Tag Archives: experts

George Floyd died of oxygen loss, not pre-existing conditions or overdose, prosecution experts say

George Floyd’s pre-existing medical conditions and drugs in his system had nothing to do with his death, two medical experts for the prosecution testified at Derek Chauvin’s murder trial Thursday. Rather, a combination of actions during his arrest that deprived him of oxygen caused his death, they said.

“Floyd died from a low level of oxygen, and this caused damage to his brain that we see, and it also caused a PEA (pulseless electrical activity) arrhythmia that caused his heart to stop,” Martin Tobin, a lung and critical care specialist at the Edward Hines Jr. VA Hospital and Loyola University’s medical school in Chicago, told Hennepin County District Court.

Tobin said handcuffing Floyd and pinning him face down to the pavement — along with the knees of Chauvin pressed into his neck and back, all combined to reduce his ability to breathe and, ultimately, killed him.

“A healthy person subjected to what Mr. Floyd was subjected to would have died as a result of what he was subjected to,” Tobin said.

‘Pressure on his chest and back’

Dr. Bill Smock, a Louisville, Ky., physician and expert on deaths from asphyxia, agreed that Floyd died “because he had no oxygen left in his body,” as a result of “pressure on his chest and back.”

Floyd, a 46-year-old Black man, died on May 25, 2020, after Chauvin, who is white, pressed a knee on the back of his neck and back for around nine minutes as two other officers held him down. Video of the arrest captured by a bystander prompted widespread outrage, setting off protests over race and police brutality across the U.S. and around the world.

Chauvin, 45, a former Minneapolis police officer, is facing trial on charges of second-degree unintentional murder; third-degree murder; and second-degree manslaughter. Thursday marked the ninth day of the trial.

The prosecution says Chauvin pressing his knee into Floyd’s neck while detaining him on suspicion of using a counterfeit bill at a convenience store, caused his death. But the defence argues Chauvin did what his training taught him and that it was a combination of Floyd’s underlying medical conditions, drug use and adrenaline flowing through his system that ultimately killed him.

Floyd suffered from heart disease and high blood pressure, while toxicology results revealed fentanyl and methamphetamine in his system.

WATCH | Expert explains why fentanyl overdose is unlikely to have caused Floyd’s death:

Dr. Bill Smock, an expert on deaths from asphyxia, said that based on the actions of George Floyd, there was no evidence he overdosed on fentanyl. 0:22

However, Tobin dismissed any suggestion that fentanyl in Floyd’s system led to his death, saying that based on his calculations, Floyd’s respiratory rate before he lost consciousness would have been much lower if this was the case.

“Do any of those conditions have anything to do with the cause of Mr. Floyd’s death, in your professional opinion, whatsoever,” prosecutor Jerry Blackwell asked Tobin.

“None whatsoever,” he replied.

Instead, Tobin went through a detailed examination of Floyd’s death, based on medical records, videos and interviews. Tobin said four things contributed to Floyd’s lack of oxygen: That he was handcuffed; put in the prone position face down on the ground; that Chauvin’s knees were pressed into Floyd’s neck and back; and that his chest was pinned against the pavement, unable to fully expand.

All of these four forces are ultimately going to result in the low tidal volume, which gives you the shallow breaths,” he said. 

In this image from video, prosecutor Jerry Blackwell poses questions in the trial of former Minneapolis police officer Derek Chauvin, who is charged with murdering George Floyd. Two medical experts for the prosecution testified Thursday that Floyd died because of a lack of oxygen caused by the way he was restrained by Chauvin and other officers during his May 2020 arrest. (COURT TV/Associated Press)

Tobin said the way the police were pushing down on Floyd’s handcuffs, combined with Floyd being pressed against the hard pavement, had the effect of putting his left side in a vise “that totally interfere(s) with central features of how we breathe.”

“There was virtually very little opportunity for him to be able to get any air to move into the left side of his chest,” he said.

“He’s jammed down against the street. And so the street is playing a major role in preventing him from expanding his chest.”

Prevented from expanding chest

Based on videos of the arrest, Tobin said, he calculated that half of Chauvin’s weight , 91.5 pounds, came down directly on Floyd’s neck. 

Tobin explained to jurors what happens as the space in the airway narrows. Breathing then becomes “enormously more difficult,” he said, comparing it to “breathing through a drinking straw,” although he later clarified it would be much harder than that.

Tobin also explained that Chavin’s knee on Floyd’s neck “is extremely important because it’s going to occlude (stop) the air getting in through the passageway.”

“Officer Chauvin’s left knee is virtually on the neck for the vast majority of the time,” he said.

Under cross examination, Chauvin’s lawyer, Eric Nelson, argued that Tobin was making certain assumptions when doing his calculations.

Tobin disagreed, saying he made “very few assumptions.”

But Tobin agreed that, for example, he never actually weighed Chauvin on May 25, 2020, or weighed his equipment.

Defence attorney Eric Nelson questions witness Martin Tobin in Hennepin County District Court Thursday. (Court TV/The Associated Press)

‘That is not a fentanyl overdose’

Meanwhile, Smock, under questioning by Blackwell, stressed that in his opinion, Floyd wasn’t exhibiting the signs of someone who had suffered a fentanyl overdose.

“When you watch those videos and we go through them, what is his respiration? He’s breathing. He’s talking, he’s not snoring. He is saying, ‘Please, please get off of me. I want to breathe. I can’t breathe.’ That is not a fentanyl overdose. That is somebody begging to breathe.”

Smock also testified that the level of methamphetamine in Floyd’s system was “really a nothing level.”

Under cross-examination, Smock was asked whether a “methamphetamine and fentanyl” death is a much different type of a death than an exclusive fentanyl death.

“Depending upon the level, yes,” he said.

A screen capture from an officer’s body-worn camera shows Floyd in his car as police attempt to arrest him on suspicion of using a counterfeit bill at a convenience store on May 25, 2020, in Minneapolis. (Minneapolis Police body camera video)

Smock was also asked if he has experience with deaths in people who have ingested methamphetamine and fentanyl and also have cardiac disease.

“Not just necessarily from those, but maybe from something else,” Smock said.

“But sometimes, it could just be from those,” Nelson said.

“It would depend upon the case,” Smock sad.

Smock was also asked if one of the side effects of prescribed amphetamine is a sudden heart arrhythmia. 

“Depending upon the level, it’s a rare side effect, but it’s certainly possible,” Smock said.

And Smock agreed that people have suffered cardiac arrhythmias during struggles with police before.

But under redirect from Blackwell, Smock agreed there was no evidence that Floyd had a heart attack or a “sudden death that looked like an arrhythmia.”

“Did you see any evidence that he died of an overdose?” Blackwell asked.

“No, sir, he did not,” Smock said.

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CBC | World News

Experts question whether Canucks can finish season following COVID-19 outbreak

The NHL says it remains hopeful the Vancouver Canucks can complete a 56-game schedule even though 25 members of the team have tested positive for a variant form of COVID-19, but some experts question if that is possible.

The Canucks released a statement Wednesday saying 21 players, including three on the taxi squad, plus four staff members, “have tested positive and the source infection is confirmed a variant.” Which variant has not been confirmed.

On Tuesday, when the Canucks had 18 players on the COVID-19 protocol list, an NHL spokesman said “a 56-game season is still the focus,” but if necessary the league has some flexibility on scheduling the opening of the playoffs. Asked Wednesday if anything had changed following the Canucks’ announcement, the spokesman said, “my answer is the same as it was yesterday.”

An NHL agent said he had heard nothing about any plans to cancel games.

“So far it sounds like they will push forward based on what I’m hearing,” the agent said.

WATCH | Concerns intensify amid Canucks’ growing outbreak:

Twenty-five members of the Vancouver Canucks organization have tested positive for a COVID-19 variant and it has put the remainder of the team’s season in question. 1:55

Dr. Zain Chagla, an infectious disease physician for St. Joseph’s Healthcare in Hamilton, said studies have shown people affected by the different variants “will recover on pace,” but depending on the severity of the virus — professional players may need extra time to regain their conditioning.

“They may be out of quarantine in 10 days, but a lot of players may not return after they are considered clear,” he said. “They may actually need a few weeks to get back to hockey normal.”

The Canucks’ situation is complicated because so many players have contracted the virus.

“If you have an outbreak of five or six [players] you can fill in the gaps, you can wait for some of your players to condition properly,” Chagla said. “At 21 players, that’s 21 different players that need to condition properly, that’s 21 players that need to get back into shape, get over their COVID and heal.”

Recovering from the virus is different from rehabbing after a sports injury.

“[A] lot of these guys, it sounds like, were in bed at home,” Chagla said. “You’re losing muscle mass; you’re losing that elite shape.”

WATCH | Vancouver Canucks sidelined by COVID-19:

The Vancouver Canucks have cancelled several upcoming games after a COVID-19 outbreak hit at least half the team’s roster. 1:59

When the first Canuck player tested positive last week, Vancouver’s next four games were postponed. The Canucks were scheduled to return to play Thursday in Calgary against the Flames. The Canucks’ website now says that game and another on Saturday in Calgary have been postponed.

The NHL season was originally scheduled to end May 8 but has already been extended to May 11 to allow for previously postponed games.

The Canucks have 19 regular season games remaining.

The cost of doing business

Corey Hirsch, a former NHL goaltender who is now a member of the Canucks’ radio broadcast team, worries about the physical strain forced on players if they are expected to play their remaining games in a condensed period of time after overcoming the virus.

“You are talking about the whole team,” he said. “You’re not only talking about one guy. My question would be if they are at risk of injury because of the physical shape they are in.”

Moshe Lander, a senior lecturer in the economics of sports, gaming and gambling at Concordia University in Montreal, said the Canucks’ situation is a result of the NHL “not bubbling up for a season.”

“The NHL has accepted this is the cost of doing business,” said Lander.

Delaying the start of the playoffs creates problems for teams in the other three divisions, Lander said. The league also won’t want the playoffs extending into late July because of the Tokyo Summer Games.

Last year’s playoffs, which included a play-in round, began Aug. 1 and ended Sept. 28.

Lander predicts Vancouver might only play 50 games, which will impact other teams in the NHL’s North Division.

“A whole bunch of Canuck games are going to be cancelled, not going to be made up,” he said. “You’re cancelling games against the Oilers, or the Canadiens, or [other teams] that are playoff-bound so their ranking system is going to be disrupted.

“The NHL has protocols in place to determine tiebreakers. I’m assuming it’s just going to be best winning percentage. Everybody has played enough games at this point that you have a reasonable enough sample size to know who [the playoff teams] are.”

Even before the virus struck, Vancouver faced an uphill battle to make the playoffs.

Heading into Wednesday night, the Canucks (16-18-3) trailed Montreal by eight points for the final playoff spot in the North Division.

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CBC | Sports News

Canadians shouldn’t shop around for vaccines with higher efficacy rates, experts say

The approval of a fourth vaccine in Canada should not give Canadians the green light to hold off on getting inoculated in order to wait for other doses with higher efficacy rates, medical experts say.

That attitude will end up lengthening the time it takes to get the pandemic under control, said Dr. Peter Juni, scientific director of Ontario’s COVID-19 Science Advisory Table.

“If people start to do that, they actually prevent Canadians from moving slowly back to normal,” he said.

On Friday, Health Canada approved the use of Johnson & Johnson’s COVID-19 vaccine. This is the fourth vaccine approved along with shots from Pfizer-BioNTech, Moderna and AstraZeneca-Oxford.

Different efficacy rates

Each vaccine has a different efficacy rate. Vaccine efficacy refers to the percentage reduction of disease in a vaccinated group of people compared to an unvaccinated group, under ideal conditions.

Pfizer-BioNtech and Moderna both have been determined by Health Canada to have efficacy rates of around 95 per cent. AstraZeneca-Oxford has an efficacy rate of 62 per cent while Johnson & Johnson has an efficacy rate of 66.9 per cent.

Despite different efficacies, trials have shown that those who did become infected after getting vaccinated experienced only mild illness, said Dr. Sumon Chakrabarti, an infectious disease specialist in Mississauga, Ont.

Of the thousands of participants in trials for the vaccines, not a single person who received a shot died or was hospitalized from COVID-19, he told The Canadian Press.

WATCH | CBC’s The National. Why experts say take the vaccine you’re offered:

As more COVID-19 vaccines become available, a new problem is emerging: people who say they will wait until the shot they prefer is available to get vaccinated. Experts say Canadians should take whatever vaccine is available to avoid prolonging the pandemic. 2:26

Dr. Zain Chagla, an infectious diseases physician at St. Joseph’s Healthcare Hamilton, said debates over efficacy are going to be part of the challenge of getting people vaccinated.

“I think there is obviously something we have to deal with here,” he said.

Some of that could have been sparked by confusion over the messaging of the AstraZeneca-Oxford vaccine. Canada’s National Advisory Committee on Immunization (NACI) has recommended against using that vaccine in people aged 65 and older “due to limited information” on its efficacy in that age group. 

In Europe, French and German officials are reversing their initial hesitancy about AstraZeneca and are now urging people to take the vaccine. There are reports that many in Germany have declined the AstraZeneca shot over concerns it may not work as well as others.

Detroit turned down Johnson & Johnson

In Detroit, Mayor Mike Duggan last week turned down 6,200 doses of the Johnson & Johnson vaccine, saying he favoured shots from Pfizer and Moderna for now.

WATCH | Dr. Sharma addresses vaccine hesitancy:

Health Canada’s Chief Medical Adviser Dr. Supriya Sharma says the process to approve vaccines in Canada “is based solely on science and evidence and grounded by regulation.” 1:50

Juni said long-term care homes are the only settings where it makes sense to use the highest efficacy vaccines, as residents are at extreme risk. 

For most people, “there is no such thing as a bad vaccine,” he said.

Juni compared the differences in efficacy to high octane versus low octane gas. Most engines, he said, just need gas.  

“But obviously in the situation we’re in right now, if you actually are about to run out of gas, you just take whatever is coming that actually works.”

Waiting for a preferred vaccine is just too risky, Chagla said. “You don’t want to be that person with zero per cent protection going into COVID-19 when you could be someone with at least 60 to 70 per cent protection, if not higher.”

‘Just take it’

“You would rather start the clock with some protection rather than no protection,” Chagla said.

Given the opportunity to get vaccinated, he offered some blunt advice: “Just take it.”

WATCH | J&J vaccine good for less accessible, marginalized communities, doctor says:

As a single dose COVID-19 vaccine, the Johnson & Johnson product will be especially helpful for people who sometimes have difficulty accessing health care, says Dr. Lisa Bryski, a retired ER doctor in Winnipeg. 1:23

Dr. Susy Hota, medical director for infection prevention and control at University Health Network in Toronto, said for those concerned about different efficacy rates, it’s important to know it’s not quite an apples-to-apples comparison because the clinical trials of vaccines were carried out differently.

Chakrabarti said the timing of the trials may have impacted efficacy. Pfizer and Moderna tested their products when the COVID burden was relatively lower in parts of the world. Johnson & Johnson and AstraZeneca, meanwhile, had their trials later when more transmissible coronavirus variants were spreading at a rapid pace.

What shouldn’t be lost, Hota said, is the overall goal of getting vaccinated which is to protect the most vulnerable from getting COVID-19 and to get us out of this pandemic.

‘Not justifiable’

That means, with the vaccine rollout being such a massive undertaking including: vaccine availability, vaccine prioritization schemes and vaccine registries, vaccine preference should not be a consideration.

“[If] you have to deal with people wanting to make decisions based on preference. It’s just, first of all, not justifiable …  but really not feasible,” Hota said.

She said people jabbed with higher efficacy vaccines are less likely to suffer from mild symptoms if they were to be infected, and on an individual level, if you don’t want to get sick at all, “that might be a better decision for you.”

“On a public health sort of population level, I would be very disappointed if people felt that was OK and it wasn’t going to cause any harm because we do need to get to a point to immunize as many people as quickly as possible to make gains in managing the pandemic itself.”

Dr. Supriya Sharma, chief medical adviser at Health Canada, says Canadians should take whatever vaccine is offered to them. (Sean Kilpatrick/Canadian Press)

Dr. Supriya Sharma, Health Canada’s chief medical adviser, said on Friday that vaccination with a vaccine with 66 per cent efficacy does not mean a person will have a 34 per cent chance of contracting COVID-19.

“While each of the vaccines Health Canada has authorized has different efficacy numbers, the reality is that you will have a greatly reduced chance of getting COVID-19 with any of the … vaccines that have been authorized,” Sharma said.

She drove home that point earlier this week, telling CBC’s The National that her message to Canadians is that when it’s their turn, “you roll up your sleeve” and “take the vaccine that’s offered to you.

“And that will help all of us bring down the COVID-19 numbers across Canada, which is the most important thing that we’re trying to do.”

Join us as experts answer some of your vaccine questions on a special CBC News National Town Hall on Tuesday, March 9. We’ll discuss the differences between vaccines, how vaccine passports work and where you might be in the queue. The special starts at 8 p.m. ET on CBC Gem and CBC News Network, and 10 p.m. local time (10:30 p.m. NST) on CBC Television.

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CBC | Health News

Canada’s private COVID-19 testing industry is booming, but some experts say oversight is lacking

Whether you’re a traveller getting a mandated COVID-19 test at the airport, or a worker on a job site like a film set or food processing plant that requires a negative test, odds are it’s being done by a private company.

Businesses offering polymerase chain reaction (PCR) tests are now a crucial part of Canada’s pandemic response, allowing thousands of people to continue to travel, visit loved ones in long-term care, and stay on the job.

But some doctors and health experts are concerned about what they say is a lack of regulation in what has become a rapidly growing part of the health-care industry.

“Who’s doing the tests? What are the standards? How do we know that they’re doing it at the same sensitivity and specificity as those done in provincial labs or hospital labs?” said Dr. Anna Banerji, a physician and infectious disease specialist at the University of Toronto’s Dalla Lana School of Public Health.

Publicly administered PCR tests are free and are meant for people with symptoms of COVID-19. Private companies generally test people who are asymptomatic, and charge a fee for the service. Demand is soaring as many workplaces require on-site testing in order to stay operational.

The federal government and the Ontario government recently added to that demand when both declared international air travellers must have PCR tests when they arrive in Canada.

New entrants

A quick and non-exhaustive search by CBC News found 15 companies offering PCR tests for COVID-19 in Canada. Some, such as LifeLabs, which says it has conducted more than one million COVID-19 tests to date, and Dynacare, are well-known names in the specimen collection and diagnostic testing industry.

Others, such as Calgary’s Ichor Blood Services, pivoted to COVID-19 testing mid-pandemic.

Pure Lifestyle in Winnipeg offered fitness and medical services prior to launching its COVID-19 testing business just after Christmas.

Private companies across Canada are jumping in to meet the growing demand for COVID-19 testing. (Evan Mitsui/CBC)

In Toronto, HCP Diagnostics garnered attention last fall when it started offering in-home COVID-19 testing for $ 400 per test. One of the directors of HCP is James Blackburn, who also co-owns an event company that organizes large parties, and a nightclub in Toronto’s Entertainment District.

Blackburn, who declined the CBC’s interview request, told The Pal’s Podcast recently that he moved into COVID-19 testing because the pandemic had shut down his other enterprises.

“If the beast squashes your business, you might as well try to get into another business and try to fight the beast, right?” he said.

Blackburn’s partners include a registered nurse and a doctor.

HCP’s timing was good. The company incorporated in October, but its website actually went live a month earlier, the same week the Ontario government amended the Laboratory and Specimen Collection Centre Licensing Act in an effort to expand testing capacity.

The change allowed a wider range of people to get into the private testing business.

HCP is now providing on-site testing for film and TV production, construction sites, manufacturing and warehousing, as well as smaller businesses in Toronto’s downtown area.

In fact, HCP said it’s so busy, it had no time to talk with CBC News about its burgeoning business.

“Given the busy nature of our programs, I have been informed that our team will not be available,” HCP’s Emily Coles said in an email.

CBC News compared prices for PCR tests across the country and found they ranged from about $ 160 at Switch Health, which is also the company testing travellers at Pearson airport near Toronto, to as much as $ 400, the top price charged by GMF Sante Med Clinic in Toronto.

Lack of oversight, experts say

But as private testing’s role in the pandemic grows, so is concern among some that it’s largely unregulated.

“When you have people working privately in no man’s land, then you really don’t know, are the tests accurate? Are they doing the right infection control?” said Banerji.

“I think there needs to be a body that has some oversight.”

While public tests are generally done in health-care environments such as hospitals and clinics, private tests can be done anywhere from construction sites to homes. Companies must use equipment and tests approved by Health Canada, but there’s no regulatory body governing the cost private companies are charging for tests, and there’s no single external system beyond the companies themselves to deal with complaints.

Dr. Anna Banerji is a pediatric infectious disease specialist and associate professor of pediatrics at the University of Toronto’s Dalla Lana School of Public Health. She says she has concerns about the lack of oversight of the private testing industry. (Submitted by Mike Cooper)

There are different governing bodies in each province that regulate the collection and processing of medical samples. In Alberta, for instance, the province does not license or approve companies for private COVID-19 testing.

In fact, no government agency in Canada is tracking how many companies are offering the service or even how many tests they’re doing across the country.

A spokesperson for Health Canada and the Public Health Agency of Canada said because medical tests fall under provincial and territorial jurisdiction, the CBC would have to contact each province and territory individually and compile the numbers ourselves.

So we did, and found the picture is still unclear.

Every province requires companies to report positive test results. But many provinces don’t know how many tests are being done overall.

WATCH | Calls to test truckers for COVID-19: 

Commercial truckers who regularly cross the U.S. border as essential workers are increasingly worried about COVID-19 risks. Many are saying they want regular rapid testing and faster access to vaccines. 1:59

Of the nine provinces that responded, only Quebec and Nova Scotia provided a breakdown of the number of private versus public COVID-19 tests administered.

Saskatchewan and British Columbia say private tests are included along with public ones in a single number released to the public daily. But neither province could say what proportion of that daily number is private versus public tests.

Newfoundland, Ontario, Manitoba and Alberta don’t keep track of private testing data at all.

Apart from Quebec and Nova Scotia, none of the provinces that responded was able to provide a test positivity rate for private tests, a percentage that reflects how many of the total number of tests are coming back positive for COVID-19. 

Possible ramifications

Experts say the lack of an accurate count and positivity rate of private tests means we may not have an accurate picture of the overall positivity rate in Canada. 

“If the government is testing, say, 50,000 people and that gives us a positivity rate of four per cent, and the private sector is testing an additional 50,000 and they’re finding no cases at all, then in fact our test positivity rate is actually two per cent, not four per cent,” said Raywat Deonandan, an epidemiologist and associate professor at the University of Ottawa’s faculty of health sciences.

“That’s a big difference. The test positivity rate tells us two things: Are we testing enough? And how present the disease is in our population.”

University of Ottawa epidemiologist Dr. Raywat Deonandan, pictured here in Toronto, says reporting complete private testing data could have an impact on COVID-19 positivity rates. (Evan Mitsui/CBC)

CBC News also reached out to nearly a dozen companies to ask about the number of tests they conduct and the positivity rates they’ve observed.

Among those that responded was Quantum Genetix in Saskatchewan, which had been doing PCR testing on cattle prior to expanding to human COVID-19 testing late last year. Quantum Genetix said it has tested about 1,500 people and had a positivity rate of just under two per cent.

Another company, Dynacare, said it conducts between 5,000 and 10,000 PCR tests per day at its lab in Ontario. It said the positivity rate ebbs and flows, but over the past 30 days it has been near seven per cent. 

Problems with private testing

With companies often dealing with customer complaints internally, it’s difficult to know how the quality of private testing compares with that of the public system. 

The day before Christmas, Allan Asselin was visiting his 88-year-old mother, Mary, in her east end Toronto seniors’ residence when one of the nurses on staff walked into the room.

“She said, ‘Your mom has COVID. You have to leave,'” Asselin said.

“Needless to say, there were tears. She was shaking. She was just in a horrible state.”

Mary Asselin, 88, had two entries for results for a single COVID test from December, one positive and one negative. (Submitted by Allan Asselin)

Mary spent Christmas and several days afterward quarantined in her room, alone and scared.

Her COVID-19 test was processed in a private lab.

Three negative tests later, she was cleared. When Allen checked the Ontario government’s COVID-19 test results site, he found two entries for that first test back on Dec. 22, one positive and one negative.

“So did she have it or did she not have it?” he said.

In another case, a 34-year-old Montreal woman who pays $ 300 every two weeks to get tested to see her elderly father says she got a positive result in the mail with her name on it but the wrong date and location of the test, wrong home address, no health insurance card number, and the notification came a month after her test was performed.

“What good does it me, or the public, to get this information a month later, after walking around and hanging out with my family, [possibly] being unknowingly positive for a month?” said the woman, whom CBC News agreed not to identify for privacy reasons. 

Private testing necessary

The fact is, however, the economy would likely not be reopening nearly as quickly as it is without private testing, which epidemiologists say plays a vital role in Canada’s pandemic response.

“I approve of private testing, if done strategically, because it alleviates strain on the public health system that should be used for things like proper surveillance, that should be used for actual symptomatic people arriving at hospitals and things like that,” said Deonandan.

Private companies, he said, should be tasked with what he calls “reassurance testing.”

“That’s when you need a test to go back to work or to keep going to work or maybe to engage in some other activity,” he said.

“But even then, that requires some serious ethical oversight.”

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CBC | Health News

Moderna study suggests half doses offer strong immune response, but experts caution against changing approach

There’s now early evidence showing Moderna’s coronavirus vaccine may elicit a strong immune response even through half doses, prompting hope that further research could back up the results and eventually allow countries like Canada to stretch out vaccine supplies.

The company’s peer-reviewed findings, based on a Phase 2 trial, were published online by the journal Vaccine last week.

The study looked at the mRNA vaccine’s “immunogenicity” — its ability to provoke an immune response — through both anti-virus, spike-binding antibody levels and neutralizing antibodies, which help to block reinfection.

Researchers determined within a two-dose regimen that both the current amount of vaccine dose and half that amount being given each time were capable of “significant” immune responses.

Those findings are welcome news, though not yet worth changing dosing approaches, said Dr. Zain Chagla, an infectious disease specialist and associate professor at McMaster University in Hamilton.

“But it does bring up the urgent need to do a Phase 3-type clinical trial of full dose versus half dose and see what happens,” he said. 

“The implications, obviously, are you all of a sudden double your vaccine supply overnight if this seems to work out.”

During a recent study, researchers determined that half the amount of Moderna’s COVID-19 vaccine dose was capable of triggering a ‘significant’ immune response. (Jean-Francois Badias/The Associated Press)

Immune response ‘increased substantially’

The Moderna vaccine is one of two options currently approved and being used in Canada to combat the spread of COVID-19, with more than 40 million doses ordered by the federal government.

Based on full clinical trial results, the current approach requires two doses of the vaccine, spaced 28 days apart.

The company’s recently released findings looked at both a full dose of 100 micrograms and a half dose of 50 micrograms, given as two doses in a randomized, observer-blind, placebo-controlled trial.

At eight different U.S. sites, a total of 600 participants were divided into age cohorts and randomly assigned at a 1:1:1 ratio to receive either the two full doses, two half doses, or two placebo doses.

By 28 days after the first shot, anti-virus spike-binding antibody levels and neutralizing antibodies were higher among people who’d been given the full dose compared to the half dose.

But that difference was “less apparent” after participants received both rounds, Moderna’s research team found.  

Both binding antibodies and neutralizing antibodies “increased substantially” by the two-week mark after participants were fully vaccinated and remained elevated through day 57, the researchers wrote.

Boxes containing the Moderna COVID-19 vaccine are prepared to be shipped at a distribution centre in Olive Branch, Miss., in late December. (Paul Sancya/Reuters)

Questions over duration of protection, variants

Outside experts who spoke to CBC News all stressed the need for future research before changing Canada’s dosing approach, given the short two-month time period and small, homogeneous group studied by Moderna. 

Chagla also said there’s a clear need to understand longer-term immunity and how other elements of the immune system — such as T-cells, which target specific bodily invaders — might be affected as well.

“The point nobody can answer for you is how long you will have protection,” said Horacio Bach, an adjunct professor in the division of infectious diseases at the University of British Columbia’s faculty of medicine.

“Nobody knows. Nobody can tell you. There are no studies; that’s the reason it’s a global emergency.”

Dr. Noni MacDonald, a researcher focused on vaccine safety who is also a professor at Dalhousie University’s department of pediatrics in Halifax, stressed that while Moderna’s study did show similar immunogenicity with two different concentrations of the vaccine, it was also based on “old data.”

The research was conducted between late May and early July 2020 — long before the clear rise of multiple virus variants, which may be more transmissible or capable of evading the body’s immune response.

If the findings hold up against emerging variants, it could mean countries like Canada could one day “stretch what we have” when it comes to Moderna shipments, MacDonald said in an email exchange with CBC News.

But right now, that’s not yet a possibility. Already the company says its vaccine may be less effective against the B1351 variant, requiring it to develop an alternative version for booster shots.

Immunologist and microbiologist Nikhil Thomas says it’s important to ‘suppress the spread of these variants,’ as the coronavirus variant first identified in the U.K. is replicating faster and transmitting ‘at a higher frequency.’ 4:17

U.S. officials discussed half-dosing

Despite limited data on the benefits of using half-doses, particularly against emerging variants, there has been discussion south of the border over taking that approach, with the U.S. government also helping fund Moderna’s most recently-published research.

In January, Moncef Slaoui, then-chief adviser of the former U.S. president Donald Trump administration’s vaccine effort — one dubbed Operation Warp Speed — said officials were considering giving half-doses of the Moderna vaccine to American adults under the age of 55.

The same month, the U.S. Food & Drug Administration released a statement shooting that idea down, saying any changes to dosing or schedules of approved vaccines would be “premature and not rooted solidly in the available evidence.”

On this side of the border, Health Canada officials told CBC News the agency has not received an application from Moderna to amend its vaccine authorization, but would “thoroughly review” one if it was submitted.

Canada has other vaccines in line for approval — how they compare to the ones already being rolled out and how COVID-19 variants are a complicating factor. 2:03

Dosing strategies have long-term impact

While Bach suspects full clinical trials might yield a similar result to Moderna’s Phase 2 trial, he said it isn’t clear if the manufacturer would even allow countries to stretch their supplies.

He also agreed keeping the current guidelines in place is the ideal approach for the time being, rather than risking lives by adopting a dosing strategy that needs more evidence.

“We don’t know where we are going,” Bach said. “You can put people in danger.”

Still, there’s some potential in Moderna’s early results, according to Chagla. 

Knowing the adequate dosing strategy will matter down the line while developing those boosters for variants, he said. And the early evidence points to the potential for increasing vaccine supply to much of the developing world, where shots remain in short supply.

“The answer will have implicating effects for years, not just the vaccine roll-out over the next few months,” Chagla said.

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CBC | Health News

Most at risk, first in line: Public health experts say racialized Canadians should be prioritized for vaccines

Two public health experts in Toronto say governments must prioritize vaccinating Black Canadians and other people of colour against COVID-19 because the data shows they are most at risk of contracting the virus.

Akwatu Khenti and Ananya Tina Banerjee told CBC Radio’s The House that failing to vaccinate those communities will not only put them at greater risk of getting COVID-19, but also increases the chance that the virus will spread more widely.

“The reason that Black people have a higher rate of positivity, or higher hospitalization rates, is actually because of social inequities, systemic racism and neighborhood vulnerabilities,” said Khenti, who teaches at the University of Toronto’s Dalla Lana School of Public Health and chairs the city’s Black Scientists Task Force on Vaccine Equity.

“If we use some type of vulnerability index we would arrive at the same conclusion, the most vulnerable should be first in line. Right now, the most vulnerable are racialized health professionals, racialized communities.”

Banerjee founded the South Asian Health Research Hub, and like Khenti, is on the faculty at the Dalla Lana School of Public Health. She said the data shows racialized communities are not only hardest hit by the virus, but many people in those communities work in manufacturing, distribution, the service industry and travel to their jobs using public transportation.

“And so given this information, it has to be prioritized that … the hardest hit neighbourhoods have to get vaccinated first or community transmission is just going to escalate,” she told The House.

CBC News: The House10:31Building an equitable vaccine rollout

Akwatu Khenti, chair of Toronto’s Black Scientists’ Task Force on Vaccine Equity, and Ananya Tina Banerjee, founder of the South Asian Health Research Hub, share what’s needed to create an inoculation campaign that provides equal access to shots. 10:31

Advisory committee looking at next priority groups

CBC News put those concerns to Canada’s chief public health officer, Dr. Theresa Tam, on Friday.

Tam noted that the goal of prioritizing specific groups or locations, such as congregate settings, is to reduce serious illness. But, she added, different provinces would use their own evidence to inform their rollout plans.

She said the National Advisory Committee on Immunization (NACI) created last year is examining the next set of priority populations for vaccines as deliveries begin to ramp up in the weeks ahead.

“For example, if you are in Toronto or if you’re in Ontario, they’ve already got data in relationship to where those higher risk populations are and that they be considered as part of the rollout for the prioritization of vaccines.”

Chief Public Health Officer Theresa Tam said Friday that the National Advisory Committee on Immunization (NACI) is looking at who should be next in line for a vaccine. (Adrian Wyld/The Canadian Press)

Ontario’s Ministry of Health told CBC News that the province is already collecting some demographic information, including age and sex, from people receiving vaccinations on a voluntary basis; it is also exploring how additional data might be used “to support the efficient, equitable and effective vaccine rollout for communities that are at-risk and disproportionately impacted by COVID-19.”

The statement goes on to say that the ministry recognizes Black and racialized communities have been disproportionately affected by COVID-19 and is working with local health authorities to establish guidelines for delivering the shots.

“The ministry works with its health system partners to ensure the guidance and information provided is clearly understood by all partners regarding the prioritization of populations for COVID-19 vaccines.

Racialized populations at risk elsewhere

The federal government already identified the need to prioritize Indigenous communities for vaccination. But this country isn’t alone in grappling with how to protect the most vulnerable sectors of the population from COVID-19 amid shortages of vaccine doses.

In the United States, Black and Hispanic Americans are bearing the brunt of infections, hospitalizations and death linked to the coronavirus. Experts there, and in Canada, are warning that the lack of race-based data on vaccinations runs the risk of leaving those same communities behind.

Khenti said part of the effort needed now is to overcome the reluctance of some people in racialized communities to get the vaccine by working with community partners and other local agencies.

“You have to work through trusted partners because the issue isn’t just one of information, it’s one of trust. And to date, many institutions haven’t made the effort to earn that trust,” he said. “Systemic racism has been ignored. It hasn’t been given the priority that it deserves, especially with respect to anti-Black racism, which is the issue facing my task force.”

Community outreach critical

That kind of community outreach is being credited with reducing coronavirus infections in South Asian communities in BC’s lower mainland

The province, like most others, doesn’t systematically track race-based COVID-19 data. But Banerjee told The House it’s possible to replicate anywhere.

“I mean, think about it. We need to bring the vaccine to the people and meet them where they’re at right now … We need to be thinking about that. We can’t just rely on these large health care systems, malls and chain pharmacies to have these vaccination programs,” she said.

Ananya Tina Banerjee, a faculty member at the Dalla Lana School of Public Health, said vaccination programs must work at the community level and meet populations where they are. (Yanjun Li/CBC News)

” And so we need to be, I think, at these access points of trust, as we call it. Just this past weekend in the U.K., there were hundreds of people actually vaccinated at a pop up clinic set up by the East London mosque to encourage Muslims to be inoculated and given their widespread concerns about the vaccination. And I think that is an incredible model that is community driven, that can be rolled out to temples, churches, gurdwaras, mosques in Ontario, especially if you want to target those racialized communities.”

But both Khenti and Banerjee warned that time is short. New, more contagious variants of the virus are beginning to spread, increasing the need to act now to give priority to Black Canadians and others who are already at higher risk of contracting COVID-19.

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Teens feeling disconnected, hopeless due to COVID-19 raises alarm for parents, experts

Ten months into the coronavirus pandemic, Toronto teen Serena Sri is sorely missing all the “amazing” things about adolescent life, from spirit days, intramural sports and learning in-person at her high school in the city’s west end to hanging out with friends and attending her beloved hip-hop dance class.

“I’m really a social person and I love being around people. With the pandemic, we can’t do that,” she said.

“I kind of feel more alone and I kind of… shut down in a sense. And I lose my motivation to do anything, even simple things in my daily life.”

The pandemic has also had a negative effect on Edmonton student Quinncy Raven-Jackson, who says a more solitary life under COVID-19 restrictions has exacerbated the anxiety disorder he’s been dealing with.

“I have difficulty with social interaction sometimes, so not seeing people, I sometimes forget how much these people care about me and stuff like that. So it was very lonely,” said the 19-year-old University of Alberta freshman. 

“I have a good relationship with both my parents and a great therapist, so I had some safe adults to speak to, fortunately. But even when you have those kinds of help, it doesn’t always really resonate.”

‘I have difficulty with social interaction sometimes, so not seeing people, I sometimes forget how much these people care about me,’ said Edmonton student Quinncy Raven-Jackson, ahead of a bit of cycling with his dad, Mark Jackson. (Peter Evans/CBC)

The COVID-19 pandemic has left many teens and young Canadians feeling disconnected, hopeless and unmotivated to navigate school and daily life — and this sentiment is causing concern for parents and experts alike.

“Everyone’s normal has now changed into something completely different from what it was 10 months ago,” said Sadia Fazelyar, a post-secondary student and youth mental health advocate for Jack.org, a national charity focused on young Canadians.

“The biggest thing I hear from youth is it’s this whole new thing that nobody really knows how to navigate properly.”

Many young people aren’t comfortable speaking up about difficulties, feelings or mental health struggles they’re facing, so they look to sports, the arts, clubs or social groups as a form of support, Fazelyar says. “Now it’s all been taken away from them and it really hits them hard.” 

WATCH | What would young Canadians tell their pre-pandemic selves?

Canadian teens and young adults on mental health challenges and thoughts about living through the pandemic. 4:40

Seeing classmates, friends or family through a screen, even regularly, doesn’t offer the same opportunity for connection, added the 21-year-old Ryerson University student.

“Youth feel alone. And it’s kind of hard to have that conversation or even to bring it up … because it feels like they shouldn’t be alone. They get to talk to their classmates five days a week on Zoom in the classroom. They can call their friends. They get to be with their family, but it’s just not the same.”

Concern about the mental well-being of Canada’s youth is rising. A child mental health research team spearheaded by Toronto’s Hospital for Sick Children is currently conducting a study into the effect COVID-19 is having on the mental health of young Canadians. Ottawa clinics and support groups are seeing a spike in demand for mental health resources, while medical officials in Calgary have noted a rise in cases of eating disorders

Wanting to explore what kids and teens are thinking and feeling about COVID-19, Nikki Martyn, program head of early childhood studies at the University of Guelph-Humber, launched a research project analyzing artwork created by youngsters in response to the pandemic.

Though submissions came from children as young as two years old, the majority were by 14- to 17-year-olds, says the educator and child psychology researcher. “It shows how much teenagers really want to be heard and have so much to say.”

The artworks include illustration, painting, sculpture, mixed-media creations, even musical compositions, and the message within them is clear, according to Martyn: It’s a painful time and young people are struggling.

WATCH | Social isolation, school closures take a toll on mental health of teens:

Teenagers are struggling with mental health during the COVID-19 pandemic, even more than usual. A few of them share their struggles and a psychologist shares an art project that helps teens express themselves. 6:45

“They’re feeling sad and alone and isolated and worried and scared. They feel lack of motivation and distress and failure,” she said.

“What I worry about is the helplessness or the disillusionment about their own future. Sometimes even anger, which we all understand. It’s the same things in some ways that we’re feeling as adults, but it’s different because of where they’re at developmentally at this time of their life.” 

The writing and phrases included within some of the artwork — “What’s the point? No one cares. This is too much. I am not OK. Broken’ — speak volumes, Martyn added.

“The teens were able to share this perspective and their experience very clearly. I think it’s really important that we listen to it.”

The majority of artworks submitted to her new research project were from 14- to 17-year-olds, showing ‘how much teenagers really want to be heard and have so much to say,’ says child psychology expert Nikki Martyn, seen with her 15-year-old son Carson Capobianco in Toronto. (Evan Mitsui/CBC)

‘It’s OK to not be OK now’

Martyn says she believes these pandemic-inspired feelings go beyond the already powerful emotions and stresses teens have in regular times, but that this moment also presents families with an opportunity to normalize open discussion about mental health.

She suggests parents open up to their kids and teens about their own vulnerabilities, sharing when they themselves are feeling drained, that they’ve had enough or that they also can’t wait for this all to be over.

“It’s OK to not be OK now,” she said.

Right now, small steps like getting outdoors and talking to a counselor are helpful, says Serena Sri, seen here with her mother Ashanty. ‘Making sure that I’m still like going outside for walks, even though it’s only with my mom.’ (Turgut Yeter/CBC)

Ashanty Sri is worried about the toll the pandemic is taking on her daughter Serena, who has also been diagnosed with anxiety. She wonders about what longer term effect there may be on today’s teens, who are navigating growing up without the social, classroom and even part-time job experiences they’re used to. 

For now, the mother-daughter duo are putting the focus on mental wellbeing by taking small steps, noted the Toronto elementary school teacher. Getting active outdoors has helped, added Serena. 

“Making sure that I’m still like going outside for walks, even though it’s only with my mom… Also a great outlet is talking to somebody like a counselor or a therapist, because I feel like it helps releasing everything.”

Maintaining connections with peers is another recommendation from Fazelyar, the youth mental health advocate — things like regular phone or video calls with friends, online game nights, watching movies together via apps or, if local restrictions permit, physically distanced time outdoors.

“You should still be ‘being social,'” Fazelyar said. 

“When you’re thrown into this or you feel like you’re kind of alone because you don’t have your friends or social network, it’s just best to find new ways to adapt.”

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CBC | Health News

Trump’s legacy leaves Arctic with fewer environmental protections and more risk of conflict, experts warn

As U.S. President Donald Trump leaves office, the Arctic is probably far from the minds of most Americans.

Yet the region, where the U.S. is one of five nations with territorial waters, has loomed surprisingly large in the waning days of his presidency.

After just four years as president, Trump’s legacy in the Arctic might be greater than many would expect. Experts say he has endangered, if not unravelled, decades of environmental regulation and careful diplomacy.

Greenland: not for sale

If people remember anything about Trump’s Arctic policy, it will likely be the bizarre idea to purchase Greenland that he discussed with his aides in the summer of 2019.

Greenland, an autonomous territory within the kingdom of Denmark, has hosted U.S. troops since the Second World War. But it was decidedly not for sale. Since 2009, it’s been formally working toward independence.

“It’s not a country that you just talk about as if it is a piece of merchandise,” said Aleqa Hammond, the chair of Greenland’s parliamentary foreign and security policy committee and one of the people working to draft a constitution for an independent Greenland.

A view of Upernavik in western Greenland. In 2019, Trump offered to purchase Greenland from Denmark, a suggestion met with widespread derision. (Ritzau Scanpix/Linda Kastrup/Reuters)

Trump’s suggestion was met with widespread derision and even caused a diplomatic spat with Denmark. The overall effect, Hammond said, was “at least one or two steps back” for the U.S. reputation in the Arctic.

“It’s not that the United States [has] not engaged in these sorts of conversations over the course of our history — we all have,” said Rufus Gifford, a former U.S. ambassador to Denmark and the deputy campaign manager for president-elect Joe Biden.

“But the way in which … [Trump’s] administration went about this was reckless.”

The U.S. under Trump quickly pivoted to more traditional methods of exerting power, giving Greenland $ 12 million for economic development and opening the first U.S. embassy in the capital, Nuuk, in more than half a century.

But the episode undermined U.S. standing in Greenland just as it sought to become an Arctic power in its own right.

“Greenland wants international co-operation, regardless of whether it’s the United States or not,” said Hammond. “The Arctic must be very aware about the agenda behind the Americans’ interest … and be sure that the Arctic people are the ones to decide in the end if this should be or not.”


Readying for a fight

Trump’s interest in Greenland might have seemed out of left field, but it highlighted the Arctic as “one of the most important centres in defence matters,” Hammond said.

Greenland is home to Thule Air Base, one of the U.S.’s most strategically important installations. The island’s land mass covers 20 per cent of the Arctic, and it’s located within a crucial gap between Russia and the north Atlantic that was heavily monitored during the Cold War.

Russian President Vladimir Putin, right, shakes hands with a Chinese serviceman during the Vostok military exercises in September 2018, which spanned vast expanses of Siberia and the Far East and the Arctic. (Alexei Nikolsky, Sputnik, Kremlin Pool Photo via AP)

“The Russians right now are building their air base just 1,000 kilometres away from Thule region,” Hammond said. “That requires America to be a stronger presence in Greenland than they ever have before.”

The Pentagon seems to agree. Under Trump, it initiated a “U.S. pivot to the Arctic,” according to Andrea Charron, director of the Centre for Defence and Security Studies at the University of Manitoba in Winnipeg.

By the end of this year, all branches of the U.S. military will have new Arctic strategies, with possible implications for Canada.

Previously, U.S. Arctic strategy focused on “co-operation and environmental security issues,” according to Rob Huebert, a professor of political science at the University of Calgary.

“Quite clearly, the major concern for the Americans now is … the growing power of Russia and the growing interest of China in the region,” he said.

Charron agrees that the attitude toward Russia’s presence in the Arctic is one area where Trump’s influence is visible.

“It’s put Russia in the Arctic as an adversary, and that wasn’t the language of before,” she said.

The new strategies even include the threat of “freedom of navigation operations,” which are military exercises aimed at provoking disputes over Russian territorial claims to the northern sea route — and, potentially, Canada’s claims to the Northwest Passage.

That was matched by aggressive rhetoric from Trump’s secretary of state, Mike Pompeo, which challenged longstanding territorial claims and prompted an official rebuke from the Canadian branch of the Inuit Circumpolar Council for treating Inuit homelands as little more than a military chessboard.

U.S. Navy sailors watch sonar screens aboard the submarine USS New Hampshire as the ship participates in exercises underneath ice in the Arctic Ocean. (Lucas Jackson/Reuters)

Canada part of defence ‘pivot’

Canada has remained steadfast in claiming the Northwest Passage as its territorial waters (having pursued a Kiwi sailor for an allegedly illegal transit as recently as last year).

But the realities of a “blue Arctic,” with its open waterways and increased marine traffic, mean it’s not just the U.S. that is preparing for confrontations with foreign powers to become a “day-to-day” part of operating there.

“Not all of this can be attributed to Trump,” Charron said, with both Canada and NATO realizing that Russian and Chinese actions in the Arctic “are highly problematic.”

Though Canada’s Arctic and defence policies don’t name adversaries the way the Americans do, both call for an increased military presence in the Arctic. Canada is investing in its navy, holding regular Arctic military exercises and entertaining closer collaboration with NATO to monitor Canadian waters, Charron said.

During this time as U.S. secretary of state, Mike Pompeo challenged Russian and Canadian territorial claims in the Arctic and dismissed China’s push to be involved in Arctic policy-making. (Mandel Ngan/AFP/Getty Images)

But that may not be enough for a U.S. military concerned about Russian adventurism. Pressure could mount for expensive modernizations of NORAD and the North warning system, which Canada and the U.S. run jointly, “to ensure that we have eyes and ears on what’s happening,” she said.

“[Canada] in turn will also pivot to the Arctic,” said Charron, emphasizing that the security concern is “not going to go away.”

Fewer environmental regulations

Trump’s most lasting Arctic legacy might be four years of refusing to acknowledge climate change and a corresponding effort to roll back decades’ worth of environmental protections in the Arctic.

In his first year in office, Trump withdrew the U.S. from the Paris climate agreement, which sets emissions targets for its signatories, in a move viewed as “antithetical to the general direction of … many of the Arctic states,” said Charron.

The Trump administration avoided acknowledging climate change or its impacts, including the rapid melting of Arctic sea ice, in any joint declarations, which caused an unprecedented rift at the Arctic Council in 2019.

Trump speaks out against international climate accords at the G20 virtual summit in November 2020. Trump railed against climate agreements at every opportunity, causing a rift with fellow Arctic nations. (Saudi Press Agency/Handout/Reuters)

“The Arctic states could not agree on a joint declaration. I mean, that’s unheard of,” said Charron. “And that’s because Trump, ideologically, will not use the term ‘climate change.'”

More practically, Trump’s administration oversaw a rapid gutting of environmental regulations, with the Brookings Institution tracking dozens rolled back under his presidency right up to last week.

In Alaska alone, those included efforts to increase logging in forests, reduce protections for endangered Arctic species and permit the use of dogs, bait and artificial light in hunting wolves and bears

The fight over development in wildlife refuge

But Alaskan environmentalists’ biggest battle with Trump has been over his push to open the Arctic National Wildlife Refuge to fossil fuel development.

The refuge is home to calving grounds of the threatened porcupine caribou herd, central to the Gwich’in people of northern Alaska and the Yukon.

“What we’ve seen over the past four years is an unrelenting push to open these calving grounds to oil and gas development,” said Malkolm Boothroyd, the campaigns manager for the Yukon chapter of the Canadian Parks and Wilderness Society.

That has only accelerated in Trump’s final months, as his administration has opened new swathes of land to development and rushed a sale of leases.

In its final days, the Trump administration pushed relentlessly to open more of Alaska’s Arctic National Wildlife Refuge to oil and gas drilling. (U.S. Fish and Wildlife Service/The Associated Press)

Huebert at the University of Calgary sees in this final rush an effort to “cripple” the incoming U.S. administration and paint the next president, Joe Biden, “as the bad guy” in the eyes of pro-development Alaskans.

In the area around the refuge, most residents vote Democrat but support responsible development, according to Donald Olson, the Democratic state senator representing Alaska’s Arctic region.

“The view from the people that I represent … is that the quality of life has been significantly increased by the oil industry,” said Olson.

But Olson said his constituents have been dismayed by Trump’s approach, which involved little to no consultation with local residents.

Trump’s push to open up the refuge to development has also made responsible development harder to defend. Public pressure from groups such as Boothroyd’s have turned some major companies — and their lenders — off drilling in the refuge.

Biden signals green agenda

Some of these policies are already set to be undone by the Biden administration — he plans to rejoin the Paris agreement on his first day in office, ban Arctic offshore drilling and “re-establish climate change as a priority for the Arctic Council,” according to campaign documents.

On defence, Biden doesn’t reject the military’s aggressive posture in the Arctic but has committed to also use international forums, such as the Arctic Council, to “hold Russia accountable for any efforts to further militarize the region,” according to Biden’s campaign platform.  

Incoming president Joe Biden has already signalled his plans to roll back some of the Trump administration’s policies, including re-entering the Paris accord and banning offshore drilling in the Arctic. (Carolyn Kaster/Associated Press)

“Biden will probably make efforts to roll back some of the worst elements of the unilateralism that Trump introduced into the Arctic,” said Huebert.

That could mean greater co-operation with Arctic Indigenous groups and a more considered approach to defence.

“I really hope that Biden confirms … that the Arctic is a homeland — it’s where people live,” said Charron. “It’s not just a big security chessboard.”

Others are more cautious in their optimism. Boothroyd, the environmental campaigner, said Trump’s four years in office left a mark in the Arctic that may be difficult to remove.

“There’s still a lot of work to undo the damage that’s been done.”

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Quebec pins all its hopes on the vaccine, but experts say action is needed on multiple fronts

The old saying holds that only fools and the dead never change their minds.

Health Minister Christian Dubé is neither of those things. Eighteen days ago, at a news conference about Quebec’s COVID-19 vaccination plan, Dubé insisted his hands were tied by Pfizer’s requirements that second doses of the two-dose protocol be held back to observe the prescribed 21-day interval between shots.

A course correction followed a few days later and this week, he announced second doses would be delayed up to 90 days.

“This is the best strategy,” he said, citing the urgency of the situation.

On Dec. 29, Public Health Director Dr. Horacio Arruda sat next to Dubé at a news conference and alluded to the possibility that Pfizer could reduce its supply to Quebec if the province didn’t follow the recommendations, a prospect since echoed by federal officials.

Dubé this week: “We’re not asking permission.”

The reversal was sudden, it also represents an unusually aggressive move by a government whose response to the pandemic has been typified by cautious decision-making.

Going it largely alone on delaying doses for months suggests, above all else, that the Legault government is pushing its entire stack of chips onto the square marked “vaccines.”

The decision is based on the advice of experts from the province’s vaccine committee, the Comité sur l’immunisation du Québec, which studied clinical evidence. And it runs counter to guidelines from Pfizer and the National Advisory Committee on Immunizations.

Quebec Health Minister Christian Dube arrives at a COVID-19 press briefing Thursday, January 14, 2021 in Montreal. (Ryan Remiorz/The Canadian Press)

A high-stakes gamble

The contrast with other major decisions made since the turn of the year is informative. 

In the same week Dubé announced his department was going full bore on vaccination, it also announced an easing of restrictions on rapid testing.

And, last week, the province highlighted the portion of an expert panel’s report on air purifiers and filters in schools that confirmed the devices won’t interrupt the main causes of disease transmission — mainly, proximity of students — rather than the part indicating they help lower the number of viral particles in the air.

Police forces across Quebec handed out 750 tickets during the first weekend of the province’s four-week overnight curfew. (Paul Chiasson/The Canadian Press)

Take, as well, the provincial curfew that went into effect a week ago, which in effect relaxes a series of previously existing measures and does little to tackle what provincial statistics indicate are a key venue for transmission: workplaces, particularly in the construction and manufacturing sector.

The rationale has been that shutting down those industries on a large scale could imperil supply of essential goods.

It’s true there are few easy policy choices in the middle of a raging pandemic.

Why the unusual forcefulness and speedy action on vaccines, then? Perhaps because there is no discernible Plan B.

Still more that could be done

Many experts believe the new restrictions that went into place last Saturday won’t be enough — and argue more needs to be done in a number of areas including testing and contact tracing, stronger measures in schools and in the many workplaces that remain open.

The headline grabber of early 2021 is the curfew that requires people to stay home between 8 p.m. and 5 a.m. Non-essential retailers, as well as non-essential offices, restaurants, bars and gyms, were ordered to remain closed, while manufacturing and construction sectors — both major sources of new outbreaks — were allowed to stay open, unhindered.

“If the manufacturing industry is accounting for ongoing community transmission, which I suspect that it is, then there needs to be more control to ensure public [health] measures there,” said Dr. Donald Vinh, an infectious diseases specialist at the McGill University Health Centre who is also a science advisor for the federal COVID-19 therapeutics task force.

Quebec Labour Minister Jean Boulet issued a statement Friday suggesting they may finally crack down. In a follow-up interview with Radio-Canada, he said inspectors will be “vigilant.”

“We won’t hesitate when there are violations of the health guidelines to hand out fines,” he said, though they have only handed out 21 at construction sites in the past week.

Schools, too, have been allowed to reopen. While the benefits of keeping them open are clear, Vinh said the government could still do more to get a handle on transmission, including a clearer stance on ventilation.

“If internally within schools there could be stricter public health measures, I think that would be helpful,” he said. 

Quebec Labour Minister Jean Boulet says certain construction sites can reopen on April 20, but strict sanitary protocols must be followed. (Jacques Boissinot/The Canadian Press)

Premier François Legault has defended the measures by saying the curfew is a way to seize the public’s attention and to limit exposure to older people while they await the vaccine.  

He has pointed out, repeatedly, that 80 per cent of those hospitalized are over the age of 65.

But, it remains unclear whether the curfew, and the other measures in place, will be effective on that front.

Testing, testing

Then there’s the question of interrupting the contagion in the community.

As Eastern Townships Public Health Director Dr. Alain Poirier said this week, the virus “is everywhere.” Quebec has been reluctant to more widely employ rapid tests as a way to better understand exactly where the virus is spreading.

On Thursday, after 200 Quebec scientists published an open letter calling on the province to make more use of rapid tests, Dubé retreated from comments on Monday that the tests were unnecessary. 

Based on a report from a panel of internal experts issued that same day, Quebec will start using rapid tests to bolster its regular testing capacity on a limited basis, in highly specific circumstances.

Is the change of heart enough? Not in the view of Dr. David Juncker, a testing expert who is chair of biomedical engineering at McGill University and a scientific adviser to Rapid Test and Trace Canada, which advocates for a large-scale implementation of the technology.

“It’s a step in the right direction … but it’s a little bit too little, too late,” Juncker told CBC’s Quebec AM. “That’s the real risk, that we’re trapped in cycles of too little, too late here.”

Photo: Radio-Canada\ Ivanoh Demers Images pour illustrer le déconfinement économique. Photo prise dans Lanaudière, Québec, Canada. Sur la photo: (Gauche à droite) Le Costco À Terrebonne est toujours aussi populaire…. File attente, Le 28 Avril, 2020 2020/04/28 (Ivanoh Demers/Radio-Canada)

He likened the government’s approach to rapid testing — which it plainly views as unreliable and a major drain on human resources — to the discussion surrounding face masks in early 2020.

Provincial public health officials initially opposed masks, before realizing they could be a key tool in preventing the spread of the virus. 

The National Testing and Screening Expert Advisory Panel, which issued its first report Friday, suggests rapid antigen tests could be exactly another useful tool, given the ability to test frequently and obtain instant results. 

In a technical briefing this week, officials with Quebec’s Health Ministry defended their approach to rapid tests, saying the current testing regime is perfectly adequate, and that, in any event, they don’t have enough people to deploy them at scale.

What’s frustrating to experts like the signatories of the open letter is there doesn’t appear to be a plan to develop that capacity any time soon.

‘We need to kickstart now’

Frontline doctors remain concerned about the coming weeks, with intensive care wards in Montreal at risk of being overwhelmed.

As COVID-19 cases surge in Ontario and Quebec, hospitals in both provinces are preparing in case they can’t treat everyone and laying out the criteria for determining who gets prioritized for critical care. 1:47

Even if hospitals are able to hang on until Feb. 8, when the measures are set to lift, the province isn’t expected to begin vaccinating older people outside care until the middle of the month.

Vinh said Quebec’s situation is rendered “tricky” by the fact vaccine procurement and supply are out of its control.

The announcement from Pfizer on Friday that it would temporarily reduce shipments of its vaccine to Canada due to issues with its supply chain underscored the risks involved in the Legault government’s plan.

The pharmaceutical giant is pausing some production lines at its facility in Puurs, Belgium, in order to expand long-term manufacturing capacity.

The move means Quebec will receive 8,775 doses instead of the 46,800 originally scheduled for the week of Jan. 25, and 39,000 of the 82,875 doses expected the following week.

The disruption is far from catastrophic, given the doses will be replaced in later deliveries and Quebec is also receiving tens of thousands of vaccines from Moderna. But it will have an impact. 

That was the week the province was supposed to begin vaccinating in private retirement homes.

In a statement, a spokesperson for Dubé said the supply chain hiccup merely reinforces Quebec’s decision.

“The strategy remains the same: we need to kickstart now and vaccinate as many vulnerable people and health-care workers as possible, as quickly as possible,” reads the statement.

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Limiting travel within provinces is key to controlling COVID-19 spread, say experts

Given how rapidly the virus behind COVID-19 spread around the world, it’s easy to forget that it isn’t a globe-trotter on its own.

The SARS-CoV-2 virus moves with its hosts, who travel around by foot, by car, by plane, unwittingly helping this unwanted hitchhiker get around.

In Ontario, where multiple levels of government are trying to prevent infected travellers from bringing the virus in from abroad, experts warn regional movement remains a far greater driver of transmission. But it may also be trickier to curb — even as the presence of several highly transmissible new variants of the virus make it crucial to slow local spread. 

“The worst thing to do would be to let it spread throughout the country,” said Dr. Andrew Morris, an infectious diseases specialist at Toronto’s Sinai Health System.

“That would be a big mistake.”

Most cases spread within Ontario

Confirmed COVID-19 cases have been climbing across the province in recent weeks, with a seven-day average of roughly 3,400 new daily infections. 

In recent months, the bulk of them have been tied to either close contact with an infected person, spread in the community, or an unknown source.

Travel outside the province, on the other hand, was the confirmed infection source for just three per cent of the latest-available new daily cases from Jan. 7. 

Provincial and local data highlights how the vast majority of cases that are happening in Toronto, for instance, are happening from “people in Ontario spreading to somebody else in Ontario,” said Dr. Michael Gardam, an infectious disease specialist from Ontario who is currently based in P.E.I.

Still, the political focus remains on international travel, with no fresh lockdown restrictions announced in Ontario on Friday despite Premier Doug Ford suggesting the COVID-19 situation is at a crisis point.

Ford did suggest more extreme measures may be needed to combat a COVID-19 situation that’s “getting out of control,” but it’s not clear if those would include curbing local travel.

Instead, and while his government is facing blow-back for a mid-lockdown trip abroad by now-former finance minister Rod Phillips, Ford has focused on international visitors.

WATCH | New COVID-19 testing rules for travellers kicked in Thursday:

New rules requiring air travellers to test negative for COVID-19 before entering Canada will kick in on Jan. 7. Under the new rule, travellers must receive a negative result within 72 hours of boarding a flight to Canada. 3:21

“We need to do everything possible to stop this virus from coming into Canada,” Ford said Wednesday.

That day, Ontario announced the launch of a pilot program at the country’s busiest airport, Toronto Pearson, to offer free, voluntary testing for certain eligible international travellers.

A new federal policy also means anyone flying into Canada will need to provide proof of a recent negative test result for COVID-19. 

However, Morris stressed a more-transmissible form of the virus recently identified in the U.K. is already here, and could be spreading locally, with multiple cases already documented in Ontario.

“But we have no plans of controlling that whatsoever right now,” he said.

Preventing travel a ‘tall order’

In Toronto, officials stressed that tackling regional movement remains a conundrum for policy-makers.

“How do you find that very delicate balance between measures that actually limit the harms done by COVID-19 and, at the same time, mitigate the impact of restrictions on activity?” mused the city’s medical officer of health, Dr. Eileen de Villa, in response to a question from CBC News.

Mayor John Tory called it a “tall order.”

“I don’t know that there is any way in which you could prevent Torontonians, or any other people in the province, from moving around,” he said.

WATCH | Toronto’s mayor on regional travel:

At a recent press conference, Toronto Mayor John Tory discussed the difficulties of limiting travel within Ontario to curb the spread of COVID-19. 0:31

But Morris said policy-makers can simply take cues from other countries and regions.

In the early months of the pandemic, both Italy and France launched requirements for travel documents justifying the nature of residents’ trips, in hopes of limiting internal movement.

Australia’s current approach goes even further, with travel restrictions across much of the country and a permit system in place to travel between certain states.

For the country’s northern cluster of beaches, outside residents aren’t allowed to enter at all unless they’re just travelling through without leaving a vehicle, or if they meet strict criteria — such as attending a funeral, buying food, or using services not available elsewhere — according to a recent report from The Guardian.

And in Canada’s so-called Atlantic Bubble, curtailing movement into the region, and between the Atlantic provinces, has been a key feature of the region’s efforts to keep the virus at bay.

Nova Scotia, for instance, recently announced it was tightening border restrictions with New Brunswick following the outbreak of cases in that province — with anyone coming in from New Brunswick now required to self-isolate for 14 days, unless crossing the border due to essential reasons like work or a medical appointment.

The government also controls major highways, Morris noted, and can close off highways to make it inconvenient for drivers to travel out of town for leisure while allowing essential workers to use those narrowed roads.

“It all relates to government commitment, to be honest with you, and how much we really care about reducing the number of cases,” he said.

Travellers and airline staff walk through a quiet Pearson airport, in Toronto, in December. (Evan Mitsui/CBC)

Residents find workarounds

Those kinds of bold approaches, however, can be derailed by public blowback. 

In December, Israel took the controversial step of mandating that all returning travellers would have to quarantine at hotels to prevent the spread of coronavirus variants, but wound up walking back the decision.

“The decision to repeal the requirement followed public criticism from a number of senior officials, and clashes between those who had been forced into the hotels and the authorities running them,” reported The Times of Israel.

Even during lockdowns, residents find workarounds, said Gardam, citing the Ontarians flocking to different cities in late 2020 depending on which ones were facing more stringent restrictions.

“I think we really saw it in the GTA, where as soon as you locked down one area, people just went to the next area,” he said. “And that was very, very, very predictable.”

That’s particularly dangerous for Ontario’s increasingly strained hospital system, which has now been tasked with transferring COVID-19 patients out of hard-hit hospitals and regions and pausing a number of non-essential procedures. 

“We’re trying to protect people who are most vulnerable from getting really sick from this, from acquiring the infection, and your community prevalence rate is the main driver of that for most people,” said Dr. Susy Hota, medical director for infection prevention and control at University Health Network in Toronto.

“We can try to preserve that as much as possible but if people are leaving their homes, there’s always that possibility.”

‘Public trust’ eroded by travel controversy

Any time there is a patchwork of policies, it creates a situation where people “have a reason to travel from an area of high transmission to an area of low transmission because it’s still open,” said Ashleigh Tuite, an infectious diseases epidemiologist and mathematical modeller with the University of Toronto’s Dalla Lana School of Public Health.

The biggest challenge now facing policy makers on the travel front is communicating with the public after numerous headline-making international trips made by some of those decision-makers, she said.

After news broke that former Ontario finance minister Rod Phillips had vacationed in St. Barts and later gave up his post, CBC News later reported that Dr. Tom Stewart, a hospital CEO and former member of the province’s command table, was under fire for a trip to the Dominican Republic.

There’s also a growing number of politicians at all levels across Canada who are being outed for various visits abroad, even as public health messaging encourages people to stay home.

WATCH | Caribbean vacation costs Ontario’s finance minister his post:

Rod Phillips resigned as Ontario’s finance minister after the controversy over his Christmas vacation to St. Barts, despite the government urging people to stay at home. Meanwhile, Alberta’s minister of municipal affairs travelled to Hawaii. 1:54

After months of efforts from residents to limit their movement, Tuite said reports of people travelling for non-essential reasons has sparked outrage — and could stymie any future government efforts to curb just that.

“If you have the people who are leading this pandemic response who have decided the risk or the rules don’t apply to them, then you’re expecting other people to follow those rules, that’s an issue for public trust,” she said.

Despite the mixed messaging, surging cases mean Ford may soon be forced face tough decisions on the thorny issue of local travel.

Because, as Morris puts it, human movement is how the world “got into this mess in the first place.”

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