As people from around the world arrive in Toronto and festivities marking the beginning of the FIFA World Cup get underway, health-care workers want to assure visitors and residents that there are key measures in place to help keep them safe.
They have spent months preparing for possible threats — from mass-casualty events to outbreaks of viral illnesses such as measles and norovirus.
Here’s what to know.
Toronto Public Health workers are used to working behind the scenes at major sports events and festivals in the city, but the main difference with the World Cup is the length — more than five weeks — and the many countries people are coming from, said Dr. Michelle Murti, the city’s medical officer of health.
“We really are inviting the world. There was a lot of replanning and planning depending on which countries we would be hosting,” she said.
Public health officials have been doing global surveillance to know which infectious diseases are common in travellers’ countries of origin, such as measles or meningitis.
The federal government has imposed temporary travel restrictions on visitors from Democratic Republic of Congo, Uganda and South Sudan amid an Ebola outbreak.
Local public health authorities weren’t involved in that decision and won’t comment on it, Murti said, but noted that the risk of Ebola is low and something like a norovirus outbreak is much more likely.
Norovirus, which spreads through both person-to-person contact or by eating contaminated food, causes nausea, vomiting and diarrhea.
There’s already an “uptick” of norovirus in different parts of North America, including Toronto, Murti said, so public health officials are keeping an eye on it through increased wastewater testing near the soccer stadium, training sites and in the FIFA Fan Festival area.
Wastewater surveillance will alert staff to step up public health messages about handwashing and staying home if you’re sick, as well as ensuring there are enough handwashing or hand sanitizer stations in FIFA activity areas.
Murti said they are also using wastewater to check for early signals of measles and mpox.
Because measles is one of the most infectious viruses in the world and symptoms may not develop for days after exposure, public health would warn people that the virus was present in a certain area and urge them to check their vaccination status if they were there. Staff would also mobilize to set up vaccine clinics if needed.
But the most important thing both Canadian and international fans should do is ensure they’re fully vaccinated against measles in advance, she said.
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“If you’re heading to a game, if you haven’t checked your vaccine status, please do get boosted if you haven’t had, you know, your two doses.”
Murti noted that fortunately, Toronto has “generally pretty high levels of vaccine coverage.”
Murti said public health is also stepping up efforts to prevent food-borne illness — such as norovirus, salmonella and listeriosis — at FIFA events.
“Food-borne illness outbreaks we know is a pretty regular feature of a lot of mass gathering(s) just because it’s hot, people are getting a lot of food from outside, maybe not sort of handling food in the same way, not washing your hands in the same way,” she said.
Toronto Public Health developed a new portal where all food vendors, including food trucks, at FIFA events had to register.
“We have a lot of health inspectors on the ground in the FanFest area who are keeping a monitoring of food that’s being sold there,” and making sure there are no unauthorized vendors, she said.
They will also be watching to ensure proper food handling, both in vendors selling to the public and kitchens preparing food for FIFA staff and volunteers.
Hospitals in Toronto all have Code Orange plans in place, where they free up space and concentrate resources to treat large numbers of patients who have been injured in a disaster.
In April, The Canadian Press witnessed a mass casualty practice scenario at Sunnybrook Health Sciences Centre, in which more than 30 Toronto-area hospitals, police services, paramedic services, fire services and other health organizations co-ordinated in advance of FIFA.
The fictional scenario was set before a World Cup soccer match in Toronto, with the mock-up involving fireworks set off in the midst of a large crowd of fans marching toward the stadium. The fireworks caused burns and a crowd surge, resulting in people getting crushed.
Using paper forms describing each “patient” and their injuries and working with the patient volumes and staffing they had at the time, the hospitals communicated with each other to make room for a sudden influx of 277 patients.
Those measures can include cancelling elective surgeries, discharging patients who are well enough to leave, admitting patients in the ER to other wards and setting up dedicated mass trauma spaces.
The city of Toronto contracted Sunnybrook to be the host city medical lead because of its experience in emergency preparedness, said Dr. Matthew Runnalls, an emergency physician at the hospital and medical director for the FIFA World Cup in Toronto.
“The first thing I learned (from the practice scenario) is that we feel fairly prepared,” Runnalls said.
“(The hospitals) were well organized, they were able to answer questions about their readiness and their status very quickly. People for the most part knew who to call and knew who to activate,” he said.
The two hospitals closest to the FIFA matches and fan zone are Toronto Western Hospital and St. Joseph’s Hospital, Runnalls said. Sunnybrook, St. Michael’s Hospital and SickKids are the city’s trauma centres.
Other hospitals that participated in the practice scenario would offer backup capacity as needed.
The FIFA mass casualty practice scenario also tested the ability of police services and hospitals to work together to reunite patients and loved ones looking for them.
In the event of a disaster, hospitals would each set up a Family Information Support Centre — or FISC — usually led by a social worker and enlisting the help of spiritual care and hospital volunteers.
The FISC collects names and descriptions of patients in the hospital’s care, including distinguishing features and what they are wearing if there’s no way to determine a patient’s name.
They also collect names and descriptions from loved ones searching for a patient.
The hospitals’ FISC teams communicate with each other to avoid having family members and friends go frantically from hospital to hospital to try to find their loved one.
Lina Gagliardi, professional leader for social work and spiritual care at Sunnybrook Health Sciences Centre, said working with police services is also critical, as they keep a database of people injured in a disaster.
In many cases, police will set up a central place for families and friends searching for loved ones to come instead of going to individual hospitals, she said.
For many health-care workers, all the preparations have made them feel ready while hopeful there won’t be any major health emergencies.
An avid soccer fan himself, Runnalls thinks the World Cup will be great for the city.
“We’re really excited. It’s going to be a ton of fun,” he said.
“It’s gonna be, I think, a really, really amazing experience.”
