reported on Saturday that Abid Hussain -- a 60-something father of two who recently visited Saudi Arabia with his daughter -- succumbed to the virus on March 19. He fell sick in late January shortly after returning from his trip, according to the newspaper.

Hussain's wife and daughter were not by his side when he died because they were in Pakistan burying Hussain's son, Khalid, who was also infected with the novel coronavirus and died February 17. According to the Birmingham Mail, Khalid, a father of two, was undergoing chemotherapy when his father returned from Saudi Arabia and, in all likelihood, infected him with the virus.

A third person, reportedly a 30-year-old woman who visited Hussain in the hospital, was also mildly infected but has now recovered.

Update: here is a Google-translated German-language press release from the Munich hospital announcing the latest death.

Update 2: the World Health Organization has now posted an official statement on the latest coronavirus developments.

Jennifer Yang is the Toronto Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar

Five things I learned from inside a biosafety 'space suit'

Last week, I took a quick trip to Winnipeg to visit the Public Health Agency of Canada's National Microbiology Laboratory (my weekend story can be read here). A few days before getting there, my contact at the lab emailed me to ask: did I want to try on a BSL-4 suit during my visit?

Um, yes.

I'm sure anyone who has ever watched a pandemic thriller — like this movie or this movie — has wondered about what it's like to wear one of these space suits. They are the daily uniform of scientists who work inside biosafety level four, or BSL-4, labs — maximum containment facilities where people like Dr. Gary Kobinger (the NML's head of special pathogens, pictured on the left) work with the world's deadliest pathogens, such as Ebola or Lassa fever.

My wardrobe coordinator for the day was lab technician Jason Gren, who hooked me up with one of the lab's yellow suits. At the NML, the suits come in three colours — white (which come from France), blue (American-made) and yellow (made in Germany) — each with their own particular features and quirks. Dr. Kobinger likes the white ones: they are quieter, lighter. Jason prefers blue, which are sturdier but also far louder, because of the way the air flows through.

As a BSL-4 lab tech, Jason both manages the house-cleaning issues (scheduling, dealing with maintenance issues, etc) and works directly with specimens. He is also an NML old hand, having worked there since it first opened in 1999. An animal nurse by trade, Jason still remembers driving past the lab back when it was under construction. "I honestly said to myself I wanna work there," he recalls. "I remember thinking, 'I wanna work with Ebola.'"

(Side note: the day I met Jason was actually his last day as a BSL-4 lab tech. After more than a decade, "it was time for a change," he said. He is now doing a different job, although still working at the NML).

So now that I've spend a few minutes inside a BSL-4 suit, here's what I can tell you:

1. According to Jason, this is the order for which your body parts enter the suit: left foot, right foot, left hand, head, right hand. Then the zipper goes up and voila, you're Ebola-proof (sorta).

2. Your hair will get super staticky and make you itchy and you will not be able to scratch your face. So, a hair tie is advised — and also maybe a headband, suggests Jason (who was less than impressed with my out-of-control hair situation and at one point muttered "holy crap" as he tried for the third or fourth time to zip me up without catching any strands).

3. It's loud. You are hooked up to valves that continuously fill your suit with air. This is for two reasons: 1) to give you oxygen 2) to increase the air pressure inside the suit -- BSL-4 suits are maintained at a positive pressure so that if someone accidentally punctures a hole in the fabric, air will whoosh out of the suit instead of in. 

4. When wearing a BSL-4 suit, everything is harder and takes longer. At one point, Jason had me put a screw into a nut (which I'm attempting in the top photo). Wearing two latex gloves, in addition to the rubbery glove attached to the suit, it took me 30 seconds to simply line the screw up with the nut. I can't imagine the dexterity required of scientists who wear these suits on a daily basis and work not only with needles, but also, you know, vials of things that can kill them and also maybe the rest of Canada.

5. Once you've been wearing it for a while, getting out of the suit is just as exciting as getting into it. "It's like being reborn," I think I said, when I finally took off the suit.

Actually, I felt quite fine inside the suit — just slightly awkward, hard of hearing and fully aware of my resemblance to a blimp. But not everyone feels comfortable inside the suit, says Dr. Kobinger —  wearing one is Lesson #1 for BSL-4 trainees and "some people, who are uncomfortable in the elevator, they don't feel good in the suit," Dr. Kobinger says. "So that's the end of their training."

I leave you now with a picture of BSL-me and Jason, who had the misfortune of spending his very last day on the job stuffing a journalist and her hair into a biosafety suit. Thanks Jason.

Jennifer Yang is the Toronto Star’s global health reporter. She previously worked as a general assignment reporter and won a NNA in 2011 for her explanatory piece on the Chilean mining disaster. Follow her on Twitter: @jyangstar