Tag Archives: ‘unprecedented’

How a national response could address an unprecedented COVID-19 surge across Canada

COVID-19 levels are surging across Canada at rates never before seen in the pandemic and showing no signs of slowing down. 

The coronavirus continues to spread like wildfire both in areas that were hit hard in the first wave and those that were practically untouched previously, and the reaction from the federal government has taken a desperate tone.

“I’m imploring the premiers and our mayors to please do the right thing,” Prime Minister Justin Trudeau said this week. “Act now to protect public health.” 

We’re now averaging 4,000 coronavirus cases per week and 50 deaths per day, with more than 45,000 active cases across the country.

A record of nearly 5,000 cases and 83 deaths were also reported in a single day in Canada this week, and we’re on track to record over 10,000 cases a day by early next month. 

But with a second wave of the pandemic that’s worsening by the day, experts say the federal government may need to do more to stop the spread of COVID-19. 

‘Never too late’ to turn around dire situation

Ontario is now projecting 6,500 new COVID-19 cases per day by mid-December if no further action is taken to address the worsening situation in the province. 

In the face of that ominous prediction and a Toronto Star investigation that found major discrepancies between guidance from experts and thresholds for increased regulations, Ontario changed its guidelines and imposed severe restrictions on five major cities and regions on Friday. 

Across the country, the situation is no less dire. 

Quebec is weighing temporarily closing schools this winter, Manitoba has imposed strict new “code red” restrictions and Alberta is limiting bar hours and activities. Cases in British Columbia are doubling every 13 days, and Saskatchewan is expanding mandatory masking.

But is that enough to curb the worsening second wave?

Experts are divided on what Canada should do next to address the unprecedented surge of COVID-19, but one thing is becoming clear — what we’re doing may not be working.

Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa, says he feels “stupid and naive” for thinking Canada had adequately prepared for a second wave when cases were low in the summer. 

“We opened up our economy perhaps a bit too early [and then] the numbers were out of control. We were testing non-strategically. We squandered our testing capacity,” he said. “But is it too late? It’s never too late.”

Deonandan estimates that while we’re still at least 12 months from the widespread rollout of a safe and effective vaccine in Canada, how we use that time is still up in the air. 

“How do you spend that year? Do you spend it rolling the dice and letting people die?” he said. “Or do you spend it paying some hard economic costs now, so that you spend most of this year in relatively good economic standing?” 

Could a national response help control Canada’s 2nd wave?

One approach that has been put forth by public health experts is the use of emergency federal powers to co-ordinate our response to the pandemic across the country. 

That can be done either by using the Emergencies Act or through the inherent power the federal government has in times of emergency under the Constitution Act

The Emergencies Act is far-reaching in that it allows the federal government to extend its power over provinces and their health-care systems to deal with the pandemic. 

WATCH | How Canada could regain control of COVID-19:

COVID-19 cases are soaring and lockdowns are returning. After eight months of the pandemic, epidemiologists have a decent playbook. Where did Canada go wrong? And how does it get back on track? 2:01

“It authorizes the federal government to essentially take control over a situation,” said Dr. Isaac Bogoch, an infectious disease physician at Toronto General Hospital and associate professor of medicine at the University of Toronto.

“That’s the nuclear bomb approach.” 

Bogoch said that strategy would be unrealistic to take in the current situation, as the federal government would then be responsible for countless health-care decisions at the provincial level. 

“Canada doesn’t have the capability of micromanaging a health-care system,” he said. “They don’t have the manpower. They don’t have the skill set. They can’t do it.”

The less extreme option is to use the emergency powers in the Constitution Act to enact stricter measures across the country to slow the spread of the coronavirus. 

“There’s no real requirement for using it except that the government says there’s an emergency,” said Amir Attaran, a professor in the Faculties of Law and School of Epidemiology and Public Health at the University of Ottawa. “That’s it. That’s all they have to do.” 

Attaran favours that approach because he feels the premiers have failed to effectively control the pandemic, save for the success of the four provinces in the Atlantic bubble. 

“The court could be called on to judge whether that’s the case or not,” he said, referring to a potential court challenge of the emergency power. “But find for me a court in this country that’s going to say there’s no emergency.”

“Anyone who says, ‘that would be an illegal overreach,’ doesn’t know, because whether it’s illegal or not comes to a decision that’s in the courts, and I have no doubt whatsoever that the judges of this country would realize, yes, we’re in quite a mess.” 

Measures enacted using Constitution Act

Under this approach, the federal government would not take over provincial health-care decisions but instead could enact measures like national mask mandates, countrywide gathering limits and even cordon off hot zones and restrict travel between regions. 

“It’s not running anything. These are orders of what must and must not happen,” Attaran said of the approach. “Operationalizing it remains in the hands of the provinces.” 

The benefit of this approach is that it would co-ordinate Canada’s response nationally and overrule provinces that may be hesitant to enact stricter measures in the face of a growing number of COVID-19 cases, hospitalizations and deaths.

The drawback is that it would likely bring the ire of premiers who feel they’re handling the situation well and don’t want to be micromanaged. 

“That just wouldn’t fly,” Ontario Premier Doug Ford said this week in response to questions about the possibility of increased federal intervention in the pandemic response. 

“That’s not their jurisdiction. We don’t need the nanny state telling us what to do. We understand our provinces, and I’ll tell you, he’d have a kickback like he’d never seen from not just me, from every single premier.” 

Ontario Premier Doug Ford said the possibility of increased federal intervention in the pandemic response ‘wouldn’t fly’ with premiers across the country. (Chris Young/The Canadian Press)

Deonandan said the two main reasons why a national strategy hasn’t been deployed is because of a lack of political will and the complexity of our country’s political makeup. 

“How does a Liberal federal government compel a Conservative government in Alberta to do something that is maybe philosophically problematic to find consensus on?” he said.

The federal carbon tax was a perfect example of this challenge, he said.

“If you can’t find a philosophical consensus, how do you, with a heavy hand, enact homogeneity of policy across the country?” 

Despite this, Attaran said the federal health minister has the power to invoke the Constitution Act to address surging COVID-19 numbers immediately — even without consulting cabinet.

“The great thing about the federal emergencies power is it comes with no substantive requirements,” Attaran said. “The only requirement legally is that an emergency measure be temporary.” 

Trudeau said this week the federal government “doesn’t decide who closes down where and how fast.” But if its emergency powers were enacted, it could ensure thresholds to stop the spread of the virus are being met across the board. 

But Ottawa might also risk alienating provincial leaders — and the Canadian public. 

“Once you take control, provinces can do anything. They can stay engaged. They can take a step back,” Bogoch said. 

“Then you’ve got problems.” 

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CBC | Health News

6 more have died as B.C. confirms unprecedented 1,120 new cases of COVID-19 over the weekend

B.C.’s COVID-19 numbers continue to grow at an unprecedented rate, with another six deaths and 1,120 new cases confirmed over the weekend.

Deputy Provincial Health Officer Dr. Réka Gustafson announced the latest numbers on Monday afternoon, revealing that the active caseload is now 2,945 patients, 90 of whom are in hospital, including 19 in intensive care.

The new case numbers confirmed for each of the last three days are the highest that B.C. has seen so far, with 352 from Friday to Saturday, 389 from Saturday to Sunday and 379 from Sunday to Monday.

“These numbers are concerning to all of us, but we have learned a lot about COVID-19 since the beginning of the pandemic,” Gustafson said.

She said the goal of public health officials will continue to be minimizing severe illness and death while keeping communities as open as possible.

The vast majority of new cases are in the Lower Mainland, including 830 in the Fraser Health region and 234 in the Vancouver Coastal Health region.

To date, 15,501 cases of the illness caused by the novel coronavirus have been confirmed in B.C. and 269 people have died. Three new outbreaks have been detected in the health-care system, bringing the total number of active outbreaks to 28, including 26 in long-term care and two in acute care.

There are now 6,448 people under active monitoring by public health workers because of potential exposure to the virus.

Asked how big a caseload B.C. would need to see before bringing in tighter restrictions seen elsewhere, including measures like closing restaurants and mandating masks, Gustafson said the province is paying more attention to things like the ability to trace contacts and provide testing.

“At this moment, we have a concerning number of new infections, but, at the moment, the number of hospitalizations is still stable,” she said.

‘Very irritating’ Halloween celebrations

Though Monday’s numbers are higher than ever before, they were not unexpected.

Health Minister Adrian Dix had warned British Columbians earlier Monday that the latest numbers would “capture people’s attention.”

That warning came after footage on social media circulated over the weekend of hundreds of people crowding Granville Street in Vancouver for Halloween festivities. 

“It’s a very irritating event because I think it was a visible symbol of people not following the rules of gathering, which are limited to 50 people,” he said. 

“Obviously, it was there for all to see.”

It will take up to two weeks before health officials can determine whether that event led to more transmission.

Despite those images, Gustafson maintained Monday that the “vast majority” of British Columbians are being safe.

In response to questions about providing neighbourhood-level updates about COVID-19 numbers in light of the Granville Street party, Gustafson said health officials are working to provide “more granular” information to the public about where outbreaks are happening.

Partiers crowd the Granville Entertainment District in downtown Vancouver on Oct. 31. (Submitted to CBC News)

Dix said a bigger problem is house parties and private gatherings, which are not visible on social media but are fuelling the province’s rising case numbers. 

Provincial Health Officer Dr. Bonnie Henry issued a public health order last week limiting gatherings at private homes to members of a household and six guests. The order includes indoor and outdoor gatherings at private homes.

Officials in Fraser Health, B.C.’s worst-hit region, said people should limit gatherings to only those who live there.

Dix also discouraged people in Metro Vancouver from holding holiday gatherings this year. 

“This is an unusual time,” he said. “Let’s celebrate virtually and with the people in our household.” 

He said the province needs to more effectively tailor its message to younger people and to those who may not speak English as a first language. 

On Monday afternoon, Dix said the human desire to be together, which he described as “one of our greatest strengths,” can also be a major weakness during a pandemic.

“We need to turn the tide. I believe we can do that,” he said. “I ask everyone listening to us today and all the people you may talk to today to recommit to stop the spread.”

But he also stressed that there is no end in sight for this pandemic, saying British Columbia will be dealing with COVID-19 for “months and months and months and months and months and months.”

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CBC | Health News

‘We’re opening everything’: Scientists share coronavirus data in unprecedented way to contain, treat disease

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.

When the story of the coronavirus (2019-nCOV) is finally written, it might well become a template for the utopian dream of open science — where research data is shared freely, unrestrained by competition, paywalls and patents. 

Already the world knows more about the early days of this outbreak than it did when SARS first appeared in China in 2002, as scientists unite in unprecedented scientific collaboration aimed at containing and treating this disease.

As detailed accounts of the first cases have been published in prominent medical journals, it’s clear that scientists were among the first responders at hospitals in Wuhan, China, the epicentre of the outbreak. 

One patient, a 49-year-old woman, was a merchant at the Huanan Seafood Wholesale Market. In late December, she developed a fever and a cough and had an uncomfortable sensation in her chest. After four days, the cough became serious enough that she went to the hospital where a CT scan revealed she had pneumonia.

The same day that she was admitted to a Wuhan hospital, a 61-year-old man arrived with similar symptoms. He was a frequent visitor to the Huanan market and had been suffering from a fever and a cough for a week before showing up at the hospital. He was so sick that he needed mechanical ventilation to breathe. 

As doctors struggled to treat what was still an unknown illness, a team of scientists arrived from the Chinese Centre for Disease Control and Prevention.

They collected fluid from deep in the patients’ lungs and carefully placed them in sterile cups to begin the process of isolating the unknown virus believed to be causing this atypical pneumonia. 

The woman survived, and she has been released from hospital. The man died. But their lung samples provided some of the earliest glimpses of a new and deadly human pathogen. 

The ultrastructural morphology exhibited by the 2019 novel coronavirus (2019-nCoV), which was identified as the cause of an outbreak of respiratory illness first detected in Wuhan, is seen in an illustration released by the U.S. Centers for Disease Control and Prevention in Atlanta on Wednesday. (Alissa Eckert/Dan Higgins/MAM/CDC/Reuters)

Within days, those scientists and several others had sequenced the viral genome, deciphering the virus’s genetic code — a vital key to diagnosing and ultimately treating the disease. They immediately shared that critical genetic roadmap with researchers all over the world.

That early collaboration allowed doctors in other countries to be ready when the first cases appeared outside China. 

Watching the virus mutate in real time 

Because the viral genomes had been publicly released, when a  65-year-old man and his 27-year-old son were admitted to a hospital in Vietnam on Jan. 22, doctors there were able to identify the virus, isolate the patients, backtrack their travel history and monitor 28 close contacts, none of whom have developed symptoms.

By then evolutionary biologist Trevor Bedford had already used the growing database of viral genomes to conclude this virus made the leap from animals to humans sometime in mid-November, an astonishingly precise estimate that helped scientists understand how long the virus had been infecting people. 

“In looking at the genomes that were coming in from Wuhan, we could see that there was very little genetic diversity,” said Bedford, at the Fred Hutchinson Cancer Research Center and the University of Washington in Seattle, Wash.

The low number of mutations not only told him the virus was new in humans, it also corrected an early misunderstanding and revealed that the virus was spreading easily between humans. 

“As soon as the first genomes were coming in, it became clear that there’s lots of human-to-human spread,” he said.

The availability of having a full genome sequence of a novel virus available to the public to be able to develop diagnostics, to be able to diagnose patients in other countries is unprecedented.– Maria Van Kerkhove, WHO infectious disease epidemiologist

The genome data also allowed some groups to quickly zero in on the animal source, by using the genetic data to link this virus to one found in Chinese horseshoe bats.

Just three weeks after the first viral sequence was published, more than 42 different genomes are available on Nextstrain, an open source viral genome database that continues to grow as scientists diagnose patients and publish the viral genomes in just a few days. 

Evolutionary biologist Trevor Bedford used the growing database of viral genomes to conclude the coronavirus made the leap from animals to humans sometime in mid-November, an astonishingly precise estimate that helped scientists understand how long the virus had been infecting people. (Robert Hood/Fred Hutchinson Cancer Research Center)

That data is allowing Bedford to watch the virus mutate in real time, making it possible to identify how people became infected and which cases are linked. It also provides critical data to allow other scientists to estimate the size of the epidemic.

Other groups are using the genetic data to develop rapid diagnostic tests and begin working on antiviral drugs. And already at least five different groups have started working on a possible vaccine, including one from Saskatchewan

“The availability of having a full genome sequence of a novel virus available to the public to be able to develop diagnostics, to be able to diagnose patients in other countries is unprecedented,” said Maria Van Kerkhove, an infectious disease epidemiologist at the World Health Organization (WHO) news conference on Wednesday. 

Sharing virus samples ‘essential’: WHO

On Tuesday, Australia announced that its scientists are the first outside China to grow the novel virus and will share it with the world.

“It is essential that viruses are shared so that the further development of diagnostics and serologic assays — so that the further development of vaccines — can continue,” said Van Kerkhove.

Part of the first genetic sequence of the coronavirus was released to the world on Jan. 10. (GenBank by Shanghai Public Health Clinical Center and School of Public Health, Fudan University)

To keep on top of the rapidly breaking science, medical and scientific journals agreed to send copies of coronavirus papers to WHO before publication, with the authors’ permission. WHO announced this development in a tweet with the headline, “Great news!”

“That is a little different,” said Edward Campion, executive editor of the New England Journal of Medicine. “The WHO wants to know what’s going on in China and have asked us to help in getting information.”

The journal also announced that it is speeding up its peer review. 

 “Some of these articles have been reviewed and edited and revised in 48 or even 24 hours, including working overnight and weekends but still going through rigorous peer review to meet the standards that we think are important,” said Campion. “We have some peer reviewers who’ve agreed to work overtime.”

On Friday, 67 leading research organizations and scientific journal publishers from around the world announced an agreement to make relevant coronavirus research immediately available and free.

Bedford said the current climate of sharing is unusual for scientists.

“You don’t really talk externally that much because you’re trying to get your best science so it can’t be scooped,” he said.

“You only really talk about things once it’s all been published. This is flipping that around entirely where people are just being completely open with what they know.” 

University of Montreal researcher Vincent Larivière said the current climate of open science suggests that science-as-usual creates barriers. (Amélie Philibert)

It’s a temporary glimpse of a world where science is openly shared. But the measures also raise questions about the way science-as-usual is practised.

Vincent Larivière is an information scientist and professor at the University of Montreal, who studies the way science is disseminated. He said the move to speed up publication and share research is a tacit admission that business-as-usual in research slows down science.

“[They say] we’re opening everything because it’s important that we advance things fast. Well, the flip side of this argument is that your normal behaviour is to put barriers to science.”

“This virus is dangerous and deadly, but there’s lots of other diseases that are dangerous and deadly, and for which opening could save lives. So if you really want to go in that direction, just open everything.” 

To read the entire Second Opinion newsletter every Saturday morning, please subscribe.

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Vancouver police search for subject of unprecedented HIV-medication order

Police are searching for a Vancouver man who is the subject of an unprecedented court order to take medication for HIV.

Last October, David Hynd pleaded guilty to violating B.C.’s Public Health Act, marking the first time B.C. medical authorities used the courts to force someone into treatment for the virus that causes AIDS.

But he now faces six counts of breaching the terms of that order — and police are asking for the public’s help in locating the 35-year-old, who has allegedly eluded them for more than a month.

Public health officials have agonized over Hynd’s case for years, fearful to be seen as criminalizing HIV or contributing to any stigma around the virus.

They say they worked with community care providers to try to force Hynd to comply with health orders — only resorting to the courts as a last step.

“We didn’t make the decision lightly, essentially. We really wanted to make sure that we got this individual connected to care both for their own health and the protection of the people around them,” said Dr. John Harding of Vancouver Coastal Health, the regional health authority. 

“It unfortunately has escalated to a level that there now is this probation order and the matter is really behind Mr. Hynd and the police at this point.”

Hynd was given a suspended sentence and a probation order in which he agreed to take regular doses of antiretroviral medication to treat HIV. (Soe Zeya Tun/Reuters)

The case centres on the management of Hynd’s HIV.

Health officials want him to take antiretroviral medication that will lower the levels of the human immunodeficiency virus in his blood to a point where he is not considered infectious.

CBC reported on the case last year when Hynd was charged, but did not publish his name because of privacy concerns.

Those factors have changed with the new allegations and the Vancouver police force’s request for public assistance.

22 probation conditions

A B.C. provincial court judge gave Hynd a suspended sentence last October after he pleaded guilty to one count of failing to comply with the order of a health officer.

He was given an 18-month probation order that included 22 detailed conditions.

Among them, Hynd was ordered to comply with “directions, assessments, examinations, treatments and counselling” from staff at a Vancouver immunodeficiency clinic.

Hynd is the first person B.C. medical authorities have forced, via the courts, into treatment for the virus that cause AIDS. (David Horemans/CBC)

He agreed to pick up antiretroviral medication within one day of receiving a prescription and to “have sufficient antiretroviral medications in [his] possession” to avoid an interruption in treatment.  

He needs permission from Vancouver Coastal Health to leave British Columbia and must attend daily appointments if the levels of HIV in his blood rise above a certain level.

He must also “inform all present and future partners” that he has HIV before any sexual contact, the probation order says. Condoms are also required when “the exchange of bodily fluids is possible.” 

‘Very unusual’

According to court documents, Hynd was allegedly late for clinic appointments, changed his residence without telling a health officer and failed to let the clinic know he would be missing an appointment,

He’s also accused of failing to show up for daily appointments which were supposed to kick in if he either failed to have tests on a regular basis, or if tests showed his viral load had risen above a level of concern.

Police say Hynd may be driving a black Dodge Ram with an Alberta license plate and is known to frequent downtown Vancouver.

“In general, people with HIV do not pose a risk to the public. This is an individual where it’s very unusual,” said Harding.

“Most people go into treatment both for their own health and for the protection of their partners and the ones around them. In this particular case, it was very challenging to keep this individual on treatment and we used every supportive measure that we had.”

Harding said the case has been difficult for medical authorities to deal with, particularly at a time when Vancouver Coastal Health has been successful in combating the spread of HIV in the Lower Mainland.

“There’s only been a handful of people that we’ve ever even put orders on. And then this is the only individual whereby we’ve had to take an extraordinary step to enforce that order,” he said.

“We just don’t want that to affect the overall access and people’s stigma towards HIV.”

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CBC | Health News

Extraordinary destruction and flooding in Mozambique point to unprecedented storm

In a small room at the Beira morgue, just eight people and a priest walk around a coffin with a young woman's body, but the sound of their grief carries far.

Christine was 32 and disabled, without the use of her legs. Her heartbroken sister, Maria Vasco, explained that when she heard the cyclone was coming, Christine left her own little house and found shelter in another, believing it would offer better protection from the ravages of the storm.

It didn't. And just like that she was gone. The loss hit her family especially hard, because it was so sudden.

Tropical Cyclone Idai ravaged Mozambique, Zimbabwe and Malawi, peaking on March 11 and killing more than 760 people in the three countries. UN Secretary-General Antonio Guterres has called it "one of the worst weather-related catastrophes in the history of Africa."

An aerial view shows the flooded plain surrounding Beira on March 20. (Adrien Barbier/AFP/Getty Images)

Beira is still in mourning, still bearing the scars of sudden catastrophe. As the city tries to get back on its feet, its people are still trying to make sense of a singular storm that defied the rules of any they have ever known.

In a local paper, a former Mozambique first lady was quoted saying that Beira will "go down in history as having been the first city to be completely devastated by climate change."

While there is still an ongoing debate, many international experts believe climate change is the culprit. The extraordinary destruction and flooding clearly points to unprecedented factors.

A mother and child displaced by the cyclone are struggling with illness after the storm. (Stephanie Jenzer/CBC)

From above, the outlines of the waterlogged city have been smudged by the winds and an angry sea. As you fly farther into the flood zone, the water goes on as far as the eye can see, submerging everything. It's believed to have covered an area as large as 2,100 square kilometres.

Within the city of Beira, the roiling sea took giant mouthfuls of the coastal road, and the wind uprooted mighty trees as if they were saplings. They now lie leafless by the side of the road in the dozens, bearing their roots clear out of the ground.

The force of Cyclone Idai was such that it uprooted massive trees as if they were saplings. (Stephanie Jenzer/CBC)

Even the morgue's roof was blown off, replaced temporarily with a blue tarpaulin held down by rope.

And houses thought to be secure came tumbling down.

"On that day, the house fell in on her," said Vasco as her sister's coffin was carried to a small truck en route to the cemetery. Christine was taken to hospital alive but then died of her injuries.

"For the family it's very difficult."

A man in Beira scrapes windblown branches from the sodden streets to be gathered in trucks and taken away. (Nahlah Ayed/CBC)

It seems nothing was immune. The large hangar at the airport has lost large tracts of roofing. The imposing Sacred Heart church of Macuti was cracked open by the wind, its roof blown clear and down to the ground, along with two of its walls, a fallen nearby tree is now leaning into the rubble.

A statue of Mary remains on one of the intact walls. The pews are visible from the courtyard.

Felipe Speng and his sister, who live nearby, walked around the site to assess the breathtaking damage. Felipe has been coming to the church for seven years.

When Cyclone Idai swept through Sacred Heart Church of Macuti, blowing the roof off and tearing down walls, 'it sounded like a big house coming down,' said Felipe Speng, who lives nearby. (Stephanie Jenzer/CBC)

"It sounded like a big house coming down," he said, describing the church's destruction that night. "Everyone was scared."

"We have lost our church, but we are still alive. It's time to say thanks to God."

Look past the mangled roofs and the sea-ravaged roads and you can see Beira is trying to pick itself up. Traffic is returning. School kids in uniform walk to class. Electricity is steadily being restored.

Many buildings in Beira were reduced to rubble by the powerful cyclone. (Stephanie Jenzer/CBC)

Small crews of street cleaners, women and men, some in hard hats and rubber boots, are manually scraping up the storm-broken branches and pitching them into garbage trucks.

They are small steps. Since the storm battered the country's infrastructure, telecommunication is still extremely difficult. Prices of goods have skyrocketed. Thousands now make their homes in schools and churches. Some 2,800 schools are believed to have been destroyed.

Food aid is arriving to hard-hit Mozambique, which faces enormous need after Cyclone Idai. (Stephanie Jenzer/CBC)

Then there is the destruction of countless of ordinary homes, displacing thousands of people.

"I have lost all my books, my bag, all things," student Daniel Sarafin told CBC.

"I was supposed to go back tomorrow, but I don't know how I'll continue studying, because I've lost everything."

As a remedy, he moved back to his village near Gorongosa National Park.

Others haven't been so lucky.

A primary school in a central Beira district has been transformed into shelter for those who lost their homes in the storm. Living there means living in close quarters with some 2,100 people.

The yard of a local primary school has been converted to cooking and washing areas while the rooms inside now house more than 250 families who have lost their homes to the cyclone. (Stephanie Jenzer/CBC)

Makeshift kitchen

What was once the courtyard is now full of women and children sheltering in the shade.

The far corner has been turned into a makeshift kitchen, where tree branches felled by the storm are being used as fuel. Classrooms are now bedrooms for way too many people.

A woman cooks over a fire in Beira. Thousands of people have been displaced by Cyclone Idai and are having to fend for themselves outdoors and in ad-hoc shelters. (Stephanie Jenzer/CBC)

School desks are workstations where women pick through the beans they plan to cook for dinner.

Two small children play in a puddle of dirty water.

"I'm here because I have nowhere else to go," says Maria Jamie Jose, who escaped her destroyed home at the height of the cyclone.

"But to live like this, it's not so good."

This woman is one of the thousands of people who have taken shelter in the Escola Primaria Eduardo Mondlane because the cyclone has made their own homes uninhabitable. (Stephanie Jenzer/CBC)

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Paramedics' workload at unprecedented, unsustainable levels in B.C., union says

Staff shortages for paramedics and ambulance dispatchers are at unprecedented levels and are impacting services across the province, the union that represents ambulance paramedics in B.C. says.

The Ambulance Paramedics and Emergency Dispatchers of BC said paramedics reported last week that during the night shift anywhere from 25 to 40 paramedic units were out of service at any given time across the Sea-to-Sky, Lower Mainland and Fraser Valley areas. This represents 30 to 49 per cent of total paramedic units available in those areas.

Union president Cameron Eby says if 40 paramedic units are out of service that means 40 ambulances are not available to people in need. He said the shortage is due to vacant staff positions, meaning the paramedics and dispatchers on shift are "stretched thin". 

According to the union, B.C. paramedics experience some of the highest paramedic workloads in Canada and this is contributing to staff burnout.

A survey by the Mental Health Commission of Canada found that 81 per cent of paramedics and dispatchers in B.C. do not think the B.C. Emergency Health Services monitors fatigue and burnout, while the majority of those surveyed said they do not feel they have an appropriate balance of call volume to recovery time.

'This is simply unsustainable'

Eby says overtime has become the rule, not the exception, for maintaining staff levels and this is reflected in service rates.

"This is simply unsustainable and puts the paramedics and the services they provide at risk," says Eby.

The union's concerns are not solely focused on the Lower Mainland. The Okanagan and Kootenay regions also experienced high out-of-service rates in the past week.

A recent auditor general report found that ambulances were only meeting response time targets for the most serious emergencies in urban centres 50 per cent of the time.

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Where will the money go? Unprecedented donations keep pouring in for Humboldt Broncos

As donations from an online fundraising campaign for the Humboldt Broncos surpass $ 11 million, people are thinking about where that money will go and how it can best be used to help the families of those killed in the April 6 bus crash, as well as rebuild the lives of those who were injured.  

Although staff from GoFundMe  — the crowdsourcing platform hosting the campaign — have been providing advice and guidance, it’s up to the Humboldt Broncos team management to distribute the donations. 

Randy MacLean, vice-president of the Humboldt Broncos, told CBC News that as funerals for the 16 people killed in the crash are underway, everyone is still in the midst of grieving and hasn’t yet begun to process what the injured survivors and bereaved families will need.

The outpouring of support, which has generated more money than any other GoFundMe campaign in Canadian history, is “a great gift” to the victims of the tragedy, said Daryl Hatton, CEO of FundRazr, a Vancouver-based online fundraising platform. (FundRazr is a competitor to GoFundMe).

It also presents some “very complex and very emotional decisions” for the team, Hatton said. 

‘Young guys’ badly injured

“You’ve got to balance a whole set of criteria of, ‘What is a life worth? What was the future income of this life worth? What’s it going to cost to have all of the different medical treatments done to support people?'” he said. 

“These are some really young guys and some of them had the potential for a career in the NHL. Their future income that they may have lost, that their families maybe [were] starting to count on, has evaporated.” 

Kenneth Feinberg, a U.S. lawyer who has advised organizers for large U.S. GoFundMe campaigns — including one for dozens of victims of the 2016 Pulse Nightclub shooting in Orlando — said the Broncos should distribute the money as quickly as possible. 

“These programs are fashioned, and drafted and designed, and then within 60 to 90 days, get the money out, shut down the fund. Everybody try and move on as best you can after a tragedy,” Feinberg said in interview with CBC Radio’s Calgary Eyeopener.

Canadian law firm to help with fund distribution

Both Feinberg and Hatton said that the team administrators should get an adviser who the community supports to help them distribute the funds.   

In an update posted on the GoFundMe page on Friday night, the Humboldt Broncos announced the team was getting that assistance from a western Canada law firm.

“In the coming weeks, we will make an announcement about the process to distribute the funds —  know that we are working around the clock with our advisers to get the funds to our families as quickly as possible,” the post said.

“MLT Aikins LLP law firm has graciously agreed to support us pro bono as we bring together the right teams of professionals to help us work through the steps of distributing these funds. We appreciate your patience as this process takes time and thoughtful consideration.”

Keep fundraising?

Feinberg said the campaign should stop raising money now that the campaign has far surpassed its original goal of $ 4 million.

But Hatton disagrees. 

Even though it seems like a lot of money, he said, “you want to know that [the injured survivors] are going to be OK for the rest of their life. And right now it’s a big uncertainty. We don’t know exactly what the insurance will look like … we don’t even know what all the costs will be yet.” 

The extent of the costs arising from a devastating accident can be difficult to imagine, said Kevin Rempel, a Toronto-based Paralympian sledge hockey player who knows first-hand what it’s like to live with a traumatic injury.    

Paralympic sledge hockey player Kevin Rempel looks at the sledge hockey sticks he placed on the balcony of his Toronto condominium in memory of the Humboldt Broncos players, coaches and volunteers who were killed by the bus crash. (Mark Bochsler/CBC)

“I don’t even know where to begin,” he told CBC News. 

Almost 12 years ago, Rempel suffered a spinal injury in a motocross accident. He was a partial paraplegic and his doctors told him he would likely never walk again.

After intensive rehab, he eventually did learn to walk, but still endures significant pain and is limited in how much activity he can do with his legs.

What care will athletes need?

As of Friday evening, 10 people from the Humboldt Broncos crash remained in hospital, with two in critical condition, according to the Saskatchewan Health Authority. Little is known about their specific injuries, except that Ryan Straschnitzki,18 — is paralyzed from the chest down. 

For some severe injuries, including paralysis and brain injuries, financial support could be required to pay for 24-hour care for basic living tasks such as dressing, bathing and eating, Rempel said. 

But even if that level of care isn’t needed, he said, there are unexpected costs that begin right after leaving the hospital and continue through the recovery process — however long that is.


Humboldt Broncos defenceman Ryan Straschnitzki has said he wants to pursue sledge hockey after the bus crash left him paralyzed from the chest down. (Submitted by Tom Straschnitzki)

“Everything from … your medications, to if you need to use catheters, to a vehicle with hand controls to start driving yourself around again, to sending you back to school for re-education,” Rempel said. 

If someone needs to use a wheelchair, “modifying your home” is an enormous expense, he said. 

People often don’t think about the cost of psychological and emotional recovery, Rempel said.  

“I worked with a psychologist for three or four years because you have that mental trauma,” he said. “Rebuilding your identity, rebuilding your life, like, ‘Who am I now? Like, am I going to find love again or a relationship? How can I get through school when I’m going through challenges with my body right now?” 

“Those ongoing costs will live on for a while,” he said. 

Because the deaths and injuries resulted from a road accident in Saskatchewan, many costs will be covered by SGI, the province’s public insurance program. 

 “We do have a very comprehensive no-fault program,” said SGI president Andrew Cartmell. “I think it’s one of the best in the country.” 

Benefits available for people who are injured range from travel and accommodation costs for families visiting their loved ones in hospital to long-term rehabilitation and “trying to get the person back to … their previous standard of living,” he said.

The no-fault system helps eliminate delays in insurance payments while investigators determine the cause of vehicle crashes, Cartmell said. 

“We don’t care about who’s at fault in the accident. We care about rehabilitating and care right away and that’s we’re able to do.”

Families getting help with funeral costs

Saskatchewan insurance also covers funeral costs up to about $ 10,000, plus additional death benefits, including grief counselling. 

Although Cartmell could not confirm whether any insurance money had been provided to cover the funerals already underway for those who died in the crash, MacLean — the Broncos vice-president —  said no families have to front those expenses out of pocket.  

​Hockey Canada’s insurance program also covers the Humboldt Broncos players, coaches and staff, spokesperson Lisa Dornan told CBC News in an email. 

Dornan said crisis management staff from both Hockey Canada and insurance provider AIG were on-site in Humboldt “to help facilitate paperwork, phone calls, funeral arrangements, the provision of hospital records, travel arrangements in certain circumstances, guarantees to funeral homes, etc. — essentially, any task that can support and assist the families and team in facilitating the claims process.” 

Both SGI and Hockey Canada said that money received by survivors and family members from fundraising campaigns would not affect their insurance benefits.  

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