Tag Archives: Doctors

Support for essential workers could bring COVID-19 under control faster in Canada, doctors say

Doctors are calling for more supports for essential workers facing “life-or-death” inequities, saying it will do more to control coronavirus outbreaks than high-profile punishments of those who break the rules.

COVID-19 has exacerbated existing problems — not only among long-term residents bearing the brunt of deaths from the virus — but also for people struggling to get by despite working on the front lines on farms, in warehouses and grocery stores.

Now, these vulnerable workers can face additional challenges from authorities such as breaking Quebec’s curfew order or living in cramped, poorly ventilated quarters that make it easy for the coronavirus to spread. 

Nav Persaud, a family physician in Toronto who holds the Canada Research Chair in health justice, said he’s “dispirited” by how little attention inequity receives. 

“It’s always been a life-or-death issue, health inequities,” Persaud said. “People not being able to afford basic necessities like healthy food, medication, safe housing has always killed people and put people’s health in jeopardy.”


An Amazon warehouse north of Calgary in Balzac, Alta., that reported an outbreak of COVID-19 last spring. Doctors say warehouse workers need immediate access to paid sick leave to help control coronavirus outbreaks. (Jeff McIntosh/The Canadian Press)

He said much of the coronavirus transmission happening now in the Greater Toronto Area is from people going to work or interacting in ways that won’t be stopped by charging those holding large parties, for instance. 

“I think the people who benefit most from those punishments are the authorities, because they can exert their power and give off the impression that they’re being helpful when they’re not,” Persaud said. “It would be better if they were providing supports.”

In Toronto, Persaud said people who rely on public transit to get to work from priority neighbourhoods with a disproportionately higher number of COVID-19 cases may face long, crowded commutes on buses. That’s why the greater supports he’s seeking also includes extended public transit.

But providing more supports is harder for politicians from all levels to do than chastising individual rule breakers, he said. 

“I’m in favour of there being rules and the rules do need to be enforced, but I think these are relatively unimportant incidents in the grand scheme of things.”

A recent opinion article by three physicians points to how Ontario’s modelling showed three times more daily confirmed cases among communities with the most essential workers compared with communities with the least. Researchers in California reported a similar observation that hasn’t yet been peer reviewed by outside experts.

Call for supports to control outbreaks faster

Martha Fulford, an associate professor of infectious diseases at McMaster University in Hamilton, Ont., would like to see an immediate “liveable support” such as paid sick leave as a fundamental for essential workers. 

“It’s extremely easy to stay home and be in isolation for somebody like me. I have a big house, I have a big yard, I can click on Amazon and get my stuff delivered,” Fulford said. “But who’s delivering it? What choice does the person delivering to my house have?

“If we don’t provide the same sorts of supports for all the essential workers, this is never going to come under control.” 

Doctors say if essential workers are now a key driver of transmission then the coronavirus won’t be contained unless they’re able to stay home when sick or potentially exposed without having to worry about putting food on the table. 


Dr. Nav Persaud, seen here in 2018, favours rules to control the COVID-19 pandemic, but said some some infractions by individuals aren’t a priority, compared to broader supports that are needed. (Craig Chivers/CBC)

Fulford also noted that the highest rates of transmission are among people living in crowded conditions or working in large warehouses

“I’m not an economist, I’m just a physician, but I can’t help but think in the long term, it would be far more cost effective to invest money in the areas where we’re seeing the highest transmission, and support them, than shut down an entire economy.”

Facilitate work from home when possible

Persaud said punishments such as charges and fines for violating COVID-19 safety rules often hit individuals rather than institutions such as employers. 

He sees the charges laid against Cargill for the country’s largest workplace outbreak in High River, Alta., as an exception and “a fairly extreme example.” The allegations haven’t been tested in court.

For other workplaces, Persaud suggested addressing larger, underlying issues contributing to outbreaks, such as office managers asking staff to come in to perform duties that could be done from the safety of home.

WATCH | Why Peel Region’s workplaces struggle with COVID-19 outbreaks:

Ontario’s Peel Region, just west of Toronto, has long been a hotspot for COVID-19, but the high number of warehouses and transportation facilities may be partly to blame. 2:15

Another recent high-profile case of charges being laid include a couple in Durham, Ont., east of Toronto, who are accused of obstructing contract-tracing efforts of public health officials investigating the introduction of the B117 variant of the coronavirus first identified in the U.K.

A third involves a penthouse owner in Vancouver who welcomed party goers. 

In contrast to charges, Fulford highlights a role model for countering conditions for outbreaks: hospitals.

“We have had hospital outbreaks and we’re not pointing fingers or getting angry because we understand, we do a root-cause analysis to figure out where we went wrong and we do better next time,” Fulford said.

Despite the best efforts of employers and workers, outbreaks can sometimes happen because of sheer bad luck.

Fulford said when an outbreak occurs in a workplace, bringing in infection prevention and control experts is a more productive approach than laying charges

“It’s a very unusual situation for me that we would be criminalizing public health interventions.”

Fulford said drug-resistant tuberculosis is one of the few instances that the Quarantine Act has been enforced for individuals. 

In the context of COVID-19, Fulford gives the example of someone who decides to meet family members from outside their household at a park and gets charged for breaking pandemic public health rules.  

In such a case, Fulford favours educating people and explaining why such behaviour is a problem to encourage them not to do it again — not naming and shaming. Otherwise, there could be unforeseen consequences for public health.

“Contact tracing is going to become a hundred times more difficult if the fear is that you’re going to be charged, your name is going to be in the newspaper.”

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CBC | Health News

Code red COVID-19 restrictions take effect in Manitoba as Alberta doctors call for ‘circuit-breaker’ lockdown

The latest:

Manitoba’s sharp new “code red” COVID-19 restrictions kicked in early Thursday as the province tries to slow the spread of the novel coronavirus.

Health officials reported 431 new cases and nine new deaths in the province on Wednesday. Hospitalizations stood at 218, with 32 in intensive care — a record high in the province.

Schools will stay open, but everything from non-essential retail to theatres and restaurant dining rooms will be closed. 

Chief Provincial Public Health Officer Dr. Brent Roussin, who earlier this week said the province was at a “crossroads in our fight against this pandemic,” urged people to stay home to stop the spread.

In neighbouring Saskatchewan, more than 300 doctors have signed a letter calling for that province to do more to fight the novel coronavirus. 

“If more is not done to change our course we are confident that winter will bring overflowing hospitals, cancelled surgeries, overwhelmed health-care providers and needless death,” the letter said.

COVID-19 case numbers have been rising in Saskatchewan, with 112 new cases reported on Wednesday. The latest figures from the province put the number of hospitalizations at 48, with 11 in intensive care.

A letter signed by hundreds of doctors and three major unions representing health-care workers in Alberta sent to Premier Jason Kenney on Thursday made an explicit call for tighter restrictions, including a suspension of many indoor group activities. 

“We have reached a juncture where only strong and decisive mandatory measures can prevent our hospitals from becoming overwhelmed,” the letter said.

The letter said the province’s testing system is “strained” and contact tracing capacities “have collapsed.”

“We see no other way to break chains of transmission and decrease cases, than to implement a ‘circuit breaker’ of short, strict measures.”

Alberta is considering stepped-up COVID-19 restrictions, two officials told CBC News, as COVID-19 cases in that province continue to climb. Health officials reported 672 new cases of COVID-19 and seven more deaths on Wednesday. Hospitalizations stood at 217, with 46 people in intensive care.


What’s happening across Canada

WATCH: How businesses and schools are dealing with airborne COVID-19:

As aerosol transmission of COVID-19 becomes more widely acknowledged, schools and businesses are looking for new ventilation solutions to guard against it. 8:00

As of 11:20 a.m. ET on Thursday, provinces and territories in Canada had reported a cumulative total of 280,001 confirmed or presumptive coronavirus cases. Provinces and territories listed 224,960  cases as recovered or resolved. A CBC News tally of deaths based on provincial reports, regional health information and CBC’s reporting stood at 10,745.

Across Canada’s North, there were two new cases reported on Wednesday: one in Nunvaut and one in the Northwest Territories. Nunavut has now seen three confirmed cases of COVID-19 while the Northwest Territories have had a total of 11 confirmed cases.

In British Columbia, the Interior Health authority has issued a COVID-19 alert to its residents as cases rise in the region. The health authority, which includes communities like Kamloops and Kelowna, said in a statement that it’s concerned with the upward trend and frequency of new local clusters.

A recent provincial health officer’s order limiting social interactions doesn’t apply to Interior Health, but local health officials said they need the public’s help to prevent further restrictions.

Ontario on Thursday reported 1,575 cases of COVID-19, with 472 in Toronto, 448 in Peel Region, 155 in York Region and 91 in Ottawa. The province reported 15 additional deaths, bringing the number of COVID-19 deaths reported in Ontario since the outbreak began to 3,293.

There were 431 people in hospital with 98 in intensive care, according to a provincial dashboard.

Dr. Samantha Hill, president of the Ontario Medical Association, told CBC News Network on Thursday that she’s concerned about the rising numbers in Ontario.

“If we keep increasing at such a fast rate, we are looking at overwhelming health-care resources,” she said, adding that health-care workers are struggling and at risk of burnout.

“There’s so much backlog of health care — that pandemic deficit that was created — we can’t afford to fall further behind and we can’t afford to lose more of our resources.”

Quebec on Thursday reported 1,365 new cases of COVID-19 and 42 more deaths, including nine reported to have occurred in the past 24 hours. The province reported 583 hospitalizations with 86 in intensive care.

No province in Canada has seen more COVID-19 cases than Quebec, which has seen a cumulative total of nearly 120,000 cases and 6,557 deaths.

In Atlantic Canada, Nova Scotia reported no new cases of COVID-19 on Thursday.

Newfoundland and Labrador reoported two new cases on Wednesday.  There was one new case reported in Prince Edward Island and no new cases in New Brunswick.


What’s happening around the world

From The Associated Press and Reuters and CBC News, last updated at 9:45 a.m. ET

More than 52 million cases of COVID-19 have been reported around the world with more than 34 million of those listed as recovered, according to a Johns Hopkins University case-tracking tool. The worldwide death toll stood at more than 1,286,000, the university reported.

In Africa, the top public health official says the continent has seen an average eight per cent rise in new coronavirus cases over the past month as infections creep up again in parts of the region of 1.3 billion people.

John Nkengasong, director of the Africa Centres for Disease Control and Prevention, said “we expected it to happen,” and warned that when the virus comes back for a second wave, “it seems to come back with a lot of full force.” The African continent is approaching two million confirmed cases, including more than 45,000 deaths.


After several months of closure, four million students in Senegal returned to school on Thursday with health instructions to avoid spreading the coronavirus. (John Wessels/AFP/Getty Images)

Nkengasong said that “we are at a critical point in the response,” and again urged governments and citizens to follow public health measures. Testing across Africa remains a challenge, with 19 million tests conducted so far. Countries with the highest increase of cases in the past week include Congo at 37 per cent, Kenya at 34 per cent and Nigeria at 17 per cent.

In the Americas, Argentine President Alberto Fernandez and several of his ministers began preventative isolation after coming in close contact with an official infected with coronavirus.

Meanwhile, in the United States Dr. Anthony Fauci said he hopes a broad embrace of public health measures aimed at fighting COVID-19 will allow the country to avoid locking down.

“If you can do that well, you don’t have to take that step that people are trying to avoid, which has so many implications both psychologically and economically,” he said. “We’d like not to do that.”

Fauci, the nation’s top infectious disease expert, told ABC’s Good Morning America on Thursday that vaccines being developed “are going to have a major positive impact” once they start being deployed.

Health-care workers and some high-risk populations could receive vaccines as early as December or early next year, he said. The “ordinary citizen” may be able to get a vaccine sometime between the end of April and June.


In the meantime, Fauci said there are fundamental things Americans can do to stem the spread of the deadly virus. They include “universal and uniform” wearing of masks, avoiding crowds, keeping physical distance, doing as many activities as possible outdoors and washing hands. He said that sounds simple against a very difficult challenge but “it really does make a difference.”

Fauci’s message echoes that of president-elect Joe Biden, who this week signalled strongly that fighting the raging pandemic will be the immediate priority of his administration.


Medical staff members treat a patient suffering from coronavirus in the COVID-19 intensive care unit at the United Memorial Medical Center in Houston, Texas, earlier this week. (Go Nakamura/Getty Images)

In the Middle East, hundreds of disillusioned doctors are leaving Lebanon amid falling wages and shortages of equipment, staff and even some basic supplies in hospitals as the country runs out of hard currency to pay for imports.

Emirates Group, the owner of the Middle East’s biggest air carrier, reported Thursday it lost $ 3.8 billion in the first half of the year, its first net loss in over three decades after the pandemic wiped out air travel.

In Europe, Ukraine’s President Volodymyr Zelensky has been hospitalized after testing positive for the novel virus. Spokesperson Iuliia Mendel told The Associated Press his symptoms remain mild and there is “nothing serious” in his condition. Zelensky disclosed Monday that he had contracted the virus.

Mendel said he was moved to a hospital in Kyiv because “there are better conditions for self-isolation and care for coronavirus patients.”

Zelensky’s chief of staff, defence minister and finance minister have been diagnosed with COVID-19.

On Wednesday, Ukraine’s government ordered non-essential businesses to shut down on weekends to stem the rapid growth of the outbreak.

Health officials reported another record 11,057 coronavirus cases on Thursday. Ukraine has reported a total of 500,865 confirmed cases and 9,145 deaths.

Dozens of hospital workers have held protests at hospitals in Greece, demanding more medical staff be hired as the country struggles to contain a resurgence of the coronavirus that has led to a new lockdown being imposed.

France’s prime minister said now is not the time to relax COVID-19 measures, a day after the country’s total reported cases overtook Russia to become the worst-affected country in Europe.

WATCH | England’s national lockdown confuses as country reaches grim milestone:

England’s latest national lockdown has been full of confusing, messy political decisions that come as the country grapples with rising COVID-19 deaths and reaches the grim milestone of 50,000 dead. 2:59

Moscow’s mayor said city authorities were expecting cases to increase and that the situation with hospital beds could remain critical for some time, TASS news agency reported.

In the Asia-Pacific region, India has reported 47,905 new cases of coronavirus infection with New Delhi setting another daily record Thursday.

The surge of 8,593 cases in the nation’s capital is the highest for any major Indian city and comes as people crowd shopping areas ahead of Diwali, the Hindu festival of lights, on Saturday.


A security guard checks the body temperature of a customer outside a shop in a market in New Delhi on Thursday ahead of Diwali. (Money Sharma/AFP/Getty Images)

Deaths, too, are climbing again, with 85 in New Delhi in the past 24 hours. Deaths are a lagging indicator of the impact of the virus, due to long periods of illness and medical treatment.

Japan reported record new infections, while Tokyo Olympics organizers said athletes arriving for the Games will not have to isolate for 14 days.

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Alberta hospitals straining dangerously under weight of COVID-19, doctors warn

As COVID-19 cases reach a critical tipping point, Alberta hospitals are in danger of being pushed beyond capacity, with the virus running through wards crowded by patients in isolation, frontline doctors warn. 

“Infection control can destroy a hospital,” says Dr. Darren Markland, an intensive care physician at the Royal Alexandra Hospital in Edmonton, one of nine hospitals in the province contending with outbreaks.

“We need to have concrete guidance and that involves possibly rotating lockdowns or just kind of flipping the breakers for two weeks to stem the tide of this.” 

Alberta must enforce more stringent public health measures immediately to protect hospitals from community spread, Markland said in an interview Friday. 

If government health officials fail to clamp down, case numbers will escalate to where they will overwhelm health-care facilities, he said.

“We need clear direction from our government, from our chief medical officer, and that can not be voluntary at this point,” he said.  “But right now, we’re getting some very vague leadership from our health authority.” 

Alberta reported about 800 new infections on Thursday, breaking the daily case record.

The province did not have an exact number because of technical problems, but the range given was well over its previous one-day record of 622 new cases.  

In her briefing Thursday, Dr. Deena Hinshaw, Alberta’s chief medical officer of health, warned that numbers will rise further and hospital care for Albertans with other issues besides COVID-19  will be affected.

As more patients are quarantined and wards are placed in isolation, operations will become more strained, Hinshaw cautioned. Additional measures will be considered unless the numbers drop dramatically in the next few days, she said.

“I am very concerned about the levels of hospitalizations for COVID-19 in Edmonton and Calgary,” Hinshaw said. 

“We must protect our health system by reducing community transmission. The fact that we are now reporting 800 new cases is extremely concerning.”

A hospital fails well before it is over capacity.​​​​​– Dr Darren Markland

While Markland worries about the growth in the caseload, the real issue in Alberta hospitals is the strain of controlling infection and isolating patients.

“A hospital fails well before it is over capacity,” Markland said. 

“When you have a pandemic, your most important mechanism is prevention of spread. And you can imagine, hospitals concentrate the sickest people in small areas. 

“As you pack sicker and sicker people in smaller areas, you are going to see spread.” 

Markland said Alberta’s hospitals are not designed to handle pandemic protocols.

Placing even a single patient in lockdown can have a ripple effect through the entire hospital, he said. 

Outbreaks make it impossible to move patients through the system, while understaffing from illness and exhaustion leads to further outbreaks, Markland said.

“You can’t get out of the emergency department. You can’t get into the cath lab. You can’t get into the operating room and you can’t get into the ICU because you can’t put uninfected people together with infected people.” 

Already the pressure on front line staff is immense, he said. 

“There is a feeling of ongoing dread,” Markland said. “We can’t be complacent about this.” 

Some hospitals are already operating at threshold.

Nine Alberta hospitals — the Royal Alexandra Hospital, the University of Alberta Hospital, Leduc Community Hospital, Misericordia Community Hospital, Grey Nuns Community Hospital, Foothills Medical Centre, Peter Lougheed Centre, Rockyview General Hospital, Chinook Regional Hospital — have declared outbreaks. All continue to operate but with restrictions.

Some wards have been locked down or non-emergency surgeries have been postponed. In some facilities, visitation has been restricted. 

In Edmonton, 30 percent of non-urgent and elective surgeries have been postponed for the foreseeable future to ensure hospitals have the capacity to withstand any outbreaks among their patients.

Health officials say hospital capacity has been limited too by the need to quarantine staff who have fallen ill or have potentially been exposed to the virus. 

We’re going to see the death rate of the virus go up.– Dr Raj Bhardwaj

Dr. Raj Bhardwaj, a family physician and urgent care doctor working in downtown Calgary, said health officials should have seen this coming.

The government’s response to the virus thus far has been weak, Bhardwaj said. 

Despite repeated warnings, little was done to avoid the anticipated second wave, he said.

The province no longer has the luxury of targeted controls, he said. More drastic measures such as rotating lockdowns will be required to turn things around.

“If we don’t impose some sort of restrictions to turn these numbers around, we are going to the hospital overwhelmed with numbers,” he said. 

“We’re going to see the death rate of the virus go up because the death rate is not intrinsic to the virus alone. It is also partly changeable, depending on our ability to treat people who are very sick from the virus.” 

Bhardwaj said he wants to see the province adopt new mandatory restrictions but a lack of transparency has stymied efforts to contain the virus.

Government health officials should be releasing more data on current hospital capacity thresholds and ensure their modelling for the trajectory of the virus is up to date, he said. 

Any investigations done on the spread of the virus within hospital wards should be made public and shared widely among the medical community, he said.

Without these critical details, the public and front-line healthcare workers are often operating in the dark, Bhardwaj said.

“There’s a lack of transparency on a lot of levels,” he said. 

“People just aren’t informed. And the people who are tasked with informing them, sadly, are not sharing the information that I’m sure that they are operating with.” 

Without better protocols, he fears for the winter ahead, Bhardwaj said.

“I fear for the public for sure, for my patients for sure. But I also really fear for my colleagues.

“I’m really worried about how they’re going to cope with the moral injury of having to deny people care or having to ration care in terms of beds and ventilators and visitors and things like that

“It’s going to be the type of damage that lasts a lifetime.”

Bracing for a spike 

Dr. David Zygun, Edmonton zone medical director with Alberta Health Services, said front-line staff are bracing for an increase in hospitalization rates.

There is no doubt that a spike in infection rates will be felt in health-care centres in a matter of days, Zygun said in an interview Friday.

Staffing is the largest challenge in Alberta hospitals right now, he said. Many workers have been sent home due to illness or possible exposure. Workers are also exhausted from the strain of months spent contending with the added anxieties of working through a pandemic.

Demand for isolation space is at an “all-time high” and it’s eating up critical space in hospitals, Zygun said.

“I am very concerned about the numbers I see in the community,” he said.

“Ultimately, that’s what’s driving a lot of the isolation and demand. Until we get control over those, we will see increasing strain.

“I absolutely have seen the stress on our frontline health-care providers and the leaders that are also trying to manage this. This now a very prolonged pandemic.” 

If hospitals do approach the tipping point, Zygun said detailed contingency plans are in place for staffing and facilities.

For instance, “unconventional” strategies could see doctors from the ER called in to assist with patients in intensive care units. If intensive care units fill up with COVID patients, cardiac units or post-op rooms could be equipped with ventilators.

Hundreds of surgeries have already been postponed. If the trend continues, more procedures will be called off, Zygun said. Any extra measures that could help curb the spread of the virus would be welcome, he added.

“We know, as the numbers go up, the end of this is further and further away. 

“We’re trying to do as much as possible. But as things escalate, we will have to focus more and more on the inpatient response. And that means delayed care for others, which is extremely troubling.”

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Steroids, inhalers and ventilators: What Quebec doctors are learning about COVID-19

At the beginning of the COVID-19 pandemic’s first wave, Dr. Joseph Dahine and his colleagues could spend over an hour huddled around the bedside of a patient in the ICU in Laval, Que., brainstorming treatment options.

There were no textbooks to tell them what to do, so they became medical detectives as Quebec faced a surge of cases, learning everything they could about the physiology and nuances of COVID-19 to save lives.

Dahine, an intensive care specialist at Cité de la Santé hospital, said he worked gruelling, 12-hour days through the spring, discussing with his team on breaks.

“We experimented a lot,” he said.

What was clear from the outset was that COVID-19 was no normal respiratory disease. Often, patients would come in with extremely low oxygen saturation levels.

“Usually that’s an emergency. The patient is dying, they are gasping for air and you need to put the tube in immediately,” said Dahine. 

But these patients didn’t appear to be in distress.

“It’s weird to tell someone, ‘OK, we’re going to put you in a coma now and we’re going to put a tube down your throat and they’re like, ‘Well, I’m fine,'” said Dahine.

Over time, Dahine and his team learned more about when to intubate a COVID-19 patient. 

In some cases, they were able to avoid it altogether. They practiced the same restraint when they removed someone from a ventilator.

Although the World Health Organization had warned it took COVID-19 patients up to three weeks to recover, Dahine recalls a 60-year-old patient who, four days in, seemed to no longer require intubation. The medical team decided to take him off the ventilator.

But when they began to dial down the pressure that kept the patient’s airways open, his lungs couldn’t take it. They had to quickly bring him back up to 100 per cent oxygen.

The man’s lungs were still too fragile. 

“We’re not surprised anymore when a patient deteriorates when we decide to wean them,” said Dahine.

“We needed to be more patient for the inflammation and the disease to improve.”

WATCH | Dr. Joseph Dahine on lessons learned during COVID-19’s first wave

One of many lessons learned treating patients this spring includes finding alternatives to early intubation. 1:21

But there are still curveballs. Inflammation of the lungs isn’t always the culprit if a patient starts to deteriorate.

COVID-19 patients in the ICU are sometimes prone to blood clots and kidney disease, which requires dialysis.

After a relatively quiet summer, a patient came in to the Laval hospital last month with cardiogenic shock — a serious condition that occurs when the heart cannot pump enough blood and oxygen to the brain, kidneys and other vital organs.

“That first case, it scared us,” said Dahine. He was worried cardiac complications might be the defining feature of COVID-19’s second wave.

But so far, it was just that one patient — and that patient pulled through.

What works, and what doesn’t

It is difficult for Quebec’s doctors to measure the degree to which improved methods have helped decrease the mortality rate of COVID-19 and length of hospital stays, given the multitude of factors at play.

(In July, the World Health Organization estimated the infection fatality rate at 0.6 per cent.)

The province’s second wave of COVID-19 has seen an increase in cases among teenagers and people in their 20s, who are less likely to suffer serious complications from the virus and, in many cases, don’t stay as long in hospital.

While doctors say there is still much to learn about the virus, new treatments and techniques have helped.

Medications such as dexamethasone, an inexpensive steroid, and remdesivir, an antiviral drug, have been shown in clinical trials to help patients with COVID-19.

Dr. Matthew Oughton, an infectious diseases specialist at the Jewish General Hospital in Montreal, said both those drugs have helped improve recovery times.

“We also know things that don’t work,” he said, mentioning, like Dahine, not putting a patient on a ventilator right away. Sometimes, the solution is as straightforward as having a patient rest on their stomach, rather than their back.

Oughton said the patients are, on the whole, spending less time in hospital. Still, the number of people being admitted has climbed in recent weeks, particularly in certain regions, such as Quebec City.

“I wouldn’t say that they have skyrocketed up, but it is making it challenging,” he said.

“It looks like we may be able to keep control on this. I say that with great trepidation, though.”

Dr. Horacio Arruda, Quebec’s public health director, on Monday said the mortality rate from complications of the virus seems to be improving in the province, and that new treatments are especially effective in young people. 

“But it’s still a disease that, if you have any underlying health conditions, can be very difficult. And even if you survive, you can have pulmonary problems, agnosia,” Arruda said at a news conference Monday. 

“It’s still a serious disease, and I think preventing it is better than getting it.”

Keeping patients out of the hospital

There are also signs of improvement outside the hospital setting.

Dr. Nicole Ezer, a researcher in the respiratory diseases program at the McGill University Health Centre, is among those working on new medications that will keep people from having to be admitted.

Ezer is testing the efficiency of ciclesonide, an inhaled and nasal steroid drug currently used for asthma and nasal rhinitis, on patients with milder symptoms of COVID-19.

If successful, the medication would allow doctors to treat patients with more mild symptoms at home — and avoid them having to go to hospital.

“I think in general there’s a lot of enthusiasm for vaccines, but we don’t know yet the efficacy of the vaccine,” said Ezer, who is also an assistant professor at McGill University.

“For us, COVID is always going to be present.”

Uncertainty remains

Despite everything doctors have learned about the disease, Dahine says it’s too soon to tell if it will mean fewer deaths for those patients that need to be hospitalized.

“Flattening the curve in the spring, making sure that each hospital did not have too big of an influx of patients at the same time, prevented us from making mistakes that would have gotten us a higher mortality rate,” he said.


Quebec’s second wave of COVID-19 has seen an increase in cases among teenagers and people in their 20s, who are less likely to suffer serious complications from the virus. (Ivanoh Demers/CBC)

The emotional burden on the families of people hospitalized with COVID-19 is something Dahine will never forget.

His hospital alone has seen households that will be forever changed by the disease. In one case, a couple came in — the wife made it, but the husband did not. There was also a son and his mother. The son survived, but his mother died.

Dahine still doesn’t know why some patients took a turn for the worse even when they had the same treatment, doctor and support team.

“I can’t take solace in the fact that it’s the patient’s fault,” said Dahine. “Certainly it’s the disease’s fault.”

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Fewer in-school HPV vaccinations could cause rise in preventable cancers, doctors warn

Clinicians are warning that the cancellation of Ontario’s in-school HPV vaccination programs in the spring of 2020 could lead to thousands of preventable cancers in the future if children aren’t tracked to make sure they eventually get immunized. 

All Ontario children normally receive two doses of the vaccine, in the fall and spring of Grade 7, but this spring’s vaccinations were cancelled due to the COVID-19 pandemic. That means last year’s Grade 7 cohort missed its second dose, while parts of this fall’s new batch of Grade 7 students could miss their first.  

The plan to administer the vaccine going forward varies across the province. The Ontario government has given local health units guidance to offer the vaccination at special catch-up clinics or make the vaccination available at doctor’s offices.

Human papillomavirus, or HPV, can cause cancer in men and women and will infect three in four Canadians during their lifetime, according to the Canadian Cancer Society.

Research suggests the vaccine has had a dramatic impact on reducing the rate of cervical, anal, penile, vaginal, head and neck cancers. 

“This is really important,” said Dr. Vivian Brown, past-president of the Federation of Medical Women in Canada and chair of HPV week in Canada. 

“We don’t want people to slip through the cracks and find out they were supposed to get a shot and never got it. They’re entitled to it, it’s paid for by public health, and we want to protect boys and girls against the cancers that HPV causes.”


All Ontario children normally receive two doses of the HPV vaccine in Grade 7, first in the fall and then in the spring. (Harry Cabluc/Associated Press file photo)

In-school vaccinations cancelled

Other physicians’ organizations, including the Society of Obstetricians and Gynaecologists, are urging public health administrators not to lose track of this cohort of children.

Public health units in Ottawa and Toronto have been trying to offer “catch-up” clinics where parents can bring in their children, but they attract significantly fewer people, Brown said.

“We know statistically that school-based programs have the best uptake,” she said. 

According to Ottawa Public Health (OPH), some 10,000 boys and girls in Grade 7 usually take part in the in-school vaccination program.

While OPH offered catch-up clinics in the summer, they’re now suspended as its focus turns to delivering the flu vaccine. The health agency is, however, offering the vaccine to physicians who can then administer the shot in their offices.

“OPH will be assessing the timing of student catch-up immunizations after the influenza vaccine season, if feasible,” said a health unit spokesperson in a statement.

Students affected by the cancellation will also have their HPV immunizations updated before the end of summer 2021, OPH said.

Toronto Public Health has cancelled in-school immunizations until the spring of 2021, and is taking appointments later this month for parents able to bring their kids to a community clinic. 


A study published last month in the New England Journal of Medicine found that girls vaccinated before turning 17 were significantly less likely to develop cervical cancer. (Joe Raedle/Getty)

Timing critical

The HPV vaccine is recommended for children younger than 15 because they seem to be better at building immunity against the virus, requiring only two doses for life-long immunity rather than three doses after the age of 15, according to public health officials.

Because HPV is a sexually transmitted virus, it’s also critical the vaccine is taken before children become sexually active.

A study published last month in the New England Journal of Medicine found that girls vaccinated before turning 17 were 88 per cent less likely to get cervical cancer. Those vaccinated after 17 cut their chances in half.


That research suggests the vaccine’s timing is critical, Brown said, and affected families should be contacted to make sure they know they have opportunities to vaccinate their child outside of the school setting.

Brown said the idea of having to diagnose someone from this cohort with cancer years later would be “heartbreaking.”

“What you would have to tell someone is that this was a preventable cancer [and they got it] because they were overlooked.”

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Doctors, pharmacies explore drive-thru, outdoor clinics to meet flu shot demand

Anticipating increased demand for the flu shot this season, pharmacist Sean Simpson has invested in a few unorthodox supplies that go well beyond extra face masks: street signage, traffic cones, a pop-up tent and hard hats.

He’ll need them for the drive-thru vaccination clinic he’s setting up in the parking lot of his Virgil, Ont., Pharmasave, a scheme he hopes will address COVID-19 fears while offering customers a quick way to get their shot.

“We’ve worked it out in our heads a number of times, and we seem to think it’ll work,” said Simpson, who was still waiting Tuesday for his vaccine shipment to arrive.

“We’ll have a setup where we’re able to vaccinate people in the car and monitor them for the recommended period of time and let them go on their way so that we can reduce the interaction with others.”


Pharmacist Sean Simpson poses outside his pharmacy in Virgil, Ont., on Monday. He’ll be offering a drive-thru flu clinic this year. (Tara Walton/The Canadian Press)

While residents in Prince Edward Island and New Brunswick have been among the first in Canada to receive doses in recent weeks, pharmacies and doctor’s clinics in much of the rest of the country are still waiting and preparing to deliver their shots. Many start their programs in October or early November.

Canadian Medical Association president Dr. Ann Collins said varied start times depend on when the vaccine supply is delivered to the province, when it is dispersed to depots, when it’s picked up by the provider and ultimately when providers have their provision plan in place.

This season, the Fredericton-based physician said pharmacists and doctors are eager to try novel ways to offer large-scale flu clinics that can maintain pandemic safety precautions, noting her own family physician hosted a flu clinic in a parking lot last weekend.

At Simpson’s Pharmacy in Virgil, drive-thru visits will be by appointment only, with waivers and related paperwork to be filled out online.

Simpson expected the outdoor clinic will limit face-to-face interaction between strangers, avoid any need for a waiting room and reduce crowding in the actual store.

Ottawa family physician Dr. Aly Abdulla said COVID-19 precautions rule out traditional mass-vaccination tactics, such as renting out the nearby legion.

At the same time, getting the shot to as many people as possible was more crucial than ever to avoid a feared “twindemic,” in which simultaneous flu and COVID-19 outbreaks overwhelm the health-care system.

Pharmacy chain staggers rollout

Abdulla expected to offer the flu shot when patients come in for routine appointments. But he’s also in talks with local public health about a joint effort that might see several doctors share the cost of renting a large space for a flu clinic, which would also allow them to pool their doses if needed.

“Our plan is to have public health screening areas — maybe arenas, maybe clinics that are not using their space on evenings and weekends — to have these flu clinics,” said Abdulla. He said he’s also heard of doctors in Guelph, Ont., and Georgian Bay considering drive-thru clinics.

“[They] will essentially be ad hoc in the community, based on what the needs are.”

This year, the Public Health Agency of Canada said more than 13 million doses have been ordered, a jump from last season’s 11.2 million doses. Ten per cent of that is the high-dose influenza vaccine — itself a 25 per cent increase from last season as public health focuses on inoculating more adults 65 years and older, who account for most hospitalizations and deaths from flu and COVID-19.

Shoppers Drug Mart said its stores in P.E.I. began delivering the flu shot Sept. 28, while those in New Brunswick began Oct. 5.

The chain, including its Loblaw pharmacies, continued a staggered rollout in Ontario on Wednesday; Manitoba and Nova Scotia next week; British Columbia, Alberta and Saskatchewan on Oct. 19; Yukon on Oct. 26 and in Quebec’s Pharmaprix outlets on Nov. 1.

WATCH | Flu shots could help avoid ‘twindemic,’ doctors say:

Health authorities are urging Canadians to get a flu shot this year to avoid the spectre of a “twindemic,” where the health-care system is overwhelmed by COVID-19 and influenza, but there are concerns about how to safely deliver flu shots to more people. 3:31

A spokesperson said availability in Newfoundland and Labrador was still to be determined and that customers should contact their local pharmacy to confirm details.

Requests ‘off the charts,’ Toronto pharmacist says

Theresa Firestone, senior vice-president of health and wellness at Shoppers Drug Mart, touted a contactless digital consent form that includes screening for COVID-19 symptoms, drop-in appointments and dedicated senior’s clinics — when stores will be opened exclusively for older shoppers — with meeting increased demand.

“Physician offices often close at the end of the workday. We have many stores open until midnight … and we have a number of stores that are 24-hours,” said Firestone.

Victor Wong, an associate owner and pharmacist at a Shoppers Drug Mart in east-end Toronto, said requests for the flu shot “have been off the charts,” with some customers asking about its arrival since the summer.


Needles and syringes used to administer the flu shot. Doctors face added costs of personal protective equipment and cleaning supplies to give the vaccine this year. (Tara Walton/The Canadian Press)

He expected demand will be high at his store after hearing some doctors were skipping the season entirely.

“We have local doctors, even within our close proximity, who have already phoned us to let us know that they will not be opening up their clinics this year for flu shots or will be diverting their flu shot patients to our store,” said Wong, whose store delivered more than 600 flu shots last year.

A recent survey by the Canadian Medical Association suggested half of 598 respondents expected they won’t have enough doses this season. A broader survey of 1,459 doctors found half had trouble accessing personal protective equipment, and many feared they’ll have trouble safeguarding patients and staff while delivering the flu shot.

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Trump’s COVID-19 condition improving, could return to White House Monday, doctors say

The latest:

  • ‘The fact of the matter is, he’s doing really well,’ Trump’s physician says.
  • Supporters rally at vigil for U.S. president outside military hospital.
  • Survey shows Biden’s lead over Trump widens slightly.
  • Differing assessments leave it unclear how ill the president might be.
  • White House chief of staff initially said Trump’s vitals ‘were very concerning.’

U.S. President Donald Trump’s condition is improving as he is being treated for COVID-19 at a military hospital, and he could return to the White House as early as Monday, the doctors leading his treatment said on Sunday.

That word came the day after a series of contradictory messages from the White House about Trump’s condition caused widespread confusion about his health.

“The patient continues to improve. He has remained without fever since Friday morning, his vital signs are stable,” Dr. Sean Dooley told reporters outside Walter Reed National Military Medical Center in Bethesda, Md., where Trump has been receiving treatment since Friday.

Before his transfer to hospital, late Friday morning, Trump’s oxygen levels dipped and he had a high fever and was given supplemental oxygen for about an hour — but was not short of breath and was soon “moving about” with “only mild symptoms” — said his White House physician, Dr. Sean Conley.

WATCH | Trump’s medical team confirms president was given oxygen Friday:

Doctors for U.S. President Donald Trump confirmed he was given supplemental oxygen Friday but say his health is improving. 3:35

Another physician on the team, Dr. Brian Garibaldi of Johns Hopkins University, said Trump completed a second dose of the antiviral remdesivir on Saturday evening and reported no side effects.

“In response to transient low oxygen levels, as Dr. Conley has discussed, we did initiate dexamethasone therapy, and he received his first dose of that yesterday, and our plan is to continue that for the time being,” Garibaldi said.

“Our plan today is to have him eat and drink, be up out of bed as much as possible, to be mobile, and if he continues to look and feel as well as he does today, our hope is that we can plan for a discharge as early as tomorrow to the White House, where he can continue his treatment course.”

Dexamethasone, a steroid, is shown in studies to improve survival for patients hospitalized with critical COVID-19 who need extra oxygen. But it should not be given in mild cases, since it can limit the body’s own ability to combat the virus, according to guidelines from the Infectious Diseases Society of America.

“The fact of the matter is, he’s doing really well,” Conley said at Sunday’s media briefing.

WATCH | What is dexamethasone?

U.S. President Donald Trump’s doctors say he is being given dexamethasone during his stay in hospital for COVID-19. Infectious disease specialist Dr. Isaac Bogoch explains what the drug is. 5:11

Trump tweeted thanks to his supporters early Sunday from the hospital. On Saturday, he released a four-minute video on Saturday in which he said the “real test” of his condition will come over the next few days.

“Over the next period of a few days, I guess that’s the real test, so we’ll be seeing what happens over those next couple of days,” Trump said into the camera, looking tired and wearing a jacket and open-necked shirt.

In Sunday’s tweet, Trump said “Thank you so much!” — referring to clusters of supporters who gathered on Saturday night outside the Walter Reed hospital waving Trump 2020 flags.


 

Trump’s illness has upended the campaign ahead of the Nov. 3 presidential election and cast a spotlight on the president’s handling of the pandemic. The Republican president is trailing Democratic rival Joe Biden in opinion polls.

A Reuters/Ipsos poll published on Sunday found that Biden had opened a 10-point lead over Trump nationally, slightly wider than it has been for the past two months. Some 65 per cent of Americans said Trump likely would not have been infected had he taken the virus more seriously — a view that half of registered Republicans polled supported. Some 55 per cent said they did not believe Trump had been telling the truth about the virus.

Trump has repeatedly played down the threat of the pandemic, even as it has killed more than 208,000 Americans and hammered the U.S. economy.

Condition unclear

Differing assessments of Trump’s health from administration officials on Saturday left it unclear how ill the president had become since he tested positive for the coronavirus on Thursday night.

A White House team of doctors said on Saturday morning that Trump’s condition was improving and that he was already talking about returning to the White House.


Signs left by supporters of Trump appear at the entrance to Walter Reed National Military Medical Center on Sunday. Trump was admitted to the hospital on Friday after contracting the novel coronavirus. (Cliff Owen/The Associated Press)

Within minutes, White House chief of staff Mark Meadows gave reporters a less rosy assessment, saying, “The president’s vitals over the last 24 hours were very concerning, and the next 48 hours will be critical in terms of his care. We’re still not on a clear path to a full recovery.”

Meadows, whose initial comments were delivered on condition that he not be identified, altered his tone hours later, telling Reuters that Trump was doing “very well” and that “doctors are very pleased with his vital signs.”

He did not clarify the discrepancy in his comments. A Trump adviser who spoke on condition of anonymity said the president was not happy to learn of Meadows’s initial remarks.

Administration officials have described the move to Walter Reed as precautionary and said Trump would stay for several days.

However, in an interview with Fox News broadcast Saturday night, Meadows revealed that Trump’s condition on Friday was far worse than officials had made public, saying doctors recommended the president go to the hospital after seeing he had a fever and his blood oxygen level dropped rapidly.

White House physician Sean Conley told reporters outside the hospital on Saturday that Trump had not had trouble breathing and was not given oxygen at Walter Reed.


Trump supporters gathered late Saturday outside the military hospital in Bethesda, Md., where the U.S. president is being treated for COVID-19. (Jonathan Ernst/Reuters)

He declined to give a timetable for Trump’s possible release from the hospital and later had to issue a statement saying he misspoke after appearing to suggest Trump had been diagnosed as early as Wednesday.

In a statement on Saturday evening, Conley said the president was “not yet out of the woods,” but his team remained cautiously optimistic.

WATCH | Illness may make Trump more relatable to voters, Republican strategist says:

Republican strategist Seth Weathers says U.S. President Donald Trump’s illness could play well for him politically, as it could help voters feel more connected to him. 5:35

“Today’s spectacle — doctors saying one thing, White House sources saying another thing and both later amending their statements — only reinforces the credibility problems of this administration,” said Kyle Kondik, a political analyst at the University of Virginia’s Center for Politics.

Campaign reshaped

With Trump off the campaign trail indefinitely, his campaign announced “Operation MAGA,” based on his slogan “Make America Great Again,” which will see high-profile allies — including Vice-President Mike Pence and Trump’s elder sons, Donald Jr. and Eric — take over in-person campaigning this week.

Pence, who tested negative on Friday, is scheduled to debate Democratic vice-presidential nominee Kamala Harris on Wednesday.

Biden, who largely avoided direct criticism of Trump during a campaign trip to Michigan on Friday, took a more aggressive tone on Saturday while speaking to a transit workers’ union, even as he wished the president well.

“I’m in a little bit of a spot here, because I don’t want to be attacking the president and the first lady now,” Biden said, adding he hoped Trump and his wife, Melania, who also has the illness, make a full recovery.

But he quickly turned to Trump’s response to the pandemic, calling it “unconscionable” and blasting the president’s comment in an interview this past summer that “it is what it is” when asked about the death toll.

Biden, who tested negative on Friday, told reporters he would next be tested on Sunday. His campaign will begin releasing the results of each test, a spokesperson said.

WATCH | New Yorkers have little sympathy for Trump:

On the streets of New York, where the pandemic has taken a heavy toll, sympathy for U.S. President Donald Trump and his COVID-19 diagnosis was hard to find Friday. 1:00

Conley said doctors plan to keep Trump on a five-day course of remdesivir, an intravenous antiviral drug sold by Gilead Sciences Inc that has been shown to shorten hospital stays.

He is also taking an experimental treatment, Regeneron’s REGN-COV2, as well as zinc, vitamin D, famotidine (sold under the brand name Pepcid), melatonin and Aspirin, Conley has said.

A number of other prominent Republicans have also tested positive for the coronavirus since Trump’s announcement, including Republican senators Mike Lee, Thom Tillis and Ron Johnson, former White House senior adviser Kellyanne Conway and former New Jersey governor Chris Christie.

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Doctors try to assuage Trump health concerns following COVID-19 hospitalization

The latest:

  • U.S. president endured ‘very concerning’ period on Friday. 
  • Trump was administered oxygen at White House, sources tell AP.
  • Trump had been treated at the hospital with remdesivir.
  • Doctor says Trump has been fever-free for 24 hours.

U.S. President Donald Trump’s doctor on Saturday painted a rosy picture of the president’s health as Trump remains hospitalized for coronavirus treatment. But that assessment was immediately contradicted by a person familiar with Trump’s condition, who said the president was administered supplemental oxygen on Friday at the White House.

As well, Trump’s chief of staff, Mark Meadows, said the president went through a “very concerning” period on Friday, and the next 48 hours will be critical in terms of his care.

The briefing by Navy Commander Dr. Sean Conley and other doctors at Walter Reed National Military Medical Center raised more questions than it answered. The president’s physician left murky the issue of whether Trump needed supplemental oxygen and declined to discuss exactly when he fell ill.

Conley, in his briefing, also revealed that Trump began exhibiting “clinical indications” of COVID-19 on Thursday afternoon, earlier than previously known.

WATCH | Trump in ‘exceptionally good spirits,’ his doctor says:

U.S. President Donald Trump is in ‘exceptionally good spirits’ as he receives treatment for COVID-19 and is recovering well, says his physician, Dr. Sean Conley. 4:23

According to the person familiar with Trump’s condition, the president was administered oxygen at the White House on Friday before he was transported to the military hospital in Bethesda, Md. The person was not authorized to speak publicly and spoke to The Associated Press on condition of anonymity,

Conley had said Trump has been fever-free for 24 hours as he updated the nation on the president’s condition from Walter Reed on Saturday afternoon. Trump was admitted on Friday after testing positive for the coronavirus and has been undergoing treatment.

While Conley said the president is not currently on oxygen, he refused to say whether Trump had ever been on oxygen, despite repeated questioning.

“Thursday no oxygen. None at this moment. And yesterday with the team, while we were all here, he was not on oxygen,” he said. Conley said that Trump’s symptoms, including a cough and nasal congestion, “are now resolving and improving.”

“He’s in exceptionally good spirits,” said another doctor, Sean Dooley.


The administration has consistently been less than transparent about the president’s health as the virus spread inside the White House. Aides had declined to share basic health information about Trump, including a full accounting of his symptoms, what tests he’s undertaken and the results. The first word that a close aide to Trump had been infected came from the media, not the White House.

In a memo released shortly before midnight, Conley did report that Trump had been treated at the hospital with remdesivir, an antiviral medication, after taking another experimental drug at the White House. He added that Trump is “doing very well” and is “not requiring any supplemental oxygen.”

Conley declined to say when Trump had last been tested before he was confirmed to have COVID-19 late Thursday. He initially suggested that Trump was 72 hours into the diagnosis, putting the confirmation of the infection to Wednesday. Conley later clarified that Trump was administered an accurate test for the virus on Thursday afternoon, after White House aide Hope Hicks was confirmed to be positive, and Trump exhibited unspecified “clinical indications” of the virus.

WATCH | New Yorkers have little sympathy for Trump:

On the streets of New York, where the pandemic has taken a heavy toll, sympathy for U.S. President Donald Trump and his COVID-19 diagnosis was hard to find Friday. 1:00

The White House said Trump was expected to stay at the hospital for “a few days” out of an abundance of caution and that he would continue to work from the hospital’s presidential suite, which is equipped to allow him to keep up his official duties. In addition to accessibility to tests and equipment, the decision was made, at least in part, with the understanding that moving him later, if he took a turn for the worse, could send a worrying signal.

On Saturday, Conley said Trump’s blood oxygen level is 96 per cent, which is in the normal range. Trump has been treated with two experimental drugs, given through an IV, that have shown some promise against COVID-19. On Friday, he was given a single dose of a drug that’s being tested by Regeneron Pharmaceuticals Inc. to supply antibodies to help his immune system fight the virus.

On Friday night, Trump began a five-day course of remdesivir, a Gilead Sciences drug currently used for moderately and severely ill patients. The drugs work in different ways — the antibodies help the immune system rid the body of the virus, and remdesivir curbs the virus’ s ability to multiply.

“We’re maximizing all aspects of his care,” attacking the virus in multiple ways, Conley said. “I didn’t want to hold anything back if there was any possibility it would add value to his care.”

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COVID-19 risks for kids are low, must be balanced against cost of being out of school, doctors say

Nerissa Crichlow of Toronto has a lot of unanswered questions about what school will look like for her twin daughters in September.

“First and foremost, are they going to be splitting up the classes? What is that going to look like? Are there going to be testing measures in place?”

She describes herself as “very concerned” about the risk of her seven-year-old daughters, Mila and Norah, contracting and bringing home the coronavirus if in-person classes resume in the fall. 

“I really need a good understanding of what the protocols are going to be. I’m asthmatic, my daughter is asthmatic, my father is asthmatic, and my mother has lung issues,” she said. 

“For me, it’s really important that the schools have some testing involved, because we are all susceptible to the virus, more so than others.”

Crichlow has plenty of company among Canadian parents who have questions about the looming school year, but the latest research shows young children are at low risk of getting or spreading the coronavirus that causes COVID-19, and that missing school can have long-term costs for a child’s well-being.


In a classroom in Thailand’s Pathum Thani province on July 1, old ballot boxes are repurposed into partitions as the Thai government eased isolation measures and reopened schools nationwide. (Athit Perawongmetha/Reuters)

Dr. Nisha Thampi understands parents’ reticence about the return to class. The medical director of infection prevention and control at Children’s Hospital of Eastern Ontario in Ottawa is both a pediatric infectious disease physician and a mother.

She said she’s been encouraged, though, by recent study results that give more insight into children’s risk of contracting the illness and of spreading it to others.

“It is with more information around the risk of transmission and infection that we can inform the policies for school setting and other community settings,” said Thampi.

A large study from South Korea, published by the Centers for Disease Control and Prevention in the U.S., found that children nine and under infected others in their households just 5.6 per cent of the time, while children 10 to 19 spread the virus at the same rate as adults, nearly 19 per cent of the time.

And research continues to show that illness is usually mild in children. 

A recent meta-analysis of 550 COVID-19 cases among children under 18 in China, Italy and Spain found just nine children had a severe case. One, who died, had underlying conditions.

Parents must be ‘partners in care’ to prevent spread

“There’s good data that shows in the majority of cases, a child with COVID-19 has a symptomatic adult in the home who is also COVID positive,” said Thampi. 

That means some of the power for controlling the spread of illness within schools hinges on parents acting as “partners in care,” teaching their kids about good hand hygiene and making sound decisions about their own physical distancing practices, she said.

While it made good sense to shut down schools at the beginning of the pandemic when we were just learning about COVID-19, we now have an opportunity to learn from other parts of the world that have reopened schools with new safety protocols in place, she said.

“I support families who are concerned about schools not being a safe place to return to, because I would suggest that a pre-pandemic school environment did not have the strategies in place to minimize infection spread,” she said.

One issue, she said, was that many parents faced work pressures that made it difficult to keep sick children at home.

Working from home isn’t possible for all jobs, but the pandemic has shown it is an option for many working parents. That, combined with a new vigilance around respiratory symptoms, may help establish new standards for keeping sick kids home from school.

“I think we will be returning to a school setting so long as the right policies are in place — a school setting that is safer in terms of infection transmission risks and that offers opportunities for learning, socialization and, importantly, peer-to-peer learning and development,” Thampi said.


Dr. Michael Silverman, chair/chief of infectious diseases for London Health Sciences Centre and St. Joseph’s Health Care London in London, Ont., said not enough attention is being paid to research on the impacts of children being out of school for months on end. (Craig Chivers/CBC News)

That could mean measures such as spreading kids apart from one another in smaller groups, training children on hygiene practices in school and doing some learning outdoors when weather permits, she said.

Now that children have been without the structure of school for many months, it’s become apparent that eliminating all risk of school-based transmission comes at a cost, said Thampi.

Getting kids back to class between waves

That’s a point Dr. Michael Silverman, chief of infectious diseases at London Health Sciences Centre and St. Joseph’s Hospital in London, Ont., wants to make clear.

“So many times I hear, ‘Well, you can’t be too careful,’ without recognizing the risks of being home,” he said.

The research that’s not getting enough attention these days are the studies on the repercussions of students being out of class, he said.

“If they miss school, there’s long-term impact on their cognitive development, on their social development and their overall ability to function in society.”

Of course, all children will be at a similar disadvantage because of school closures, but the impacts will still be there, he said. 

A study from UNICEF Canada found that the COVID-19 pandemic is having an unprecedented impact on the lives of children and youth, citing disrupted routines and loss of education and other resources. The organization is calling on governments to “deliver new crisis mitigation measures” because children “cannot wait months or years to return to school.”   

Given that children under 10 pose little risk of infection transmission to others, it makes sense to return their cohort to class, said Silverman.


Teacher Janick Mille welcomes students at Ecole Marie Rose in Saint Sauveur, Que., as elementary schools outside the greater Montreal reopened back on May 11. (Ryan Remiorz/The Canadian Press)

“If they’re the least likely to get sick, they’re the least likely to transmit, and they do worse with distance learning, the priority should be at least the very young children should be able to get back to school,” he said.

As September approaches, teacher unions are asking for clear plans for safely reopening schools. The Ontario English Catholic Teachers Association, for example, has called on the provincial government to give direction to school boards about their responsibilities to ensure the safety of students and staff.

Silverman points out that most infectious disease experts anticipate a second wave of the illness will come.

“If we don’t take advantage of the time when we’re at a relatively low level of transmission, when another high level of transmission comes … and then we close the schools again, there will be an extremely long period of time with no education.”

Silverman said he believes the choice should remain with parents as to whether their kids learn in the classroom — with best practices for infection-control in place — or from home. 

“What I’m advocating is that we should not close all schools and take away all parents’ choice. That parents should be able to make educated choices on behalf of their children as to what they feel is best for their family.”

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Doctors call fatty liver disease a growing public health concern in Canada

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.


Alcoholism, fatty liver disease, hepatitis B, and hepatitis C are all common causes of various forms of liver disease. (CBC)

“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.”

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