Tag Archives: patients

Ontario issues emergency orders to allow hospitals to transfer patients without consent

The Ontario government’s health agency has issued two emergency orders to help hospitals cope with a surge in COVID-19 hospitalizations and intensive care admissions that is threatening the province’s critical care capacity, the Ministry of Health said in a news release Friday. 

One order allows hospitals to transfer patients without their consent if those facilities are in danger of being overwhelmed. This is the first time such an order has been made during the pandemic

The other allows the redeployment of health-care professionals and other staff who work for the province’s community care agencies to work in hospitals.

“With Ontario’s hospitals facing unprecedented critical care capacity pressures during the third wave of the COVID-19 pandemic, our government is taking immediate action to ensure no capacity nor resource in Ontario’s hospitals goes untapped,” Minister of Health Christine Elliott said in the release.

In an exclusive interview with CBC News on Friday evening, Elliott said the province is concerned about the increasing number of COVID-19 cases driven by the variants of concern, which are deadlier and result in more hospitalizations and ICU admissions. 

The province reached a record number of 552 people with COVID-19 in ICUs on Friday. 

Boosting capacity

Effective immediately, health-care professionals and other staff with Ontario Health and Home and Community Care Support Services organizations will be provided the authority to voluntarily deploy staff, such as care co-ordinators, nurses, and others, to work in hospitals that are experiencing significant capacity pressures due to COVID-19.

Elliott said these staff members would work primarily as ward nurses to allow nurses currently in those hospitals who have intensive care experience to move to those units. 

She didn’t have an exact number of workers who could be redeployed, saying: “We’re not looking at huge numbers of people but any assistance that we can get will be most welcome.” 

The organizations will also be authorized to deploy staff to backfill redeployed staff within and to another Home and Community Care Support Service organization.

During surges when the demand for critical care threatens to overwhelm a hospital, hospitals will be allowed to transfer patients without obtaining their consent or, when the patient is incapable, their substitute decision maker’s consent. 

The attending physician must be satisfied the patient will receive the care they require at the other site, and that the transfer won’t compromise the patient’s condition. 

After the surge, the other hospital would be required to make reasonable efforts to transfer the patient back to the original site, or to another suitable location, with the proper consent, as soon as possible, the government says. 

Elliott says the non-consenting transfers will only be done in extreme circumstances, adding that no hospital in the province has neared this capacity level yet. However, she noted that it’s a waiting game as numbers are expected to increase in the next short while. 

These orders are expected to increase ICU capacity in Ontario by up to 1,000 beds, the news release reads. The orders will remain valid for 14 days unless revoked or extended, the government said. 

Over the last year, the government has created over 3,100 more hospital beds. 

“Now we know that we need to take more steps and increase capacity again,” Eliott said. 

She added that these measures will help to ensure that hospitals continue having adequate staffing and resources to care for patients. 

Hospitals have also been told to ramp down all elective surgeries and non-urgent activities in order to preserve critical care and human resource capacity, effective Monday.

“We understand that deferring scheduled surgeries and other procedures will have an impact on patients, their families and on caregivers. We are monitoring the situation and will work to resume as soon and as safely as possible these deferred services and procedures,” said Matt Anderson, CEO of Ontario Health.

Elliott said this order will create between 700 to 1,000 more spaces in hospitals that will be used for COVID-19 patients.

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Ontario orders hospitals to halt non-emergency surgeries as COVID-19 patients fill ICUs

The Ontario government’s health agency is telling hospitals across most of the province to stop performing all but emergency and life-saving surgeries because of the growing caseload of COVID-19 patients, CBC News has learned.

A memo was sent to hospitals Thursday night telling them to postpone their non-emergency surgeries, effective Monday, everywhere but in northern Ontario. 

“Given increasing case counts and widespread community transmission across many parts of the province, we are facing mounting and extreme pressure on our critical care capacity,” says Ontario Health CEO Matthew Anderson in the memo, obtained by CBC News.

“We are instructing hospitals to ramp down all elective surgeries and non-emergent/urgent activities in order to preserve critical care and human resource capacity,” says Anderson. 

The provincial health agency is also warning hospitals that they may be asked to send staff to harder-hit areas. 


Dr. Chris Simpson is the executive vice-president of medical at Ontario Health and a cardiologist at Kingston Health Sciences Centre. (CBC)

“We may request available health-care workers/teams to support care in other parts of the system,” says Anderson. “We may be asking you to identify available staff who might be redeployed to sites requiring support.” 

The order comes with Ontario hospitals reporting a record number of patients critically ill with COVID-19 in the intensive care units. Premier Doug Ford cited the pressure on ICUs in his decision Wednesday to declare a third state of emergency and put the province under a stay-at-home order.    

There were 532 patients with COVID-19 in the province’s ICUs on Wednesday night, according to a daily report from Critical Care Services Ontario. 

Ontario has roughly 2,000 ICU beds. Emergency patients who don’t have COVID-19 typically fill 1,200 to 1,400 of those beds.

Modelling from Ontario’s COVID-19 Science Advisory Table projects 600 COVID-19 patients in ICUs by the middle of April, and 800 by the end of the month, should current case trends continue.  

“To look after the kinds of patients that we know are going to be coming over the next couple of weeks, we need to generate more capacity,” said Dr. Chris Simpson, Ontario Health’s  executive vice-president of medical, in an interview Thursday night. 

“To do that, we need to ramp down some of the surgeries and procedures and other care that can be deferred,” said Simpson, who works as a cardiologist at Kingston Health Sciences Centre. That hospital has already been the destination for numerous transfers of patients from the Greater Toronto Area in an effort to relieve the pressure on the busiest hospitals.  

Emergency surgeries for such things as strokes, heart attacks and trauma would not be postponed, nor would urgent cancer surgeries, said Simpson. However, operations such as hip and knee replacements would be deferred. 

Ontario has not ordered such an across-the-board postponement of non-emergency surgeries since the first wave of the pandemic hit the province in March 2020. 

Postponing elective surgeries frees capacity in ICUs because some patients need critical care after their operations, sometimes because of the intensity of the surgery or because of complications, said Simpson. 

“We need to ensure that every ounce of capacity that we have is used as best as we possibly can,” he said.

Ontario already has a backlog of more than 245,000 medical procedures deferred from earlier in the pandemic, according to the most recent provincial data. 

The Ford government allocated an extra $ 1.8 billion in last month’s provincial budget to help hospitals care for COVID-19 patients and clear the backlog.

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Racial trauma counsellors in B.C. see surge in patients amid ongoing anti-Asian hate

Ever since the Atlanta spa shootings on March 16 that killed eight people, including six women of Asian descent, Angela Leong stopped walking to and from work because she was too scared to be out in public.

“Quite frankly, I’m scared and I don’t want to work anymore,” Leong said. “I’m not comfortable with walking down the streets, so I started taking Uber exclusively just to go back and forth to my office.”

Leong, a registered clinical counsellor in Vancouver, says some of her Asian Canadian clients have been echoing the same fears and have stopped visiting the office after sunset. She said since the surge in anti-Asian hate crimes in both in the United States and Canada, she’s seen an increase in patients experiencing racial trauma.

According to a report released in March by the Chinese Canadian National Council (CCNC) Toronto chapter, there were more than 1,000 cases of both verbal and physical attacks against Asians across the country from March 2020 to February 2021. And since the start of the pandemic, Canada had more anti-Asian racism reports per capita than the United States.

In February, Vancouver police said they saw anti-Asian hate crimes jump by more than 700 per cent in 2020 as reports of incidents rose from 12 in 2019 to 98 in 2020.

Linda Lin, a registered clinical counsellor who focuses on racial identity and trauma, says she’s also seen a spike in people who are seeking mental health support.

“I noticed a tenfold increase in my caseload,” said Lin. “They are clients who are coming to talk about … past experiences of racialized verbal abuse or incidents linked with COVID-19.”


Racial trauma therapist Linda Lin said she also remembers the challenges of growing up with a different culture in a predominately white neighbourhood. (Submitted by Linda Lin)

She said racial trauma can stem from feelings of being marginalized while growing up in Canada or from feeling discriminated against because of ethnicity or race.

Leong said in the past two weeks, 66 to 75 per cent of her clients were from the Asian community, whereas just eight weeks before the shooting in Atlanta, only 35 to 52 per cent of her clients were Asian. 

“My patients have been telling me … there has always been aggressive behaviour as a result of their race or ethnicity,” she said.

Triggering events

Co-founder of the Asian Canadian Women’s Alliance and former journalist Jan Wong said the recent increase in anti-Asian hate is bringing back memories of her own experience of racism, which triggered a severe clinical depression.

In 2006, she said she received an onslaught of racist messages and attacks against her family’s Chinese restaurant after a story she published in the local paper.

“I noticed people in Quebec started … saying that we were serving cat and dog and rats and that we were dirty,” Wong told Canada Tonight host Ginella Massa.

“In fact the restaurant had to close.”


Jan Wong says hearing about the recent surge in anti-Asian hate crimes is bringing back memories of the racist attacks she and her family experienced in 2006. (Submitted by Jan Wong)

She said hearing about the frequent racist attacks against members of the Asian community is having a negative impact on her.

“I have raised cortisone levels because of this, and if you have chronically raised cortisone, you can end up in depression,” Wong said. “It makes me really angry.”

Need for education

Rage and anger are common signs of racial trauma, according to Lin, as individuals who have been victims of racial abuse and violence often feel silenced and invalidated.

“I’m hearing stories of discrimination … and people are hoping to be seen and heard and hoping to be respected,” Lin said. “I’m also noticing people trying to protest not just for their own story of racial trauma but for their parents and their community as well.”

Queenie Choo, CEO of United Chinese Community Enrichment Services Society (S.U.C.C.E.S.S.), says she’s not surprised to hear that there has been an increase in Asian Canadians seeking mental health support.

She said in January 2021, the organization received over 400 calls through its help line, which provides counselling services in Mandarin and Cantonese.


S.U.C.C.E.S.S. CEO Queenie Choo says that in January 2021, the organization received over 400 calls through its help line. (Rafferty Baker/CBC)

“People feel that they are in such a vulnerable situation where they could be subject to attacks, whether that’s physical, mental or emotional … and I think that is all very negative to people’s mental health,” Choo said.

What the government is doing

When asked about federal efforts to combat anti-Asian racism, the Canadian Heritage department said in an emailed statement that the government set up an anti-racism secretariat in March 2020 and is “engaging on a regular basis with pan-Asian networks of community organizations” to discuss how it can be more effective in countering anti-Asian racism.

As part of a four-year anti-racism strategy announced in 2019, it has committed $ 15 million to 85 projects to combat racism and discrimination, it said, including anti-Black racism, anti-Asian racism, anti-Indigenous racism, anti-Semitism and Islamophobia.

It has also created a Centre on Diversity and Inclusion at the Treasury Board secretariat and invested in more disaggregated data, the statement said.  

The statement also said the government is redoubling its efforts when it comes to:

  • Taking action on online hate.
  • Advancing economic empowerment opportunities for specific communities.
  • Building a whole-of-federal-government approach on better collection of disaggregated data.
  • Implementing an action plan to increase diverse representation in hiring, appointments and leadership development within the public service.

“There is more work to do,” the statement said. “However, our government will continue to condemn all forms of racism and take concrete steps to confront anti-Asian racism and discrimination in all its forms.” 

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Medications used for COVID-19 patients part of murder investigation into Dr. Brian Nadler

The medication used for COVID-19 patients at an eastern Ontario hospital is part of the murder investigation into Dr. Brian Nadler, CBC News has learned.

Nadler, a physician at the Hawkesbury and District General Hospital, has been charged with one count of first-degree murder in the death of patient Albert Poidinger, 89.  

The Ontario Provincial Police (OPP) has said they are waiting for the results of post-mortem investigations into several other people who died at the hospital recently.

An OPP spokesperson has described the deaths as “potentially suspicious.”

The OPP has not confirmed whether Poidinger was one of Nadler’s patients nor whether he has links to other patients.

However, sources familiar with the investigation have confirmed a report in the Ottawa Citizen that police are looking at at least five COVID-19 patients who died at the hospital between March 17 and 25. The sources spoke on condition of anonymity because they were not authorized to speak publicly. 


A person enters the hospital in Hawkesbury, Ont., on Friday. (Adrian Wyld/The Canadian Press)

Nadler, 35, was arrested at the hospital last week. Those same sources told CBC News police were responding to a call that day from a whistleblower at the hospital. 

He appeared in court remotely on Friday.

Nadler’s lawyer, Alan Brass, says his client maintains his innocence.

On Thursday, prior to Nadler’s arrest, the hospital reported a large outbreak of COVID-19, the second in just a week, involving 16 patients and five staff members testing positive, and five deaths. 

The death toll contrasts with the number of COVID-19 fatalities reported by the United Counties of Prescott Russell — a region within the Eastern Ontario Health Unit — which reported a single death in January, and two in February. 

The College of Physicians and Surgeons is also investigating Nadler, and has suspended his licence 

Nadler had just begun working at the hospital in 2020, and was under a restricted licence, which meant he remained under the supervision of another doctor for a year until Feb. 3, 2021, CBC News has learned. 

According to the terms of the restriction, the supervising doctor was expected to inform the college “of any concerns regarding Dr. Nadler’s knowledge, skill, judgment or attitude.”

The college says it will not provide details about the licence restriction, adding in a statement to CBC: “There are a number of circumstances in which the College might require a clinical supervisor. Considerations would include a physician’s education and training, practice history including in other jurisdictions, and whether the physician has been in continuous practice or has not practiced for an extended period of time.”

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The human side of healing: How seeing loved ones helps COVID-19 patients

Tom and Virginia Stevens have been married 66 years, and lived together in an assisted-living facility in Nashville, Tenn., when they got COVID-19 last summer and had to be transferred to Vanderbilt University Medical Center.

The couple was split up and put into separate rooms. 

“I think that traumatized them,” said their son, Greg Stevens. “They kind of live for each other, at this stage, so adding to the not-feeling-great and the stress of COVID, they separated them.”

Tom Stevens, 89, became disoriented.

“They found my dad wandering the halls and he was looking for my mom,” said Greg. 

The care team decided to bring the couple together into the same room, in the COVID-19 unit, for their two weeks of treatment — which their son credits with their recovery.

Virginia Stevens, 88, was elated by the move.

“When we finally were united together in the hospital, we just shouted ‘Hallelujah!'” she said from her son’s house, where they are all now living after being released from hospital. 


Virginia, right, and Tom Stevens at their son Greg’s home, where they have been living since recovering from COVID-19 at the Vanderbilt University Medical Center. (Ian Maravalli)

The Stevens’ story, which was featured in an essay by Vanderbilt ICU Dr. Wes Ely in the medical journal The Lancet, is more than a heartwarming anecdote in a year of pandemic isolation.

It illustrates a finding from a recent study of more than 2,000 COVID-19 patients, also published last month in The Lancet, that looked at delirium, which can be “highly prevalent and prolongued in critically ill patiients with COVID-19.” While the use of certain medication was linked to higher risk of delirium, family visitation — whether real or virtual — lowered it.

“We know that the human side of healing is real,” said Ely, a co-author on the study and co-director of the Critical Illness, Brain Dysfunction, and Survivorship Center at Vanderbilt and is writing a book about rehumanizing the recovery process with an emphasis on bringing families together to help. 

“People’s brains clear when a loved one is around them and they get anchored. So, it’s like removing sensory deprivation. This is science as well as humanities.”


Dr. Wes Ely, at his home in Nashville, is an ICU physician ta Vanderbilt University and co-director of the Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center. He’s writing a book about rehumanizing the ICU and recovery process after critical illness. (Ian Maravalli)

In Toronto, Sunnybrook Health Sciences Centre physician Donald Redelmeier supports the idea that family connection while COVID-19 patients are in the ICU has great value. 

“Delirium is always worse when there is separation from the family. It’s blatantly obvious,” he said.

“Not all married couples should be brought together, though,” said Redelmeier, adding that it depends on the couple’s relationship and that cases should be judged individually. 

Visiting constrained during pandemic

Despite those benefits, hospital visitation has been tightly curtailed during the COVID-19 pandemic as an infection control measure — although one with its critics.

Advocates have flagged the crucial role of families in patient care, and health-care workers have shared the difficulty of holding up an iPad so a loved one could say goodbye.

“Generally the family is not allowed [into COVID-19 ICU areas] in Canada. There are institutional restrictions which have become much more intense with the COVID epidemic,” said Redelmeier.

Ely acknowledges the need for infection control, but says there are other options, besides isolation.

“We have to reopen these hospitals to the loved ones,” he said.

“The message is … that PPE [personal protective equipment] works, and that people need other people and doctors and nurses are not a substitute for loved ones.”

Confusing and foggy

For Sharon and Fred Reyes, in Nashville, it was more than five weeks before they could even lay eyes on each other through a glass wall in Vanderbilt’s ICU. Fred contracted COVID-19 in May 2020, and the hospital didn’t allow family visits at that time.

“It was extremely difficult to be separated from your loved one during the greatest fight of their life,” said Sharon. Her husband was close to death three times over his 80 days in hospital, she said.


Sharon and Fred Reyes sit outside their home in a Nashville suburb. Fred was hospitalized for 84 days after he contracted COVID-19 in May 2020. Sharon was not allowed to visit for the first six weeks of his hospital stay. (Ian Maravalli)

Fred describes his days in ICU as confusing and foggy. 

“I remember so many times just calling for her, just wanting her to be there,” he said of his wife. 

“So many days I just didn’t have a thorough grasp of what was happening,” he said. “I needed to have my loved one.”

When asked if he remembers that first time he saw Sharon through the ICU glass, Fred chokes up and can’t hold back tears. 

“It was quite emotional,” he said. “And though it was through the glass at first, you know, we were there communicating. We were able to communicate something that was difficult. And then we moved into a medical ICU and I was able to be with her more. And things did change dramatically.” 

WATCH | Fred Reyes recalls seeing his wife for the first time during COVID-19 treatment:

Nashville resident Fred Reyes talks about what it felt like to see his wife, Sharon, after spending more than five weeks in the ICU at Vanderbilt University Medical Center last summer. 2:05

Hopes for change

Kathy Henderson of Mufreesboro, Tenn., hopes that with the collective COVID-19 deaths in the U.S. now over half a million, something might change for the better in the way patients are cared for with regards to family connection. 

“I mean a million people read that Lancet article about little old me in Tennessee,” she said of Ely’s essay, which featured the story of her own parents, Mary and Philip Hill, along with Tom and Virginia Stevens.


Kathy Henderson at her home in Murfreesboro, Tenn., lost both parents to COVID-19 in September 2020. She fought to get her mom in the same hospital as her father, so they could be together. (Ian Maravalli)

Her parents contracted COVID-19 last September. Mary was sent to the local hospital but Philip was transferred to Vanderbilt because he had underlying heart issues.

Henderson had an uphill battle trying to convince both hospitals that her mom should be transferred to be with her dad. 

“I knew that if the worst did happen it would just be awful to have the two of them in separate hospitals, not even to be able to say goodbye,” she said of her parents who lived and worked together and had been married for 61 years.

“Even if I could get mom’s stretcher to pass by my dad’s window that would be better than nothing.”


Mary and Philip Hill were reunited for a tender moment in the ICU while both were being treated for COVID-19 at Vanderbilt University Medical Center last year. They died within six hours of one another. (Lauren Birmingham)

She was successful. Her parents ended up being treated in side by side rooms in the ICU and they were granted a moment together in the same room, in their beds, while Henderson joined them remotely on Zoom.

Mary Hill rubbed her husband’s hand and said, “I’m here Phil Hill, I’m here,” Henderson recalled.

Two days later they both passed away within six hours of each other.

WATCH | The benefits of bringing families together during COVID-19 treatment:

COVID-19 restrictions are keeping many patients apart from loved ones in the hospital, but doctors, patients and families are speaking out about the benefits of bringing families physically together during treatment. 3:32

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Patients receiving treatment abroad exempt from testing, quarantine rules

Patients who need medical treatment in another country will not have to follow new COVID-19 testing and quarantine rules required for those entering Canada.

Official regulations posted on the federal government website confirm that people receiving “essential medical services” in a foreign country will not have to undergo tests and mandatory quarantines if they have a written statement from a licensed health care practitioner in Canada — and from a practitioner in the country where they are receiving the treatment — affirming that the treatment is essential.

Proof of a negative polymerase chain reaction test — also known as a PCR test — is now required for non-essential travellers crossing into Canada via the land border. 

The test result must be obtained within 72 hours of arriving at the border but essential workers — such as truckers, emergency service providers and those in cross-border communities — are exempt.

After passing through the land border, travellers have to take another test upon arrival and a third test near the end of their 14-day quarantine periods.

That additional layer of testing comes into effect on Feb. 22 — the same day air passengers landing in Canada will be subjected to a new rule requiring them to quarantine in a hotel at their own expense for up to 72 hours while they wait for PCR test results.

The cost of those hotel stays is estimated at about $ 2,000, but it depends on where the traveller is isolating. Passengers will need to book a hotel in the city in which they first arrive: Vancouver, Calgary, Toronto or Montreal. 

Quarantine presents financial burden

Vancouver resident Kimberly Muise, who travels to Los Angeles every month to take part in an immunotherapy clinical trial to treat Stage 4 cervical cancer, told CBC Chief Political Correspondent Rosemary Barton on Sunday that a mandatory quarantine at the traveller’s expense would be a financial burden.

Reacting to confirmation of the exemptions in a government order-in-council (OIC), Muise said Tuesday she’s glad the government listened to Canadians’ concerns.

“This will make a huge difference in my life and the life of my family as I continue my battle with cancer,” she said in an email to CBC.

“I know that the inclusion of essential medical services and treatment in this OIC will also improve the lives of so many Canadians who require medical treatment outside of Canada and were similarly facing almost unbearable stress in dealing with their essential travel during the pandemic.” 

In an interview Sunday, Public Safety Minister Bill Blair had told Barton that there will be some leeway in determining what constitutes essential travel and that the government will deal appropriately with “compelling and compassionate cases,” such as people receiving medical treatment abroad.

Blair said Muise’s case had been brought to his attention already by her local member of Parliament and he was talking to the Public Health Agency of Canada and British Columbia’s health authority about her situation.

“We want to make sure that that woman can receive her treatment and put in measures that can protect her, protect her family and protect her community, but also deal with the exceptional circumstances that that woman is experiencing in an appropriate way,” he said.

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Roche arthritis drug cuts deaths in hospitalized COVID-19 patients, study suggests

Roche’s arthritis drug tocilizumab cuts the risk of death among patients hospitalized with severe COVID-19, also shortening the time to recovery and reducing the need for mechanical ventilation, results of a large trial showed on Thursday.

The findings — from the U.K.-based RECOVERY trial, which has been testing a range of potential treatments for COVID-19 since March 2020 — should help clear up confusion about whether tocilizumab has any benefit for COVID-19 patients after a slew of recent mixed trial results.

“We now know that the benefits of tocilizumab extend to all COVID patients with low oxygen levels and significant inflammation,” said Peter Horby, a professor of emerging infectious diseases at Oxford University and the joint lead investigator on the RECOVERY trial.

In June last year, the RECOVERY trial found that the cheap and widely available steroid dexamethasone reduced death rates by around a third among the most severely ill COVID-19 patients. That drug has since rapidly became part of standard-of-care recommended for severe patients.

Tocilizumab, sold under the brand name Actemra, is an intravenous anti-inflammatory monoclonal antibody drug used to treat rheumatoid arthritis. It was added to the trial in April 2020 for patients with COVID-19 who required oxygen and had evidence of inflammation.

The study included from 2,022 COVID-19 patients who were randomly allocated to receive tocilizumab by intravenous infusion, and who were compared with 2,094 patients randomly allocated to usual care alone. Researchers said 82 per cent of all patients were taking a systemic steroid such as dexamethasone.

Results showed that treatment with tocilizumab significantly reduced deaths — with 596 (29 per cent) of the patients in the tocilizumab group dying within 28 days, compared with 694 (33 per cent) patients in the usual care group.

This translates to an absolute difference of four per cent. It also means that for every 25 patients treated with tocilizumab, one additional life would be saved, Horby and his co-lead investigator Martin Landray said.

They added that benefits of tocilizumab were clearly seen to be in addition to those of steroids.

WATCH | Progress and setbacks in treating COVID-19:

While vaccines can prevent recipients from getting sick, finding and approving treatments for the virus has been difficult. 2:06

“Used in combination, the impact is substantial,” said Landray, who is also an Oxford professor of medicine and epidemiology.

Roche’s drug division chief Bill Anderson said last week that previous mixed results were likely due to differences in the type of patients studied, when they were treated, and the endpoint — the juncture at which success or failure is measured.

“We think we’re sort of zooming in on both the most relevant endpoints and relevant patient population,” Anderson said. “It seems like the ideal candidates are patients who are really in that acute phase of inflammatory attack.”

Drug used for some patients with COVID-19 in Canada

Actemra, along with Sanofi’s similar drug Kevzara, was authorized by Britain’s NHS in early January for COVID-19 patients in intensive care units after preliminary data from a smaller study called REMAP-CAP indicated it could reduce hospital stays by about 10 days.

The researchers said preliminary results will be made available on the medRxiv preprint server shortly and submitted to a peer-reviewed medical journal.

Dr. Niall Ferguson, head of critical care at Toronto’s University Health Network and Sinai Health System, sees potential in early data for tocilizumab, which is approved for use in Canada to treat rheumatoid arthritis.

Although evolving data has been mixed and is still emerging, Ferguson noted last week that the monoclonal antibody is already being used off-label for some severe patients in Toronto.

“It’s happening on a bit of an ad hoc basis when patients are caught at the right time and look like they may have a bit of
additional inflammation going on that could be set aside with this drug,” said Ferguson, who looks after the most severe COVID-19 cases at Toronto General Hospital.

Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine who was not directly involved in the U.K. trial, said its results were important.
 
“It is a large trial and the benefits were seen both on earlier discharge from hospital and mortality,” he said. “The 
magnitude of benefit is not startling but is clinically important, with a reduction in deaths from 33 per cent to 29 per cent.” 
 

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Little evidence that colchicine benefits COVID-19 patients, Quebec advisory panel finds

Clinical experts with the Quebec government say there isn’t enough evidence yet for them to recommend widespread use of colchicine to treat COVID-19 patients, dampening hopes the drug could be a short-term tool to reduce hospitalizations and deaths.

Last month, the Montreal Heart Institute released a statement vaunting the results of a clinical trial that found the rate of hospitalization or death was 21 per cent lower among patients who took colchicine, compared to a placebo. It reported even more impressive results among “patients with a proven diagnosis.” 

The findings made headlines around the world. Premier François Legault called the results “big news.”

Colchicine is a cheap, widely available drug in Canada, well-known to doctors for its effectiveness at treating gout. And so far physicians have struggled to find effective drug treatments for the new disease.

The news release, though, left out key elements of the study. When the researchers released more detailed findings, their peers in the medical community struck a more cautious tone.


The $ 14-million colchicine study was funded by the Quebec government and several organizations. (Ivanoh Demers/Radio-Canada)

McGill’s Office for Science and Society joined several others in decrying a practise known as “science by press release,” where seemingly exciting findings are published by funding bodies before being peer-reviewed and with little in the way of data.

Amid the controversy, the Quebec provincial government’s clinical research institute (known by its French initials as the INESSS) quickly undertook its own detailed analysis of the colchicine study.

In a briefing Thursday with journalists, the INESSS experts said based on the available evidence they consider it “premature to support the use of colchicine in non-hospitalized persons with a diagnosis of COVID-19.”

Finding inconclusive, INESSS says

The $ 14-million colchicine study, funded in part by the Quebec government, was launched in March, initially with the aim of recruiting 6,000 people in six different countries.

Led by Dr. Jean-Claude Tardif, director of the Montreal Heart Institute’s research centre, the investigators wanted to see whether the anti-inflammatory medication would limit symptoms of the disease in people with pre-existing medical conditions. 

But the study was halted after recruiting 4,500 participants. The researchers cited both logistical issues and the desire to get results to health-care professionals as quickly as possible, given the strain the pandemic was placing on hospital resources.

In its review, the INESSS said that was the right decision given the circumstances, and acknowledged Tardif’s hypothesis and research design were sound.

Dr. Luc Boileau, the president of the advisory body, said the move to publish the results in a press release, ahead of peer-review, was “not irresponsible but is infrequent.”

“We’re in the context of a pandemic … and there is a legitimate public interest in the results,” he said.

But following a close reading of those results, the advisory body determined there was insufficient evidence to draw firm conclusions about the benefits of colchicine for COVID-19 patients.


A nurse at Brattleboro Memorial Hospital, in Vermont, draws up the Moderna COVID-19 vaccine into a syringe. (Kristopher Radder/The Brattleboro Reformer/The Associated Press)

 

The participants in the study included patients who tested positive via the gold-standard PCR test, as well as those who had been diagnosed simply by virtue of having been exposed to someone with the virus (known as an epidemiological link).

When those two groups were considered together, there was no statistically significant difference in hospitalizations or deaths between participants receiving colchicine and those receiving a placebo, said Dr. Michèle de Guise, who headed the review.

There was a statistically significant difference among those who tested positive through PCR. In this smaller group, those who received the drug were 25 per cent less likely to die or require hospitalizations when compared with the placebo group.

That was one of the findings that went into the news release put out by the Montreal Heart Institute. But when considered in absolute terms, the difference is less impressive.

In the placebo group, six per cent of the 2,084 subjects either died or required hospitalization. In the experimental group, 4.6 per cent of 2,075 subjects died or required hospitalization.

From a clinical perspective, that 1.4 percentage point difference “means that 71 patients would need to be treated with colchicine to achieve one less event,” said de Guise.

Potentially alarming side effect

The study also turned up a potentially frightening side-effect. Eleven participants who took colchicine experienced a pulmonary embolism, compared with two in the placebo group.

That alarmed the experts INESSS consulted, de Guise said.

“That was unexpected and it worried them,” she added.

The INESSS stressed its findings were preliminary and said it would review them as more data becomes available. 

In the meantime, COVID-19 patients interested in using the drug should have a discussion with their physician, said Boileau.

Quebec’s Health Ministry said it would issue guidelines on colchicine treatments for COVID-19 after taking the time to analyze the recommendations made by the INESSS.

A spokesperson for the Montreal Heart Institute said Thursday they too would read the INESSS report before commenting.

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Inside Manitoba’s busiest ICU: The beds are full and COVID-19 patients keep coming

‘What we don’t have is staff’

It’s nine in the morning and hospital beds are as coveted as they have been for months.

As part of the pandemic response, health officials meet virtually every morning to discuss the management of an overflowing hospital.

In a meeting room, charts and graphs are beamed onto a white wall for people on the call, like a scene out of a science-fiction movie.

Some rows are coloured in red, which represents an overcapacity unit.

They can tell the number of suspected COVID-19 positives across the HSC site, broken down by unit.

“Right now on our children’s unit, we have three suspect positives,” Jennifer Cumpsty, acting chief nursing officer for HSC, told a visitor later in the morning.

Jennifer Cumpsty, acting chief nursing officer for HSC, describes the purpose of the hospital command centre where they strategize the movement of patients every morning. (Mikaela MacKenzie/Winnipeg Free Press/Canadian Press)
Jennifer Cumpsty, acting chief nursing officer for HSC, describes the purpose of the hospital command centre where they strategize the movement of patients every morning. (Mikaela MacKenzie/Winnipeg Free Press/Canadian Press)

The problem, says Cumpsty, isn’t space in the hospital; they can keep finding rooms to put more beds and more COVID-19 patients.

“What we don’t have is staff,” she said. “That is our limiting factor.”

To address that, teams of specialists led by critical-care nurses have formed to care for patients befallen by the virus.

These teams include staff who would otherwise not work in critical-care units, such as the nurses in the GD-2 unit — an orthopedic surgical ward before the pandemic, said Anna Marie Papiz, the unit’s manager of patient care.

“Staff, if you were to speak to them and ask them, have they had experiences with patients who have passed away … many of them would say very rarely, and now that’s become commonplace here,” she said.

In December alone, 212 Manitobans have died of COVID-19 so far — that’s 40 per cent of the 523 people who’ve lost their lives from their virus.

“The number of patients that we’re sending up to MICU [medical intensive care unit], the number of deaths that we are encountering, is far greater than we’ve experienced as surgical nurses.”

Health-care workers are dealing with long hours and juggling many patients at once in their fight against the contagious coronavirus. (Mikaela MacKenzie/Winnipeg Free Press/Canadian Press)
Health-care workers are dealing with long hours and juggling many patients at once in their fight against the contagious coronavirus. (Mikaela MacKenzie/Winnipeg Free Press/Canadian Press)

Papiz said that staff are working through their fears, putting in long hours and overtime. They’re skipping their breaks to tend to the patients entrusted to their care.

Surgical nurse Aaron Turner said his colleagues are brushing up on skills they haven’t practised since university.

“There was a lot of anxiety from staff, pushing ourselves well out of our comfort zone,” he said.

One of his new duties, he said, is connecting dying patients by phone with their loved ones, who are barred from entering the hospital.

“It’s not something we’ve had to do before,” Turner said. “It becomes part of business, I suppose, but you can never get used to that.”

Despite these new duties, health officials put up for interviews exude a confidence that the employees they have in place — reassigned and otherwise — can handle the influx of COVID-positive cases.

Hospital resources were stretched so thin in early November, the province imposed a near-lockdown to try to slow admissions.

But officials do openly question whether the health-care system can handle the numbers they’re seeing much longer.

“They are working overtime,” Cumpsty said of the staff. “They are stretched beyond right now.”

WATCH | ‘Every spare space’ turned into a COVID-19 unit:

That stretching has included a change, from one-to-one nursing care before the pandemic, to a “team-based” staffing approach, where one nurse cares for multiple patients, with support ranging from respiratory therapists to physiotherapists.

Not everybody on the front lines believes the new care model, announced in November, is tenable.

“Patients will almost surely die in this environment,” a group of nurses at HSC’s medical ICU wrote in an email to officials. “Patients are already suffering from neglect.”

The emails surfaced this week, after they were obtained by the Opposition Manitoba NDP.

In another message, staff said they cannot be expected to monitor several isolated patients at once.

They questioned the unimaginable decision that may arise if a nurse is left alone with multiple patients when a colleague goes on break.

“What room should they prioritize to go first if both alarms require their immediate attention for it’s a matter of life and death?” the email asks.

“Please don’t place these tough decisions on their shoulders.”

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Ontario tells hospitals to activate emergency plans as number of COVID-19 patients spikes

Hospitals across Ontario have been ordered to brace for a spike in COVID-19 patients.

A memo from Ontario Health obtained by CBC News tells hospitals to prepare to activate emergency plans immediately. For hospitals in the grey lockdown and red control zones that means making available up to 15 per cent of their beds for COVID-19 patients.

Matthew Anderson, CEO of Ontario Health, a provincial government agency, said in the memo dated Tuesday that the pandemic has entered a more critical phase with community transmission now widespread.

Anderson said the ability of hospitals to care for patients with and without COVID-19 is being challenged. The memo was sent to every hospital CEO in the province.

Ability to care for patients ‘being challenged’ 

The memo tells all hospitals to be ready to activate their “surge capacity plans” within 48 hours.

“As we are all aware, we have entered a more critical phase of the pandemic where we are seeing widespread community transmission,” Anderson said in the memo. 

“Our ability to care for patients (COVID and non-COVID alike) is being challenged, so we are asking hospitals to work together, even more, to ensure we can continue to have the bed capacity to care for patients safely and effectively.”


A view of the emergency department at Humber River Hospital in Toronto. (Craig Chivers/CBC)

Under those plans, hospitals located in regions now in grey lockdown or red control zones need to make 10 to 15 per cent of their beds available for COVID-19 patients.

At the moment, Toronto, Peel and York regions and Windsor are in the grey lockdown zone while Durham and Halton regions, Hamilton, Simcoe-Muskoka, Waterloo region, Wellington-Dufferin-Guelph and Middlesex-London are in the red control zone.

Hospitals in the rest of the province are being told to prepare their facilities in case the public health units in which they are located are moved into a red control zone.

“The actions we collectively take in the next days and weeks will set the stage for our ability to meet escalating and anticipated capacity demands,” Anderson said. 

“Above and beyond actions at an individual organization’s level, we must all take a holistic view to ensure we have a coordinated and equitable approach to serve our patients safely and compassionately across the regions.”

Memo comes after number of hospitalizations tops 900

The memo comes as the number of COVID-19 patients in Ontario hospitals surpassed 900 for the first time since May. 

The number of people in Ontario hospitals with confirmed cases of COVID-19 is now 921, up from 857 on Monday — an increase of 64.

Of those, 249 are being treated in intensive care and 156 require the use of a ventilator, up five and seven, respectively, from Monday.


Medical staff at North York General Hospital. There are 921 people in Ontario hospitals with confirmed cases of COVID-19. The number surpassed 900 Tuesday for the first time since May. (Evan Mitsui/CBC)

Some hospitals in the GTA are already full and have resorted to transferring patients to other facilities to ease the pressure.

Hospitals in Scarborough, Brampton and Mississauga, for example, have cancelled scheduled surgeries, while hospitals in York Region and Hamilton have warned that a capacity crisis is imminent.

In a statement a week ago, the CEOs of three hospitals in York Region said Mackenzie Health, Markham Stouffville Hospital and Southlake Regional Health Centre had reached a “tipping point” in their ability to manage the volume of COVID-19 patients. 

“After seeing a significant increase over the last week in the number of COVID-19 patients admitted to our hospitals, we are concerned about how this may impact access to care like scheduled surgeries for all patients across our communities,” the CEOs said.

“We are counting on our communities to help keep our staff, physicians and volunteers safe so they can continue to care for everyone who relies on us for care, for COVID-related illness as well as non-COVID-related illnesses and emergencies. 


Southlake Regional Health Centre in Newmarket is pictured here. A week ago, the CEOs of three hospitals in York Region said Mackenzie Health, Markham Stouffville Hospital and Southlake Regional Health Centre had reached a ‘tipping point’ in their ability to manage the volume of COVID-19 patients. (Evan Mitsui/CBC)

The CEOs said while health care facilities had collaborated well to prepare for a second wave, it was the community’s turn to step up.

“What we need now more than ever is support from our communities to be vigilant in following public health guidance aimed at slowing the spread,” the statement said.


The province recognizes that COVID-19 has put increasing pressure on hospitals, according to a spokesperson for Health Minister Christine Elliott

“The situation we are seeing in our hospitals is a reflection of COVID-19 spread in the community,” Alexandra Hilkene said in a statement.

“We continue to closely monitor the evolving situation and are committed to working with our partners to ensure there is capacity in hospitals across the province to provide care for any Ontarian requiring hospitalization.”
 

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