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Immunization committee to recommend provinces stop giving AstraZeneca vaccine to those under 55: sources

Canada’s National Advisory Committee on Immunization (NACI) is expected to recommend today a pause in the use of the AstraZeneca-Oxford COVID-19 vaccine on those under the age of 55 because of safety concerns, sources told CBC News.

The updated guidelines will be issued later today, according to sources who spoke on the condition of anonymity. The expected change comes following reports of rare blood clots in some immunized patients.

Canada is expected to receive 1.5 million doses of this product from the U.S. on Tuesday.

Officials from NACI will provide an update to reporters at 3:10 p.m. ET. CBCNews.ca will carry the remarks live.

Meanwhile, Health Canada — which approved the vaccine for use in Canada in February — said its regulators would be adding “additional terms and conditions on the authorizations” for AstraZeneca and a biologically identical version of the drug manufactured by the Serum Institute of India, which has been branded Covishield.

The manufacturers will be required to conduct a “detailed assessment of the benefits and risks of the vaccine by age and sex in the Canadian context,” information that could lead to “additional regulatory actions.”

“This information will support the ongoing evaluation of these rare blood clotting events, and allow Health Canada to determine if there are specific groups of people who may be at higher risk,” the department said in a press release.

The AstraZeneca shot has not been widely used in people under the age of 55 in this country. Some jurisdictions, such as P.E.I., have been using some of their supply to immunize young people who work in public-facing sectors like grocery and convenience stores. In New Brunswick, the shot was made available to first responders and some teachers last week. 

A spokesperson for P.E.I.’s health department confirmed use of the vaccine had been suspended for those 18 to 29 years of age.

Speaking to reporters in Niagara Falls, Ont., Ontario Premier Doug Ford said today that the province would follow NACI’s guidance and reserve the current supply of AstraZeneca for those in the older cohort.

He said there have been reports of blood clots in younger women in other places.

“I won’t hesitate to cancel that in half a heartbeat. If it’s going to put anyone in harm, we just won’t use it, simple as that,” he said, adding he didn’t want to “roll the dice” by using AstraZeneca on a group that may have an outsized chance of developing complications.

“The guidance from the federal government is that it is safe for people over 55,” Ford said. “I’m talking about younger people taking it, 35 years of age and in that range, that’s where the problem is.”

After a review, the European Union’s drug watchdog, the European Medicines Agency, found the vaccine is not linked to an increase in the overall risk of blood clots.

The EMA said, however, that it could not definitively rule out a link between the vaccine and rare types of blood clots associated with thrombocytopenia, or low levels of blood platelets.

Specifically, it pointed to 18 cases of an extremely rare type of blood clot called cerebral venous sinus thrombosis (CVST), a condition that is much more common in women than men. Most of the cases occurred within 14 days of receiving the AstraZeneca shot, and the majority were in women under the age of 55.

Dr. Joss Reimer, the medical lead on Manitoba’s vaccine implementation task force, said that the province also would pause its deployment of the vaccine among people under 55 because of a “very rare subtype, one specific type of blood clot.”

She said that while there have been no complications reported in Canada, “out of an abundance of caution” Manitoba will restrict the shot to people 55 to 64, for now.

Reimer said it’s not known yet how common this rare blood clot side effect is but early data out of Europe suggest it could be an outcome for 1 out of 100,000 AstraZeneca shots deployed, or even more than that — the science isn’t settled, she said.

“This is a pause while we wait for more information to better understand what’s happened in Europe. This is an important and evidence-based change,” she said, adding this sort of shift is a testament to Canada’s robust vaccine monitoring system.

Reimer said it’s “probably” fine to use the vaccine on all groups — but she’s not comfortable with just “probably” and wants to wait to see more data from Europe.

Last week, the Public Health Agency of Canada said it’s “possible” the vaccine may be associated with “very rare but serious cases of blood clots associated with thrombocytopenia.” Health Canada has maintained that the benefits of the AstraZeneca COVID-19 vaccine continue to outweigh the risks.

Health Canada has said it is aware that researchers in Europe have indicated that they have identified a possible cause for these very rare events, but says little information is available about the findings.

“We have been discussing the rare reports of blood clots and low platelet counts with the European Medicines Agency and other regulators,” Dr. Supriya Sharma, Canada’s chief medical adviser, said on Thursday. “Health Canada will make decisions for Canada based on the science and evidence.

“This is just the latest issue the company has faced over the last three months.

Earlier this year, a number of European countries halted vaccinations in response to questions about the AstraZeneca product’s efficacy in people over the age of 65, only to restart them after new evidence emerged.

After Health Canada approved the shot for all adults, NACI recommended the product be used only on people under the age of 65, citing a dearth of clinical trial data on the vaccine’s effectiveness in older people.

NACI changed course earlier this month after reviewing three “real-world studies,” saying the two-dose viral vector vaccine can and should be used on seniors.

Last week, the U.S. Data and Safety Monitoring Board (DSMB), which keeps an eye on clinical trials, found “outdated information” may have been reported by the company when it released data on U.S. trials. 

Dr. Anthony Fauci, U.S. President Joe Biden’s chief medical adviser and the head of the NIAID, said the monitoring board was surprised by the the better-than-expected efficacy results published by AstraZeneca.

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CBC | Health News

Ontario records 1,699 new COVID-19 cases as vaccine bookings start for those 75 and older

Ontario reported 1,699 new cases of COVID-19 Monday, as the province’s vaccination rollout expands.

Health Minster Christine Elliott said there were 500 new cases found in Toronto, as well as 318 in Peel, 155 in York Region and 114 in Hamilton. The seven-day average, which smooths out peaks and valleys in the data, now stands at 1,600.

Those cases come with around 31,100 tests completed, which is well below the province’s capacity. Testing numbers usually dip over the weekend, before rising later in the week.

The province is reporting three new deaths of people with COVID-19, as well as 1,175 cases that have been marked as resolved. The death toll for the pandemic now stands at 7,244.

There are 813 people in hospital, up from 765 the day before — and that’s with the caveat of that figure being typically underreported on weekends.

There are also 298 people in intensive care, and 186 of those are on a ventilator, the province says. That’s down slightly from 302 and 189 the day before, respectively.

As of 8 p.m. Sunday, the province had administered just over 1.5 million vaccine doses, Elliott said. There were 31,335 vaccines administered Sunday, with 299,297 now fully vaccinated.

At a news conference Monday afternoon, Premier Doug Ford said the province is making “tremendous progress” on its vaccine plans, and lauded the work of front-line health-care workers.

“We’re so grateful to them for the vital role they’ve been playing in the fight against this virus,” he said. 

The premier once again pushed the federal government to provide more vaccine doses, saying Ontario needs a steadier supply.

“We’re at a fraction of our capacity. We need more vaccines,” he said.

Ontario’s test positivity rate now 5.4%, top doctors say

Dr. David Williams, the province’s chief medical officer of health, said on Monday that the number of new cases daily, the test positivity rate and the percentage of new cases that are variants of concern are all on the increase in Ontario.

“We’re in the third wave. The numbers are slowly going up. They’re not going as fast as predicted by the modellers, and that’s to your credit. But … it’s still going up,” Williams told reporters at a provincial update.

“We’re not doubling, but we’re going up continually with our variants of concern and we’re now starting to see impacts on our hospital rates. That dip down to where we had hoped to get to, we didn’t get to, and now it’s picking back up again.”

Since its last update on Thursday, Ontario is reporting 7,064 more cases of COVID-19, according to Dr. Barbara Yaffe, the province’s associate medical officer of health. 

Ontario’s seven-day average for daily cases, which now stands at 1,600, is an increase from 1,350 last week and 1,155 two weeks ago, Yaffe said. The province is also reporting an additional 42 deaths since Thursday. 

A total of 31,089 tests have been completed as of Monday and the test positivity rate is 5.4 per cent, marking the first time since Feb. 1 that the test positivity rate is above five per cent, she said.

The average test positivity rate over the last seven days is 3.9 per cent, an increase from three per cent from the same time period last week.

Dr. Barbara Yaffe and Dr. David Williams speak during a provincial update. ‘We’re in the third wave. The numbers are slowly going up,’ Williams said on Monday. (Evan Mitsui/CBC)

Ontario reporting 1,424 cases of variants of concern

Ontario is reporting a total of 1,424 confirmed cases of variants of concern on Monday.

Of this number, 1,340 are of the B117 variant first identified in the United Kingdom, 48 are of the B1351 variant, first identified in South Africa, and 36 of the P1 variant, first identified in Brazil.

A mutation has been detected in a total of 13,226 samples, but the lineage has not yet been determined, Yaffe said. 

The seven-day rolling average positivity rate for variants of concern is 46.4 per cent, an increase from 37.9 per cent a week ago, she added.

Other public health units that saw double-digit case increases of COVID-19 were:

  • Ottawa: 85
  • Durham: 79
  • Simcoe Muskoka: 64
  • Halton: 57
  • Lambton: 42
  • Eastern Ontario Health Unit: 39
  • Sudbury: 34
  • Waterloo: 31
  • Niagara: 24
  • Thunder Bay: 16
  • Windsor-Essex: 16
  • Brant County: 15
  • Wellington-Dufferin-Guelph: 14
  • Kingston, Frontenac and Lennox & Addington Public Health: 13
  • Leeds, Grenville & Lanark District Health Unit: 12
  • Southwestern Public Health: 11
  • Middlesex-London: 11
  • Chatham-Kent: 10

(Note: All of the figures used in this story are found on the Ministry of Health’s COVID-19 dashboard or in its Daily Epidemiologic Summary. The number of cases for any region may differ from what is reported by the local public health unit on a given day, because local units report figures at different times.)

Meanwhile, Ontario residents who are 75 or older can start booking their COVID-19 vaccines through the government’s online system starting today.

People in that age group were initially set to become eligible by the first week of April, but the province announced last week it was moving up the date, saying vaccinations are ahead of schedule.

Similarly, York Region has announced that it is now offering vaccine appointments for residents 70 and over, who were born in 1951 and earlier, effective March 23.

Also starting today, certain pharmacies and family physicians in some regions will be allowed to administer the Oxford-AstraZeneca shot to anyone 60 or older.

Ford said Monday that the province plans to expand that pilot project, with a focus on Peel Region and Toronto.

“We’re going to double the amount of pharmacies up to 750,” Ford said.

A number of regions are also moving to different restriction levels in the province’s colour-coded pandemic framework Monday.

The Brant, Chatham-Kent and Leeds, Grenville and Lanark regions are now in the red zone — the second-most restrictive.

Wellington-Dufferin-Guelph is now in orange, and four others — Timiskaming, Porcupine, North Bay Parry Sound and Kingston, Frontenac and Lennox & Addington — are in yellow.

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CBC | Health News

Canada will recommend AstraZeneca-Oxford vaccine for those over 65, documents show

Canada will change its guidelines on the AstraZeneca-Oxford COVID-19 vaccine and recommend it be given to those over age 65, according to documents obtained by CBC News and sources with direct knowledge of the guidelines.

The National Advisory Committee on Immunization (NACI) previously recommended Canadians over 65 not receive an AstraZeneca-Oxford shot earlier this month, despite emerging evidence from around the world demonstrating its ability to prevent severe COVID-19 in older adults.

But the NACI recommendations were based largely on AstraZeneca-Oxford’s clinical trial data and didn’t examine real-world evidence past Dec. 7 — months before the effectiveness of the vaccine was fully realized in other countries for older age groups.

Those recommendations led provinces to reorganize their vaccination plans for seniors and meant those aged 60-64 could receive the shots ahead of older age groups, who are at greater risk of hospitalization and death from COVID-19.

Sources with firsthand knowledge of the new recommendations confirmed to CBC News that NACI plans to update its guidelines on the vaccine Tuesday. 

Documents obtained by CBC News — marked “final” and dated Tuesday, but which may be subject to change — show the decision is based on emerging real-world data from other countries. The recommendations also state that mRNA vaccines, such as those from Pfizer-BioNTech and Moderna, will still be “prioritized” for older age groups. 

“Following this careful review, NACI decided to expand recommendations for the use of the AstraZeneca-Oxford vaccine to include those 65 years of age and over,” the documents read. 

Pharmacist Abraam Rafael administers a COVID-19 vaccine to Maureen Doyle at his pharmacy in Toronto on Sunday. (Cole Burston/The Canadian Press)

The documents state real-world data of vaccine effectiveness — for those over 65 who received one dose of AstraZeneca’s — saw a “reduction in the risk of symptomatic disease and hospitalization” that appeared to reach a “comparable level” to those aged 18 to 64.

CBC News reached out to representatives from NACI, Health Canada and the Public Health Agency of Canada for comment but did not receive a response by publication time.

No evidence

Other countries such as France and Germany initially advised those 65 and older not to receive the shot, but overturned their decisions earlier this month after new evidence showed the vaccine significantly reduced hospitalizations in that age group.

But Germany followed other European countries like Denmark and Norway on Monday and suspended the use of the AstraZeneca-Oxford shot over reports of blood clotting in some recipients of the vaccine. Italy and France did the same. 

WATCH | Benefits outweigh risks with AstraZeneca vaccine, experts say:

Despite some European countries temporarily halting use of the AstraZeneca-Oxford vaccine after 30 cases of blood clots, experts maintain it is still safe to use in Canada. 2:01

AstraZeneca-Oxford said Sunday a “careful review” of all available safety data for more than 17 million people vaccinated in the European Union and the U.K. showed “no evidence of an increased risk” of blood clots. 

It’s unclear if NACI’s guidelines for the vaccine will change further in light of the blood clotting reports, but the documents make no mention of them and there is no evidence to suggest Canada will follow suit in suspending the use of the shot. 

Prime Minister Justin Trudeau said Monday the AstraZeneca-Oxford vaccine is safe and Canadians should have no concerns about receiving it.

Already hesitant

It’s unclear how the change in recommendations will affect provincial and territorial vaccine rollout plans, given that those aged 60-64 have already started receiving shots and continue to be booked for appointments. 

Quebec is the only province so far to ignore the national recommendations. Officials there said last week they would administer the AstraZeneca-Oxford vaccine to seniors.

Dr. Zain Chagla, an infectious diseases physician and medical director of infection control at St. Joseph’s Healthcare Hamilton, said the vaccine has already raised concerns from the public because the clinical trials underestimated its effectiveness, did not enroll enough people over 65 and lacked key data because few participants actually got infected with COVID-19. 

“People are already hesitant around this vaccine from that,” he said. “And even if you do get better data to support its use you now still have to fight against these three different streams of negativity towards this vaccine.” 

Dr. Nathan Stall, a geriatrician at Mount Sinai Hospital in Toronto, said issues with data from Scotland, regarding the effectiveness of the vaccine in older age groups, may have factored into NACI’s initial decision. 

“Overall, what has happened with the AstraZeneca vaccine has been very, very unfortunate from almost the get-go,” said Stall, who is a member of NACI but does not speak on behalf of the committee. “So many things, unfortunately, went wrong along the way.” 

Stall said the reported blood clotting also “reared its ugly head” at an extremely unfortunate time. 

“Then of course, people see a product that I think they perceive as inferior,” he said. “Secondly, [the initial shipment] expires on April 2, so people feel like this is sort of like this second rate product that’s imminently expiring that the government is trying to get rid of.” 

Stall said all of those factors combined have led to a “very, very understandable but unfortunate perception” that AstraZeneca-Oxford’s is somehow a “bad vaccine” — which simply isn’t true. 

WATCH | Blood clots likely unrelated to vaccine, epidemiologist says:

People who got blood clots after taking the AstraZeneca-Oxford COVID-19 vaccine probably would have gotten them anyway, says epidemiologist and cardiologist Dr. Christopher Labos. He says blood clots are a common ailment among people who are currently the focus of many vaccine programs. 4:01

“I do believe that probably when all is said and done, that the AstraZeneca vaccine is going to show similar real world efficacy in terms of preventing those outcomes we care most about, the hospitalizations and deaths, very comparably to the mRNA vaccines,” he said. 

Matthew Miller, an associate professor of infectious diseases and immunology at McMaster University in Hamilton, said the emergence of real-world data allows officials to continually assess how effective the vaccine is globally.

“That data is now very strongly suggesting that the vaccine is working in those older individuals, and is particularly good at preventing severe infection and hospitalization, which are ultimately the outcomes that are most important,” said Miller, who also works with NACI.

“What we don’t want to have happen is these individuals, especially those who belong to vulnerable demographics, becoming seriously ill, hospitalized and dying. Those are the things that stretch ICU capacity and so those are the outcomes of greatest concern.”

Chagla says clear, transparent communication from politicians and public health officials is needed in order to explain to Canadians why the change was made. 

“It wasn’t the fact that it was ineffective, it was the fact that there just wasn’t data — but there is now,” he said. 

“There is going to be a stigma done by this but at least if people have the right information to make an educated decision and feel like their public health officials are being open and transparent with them, it at least encourages people to make the decision that they need to.”

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CBC | Health News

Canada honours those who died of COVID-19 a year after pandemic declared

Canada’s political leaders today marked one year since COVID-19 was declared a global pandemic by remembering those who died and praising the health sector and other essential workers who have kept the country functioning during a worldwide public health crisis.

“It has been a tough year, a heartbreaking year. But it has been a year we have faced together,” Prime Minister Justin Trudeau said in a solemn speech before the House of Commons.

“And that is something we must never forget.”

Over 2.5 million people around the world have died from COVID-19, the deadly disease caused by the novel coronavirus that has disrupted social and economic life around the world. More than 22,000 people have died of the disease in Canada.

Earlier this week, Trudeau designated March 11 as a national day of observance — the one-year anniversary of the World Health Organization declaring COVID-19 a global pandemic.

Sacrifices, secondary impacts

Trudeau spoke of the sacrifices Canadians have made by staying apart from each other to prevent the spread of the virus, and the solidarity shown in the national effort to end the pandemic.

He spoke of essential workers stocking grocery store shelves, of people cheering health care workers from their balconies and of businesses mobilizing to produce personal protective equipment.

“A year ago, Canadians were asked to stay home and to stay safe. And yet even apart, or perhaps because we were apart, our communities became stronger and stronger,” he said.

Rising in the House after Trudeau, Conservative Leader Erin O’Toole focused part of his speech on the devastating impact COVID-19 has had on people who lost jobs, on businesses that lost income and on others who faced hardship from the secondary impacts of the pandemic.

“In B.C., there have been 60 per cent more deaths from the opioid epidemic than from COVID-19. Increasing rates of domestic violence have been the shadow pandemic this past year. Youth mental health issues, presenting as anxiety to eating disorders, are alarmingly on the rise,” said O’Toole. 

“The true cost of this pandemic on the lives and livelihoods of Canadians of all walks of life has been staggering.”

Crosses representing resident who died of COVID-19 are pictured on the lawn of Camilla Care Community, in Mississauga, Ont., on Jan. 13, 2021. (Evan Mitsui/CBC)

O’Toole also criticized the Trudeau government’s pandemic response, suggesting that health care workers haven’t received enough support and that a slow rollout of COVID-19 vaccinations means it’s uncertain when the country will get back to normal.

“Like many Canadians, we are frustrated by the slower pace of vaccines than elsewhere, but we want the government to succeed for the health and well-being of Canadians so that we can get our lives back to normal,” O’Toole said.

NDP Leader Jagmeet Singh paused briefly in his remarks before citing the fact that seniors living in long-term care homes bore the brunt of the pandemic, calling it a source of “national shame”.

“I think of so many people, so many loved ones who were lost when their family could not be there with them in their last days,” said Singh. “They were lost and families couldn’t grieve their loss.”

Bloc Québécois Leader Yves-François Blanchet also spoke of the tragic impact of the pandemic on seniors — “the most fragile among us” — and other vulnerable people.

“People who are isolated, who live in poverty, who suffer from anxiety are suffering even more, and are made even more vulnerable by the pandemic,” he said speaking in French.

Blanchet expressed his appreciation for workers in health care, education and child care, and recognized that many of those workers are women.

He also called on Canada to address inequalities and flaws in the national health care system that were exposed during the pandemic.

Impact on mental health

In Ontario, where more than 7,000 people have died of COVID-19, Premier Doug Ford offered condolences to the families of the pandemic’s victims and recognized the difficulties others have faced in trying to limit the spread of the virus.

“Over the past year, the vast majority of people have followed public health restrictions to stop the spread, and we recognize the extraordinary burden this has placed on individuals, families and businesses across Ontario,” said Ford in a media statement.

The Canadian flag flies over the Peace tower at half mast to recognize a national day of observance for COVID-19, in Ottawa, Thursday, March 11, 2021. (Adrian Wyld/The Canadian Press)

“And the uncertainty created by the pandemic has had a devastating impact on our collective mental health — especially that of young people, who have been forced to put their lives on hold, and seniors who have had to isolate themselves from friends and family.”

Other ceremonies will be held across the country today. In Quebec, which has experienced the largest number of COVID-19-related deaths among provinces, Montreal Mayor Valerie Plante will make a speech later in the day and Premier François Legault will take part in a ceremony at the legislature in Quebec City.

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CBC | Health News

How the Novavax COVID-19 vaccine differs from those already approved in Canada

The Novavax vaccine, now closer to joining Canada’s COVID-19 inoculation program, differs from the two vaccines Canadians are currently receiving to guard against the respiratory illness, primarily because of how it’s engineered to induce an immune response in the body.

It’s a protein subunit vaccine, meaning it uses nanoparticles of a lab-grown spike protein that mimics the natural spike protein on the surface of the novel coronavirus and which helps the virus bind to cells and cause infection.

When the particles are injected into the body with an adjuvant — a compound that enhances immune response — the body learns to recognize and fight off the virus.

Protein subunit vaccines don’t elicit as strong an immune response as whole virus vaccines, so they often include an adjuvant. Novavax uses a proprietary adjuvant called Matrix-M, which is based on a type of compound found in many plants called a saponin. The company says it boosts the body’s immune response and generates a bigger immune response with a lower dose.

The tried-and-true method of making a custom copy of a virus spike protein has been used to develop vaccines against HPV, hepatitis B and influenza.

The Moderna and Pfizer-BioNTech vaccines, on the other hand, use a newer approach.

Both use messenger RNA (ribonucleic acid) technology, or mRNA, which the Centers for Disease Control says has been studied for more than a decade.

Those vaccines give genetic instructions to the cell on how to make a piece of the spike protein that is unique to the virus that causes COVID-19.

Maryland-based Novavax says its two-dose vaccine, which will be administered 21 days apart, remains stable at 2 C to 8 C, meaning it only needs basic refrigeration.

Pfizer’s vaccine needs to remain frozen before use at –70 C, while Moderna’s vaccine needs to be stored at –20 C. Official guidelines say doses of the Pfizer-BioNTech vaccine should be given 21 days apart, while Moderna recommends spacing shots 28 days apart.

Early findings from U.K. research show the Novavax vaccine appears to be 86 per cent effective against a new variant of the virus first reported in Britain and 60 per cent effective against the variant circulating in South Africa, the company said on Jan. 28. The efficacy against the original strain of virus that causes COVID-19 is thought to be around 89 per cent.

WATCH | Officials provide update on vaccine deliveries to Canada:

Maj.-Gen. Dany Fortin briefed reporters in Ottawa Thursday on Canada’s vaccine procurement and distribution program. 2:40

Prime Minister Justin Trudeau says Canada has signed a tentative agreement for Novavax to produce tens of millions of doses of its COVID-19 vaccine in Canada once it’s approved for use.

Novavax is still conducting clinical trials, but if Health Canada approves the vaccine, a new National Research Council-owned facility in Montreal will begin pumping out doses when the building is finished later this year. It would be the first COVID-19 vaccine to be produced in Canada.

Innovation Minister François-Philippe Champagne says the Montreal facility should be in a position to produce the vaccine “by the end of the year.”

Novavax has said it plans to develop a new vaccine aimed specifically at the variant found in South Africa. 

WATCH | Growing concern about COVID-19 variants in Canada:

COVID-19 numbers are falling, but Canadian health officials are becoming increasingly concerned about the presence of two coronavirus variants. A variant first found in the U.K. has been confirmed in three provinces while a variant first discovered in South Africa variant has been found in two provinces. 4:15

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CBC | Health News

What Canada’s hardest-hit provinces can learn from those that handled COVID-19 best

When epidemiologist Susan Kirkland opened a Halifax newspaper on Saturday, she was stunned. 

“Three protest rallies planned,” the Chronicle Herald headline read, in part.

“Oh, no,” the head of public health and epidemiology at Dalhousie University thought to herself. “Please don’t be anti-vaxxers or anti-maskers.”

As Kirkland read further, she realized they weren’t related to the pandemic at all. 

One was a rally for alleged victims of a pediatric dentist, a second to demand reparations for former residents of Africville and the third was an anti-war protest about an upcoming security conference. 

“Oh,” she said with relief. “Phew.” 

Critical juncture for Atlantic bubble

The situation in the Atlantic bubble has been like night and day from the rest of Canada. 

The four Atlantic provinces have managed to control the spread of COVID-19 through tight border restrictions, strict isolation of travellers and comprehensive tracing of outbreaks. 

But Kirkland says much of the credit also belongs at an individual level. 

“I do feel like the response from the public in the Atlantic region is different than other parts of the country,” she told CBC News. 

“I think there’s also a certain amount of pride that we have been able to maintain the bubble, and I don’t think that people want to see it change.”

Visitors explore Peggy’s Cove, N.S., on July 4. When the Atlantic bubble is operating, people in the four Atlantic provinces can move around the region without self-isolating. People from outside Atlantic Canada must self-isolate for 14 days upon arriving. (Andrew Vaughan/Canadian Press)

But it has changed, put on hiatus with the news Monday that Prince Edward Island and Newfoundland and Labrador were pulling out of the bubble due to rising COVID-19 cases in New Brunswick and Nova Scotia. 

Nova Scotia reported 37 new cases of COVID-19 Tuesday, its most in a single day since April 23. 

“I am worried. I think that we’re on the brink and at a very, very critical juncture,” Kirkland said. “This is the point where we either make it or break it. We’ll keep numbers low or they will, like everywhere else, just begin to escalate and skyrocket.

“The window is narrowing — but we still have the potential to get it under control.”

‘Squandered’ sacrifices in Alberta

Elsewhere in the country, people are facing a much different situation. 

Alberta is seeing COVID-19 cases skyrocket at an unprecedented rate, rising to more than 1,500 per day and even outpacing provinces such as Ontario despite only having a third of the population. 

“I’ve been worried for many weeks now,” said Dr. Leyla Asadi, an infectious diseases physician in Edmonton. “I don’t know what the next two weeks will bring.” 

Asadi says the situation in Alberta isn’t a result of individuals not following public health guidelines necessarily, but instead reflects that the province has been a victim of its own success. 

A man wears a mask in downtown Calgary on Oct. 30. On Nov. 14, Alberta broke 1,000 daily new cases of COVID-19 for the first time. (Jeff McIntosh/The Canadian Press)

When COVID-19 cases dropped to relatively low numbers in the summer, there was a reluctance to act on the part of the provincial government. 

“We had great success and maybe that resulted in our leadership questioning the models and, because crisis was averted, perhaps they thought that the models just weren’t accurate,” she said. 

“We’ve squandered our sacrifices from the summer, and now we’re in a really tough place.”

Premier Jason Kenney declared a state of emergency in Alberta Tuesday and implemented new public health measures to address the rising COVID-19 case numbers across the province, but stopped short of a lockdown. 

Most indoor social gatherings are prohibited, while outdoor gatherings, weddings and funerals can have a maximum of 10 people. Masks are also mandatory in all indoor work places in Calgary and Edmonton, but not provincewide. 

Unlike Nova Scotia, which instituted mandatory mask mandates on July 24 — a day when it reported no new cases — Alberta has hesitated.

Alberta’s daily reported COVID-19 cases now rival Ontario’s for the highest in the country, even though it has a third of the population. The province’s resistance to restrictions may be crumbling, but Alberta’s top doctor says a surge in hospitalizations is inevitable as cases ‘snowball.’ 2:02

Asadi, who was part of a group of experts who penned a letter to provincial leaders last month calling on them to put in place stricter restrictions, said before Kenney’s announcement that masks are “low-hanging fruit.”

“Having masks mandated provincially, that’s not going to negatively impact the economy in any way,” she said. 

“If we act earlier then the measures can be more targeted and can be shorter in time. But now, I can’t see anything other than a strict lockdown getting us out of trouble — and it won’t even get us out of trouble.” 

Reluctance to act ‘early and hard’ reason for surge

COVID-19 is spiralling out of control in many parts of the country, with a record high 5,713 cases in a single day this week.

Ontario and Manitoba also announced all-time high numbers of new COVID-19 cases, and millions of Canadians were plunged back into strict lockdowns in different parts of the country.

In response, Canada’s chief public health officer said provinces and territories need to be more proactive — and act sooner rather than later.

Canada’s Chief Public Health Officer Dr. Theresa Tam talks to The National’s Andrew Chang about the holiday season and getting to the end of the COVID-19 pandemic. 6:31

It’s not only the number of cases that are worsening; it’s who is being infected.

“The other huge problem that we have now are the inequities associated with this pandemic,” said Dr. Allison McGeer, an infectious disease physician with Sinai Health System in Toronto.

“Part of the reason I think that we’re not paying as much attention as we should be to the harm is that the harm is not predominantly occurring to the people in power in our society.”

McGeer is watching the worsening outbreaks across Canada through the eyes of a microbiologist who has decades of experience in infection prevention and control.

“I’m a little bit worried about what’s going to happen in Alberta,” McGeer said. “I think we’ll be cancelling surgery again, probably in order to cope with the ICU load three or four weeks from now.”

Surgeries such as hip and knee replacements could be cancelled down the road, as it can take up to two weeks for symptoms of COVID-19 to appear.

Surgical oncologist Dr. Usmaan Hameed, centre, operates on a patient at North York General Hospital on May 26. Putting in measures sooner could help prevent surgeries from being cancelled. (Evan Mitsui/CBC)

“The reason we’re having this surge is because we kept things open longer than we should have,” she said. 

“The more cases you have when you act, the longer it takes to slow down and regain control and the more trouble you’re in going forward. So if we had put in measures two weeks before we did, then we might not be cancelling surgery.”

McGeer also acknowledges that politicians in Canada can only re-introduce safety measures when their citizens are behind them.

“If politicians move and they don’t have the population with them, then it’s not going to work either.”

McGeer advocates for preventative measures such as testing, tracing and isolating individuals who test positive to keep COVID-19 case counts low.

“It’s very clear that if we had been able to start this outbreak early and hard with preventive measures, if we’d been able to do the contact tracing, if we’d been willing to put people up in hotels for quarantine, we might be where Newfoundland is now,” she said. “And that has huge rewards.”

Those tantalizing rewards could help reinvigorate Canadians outside the Atlantic provinces who face a resurgence of COVID-19 cases and the hospitalizations and deaths that could follow the holiday season. 

“I get how tired people are; I’m tired of it myself. But this is not about being tired,” McGeer said. “We just need to hold on until we can get vaccines, right? And they are coming.”

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Trump missed opportunity to show empathy for those hurt by COVID-19, say strategists

If U.S. President Donald Trump wanted to help his flagging re-election campaign, he could talk about his personal experience with COVID-19 and express empathy for the millions who have had to deal with the potentially fatal disease.

That would be the advice of American University communications professor Leonard Steinhorn, if he were counselling the president.

“If he used this as an opportunity to communicate with Americans on a sort of more personal basis, it could have, in some ways, a positive impact on his campaign,” Steinhorn told CBC News.

Instead, upon his departure from Walter Reed National Military Medical Center on Monday evening, Trump downplayed the seriousness of the disease, releasing a video telling Americans they should not fear the virus, not let it take over their lives and that he feels better than he did 20 years ago.

“He wants his personal experience to vindicate the policies, the policies he’s had to reopen America,” Steinhorn said. “And to vindicate everything he’s been saying and doing.”

The Republican president was admitted to Walter Reed on Friday after being diagnosed with the disease caused by the novel coronavirus. On Monday, he returned to the White House, where he will be cared for around the clock by a team of doctors and nurses.

His return to the White House was also accompanied by a video statement he released via Twitter. Trump said he learned so much about the virus while in hospital and he promised vaccines are coming “momentarily.”

“Don’t let it dominate you. Don’t be afraid of it,” Trump said. “We’re going back, we’re going back to work. We’re going to be out front. … Don’t let it dominate your lives. Get out there, be careful.”

‘Willful blindness’

While the whole ordeal has been shrouded in secrecy and has led to contradictory statements from medical officials and White House staff, it was an opportunity for the president to express solidarity and empathy with those who have been impacted by the virus, said Andrew MacDougall, ex-director of communications to former prime minister Stephen Harper.

For Trump to “come out of a virus that has killed over 200,000 Americans, made millions more ill, and cannot offer one word of empathy or sympathy for what these families and their loved ones are going through … there’s just willful blindness that his experience is not everyone else’s experience.”

“It’s just me, me, me me, me, me,” said MacDougall.


Politically, however, what’s important to Trump is how his message will play to voters, particularly the undecided ones who are crucial for an electoral victory on Nov. 3.

“I accept that there’s a small percentage of people who do want to hear that [tough] attitude,” MacDougall said. “It’s not enough to shift new voters over to his column, which is what he needs to do. He needs to make up a lot of ground, there’s not a lot of time to do it and he’s wasted this opportunity — if anything, he’s polarized people even more about it.”

Brendan Buck, a former adviser to former House speaker Paul Ryan, told the New York Times that the president’s approach was not necessarily helpful to him politically because it “didn’t pass the laugh test for a super-serious situation that has ruined millions of people’s lives.”

For political leaders, contracting COVID-19 does seem to inspire some good will from the broader populace. Both British Prime Minister Boris Johnson and Brazilian President Jair Bolsonaro saw slight increases in their popularity after they announced they were infected. But those bumps were short-lived, polls suggest.

Will it help him?

In almost every conceivable poll, the U.S. president is behind, said Kyle Kondik, managing editor of the political analysis newsletter Sabato’s Crystal Ball at the University of Virginia Center for Politics.

“The question we need to ask ourselves all the time, it’s not whether something will hurt him but whether it will help him,” Kondik said. “This whole coronavirus situation — what’s going to come out of this to help him?”

“I just go back to the general sense of chaos, which certainly has been a feature of this White House and has been a feature of this latest episode,” Kondik said. “And if you feel like that’s a problem for the president, and I feel like it is, it doesn’t help.”

WATCH | Politico reporter speaks about impact of U.S. President Donald Trump’s current messaging around the coronavirus

According to Politico reporter Daniel Lippman, U.S. President Donald Trump’s current messaging around the coronavirus could be ‘deadly’ for some people and damaging to his re-election chances. 6:39

The coronavirus ranks highly as a concern for voters, just below the economy, said Tom Bevan, co-founder of the politics website RealClearPolitics. The demographic where it’s of particular concern is voters over 65, where Trump is struggling.

“Trump is not doing as well with seniors. That’s been reflected in all the data. It’s a group he won in 2016 and now he’s trailing [Democratic presidential candidate Joe] Biden,” Bevan said. “I think it’s safe to say that at least part of that is attributable to his handling of the coronavirus.”

Bevan said it’s possible that those undecided voters may not be viewing the actions of Trump or his administration in the same way as partisans.

This photo shows the seating arrangement for several people in Trump’s inner circle who have tested positive for COVID-19 after the president and his wife confirmed their diagnoses on Friday. (CBC News)

“Maybe they like [Trump’s] message. Maybe they don’t. Maybe they don’t care. [Maybe] they just care about the economy and health care and all this stuff is sort of a sideshow,” Bevan said. “It’s too early to tell. I’ve no idea how voters are going to process that information [about his hospitalization], because it just came so fast.”

Outbreak at the White House

The White House is experiencing a larger coronavirus outbreak, with many staffers having contracted the disease. The outbreak may be the result of a Rose Garden ceremony on Sept. 26, when Trump announced his nomination of Judge Amy Coney Barrett to the Supreme Court.

Many in attendance sat in close proximity and didn’t wear masks. Along with the president and the first lady, a number of prominent Republicans have tested positive for the coronavirus, including White House press secretary Kayleigh McEnany; Republican senators Mike Lee, Thom Tillis and Ron Johnson; former White House senior adviser Kellyanne Conway; and former New Jersey governor Chris Christie.

Meanwhile, the White House has decided not to trace the contacts of guests and staff members at the celebration, the New York Times reported. Instead, it has limited its efforts to notifying people who came in close contact with Trump.

Steinhorn said the question is whether voters will see Trump’s approach to his infection, and the White House’s response to its own outbreak, as a metaphor for how this administration has dealt with the pandemic more broadly.

“This episode magnifies the credibility gap that characterizes this White House,” he said. “But beyond credibility, it’s also the image of chaos.”

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COVID-19 poses big challenges for day camps, programs catering to those with special needs

Parents across the country are trying to fill the empty days this summer for their kids, after many camps and programs were cancelled due to the pandemic. The scramble for playdates, day trips and other activities is a daily preoccupation, but for those with children who are among society’s most vulnerable, the need for daily structure is even more crucial.

“Our parents were at their breaking points,” says Yaffi Scheinberg, executive director of Kayla’s Children Centre (KCC) which operates a day camp in Thornhill, Ont., for children with special needs.

Kathy Laszlo, co-founder and director of Developing and Nurturing Independence (DANI), says it was a similar situation for the families of the adults in its programs, many of whom have been without access to support during the pandemic lockdown. “When there is no respite, there is no health worker coming to your house, there is no one taking out your kid. So you’ve had to do this 24/7 in the last 18 weeks, and it was a great toll on the families.”

KCC and DANI are the only special needs programs of their kind that have reopened in Ontario so far during the COVID-19 pandemic.

KCC runs a school and a variety of programs for children with disabilities and complex medical issues. The organizers were debating whether or not to open this year, due to the risks posed by COVID-19 and the complexity of making sure the campers would be safe. However, they really wanted to support parents of high-needs kids who were looking at a summer without the break the camp provides them with.

“We feel like we’re literally saving lives by having this camp open and giving these kids this opportunity, and giving their parents the chance to recuperate from the trauma that they went through in the last couple of months,” Scheinberg says.

The programs at Kayla’s Children Centre give campers and their families a break from the stresses of months of COVID-19 isolation, says executive director Yaffi Scheinberg. (Perlita Stroh/CBC)

Julie Higgins is one of those parents. Her six-year-old daughter Emily has attended the camp for three years. Emily suffers from Rett Syndrome, a neurological disorder that robs her of control over her body. She also experiences strong, painful muscle spasms.

After being isolated at home for four months with her daughter, Higgins admits the toll the situation was taking on the family was severe.

“It was awful,” says Higgins. “We were in crisis and desperate for anything, it was quite a few months of just survival and just day by day, hour by hour.”

When Higgins heard KCC camp was opening, she decided Emily needed the respite as much as the rest of her family.

“We knew they would take every precaution to make sure it was safe. And obviously you know you’re taking a bit of a risk, but we also took into consideration what it was doing to Emily not being around other people, and that was really hard on her.”

Julie Higgins, left, says that at the KCC camp her daughter Emily gets the structure and therapy she needs to thrive. (Perlita Stroh/CBC)

Also hard on Emily was the loss of skills she was experiencing due to the interruption in her therapies. At KCC she receives physiotherapy and occupational therapy, as well as taking part in recreational activities. All that structure is what Higgins says makes her thrive.

“Even though we tried to do as much as we could at home, it’s not the same. So, she’s getting all that now. She loves it. We can see her strength is back.”

KCC has more than 80 campers this summer and runs the full months of July and August.

Emily’s favourite activities at camp include music class and water play. Higgins, who drives her an hour each way to get to and from the camp each day, says her daughter’s overall mood has improved dramatically since she’s been there.

“She’s happy, so we’re happy.”

Julie Higgins says until the KCC camp was able to open, the stress of isolation during the pandemic was taking a toll on her daughter Emily and the rest of the family. ‘We were in crisis and desperate for anything.’ (Perlita Stroh/CBC)

Delicate decisions

Opening the camp during a pandemic was not easy. KCC consulted with public health officials as well as Toronto’s Hospital for Sick Children when considering how it could open.

The organizers are using a large building where they can space children out, and they’re keeping campers in cohorts of five that do not mix. They take everyone’s temperatures at the door, and ensure all counselors and staff wear masks.

They started planning for the possibility of opening in March and remained in constant touch with parents about their intentions.

Emily’s favourite activities at the KCC camp include music class and water play. (Perlita Stroh/CBC)

Scheinberg knew the decision parents were weighing about sending their kids was a delicate one. Many of the children have underlying health conditions that make them high-risk if they contract COVID-19. But on the first day of camp she knew her staff had made the right decision.

“Lots of our parents dropped off their kids that first week and sat in their cars and sobbed. They had a flood of emotion as everything they’d gone through over the past four months just hit them,” says Scheinberg.

“That was really emotional for us, as a staff, to witness.”

Recreational therapies for adults

Special needs children and their families aren’t the only ones who’ve suffered as a result of the isolation COVID-19 created. Adults with developmental and physical disabilities were also left without the structure of their day programs and specialized therapies.

DANI, also based in Thornhill, has provided these adults with recreational therapies, vocational training and a day program since 2006. When it closed in March due to the pandemic, many of its families were left without care.

Even though DANI did transition to online programming, not all of its clients could participate. That didn’t sit well with Kathy Laszlo, who co-founded the centre after her own special-needs son aged out of programs for children with disabilities.

“I personally feel that even if one person is left behind because they cannot be part of this online learning, it’s one too many,” says Laszlo.

“We always want to put the participants first. We knew it was going to be a major undertaking, but it’s their need and the families’ need.”

Kathy Laszlo says reopening the DANI camp and making sure everyone would be safe was a huge undertaking, but it was well worth the effort. (Perlita Stroh/CBC)

Laszlo was right, reopening DANI was a huge undertaking. The centre fundraised and spent upwards of $ 25,000 installing plexiglass barriers, investing in personal protective equipment (PPE) and sanitation stations, and hiring a consultant to help them meet government protocols.

Even then, it could only offer its participants two half-days per week to ensure proper social distancing. They are currently able to accommodate most of their 34 regular program participants, and plan to continue doing so as long as restrictions allow.

Laszlo says even this reduced program was worth the effort.

“The parents are overjoyed, they are so grateful. Anything we can do, even three hours twice a week, we see them when they drop off the participants and they can’t thank us enough.”

Gary and Rina Kogon’s daughter Tanya, 42, is one of those able to attend the DANI program. She suffers from cerebral palsy, a global development delay and a seizure disorder. The past four months at home were not easy for her, or her parents.

“She requires 24/7 care, someone nearby,” says Gary. “Unrelenting is a good word, because we don’t have that break … but like everything else with these special needs, you don’t have a choice, you just do it.”

Gary and Rina Kogon’s daughter Tanya requires 24/7 care. Gary says she was excited about the camp reopening, and ‘when she’s happy, we’re satisfied.’ (Perlita Stroh/CBC)

Rina adds that knowing her daughter is in good hands and receiving much-needed stimulation helped her make the decision to send Tanya back to DANI, even with the risk posed by COVID-19.

“When we saw how they were doing it, I felt relieved,” says Rina. “And, she was looking forward to it, she was so excited.”

“When she’s happy we’re satisfied,” adds Gary.

Tanya Kogon, left, walks with some of the staff at the DANI camp. (Perlita Stroh/CBC)

DANI hopes to ramp up its program to full time as remaining COVID-19 restrictions are loosened. The group is also looking for more space so they can bring back more participants, and applying for government grants to expand their online learning program for clients who can’t yet return physically.

Lazlo says her knowledge of what her own son needs drives her to keep going and helping others.

“People with disabilities need a good schedule,” she says. “Most of them don’t chit-chat on the phone, they don’t do Facebook and all those typical things a 20-something would do. They need a personal touch, to be together, to be heard, to talk or be listened to. Or even just to be there.”

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Hydroxychloroquine fails to prevent COVID-19 in those at high risk, trial shows

The drug hydroxychloroquine, which has been the subject of heated debate as a potential treatment for COVID-19, was not effective in preventing the disease in Canadians and Americans at high risk, according to the first gold standard clinical trial.

In Wednesday’s issue of the New England Journal of Medicine, medical researchers reported on testing the use of hydroxychloroquine in 821 adults in the U.S. and in Quebec, Manitoba and Alberta. The participants did not have symptoms but were exposed to someone with confirmed COVI9-19 in a health-care or household setting.

Hydroxychloroquine is often used to treat autoimmune diseases such as lupus. U.S. President Donald Trump said he’s taken hydroxychloroquine, although he’s not tested positive for the coronavirus infection. No studies have proven this drug or any others are effective against COVID-19.

The exposures were all considered high risk because the participants were less than two metres away from a confirmed case for more than 10 minutes without wearing a mask or face shield. The goal of the randomized trial was to see if hydroxychloroquine could prevent symptoms of infection, known as post-exposure prophylaxis, compared with taking a sugar pill.

“In this trial, high doses of hydroxychloroquine did not prevent illness compatible with COVID-19 when initiated within four days after a high-risk or moderate-risk exposure,” the study’s authors wrote.

Gold standard method

Dr. Emily McDonald, a physician at the Research Institute of the McGill University Health Centre, co-authored the randomized control trial in which half of participants were randomly assigned to the drug and half to the placebo without investigators knowing to avoid bias in interpreting any symptoms or their resolution.

McDonald called it the gold standard method to have the best evidence to support how to prevent spread of COVID-19.

“When we politicize the drug and we stop studies early for reasons that are perhaps not entirely valid, we risk never answering the question properly because the enrolment for the studies drops off,” McDonald said.

Dr. Emily McDonald says researchers finally have the type of evidence that they need to answer one key question about hydroxychloroquine. (McGill University)

Overall, 107 of 821 of participants developed COVID-19 based on a swab or compatible symptoms during 14 days of followup.

No deaths occurred

Of those who received hydroxychloroquine, investigators said 49 developed the disease compared with 58 in the placebo group, a difference that could simply be random.

Two patients were hospitalized, one in each group. No deaths occurred.

Medication side-effects such as nausea and abdominal discomfort were more common for patients taking hydroxychloroquine compared to placebo (40 per cent versus 17 per cent), but no serious treatment-related adverse reactions were reported, including any heart arrhythmia.

Earlier on Wednesday, the World Health Organization announced it was resuming the hydroxychloroquine arm of its global Solidarity trial into potential treatments for COVID-19 following a pause to check for any potential safety concerns such as heart problems.

“WHO’s very much in favour of and encourages the continuation of randomized trials that are looking at different drugs to reduce mortality but also to reduce the severity of the illness,” Dr. Soumya Swaminathan, WHO chief scientist, told reporters.

Other results expected soon

The Solidarity trial includes participants and researchers in Canada. 

Dr. David Boulware, the trial’s lead researcher and an infectious disease physician at the University of Minnesota, said results of another placebo-controlled trial are expected soon, this one testing hydroxychloroquine as a coronavirus treatment, rather than to prevent infection. 

Whether the drug can be given as an effective treatment sooner either in the community or in the hospital remains to be answered, McDonald said. But so far, results suggest it’s safe to continue studying it.

Participants for the trial were recruited online. They ranged in age from 33 to 50, and most were health-care workers. They did not have underlying health conditions that could make taking the drug dangerous. 

Dr. Michael Hill is studying hydroxychloroquine as a treatment for COVID-19 at the University of Calgary as part of another clinical trial that was paused. Hill was not involved in the newly published study and said it’s not surprising if the public is confused about the drug given the promotional messages from political leaders like Trump and Brazil’s president Jair Bolsonaro.

“I’m sure when we look back at it, we’ll use it as a case history example,” Hill said. “But I hope we get stronger and stronger oversight of the science irrespective of what happens next.”

Previous studies of hydroxychloroquine were observational in design, which greatly increases the potential for bias when managing patients, compared with a well-conducted, randomized clinical trial.

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Why mass COVID-19 testing — even of those who are symptom-free — is key to stopping spread

This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

A scientist on the front line of Italy’s fight against the COVID-19 outbreak is issuing a plea to countries like Canada: Test everyone possible, even people not showing symptoms. 

“Test the neighbourhood, test the relatives, test the friends, and isolate all positive individuals,” said Andrea Crisanti, an infectious disease expert at Imperial College London who is working on the ground in Italy. 

“If you do it now, you will stop the disease.”

While on sabbatical at the University of Padua, Crisanti has been participating in a mass testing experiment for COVID-19 infections in Vò, a town of roughly 3,400 people located west of Venice.

Though the country’s overall death toll is in the thousands and climbing, Crisanti said Vò has effectively stopped its local outbreak by testing — and retesting — every single resident, regardless of whether they showed any symptoms.

The town had its first confirmed COVID-19 case on Feb. 21, he said. 

The initial round of testing that month showed three per cent of the population had been infected with the illness. Every single one of those residents was then put under isolation at home and not allowed to have any contact with others.

Ten days later, the entire town was retested — at which point the rate of infection had dropped to 0.3 per cent, marking a 90 per cent decrease.

“What we learned is that 25 per cent had influenza-like symptoms, and 75 per cent were completely asymptomatic,” Crisanti said. “They were completely unaware.”

He said given the high number of people who didn’t show symptoms, the takeaway for other countries is to test widely, catch all possible cases early, and isolate them to prevent the virus from spreading like wildfire through a community.

Infectious disease expert Andrea Crisanti says 75 per cent of those tested in Vò did not show symptoms. (Alastair Grant/The Associated Press)

It’s a call echoed by a growing chorus of global experts, from Canadian infectious disease specialists to the World Health Organization, amid increasing concern over countries not knowing the true number of infected individuals.

“We clearly need to rapidly scale our capacity to test more broadly because that will be extremely helpful in enabling Canada to follow a similar path as South Korea, Japan and Hong Kong,” said Dr. Isaac Bogoch, an infectious disease physician at Toronto General Hospital.

“We want to take that pathway – not the pathway of countries like Italy, Iran and Spain.”

A medical worker wearing a protective mask and suit treats patients suffering from COVID-19 in an intensive care unit at the Oglio Po hospital in Cremona, Italy, on March 19. (Flavio Lo Scalzo/Reuters)

Dr. Theresa Tam, Canada’s chief public health officer, said Friday at least 66,000 tests have been done in this country, with 10,000 of those in the 24 hours since Thursday alone. 

On Wednesday, Health Minister Patty Hajdu signed an interim order to obtain more diagnostic test kits and other medical devices to address the growing need amid a rise in cases. 

“Early diagnosis is a critical component,” Hajdu said. “So we are taking extraordinary measures to help make that happen as quickly as possible.”

‘Million-dollar question’

One crucial reason for widespread testing, as the Vò experiment suggested, is that it could catch anyone who may be unknowingly carrying the virus and potentially spreading it across Canada.

There are two types of patients who could be doing this without their knowledge.

Asymptomatic carriers show absolutely no symptoms, while subclinical carriers are people who may have mild symptoms but aren’t sick enough to seek medical care.

In both cases, these people could be flying under the radar — unless they’re tested.

The degree to which that’s happening right now is the “million-dollar question,” says Jason Kindrachuk, an assistant professor and Canada Research Chair in emerging viruses at the University of Manitoba. 

“Everybody wants to know exactly what role people with asymptomatic or subclinical infections are playing in transmission,” he said. “The simple fact is, where we are right now, we still don’t know.”

A police officer uses a digital thermometer to take a driver’s temperature at a checkpoint in Wuhan, China. (Chinatopix via The Associated Press)

Since the virus is so new, research is just beginning to emerge shedding light on how it transmits.

One study published in the journal Science this week found COVID-19 patients in the epicentre of the outbreak in Wuhan, China, with mild, limited or no symptoms went “unrecognized” and exposed “a far greater portion of the population to virus than would otherwise occur.” 

The study concluded that these “undocumented infections” were the source of transmission for up to 79 per cent of documented cases in the city.

‘Every inch of my body hurt’

In Ontario, where there are now more than 300 confirmed cases of COVID-19 — close to a third of Canada’s total — health officials say 3,000 tests are now being conducted each day, with a goal of eventually conducting 5,000 daily tests by expanding laboratory access.

Officials are “very aware of the need to increase our capacity for testing,” Ontario Health Minister Christine Elliott said this week.

She said some residents face at least a four-day wait to learn their test results, which she called “unacceptable.”

Other Canadians have told CBC News they simply weren’t tested at all, despite showing symptoms that aligned with COVID-19.

Ontario couple Curtis Connor and Kris Chandler, shown here speaking to CBC News via a Skype from their home, both fell ill in early May but haven’t been able to get tested for COVID-19. (CBC News)

That was the case for Ontario couple Curtis Connor and Kris Chandler, who live in Paisley, a village about 200 kilometres northwest of Toronto.

Both fell ill on March 4, and say the symptoms went beyond any flu bug they’d experienced before — including days-long fever, pain and breathing problems.

“Every inch of my body hurt beyond what you can imagine,” Connor, 50, recalled. 

“I felt that my lungs had caught fire,” said Chandler, 49. “I couldn’t walk 10 steps without losing my breath.”

Chandler suspects their illness stemmed from her workplace, where shift workers are often travelling in and out of the country, but she may never know for sure.

Despite seeking medical care and asking to get tested, the pair was told by their physician that no one would be tested unless they’d travelled abroad themselves. Since the couple hadn’t been away, they’re now left without answers.

According to Dr. Margaret Tromp, president of the Society of Rural Physicians of Canada — which includes roughly 2,000 small-town clinicians — rationing testing to diagnose vulnerable patients has been a directive from many local public health units.

“Testing is not that readily available because we have a limitation on the number of swabs that are available,” she said.

“It obviously would be better if we could test more people, but we have to be realistic when a pandemic comes and we need supplies, that supplies cannot be instantly produced.”

Widespread testing is ‘eyes and ears’ of epidemic

While government efforts could soon expand Canada’s testing capacity, Dr. David Fisman, an epidemiologist with the University of Toronto’s Dalla Lana School of Public Health, says the lack of kits is leaving the country without its “eyes and ears” in the outbreak.

“If we don’t have lots and lots and lots of testing, and if we’re not testing in places where we don’t expect to find [COVID-19], then we’re not going to know the full extent of this epidemic, and not be able to come up with the best ways to protect ourselves,” he said.

Dr. Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, stressed Monday the most effective way to prevent infection and save lives is by “breaking the chains of transmission” through widespread testing and isolation. 

“You cannot fight a fire blindfolded and we cannot stop this pandemic if we don’t know who is infected,” he said. “We have a simple message for all countries: Test, test, test.” 

Speaking to CBC News by phone from Italy, Crisanti said Canada needs to take cues from other regions where mass testing is the new normal, including the Italian town of Vò.

“If you hadn’t tested everyone like that,” he warned, “there would have been no way to know just how high the infection rate really was.”

To read the entire Second Opinion newsletter every Saturday morning, subscribe by clicking here.

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