Doctors like Jordan Feld and Morris Sherman are worried about how many people like Lance Gibson are out there across Canada.
Gibson, a sergeant in the Canadian Armed Forces based at CFB Borden, north of Toronto, has hepatitis C.
He was completely unaware of the chronic infection for years, probably decades. Tests done during a military physical in late 2008 noted Gibson had an abnormal blood platelets reading and further testing led to an early 2009 diagnosis. By the time Gibson realized he was carrying the virus, he was already on a potentially fatal track — he had stage 5 liver failure.
Gibson had had no clue his liver was dying. He'd never felt fitter in his life.
"It just came right out of the blue," says Gibson, 49, who has served in the military for 30 years.
Feld and Sherman are hepatologists — liver specialists — who have seen too many cases like Gibson's. And they fear they will soon face many more people who are completely unaware that they are on the verge of irreversible liver damage due to a virus most contracted years earlier. They believe a silent epidemic of hepatitis C infections will soon reach the point where it bursts into view, placing a huge strain on the health-care system.
Attempts to puzzle out how they became infected sometimes arrive at a conclusion. Some may have tried injection drugs in the freewheeling late 1960s, or had a blood transfusion before blood products were screened for hepatitis C (that began in 1992 in Canada). Some had medical procedures in parts of the world where needle reuse was or remains a common practice. Some got a tattoo in the wrong place at the wrong time.
But in about 30 per cent of cases no answer can be found, says Feld. That's why, he argues, efforts aimed at finding people infected with hepatitis C cannot focus solely on people who fall into high-risk groups such as injection drug users (present and past), immigrants from countries with high rates of hepatitis C and people who had blood transfusions before screening went into effect.
"It is true that if you really dug deep, obviously everyone (with hepatitis C) has some risk factor. They got the infection somehow. But finding the risk factor is so difficult that risk factor-based screening for almost any infection that it's been studied in is ineffective," says Feld, who practises at Toronto Western Hospital.
Gibson had blood transfusions in 1981, when he was a teenager. That's how, he believes, he became infected.
In the world of hepatitis C, he's one of the lucky ones. Gibson's sister gave him a piece of her liver in May 2012. But he remains infected and will continue to be monitored by his doctors.
In the same month Gibson had his liver transplant, the U.S. Centers for Disease Control took the unusual step of recommending that all baby boomers be screened once for hepatitis C. That's because the evidence suggests rates of the disease are higher among this age cohort in the U.S. than groups born before or since.