Public health officials are urging Canadians to dramatically limit their contacts with other people as the country continues on a “rapid growth trajectory” for COVID-19 cases and the holiday season begins.
This week’s approval of a COVID-19 vaccine has led to a groundswell of public optimism — but public health officials are warning the pandemic is a long way from over. Releasing new modelling from the Public Health Agency of Canada (PHAC) today, Chief Public Health Officer Dr. Theresa Tam said that if Canadians maintain their current contact levels, more than 12,000 new cases will be recorded daily by January.
If people increase their level of contacts, however, that number could surge to more than 30,000 cases daily by January, according to the modelling sheets.
PHAC modelling suggests combined efforts are “urgently needed” to bend the curve as outbreaks continue in long-term care facilities and First Nation communities, putting a strain on hospitals and regional health care systems.
Tam told a media briefing in Ottawa that only one per cent of Canadians have tested positive for the novel coronavirus, which means most Canadians remain vulnerable to infection.
3 weeks, 100K new cases
About 100,000 new cases have been reported across the country in just the last three weeks, with growth being driven primarily by the six provinces west of the Atlantic region. In recent weeks, each of these provinces has recorded its highest daily case count, and several also have seen their highest daily number of deaths to date.
“We have yet to see the kind of sustained decline in daily case counts that would indicate we are bringing the pandemic under control,” Tam said.
WATCH / Dr. Tam on impact of COVID-19 on health system
Chief Medical Officer, Dr. Tam, updates reporters with the rising number of COVID 19 cases in regions across the country and reveals modeling projections. 0:50
Health Minister Patty Hajdu said Canada is entering a tricky season, when people traditionally take a break from work to spend time with family. Despite the positive news on the vaccine front, she urged Canadians to be vigilant in practising public health guidelines because a “very clear danger” remains.
“We’re going to have to be very, very cautious over the next several weeks to protect those people who are counting on us to work together,” she said.
Hajdu urges collaboration
Asked if the government should impose more restrictive measures to stem the disastrous rise in cases, Hajdu said the best approach is for the federal government to collaborate with the provinces.
“Yes, it is a tragedy, I completely agree with you, that cases are rising,” she said. “They are rising globally. There are very few countries that are not seeing growth right now. But I will tell you this — I believe it’s that effort of partnership, that we-will-do-whatever-it-takes attitude, that will get our country through this.”
Short-term projections suggest there could be up to 577,000 cases and 14,920 deaths by Dec. 25.
As of Friday morning, Canadian public health officials were reporting a total of 443,922 cases and 13,154 deaths.
Today’s projections are particularly grim for First Nations, where the number of active cases has doubled in the last month. The current number of active cases is more than 20 times higher than the peak number during the first wave of the pandemic for First Nations on reserve.
As COVID-19 cases rise steeply across parts of Canada, some infectious disease experts are calling for a new strategy to curb the unruly spread of the virus.
The proposed goal is simple: whittle down case counts to zero, or at least close to it.
But doctors say it will be far more complicated to figure out how to reach that target, with some skeptics casting doubt as to whether it’s even realistic.
Advocates have taken to Twitter this week urging Canada to embrace an elimination-style strategy under the hashtag COVIDzero.
The aim of the approach is to wipe out the virus through stricter restrictions ranging from targeted closures to full-on lockdowns, bolstered testing and tracing capabilities and government relief for individuals and businesses.
While skeptics believe in the concept behind that idea, they worry it may fall short in execution.
“The goals are important — aiming for a low case number, an appropriate testing strategy, supporting people through contact tracing and isolation —that should be a part of our response,” said McMaster University’s Dr. Zain Chagla.
“But I don’t think we can plausibly achieve zero. And we have to be very, very careful and transparent about what this [strategy] would entail.”
Dr. Irfan Dhalla, an associate professor at University of Toronto who is among many doctors advocating for COVIDzero, has been arguing for an elimination strategy for months.
But he says the timing now is “urgent” as Canada’s average daily counts have climbed into the 5,000-range, and hospitals have begun facing “significant challenges” with overwhelmed intensive care units.
“We need more restrictions on activity than we have,” Dhalla said. “But we don’t necessarily need to prolong a lockdown.”
WATCH | Lockdowns and variations:
As COVID-19 cases continue to surge across Canada, provinces are implementing the short, sharp “circuit-breaker” lockdowns to fight the spread of the virus and prevent health-care systems from being overwhelmed. 1:58
Dhalla says places around the world have been successful in containing the virus by implementing elimination-type strategies, including Australia, New Zealand, Thailand and even Canada’s Atlantic bubble.
While a lengthy lockdown was needed in some of those areas — Melbourne had a strict shutdown lasting more than 100 days — Dhalla also pointed to places like South Korea, which relied on testing and tracing rather than a full lockdown, to show that it is possible.
Dr. Isaac Bogoch of the University Health Network “strongly doubts” a COVIDzero strategy can be achieved in Canada without a lengthy lockdown.
“And even if you do have lockdowns, like we did before, you still won’t get to zero unless you address the structural inequities that are driving COVID-19 in Canada,” he said.
Bogoch, like Chagla, sympathizes with the spirit of the COVIDzero movement, but questions if it’s feasible.
“If indeed you want to take an elimination strategy, it’s important to know what that involves,” Bogoch said. “At the end of the day, you can have all the hashtags and platitudes you want on social media. But there are very challenging hurdles to overcome to get to [a COVID zero] state.”
Businesses and low-income workers need support
He said one of the most significant obstacles will be convincing leaders at all levels of government to agree on a consistent message.
Officials would also have to provide “tremendous support” to businesses and low-income, marginalized workers to make up for lost revenues and employment cuts, said Bogoch.
There are also travel restrictions to consider, he said, pointing out that people in Melbourne were allowed only a five-kilometre radius for leaving their homes for essential purposes.
Canada had nearly 51,000 active cases as of Tuesday afternoon and more than 11,000 deaths since the pandemic began earlier this year.
Dhalla says that’s inexcusable at this stage in the pandemic.
“We’re losing several dozen Canadians every day to this virus, that at this point, we know how to prevent,” Dhalla said. “And we’re struggling in some hospitals, where we simply cannot provide the quality of care that we would like.”
Chagla agrees that pressure on hospitals needs to be lifted, noting that other plans of action have been brought forward recently to deal with the surge.
Some have argued for shorter “circuit breaker” lockdowns or targeted closures, while others have advocated for rapid testing to weed out new infections.
Chagla says a targeted closure approach appears to be working in Ottawa, where the spread has slowed down recently. But that may not translate to other hotspots like Brampton, Ont., where the positivity rate in some neighbourhoods is close to 20 per cent.
A period of lockdown could alleviate some of the strain on hospitals and contact tracing capacities, he said. But how close to zero cases would we need to get to before restrictions could lift?
Dhalla said it’s “less about a number than it is about the trajectory,” using Toronto’s daily average of 500 new cases as an example. As long as the number is increasing, restrictions would remain.
While Chagla concedes that a full lockdown is “likely on the table at some point,” he says we need to work harder this time to fix the root of transmission.
He estimates it would take five or six months of a full lockdown, while also boosting testing and tracing, for Canada to get to a truly zero state.
“I wish there was a simple answer to this,” he said. “But the thing is when you just do a lockdown and you don’t address problems in those communities, you’re going to see the same issues after the lockdown is over.”
Canada now has more than 70,000 confirmed and presumptive coronavirus cases after Ontario reported 361 new cases on Tuesday, bringing the province’s total caseload to 20,907.
As of 6 p.m. ET, provinces and territories reported a total of 71,157 cases, with 34,055 listed as recovered or resolved. A CBC News tally of coronavirus-related deaths in Canada based on provincial data, regional health information and CBC’s reporting stood at 5,283.
The majority of the deaths have occurred in long-term care homes, and the disease has hit the elderly the hardest in Canada.
On Tuesday, Prime Minister Justin Trudeau promised to help find long-term solutions to the tragedies unfolding in long-term care facilities, and said the government would provide additional aid to seniors, in the form of a one-time payment of up to $ 500 to help offset any increases in the cost of living due to the COVID-19 pandemic.
Seniors who qualify for Old Age Security will be eligible for a one-time, tax-free payment of $ 300, and those eligible for the Guaranteed Income Supplement will get an extra $ 200.
Trudeau was also asked Tuesday about easing restrictions at the U.S.-Canada border.
Ontario, one of the hardest-hit provinces in Canada, is among the provinces urging Ottawa to keep the border with the U.S. closed, a message top officials in B.C. echoed on Monday. Late last week, Ontario Premier Doug Ford said he didn’t want the border reopened and called for a “tenfold” increase of screenings at airports and border crossings once restrictions are lifted.
The current border deal with the United States, which prohibits non-essential travel between the two countries, is set to expire on May 21. Deputy Prime Minister Chrystia Freeland said Monday that talks between the federal government and the U.S. were ongoing.
WATCH | Canada will be ‘very, very careful’ on easing border restrictions, Trudeau says:
Prime Minister Justin Trudeau hinted that Canada is in no rush to ease restrictions at the U.S. border to allow for non-essential travel. 2:11
Dr. Bonnie Henry, B.C.’s top public health official, weighed in on the border question on Monday, saying that while there could be room for some leeway around issues like family reunification, “broad reopening of the borders is not in our best interest.”
B.C. Health Minister Adrian Dix reiterated that message and said Premier John Horgan had made his position known to the federal government.
“The premier has also repeatedly made this point to the prime minister: it’s our view that the border should not open to visitors at this time.”
Ottawa is looking at beefing up protocols around a requirement that any newcomers to the country self-quarantine for two weeks.
Trudeau said once Canada has controlled the spread of COVID-19, preventing transmission of the virus from outside the country into Canada “will be an essential part of ensuring that we don’t fall back into a second wave” that could be as serious or worse than the current outbreak.
WATCH | COVID-19: What has two months of physical distancing accomplished?
Experts answer questions about the COVID-19 pandemic two months after it was declared. 6:40
The novel virus, named SARS-CoV-2, causes an illness called COVID-19. There’s no proven vaccine or treatment for the virus, which first emerged in China. The novel coronavirus causes mild or moderate symptoms for most people. For some, especially older adults and people with existing health problems, it can cause more severe illness or death.
Public health officials have cautioned that case numbers are likely higher than reported figures because those numbers don’t include people who haven’t been tested and cases still under investigation.
Read on for a look at what’s happening in Canada, the U.S. and around the world.
Here’s what’s happening in the provinces and territories
British Columbia recorded seven new cases of COVID-19 Tuesday, bringing the number of people who have tested positive in the province to 2,360. Dr. Bonnie Henry, B.C.’s health officer, says there are no new community or long-term care outbreaks, although the province’s death toll reached 131 after another person died in a long-term care residence. Read more about what’s happening in B.C., where police say they are investigating another attack sparked by racist comments.
Alberta has released an online tool for businesses ahead of reopening. Dr. Deena Hinshaw, the province’s top public health official, says there’s no decision yet around whether to move into the next phase, but she said she sees some positive signs. “Hospitalizations and ICU admissions are down, recovered case numbers are up, and I am encouraged to see fewer daily new cases than even one week ago.” Read more about what’s happening in Alberta.
WATCH | Can government financing save Canada’s airlines?
New financing from the federal government could become a key factor in helping lift Canada’s airlines from a financial nosedive caused by the COVID-19 pandemic, industry experts say. 2:11
Manitoba health officials reported one new COVID-19 case Tuesday, bringing the province’s total to date to 290. The new case is related to a cluster at a workplace in the Prairie Mountain Health region in western Manitoba that has now reached 11 people. Officials say there is no cause for public concern about the cluster, as affected staff and their close contacts are all self-isolating. Read more about Manitoba.
Nova Scotia reported just one new case of COVID-19 on Tuesday, bringing the number of confirmed cases in the province to 1,020, with 864 of those considered resolved. But Dr. Robert Strang, the province’s chief medical officer of health, said while it’s “good news” to see the numbers go down, he wants to “caution everyone against reading too much into any single day or few days.” Read more about what’s happening in Nova Scotia, including Strang’s “slow, cautious approach” to reopening.
WATCH | Front-line workers hit hard by COVID-19:
Front-line workers, including grocery store workers, transit and taxi drivers, are a group that has been hit hard by the COVID-19 pandemic along with the homeless population. 2:41
From Reuters and The Associated Press, updated at 1:45 ET
Leading U.S. infectious disease expert Anthony Fauci on Tuesday warned Congress that a premature lifting of lockdowns could lead to additional outbreaks of COVID-19, which has already killed more than 80,000 Americans and brought the country’s economy to its knees.
Fauci, director of the National Institute of Allergy and Infectious Diseases, told a U.S. Senate panel that the outbreak is not yet under control in parts of the country.
“I think we’re going in the right direction, but the right direction does not mean we have by any means total control of this outbreak,” Fauci said during hours of testimony.
Fauci, who is also a member of the White House task force on coronavirus, also urged states to follow health experts’ recommendations to wait for positive signs, including a declining number of new infections, before reopening.
President Donald Trump has been encouraging states to end a weeks-long shuttering of major components of their economies.
WATCH | Highlights from Dr. Fauci’s testimony to the U.S. Senate:
Infectious disease expert Dr. Anthony Fauci says the U.S. is headed the right direction in fighting the coronavirus, but does not have it completely under control. 10:00
Asked whether college students can feel safe if classes resume on campuses in late August or early September, Fauci said that expecting a treatment or vaccine to be in place by then would be “a bridge too far.”
He also clashed with Sen. Rand Paul of Kentucky over school reopenings.
“As much as I respect you, Dr. Fauci, I don’t think you’re the end-all,” Paul said to Fauci during the hearing. “I don’t think you’re the one person who gets to make a decision.”
Fauci agreed he is not the end-all, but cautioned, “I think we’d better be careful that we are not cavalier in thinking that children are completely immune to the deleterious effects.”
Tesla’s Musk facing fines
Tesla CEO Elon Musk, meanwhile, reopened his California factory in violation of government orders, a move that was drawing both support and criticism online.
Tesla is restarting production today against Alameda County rules. I will be on the line with everyone else. If anyone is arrested, I ask that it only be me.
Among the supporters was Trump, who on Tuesday morning tweeted that Tesla’s San Francisco Bay Area factory should be allowed to open despite local health department orders that it stay closed except for minimum basic operations.
“It can be done fast & safely,” the president tweeted, joining many of Musk’s Twitter followers who back the defiance.
The restart defied orders from the Alameda County Public Health Department, which has deemed the factory a nonessential business that can’t fully open under virus restrictions. State law allows a fine of up to $ 1,000 a day or up to 90 days in jail for operating in violation of health orders.
The plant in Fremont, a city of more than 230,000 people south of San Francisco, had been closed since March 23. It employs about 10,000 workers.
Here’s what’s happening around the world
From The Associated Press and Reuters, updated at 3:45 p.m. ET
Lebanon’s government agreed on a “full closure” of the country for four days, the presidency said as the cabinet met on Tuesday to try to ward off a second wave of coronavirus infections. The closure starts on Wednesday night.
Spain is reporting 176 new confirmed deaths for coronavirus during the past 24 hours, bringing the country’s total death toll to 26,920. New infections confirmed by laboratory tests are up on Tuesday by 426. The total contagion, including antibody tests, stands at 269,520. The figures were slightly up from a day before, but records usually see an increase on Tuesday as unreported data over the weekend shows up in official statistics. Nearly 140,000 people have recovered after contracting the virus, Spain’s Health Ministry said.
France‘s death toll from COVID-19 rose by 348 to 26,991 on Tuesday. Only the United States, Britain and Italy have more reported deaths from the illness. President Emmanuel Macron’s government reiterated that it was ready to tighten restrictions again if necessary to slow the spread.
French children went back to school on Tuesday as the country is gradually lifting confinement measures, following two months of lockdown. Classes are capped at 10 students at preschools and 15 elsewhere.
The move comes a day after Switzerland opened up classrooms to many students.
Italy said it would give regions the power to roll back restrictions, in a move that is likely to see most remaining curbs lifted next week.
Indonesia’s death toll from the coronavirus outbreak breached the 1,000 mark on Tuesday, making it the country with the most COVID-19 deaths and the highest fatality rate in Southeast Asia. The COVID-19 task force spokesperson Achmad Yurianto confirmed 16 new deaths in the last 24 hours, taking the country’s death toll to 1,007.
The number of coronavirus fatalities has come under scrutiny in recent days as media reports and medical experts said the national death toll was likely more than double the official figure.
China is reportedly set to test all 11 million residents of Wuhan province, the epicentre of China’s COVID-19 outbreak, over the next 10 days.
WATCH | Freelance reporter Patrick Fok reports on mass testing and worries over a 2nd wave of coronavirus after an outbreak in northeast China:
Freelance reporter Patrick Fok reports on mass testing and worries over a second wave of the coronavirus after an outbreak in northeast China. 2:55
South Korean authorities combed through smartphone data, credit card statements and CCTV footage to identify people who visited nightclubs at the centre of one of Seoul’s biggest clusters. More than 100 new cases linked to the nightclubs have brought fears of a second wave of infections in a country held up as a coronavirus-mitigation success story.
Senegal announced the reopening of mosques and churches and easing of other restrictions, even as the largest one-day jump in cases was recorded on Monday.
The U.S. government has donated 1,000 ventilators to South Africa to help the country respond to COVID-19. South Africa has the most confirmed cases of the disease in Africa with more than 10,600, including 206 deaths.
Brazil reported 5,632 new cases and 396 additional deaths, bringing the national tally to 168,331 and 11,519 deaths. President Jair Bolsonaro declared gyms and hair salons as essential services that can stay open.
The country’s biggest homeless population has begun succumbing to COVID-19, and activists warn the worst is yet to come as colder weather bears down and shelters risk becoming hotbeds for infection. At least 22 homeless people in Sao Paulo have died from COVID-19 so far, according to city hall, and there are hundreds of suspected cases throughout the state, both on the streets and in shelters.
The dispatches from the front lines of the COVID-19 outbreak in northern Italy are chilling.
“Nurses with tears in their eyes because we can’t save everyone … Every ventilator becomes like gold.”
That was the message last week from Dr. Daniele Macchini, an Italian physician whose lengthy Facebook post was published in a local newspaper, translated into English and circulated on social media.
“And there are no more surgeons, urologists, orthopedists; we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us,” he wrote.
Three professors from the University of Milan also sent a letter warning doctors in the rest of Europe to “get ready,” because 10 per cent of patients who test positive for COVID-19 end up needing intensive care.
“This situation is like a bomb that explodes, and you’re simply overwhelmed by an incredible number of patients,” another Italian physician, Dr. Giacomo Grasselli, told the CBC News Network this week.
WATCH | Italian doctor says coronavirus is like a bomb that exploded:
Doctor at epicentre of Italian outbreak says coronavirus is a potential disaster for the entire world. 6:57
Grasselli is co-ordinating the intensive care response in Milan, the largest city in the country’s hard-hit northern region. All of Italy’s 60 million people are now under a sweeping lockdown, subject to travel and social restrictions aimed at curbing the spread of Europe’s worst outbreak of coronavirus.
“We’re living this now,” said Grasselli. “My mission is not only to take care of Italian patients, but also to tell other people in the world how to get ready for this.”
There’s still time to ‘flatten the curve’
Canada still has time to avoid such a situation, experts say.
As the global number of coronavirus cases nears 120,000 people in 115 countries, chances of stopping its spread are now considered unlikely. So public health officials have turned their attention to slowing it down.
And the key is to “flatten the curve” — a reference to an epidemiological graph of a disease outbreak.
A large spike on that graph, representing a sudden increase in people with infections, can be catastrophic even for health-care systems in highly developed countries like Canada.
“If you can slow it down enough and flatten the curve, so the same number of people get infected, but over a much longer period of time, then … what you’re allowing is that the capacity will not be exceeded,” said Dr. Anand Kumar, a critical care physician at Winnipeg’s Health Science Centre.
“And that protects the community, so that an ICU bed will be available when it’s needed.”
Most healthy people will experience a mild COVID-19 infection because their immune system will protect them. But so far, the experience in Italy and China suggests that as many as 10 per cent of people infected can require critical care.
That creates an urgent need for beds in intensive care units, along with ventilation, dialysis and other life support technology. It also requires qualified health-care specialists to manage patients — excess capacity that Canadian hospitals just don’t have.
We’re at capacity most of the time.– Dr. Robert Fowler, critical care physician and researcher
Most of the country’s hospitals are already operating at 100 per cent capacity, a largely normal situation in Canada’s health-care system.
“We’ve got a system that is designed to meet what our usual demands are,” said Dr. Robert Fowler, a critical care physician at Toronto’s Sunnybrook Hospital. “We’re at capacity most of the time.”
Add to that the extra load from this year’s bad flu season, and suddenly, even in Canada, there’s a risk that care might not be available when patients need it.
“Ideally, you prevent people from being infected — but you certainly don’t want to have everybody infected at once,” said Fowler. “We don’t want to overwhelm the system.”
But the Italians warn that could happen.
“If you do not stop the spread of the disease, your health system — no matter how good, how efficient, how modern it is — sooner or later will collapse,” said Grasselli. “Because the number of patients is too high for the resources we have everywhere in the world.”
That’s why in Canada (and elsewhere) large events are being cancelled, some people are being told to work from home, and some students will be taking courses online for a few weeks. It’s a temporary public health strategy aimed at slowing the potential spread and buying time.
“That’s what people are trying to do to try to prevent the spread right now so we don’t get overwhelmed,” said Fowler. “And it’s going to very much depend on how effective we are at preventing transmission in the community.”
Another complicating factor is the fact that there is no vaccine and there are no drugs to treat COVID-19.
“In this particular circumstance, we’re not going to have a vaccine for at least a year, if not a year-and-a-half,” said Kumar. “And there’s no known antiviral drug for coronavirus, so essentially all we can offer is supportive care.
“If you get mildly ill, there’s not something we can give you to stop you from getting severely ill. So what’s going to happen is going to happen. And we’re just going to have to try to support patients as best we can.”
The importance of beds, ventilators
Fowler led a team of researchers that conducteda survey of Canada’s critical-care capacity after the 2009 H1N1 epidemic. At the time, there were about 3,200 ICU beds and almost 5,000 mechanical ventilators spread out in 286 hospitals across Canada.
Ventilators are mechanical breathing machines that will be critical for COVID-19 patients whose lungs are so badly damaged they have trouble getting enough oxygen.
The survey concluded that intensive care resources vary widely across Canada and “during times of increased demand, may result in geographic differences in the ability to care for critically ill patients.”
Ontario, for example, had an extra 209 ventilators stockpiled and spread out across the province as of last August, according to one provincial document.
“The physical space within a hospital to care for people is, I think, probably even more challenging beyond the physical number of ventilators,” said Fowler.
Kumar is particularly concerned about the number of qualified staff to handle a possible surge in patients.
“The bottleneck is in manpower, even more than physical space and even ventilators,” he said. “I think everybody is contingency planning for the possibilities.”
Some of the challenges now relate to approaching the management of COVID-19 on a national scale — and being ready to help regions that are hit harder, experts say. That may involve moving equipment and health-care workers to where they are most urgently needed.
“There’s patchiness in where these outbreaks hit,” said Fowler. That means doctors and nurses can be completely overwhelmed in one place, but it can be business as usual in the rest of the country.
In Italy, health-care workers are already talking about the grim reality of “triaging” under strained circumstances, which means they’re being forced to choose between life and what might have been a preventable death for some people, based on the availability of ventilators and ICU beds.
Canada has studied the concept of such triaging, but Fowler said so far no system has been established.
“In Canada, we don’t really have a working example of what that would look like and we haven’t had to do that,” he said.
“We shouldn’t be having that conversation ahead of the conversation about when a place gets busy, how can we bring support.”
The Quebec government has promised to hold “at least one day” of public consultations about its intention to allow people with mental illness to seek a medically assisted death.
Health Minister Danielle McCann was facing outcry after announcing earlier this week that the government would comply with a Superior Court decision that struck down the “end-of-life” requirement in Quebec’s law on medically assisted death.
McCann’s announcement meant that as of March 11, medically assisted death would be accessible to people with mental illnesses, as well as others with incurable but not terminal symptoms.
That sparked concern the government was pushing ahead with a major change without thinking through the consequences.
McCann responded to the pressure on Thursday, saying a public consultation will take place next month. It may include an online component.
The minister also sought to reassure those who feared the new policy will make it too easy for people with mental illnesses such as depression to receive a medically assisted death.
“We’re talking about exceptional cases,” McCann said Thursday in an interview with Radio-Canada.
“We’re talking about people with extremely severe, persistent disorders, decades of inefficient treatments — people who are resistant [to treatment]. It’s a very small number of people who would be able to receive medical aid in dying in this context.”
McCann has asked the Quebec College of Physicians to draft guidelines for determining when a patient with mental illness can qualify for the procedure.
These requests will take time in order to be properly evaluated, said Dr. Yves Robert, a representative of the college.
“Several mental disorders involve a wish to die as a symptom,” he said. The challenge for doctors will be distinguishing between a wish to die that is a symptom, and one that is “free and informed.”
Robert said it was important to remember that not all requests for a medically assisted death are granted. “It’s a constitutional right to make the request. But it’s a conditional right to obtain it.”
Quebec entering ‘grey zones:’ expert
But even with McCann’s promise to hold public consultations, opposition parties remained worried the government was pressing ahead too quickly.
“It’s clear more time is needed,” said Véronique Hivon, the Parti Québécois’s critic for end-of-life care, who also played a key role drafting Quebec’s assisted dying law.
Hivon said the government should have asked the court for an extension.
“You can’t just be in a legal bubble and say there’s a judgment and it’s going to land like that, like magic, without preparing things,” she said.
Hivon’s concerns were echoed by a leading expert on the issue. Éric Racine, who heads a health ethics research unit affiliated with the Université de Montréal, said the Superior Court ruling threw Quebec into uncharted territory.
“We’re in grey zones here and we’re at the very beginning of what should be a debate, but is going fast, fast, fast at the legislative level,” said Racine.
“The need for dialogue may be even more crucial, but we haven’t really been able to prepare for this.”
Racine said the Superior Court decision, which removed the end-of-life requirement, is prompting Quebec to think hard about the ethics of well-being.
Without that requirement, more weight will be placed on the evaluations done by the health professionals considering the application for an assisted death. In mental health cases, these are more subjective, Racine said.
“As you can easily understand this is not easy…. These are assessments that need to be thoughtful,” he said.
“It raises questions about how we view suffering and the well-being of the person.”
The global average temperature is set to rise to at least 1.2 to 1.3 degrees Celsius above pre-industrial levels over the next five years, a World Meteorological Organization (WMO) official said on Monday, close to a limit adopted in a global treaty.
The prediction comes as governments are due to meet in New York for the UN Climate Action Summit to build on their pledges from the 2015 Paris Agreement, which aims to cap the global temperature rise at 1.5 degrees.
The agreement, adopted by almost 200 nations, set a goal of limiting warming to “well below” a rise of 2 C above pre-industrial times while “pursuing efforts” for the tougher 1.5 C goal.
A rise of 2 C is expected to wipe out more than 99 per cent of coral reefs and melt most of the sea ice in the Arctic.
“Basically we are on track to reach at least 1.2 to 1.3 degrees centigrade [above pre-industrial levels] over the next five years,” Omar Baddour, WMO senior scientific officer, said in response to a Reuters question at a Geneva news conference.
“It needs drastic actions,” he added.
The comments came after the UN agency released a report on Sunday showing that the period from 2015 to 2019 was set to be the warmest five-year period on record, rising by 0.2 degrees Celsius over 2011-2015.
“Not only are these statistics alarming they dispel any false sense of security that maybe we will muddle through this,” said Maxx Dilley, director of the climate prediction and adaptation division of the WMO, told journalists.
“There is going to have to be a dramatic scale up in the level of ambition and as well as in the level of actual follow through on the current policies that are intending to address this,” he added.
The WMO report also showed record carbon dioxide and other greenhouse gases in the atmosphere recorded over the same period, with the pace of carbon dioxide growth up 20 per cent versus the last five-year assessment.
There is a lag in the period that the world’s climate responds to carbon dioxide and other gasses, meaning that the emissions produced today can affect temperatures 20 years later, Dilley added, locking in the warming trend.
Referees have been told by the head of French soccer to ignore a FIFA directive and no longer stop matches when there is homophobic chanting.
In response, anti-discrimination groups urged Noel Le Graet, the French Football Federation president, to resign.
Several league games in the top two French divisions have been halted by referees this season. But Le Graet wants referees to let play continue if there are more homophobic chants, starting from this weekend.
“To say that football is homophobic, and could be the only symbol of homophobia in France, that’s a bit strong. I don’t accept it,” Le Graet told France Info radio station on Tuesday. “We’ll make sure there are no more banners (in stadiums); that’s different. But stopping games, no.”
Le Graet said he is against homophobia but added that matches should be stopped only in cases of racism — such as racist chanting or monkey noises aimed at black players — or security problems such as fan violence.
“Stopping matches (for homophobic chanting) doesn’t interest me. It’s an error,” Le Graet said. “I would stop a game for racist chants, that is clear. I would stop it for a fight, for incidents, if there is a danger somewhere inside the stadium.”
FIFA earlier this year reminded federations and referees to follow a three-step procedure which allows them to stop, suspend and ultimately abandon a game if discriminatory behaviour persists. FIFA did not respond to an email requesting comment on the order from Le Graet, who is also a member of the world soccer body’s ruling council.
The Rouge Direct group, which campaigns against homophobia in French stadiums and sport, called on Le Graet to resign and withdraw his comments immediately.
Spokesman Julien Pontes said the group would go to court if he refuses to do so, saying it would argue that the FFF boss was discriminating between different forms of discrimination and making homophobia appear less of an issue than racism.
Calls for resignation
“He must leave,” Pontes said of the FFF head. “At a minimum, he must withdraw what he said.”
French President Emmanuel Macron and sports minister Roxana Maracineanu also weighed in on the issue.
“Football should reconcile everyone. And I think that when football reconciles everyone, it should also carry our country’s values of unity,” Macron said. “I’m myself a football fan, I’m not naive. We know what it is when a stadium heats up, and sometimes the insults, to say the least, that fly. I’m not about to say that all this should end. But we can’t explain every day to our young people, and less-young people, that they must restore decency to the country, that they must stop the violence and to say at the same time that we must accept the worst.”
Maracineanu rebuked Le Graet and reminded him of his leadership responsibilities in the “fight against all forms of discrimination,” adding that she will continue to “watch over the protection of all our citizens.”
Last month, Maracineanu congratulated referee Mehdi Mokhtari for interrupting a second division game between Nancy and Le Mans after homophobic chanting.
French anti-racism organization SOS Racisme earlier also hit out at Le Graet, saying in a statement that “his words contribute to undermining the efforts” made in the fight against all forms of discrimination — be it racism, homophobia or sexism.
“It’s time for Noel Le Graet to retire,” SOS Racisme said.
The high-profile first division match between Nice and Marseille on Aug. 29 was halted for several minutes during the first half after Nice fans unfurled three banners with homophobic messages. There was also sporadic chanting against the French league with an anti-gay slur.
Le Graet urged stadium stewards and security officials to do a better job in preventing fans from bringing banners to games.
“Don’t come to stadiums with banners, it’s as simple as that,” he said. “We’ll make sure that they won’t be able to get in.”
It has come up on the margins, but the increasingly violent clashes in Hong Kong have barely registered on the formal agenda of G7 leaders meeting in Biarritz, France.
At least one expert says the crisis is a crucial test for the world’s major democracies — one they may be failing.
A Hong Kong police officer fired a gunshot during protests on Sunday, the first time live ammunition has been used since demonstrations broke out.
Water cannons have also been deployed by authorities and protesters have reportedly lobbed bricks.
At least 36 people were arrested Sunday. Dozens were injured on Saturday in a sharp escalation of violence, after a senior Hong Kong official warned China’s military could intervene during any civil unrest.
I think it represents what democracies are about– Colin Robertson, former diplomat
The importance of the world’s leading liberal democracies presenting a united front on events in the former British colony cannot be understated, said Colin Robertson, a former diplomat and vice-president of the Canadian Global Affairs Institute.
“I think it represents what democracies are about.”
Hong Kong, which counts approximately 300,000 Canadian-Chinese citizens, is perhaps the most cosmopolitan city in Asia, and its political autonomy was guaranteed by international covenants.
The potential violation or even the stealth dismantling of its political and economic freedoms would be a major blow, and having G7 leaders lay down a marker in the face of authoritarian threats — veiled or otherwise — is important.
“If we give China a pass, which I believe [U.S. President Donald] Trump would be inclined to do, then I think you begin to wonder,” said Robertson.
“We [democracies] are really on our back foot because around the world, we’re losing, and we appear to be losing in so many places.”
The leader to watch, given his country’s long history in Hong Kong, will be newly installed U.K. Prime Minister Boris Johnson, Robertson added.
“Where does he come from on this? I think his inclination might be to just put it under the table.”
The issue of Hong Kong was raised at least twice in bilateral discussions Prime Minister Justin Trudeau had with Johnson and Japan’s Shinzo Abe.
Canada and the EU issued a joint statement on Hong Kong earlier this month, calling for China to show restraint.
“It is crucial that restraint be exercised, violence rejected and urgent steps taken to de-escalate the situation,” said the Aug. 17 statement.
“Fundamental freedoms, including the right of peaceful assembly, and Hong Kong’s high degree of autonomy under the ‘one-country, two-systems’ principle, are enshrined in the [Hong Kong] Basic Law and in international agreements, and must continue to be upheld.”
The statement drew a sharp, personal rebuke for Canadian Foreign Affairs Minister Chrystia Freeland from Chinese authorities.
A Canadian official going into the weekend’s gathering said there hasn’t been much indication from the other countries that they consider Hong Kong a major topic for the leaders beyond where it might fit in an overall discussion about China.
RaniaKhunaysir didn’t see it coming when she booked a last-minute Caribbean vacation for her young family.
The Toronto parent had no idea the airplane cabin would be fumigated with them on board just before they landed in Jamaica, despite guidelines that say passengers should be clearly and repeatedly informed of the requirement before they fly.
“Suddenly there was an announcement on the intercom saying that [flight attendants will] be walking down the aisle spraying a non-toxic insecticide … I thought insecticide doesn’t sound non-toxic,” Khunaysir told Go Public about the family’s flight last August.
Khunaysir’s husband Randy Beharry and their three-year-old daughter are both asthmatic. The couple’s son, who was seven months old at the time, was also on the flight.
“I was worried about my kids.” Beharry said. “My asthma triggered probably within minutes. I had a hard time breathing,”
The experience left the family concerned about potential health impacts of the spray and calling for strict rules that require passengers to be clearly informed before they fly.
“I don’t want to be inhaling this pesticide,” Khunaysir said.
More than two dozen countries, such as Jamaica, the Dominican Republic and Mexico, require airlines to spray insecticides on flights that arrive from Canada. The process is meant to kill insects that could spread disease.
Beharry and his daughter are both asthmatic. He says his asthma was triggered after the plane was sprayed with pesticide and he had to use his inhaler. (Oliver Walters/CBC)
The World Health Organization has said it has found no evidence the sprays used are harmful to human health when they are used as recommended, but also says non-chemical methods need to be found.
The long-standing practice is raising concerns among some health experts.
“There is no such thing as a non-toxic pesticide,” said researcher Chris van Netten, a professor emeritus with the University of British Columbia’s school of population and public health.
He calls the widespread system of spraying pesticides “not acceptable” and said airline crew members and passengers need to be better informed and protected — especially children, older travellers and those with respiratory problems.
Josie Ball wants passengers to be informed about pesticide use before they get on a flight. She now brings a mask with her when flying to destinations she knows require spraying. (Robert Krbavac/CBC)
Frequent flyer brings her own mask
Frequent traveller Josie Ball from Selkirk, Ont., flies to Cuba several times a year with Sunwing and said she was shocked the first time she was on a flight where the cabin was sprayed.
She said people on her flight in April 2018 were coughing and wheezing.
“I think the public should have been aware … that there is a spraying in these countries … and [told] a little bit more about the chemical they’re spraying,” she said.
She now takes her own mask when she’s travelling to hotter countries.
Harlene Hart from Newington, southeast of Ottawa, was on her way to Cuba on another Sunwing flight in February, a birthday present from her boyfriend, when the cabin was sprayed with pesticide about an hour before they landed.
“Insecticide should be sprayed in a well-ventilated area,” she told Go Public in an email. “Not a sardine can with partially reused air.”
What upsets her most, she said, is that she wasn’t clearly notified before she purchased her ticket. She said she wouldn’t have taken the trip if she had known.
Canadian airlines are not obligated to let passengers know before they fly that the cabin will be sprayed with insecticide — despite studies cited by health experts Go Public spoke with who say the spraying can cause serious asthma attacks, skin irritations and long-term problems with the nervous system.
Transport Canada said there’s nothing it can do, but the transportation authority does acknowledge the practice could pose a “foreseeable hazard.”
The video below was posted by YouTube user ScottTheCoffeeGeek. It is unverified, but appears to show a flight attendant on a China Eastern flight carrying out the “top-of-descent” disinsection procedure, which involves spraying while passengers are on board.
Go Public found an advisory issued in 2009 where the department said passengers with respiratory issues need to be clearly informed before they fly so they can get “advice from their own physician … on whether they should travel to those destinations.”
That advisory sets guidelines — not rules — saying airlines should notify passengers:
• Before they purchase their tickets. • On the flight ticket itself. • Before boarding the aircraft.
None of the four Canadian airlines that travel to these destinations informs passengers using all three methods.
WestJet points out that disinsection is only required on four of the 20 countries it flies to, and two other airlines that fly to these countries — Sunwing and Air Transat — say they are complying with guidelines by putting the information on their websites and telling passengers who ask.
Air Canada also requires passengers booking online to click on a box agreeing to the airline’s “General Conditions of Carriage.” Halfway through that document there is information about the spraying being carried out on certain routes.
The airline also mentions aircraft disinfection on its “Health Tips” section of the website and provides a link to that section on the itinerary emailed to passengers who book directly with Air Canada.
However, passengers won’t see that link if they book through third party websites like Khunaysir did when she booked her Air Canada flight.
Van Netten, who has studied the effects of repeated exposure to pesticides, said the message that insecticide will be used in plane cabins isn’t getting through. He said airlines and Transport Canada can do better.
“People have a right to know what they are going to be exposed to.”
Researcher Chris van Netten at the University of British Columbia has studied the effects of spraying pesticides on planes. He says the practice is nothing new, but that passengers need to be better informed. (Ana Komnenic/CBC)
The practice of fumigating an airplane’s cabin started decades ago. It’s mandated by governments outside Canada and considered necessary to control potentially deadly diseases that can be transmitted via insects — such as malaria and yellow fever — before entering certain tropical countries.
Twenty-seven countries require Canadian airlines to spray. Two methods are used, according to the Transport Canada website: spraying aerosol insecticides in the cabin while passengers are onboard and treating the airplane’s interior surfaces before passengers board.
“Both of them have their problems,” van Netten said.
He said the second method leaves toxic residue on surfaces travellers eat and sleep on, noting recent studies have drawn a link between both methods of spraying and effects on the nervous system.
“Tingling in the fingers for instance — that’s how it would start. And it can go all the way up to a neurological impairment … but that takes a lot of exposure to get to that stage.”
The spray often contains an insecticide called Permethrin, a pesticide that’s been approved by the World Health Organization for what’s called “disinsection” on flights.
‘Report about skin peeling off’
Troy Winters from the Canadian Union of Public Employees says he’s concerned about potential long-term effects of pesticides on airline employees. (Jacy Schindel/CBC)
The union representing flight attendants in Canada is also worried about the spraying.
“We get reports of a sore throat, sore eyes … lots of skin conditions,” said Troy Winters, senior health and safety officer for the Canadian Union of Public Employees.
“I’ve got a recent report about skin peeling off of the inside of somebody’s hand and we had one fairly serious asthma reaction.”
He’s concerned about the long-term effects of repeated exposure on airline staff, saying some can be exposed to the spray more than 100 times during their career.
“Recently I’ve started to see some reports of potential longer-term results and I’m concerned about potential long-term neurological effects.”
There are no industry-wide rules on what, if any, protective gear flight attendants wear while fumigating.
All the airlines say they provide training and safety equipment to staff.
Winters would like to see the Canadian government put pressure on the destination countries to reduce the use, suggesting a review of whether a flight leaving Canada in the dead of winter really needs to be fumigated.
There are 27 countries that require Canadian airlines to spray incoming flights with pesticide.
The search for a safe alternative
The U.S. has a law that requires airlines to disclose disinsection on their website and refer travellers to the specific section when they buy a ticket.
The Federal Aviation Administration’s Reauthorization Act also recommends the U.S. government work with WHO to find a “safe, effective, and nontoxic means of preventing the transportation of disease-carrying mosquitoes and other insects on commercial aircraft.”
There are non-spraying methods being developed, like a mechanical air curtain that blows everything out in one direction, but they are still in the testing stages.
WHO says the chemicals used pose no risk to human health when used properly, but when it reviewed current disinsection practices in 2018, it said there is a need for new “nonchemical” methods.
For now, travellers have few options — such as choosing to travel to countries that don’t require spraying, travelling with a mask to put on before the spraying starts and being sure to wipe down all surfaces on the plane when passengers settle in.
‘Let’s go somewhere else’
Khunaysir and Beharry say given the age of their children and asthma issues, they would have chosen another destination if they were told ahead of them that they’d be sprayed.
“I’m really surprised that they allow this to continue,” Khunaysir said.
“I would’ve had no problem saying, ‘Let’s change our destination, let’s go somewhere else, where they don’t require that.'”
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Health Canada's recent warning that homeopathic remedies are not an alternative to vaccines doesn't go far enough to prevent the damage the products could do as the country fights off a resurgence of measles, doctors and health policy experts say.
'It's nonsensical to have these products licensed by Health Canada," said Dr. Mark Loeb, director of the infectious diseases division at McMaster University in Hamilton.
The federal government is investigating reports that some homeopathic and naturopathic practitioners in British Columbia have promoted homeopathic products called "nosodes" (also marketed as "homeoprophylaxis") as alternatives to conventional vaccinations.
"Nosodes are not, and never have been, approved by Health Canada to be vaccine alternatives," a safety alert issued by the department earlier in March said. "No homeopathic products should be promoted as an alternative to vaccines because there are no substitutes for vaccines."
Children given homeopathic remedies instead of vaccinations "are at risk of developing serious and potentially fatal childhood illnesses such as measles, mumps, rubella, polio and whooping cough," the statement said.
Health Canada requires labels on homeopathic nosodes to include statements that the product is "neither a vaccine nor an alternative to vaccination," that it "has not been proven to prevent infection" and that "Health Canada does not recommend its use in children," it said.
The warning comes as at least 17 cases of measles have been confirmed in B.C. this year, as well as cases in Nunavut and Ontario and several outbreaks in the U.S.
Public health officials on both sides of the border say false information spread by anti-vaccination groups is fuelling fear among parents, making them hesitant to vaccinate their children.
Dr. Mark Loeb, director of the infectious diseases division at McMaster University in Hamilton, hopes the results of his study showing that homeopathic alternatives have no immunization effect will help convince hesitant parents that vaccination is the only way to protect their children against diseases such as measles. (McMaster University)
According to the Public Health Agency of Canada, communities need a vaccination rate of 95 per cent to be adequately protected against measles. If vaccination coverage drops below that, the risk of infection rises — along with the risk of undoing decades of progress that led to measles elimination in Canada back in 1998.
As proponents of homeopathic remedies claimed they could provide a "natural" alternative to vaccines, Loeb led a randomized, blinded, placebo-controlled trial to do a "head-to-head comparison" between homeopathic nosodes and conventional vaccines given to university students.
Apprehensive parents who had not vaccinated their children but are aware of the growing risk of measles have emailed him to ask about his findings.
"It's a prime example of vaccine hesitancy," Loeb said. "They seem to be on the fence, you know? They're worried about measles outbreaks and they're worried about conventional vaccines."
Loeb hopes his research will put their doubts to rest and help them understand there are no alternatives to conventional vaccines when it comes to protecting their children's health.
Health Canada needs to help reinforce that point, he said, by ceasing approval for homeopathic nosodes — not just warning people about them.
"They should not be sold. There's no reason for these to remain on the market," Loeb said.
'Can contribute to vaccine hesitancy'
The promotion of homeopathic remedies in general can play into common strategies used by anti-vaccination proponents to spread misinformation, said Dr. Vinita Dubey, the city of Toronto's associate medical officer of health.
That misinformation includes "false logic that natural things are good and safe, while unnatural things are not … the argument that governments promote vaccination because of influence from pharmaceutical companies [and] selectivity in choosing which scientific papers to focus on," Dubey said in an email to CBC News.
"Homeopathy can contribute to [the] vaccine hesitancy issue in so far as it uses the above techniques to falsely convince the public that vaccines are not safe," she said.
Homeopathic claims can play into the kind of misinformation spread by anti-vaccination groups, says Dr. Vinita Dubey, associate medical officer of health for Toronto Public Health. (Keisha Mair/Toronto Public Health)
"The research and evidence show that vaccines are safe and effective and a necessary public health intervention that has saved millions of lives."
Homeopathy is based on an unproven theory rejected by modern science — that water can be exposed to bacteria, viruses, plants or minerals and then retain a memory of them, even after all traces of the substances have been eliminated through dilution — and that the water's "memory" can treat diseases. There is no evidence to show that the water products have any medical benefit beyond a placebo effect.
Health Canada itself says that homeopathic remedies are not approved "for the treatment of any medical condition or to prevent infection."
But it still continues to license them as "natural health products," which have a different threshold for evidence than medications or vaccines.
For homeopathic remedies, "evidence usually consists of references to traditional homeopathic textbooks, which are not based on modern science," a spokesperson for Health Canada said in an email.
Even though Health Canada bans the promotion of homeopathic remedies as vaccine alternatives, the fact that it licenses them at all is harmful, especially in the midst of a vaccine misinformation crisis, said Timothy Caulfield, Canada research chair in health law and policy at the University of Alberta.
"It's this kind of token of legitimacy that can be used by those marketing homeopathy," Caulfield said. "Even if they're not necessarily saying it's an alternative to vaccines, it's often implied, right? 'Boost your immune naturally' — a lot of naturopaths claim that you can do that and then they offer a homeopathic treatment."
The rise of vaccine hesitancy highlights the importance of tougher regulations to curb unproven health products, Caulfield said.
"It's kind of a warning sign of how the spread of misinformation is starting to have a tangible impact," he said.
Timothy Caulfield, Canada research chair in health law and policy at the University of Alberta, says Health Canada needs to stop licensing unproven homeopathic remedies and that naturopaths should take homeopathy off their roster of therapies. (Timothy Caulfield/University of Alberta)
Caulfield agrees with Loeb that Health Canada should stop licensing homeopathic remedies. But he also thinks naturopaths — as a regulated health profession — should take responsibility.
"If they really are a science-based profession, then their regulatory body should say, 'stop providing homeopathy, period,'" he said. "If the colleges [of naturopathy] aren't willing to do this … then I think we need to revisit how we regulate these kinds of professions."
Naturopaths are pro-vaccine, colleges say
According to the Canadian Association of Naturopathic Doctors, naturopathy "blends modern scientific knowledge with traditional and natural forms of medicine" through a variety of therapies — of which homeopathy is one.
But the association "recognizes the value of vaccines" and "fully supports Health Canada's position on nosodes — they are not an alternative to vaccines," said executive director Shawn O'Reilly in an email to CBC News.
"In fact the childhood immunization schedule is taught in the curriculum of the accredited naturopathic medical programs and students must meet the clinical competencies for immunization education in order to graduate," he said.
The College of Naturopathic Physicians of British Columbia — where some naturopaths were promoting homeopathic alternatives — says that conduct is in violation of its "immunization standard" and that it supports vaccination.
"Naturopathic doctors are part of the effort to reduce vaccine hesitancy. They are uniquely positioned to educate patients who, due to misinformation and fear, may otherwise forego or have limited contact with allopathic [conventional] medical care, including access to and information about vaccinations," said PhillipaStanaway, the college's registrar and CEO, in an email to CBC News.
"When patients inquire about the use of nosodes instead of vaccinations, naturopathic doctors are obliged to inform them that nosodes are not a safe or effective alternative to vaccinations," she said.