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After a slow start, Canada’s vaccine rollout is now a race against time

Last week, before the crack of dawn, 466,800 doses of Moderna’s COVID-19 vaccine landed at Toronto Pearson Airport in the belly of a FedEx plane after a journey of 8,500 kilometres, from Madrid via Paris and Indianapolis.

If cargo could fly first class, this cargo would qualify.

The vaccine doses, housed in metallic cargo containers, were unloaded before any of the other cargo. As they were carefully lowered off the hydraulic lift and onto a cargo trailer, temperature sensors showed the doses had arrived at their ideal temperature of -20ºC. Ground staff whisked the pallets off the tarmac for customs inspection so that they could be redistributed to the provinces and, eventually, injected into the arms of Canadians.

Minister for Public Services and Procurement Anita Anand was on the runway that morning to oversee the delivery — the latest in a series of deliveries that have been growing in size and frequency in recent days.

“All day long, I’m spending my time trying to move doses from [the third quarter] or from the fall to the spring … and working with suppliers to try to accelerate doses,” said Anand.

“But being here, and seeing the doses come off of the plane, means it is going to happen. Doses are going into arms in the very near term, and that is so meaningful and so important for Canadians.”

Under pressure

Canada’s vaccine rollout got off to a sluggish start. As countries like Israel and the United Kingdom started mass campaigns early in 2021, Canada saw its per capita vaccination rates plunge in international rankings.

Critics at both the federal and provincial levels have blamed the slow pace on Ottawa’s procurement process. Some have pointed to a lack of domestic vaccine manufacturing facilities, or the fact that provinces aren’t able to sign their own contracts with vaccine producers.

Anand knows she’s under enormous pressure to deliver.

“We did come through a rough period in February, and that’s because global supply chains, as a general matter, are just ramping up,” Anand said, referring to manufacturing delays at both Pfizer and Moderna that resulted in smaller-than-anticipated shipments to several countries, including Canada.

“This is the largest vaccination campaign in global history, as well as Canadian history. Having said that, we are ramping up.”

Public Services and Procurement Minister Anita Anand (left) and Major General Dany Fortin look on as Prime Minister Justin Trudeau responds to a question during a news conference in Ottawa Monday, Dec. 7, 2020. (Adrian Wyld / Canadian Press)

Canada is expecting 8 million doses of COVID-19 vaccines by the end of March. Deliveries are set to ramp up sharply after that, fuelled by weekly Pfizer deliveries of at least a million doses. More than 7 million doses are expected to land in April alone.

Anand said she expects 36.5 million doses by the end of June — enough for every person in Canada to receive a single dose.

“The ramp-up is going to be very steep. But again, we’ve got to watch supply chains. This is very early days in this race of making sure that we have everyone inoculated,” she said.

Prime Minister Justin Trudeau continues to stick to a September deadline for getting every eligible and willing Canadian vaccinated. Because of the increasing supply — and updated guidelines that allow public health officials to wait up to four months before delivering a second dose — provinces are now looking to complete their first round of vaccinations before summer.

The ‘big lift’

The appearance of more contagious COVID-19 variants that might cause more severe illness has put increased pressure on governments to vaccinate quickly.

“The provinces and territories are telling us that they are ready, they want more vaccine. And that’s exactly what we as a federal government are aiming to do,” Anand said.

Trudeau has called Canada’s vaccine supply ramp-up “the big lift.” The prime minister told a virtual roundtable of health care workers in February that the country would be going from a trickle of deliveries in the early months of the year to “receiving millions upon millions, even tens of millions of vaccines into the spring. And we’re going to have to make sure we’re getting them out to everyone.”

The challenge is a daunting one. Taking into account the 8 million doses delivered to Canada before the end of March, about 23 million more Canadians are eligible for vaccination this spring.

To deliver first doses to that entire population between April 1 and July 1, health care workers will have to vaccinate an average of 255,000 people per day, seven days a week.

Watch: Ontario launches online booking system as fears of a third wave grow

Ontario’s provincial COVID-19 vaccine booking system launched to mixed reviews, with many saying they got an error message or waited in jammed phone queues. Meanwhile, doctors in the province raised concerns of a third wave of COVID-19 infections. 1:49

Ontario Premier Doug Ford says his province has the capacity to administer 150,000 vaccines a day. “We’re making steady progress,” Ford told reporters during an update on the province’s rollout on Sunday. “We just need more vaccines.”

That’s a message the federal government is hearing a lot lately from municipalities. Anthony Di Monte, general manager of emergency operations for the City of Ottawa, said the city has seven clinic-based immunization sites — including re-purposed hockey arenas and community centres — plus two hospital sites and a mobile unit ready to inoculate the city’s population of one million.

He said that once he gets the doses he needs, he’ll be ready to launch on 72 hours’ notice Ottawa’s complete mass vaccination program — which is set to deliver, for a start, 11,000 shots a day through all ten sites.

Anthony Di Monte, general manager of emergency operations for the City of Ottawa, speaks to the CBC’s David Cochrane. (Sarah Sears/CBC News)

“Our objective for all seven of our (clinic-based) sites is to do in the neighborhood of 1,200 to 1,400 vaccinations a day, per site,” said Di Monte. 

“We’ve got some confidence that we could probably crank that up a little bit and get closer to the 2,000 mark per site once we get rolling and we have enough staff.”

With enough doses and enough people, Di Monte said, Ottawa can keep its clinics open around the clock. The city has plans for a drive-through vaccination site in the sprawling parking lot outside the Canadian Tire Centre, home of the Ottawa Senators; it’s also looking at using two convention centres.

‘We ramp up and we never go back’

What Di Monte fears is a disruption in supply that would force him to close a vaccination site.

“You want the machine to start going and flowing and a regular flow,” he said. “I would prefer to see that we ramp up and we never go back. We just keep going and I’ll turn the switch up as much as we have capacity.”

Anand said her department is keeping a close watch on those supply lines.

“We are seeing vaccine nationalism take hold in certain areas of the world, including in Europe and, to an extent, the United States,” she said. “And we’ve got to make sure that Canada’s supply chain is protected.”

The cargo flight Anand met at the airport last week crossed European and American borders, offering a clear example of how “vaccine nationalism” — countries limiting exports to concentrate on vaccinating their citizens first — could tie Canada’s supply lines in knots.

Anand said Canada’s diverse vaccine portfolio — four vaccines from five different suppliers — serves as a hedge against that threat.

“We have to make sure that we’re on top of this file and the delivery schedules,” she said.

“I’m thinking of all the elderly people in Canada who need vaccine, want a vaccine, and Canadians at large. This is what makes this work so important, and this is why we have to see this right through to the end so every single Canadian will have access to a vaccine before the end of summer, if not before.”

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Media, protesters caught in Hungary and Poland’s slow squeeze

Dozens of newspapers, TV stations and websites blank or black: this was what the national strike of private media in Poland protesting a sudden and crippling government tax on advertising looked like on Feb. 10.

In Hungary the same week, an opposition radio station was ordered by a court to turn off its microphones this coming Monday.

This is the politics of the slow squeeze in Central Europe. It’s a strategy designed by two men, the prime minister of Hungary, Viktor Orban, and the vice-premier and de facto leader of Poland, Jaroslaw Kaczynski.

Their countries, both former members of the Soviet bloc, belong to the European Union, and profit from it, but their ideas on democracy and the rule of law, principles their countries agreed to uphold when joining in 2004, are far from those endorsed by EU leaders in Brussels.

‘A 21st-century Christian democracy’

For Hungary’s Orban, democracy of the liberal kind is a dirty word. He has, instead, vowed to build an “illiberal state.”

“We have replaced a shipwrecked liberal democracy with a 21st-century Christian democracy, which guarantees people’s freedom and security,” Orban proclaimed to the Hungarian parliament in May 2018.

A year later, he told a summit of students and policy makers that “the essence of illiberal democracy is Christian liberty and the protection of Christian liberty.”

“Our task will be to turn against liberal internationalism,” he said.

Orbán speaks to the media as he arrives at EU headquarters in Brussels on Dec. 10, 2020. Earlier this month, a Hungarian court ordered the closure of one of Klubrádió, one of the last remaining independent radio stations in the country. (John Thys/AFP via Getty Images)

Kaczynski is a devout Catholic but above all a devout Pole. 

Late last year, the biggest chain of regional dailies and weeklies in Poland, with a reach of 17 million readers, was bought from a German publishing house by state-controlled petrochemical company PKN Orlen. On Feb. 4, Kaczynski explained that for two decades, the German-owned, or “non-Polish” as he prefers to put it, papers had been “demoralizing” Polish young people.  

His government’s goal was “re-polonization,” and this was a shining example. Others see the deal as a Putin-style approach.

“The consolidation of the state, the oil sector and the media is a well-known manoeuvre in the Russian scenario,” Peter Wolodarski, editor-in-chief of the major Swedish paper Dagens Nyheter and of Polish origin himself, wrote in his paper late last year. 

“This should be an alarm signal for the world.”

‘Media without choice’ read the headlines on the front pages of Poland’s main private newspapers, part of a protest against a proposed media advertising tax that journalists say is politically motivated to consolidate government control over media. (Kacper Pempel/Reuters)

The politics of resentment

Kaczynski, 72, and Orbán, 57, are believers in nationalism and the politics of resentment. 

Kaczynski’s view is that, in the years after communism crumbled more than 30 years ago, Poland’s liberal democratic leaders betrayed the country’s Christian principles. 

He went on record in 2005 with this apocalyptic prediction: “the affirmation of homosexuality will lead to the downfall of civilization.”

When it won elections that year, his Law and Justice party promised a “moral revolution” to root out corruption and a so-called fourth republic, in league with the Catholic Church. 

Kaczynski, seen in the lower house of parliament in Warsaw last May, is a devout Catholic and has promoted the idea of a ‘moral revolution’ in Poland. (Wojtek Radwanski/AFP via Getty Images)

Orban, his country’s longest-serving prime minister, posted on Facebook last year a map of a pre-WWI “Greater Hungary.” The country was on the losing side of the First World War and stripped of about 70 per cent of its territory. Predictably, the post infuriated neighbouring countries. 

Orban’s vision is of a Christian Hungary with no Muslim refugees, or “invaders” as he called them in a 2018 interview.

Both Orban and Kaczynski are nationalists who refuse the dreams of a more federal, multicultural Europe and brook little or no criticism of their vision.

Media feel the squeeze

And so, the strike and the radio station.

The sudden tax on advertising threatens the existence of independent Polish media outlets, their editors said.

“This is simply extortion,” they wrote in an open letter to the government on Feb. 10.

The Polish prime minister defended the tax as “a fair step,” saying the money raised would go toward fighting COVID-19 and would level the playing field between domestic and foreign players and small and big companies.

The editors said that Polish state media, filled with ruling-party loyalists, receive huge subsidies and would likely get more to offset the tax. The independent sector would receive none, they said.

The closure in Hungary of Klubradio is a slight departure from Orban’s previous strategy, which involved government allies buying up critical media. In 2019, Reporters Without Borders said the degree of media control under the Orban government was “unprecedented” among EU member states.

An employee of Klubradio works at the station’s headquarters in Budapest. The station’s licence will expire Sunday after Hungary’s broadcast regulator refused to renew it, a move that Orban critics say was intended to silence opposition to his government. (Bernadett Szabo/Reuters)

In the spring of 2020, a pro-Orban businessman took a 50 per cent stake in the firm that controls the advertising and revenue of Index, Hungary’s biggest news site. The editor-in-chief was soon under fire. Then he was gone. Seventy journalists resigned in protest. And Index is now a tame animal.

Klubradio’s licence, which expires Feb. 14, was not renewed last September by the government broadcasting authority for violating broadcasting rules on “six occasions in the last seven years,” according to the secretary of state for international communication and relations.

The station argued its infractions were minor and similar to those of other broadcasters that had not had their licences revoked.

The government has called allegations that the closure is part of a government crackdown on press freedom “a fiction” and part of the anti-Orbán agenda of the mainstream liberal media.

State TV decries ‘leftist fascism’

In Poland, when the Law and Justice party took power in 2015, its first priority was to fill the top positions in state-financed TV and radio with loyalists. 

The result was on display when tens of thousands of women demonstrated in October 2020 against a court ruling that struck down one of the few remaining exceptions to the near-total restriction on abortions.

The state TV channel TVP displayed a banner saying, “Leftist fascism is destroying Poland” on several occasions during its coverage of the demonstrations and opposition parties’ protests against the abortion law in parliament.  

A screen shot of an Oct. 28, 2020, newscast on the Polish state television channel TVP displaying a banner saying ‘Leftist fascism is destroying Poland’ during the anchor’s lead-in into an item on the demonstrations against a ruling further restricting abortion. (Archiwum Wiadomości/YouTube)

This bitterly contested ruling was the result of the alliance between the government of the majority Catholic country and the Catholic Church. But first, it required compliant judges.

So, soon after coming to power, the government brought in rules lowering the retirement age for judges, then replacing the departing ones with loyalists on the Constitutional Tribunal. They, in turn, handed down the abortion ruling.

A large crowd in Warsaw protests a ruling by Poland’s Constitutional Tribunal that struck down one of the few remaining exceptions to abortion restrictions Oct. 30, 2020. (Omar Marques/Getty Images)

Kaczynski’s government, which denies trying to influence the court, proceeds carefully.  After the massive demonstrations, it postponed bringing the abortion law into effect. Then, three months later, in the middle of a cold winter, it activated the ruling.

There were more nights of demonstrations by thousands of women, but there was a sense of frustration.

“This pause between the verdict and its coming into effect is typical of how they proceed,” one demonstrator named Ania told French daily Le Figaro. “They go slowly, and people get tired.” 

It was another example of the slow squeeze.

WATCH Demonstrations across Poland protest new abortion restrictions:

Thousands of people in Poland took to the streets after a new, highly restrictive abortion law came into effect. 0:46

EU intervention comes too late

Orban changed the retirement rules for judges as well, then also packed the courts with loyalists.

He then squeezed Central European University in Budapest, funded by Hungarian-American Jewish financier George Soros, a frequent target of Orban’s and the subject of various conspiracy theories and rhetoric widely decried as anti-Semitic.

The university was forced to move to Vienna after the courts said the university was illegal because it was incorporated in the U.S

The EU has tried to fight back, launching cases in the European Court of Justice and winning them. Hungary’s actions against Soros’s university were ruled illegal under EU law as was its forced early retirement of judges. Poland’s new retirement rules for judges were also deemed unconstitutional.

But the cases took several years. New judges were already in place in Poland and Hungary. The university had moved.

People attend a rally in support of Central European University in Budapest in November 2018. The school was deemed illegal because it was incorporated in the U.S., a ruling that the European Court of Justice later found violated EU law. (Bernadett Szabo/Reuters)

There are, however, worrying signs for both leaders. In Hungary, six opposition parties have united and polls show their coalition neck and neck with Orban’s party, Fidesz.

“Fidesz is gradually dropping, and this is mostly due to the virus’s economic impact and the perception that the government isn’t handling the crisis as well it should,” Tibor Zavecz, head of Zavecz Research, told BNN Bloomberg in December.

In Poland, support for the Law and Justice party has dropped from 47 per cent in May 2020 to 36 per cent in February, according to Politico’s poll of polls. Here, too, the pandemic has hurt.

But Orban doesn’t face an election until 2022 and Kaczynski not until 2023.

Until then, the work of the “moral revolution” in Poland and of “illiberal democracy” in Hungary will go on.

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Damaged roads, lack of gear slow Indonesia earthquake rescue

Damaged roads and bridges, power blackouts and lack of heavy equipment on Saturday hampered rescuers after a strong earthquake left at least 46 people dead and hundreds injured on Indonesia’s Sulawesi island.

Operations were focused on about eight locations in the hardest-hit city of Mamuju, where people were still believed trapped following early Friday’s magnitude 6.2 quake, said Saidar Rahmanjaya, who heads the local search and rescue agency.

Cargo planes carrying food, tents, blankets and other supplies from Jakarta landed late Friday for distribution in temporary shelters. Still, thousands of people spent the night in the open fearing aftershocks and a possible tsunami.

National Disaster Mitigation Agency spokesperson Raditya Jati said rescuers had so far recovered the bodies of 37 victims in Mamuju and nine in neighbouring Majene district.

At least 415 houses in Majene were damaged and about 15,000 people were moved to shelters, Jati said.

Rescuers search for survivors at a collapsed building in Mamuju city on Saturday. (Hariandi Hafid/AFP via Getty Images)

Bodies retrieved by rescuers were sent to a police hospital for identification by relatives, said West Sulawesi police spokesperson Syamsu Ridwan.

He said more than 200 people were receiving treatment in the Bhayangkara police hospital and several others in Mamuju alone. Another 630 were injured in Majene.

Among those pulled alive was a young girl who was stuck in the wreckage of a house with her sister.

Search and rescue workers inspect a collapsed building following the 6.2-magnitude earthquake in Mamuju, West Sulawesi province. (Sigid Kurniawan/Antara Foto via Reuters)

The girl was seen in video released by the disaster agency Friday crying for help. She was being treated in a hospital.

She identified herself as Angel and said that her sister, Catherine, who did not appear in the video, was beside her under the rubble and was still breathing.

The fate of Catherine and other family members was unclear.

Landslides, power outages

The quake set off landslides in three locations and blocked a main road connecting Mamuju to Majene. Power and phone lines were down in many areas.

Mamuju, the capital of West Sulawesi province with nearly 75,000 people, was strewn with debris from collapsed buildings. A governor office building was almost flattened by the quake and a shopping mall was reduced to a crumpled hulk. A large bridge collapsed and patients with drips laid on folding beds under tarpaulin tents outside one of the damaged hospitals.

Two hospitals in the city were damaged and others were overwhelmed.

Many survivors said that aid had not reached them yet due to damaged roads and disrupted communications.

Video from a TV station showed villagers in Majene, some carrying machetes, forcibly stopping vehicles carrying aid. They climbed onto a truck and threw boxes of instant noodles and other supplies at dozens of people who were scrambling to get them.

Two ships headed to the devastated areas from the nearby cities of Makassar and Balikpapan with rescuers and equipment, including excavators.

State-owned firm AirNav Indonesia, which oversees aircraft navigation, said the quake did not cause significant damage to the Mamuju airport runway or control tower.

Residents gather at a makeshift shelter in Mamuju on Saturday, a day after the quake rocked Indonesia’s Sulawesi island. (Muhammad Rifki/AFP via Getty Images)

Indonesian President Joko Widodo said Friday that he instructed his cabinet ministers and disaster and military officials to co-ordinate the response.

In a telegram sent by the Vatican on behalf of Pope Francis, the pontiff expressed “heartfelt solidarity with all those affected by this natural disaster.”

The Pope was praying for “the repose of the deceased, the healing of the injured and the consolation of all who grieve.” Francis also offered encouragement to those continuing search and rescue effects, and he invoked “the divine blessings of strength and hope.”

International humanitarian missions including the Water Mission, Save the Children and the International Federation of Red Cross said in statements that they have joined in efforts to provide relief for people in need.

Indonesia, home to more than 260 million people, is frequently hit by earthquakes, volcanic eruptions and tsunamis because of its location on the “Ring of Fire,” an arc of volcanoes and fault lines in the Pacific Basin.

In 2018, a magnitude 7.5 earthquake in Palu on Sulawesi island set off a tsunami and caused soil to collapse in a phenomenon called liquefaction. More than 4,000 people were killed, including many who were buried when whole neighbourhoods were swallowed in the falling ground.

A massive magnitude 9.1 earthquake off Sumatra island in western Indonesia in December 2004 triggered a tsunami that killed 230,000 people in a dozen countries.

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Quebecers need to further reduce contacts to slow spread of COVID-19, projections suggest

Quebecers will need to be more diligent about physical distancing and further reduce their contacts to avoid a rise in the number of COVID-19 cases, hospitalizations and deaths, according to the latest projections by government-affiliated experts. 

The projections suggest that even with the closure of bars and restaurants, the cancellation of organized sports and further restrictions in schools put in place at the beginning of October, those numbers will continue to rise into the New Year.

But if the population reduces its contacts by another 25 per cent, according to one model, by maintaining two metres of physical distance in public spaces, wearing masks and limiting gatherings, the spread of the virus is likely to plateau and even decline. 

The findings were presented Friday by Quebec’s public health research institute, the INSPQ.

The presentation included three mathematical models: one if no measures had been introduced after cases started to climb in the middle of August and September; another if the restrictions imposed in early October are maintained; and a third that showed the impact of reducing contacts. 

Dr. Jocelyne Sauvé, vice-president of scientific affairs at the INSPQ, said the modelling suggests Quebec was headed for a “fairly catastrophic” rise in cases in September had nothing been done, with a death toll that could have exceeded the first wave.

But she said the projections show that further effort from the population will be necessary to stabilize the pandemic.

Marc Brisson, a health economics professor at Université Laval who presented the findings, said in practical terms this means further cutting back on non-essential contacts and keeping two metres apart while, for example, speaking to another parent during school drop off.

All three models were prepared with the assumption that Quebec’s long-term care homes and private seniors’ residences are better protected than they were in the spring.

Brisson said the INSPQ is preparing another round of projections to be released later this fall that would include the impact of more effective testing and contact tracing on the rate of transmission.

The previous round of INSPQ projections was released in July and forecast that a second wave would hit Quebec sometime in September. Its force would depend on how well Quebecers were following health guidelines.

Health Minister Christian Dubé said Friday the projections reinforce what the province has been saying — that the actions of individuals have major consequences.

Dubé also pointed to another study, prepared by Quebec’s health research institute INESSS, that suggested Quebec’s hospitals were under less strain than they had been a week ago.

“We have been doing well on stabilization, but we want those cases to continue to decline. Why do we do this? We want to protect our health system and have as few victims as possible,” he said.

“We would have hit a wall if we didn’t do what we did Oct. 1.”

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Slow return for Canada’s dental offices as pandemic restrictions ease

As dental offices start to reopen across the country, the guidelines vary from province to province but the concerns remain the same: having the right protocols and enough protective gear to safely see patients, and seeing enough of them so they can keep the office running. 

“It is going to be a little slower,” said Dr. Ken Phillips, of  Royal Centre Dental Group in downtown Vancouver. 

“We have to be really careful that we don’t introduce another wave of this pandemic.”

Before seeing a patient with a broken tooth, Phillips and a colleague go through a meticulous routine of gearing up.

It includes one gown, two face masks, a face shield and goggles. He sanitizes his hands at the start and then again before he puts on his gloves. 

WATCH | What kind of non-medical masks should people wear?

An emergency room doctor answers viewer questions about the COVID-19 pandemic including what kind of non-medical mask people should wear. 2:46

The patient is waiting in the empty mall, because the reception area in the office is closed off, to be replaced with a virtual waiting room app that will notify patients when it’s their turn.

When this patient is called in, she is asked if she has any COVID-19 symptoms, and her temperature is taken. It’s only when the thermometer reads 36.1 degrees that she is pointed toward the dental chair.

Aside from emergency services, most dental procedures were considered non-essential when provinces and territories implemented pandemic restrictions.

Before the closure, the office was seeing about 50 patients a day, but now they are seeing only a handful. Phillips’ office stayed open with just a few staff members, but many others were completely closed. 

No income

Dr. Sura Hadad was one of those who shut down her clinic. But her bills haven’t stopped. 

She says rent in the Halifax strip mall where she is located is more than $ 10,000 a month, and she also has loan payments for some of the equipment in the office. On top of that, she has a mortgage and four children. 

“Everybody is like, oh, you are a dentist, you have it easy,” she said.

“To run a dental office is very expensive, the overhead, the staff, everything.”

Dr. Sura Hadad shut down her Halifax dental clinic due to coronavirus, but her rent and other expenses still have to be paid. When she does reopen, restrictions mean she won’t be able to see the same number of patients, nor take in the same income. (Patrick Callaghan/CBC)

Hadad qualified for the federal government’s $ 40,000 business loan, but a dozen staff members have been laid off.

When she does reopen, restrictions mean she won’t be able to see the same number of patients, nor take in the same income. 

“I don’t know if we are going to be able to bring all the staff back or what is going to happen,” she said.

“It is so hard.”

Hadad is waiting for direction on how and when her clinic can safely start to see patients, but in some other provinces guidelines have already been issued. 

Judgment call

In B.C., where new daily cases of COVID-19 have remained low throughout May, recent guidelines from B.C.’s College of Dental Surgeons state that procedures should only be done when the benefits far outweigh the risk — a judgment call that has to be made by individual dentists.

They also suggest that patients who are at high risk, including those with diabetes and those over the age of 70, should have appointments deferred as long as possible. 

However, Dr. Alastair Nicoll, the chair of the B.C. Dental Association’s “Back to Work task force,” says provincial experts have concluded if there is low prevalence of disease in the community, and patients do not show any signs of COVID-19, many procedures can be done without additional safety gear. 

“Dentists have been dealing with infectious diseases and the risk of transmitting them to staff and patients in the dental office setting for decades,” said Nicoll.

“What we have been using for many, many years is the proper level of personal protective equipment [PPE] for most cases.”

Not enough PPE

But in Ontario, where hundreds of new COVID-19 infections are still being reported daily, dentists are scrambling to find enough personal protective equipment.

There are some 10,000 dentists and their staffs in the province, according to Dr. Kim Hansen, president of the Ontario Dental Association and a dentist in Prescott. 

Dr. Rob Eisen of the North York Smile Centre in Toronto hands one of his patients toothpaste and floss at a drive-thru event on Sunday. (CBC)

“Just imagine the amount of PPE that we are seeking.” 

A survey conducted by the association found that in April, 40 per cent of its members were unable to provide emergency services and the primary reason was because of a lack of safety gear. 

Hansen noted that back in March, many dentists donated some of their safety gear when shortages were reported among front-line workers. 

New guidelines released on Monday by Ontario’s Royal College of Dental Surgeons outline the required PPE as well as rules around sealing off a room after aerosol-generating procedures like drilling or ultrasonic scaling and polishing.  

The amount of time a room needs to be left vacant varies depending on the rate of air exchange in the building, which is why the dental association was encouraging its members to contact an HVAC specialist and get their ventilation systems evaluated. 

WATCH | Improving ventilation in efforts to cut risk of transmission

The owner of United Boxing Club in Toronto’s west end is already taking steps to cut the risk of infection inside his gym prior to opening his doors again. 2:43

But for now, Ontario dentists can only see patients for essential care, including procedures that “relieve pain and suffering.”

The guidelines say they won’t be able to see patients for routine check-ups until community transmission of COVID-19 has been significantly mitigated.    

Dr. Rob Eisen and his colleagues at North York Smile Centre in Toronto held a drive-thru check-in on the weekend, where patients could pull up and ask questions — and leave with the standard toothpaste and dental floss. 

“I think part of reopening is really connecting with our patients still and making sure that they are comfortable,” said Eisen, who has been providing emergency care and consultation over the phone.

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India’s COVID-19 lockdown is among the strictest in the world but has yet to slow the spread

Shortly after extending what was already one of the strictest COVID-19 lockdowns by almost another three weeks, Indian Prime Minister Narendra Modi assured those watching his televised address this week that “the country is in a very well-managed position.” 

The situation on the ground, however, suggests otherwise: While proportional to its population of 1.38 billion, India’s COVID-19 caseload is small, it’s been rising despite the lockdown and has surpassed 16,000, with 2,154 new cases reported Saturday, the highest increase in a single day. 

There had already been reports of hunger and distress among the poor, who have been hit hardest by the lockdown, and news that the 21-day countrywide shutdown would be extended by another 19 days to May 3 sparked further chaos.

Hundreds of migrant workers — angry at being locked down with little access to daily essentials and no income — protested in the streets of Mumbai and Surat, a textile manufacturing hub in western India, demanding authorities transport them back to their villages. 

Restrictions on movement have been strictly enforced by police and include the shutdown of passenger trains, buses and all domestic and international flights, as well as schools and social and religious institutions. 

The government has allowed “select, necessary activities” to resume in areas that are not COVID-19 “hotspots” as of April 20 in addition to those already deemed essential. Permitted activities now include agriculture, fisheries, banking, a rural work-for-relief program and some construction, industry and manufacturing.

Police officers advise women to maintain distance as they wait to collect groceries in Ahmedabad in the northwestern state of Gujarat. Physical distancing and restrictions on movement have been strictly enforced. (Amit Dave/Reuters)

Government promises more relief

India has been under lockdown since March 24. At 8 p.m. that night, Modi announced on TV that in four hours, he would be halting all activity in the entire country to prevent the spread of the coronavirus. 

“If you do not take these 21 days seriously, then the country will go back by 21 years,” he warned.

But absent any advance notice or consultation with state governments and with only limited financial aid and food rations for the most vulnerable, the announcement sparked despair among India’s millions of workers, especially those known in India as daily wagers.

These are workers who live practically day to day, employed on construction sites, in small and medium manufacturing units and cottage industries, and in hotels and homes.

Migrants workers in Mumbai rest inside a workshop after it was shut down. India relies on millions of migrant workers who come to the cities to work. Many of them live where they work and were left without access to income or basic necessities after most activity in the country was shut down last month. (Prashant Waydande/Reuters)

Much of the labour force in India’s cities is made up of interstate economic migrants from villages around the country (at least 45 million of them, according to the 2011 Census), and as transportation and their means of employment ground to a halt, a large number were left with no choice but to walk hundreds of kilometres back to their villages in a desperate bid for survival. 

Researchers have compiled cases of almost 200 Indians who have died as a result of lockdown-related distress, and social media is replete with SOS calls and cellphone videos from labourers stuck inside their tenements or cramped work sites, which double as accommodation for some. 

The government’s relief package, which includes food, gas and cash for poor households and health insurance for medical staff, has been criticized by some as too modest, at about 0.8 per cent of GDP,  excluding millions of those who need it. Finance Minister Nirmala Sitharaman said on Friday additional assistance would be announced in the coming days.

With no way to earn an income and the public transportation system shut down, some migrant workers had little choice but to walk back to their home villages. (Danish Siddiqui/Reuters)

Is it working?

The lockdown has pushed the already sagging Indian economy into further decline, with the Centre for Monitoring the Indian Economy, a Mumbai-based think-tank, estimating that unemployment shot up from less than seven per cent in mid-March to more than 23 per cent in the first week of April. 

Barclays estimated the cost to the economy would be $ 234.4 billion US and zero per cent GDP growth for 2020.

Daily wage labourers in New Delhi queue for free food at a construction site where activity has been halted because of the nationwide lockdown. Some construction activity will be allowed to start up in areas that do not have large COVID-19 outbreaks. (Adnan Abidi/Reuters)

Meanwhile, the public health benefits remain unclear. India has not “flattened the curve” in the past three and a half weeks, with cases rising from around 600 to more than 16,000 in that time.

The number of new cases continues to go up, as does the number of deaths, which rose from 13 on March 25 to more than 520 currently.

While over half the cases are in the cities of Delhi, Mumbai, Pune, Indore and Bhopal, testing has shown that COVID-19 is present in almost all of India’s 28 states and eight union territories. 

A doctor scans residents from Dharavi, one of Asia’s largest slums, with an infrared thermometer to check their temperature as a precautionary measure against the spread of COVID-19 in Mumbai. (Francis Mascarenhas/Reuters)

“The three-week lockdown was supposed to buy the government time to ramp up testing, increase surveillance and contact tracing, acquire PPE (personal protective equipment) kits in requisite numbers for frontline workers, train health personnel, prepare hospitals to receive COVID-19 patients, and draw up a comprehensive plan for controlling the spread of the virus,” said Anant Bhan, a researcher in global health, bioethics and health policy. 

“There have been pockets of containment, but there is no indication that authorities have used this three-week window to address the big picture.”

The Ministry of Health and the Indian Council of Medical Research (ICMR), which has been overseeing testing protocols and pandemic-related policy, did not respond to questions from CBC News.

Chalk circles are visible on the streets of many Indian cities these days as a means of keeping people apart. Here people physically distance as they wait to buy medicine in Kolkata. (Rupak De Chowdhuri/Reuters)

Slow to respond

The first COVID-19 case was reported in India on Jan. 30 in a student who returned to her home in Kerala from Wuhan, China, but as late as March 13, a day after India’s first coronavirus death and two days after the WHO declared a pandemic, the government said the virus was not a health emergency. 

Eleven days later, as deaths rose in parts of Europe and North America, Modi announced he was locking down the country.

A migrant worker carries his son as they walk along a New Delhi road to return to their village. Trains, buses and other means of public transportation have been shut down in the country. (Danish Siddiqui/Reuters)

“It was like taking a sledgehammer to the problem, with no clear explanation, plan or a strategy to exit,” said Vikram Patel, professor for global health at Harvard Medical School, who is currently under lockdown in the tiny western Indian state of Goa. 

“These three weeks have been completely wasted because in the absence of a systematic testing protocol across the nation, we do not have an understanding of the spread … and we have no way of evaluating the lockdown.”

Nevertheless, as cases rise in the world’s most densely populated country, a lockdown continues to be the favoured tool for federal and state governments. 

People caught violating the lockdown do sit-ups as punishment while police watch in Chennai, the capital of the eastern state of Tamil Nadu. (P. Ravikumar/Reuters)

Lockdown preferred approach in states 

A day before Modi’s announcement, Maharashtra, the state with the largest number of cases, said it would extend the lockdown until April 30 since “there has been no reduction in cases.” 

Maharashtra has reported more than 3,600 cases so far, including more than 2,100 in Mumbai, a densely packed metropolis and the country’s financial capital.

The eastern Indian state of Odisha, an overwhelmingly rural region that has reported just 60 cases and one death, has adopted the same approach, announcing a similar extension last week. 

People wait to receive free food being distributed by Central Reserve Police Force in Chennai. (P. Ravikumar/Reuters)

“The one-size-fit-all lockdown has brought untold misery and suffering to millions of farmers, migrant labourers, daily wagers and business owners,” opposition MP Rahul Gandhi tweeted a day before Modi extended the lockdwon.

“It needs a ‘smart’ upgrade, using mass testing to isolate virus hotspots and allowing businesses in other areas to gradually reopen.”

The government’s plan to allow some parts of the economy to reopen in areas without COVID-19 outbreaks starting Monday is an attempt to do that.

Farmer Anil Salunkhe feeds strawberries to his cow in the village of Darewadi in the western state of Maharashtra, which has the highest number of COVID-19 cases among India’s 28 states and eight union territories. (Rajendra Jadhav/Reuters)

Limited testing

The government has done a good job of raising public awareness of COVID-19, says Partho Sarothi Ray, a molecular biologist at the Indian Institute of Science Education and Research Kolkata, but has been slow to ramp up testing.

About 386,000 people have been tested in India so far, the ICMR said Sunday (with rates varying widely among states). That is about 280 tests for every million people — among the lowest rates in the world. 

India, with a population of 1.38 billion, has conducted about 280 coronavirus tests for every million people so far. (P. Ravikumar/Reuters)

The government has set the price of the test at 4,500 rupees (around $ 82) for all but the poor who have enrolled in a government health insurance scheme. 

“4,500 rupees is expensive,” said Ray. “And the test need not cost more than 800 rupees. Given there is a demand globally for testing kits, we also need to develop our own indigenous testing capacity.”

On Friday, the southern Indian state of Karnataka cut the price by half to 2,250 rupees. 

An order for 650,000 test kits placed in late March by Indian authorities with China was finally dispatched on Thursday, according to Indian Ambassador to China Vikram Misri.

Earlier this week, Dr. R.R. Gangakhedkar of the ICMR said the country had enough kits “for six weeks” but did not specify how many. 

“We have issued detailed protocols for who should get tested,” he said at a briefing Tuesday. “I cannot say why more people are not getting tested.” 

Nurses seek better protective measures

Neither the prime minister nor the health minister has held a press conference since the lockdown began, but in daily briefings, Health Ministry officials have been optimistic, even insisting that the country is “over-prepared” when it comes, for example, to available PPE and hospital beds.

In his TV address this week, Modi struck a similar tone. “The path that India has taken within our limited resources has become a topic of discussion in the entire world today,” he said.

A man in New Delhi watches Prime Minister Narendra Modi’s address to the nation on April 14, in which he announced that the 21-day lockdown would be extended by 19 days until May 3. (Anushree Fadnavis/Reuters)

But the specifics of a nationwide policy to tackle the virus remain elusive, Patel says. 

When asked, for example, why the Health Ministry has not made public the list of dedicated hospitals for treating COVID-19 cases, ministry official Lav Agarwal said, “We do not want people to unnecessarily feel panic and flood those hospitals.” 

He said anyone with symptoms should call official helplines.

Officials have also not disclosed how many health workers have been infected even amid reports of doctors and nurses contracting the virus and some dying from it, and at least one private hospital having to be sealed off because of an outbreak among staff. 

On Wednesday, the United Nurses Association, one of the largest nurses’ unions in the country, petitioned the Supreme Court, saying the government had not addressed the risks faced by frontline workers. 

Medical staff stand outside a hospital in Kolkata to show solidarity with people who are affected by the coronavirus and other health-care workers from around the world. (Rupak De Chowdhuri/Reuters)

The government told the court it would set up a helpline and respond to any grievance raised by a nurse within two hours. 

“When the government says there is adequate PPE, they are perhaps limiting themselves to the COVID-19 dedicated hospitals, What about the rest?” Joldin Francis, the general secretary of the union’s Delhi branch, told CBC.  

“We have seen outbreaks in other hospitals. In the absence of mass testing, we do not know which patient might be carrying the virus, and we are working in conditions of great risk.” 

Kerala seems to be flattening its COVID-19 curve

One state that seems to have used testing effectively to contain the spread is Kerala. 

The coastal state of 35 million on the southern tip of India has the best human development indices and public health infrastructure in the country. As soon as its first case of COVID-19 was detected on Jan. 30, the state government moved swiftly to test and contact trace, set up quarantine facilities and institute containment measures in areas reporting multiple cases. 

Medical staff at a government-run medical college collect swabs from people to test for the coronavirus at a walk-in sample kiosk (WISK) in Ernakulam in the southern state of Kerala, which began testing for coronavirus and isolating cases early. (Stringer/Reuters)

The health measures have been backed by a welfare safety net, including financial support, food rations, community kitchens and special outreach for migrant labourers. 

Kerala’s approach seems to be working, with the number of active cases coming down, and the disease curve starting to flatten, the state’s finance minister, Thomas Isaac, tweeted this week. 


With two deaths out of 399 cases, it has the lowest case fatality rate in the country, at 0.5 per cent.

Kerala’s relative success stands out in a country where domestic public health spending is under two per cent of GDP – compared to about eight per cent in Canada and three per cent in neighbouring China. 

Public health infrastructure, particularly across rural India, suffers from decades of neglect and absence of trained personnel. Hundreds of thousands of people die annually of preventable diseases, such as tuberculosis and malnutrition. 

“Malnutrition is a significant co-morbidity for the coronavirus. If the virus spreads to the poor, or to populations such as Adivasi (indigenous communities) areas, we will have a public health disaster on our hands,” said Ray. 

He urged authorities to ramp up testing.

“The more you test, the more lives you will save, and the sooner you will bring the country out of the lockdown.” 

A screen shot of a graph showing the number of confirmed cases of COVID-19 in India between January and April of this year produced by the Center for Systems Science and Engineering at the Johns Hopkins University and Medicine in Baltimore. (Johns Hopkins University and Medicine Coronavirus Resource Center)

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CBC | World News

Government documents reveal a slow start to Canada’s COVID-19 response

Briefing notes prepared by bureaucrats for federal ministers show just how quickly the COVID-19 situation evolved in Canada — with public health officials stating the risk of transmission in Canada was low right up until early March, only to recommend an ordered shutdown of economic life in this country some two weeks later.

Prime Minister Justin Trudeau warned Thursday that it could be as long as a year before normal life returns in Canada — a dramatic change in messaging, considering how Public Health Agency of Canada officials were advising policymakers less than two months ago that COVID-19 risks were low in this country, and that mandatory quarantines for returning travellers would be too difficult to enforce.

A March 10 department-drafted briefing note prepared for Health Minister Patty Hajdu ahead of question period said that, with just 12 cases being reported nationwide at that point, “the risk of spread of this virus within Canada remains low at this time.” The note also said the public health system is “well-equipped to contain cases coming from abroad, limiting the spread in Canada.”

A month later, Canada has more than 21,000 cases.

As the documents show, as early as Jan. 28 the World Health Organization (WHO) was describing the risk of COVID-19 transmission as “very high” in China and “high at the global level.”

Early messages from bureaucrats to Health Minister Patty Hajdu never hinted at the eventual scope of the pandemic. (Sean Kilpatrick/The Canadian Press)

The tranche of documents, prepared by various government departments and tabled with the Commons Health committee late Wednesday, include many of the early planning memos that informed the federal government’s response to COVID-19 in January and February.

They show that while the government was seized with repatriating Canadians from China’s Hubei province and various cruise ships during that time, there was little talk of a possible pandemic.

Public health officials questioned the accuracy of media reports out of the city of Wuhan, in Hubei, suggesting that the virus was spreading through person-to-person contact.

“Based on the latest information that we have, there is no clear evidence that the virus is easily transmitted between people,” a Jan. 19 briefing note prepared for Hajdu said.

The documents also reveal that the government was reluctant to strictly police travellers arriving from Hubei, the region of China where the novel coronavirus is thought to have originated.

‘Next to impossible’ to stop COVID-19: minister

According to talking points prepared for a Jan. 30 call with her provincial and territorial counterparts, Hajdu said preventing the virus from arriving in Canada was “next to impossible” because of the nature of global travel.

“What really counts is limiting its impact and controlling its spread once it gets here,” the talking point reads.

Three days later, the U.S. barred all non-citizens coming from China from entering the country.

While there were information booths at major Canadian airports starting on January 21, the decision to collect personal contact information from inbound Hubei travellers was only made on Feb. 19 — information that could then be used by public health officials to follow up with people if an outbreak emerged.

Scenes from a pandemic: passengers arrive at the Calgary Airport after being briefed on mandatory self-isolation rules March 25, 2020. (THE CANADIAN PRESS)

The government relied on individuals to self-report to Canadian Border Services Agency (CBSA) officers if they were experiencing flu-like symptoms, long after temperature monitoring measures were commonplace at airports in Asia.

Between Jan. 22 and Feb. 18, 58,000 travellers arrived in Canada from China — 2,030 of them were coming from Hubei province.

Only 68 were pulled aside for further assessment by a quarantine officer and only three passengers were actually flagged for a medical exam — the other 65 passengers were sent away with a pamphlet.

It’s impossible to know how many pre-symptomatic and asymptomatic passengers were released into the general Canadian population.

Bureaucrats warn against mandatory quarantines

On Feb. 7, the government started recommending that inbound Hubei passengers start to voluntarily self-isolate for 14 days to prevent transmission.

In an undated memo to Hajdu sent in mid-February, department officials warned that Canadians may question the effectiveness of “voluntary” self-isolation measures for these travellers.

But the memo says “there is no ability to enforce or ensure compliance” with a mandatory isolation order without the use of the Quarantine Act — a measure the government would end up enacting weeks later.

The memo said it was best to leave all self-isolation measures as voluntary to ensure there is “less pressure on public health resources.”

The memo said public health officials didn’t have the capacity required to quarantine passengers from China; 20,000 such travellers were arriving in Canada each week at the time.

The Public Health Agency scrubbed any references to China in pamphlets disseminated to returning travelers starting on Feb. 24, after it was clear that there was community spread of COVID-19 in countries like Iran and Italy.

I think we’ve seen countries around the world caught off guard by the nature of this epidemic.– Prime Minister Justin Trudeau

Calls between Hajdu and her provincial and territorial counterparts later in February focused on quarantine facilities for returning Hubei and cruise ship travellers in Trenton and Belleville, but said little about how the various jurisdictions would respond if COVID-19 escalated.

According to briefing notes for a Feb. 10 call, Hajdu said that while the country was in a “containment phase, we cannot ignore what comes next.”

The note states that the Public Health Agency of Canada was “doing advanced thinking and scenario analysis, including a pandemic scenario,” but it’s not clear if those scenarios were actually discussed with provinces and territories on that call.

The pandemic has made N95 masks rare and coveted objects. (Michael Wilson/CBC)

Health Canada expected Hajdu would be pressed by the provinces about the supply of personal protective equipment (PPE) on the call. The department told her then there were ongoing “attempts” to secure devices like N95 and surgical masks for the national stockpile but “deliveries were staggered by industry due to mounting market pressures.”

It said it had procured only a “modest” amount of the masks — items that would be badly needed a month later.

By Feb. 26, when there were 78,000 COVID-19 cases in mainland China, public health officials continued to counsel Hajdu that “the public health risk within Canada remains low.” A month later, there would be 1,000 cases in Ontario alone.

Even after the number of suspected COVID-19 cases in Canada started to rise by mid-February, Canada’s National Microbiology Laboratory in Winnipeg did very few tests, with most of them reserved for travellers from China. It is now understood there was widespread transmission of the disease in Europe and in some U.S. hotspots like New York by this time.

By Feb. 17, the national lab had run only 461 tests — a marginal increase from the 367 tests run the week before.

By Feb. 25, Ontario and B.C. had provincial labs ready to test but the other provinces were still relying on sending samples to Winnipeg — a cumbersome process that made it difficult to identify and isolate cases in the other provinces early on.

Countries ‘caught off guard’: Trudeau

When asked Thursday what went wrong in the government’s COVID-19 planning, Trudeau said there will be time for reflection at a later date. He said he was confident the government made the “best decisions” with “the information we have.”

“I think we’ve seen countries around the world caught off guard by the nature of this epidemic,” he said. “The challenges we faced in terms of getting Canadians protected are echoed in challenges faced around the world.

Watch: Trudeau warns Canadians need to remain vigilant

Prime Minister Justin Trudeau said normal life for Canadians will not return until a COVID-19 vaccine is developed 2:32

“I think Canada has done a good job of keeping on a path that is going to minimize as much as possible the reality we’re in right now. As we look back at the end of this, I’m sure people will say, ‘You could have done this a few days before.'”

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CBC | Health News

Coronavirus: Cases in China slow dramatically as Italy begins nationwide travel ban

The latest:

Starkly illustrating the global east-to-west spread of the new coronavirus, Italy began an extraordinary, sweeping lockdown Tuesday while in China, the diminishing threat prompted the president to visit the epicentre and declare: “We will certainly defeat this epidemic.”

Chinese President Xi Jinping’s trip to the central city of Wuhan — his first since the start of the outbreak — was the latest sign that China is edging back toward normalcy after weeks of extreme quarantine measures. China reported just 19 new infections Tuesday, down from thousands each day last month.

The visit also was likely to be seen as an attempt to bolster views of the ruling Communist Party’s handling of the crisis. Xi was conspicuously absent from the public eye during the early days of the outbreak and alarms were not sounded until late January.

“Things are slowly returning to normal,” said Yang Tianxiao, a finance worker in Beijing, where the city government is gradually easing restrictions that kept many office workers at home.

Xi addressed patients and medical workers via a video link. He also strolled through an apartment complex where residents are still quarantined.

“Wuhan must prevail, Hubei must prevail, all of China must prevail,” Xi said.

A discharged COVID-19 patient carries luggage while departing Wuchang Fang Cang makeshift hospital, which is the latest temporary hospital being shut down in Wuhan, China’s Hubei province. (Getty Images)

With patient numbers falling, Wuhan closed the last of 16 temporary hospitals used mainly to house those with mild symptoms.

Authorities in Hubei province, where Wuhan is located, stepped up preparations for resuming business production, reopened some roads to restore agricultural production and announced the launch of a colour-coded app-based system that will allow people who are deemed healthy to travel freely within the province.

But disruptions spread elsewhere, upending life in Italy in particular.

Travel restrictions previously limited to the country’s north were extended everywhere. Teams of Italian police patrolled cafes to make sure owners were keeping customers one metre apart. The streets of the Italian capital were as quiet as they are during the annual mid-August vacation shutdown.

“We’re only at the beginning,” said Dr. Massimo Galli, head of infectious disease at Sacco Hospital in Milan, where people at the city’s main train station were required to sign forms certifying the necessity of their travel.

For most people, the new coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia.

The World Health Organization says people with mild illness recover in about two weeks, while severe cases may last three to six weeks. In mainland China, where the outbreak emerged in December, almost three-quarters of its more than 80,000 patients have recovered. 

But with more than 110,000 cases in reported  in countries around the world, WHO and local health officials are emphaszing the importance of educating the public about how to avoid infection, and preparing health systems to deal with a surge in cases.

Here’s a look at what’s happening in Canada, the U.S. and some of the hard-hit regions around the world.

Here’s what’s happening in Canada

A flight carrying Canadians who were aboard the Grand Princess cruise ship landed at CFB Trenton early Tuesday morning. The chartered plane, which departed from California, ferried the Canadian travellers to Ontario, where they will complete a 14-day quarantine period. 

Speaking after the plane landed in Canada on Tuesday, Foreign Affairs Minister François-Philippe Champagne said 228 people were on the flight. He said a “limited number” of people who had other medical conditions that are not related to COVID-19 will stay behind to be treated in California.

Champagne said there are also some Canadian crew who were on the Grand Princess who tested positive for COVID-19 who will stay in the U.S. for treatment. He did not specify how many Canadians tested positive.

Some of the Canadians who were aboard a cruise ship off the coast of California have arrived in Ontario and will spend 14 days in quarantine. 4:51

Officials had previously said there were 237 Canadians among the 3,500 passengers and crew on board the Grand Princess cruise ship.

The repatriated travellers arrived a day after Canada reported its first COVID-19 related death. A man in his 80s who lived at a long-term care facility in B.C. died on Monday, provincial health officials said.

Ontario health officials announced on Tuesday a new case of the novel coronavirus — a man in his 40s who had travelled to Switzerland. 

As of 11 a.m. ET on Tuesday, 80 presumptive and confirmed COVID-19 cases had been reported in Canada, including:

Dr. Theresa Tam, Canada’s chief public health officer, reiterated on Monday that the risk from the coronavirus to the general population in Canada is low, but she cautioned that the situation could change rapidly. 

“We are most concerned for Canada’s vulnerable populations,” Tam said.

Federal Health Minister Patty Hajdu said some provinces have indicated they don’t have all the supplies they might need to respond to COVID-19 cases.

“We are gathering that information — and we have said all along that we will be there as a federal government to support them with the resources they need, whether those are financial resources or practical resources.”

Here’s what’s happening in the U.S.

Fear has been rising in the United States, where more than 750 people are infected and even some top political leaders were quarantined.

President Donald Trump was planning to announce proposals Tuesday aimed at curbing the economic fallout from the outbreak. He said the measures would include payroll tax relief.

WATCH: Weighing the risks of mass gatherings during the coronavirus outbreak

A look at what risks are taken into consideration when deciding where a mass gathering, like a conference, is cancelled. 1:59

After days of questioning about testing capacity, the director of the U.S. Centers for Disease Control and Prevention (CDC) said Tuesday that about 4,900 people have been tested for the coronavirus in U.S. labs as of Monday. That number does not include Americans who have been tested in clinical or private labs, Robert Redfield said. 

Redfield said that as of Monday, private companies Laboratory Corp of America and Quest Diagnostics have enough coronavirus tests available that any U.S. doctor’s office who uses those companies can have their patients tested.

People living in the U.S. also got some information on how private insurance companies will respond to COVID-19. Speaking at a White House meeting with insurance company executives, Vice-President Mike Pence said the companies have agreed to cover coronavirus treatment and waive co-payment fees for coronavirus testing

The companies have also agreed to cover telemedicine for patients to get care without having to leave home, Pence added. 

Here’s what’s happening in Italy and Europe

The Italian government is assuring its citizens that supermarkets will remain open and stocked after panic buying erupted after broad anti-virus measures were announced nationwide, sparking overnight runs on 24-hour markets.

Some 9,172 people were infected in Italy and 463 have died, and there was a growing sense the numbers would only worsen.

Shoppers lined up overnight outside a Rome Carrefour to stock up after the government extended restrictions on movement from hard-hit northern Italy to the rest of the country. Some shoppers wore masks as they waited with their carts to be allowed into the store a few at a time.

Premier Giuseppe Conte’s office issued a clarifying statement after he signed the new decree late Monday, stressing that movement outside homes for “normal necessities” such as grocery shopping will be allowed, as well as for work or health reasons.

WATCH: Canadian describes life under lockdown in northern Italy

Don’t panic and stay calm, says Canadian living under virus lockdown in Italy. 6:15

The statement said runs on supermarkets were contrary to the intent of the new decree, which aims to prevent Italians from congregating. The government assured citizens that markets would be regularly supplied.

However, hard-hit Italy got a reminder that most patients ultimately recover from the illness: a 38-year-old man who was Italy’s first coronavirus patient was moved out of intensive care for the first time since testing positive.

In France, the death toll from COVID-19 has risen to 30. Poland, which is reporting 17 cases, moved to cancel all mass events. The number of people testing positive for coronavirus in the U.K. has risen to 373, up from 319 the day before, health officials said on Tuesday.

Earlier, the health ministry said a sixth person had died in Britain after acquiring the virus.

The Czech Republic, which has 40 confirmed cases, is banning all public events with more than 100 people and is closing schools.

Austria is introducing border checks and will deny entry to people arriving from Italy, Chancellor Sebastian Kurz said on Tuesday.

Here’s what’s happening in Iran and the Middle East

Iran said Tuesday the coronavirus has killed 54 more people, raising the death toll to 291 amid 8,042 reported cases in the Islamic Republic. Many experts fear the scope of the illness there is far wider than reported.

Lebanon recorded its first death from coronavirus on Tuesday, local broadcasters said, adding that the patient had been in quarantine since returning from Egypt. The government has halted flights for non-residents from epicentres of the virus, shut schools and warned against public gatherings as the total number of cases rose to 41 this week.

Here’s what’s happening in South Korea and Japan

A downward trend in new coronavirus cases in South Korea raised hope on Tuesday that Asia’s biggest outbreak outside China may be slowing, but officials urged vigilance with new clusters of infections emerging from a call centre and a dance class. The Korea Centers for Disease Control and Prevention (KCDC) reported 35 new coronavirus cases, down from a peak of 909 on Feb. 29.

The new figures brought the national tally to 7,513, while the death toll rose by eight to 59. The fall in the daily tally of new infections to its lowest level in 11 days coincided with the completion of testing of most of the roughly 200,000 followers of a fringe Christian church at the centre of South Korea’s epidemic.

Workers at a building where 46 people were confirmed to have COVID-19 wait in line for a coronavirus test at a temporary facility in Seoul on Tuesday. (Jung Yeon-Je/AFP/Getty Images)

Yoon Tae-ho, director general for public health policy at the health ministry, urged businesses to do what they could to help stem the outbreak after the discovery of 64 new cases among call-centre workers and their relatives. “The rate of increase is declining but there are still many new cases,” Yoon told a briefing.

The vast majority of South Korea’s cases have been in the southeastern city of Daegu, where the church at the centre of the outbreak is based, and the nearby province of North Gyeongsang. But alarm has been raised in the capital, Seoul, with the new cases there linked to the call centre, operated by an insurance company.

Japan, which has been dealing with both domestic patients and hundreds of people who were infected while living under quarantine on a cruise ship, passed an emergency bill that allows the prime minister to declare a state of emergency, if needed.

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CBC | Health News

Coronavirus: Italy locks down north in bid to slow spread of COVID-19

The latest:

  • WHO says more than 100 countries have reported lab-confirmed cases of COVID-19.
  • Stock markets tumble amid fears about the widening coronavirus outbreak.
  • Italy attempts to lock down north as cases rise to 7,375, with 366 deaths.
  • Canada’s chief public health officer recommends Canadians avoid cruise travel.
  • Read more about how Canada will cope with community transmission of COVID-19.

Italy took a page from China’s playbook over the weekend, attempting to lock down 16 million people — more than a quarter of its population — for nearly a month to halt the relentless march of the novel coronavirus across Europe.

Confusion still reigns in the country over who may go where and under what circumstances, after the government imposed strict new limits on travel in an effort to contain the rapidly spreading virus.

Travellers at Milan’s main train station were being required to sign a form from the police, self-certifying that they are travelling either for “proven work needs,” situations of necessity, health reasons, or to return to their homes. They must provide their identity documents and contact phone numbers, and describe exactly the reason for moving.

Police officers in masks were checking tickets and documents as people lined up to reach the train tracks, backed up by soldiers also in masks, and finally by railway security further back, unmasked. Procedures have tightened significantly since the blockade involving the populous region of Lombardy and 14 provinces went into effect.

After mass testing uncovered more than 7,300 infections, Italy now has registered more cases of the virus than any country but China, where the disease is in retreat. The death toll in the country rose to 366.

On Monday, the Italian government urged the European Union to adopt a package of measures to counter the impact of the coronavirus outbreak on the economies of the block.

Prime Minister Giuseppe Conte said Monday the government would further increase spending in a “massive shock  therapy” to offset the economic impact of the epidemic.

Around the globe, more and more events were cancelled or hidden behind closed doors, from the Pope’s Sunday service to a Formula One car race in Bahrain to a sumo competition in Japan, where wrestlers arrived at the arena in face masks and were required to use hand sanitizer before entering.

Here’s a look at what’s happening in Canada, the U.S. and hard-hit regions around the world.

Here’s what’s happening in Canada

Dr. Theresa Tam, Canada’s chief public health officer, said there now more than 110,000 confirmed cases worldwide, and 72 confirmed and presumptive cases in Canada.

Speaking alongside the health and foreign affairs ministers on Monday, Tam recommended that Canadians avoid travelling on cruise ships.

Case numbers have been increasing in Canada, with most in Ontario and B.C., followed by Alberta and Quebec.

Ontario’s health ministry has reported 34 cases, the most in any Canadian province. 

Quebec has reported four confirmed and presumptive cases. The most recent patient — reported in the Montérégie region, southeast of Montreal — had recently returned from a cruise, officials said. 

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Alberta on Monday reported seven cases, while B.C. has reported 27 cases.

“We’ve seen the progression around the world, we’ve seen what’s happened in other communities, and we’re preparing as best we can for that,” Dr. Bonnie Henry, B.C.’s public health officer, said over the weekend.

The Public Health Agency of Canada, which assesses the risk around COVID-19, says the risk in Canada is low.

Here’s what’s happening in the U.S.

In the United States, where more than 500 infections have been reported, attention was fixed Monday on cruise ships on opposite sides of the country that were kept at bay over fears of virus threats.

The Grand Princess cruise ship, which has at least 21 confirmed virus cases, was expected to dock in Oakland, California, amid elaborate anti-coronavirus protective procedures. Fleets of buses and planes were ready to whisk the more than 2,000 passengers to military bases or their home countries for a 14-day quarantine.

Canadians on the Grand Princess will be repatriated to Canada, where they will undergo a 14-day quarantine.

In Florida, passengers were disembarking from the Regal Princess after it received clearance to dock. Two crew members eyed as possible carriers had negative tests for the virus.

Trading in Wall Street futures was halted for the first time since the 2016 U.S. presidential election after they fell more than the daily limit of five per cent. Bond yields hit new lows as investors bought them up as safe havens.

The benchmark U.S. crude price was down over 20 per cent, the biggest daily drop since the Gulf war in 1991, to hit their lowest levels since 2016. They were down as much as 30 per cent earlier, deepening a rout that began when Saudi Arabia, Russia and other major producers failed to agree on cutting output to prop up prices. A breakdown in their co-operation suggested they will ramp up output just as demand is sliding.

Here’s what’s happening in Iran and the Middle East

State television in Iran said the virus had killed another 43 people, pushing the official toll up to 237 with 7,161 confirmed cases. But many fear the scope of illness is far wider there.

The new virus has caused major economic disruptions, including in global aviation, which has helped slow demand for oil. An OPEC meeting with Russia last week failed to see countries agree to a production cut. In response, Saudi Arabia has warned it will increase its production and slash its own prices to claw back market share.

Saudi Arabia closed off air and sea travel to nine countries affected by the novel coronavirus Monday as Mideast stock markets tumbled over fears about the widening outbreak’s effect on the global economy.

Qatar announced on Monday it was suspending schools and universities from Tuesday, March 10, to control the coronavirus outbreak, according to the state news agency.

Iran has released approximately 70,000 prisoners because of the coronavirus outbreak in the country, Iranian judiciary chief Ebrahim Raisi said on Monday, according to Mizan, the news site of the judiciary.

Here’s what’s happening in Europe

European Union leaders will hold emergency talks soon to discuss a joint response to the coronavirus, officials said on Monday, as the bloc’s executive considers relaxing state subsidy rules to allow extra public spending. The announcement of the teleconference, likely to take place on Tuesday, came after Italy and France called for Europe-wide stimulus to counter the economic impact of the epidemic.

France has reported 1,191 cases with 21 deaths.The number of people infected in the Netherlands increased to 321 on Monday, up from 264 a day earlier, Dutch health authorities said.

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Germany on Monday reported 210 new confirmed cases of the coronavirus, the Robert Koch Institute said.The number of cases in Germany rose to 1,112, up from 902 reported on Sunday.

Chancellor Angela Merkel has warned against thinking that measures to slow the spread of the new coronavirus are in vain, insisting that they are buying “valuable time.”

In the U.K., the number of confirmed cases stood at 319 on Monday.

Schools and universities in the Basque capital Vitoria will close for two weeks, sending tens of thousands of pupils home, authorities in the region said on Monday as the coronavirus spread in Spain. With nearly 150 confirmed cases, the Basque Country in northern Spain is among the worst-hit areas in the country, which has a total of 999 cases.

Here’s what’s happening in Japan and South Korea

In South Korea, officials reported 165 new coronavirus cases, bringing the national tally to 7,478, while the death toll rose by one to 51. The numbers showed the rate of increase in new infections fell to its lowest level in 11 days in one of the most severely affected countries outside mainland China.

South Korean soldiers prepare to do work at an apartment complex that is under isolation amid mass infection of coronavirus disease reported in Daegu, South Korea. (Kim Kyung-Hoon/Reuters)

A Japan Airlines Co Ltd. cabin attendant has tested positive for coronavirus, the airline said on Monday, the latest case in what has become a widening outbreak for Japan.

The infection comes after local media reported that one person in Kanagawa prefecture had died from the virus, bringing the country’s death toll so far to 15, including seven from the quarantined cruise ship near Tokyo.

Here’s what’s happening in China

Mainland China, outside Hubei province, reported no new locally transmitted cases for the second straight day, as a senior Communist Party official warned against reducing vigilance against the disease and of the risk to social stability.

“We must stay cautious, not be blindly optimistic and must not have war-weariness…,” said Chen Yixin, secretary general of the Communist Party’s Politics and Law Commission.

“We should not reduce the vigilance against the epidemic and the requirements of prevention and control.”

China had 40 new confirmed cases of coronavirus infections on Sunday, the National Health Commission said on Monday, down from 44 cases a day earlier, and the lowest number since the health authority started publishing nationwide data on Jan. 20.

Of the new cases on Sunday, 36 were new infections in Wuhan, the provincial capital of Hubei, while the remaining four in Gansu province were imported from Iran.

The total number of imported cases hit 67, including the four Gansu cases.

Here’s a look at some other areas of concern around the world

A government worker disinfects a high school in Manila on Monday amid concerns about the spread of COVID-19. (Maria Tan/AFP/Getty Images)

  • The Philippine president has declared a state of public health emergency throughout the country after health officials confirmed over the weekend the first local transmission of the novel coronavirus.
  • Nigeria has a second confirmed coronavirus case, the country’s health minister said on Twitter on Monday. The first case was an Italian man who travelled to the southwestern state of Ogun.
  • Singapore will allow the Costa Fortuna cruise ship to dock on Tuesday, after it was rejected by Thailand and Malaysia.
  • Indonesia says the number of confirmed cases of people infected with the coronavirus had risen by 13, including 11 Indonesians and two foreigners, taking the total number of cases to 19 in the Southeast Asian country.
  • A special North Korean flight believed to be carrying dozens of diplomats and other foreigners has arrived in Russia’s Far East as the country tightens its lockdown to fend off the coronavirus. North Korea has not publicly confirmed a single case of the COVID-19 illness, but its state media have indicated thousands of people have been quarantined. North Korea lifted a month-long quarantine on foreign diplomats last week, allowing them to leave the country if needed.

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‘Start low and go slow’: New cannabis products could put party hosts at risk of liability

The holidays are here, meaning Canadians will be celebrating with family, taking some much deserved time off and gearing up for the new year. 

It’s also, coincidentally, when new cannabis products will be trickling onto the market. 

Edibles, beverages, vapes and topicals – such as lotions – became legal for sale in Canada on Dec. 17, but they all have different intoxicating effects. 

They also have wide ranging levels of potency, depending on whether you’re eating a cookie or vaping. 

And if you’re hosting a party you could be at risk of significant legal liability if you’re not careful, so experts have provided some tips to navigate this uncharted territory.

Uncharted territory

While no cases have yet been tested in court, legal experts say they expect cannabis liability to be similar to that of alcohol when it comes to impaired driving or injury in the home. 

“The way that it relates to alcohol is that it’s the person who’s hosting the party, it’s their responsibility to make sure that they’re monitoring everyone’s actions at the party,” said Harrison Cooper, an associate lawyer at Ontario personal injury law firm Oatley Vigmond. 

“And making sure that their guests aren’t going to do something stupid like get behind the wheel of a car when they’ve had too much to drink.” 

Cooper said the same obligation would exist with cannabis, but the issue is that while the use of alcohol is predictable for most people, cannabis use may not be.

If a host were to provide cannabis edibles to guests and someone had a “bad outcome,” Cooper said they could potentially be more liable than if someone brought their own to the party and used them there. 

“This adds a whole new layer of complexity,” said Brett Stephenson, a partner at Vancouver-based specialty insurance law firm Dolden Wallace Folick LLP. 

“How do you know what has been consumed either before or after someone’s been to your house? And how are these products interacting together? I think that’s the biggest concern.” 

Mixing alcohol and cannabis could create an entirely new area of legal exposure because of the uncertainty around how the substances interact in the body. (Justin Sullivan/Getty Images)

Stephenson said the mixing of alcohol and cannabis creates an entirely new area of legal exposure because of the uncertainty around how impaired a user can get when taking both.

Little research has been done on the effects of combining the two substances, but a 2015 study in the journal Clinical Chemistry found users had significantly higher amounts of THC in their blood after using both. THC the main psychoactive ingredient in marijuana. 

Last year, a decision came out of the Ontario Court of Appeal that Stephenson said anyone hosting parties over the holidays should be aware of. 

An Ontario man was killed in October 2011 after he drank heavily with a friend, walked home, then drove impaired and crashed his car.

The court later found the homeowners could be liable for damages because they breached a duty of care as hosts.

“This found that social host liability can arise even after one’s guest has arrived home safely,” Stephenson said. 

“So that’s a major concern that I don’t think most homeowners are aware of.”

‘Start low and go slow’

Robert Gabrys, a research and policy analyst at the Canadian Centre on Substance Abuse and Addiction (CCSA), recommends people start off with low doses when it comes to cannabis. 

“Start low and go slow,” he said. “It does affect everybody differently and it’s hard to predict.” 

When it comes to THC, Gabrys recommends starting off with about 2.5 mg per product. 

While sales of edible products only became legal recently, there has been nothing to prevent people from buying legal cannabis and making their own. (Chris Young/The Canadian Press)

Edibles can take quite a bit of time to kick in, up to two to four hours in some cases, but the effects can last much longer – up to 12 hours for psychoactive effects and 24 hours for symptoms such as drowsiness. 

“Currently, there aren’t any specific time frames that are recommended for how long you should wait after consuming an edible,” he said. 

“One thing we always sort of say is just to clear your schedule for pretty much like an entire day.” 

Cannabis beverages have a similar effect, but the onset of symptoms can happen much quicker – in some cases about 30 minutes after drinking. 

“If you’re expecting your cannabis beverage to give you the exact same feeling or the exact same onset [as alcohol] and then you keep consuming it expecting it to be like alcohol – the result is not going to be all that fun,” said Abi Roach, the executive chair of NORML Canada and owner of the HotBox Cafe in Toronto. 

“You have to educate yourself. Different products have different strength onsets, and different reactions with your body.” 

Abi Roach has operated her cannabis lounge in Toronto’s Kensington Market for nearly 20 years. She urges new users to be cautious when trying new products. (Evan Mitsui/CBC)

Roach recommends researching brands, potencies and asking questions of suppliers so you don’t put yourself at risk of over-intoxication. 

“It’s very, very important that if you’re having a party and you’re serving edibles please find out what the actual onset effect is expected and maybe just put it on a little card by the item that you’re serving,” she said. 

The federal government has set strict packaging guidelines for edibles and beverages, with a limit of 10 mg of THC per package. 

But that’s considered a low dose for experienced users, and Roach said she is concerned that could mean high sugar content and added calories. 

“If you need to dose 100mg, you have to eat 10 units essentially to get one dose,” she said.

Topicals are another type of product where Roach believes there has been a “missed conversation,” largely because they doesn’t necessarily allow THC to enter the bloodstream. 

“Topicals work very, very differently. Even if they’re high THC, you’ll never really get ‘high’ from a topical,” she said. 

“It’s actually a wellness product. It should be sold over the counter in pharmacies.”

Vaping brings its own concerns

The release of cannabis vaping products comes amid an outbreak of vaping-associated lung illnesses across North America involving cannabis vapes and nicotine e-cigarettes

As of Dec. 10, 2,409 cases, including 52 deaths, have been reported to the U.S. Centers for Disease Control (CDC) in all 50 states this year. 

There have been 14 cases of vaping-associated lung illness reported to the Public Health Agency of Canada as of Dec. 10. Three occurred in British Columbia, two in New Brunswick, four in Ontario, and five in Quebec.

Health Canada has said it’s preparing to test the health effects of inhaling substances emitted from cannabis vapes, but the long term health effects of the devices are unknown. (Steve Helber/The Associated Press)

An additive called vitamin E acetate has been blamed for the majority of cases in the U.S., but little is known about the long-term health effects of vaping overall.

Health Canada has said it’s preparing to test the health effects of inhaling substances emitted from cannabis vapes, but did not do so prior to them being legally available.

The products are much more potent than anything else on the market, with a maximum THC amount up to 1,000 mg per package (a gram of dry cannabis has about 100 mg of THC).

The overall message is that we just don’t know, so people have to be careful,” said Gabrys at the CCSA. 

“There is a risk that you’re taking by by using these products – they’re not harmless.”

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