This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.
Canada’s decision to suspend the use of the AstraZeneca-Oxford vaccine in Canadians under 55 during a surging third wave and a slow vaccination rollout is a calculated risk.
Health Canada says the benefits of the vaccine to protect against COVID-19 still outweigh the potential risks, with more than 300,000 doses of the shot administered and no cases of the serious clotting condition, known as vaccine-induced prothrombotic immune thrombocytopenia (VIPIT), in Canada.
But the decision to restrict the use of one of four approved vaccines at a time when COVID-19 levels are rising again in Canada’s hardest hit provinces is a tough pill to swallow for some.
“It can be a very powerful tool when we’re at this stage of the pandemic where we’re talking about, in hotspots at least, the system getting to a point of potential collapse,” said Dr. Susy Hota, an infectious disease specialist at the University Health Network and an associate professor of medicine at the University of Toronto.
“There are humans behind that story, and when you’re in a hospital where you’re seeing an exponential rise in the number of COVID-positive patients coming in, and your staff to help manage these patients is the same pool of staff — then those numbers aren’t adding up.”
But on an individual level, experts say the lack of data on the risk of VIPIT to Canadians from the AstraZeneca vaccine is concerning and NACI was right to err on the side of caution in order to avoid putting lives unnecessarily at risk.
The good news is that vaccines work; eight provinces and territories reported no new deaths in a single day this week, and the decision to prioritize COVID-19 vaccines in long-term care has led to a dramatic drop in deaths in residents.
The bad news is that the race between vaccines and variants is taking on new urgency; the majority of vulnerable Canadians are still unvaccinated and the third wave is hitting younger adults harder and showing no signs of slowing down.
“It’s so complicated, because I look at it as being two things: What is the absolute risk of this potentially related severe side effect versus the absolute risk of the disease?” said Dr. Lynora Saxinger, an infectious diseases physician and an associate professor at the University of Alberta faculty of medicine in Edmonton.
“The other consideration is, what is the public backlash to potential outcomes of any particular course of action?”
WATCH | AstraZeneca now only recommended for Canadians over 55:
Canada’s vaccine advisory committee has changed its advice and now says the AstraZeneca COVID-19 vaccine should only be given to people aged 55 and up following concerns it could be linked to a rare blood clot. 2:21
Health Canada says VIPIT occurs at a rate of about one in 100,000 people vaccinated, with a mortality rate of about 40 per cent, although more research is needed and that risk is reduced if treated early enough. The total number of people in Europe who got the rare blood clots after vaccination is small — as of Thursday, dozens of cases have been reported compared to millions who received the shot.
But crucially, the people who appear to have an elevated risk of the rare blood clots are not the same age group most at risk from COVID-19.
“If you look at the average 30 or 40-year-old Canadian, their risk of getting severely ill from COVID based on our current experience is substantially less,” said Dr. Andrew Morris, a professor of infectious diseases at the University of Toronto.
“You’re asking them for the good of the country to take on a risk that they wouldn’t even get with COVID. So why would you give them a vaccine that is more likely to give them harm then COVID is? It makes no sense.”
Canada has had close to 23,000 COVID-19 deaths in the year since the pandemic began, but fewer than a thousand of those have been in people under 60 and just over 300 in Canadians under 50.
“What happens to NACI if they say that everything is fine, despite the European experience which really brings it into question, and then we have even one death in Canada from this?” said Morris. “NACI would be just absolutely raked over the coals.”
‘Vaccine risk versus disease risk’
Dr. David Fisman, an epidemiologist at the University of Toronto’s Dalla Lana School of Public Health, said the debate over whether suspending the vaccine in younger Canadians was the right decision is due to a miscalculation of risks for that age group.
“I think what you see is a bit of wire crossing around vaccine risk versus disease risk,” he said.
There is also a risk of clots from getting COVID-19, but that’s conditional on getting the disease first, and there are other vaccines to protect against it, he said, rather than using a vaccine linked to adverse events in this age group.
“The adverse effect here is rather devastating,” he said. “[VIPIT] seems to be killing about half the people who suffer these consequences, and is highly likely to cause permanent neurological damage in survivors.”
“Given that these are young people working in healthcare, it is likely that vaccination is conferring damage or death that they would not have suffered otherwise.”
Dr. Menaka Pai, a clinical hematologist at McMaster University and a member of Ontario’s COVID-19 Science Advisory Table, says the risks associated with VIPIT in younger adults are dangerous enough to warrant halting its use in those under 55.
“The clots that we see with VIPIT — they’re serious. If you’re not aware of them they can be hard to diagnose, they can be hard to treat,” she said.
“If you’re older and likely to experience all the other horrible things that COVID does, including killing you, then your decision about urgency and needing any vaccine frankly is really different from somebody who is younger and probably better able to weather the storms of COVID.”
WATCH | Should people who’ve had the AstraZeneca vaccine be concerned?
Infectious disease experts take questions about the changing advice for the AstraZeneca COVID-19 vaccine including if those who’ve had a shot should be concerned. 4:22
Pai says critics of NACI’s decision are inaccurately drawing comparisons with the risk of VIPIT to the risk of birth control pills, which also carry an increased risk of blood clots.
“The reality is that every year a little under one in 3,000 women will get a blood clot on the combined oral contraceptive pill and every year one in 300 pregnant women will get a blood clot,” she said.
“But the clots that you get on those hormones are very different from the clots that we’re seeing related to the AstraZeneca vaccine.”
Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa, says if the risk from the AstraZeneca-Oxford vaccine to younger Canadians can be mitigated with another COVID-19 shot, then the decision to halt the use of it makes sense.
“This is not the same as going to a place like Brazil where the disease is rampaging out of control,” he said.
“Whereas this is the only vaccine you have available to you — take it now or I can’t guarantee you will be alive in a month. It’s a different scenario entirely.”
But Deonandan says he can sympathize with critics of NACI’s recommendations to suspend the vaccine because of the damage the decision may do to the public perception of COVID-19 vaccine safety overall.
“If you are saving any lives, you’re saving one or two lives [from VIPIT],” he said. “On the other hand, you’re creating such distrust of the vaccine you may be causing hundreds, possibly thousands of deaths from people not taking the vaccine.”
“But given what NACI’s job is, which is to advise how best to deploy vaccines, they used the best evidence and came upon the right decision for their mandate.”
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News this week that a cluster of more than 40 cases of an unknown neurological disease have been identified and found only in New Brunswick has residents of several communities on edge.
The mystery illness has similarities to Creutzfeldt-Jakob disease, a rare and fatal brain disease.
First diagnosed in 2015, according to an internal Public Health memo sent this month to medical professionals, the disease affects all age groups and appears to be concentrated in the Acadian Peninsula in northeast New Brunswick and the Moncton region in the southeast.
Since that news was reported on Wednesday, people in those communities have been wondering how alarmed they should be.
“People are wondering, what is it? Why is it only here? We are hoping that somebody will tell us,” Anita Savoie Robichaud, the mayor of Shippagan, a town on the peninsula, said Friday.
Yvon Godin, the mayor of Bertrand, a village further north on the peninsula, who also chairs the Forum of Acadian Peninsula Mayors, agrees.
“We are very, very worried about it,” Godin said. “Residents are anxious, they’re asking ‘Is it moose meat? Is it deer? Is it contagious?’ We need to know, as fast as possible, what is causing this disease.”
Dr. Neil Cashman understands the concern.
Cashman, a professor in the University of British Columbia’s faculty of medicine, is a neurologist with a special expertise in prion diseases — a group of neurodegenerative diseases caused by proteinaceous infectious particles, or prions — including Creutzfeldt-Jakob disease.
When Cashman first heard about the cases in New Brunswick, he says his first thought was, “We have a problem on our hands.”
Clearly, he said, “this was a call to arms to identify the cause.”
Those efforts are already underway.
Teams of researchers, scientists and epidemiologists began assembling about a year ago, both at the national level at Health Canada’s Creutzfeldt-Jakob Disease Surveillance System, to which Cashman is acting as an adviser, and at the provincial level with a research team headed by Moncton neurologist Dr. Alier Marrero.
Having this news put under “the active scrutiny of the public” this week has been a good thing, Cashman said, because it has pulled in clinical and scientific expertise from across Canada.
“There are people offering to help, and these people would not be doing that unless they were aware of this cluster.”
But their work is just beginning.
‘This is something new’
Cashman has a pretty good idea what this mystery disease is not.
All the evidence, he said, points to this not being a prion disease such as Creutzfeldt-Jakob disease.
“There is no evidence, not a hint — even in the three autopsies that have been performed — of a human prion disease. That came as a surprise to me, frankly,” he said. “So in essence, this is something new, and we need to get on the stick and figure out what this is.”
Cashman said he’s tapping into his expertise in neurology and environmental toxins to look for other explanations.
The fact that the cases are limited to certain regions “fits with the notion of an environmental toxin,” he said.
A possible culprit might be B-methylamino-L-alanine (BMAA), an environmental toxin made by certain bacteria that can accumulate in fish and shellfish.
Domoic acid, another toxin produced by bacteria and that accumulates in shellfish, sardines and anchovies, is another possibility. So is lead, which can be responsible for clusters of neurodegeneration.
“All of these are speculation at this point,” Cashman stressed. “A lot of scientific acumen will be required to pin it down to a cause.”
That will take time, and no one can say for sure how long.
“It’s possible ongoing investigations will give us the cause in a week, or it’s possible it will give us the cause in a year,” he said.
“There’s no sensible timeline I can provide on when we’ll have an answer. It’s just something that has to be the focus of scientific attention, and as rapidly as possible.”
In the meantime, he said, he’d advise residents to continue doing what they have been doing, try not to be consumed by anxiety and have faith that a solution will be found.
“I know it sounds like a tired statement, but I would say stay calm, carry on,” he said. “We’ve got to figure it out and the Public Health Agency of Canada is in a good position to do that and come up with a cause … and then of course it can be ameliorated.”
Doctors in New Brunswick are being told to be on the lookout for symptoms of an unknown neurological disease that appears to be a new condition found only in the province and is believed to be linked to environmental causes.
At a public health update on COVID-19 Thursday, Dr. Jennifer Russell, the province’s chief medical officer of health fielded a number of questions about the mystery disease that was originally identified in the province in 2015.
In an internal memo obtained by Radio-Canada, sent on March 5 by the office of the chief medical officer of health to the New Brunswick Medical Society and to associations of doctors and nurses, the department highlighted a cluster of 42 cases of a progressive neurological syndrome of unknown origin.
Symptoms similar to Creutzfeldt-Jakob disease
The disease has symptoms similar to those of the rare and fatal Creutzfeldt-Jakob disease, but “testing so far has ruled out known prion diseases,” the memo stated.
The first case of the disease was diagnosed in 2015, according to the memo. Three years later, in 2019, 11 additional cases were discovered, with 24 more cases discovered in 2020 and another six in 2021. Five people have died.
The symptoms are similar to those of prion diseases, which include Creutzfeldt-Jakob disease and some of its variants, including mad cow disease, or bovine spongiform encephalopathy (BSE).
However, despite many similarities, tests for Creutzfeldt-Jakob disease have so far ruled out known prion diseases, the March 5 public health memo states.
Scientists are currently looking into the possibility that this is a new variant of a prion disease — or a new disease entirely.
On Thursday, Russell confirmed it is “most likely a new disease,” and noted “we haven’t seen this anywhere else” in Canada.
The cases have been reported to Health Canada’s Creutzfeldt-Jakob disease surveillance system, which determined that the rising number of cases should now be considered a cluster, Russell said.
At that point, she said, the March 5 memo was sent out to the province’s health-care professionals.
Doctors suspect environmental link
According to preliminary data from a research group on the subject, headed by neurologist Alier Marrero of Moncton’s Dr. Georges-L.-Dumont University Hospital Centre, the disease is not genetic.
“We don’t know yet where this is coming from,” but the leading hypothesis so far is that it’s environmental, Marrero said in an interview with CBC News on Thursday.
“We believe it is acquired from exposure to something in the environment … either food, water … toxins.”
Over the course of the six years since the disease first appeared in New Brunswick in 2015, case numbers have grown steadily and “clustered” in the Moncton and Acadian Peninsula areas of the province.
“We have seen clustering of cases in some areas and we don’t know why,” Marrero said.
According to the Public Health memo, the median age of the cases is 59 years, although female cases tend to be younger, with an average age of 54. Cases are distributed equally among men and women, the memo said.
The symptoms of the disease are typically not very specific in the initial stages.
“It’s usually behavioural changes … for instance, an excess of anxiety, a little bit of irritability, unexplained pains in the limbs, muscle spasms, insomnia,” Marrero said.
As the disease progresses over a course of 18 to 36 months, loss of balance and co-ordination have been observed, and “sometimes patients have abnormal and rapidly progressing brain atrophy.”
No public health threat
However, Marrero and Russell both stopped short of calling the cases a public health threat.
“Fear is usually bad advice because it will paralyze us,” Marrero said. “We are working very hard to figure this out, so we can stop it, so we can treat it.”
He advised that if anyone suspects they have symptoms of the disease, they should report them to their doctor, who will then refer them to the clinic.
Symptoms that might appear to be related to the disease could actually be caused by another condition, he said.
“For instance the patient could have multiple sclerosis, they could have Alzheimer’s disease … or some other condition that could be known and treated. So it’s important that they get referred and evaluated.”
“Right now, it’s just about awareness, making sure that physicians are watching for neurological symptoms like this so they can refer them to be assessed,” she said.
“We have a lot of work ahead of us in terms of trying to determine the cause.”
Heart researchers say there’s a surprising reason Canada has seen higher COVID-19 deaths than many countries with fewer health-care resources — more Canadians live longer with chronic disease, putting them at greater risk of dying from COVID-19.
Research led by Heart & Stroke also found the pandemic has likely postponed thousands of cardiovascular procedures.
Lead author Cindy Yip said the findings underscore the devastating consequences of poor heart health, even if excellent medical care and technology are available.
“Quality of care is good to have, but it’s not enough,” said Yip, principal investigator and director of data knowledge management at Heart & Stroke, formerly known as the Heart and Stroke Foundation.
She said Canadians are somewhat vulnerable to pandemics such as COVID-19 because so many have survived other health crises.
“Because people are living longer with chronic disease like heart conditions and stroke, we need to take actions, and we need them to take care of their health in order to avoid the poor outcome from COVID-19.”
The study notes 11.7 per cent of Canadians suffer from cardiovascular disease, including strokes. That puts Canada in the top third among 63 countries studied — worse than the 11.6 per cent found in the United States, 10 per cent in Russia, 7.6 per cent in South Korea, 4.3 per cent in India and 3.8 per cent in Pakistan.
When it came to reported death rates from COVID-19, Canada ranked higher than all but 14 of the 65 countries studied (two additional countries had insufficient data). That included places with poorer health-care resources such as Russia, India, Pakistan, and China.
The study looked at COVID-19 cases reported between Jan. 21 and April 30, when Canada listed 54,457 confirmed cases and a case fatality rate of 6.1 per cent.
Lower foreign death rates included one per cent in Russia, 5.5 per cent in China and 3.3 per cent in India.
Age 65+ a factor
Yip acknowledged that countries vary in how they report COVID-19-related deaths, but said researchers strove to use comparable numbers.
She said the analysis accounted for the wide range in access to health-care services among countries. But a strong relationship between COVID-19 deaths and the prevalence of heart conditions and stroke was still there.
For every one per cent increase in the number of people with heart problems, the COVID-19 death rate was 19 per cent higher.
Age was also a factor.
For every one per cent increase in the number of people aged 65 and older, the COVID-19 death rate was nine per cent higher. Nearly 17 per cent of the Canadian population was 65 or older in 2017, according to the study’s supplemental data.
The study also tried to number the heart-related medical procedures that have been postponed by the pandemic, but Yip said data here is limited, forcing researchers to extrapolate.
Plan needed for those with worsening conditions
She noted data provided by 20 cardiac centres in Ontario indicate fewer heart procedures were performed between March 16 and May 3 and the same period last year: 42 per cent fewer bypass surgeries, 37 per cent fewer angioplasty procedures and 45 per cent fewer valve surgeries.
The report estimates that province-wide, 1,252 procedures are being postponed each month by COVID-19 precautions.
Yip said that could easily translate to thousands of patients across the country. And that means health-care providers need “a very strategic plan” to provide care for people whose conditions may be worsening.
Yip said the study lends increased force to public health directives to physically distance and wash hands often.
But she said it also underscores the need for heart-healthy habits — regular exercise, healthy eating and no smoking or vaping.
“Take care of your heart and brain health because if you don’t have good heart and brain health, if you get COVID-19 your outcome is not good.”
Doctors are warning that soaring rates of a common, but often undetected, liver disease could impose an enormous burden on Canadian health care over the next decade if there isn’t more public awareness.
“There’s a reason why they call liver disease the silent killer,” said Dr. Mark Swain, a University of Calgary liver specialist who led a study published recently in the online journal CMAJ Open.
“It’s because liver disease broadly has no symptoms.”
Liver cells are like balloons that can fill with fat over time, especially when someone is obese, he said.
The paper notes an estimated one-quarter of Canadians over the age of 20 have this condition, called nonalcoholic fatty liver disease, or NAFLD.
Swain, who directs the university’s gastroenterology and hepatology division, said physicians have historically treated it as relatively benign because liver fat usually just sits there and doesn’t do much.
But about three to five per cent of those with the disease go on to develop a more problematic condition called nonalcoholic steatohepatitis, or NASH. In those cases, Swain said, an immune response can trigger inflammation, which can lead to scarring or even cancer.
Swain and other researchers with the The Canadian NASH Network, a coalition of doctors focused on the disease, used trends in obesity rates to forecast the prevalence of fatty liver disease in the Canadian population between 2019 and 2030.
The study found cases of NAFLD are on track to rise 20 per cent in that time frame and that its more advanced form, NASH, is projected to rise by 35 per cent.
Cases of liver failure, liver cancer and the need for transplants are expected to rise by a total of 65 per cent to 579,000 by 2030.
Deaths are expected to double to 49,100 in that time.
“There has been a conditioning amongst many health-care professionals that it’s not of concern,” said Swain.
Symptoms appear late
“We really need to be better at increasing awareness, both in the population and amongst health-care professionals and allied health-care workers, that this is an issue.”
A dollar figure for the cost-burden on the health-care system has not been calculated in Canada, but Swain expects it would be “astronomical.”
Dr. Diana Mager, an associate professor of clinical nutrition at the University of Alberta, said patients are often surprised to find out that they even have fatty liver disease. Symptoms, like a sore abdomen, don’t show up until it’s well advanced, she said.
“People walk around for years with NAFLD and don’t know they have it.”
The biggest culprits seem to be processed foods and sugary drinks, she said. Mager, who specializes in pediatric patients, said fatty liver disease has been showing up in children and adolescents.
A more wholesome diet and more active lifestyle can reverse the disease in its early stages, she said.
There’s some debate as to whether the same holds for when the disease is more advanced. But, at the very least, lifestyle changes can slow its progression, said Mager, who also chairs the Canadian Liver Foundation’s national education advisory committee.
Simply telling people to go on a diet and lose weight isn’t enough, she said.
“It’s one thing to tell the Canadian public, ‘Don’t eat this and don’t eat that.’
“But if there isn’t an availability of affordable healthy foods, then that’s a problem. You can’t expect a family, if they can’t afford to purchase those foods, to be able to consume those foods on a regular basis.”
In the quiet of the University of Saskatchewan’s shuttered campus, there is one constant beacon of light and hope. Dr. Volker Gerdts and his team of researchers are working in shifts around the clock to find a vaccine for the novel coronavirus — and feeling the pressure to move even faster.
“There is a real sense of urgency,” Dr. Gerdts says.
“We have a highly motivated team, and everybody is willing to step up and do as much as they can. And so this is really, you know, a race against the disease.”
Gerdts is the director and chief executive officer of the University of Saskatchewan’s Vaccine and Infectious Disease Organization – International Vaccine Centre (VIDO-InterVac). The lab in Saskatoon is one of the most advanced infectious disease research facilities in the world and has been evaluating COVID-19 vaccine models for several weeks.
A recent $ 28-million funding boost from the federal and provincial government to enhance its COVID-19 research capacity to test antivirals, drugs, and therapeutics has been helping fast-track that research even more.
$ 115 million for research into vaccines and treatments being developed in hospitals and universities.
$ 662 million for clinical trials in Canada.
$ 350 million to expand national testing and modelling for COVID-19.
An immunity task force focused on blood-based tests used to determine if someone has been exposed to the virus.
Prime Minister Justin Trudeau announced a $ 1.1 billion strategy to fund COVID-19 medical research and a task force to study immunity. 3:53
VIDO-InterVac is already at the forefront of an extraordinary global effort to halt the spread of the deadly novel coronavirus. It’s one of a handful of labs in the world with a potential vaccine at the animal testing phase.
The new federal funding includes $ 23 million to support pre-clinical testing and clinical trials of a potential COVID-19 vaccine, essential steps to ensuring that vaccines are effective and safe for human use.
“What was my reaction? Ecstatic,” Gerdts says. “Good to see the commitment from the Government to fund a Canadian vaccine for Canadians.”
Next month could be a turning point for VIDO-InterVac, when ferrets — chosen because their respiratory system is similar to that of humans — are exposed to the novel coronavirus to see if the lab’s vaccine candidate works. VIDO-InterVac is also testing other researchers’ vaccines on hamsters.
Gerdts says the research is moving at an accelerated rate, and everyone is looking for a breakthrough before the pandemic’s next potential wave of infections.
“The concern that we all have at the moment is whether there is another phase to this or not. And so having a vaccine for the next phase is absolutely critical. It will allow us to improve what we call herd immunity, to get more people vaccinated — more people with an immune response in the population, and the better we all are protected in the future.”
There are at least 70 research teams around the world, including in Canada, racing to develop a COVID-19 vaccine in a year, something that has never been done before. 1:58
Gerdts’ team is part of the World Health Organization’s pandemic vaccine network, made up of expert groups of nearly 200 scientists and researchers from around the world.
They’re working in tandem and exchanging notes in real time on medical servers and through weekly phone calls. There’s even a vaccine tracker built by the Vaccine Centre at the London School of Hygiene & Tropical Medicine that monitors the 60-plus COVID vaccines in development and their progress.
It’s a remarkable coordinated effort that is breaking down scientific borders and academic bragging rights.
“The most important thing in all of this is not to be first,” says virologist Paul Duprex from the University of Pittsburgh, who is part of the WHO vaccine braintrust.
Duprex says scientists usually compete to publish their findings first, for the credit that comes with it. The new virus has changed that, and there will be plenty of time to publish later.
“Let’s just cut the crap and move forward and work together and be collegial. This is a worldwide problem, and this is a worldwide issue that we should solve together,” he says.
Duprex adds that the WHO collaboration is speeding up the process to find a successful vaccine among the dozens in development.
“I’m really glad that we’ve got lots and lots of different options, because you know what’s going to happen. Those vaccines are going to faIl at different stages in the testing process,” says Duprex. “So therefore, if we have backups upon backups and backups, that allows us to get something across the finish line.”
Infectious disease researcher Allison McGeer says this new, faster pace of global research means a vaccine could be developed more quickly and that could save lives.
“It’s critically important to do it faster,” says McGeer, who is with the Lunenfeld-Tanenbaum Research Institute, part of Sinai Health in Toronto.
McGeer says that doesn’t mean shortcutting safety trials, but rather streamlining research processes to get a safe and effective vaccine into people’s arms faster.
“That allows a certain amount of creativity about how to do that. Whereas normally people would say, ‘well, you know, I’m just not sure about that and I want to be absolutely sure about it.’ Now there’s a good reason for doing it differently and you can make processes for developing vaccines faster in general, which we all agree would be a good thing.”
The search for a COVID 19 vaccine is already well underway and the University of Toronto joined the race thanks to a $ 10 million dollar donation. Ali Chiasson spoke to the research lead for this new lab that will be running 24/7. 2:43
A Canadian team
At VIDO-InterVac, Gerdts says if his team’s potential vaccine passes the animal test next month, human trials will follow in the fall and pave the way for a possible vaccine in a year.
The new government funding is also building manufacturing capacity in Canada, including at VIDO-Intervac, which hopes to be in a position to produce up to 20 million doses of new vaccine during a pandemic.
And while all the work behind finding a vaccine is part of a global effort, Gerdts says it’s a uniquely Canadian one, too.
“We’re a Canadian team making a vaccine for Canadians, and so it’s our highest priority to make sure that this vaccine will be available for Canadians. And we have received funding from the federal government and the provincial government to do this kind of research, so it’s important that we make sure that Canadians will have access to our vaccine.”
And while this pandemic is still in its early stages, Gerdts is already looking ahead to the next one.
He says good science can simulate the evolution of a pathogen in the lab, to help predict the next deadly virus and give the world time to prepare. The lessons of this pandemic, Dr. Gerdts says, are already too harsh.
“We’re still talking about a year before we have a vaccine ready. People are dying right now, and the cost to the global economy is already in the trillions. We need to have vaccines ready for whatever the next pathogen might be. And this is where we have to push the envelope.”
The NFL campaign and an abbreviated baseball season may be possible if games are played without fans and players are kept in lockdown, U.S. President Donald Trump’s leading infectious disease adviser said Wednesday.
It has been a little over a month since the NBA season was abruptly halted amid the novel coronavirus outbreak, with most professional sports following suit, leaving arenas and stadiums empty amid speculation over when live sport can return.
“There’s a way of doing that: Nobody comes to the stadium, put them [the player] in big hotels, wherever you want to play, keep them very well surveilled,” Anthony Fauci, the leading U.S. health expert said in a Snapchat interview.
“Make sure they don’t wind up infecting each other or their family and just let them play the season out.”
Fauci, who appeared last month in an Instagram live interview with Golden State Warriors star Steph Curry, said he would recommend athletes should be tested roughly once a week after play resumed.
NFL season slated to begin Sept. 10
The prospect of sports going ahead without fans has met with some criticism. Major League Baseball recently damped down talk it would return as soon as May with players competing in an isolation bubble.
Last month, before professional sport was suspended, 16-time NBA all-star LeBron James called the notion of playing without fans impossible.
“People say, ‘Well, you know, you can’t play without spectators,” said Fauci. “Well, I think you probably get enough buy-in from people who are dying to see a baseball game, particularly me.
“I’m living in Washington, we have the world champion Washington Nationals, I want to see them play again.”
The NFL regular season is due to kick off on Sept. 10, but there is no date for the MLB to start or for the NBA and NHL to resume. Major League Soccer said on Tuesday its projection to return in mid-May was “extremely unlikely.”
The U.S. could see “millions of cases” of COVID-19 and between 100,000 and 200,000 deaths related to the novel coronavirus, according to Dr. Anthony Fauci, the U.S. government’s foremost infectious disease expert.
Fauci, director of the National Institute of Allergy and Infectious Diseases, was speaking to CNN’s State of the Union program on Sunday as the U.S. was leading the world in the number of reported infections, estimated at more than 122,000. The U.S. death count crossed 2,100 on Saturday, more than double the level from two days ago.
“But I don’t want to be held to that,” Fauci said, regarding what he considers a worst-case scenario. “We don’t need to make a projection when it’s such a moving target that you could so easily be wrong and mislead people.”
The virus has hit hard in big American cities like New York, Detroit, New Orleans and Chicago, and has also made its way into rural America with outbreaks in small Midwestern towns and Rocky Mountain ski havens.
New York remains the worst-hit U.S. city and is home to more than a third of the country’s cases. There have been more than 44,000 cases statewide and more than 500 deaths. The United Nations has donated 250,000 protective face masks to New York City.
U.S. President Donald Trump backed away from calling for a quarantine for coronavirus hotspots in New York, New Jersey and Connecticut, instead directing Saturday night that a “strong travel advisory” be issued to stem the spread of the outbreak.
More help for vulnerable groups
In Canada, Prime Minister Justin Trudeau announced new federal funding on Sunday for those experiencing higher levels of stress because of self-isolation policies — including children, seniors, the homeless and those facing violence at home.
He said the government is contributing $ 7.5 million to Kids Help Phone to hire more counsellors, adding that children feeling anxious should go online, call 1-800-668-68968, or text 686868 to reach the service.
WATCH | An employment lawyer says theCOVID-19 ‘trickle effect’ on our economy will be long-standing:
Lawyer Muneeza Sheikh talks about layoffs, disruptions during coronavirus pandemic 5:33
Trudeau also said he’s offering $ 9 million to the United Way through the government’s New Horizons for Seniors Program to help provide things such as health checks and grocery or meal delivery service.
The government is allocating $ 200 million to help the homeless or those fleeing family violence or sexual violence, he said.
WATCH | Toronto doctor describes what it’s like on the COVID-19 front lines:
Dr. Joshua Tepper is the president and CEO of North York General Hospital in Ontario. 1:53
Since a stop in Chile on March 14, the ship has been turned away from several ports after reporting that some of those on board were suffering from flu-like symptoms. Panama on Saturday reversed its decision to block the ship from the canal.
Global Affairs Canada says there are 248 Canadians stranded aboard MS Zaandam, where some passengers have tested positive for the virus and four people have died. No Canadians on the vessel are reported ill.
The operator said on Saturday that it would be transferring asymptomatic people on board to Holland America’s sister ship the Rotterdam, which was also given permission to transit the Panama Canal.
Foreign Affairs Minister François-Philippe Champagne says he has been co-ordinating with his Panamanian counterpart and will continue efforts to bring any non-infected Canadians home once the ship docks in Fort Lauderdale.
Prime Minister Justin Trudeau will give his daily briefing to Canadians on the coronavirus pandemic at 11:15 a.m. ET. CBC News will cover it live right here.
WATCH | A COVID-19 patient asks Canadians to obey doctors, government:
B.C. resident Erin Leigh, 38, is recovering from the novel coronavirus in hospital. She told CBC News she had never experienced an illness like COVID-19. 7:00
The number of cases of the respiratory illness stands at more than 663,800 across the globe, with more than more than 30,000 deaths. Canada now has 5,866 confirmed and presumptive coronavirus cases, and at least 63 deaths, with more than 500 people recovered, according to figures compiled on Sunday.
Ontario Premier Doug Ford on Saturday announced stiff new measures to prevent price gouging for important products during the COVID-19 crisis. He said individuals found guilty of price gouging could face fines of $ 100,000, while company directors could face fines of $ 500,000 as well as a year in jail. Corporations may be fined as much as $ 10 million.
Canada’s most populous province is also prohibiting gatherings of more than five people, replacing an order that barred public events of over 50 people. The new order does not apply to households with more than five people. Child care centres supporting health care workers and first responders are exempt. Funerals will be permitted with up to 10 people at one time.
Transport Canada on Saturday has laid out new rules, in effect on Monday, for domestic travel, meaning anyone showing symptoms of COVID-19 won’t be allowed to board a domestic flight or inter-city passenger train.
For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. But for others, especially older adults and people with existing health problems, the virus can cause more severe illness, including pneumonia, and lead to death.
More than 130,000 people have recovered, according to a Johns Hopkins University tally.
Prime Minister Justin Trudeau’s wife, Sophie Grégoire Trudeau, says she has recovered from COVID-19 after contracting the illness while on a trip to the United Kingdom earlier this month.
WATCH | Sophie Grégoire Trudeau says she’s recovered from COVID-19:
In a series of videos on Instagram, Sophie Grégoire Trudeau says she has been given a ‘clear bill of health’ from health officials. She thanked Canadians for their support and offered encouragement to get through the pandemic. 2:08
As the pandemic continues to shift westward, the situation has calmed in China, where some restrictions on people’s lives have now been lifted. Six subway lines have restored limited service in Wuhan, where the virus first emerged in December.
China reported 45 new coronavirus cases in the mainland for Saturday, down from 54 on the previous day, with all but one involving travellers from overseas, the country’s health authority said on Sunday local time. China also reported five new deaths on Saturday, all of which were in Wuhan in Hubei province, where the COVID-19 respiratory illness was first identified. A total of 3,300 people have now died in mainland China, with a reported 81,439 infections.
WATCH | A laid-off Sunwing pilot talks about recovering from COVID-19:
‘Won’t be travelling for a while,’ laid-off pilot Derek Butcher tells CBC 4:45
The Chinese Embassy in Canada said on Twitter on Saturday that the Bank of China donated medical supplies to Canada, including 30,000 medical masks.
On March 27, Bank of China donates medical supplies (including 30000 medical masks, 10000 sets of protective clothing, 10000 goggles and 50000 pairs of gloves, followed by N95 medical masks) to Canada fighting against COVID-19. We are together! <a href=”https://t.co/47VlWPlQyG”>pic.twitter.com/47VlWPlQyG</a>
Canada’s Foreign Affairs Minister Champagne welcomed the donations, saying on Twitter: “In the face of a global pandemic, supporting each other is not only the right thing to do, it’s the smart thing to do.”
WATCH | Infected Canadian flight attendants speak out:
Airline crews tell CBC they didn’t feel adequately protected from COVID-19 after several employees test positive for the illness. 2:01
Infant who tested positive in Illinois has died
The first infant death related to COVID-19 in the United States has been reported in the Chicago area. The Illinois Department of Public Health said in a statement Saturday that the child was younger than one year in age and tested positive for the virus.
“Right now things are really dire. We’re seeing a lot more sick patients. Our hospitals are full, the emergency department is full,” Ugo Ezenkwele, chief of emergency medicine at Mount Sinai Queens hospital, told CBC News on Sunday.
“Three weeks ago, we saw a patient come in with mild symptoms, and now we’re seeing patients who are fairly sick, severely sick, requiring more oxygen,” he said, adding the hospital in the New York City borough of Queens is no longer doing elective surgeries.
Mexico’s deputy health minister Hugo López-Gatell on Saturday called for all residents in Mexico to stay at home for a month, saying it was the only way to reduce the transmission rate. Mexican health authorities said the country had 848 confirmed cases of COVID-19 as of Saturday, 131 more than the previous day, and 16 deaths.
British Prime Minister Boris Johnson said in a letter being sent to 30 million households in the U.K. that “things will get worse before they get better.” The government released the letter Saturday as Johnson continued to self-isolate after testing positive for COVID-19 and the number of cases in the U.K. rose to 17,089, with 1,019 deaths.
Dr. Howard Njoo, Canada’s deputy chief public health officer, has said the fight against the pandemic is far from over and that it could include a second wave.
“We have now completed tests for over 184,000 people in Canada, which is 84,000 additional people tested since Monday,” Dr. Theresa Tam, Canada’s chief public health officer, said Saturday.
Air Canada lines up additional flights
Since March 21, Air Canada has operated nine special flights in collaboration with the federal government to bring Canadians home from various countries — three flights from Morocco, three from Peru, two from Ecuador and one from Spain. The airline issued a news release on Saturday, announcing the following flights for Canadians:
Here’s what’s happening in Canada’s provinces and territories
In British Columbia, the provincial government reported 92 new cases of COVID-19 on Saturday, boosting the provincial total to 884. On a more positive note, provincial health officer Doctor Bonnie Henry said 396 people have recovered from the illness in B.C. Read more in this analysis about how the curve could be flattening in B.C., but any definitive declaration of “turning the corner” cannot yet be made.
WATCH | Canmore, Alta., and other small towns worried about influx of visitors:
As some Canadians across the country go to cottage country to isolate with their families during the COVID-19 crisis, small town mayors worry about the stress it will put on local health-care systems. 1:49
Saskatchewan said there’s been a large increase in cases connected with a snowmobile rally held earlier this month. Health officials now say 18 cases in total have been linked to the event, and all of them are self-isolating at home. Read more about what’s happening in Saskatchewan.
Manitoba is expanding its COVID-19 testing to include symptomatic health workers, people who live in group care settings (including long-term care and remote work camps), inmates and more. Chief provincial public health officer Dr. Brent Roussin also said all people living on First Nations in the province who are experiencing respiratory symptoms will be tested. Read more about what’s happening in Manitoba, which recorded its first death on Friday.
Quebec Deputy Premier Genevieve Guilbault is announcing police checkpoints as of this afternoon in eight regions outside major Quebec cities where the population is deemed more at risk. Guilbault says only essential travel will be allowed in those regions and that Quebec provincial police have also set up checkpoints near the Canada-U.S. border to intercept snowbirds returning to the province to ensure they understand there’s a 14-day quarantine. Read more about what’s happening in Quebec.
As Canadians continue to grapple with physical distancing and how to deal with COVID-19, most grocery store workers still have to go to work and come in contact with others. 2:17
Newfoundland and Labrador health officials are expressing concerns after finding the first case of community transmission of COVID-19. Chief medical officer of health Dr. Janice Fitzgerald says a patient admitted to a hospital in St. Anthony, N.L., was one of the 18 new cases announced on Saturday. Fitzgerald describes the case as a significant development because the patient had no history of travel or exposure to a known case of COVID-19. Read more about what’s happening in N.L.
Health authorities in the Nunavik region of northern Quebec have confirmed a case of the novel coronavirus. Kativik Regional Police say a woman is in self-isolation while “sharing a house with others” in Salluit, a hamlet of about 1,200 people on the Hudson Strait. Residents of that community, as well as Kuujjuaraapik and Whapmagoostui in northern Quebec are under a nighttime curfew, imposed Saturday.
Here’s what’s happening in the United States
From Reuters, updated at 9:30 a.m. ET
In the U.S., a 49-year-old prisoner in Oakdale, La., who was serving a 27-year prison term for a drug charge, became the first federal inmate to die from COVID-19, the federal Bureau of Prisons (BOP) announced late on Saturday. A total of 14 inmates and 13 staff in federal prisons across the United States have fallen ill with the virus, according to the BOP’s website.
Cities including Detroit, Chicago and New Orleans are growing as hotspots of infection, while New York City continues to be pummelled. Nurses there are calling for more masks and other gear to safeguard themselves against the virus that has so far sickened more than 52,000 people and killed over 700 in New York state, mostly in the city.
The Centers for Disease Control and Prevention on Saturday warned residents of New York, New Jersey, and Connecticut against non-essential domestic travel for 14 days.
The Rhode Island National Guard started going door to door on Saturday in coastal areas to inform any New Yorkers who may have come to the state that they must self-quarantine for 14 days. Gov. Gina Raimondo expanded the mandatory self-quarantine to anyone visiting the state. She also ordered residents to stay at home, with exceptions for getting food, medicines or going to the doctor, and ordered nonessential retail businesses to close Monday until April 13.
Health officials in Detroit, where poverty and poor health are longstanding problems. The number of infections surged to 1,381, with 31 deaths, as of noon Saturday.
“At this time, the trajectory of Detroit is unfortunately even more steep than that of New York,” said Dr. Teena Chopra, the medical director of infection prevention and hospital epidemiology at the Detroit Medical Center.
WATCH | ‘We are fighting a war’ says Canadian nurse in Detroit:
Jenna Meloche lives in Amherstburg and works in Detroit where the number of COVID-19 deaths is rising. 2:05
On Friday, Trump signed a sweeping $ 2.2-trillion relief bill into law, only hours after it had been approved by the House of Representatives, after having been passed by the Senate earlier this week.
He also invoked emergency powers to require General Motors Co. to build much-needed ventilators after he accused the largest U.S. automaker of “wasting time” during negotiations.
Britain has placed an order for 10,000 ventilators to be made by a consortium of companies including Ford, Airbus and Rolls-Royce as part of efforts to fight coronavirus, an industry source told Reuters.
Here’s what’s happening in Europe
From Reuters and The Associated Press, updated at 5:00 a.m. ET
The death toll in Italy surpassed 10,000 on Saturday, making it the highest of any country in the world. The number of fatalities surged Saturday by 889, bringing the country’s total to 10,023, according to the Civil Protection Agency.
Italy has the second highest number of cases, behind the United States. It surpassed China’s tally on Friday.
Meanwhile, the Vatican said Saturday that tests carried out in the residence where Pope Francis lives showed that the 83-year-old pontiff and his closest aides do not have coronavirus. Tests were made on 170 people in the Vatican and six were positive, including one who lives in the Santa Marta guesthouse.
WATCH | Pope Francis holds solitary Vatican service for those dealing with COVID-19 virus:
Under darkness and rain, Pope Francis holds solitary Vatican service for those dealing with COVID-19 virus 1:23
In France the next two weeks will be the toughest yet in the fight against coronavirus, Prime Minister Edouard Philippe warned on Saturday as his government raced to add intensive care beds and source protective gear. To free up intensive care beds in worst-hit areas, the army and emergency workers were this weekend stepping up the transfer of patients to less-affected regions, using a military helicopter and a specially adapted TGV train.
By Saturday, the coronavirus had claimed 2,314 lives in France, with more than 37,575 confirmed cases, according to official figures.
In the United Kingdom, 17,089 people have tested positive and 1,019 have died of COVID-19 as of Saturday morning, the Department of Health and Social Care said on Twitter. Britons should be prepared for a “significant period” in lockdown, senior cabinet minister Michael Gove said on Sunday.
In Germany, the number of confirmed cases has risen to 52,547 and 389 people have died of the disease, statistics from the Robert Koch Institute for infectious diseases showed on Sunday.
In Spain, Prime Minister Pedro Sanchez announced his government will order a two-week ban on commuting to all non-essential businesses starting on Monday. In a publicly televised address, he said all workers are ordered to remain at home “as if it were a weekend” to “intensify” efforts to stem the outbreak of the coronavirus.
Spain is approaching the end of the second week of stay-at-home rules and the closing of most stores, but workers were allowed to go to offices and factories if they were unable to work from home. Spain reported 6,528 fatalities on Sunday, up from 5,690 the previous day, and a total of 78,797 cases.
Ireland reported 14 deaths on Saturday, all in the east of the country and the most in a single day so far to bring the total number of fatalities to 36, the Department of Health said. The country also reported an additional 294 confirmed cases to bring the total to 2,415. Prime Minister Leo Varadkar on Friday ordered a lockdown until April 12. Travel more than two kilometres from home is banned, while all those over 70 are being instructed to “cocoon.”
In Russia, the mayor of Moscow urged residents on Saturday to stay home during the non-working week announced by President Vladimir Putin in a bid to curb the spread of the virus. Russian authorities say they recorded 1,264 COVID-19 cases on Saturday, a rise of 228, the largest daily increase since the start of the outbreak. The government says it will close all border crossings on March 30; the country has already grounded all international flights and declared next week a non-working week.
In southern Finland, police are preparing to enforce the new regulation aimed at ceasing all unnecessary human traffic to and from Uusimaa, the region that includes the capital, Helsinki, according to Social Affairs Minister Krista Kiuru. The Nordic country has so far confirmed 958 coronavirus cases — the vast majority of them in Uusimaa — and five deaths. The exceptional move, which is set to end April 19, affects the daily lives of some 1.7 million people, nearly a third of Finland’s population.
Switzerland’s infections topped 11,800 as the government pumped money into the economy and army medical units helped hospitals. Swiss authorities are lighting up one of their most famed landmarks, the Matterhorn, to show solidarity in the fight against the coronavirus.
Here’s a look at what’s happening in some other parts of the world
Forty-six passengers onboard the German cruise ship Artania have been reported as showing COVID-19 symptoms, according to Western Australia Premier Mark McGowan on Saturday. The Artania was allowed to pull into in Fremantle, Western Australia, on Thursday and sick passengers were taken off to be treated in Perth on Friday. The state government initially had not wanted the ship to dock and tried to divert it to a military base. There are more than 800 people onboard the vessel.
Indian Prime Minister Narendra Modi apologized to the public on Sunday for imposing a three-week national lockdown, calling it harsh but “needed to win” the battle against the coronavirus pandemic. The unprecedented lockdown order, which came into effect on Wednesday to keep India’s 1.3 billion people at home for all but essential trips to places like markets or pharmacies, is meant to prevent the spread of the virus from surging and overwhelming India’s already strained health care system. Indian health officials have confirmed 867 cases of the coronavirus, including 25 deaths.
In Japan, Prime Minister Shinzo Abe on Saturday promised an unprecedented package of steps to cushion the world’s third-biggest economy from the pandemic, saying the country was close to a national emergency as infections surged. The size of the package will exceed that compiled in response to the global financial crisis of 2008, which was worth a total 57 trillion yen ($ 740 billion Cdn), Abe said.
Meanwhile, Tokyo Gov. Yuriko Koike issued a plea following a surge in infections this week that she said put Tokyo on the brink of an emergency. She asked the tens of millions of people in the city and surrounding regions to avoid non-essential, non-urgent outings until April 12, particularly this weekend.
Japan reported 68 new cases on Sunday for more than 1,700 cases, excluding 712 from a cruise ship, with 55 deaths, public broadcaster NHK said Sunday. Tokyo Governor Yuriko Koike has asked the tens of millions of people in the city and surrounding regions to avoid non-essential, non-urgent outings until April 12, particularly this weekend.
Malaysia reported 150 new coronavirus cases on Sunday, taking the total to 2,470, the highest in Southeast Asia. The number of deaths from the virus outbreak rose by seven to 34, the health ministry said.
Iran has confirmed another 144 deaths from the coronavirus and says thousands more are in critical condition as the military completed work on a 2,000-bed field hospital in an exhibition centre in the capital. Iran has reported nearly 2,400 deaths among more than 32,000 cases.
Iranian officials have repeatedly insisted they have the outbreak under control, despite concerns it could overwhelm the country’s health facilities. Authorities have urged people to stay home but have not imposed the sweeping lockdowns seen elsewhere in the region.
In the continent of Africa, coronavirus has now spread to dozens of the 47 countries of the WHO Africa region, with 2,650 infected and 49 dead, the head of the World Health Organization (WHO) said on Saturday.
Social distancing & hand washing at a clinic in <a href=”https://twitter.com/hashtag/Kenya?src=hash&ref_src=twsrc%5Etfw”>#Kenya</a>: two of the most effective ways to stop the spread of <a href=”https://twitter.com/hashtag/COVID19?src=hash&ref_src=twsrc%5Etfw”>#COVID19</a>.<br><br>📸:<a href=”https://twitter.com/MOH_Kenya?ref_src=twsrc%5Etfw”>@MOH_Kenya</a> <a href=”https://t.co/WBzsUvBFWw”>pic.twitter.com/WBzsUvBFWw</a>
Saudi Arabia recorded 99 new cases on Saturday, taking its total to more than 1,200 coronavirus infections — the most in the Gulf Arab region, with four fatalities. On Sunday local time, the Kingdom said it was extending indefinitely the suspension of international passenger flights and workplace attendance in both public and private sectors among efforts to contain the spread of the coronavirus.
South Africa has the most cases in Africa and as of midnight entered a three-week lockdown. In Johannesburg, police fired tear gas and beat people on the streets and in camps as the country’s first day of a coronavirus curfew slid into chaos.
In Kenya, ferry commuters racing to board a boat in Mombasa to beat the local curfew were met with tear gas.
Indonesia authorities in Jakarta have extended a state of emergency for the next two weeks. The country has reported 102 deaths and 1,155 infections.
The United Arab Emirates extended on Saturday to April 5 a nightly curfew to sterilize public places to combat the coronavirus as neighbouring Qatar reported its first death from the disease.
Turkey halted all intercity trains and limited domestic flights on Saturday, as the number of coronavirus cases jumped by a third in a day to 5,698, with 92 dead.
A new guideline from Heart and Stroke Foundation says a daily dose of Aspirin could do more harm than good for those at low risk of stroke or heart disease.
The recommendations published Monday in the Canadian Medical Association Journal say acetylsalicylic acid (ASA) should not be taken as a preventive measure for those who do not have a history of stroke, heart or vascular disease.
That’s a major shift from the decades-old practice calling for a daily, low dose of ASA, which in addition to Aspirin is also known by the brand names Entrophen and Novasen.
The Heart and Stroke writing group, chaired by McGill University neurologist Dr. Theodore Wein, developed the guideline after strong new research linked daily ASA doses to serious side effects such as internal bleeding.
Wein says the new recommendations only apply to those who have not had a stroke, heart condition or peripheral artery disease.
He says it is still “strongly recommended” that anyone with a history of stroke, or heart or vascular disease continue to take low-dose, daily ASA to prevent another event, if their doctor has prescribed the treatment.