Tag Archives: medical

Stress from scuffle with police ‘more than Mr. Floyd could take’, medical officer testifies

George Floyd’s scuffle with police, along with Derek Chauvin’s knee pressed into his neck, was too much for his underlying heart condition and caused the death of the 46-year-old Black man, the local county’s chief medical officer told a Minneapolis court on Friday.

“[The adrenaline is] going to ask your body for more oxygen so that you can get through that altercation,” said Dr. Andrew Baker, the Hennepin County medical examiner who conducted the autopsy on Floyd and ruled his death to be a homicide.

Baker’s testimony marked the 10th day of the murder trail of Chauvin, a former Minneapolis police officer who is facing trial on charges of second-degree unintentional murder; third-degree murder; and second-degree manslaughter in connection with the death of Floyd.

“And in my opinion, the law enforcement subdual restraint and the neck compression was just more than Mr. Floyd could take by virtue of those heart conditions,” Baker said.

Baker’s testimony veered somewhat from what the court had previously heard from other medical witnesses called by the prosecution.

Floyd died on May 25, 2020, after Chauvin, who is white, pressed a knee on the back of his neck for around nine minutes as two other officers held him down.

Witness reaffirmed autopsy report

The outcome of the high profile trial is being closely watched after video of the arrest of Floyd captured by a bystander prompted widespread outrage, setting off protests over race and police brutality across the U.S. and around the world.

Prosecutor Jerry Blackwell questions Baker at the trial of former Minneapolis police officer Derek Chauvin. (Court TV/Associated Press)

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.

The court has so far heard from prosecution medical experts, including a leading lung specialist, who have testified that Floyd died from asphyxia — or insufficient oxygen — because of the actions of police. Baker has not ruled asphyxiation to be a cause of Floyd’s death.

Previous witnesses had significantly downplayed Floyd’s pre-existing medical conditions and drugs found in his system as playing a role in his death. 

However, Baker reaffirmed the findings of his autopsy report. He said those elements were contributing factors, though not the primary cause of death.

Adrenaline impacts

Under questioning by prosecutor Jerry Blackwell, Baker explained that Floyd had narrowed coronary arteries — about 75 per cent blockage in his left anterior descending artery and 90 per cent blockage in his right coronary artery. Floyd also had hypertensive heart disease, meaning his heart weighed slightly more than it should.

Chauvin’s defence attorney Eric Nelson cross-examines Baker. (Court TV/Associated Press)

Floyd’s confrontation with police, which included being pinned facedown on the pavement while Chauvin pressed his knees into his neck, produced adrenaline that made Floyd’s heart beat faster.

Baker testified that Floyd died of “cardiopulmonary arrest complicating law enforcement subdual, restraint, and neck compression.” 

Asked to explain cardiopulmonary arrest, Baker said that was “fancy medical lingo for the heart and the lungs stopped.”

He also explained the definition of “homicide” in an autopsy report, that it was a medical and not a legal term, which is applied when the actions of other people were involved in an individual’s death.


During cross-examination, Chauvin’s lawyer Eric Nelson seized on the potential role played by Floyd’s heart condition and drugs found in his system.

“In your opinion, both the heart disease as well as the history of hypertension and the drugs that were in his system played a role in Mr. Floyd’s death?” Nelson asked Baker.

“In my opinion, yes,” Baker said. 

Chauvin takes notes at his trial in the death of George Floyd. (Court TV/Associated Press)

Baker also agreed that he had certified overdose as the cause of death in other autopsies where that individual had much lower levels of fentanyl in their system than was found in Floyd.

Nelson asked Baker if he recalled having conversations last year with prosecutors in which he described the level of fentanyl found in Floyd’s system was a “fatal level.”

“I recall describing it in other circumstances, it would be a fatal level,” Baker said.

But Baker also agreed that he had described Floyd’s s death as a “multifactorial process.”

He said drugs and hypertension were not “direct causes” but they were “contributing causes.”

The trial continues. 

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CBC | World News

Canadian Medical Association elects first Indigenous president

The Canadian Medical Association (CMA) has elected its first Indigenous president.

Members selected Dr. Alika Lafontaine, an anesthesiologist in Grande Prairie, Alberta, as CMA president for 2022-23. He will serve as president-elect until August 2022, after which he will become the official CMA president, says a news release from the CMA.

Lafontaine is from Treaty 4 Territory in southern Saskatchewan, and is of Cree, Anishinaabe, Metis and Pacific Islander ancestry.

His nomination comes as the health care sector in Canada grapples with issues of inequity, including racism. 

Earlier this year, the federal government committed to legislation that would aim to ensure Indigenous control over the development and delivery of Indigenous health services. 

Lafontaine said he will focus on addressing issues of inequity during his tenure, and on establishing national licensing for physicians.

“Mobility, employability and collaboration should exist in a post-pandemic world, along with the decreased stress, burnout and improved wellness that will result,” Lafontaine said in the media release.

“It’s also time to eliminate racism, sexism, ableism, classism and all other ‘-isms’ that permeate health system culture.”

The nomination is waiting on confirmation by the CMA General Council in August 2021.

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Military medical intelligence warnings gathered dust as public health struggled to define COVID-19

Public health officials failed to cite early warnings about the threat of COVID-19 gathered through classified military intelligence as the pandemic crisis emerged a year ago, CBC News has learned — an oversight described as a strategic failure by intelligence and public health experts.

For over seven decades, Canada and some of its closest allies have operated a largely secret formal exchange of military medical intelligence. That relationship regularly produces troves of highly detailed data on emerging health threats.

The small, specialized unit within the Canadian military’s intelligence branch began producing warnings about COVID-19 in early January of last year — assessments based largely on classified allied intelligence. Those warnings generally were three weeks ahead of other open sources, say defence insiders.

But documents show the Public Health Agency of Canada’s (PHAC) COVID-19 rapid risk assessments — which politicians and public servants used to guide their choices in early days of the pandemic — contained no input from the military’s warnings, which remain classified.

Three of the five PHAC risk assessments — obtained under access to information law by one of the country’s leading intelligence experts and CBC News — show federal health officials relying almost exclusively on assessments from the World Health Organization.

Even those writing the risk assessment reports acknowledged the dearth of intelligence.

Confidence level ‘low’

“Due to the limited epidemiologic data from China, and limited virologic information available for the etiologic agent, the confidence level for this assessment is considered as ‘low’ and the algorithm outputs remain uncertain at this time,” said the Feb. 2, 2020 PHAC risk assessment report.

The analysts at PHAC were uncertain because — as the world learned later — China was stonewalling the WHO about the extent of the Wuhan outbreak and assuring international health experts that everything was under control.

Biosafety Officer Dr. David Harbourt speaks about protective suits for handling viral diseases in a biosafety level 4 training facility at U.S. Army Medical Research and Development Command at Fort Detrick in Frederick, Md., Thursday, March 19, 2020. (Andrew Harnik/The Associated Press)

Meanwhile, in the military medical community, alarm bells were ringing. In the U.S., the National Center for Medical Intelligence (NCMI), located in Fort Detrick, Maryland, was not only gathering raw intelligence through various classified means — it was producing comprehensive assessments of the trajectory of the virus as of last February.

“This coronavirus pandemic is right in their wheelhouse, which is part of their core mission — to be on the lookout for any early indications of infectious disease,” said Dr. Jonathan Clemente, a physician practicing in Charlotte, North Carolina who has researched and written extensively about the history of medical intelligence.

‘Strategic surprise’

The original purpose of military medical intelligence among the allies was to assess sanitary and health conditions in the places around the globe where their troops were deployed.

But over the years, Clemente said, the mandate evolved to include “preventing strategic surprise” — such as pandemics and deliberate biological attacks. 

“So there’s a wide range of reports, from your short-form daily bulletins to long-form assessments,” he said.

“It’s important to know that this is different from, say, the World Health Organization because the NCMI has access to all-source intelligence, meaning they have access to the most secret levels of intelligence, including clandestine human reporting, satellites, signals intelligence and … open [source] reporting.”

The information gathered through such intelligence channels would be knowledge “that other traditional health care and public health agencies” don’t have, he added. It’s also the kind of knowledge that would have informed the Canadian military’s medical intelligence branch as the pandemic was gathering momentum.

‘A terrible failure’

The fact that PHAC didn’t track what the military medical intelligence branch was seeing, coupled with changes to the federal government’s own Global Pandemic Health Information Network (GPHIN), represent “a terrible failure,” said Wesley Wark, a University of Ottawa professor who studies intelligence services and national security. He requested the documents through the access to information law.

The auditor general is reviewing what went wrong with the country’s early warning system, including the risk assessments. Flaws in those assessments may have affected the introduction of anti-pandemic measures such as border closures and mask mandates.

Security intelligence expert Wesley Wark says Canada’s failure to incorporate military intelligence into its COVID-19 rapid risk assessments was a fundamental error. (Sean Kilpatrick/The Canadian Press)

A second, separate independent review of Canada’s early pandemic response has been ordered by Health Minister Patty Hajdu.

CBC News first reported last spring that the military medical intelligence branch (MEDINT) began writing reports and issuing warnings about COVID-19 in January 2020. At the time, a spokesperson for MEDINT would not comment “on the content of intelligence reports that we receive or share.”

A follow-up investigation by CBC News has shed more light on the long-established secret network the allies use to warn each of health threats.

It’s governed by an obscure forum going by a rather clunky name: the Quadripartite Medical Intelligence Committee (QMIC).

A ‘Five Eyes’ network for pandemics

Originating in the Second World War, the forum allows the American, Canadian, British and Australian militaries to exchange classified global health data and assessments about emerging health threats.

Clemente describes it as the medical equivalent of the better-known Five Eyes intelligence-sharing alliance between Canada, the United States, Great Britain, Australia and New Zealand.

Clemente said that, through U.S. freedom of information law, he has compiled a comprehensive, declassified portrait of the deep health intelligence ties between allies — especially between Canada and the U.S.

He said he also has collected reports and analyses on how NCMI tracked and assessed previous pandemics and disease outbreaks, including SARS, H1N1 and Ebola.

Those assessments — copies of which were obtained by CBC News — are very precise and complete. The U.S. military’s assessments of the novel coronavirus and the disease it causes remain classified, but Clemente said it’s certain that NCMI was doing similar surveillance on COVID-19 which would have been shared with allies.

Wark said Canada’s public health system was redesigned almost two decades ago with the aim of preventing “strategic surprise,” but many of initiatives planned or implemented following the SARS outbreak were allowed to wither away and die.

One 2004 proposal which fell by the wayside was to find a mechanism that would allow PHAC to seamlessly incorporate classified intelligence into its system of reporting.

Greg Fyffe, the former executive director of the Intelligence Assessment Secretariat in the Privy Council Office (which supports the prime minister’s office), said military medical intelligence assessments rarely came across his desk during his tenure a decade ago.

He said that when intelligence reports reach the highest levels of government, they often arrive in summary form and analysts occasionally have to seek out more details.

“There’s so much intelligence information out there that it’s not a matter of saying … ‘I have a little bit of something that you’d like to see,'” said Fyffe. “We’re talking about huge volumes of material which can’t all be shared.”

In a year-end interview with the CBC’s Rosemary Barton, Prime Minister Justin Trudeau dismissed the suggestion that better early warnings could have stopped COVID-19 from spreading to Canada.

WATCH: Prime Minister Justin Trudeau on pandemic early warnings

Prime Minister Justin Trudeau talks to chief political correspondent Rosemary Barton about the lessons learned from his government’s early response to the COVID-19 pandemic, what should’ve been done sooner and his conversations with U.S. President Donald Trump about shutting down non-essential travel along the border. 5:58

“I think we used all the resources that we always have to follow and monitor,” he said. “I don’t know that it would have made a huge difference for us to have extra reporting on top of what we were getting.”

The prime minister said that, in hindsight, there were things “we probably would have wanted to have done sooner in terms of preparing,” such as bolstering stocks of personal protective equipment (PPE) and other medical supplies.

‘We could have been much better prepared’

Defence Minister Harjit Sajjan indicated in a year-end interview that he shared the information he had and there were “many conversations” within the government. 

While he cautioned that military intelligence alone can’t cover global disease surveillance, he did acknowledge that Canada’s early warning mechanisms need a serious review “from a whole-of-government perspective … making sure we have the right sensors out.”

Preparation is the whole point of early warning, said Wark, who agreed with Trudeau’s assessment of the volatility of the novel coronavirus’s transmission.

“We wouldn’t have stopped it from coming to Canada,” said Wark. “That would have been impossible. But we could have been much better prepared to meet its onslaught, and we were not. We suffered a terrible failure of early warning, of intelligence, of risk assessment.

“And the main lesson that has to be drawn … from the experience of COVID-19 is that we have to fix all of those things. We have to have a better early warning system.”

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Medical experts led by SickKids release new back-to-school recommendations

SickKids has released new proposed guidelines for reopening schools in Ontario come September, including recommendations like staggered lunch times, no large assemblies, and mandatory masks for older students. 

The document, which was released Wednesday in collaboration with doctors from across the province, builds on COVID-19 recommendations the organization first released last month. It suggests various health and safety protocols for schools that take a student’s age and developmental considerations into account. 

CBC News has learned Ontario’s education minister Stephen Lecce will unveil the province’s plans for the upcoming school year on Thursday. 

The group says it is recommending the use of masks for high school students, with consideration for middle school students, whenever physical distancing can’t be maintained. Around 61 per cent of the authors agreed masks shouldn’t be required for elementary school kids. 

“[Mask wearing] probably will diminish the infectivity of some individuals with COVID, however there are also a number of potential harms,” said Dr. Jeffrey Pernica of McMaster Children’s Hospital, saying that masks could distract and interfere with learning, especially for those with articulation problems, neurological issues, or kids who are learning a second language. 

He also said that masks would have to be worn correctly in order to be effective, adding that it could be “impractical” for teachers to enforce.

The doctors aren’t recommending that elementary school children wear masks, saying that they could be a distraction and interfere with learning. (Halfpoint/Shutterstock)

Most of the doctors also agreed that if community transmission is low, masking should not be mandatory for students returning to class. 

“The lower the level of COVID in the community … the less benefit there is with masking — but the harms remain the same,” Pernica said. “This is why our recommendations are what they are right now.”

Pernica also added that if the levels change, so will the recommendations. 

Premier Doug Ford addressed the masking recommendations in his news conference on Wednesday, saying he could “never argue against medical professionals.”

“I know [Education Minister Stephen Lecce] is going to be rolling out his plan this week,” said Ford, adding that Lecce has been taking advice from hospitals throughout the province, including SickKids and the University Health Network. 

“They’re the experts when it comes to health and I highly recommend that we follow the health experts as we’ve been doing from day one.”

Ford also acknowledged he was “nervous” sending kids back to school, and called it “concerning” that two million kids would be returning to class, along with around 140,000 teachers. 

He stressed the importance of getting the plans right.

“What’s even more concerning is if one of the kids has COVID and they bring it home to their parents or their grandparents,” he said.

“It’s going to be a tough challenge, but we’ll get through it. We’ll work together.”

Dr. Sean Ari Bitnun, a physician at SickKids, further emphasized that one single measure wasn’t going to mitigate things — success relies on the package. 

“If we’re not focusing on any of the other recommendations, we are bound for disaster,” he said. “It really is the bundle effect that is going to create a safe environment for teachers and students.”

When it comes to physical distancing, the document says its role “should be discussed with students of all ages,” but added it would not be practical to enforce for kids in elementary school, especially during play times. 

Instead, the report says “cohorting” — where kids would avoid mixing with other classes and grades — could be used as a strategy.

Since this would be difficult for high school students, the need for physical distancing would have to emphasized in older kids, the report says.

“Two metres is optimal, but the transmission at one metre is not significantly different,” said Dr. Charles Hui of CHEO. 

Other recommendations include: 

  • Implementing strict screening for students and employees who are symptomatic or have been exposed to the virus.
  • Teaching kids how to clean their hands properly with developmentally and age-appropriate material.
  • Arranging classroom furniture to leave space between students. 
  • Having smaller class sizes. 
  • Cancelling choir practices, performances, and band because of the high risk of transmission from wind instruments. 
  • Continuing sports and physical education classes, but cleaning sports equipment and delaying team and close contact sports. 
  • Implementing a regular cleaning schedule. 

The doctors said that it would be up to each school to figure out how to implement changes when it came to aspects like running school libraries or preventing masses of students from rushing out into the hallways at the end of the school day.

Dr. Bitnun also called for local public health units to closely collaborate with schools, saying that “there will undoubtedly be positive cases with the children and for teachers.”

‘Putting out fires as they come up’

The document stresses that opening schools safely — and keeping them open — will be directly impacted by how the virus is spreading in the community.

The recommendations reflect a mark of less than 200 new confirmed cases a day, and experts say that “may evolve” as the epidemiology of COVID-19 changes and new evidence emerges. 

The school boards have until Aug. 4 to submit their reopening plans to the provincial government. (Mike Crawley/CBC)

The doctors said they haven’t identified a specific level of community spread that, if breached, would means schools would have to close.

“A specific number in isolation doesn’t really have value,” said Dr. Bitnun. “My view, and I think this is shared by the others, is maybe the most important thing is to have a robust system of testing and contact tracing … in other words, we should focus on, to paraphrase, putting out fires as they come up rather than shutting down everything based on a specific number.”

Staying home could impact already vulnerable students

Back in June, experts said data showed children weren’t “super-spreaders” of the virus like they originally thought they would be, and added that there was evidence the virus presented less severely in kids. 

The experts quoted in the document continue to push for full-time instruction, saying that remote learning would be “insufficient to meet the needs” of youth.

“Thinking about developmental impact and mental health impact has to be in the same equation as the potential harm of COVID,” said Dr. Sloane Freeman, lead pediatrician for the Model Schools Pediatric Health Initiative at St. Michael’s Hospital. 

Going back to part time, they said, would affect working parents and caregivers, and mean bringing more people into the loop, like babysitters or grandparents. 

Not going back, doctors say, could impact already vulnerable students the most. 

“Medically complex children or children with severe underlying medical or behavioural illness, I think those families are disproportionately affected by what is going on in terms of isolation and trying to manage at home,” said Dr. Jeremy Friedman, a pediatrician at SickKids. “I think that those families, more than any others probably, will not be able to withstand the sort of time period we’re talking about for [when] this pandemic has moved into a more stable phase.”

“The sad irony is that I think that the children who are perhaps the most fragile and most at risk, those children, those families are the ones that probably need to have the normality and the routine,” he said.

School boards have until Aug. 4 to submit plans

Ontario school boards have until Aug. 4 to submit their reopening plans to the provincial government for approval. 

The Toronto Catholic District School Board has already submitted its plans, which include running full classes. 

The group involved in SickKids’ report includes officials, physicians and infectious disease specialists from SickKids, Unity Health, McMaster Children’s Hospital, The Children’s Hospital of Eastern Ontario, Holland Bloorview Kids Rehabilitation Hospital, Kingston Health Sciences Centre and London Health Sciences Centre. 

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MAID town hall: What the government, experts say about proposed changes to medical assistance in dying law

Whether you support it or are against it, one thing is for certain — medical assistance in dying, or MAID, is a complex, multilayered and deeply personal issue.

Canada’s Parliament passed Bill C-14 in 2016, legalizing assisted dying. Since then, more than 13,000 people have chosen to end their lives that way. 

However, a Quebec Superior Court decision struck down the “reasonably foreseeable death” clause in Bill C-14 as unconstitutional, forcing the government to amend the law earlier this year.

The amended law, known as Bill C-7, was tabled on Feb. 24. The proposed changes address, among other things, concerns around who is eligible for MAID, the role of palliative care, and the role of consent.

A full review was scheduled to begin this summer, but has been delayed due to COVID-19. The pandemic has also had an impact on the delivery of MAID across Canada as some hospitals temporarily restricted services, and personal protective gear (PPE) and physical distancing requirements added a layer of complexity to the procedures.

Canadians across the country still have many questions about who can access medical assistance in dying, and when. After the government tabled Bill C-7 in February, The National co-host Andrew Chang and members of the public put some of those questions and concerns to experts in a CBC town hall as part of an important yet difficult conversation. The expert panellists included:

  • David Lametti, Minister of Justice and the government’s lead on the MAID file
  • Madeline Li, former head of MAID at University Health Network
  • Trudo Lemmens, professor and Scholl Chair in Health Law and Policy in the Faculty of Law at the Dalla Lana School of Public Health, and the Joint Centre for Bioethics at the University of Toronto
  • Susan Desjardins, Dying With Dignity Canada

The National Conversation on MAID was recorded on March 5, 2020, but due to the pandemic it was delayed and aired on The National on July 16 and on CBC News Network on July 19. These are some highlights from the town hall.

Safety checks

The National co-host Andrew Chang (left), and members of the March 5 town hall studio audience posed questions about the amended medical assistance in dying legislation to a panel of experts and officials, including David Lametti, Minister of Justice and the federal government’s lead on the MAID file. (Anand Ram/CBC)

Phyllis Fehr is 60 years old, and a former intensive care nurse.  She was diagnosed with Alzheimer’s seven years ago. While the diagnosis was difficult for her to accept initially, she does not let it stop her from living and ending her life her way. 

Fehr asks: “How will the medical system ensure that there are enough safety checks in place that I will indeed receive MAID when I am near death, and not too soon before I am ready?”

Madeline Li believes that advanced directives discussed and drawn up with family members, along with guidance from clinicians, can help ensure that patients’ wishes as to the timing of MAID is clear:

Madeline Li discusses safeguards that are in place around medical assistance in dying. (The MAID town hall was recorded March 5, 2020.) 0:52

Minister Lametti added that in addition to current safeguards already in Bill C-14, other safeguards are also under consideration.

“There will have to be safeguards that we look at when we do deal with dementia and Alzheimer’s more specifically … we’re always trying to find the right balance between safeguards and a person’s ability to choose.”

Competency clause

Phyllis Fehr. (Evan Mitsui/CBC)

Ron Posno has dementia and is a strong advocate of allowing advance directives for MAID. At present, the law requires a final consent just before MAID is administered — which is a worry for people with dementia, since they lose the ability to do that as their illness worsens.

Posno asks: “Those of us with dementia have so far been left out of the conversation around MAID. Will people with dementia be included in the new amended MAID legislation?”

Minister Lametti says he believes that MAID and dementia is an issue of such complexity that comprehensive further review is needed before a decision of any kind can be made:

Minister of Justice and Attorney General David Lametti explains why dementia and cognitive decline patients are not yet allowed access to medical assistance in dying. (The MAID town hall was recorded March 5, 2020.) 0:56

Trudo Lemmens adds that advanced directives for MAID by dementia patients is globally a hot-button issue. He points out that it is so complicated that, “there is no country in the world except the Netherlands that allows an advanced request for medical aid in dying in the context of severe dementia.”

Power of attorney

Ron Posno. (Evan Mitsui/CBC)

Judy Kirby watched her mother die a slow, painful death. She had power of attorney over her mother’s treatment, and although she could have stopped her being given water and oxygen, she says she did not have the legal ability to ask for MAID for her mother.

Kirby asks: “Will or when will MAID be available to a power of attorney to make those decisions?”

Minister Lametti told Kirby that allowing a power of attorney to make decisions around MAID is an “ethically charged issue,” and that the government is going to look at it at a later stage:

Minister of Justice and Attorney General David Lametti explains why someone with a power of attorney can not make a request for medical assistance in dying. (The MAID town hall was recorded March 5, 2020.) 1:00

Susan Desjardins, from Dying With Dignity, shared with Kirby that she had personally gone through a similar experience. She suggests the patient, “identify not necessarily a power of attorney, but an advocate who could speak for them if they can’t speak for themselves at a time at which they would meet certain conditions they had defined, [and] that at which time they would have wanted to have an assisted death.”

Expert assessment

Judy Kirby. (Evan Mitsui/CBC)

Jason LeBlanc posed a question to the panelists on behalf of his girlfriend, Justine Noel, who was too sick to attend the town hall.

Justine is 29 years old and has fibromyalgia. She has submitted three MAID requests and has been denied twice. She’s awaiting official assessment on her third request. LeBlanc says Noel is worried she will be denied access to MAID once again, due to a lack of medical expertise available to assess her specific condition. 

Leblanc asks: Justine’s question is, what do you intend to do when there is no available MAID assessor with expertise in the applicant’s condition?”

According to Minister Lametti, the expert assessment for MAID no longer requires a specialist, but rather a practitioner with “some level of expertise in the condition.” He adds:

Minister of Justice and Attorney General David Lametti explains who can perform an expert assessment for medical assistance in dying. (The MAID town hall was recorded March 5, 2020.) 0:49

Foreseeable death 

Jason Leblanc. (Evan Mitsui/CBC)

Ernest Frederiksen is a 27-year-old who has lived in constant pain for more than 11 years, due to fibromyalgia and arthritis. 

He applied for access to MAID in 2016 and was denied, as his death was not considered “reasonably foreseeable.” He plans to apply again in a few months.

Frederiksen asks: ” Why should I, or those like me whose deaths are not reasonably foreseeable, have to continue enduring physical or psychological suffering that is intolerable and that cannot be relieved, through a 90-day waiting period instead of a waiting period of 30 days?”

Susan Desjardins from Dying with Dignity, also questions the rationale behind a 90-day waiting period before MAID can be given. “Do we really need a 90 day period, or is some of your length of period [not] reasonable to achieve the goals that we’re trying to here in terms of balancing things?”

Minister Lametti pointed out that there were waiting periods under the old act. However, in Bill C-7, waiting periods have been eliminated “because we found that they don’t work.” He adds that the 90 days is a “period of assessment”:

Minister of Justice and Attorney General David Lametti explains why the 90-day period mandated by the government for MAID is one of assessment, and not a period of waiting. (The MAID town hall was recorded March 5, 2020.) 0:55

MAID and the marginalized 

Ernest Frederiksen (CBC)

Sarah Jama is the founder of the Disability Justice Network of Ontario. She’s worried that once the requirement for “foreseeable death” is removed, MAID will be accessed by a disproportionate number of disabled and racialized people, as a result of a failure of the system to help them live full, sustained lives.

Jama asks: “How are we going to make sure that marginalized communities like the Indigenous, racialized people, and those with disabilities, don’t feel pressured to access MAID because they feel like a burden on the state?”

Trudeau Lemmons shares Jama’s concerns. “People with disabilities are now confronted with the choice when they enter the hospital. You can have MAID in 90 days, or you can go through administrative difficulties of applying for a new system of disability support … that’s actually not available.”

Minister Lametti admitted that the government needs to do more for marginalized people and communities. He stressed that the decision for MAID should never be one of compulsion, but rather always be an informed choice:

Minister of Justice and Attorney General David Lametti on the government’s role in building a system of sustainable care for marginalized communities. (The MAID town hall was recorded March 5, 2020.) 0:47

Moral dilemma

Sarah Jama. (Evan Mitsui/CBC)

Bob Davies is a pastor at Kanata Baptist Church. As a person of faith, his biggest concern is the impact of MAID on those caregivers, organizations and people whose moral code does not permit it. 

Davies asks: “What is being done to protect organizations, health care workers, caregivers and others from facing the emotional and psychological consequences of participating in or being near a medically assisted death that is against their conscience?”

Minister Lametti assured Davies that no clause in Bill C-14 will compel anyone to participate in MAID if they choose not too:

Minister of Justice and Attorney General David Lametti discusses the support available for those providing medical assistance in dying services. (The MAID town hall was recorded March 5, 2020.) 0:34

MAID and mental health

Bob Davies. (Evan Mitsui/CBC)

Glenn Johnson has been living with PTSD and chronic depression for many years. He also suffers chronic pain from degenerative disc disease. He knows that he will want MAID when conditions for him worsen, and he wants MAID extended to those with mental health issues.

Johnson asks: “Pain is pain. Suffering is suffering. And there is no foreseeable end to either my chronic pain or my mental health issues. I want to know why people like myself, with mental illness, are not able to access MAID?”

Trudo Lemmens admits that MAID and mental health illness is one of the most complex issues to tackle. Determining who will and will not get better is close to impossible, he says:

Trudo Lemmens on why the law excludes those with mental illness from access to MAID. (The MAID town hall was recorded March 5, 2020.) 0:56

Minister Lametti added that, “it is an ongoing challenge to better understand the various kinds of mental health issues that might become the basis for a MAID request down the road. We just kept hearing again and again that we weren’t ready to make it part of the MAID package.”

Palliative care vs. MAID

Glenn Johnson. (Evan Mitsui/CBC)

Dr. Naheed Dosani is a Toronto palliative care physician who works at hospitals and within the community to care for people with life-limiting disease at a variety of stages of illness.  

In his view, priority needs to be given to better access and options around palliative care, rather than MAID.

Dr. Dosani asks: “How are we working to build up our health care and social care systems, not just in hospitals but in the community too, so that all Canadians from all walks of life have equitable access to quality of life-based palliative care?”

Minister Lametti agreed that access to quality palliative care is crucial. “As a government we have identified palliative care as critically important, and we’re developing an action plan. We’ll obviously work with our provincial partners and territorial partners to try to make sure that it happens.”

Susan Desjardins adds that she believes that both MAID and palliative care focus on the same thing — the quality of dying:

Susan Desjardins shares her personal experience with family members accessing palliative care and MAID. (The MAID town hall was recorded March 5, 2020.) 1:06

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‘Serious’ questions raised about hydroxychloroquine study, medical journal says

The Lancet medical journal said on Tuesday “serious scientific questions” had been brought to its attention about the validity of the data behind a widely cited and already corrected study on the dangers of the use of the anti-malarial drug hydroxychloroquine in hospitalized patients with COVID-19.

The Lancet’s “expression of concern” follows the May 22 publication of a study that found hydroxychloroquine, which U.S. President Donald Trump took and has urged others to use, was tied to an increased risk of death in hospitalized COVID-19 patients.

Several clinical trials, including in Canada, were put on hold after the study was published.

The article, called “Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis,” was an observational study — meaning it compiled real-world data, rather than conducting a traditional clinical trial — and used data provided by health-care data analytics firm Surgisphere.

The Lancet last week issued a correction to the study regarding the location of some patients following criticism of its methodology, but said the conclusions were not changed.

Also last week, nearly 150 doctors signed an open letter to the journal calling the article’s conclusions into question and asking to make public the peer review comments that led to it being published.

Although it wasn’t a rigorous experiment that could give definitive answers, the Lancet study had wide influence because of its size.

The World Health Organization said it would temporarily stop a study of hydroxychloroquine and France stopped allowing its use in hospitals.

Health Canada has not paused trials it has authorized on hydroxychloroquine in COVID-19 patients. Instead, the regulator is asking for new safety assessments from the independent committee of experts who regularly review safety data collected during clinical trials.

“Based on this information, Health Canada will determine whether additional measures should be taken with respect to these clinical trials,” a spokesperson said in an email last week. “While this review is still ongoing, Health Canada is not aware of any reports of cardiac arrhythmias in the clinical trials that have been authorized in Canada.”

The New England Journal of Medicine also issued an “expression of concern” Tuesday on a study it published May 1 that suggested widely used blood pressure medicines were not raising the risk of death for people with COVID-19.

Dr. Mandeep Mehra of Brigham and Women’s Hospital in Boston led both studies, which relied on Surgisphere’s database of health records from hundreds of hospitals around the world. Editors at the New England Journal of Medicine wrote that they’ve asked the authors to provide evidence the information is reliable. 

WATCH | Handwashing put to the test

Using “glo germ,” a product that shows up under black light, Andrew Chang takes a first-hand look at how germs are transmitted, and how to wash them off our hands effectively. 7:03

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Medical examiner rules George Floyd’s death a homicide

A Minnesota medical examiner on Monday classified George Floyd’s death as a homicide, saying the Minneapolis man’s heart stopped as police restrained him and suppressed his neck, in a widely seen video that has sparked protests across the country.

“Decedent experienced a cardiopulmonary arrest while being restrained by law enforcement officer(s),” the report by the Hennepin County Medical Examiner read.

Under “other significant conditions,” the medical examiner wrote that Floyd suffered from heart disease and hypertension and listed fentanyl intoxication and recent methamphetamine use.

A Minneapolis police officer has been charged with third-degree murder in Floyd’s death. Bystander video showed the officer, Derek Chauvin, pinning down Floyd with a knee on Floyd’s neck despite the man’s cries that he couldn’t breathe. He eventually stopped moving.

A separate autopsy commissioned for Floyd’s family found that he died of asphyxiation due to neck and back compression, the family’s attorneys said Monday.

The autopsy found the compression cut off blood to Floyd’s brain, and that the pressure of other officers’ knees on his back made it impossible for him to breathe, attorney Ben Crump said. He called for the third-degree murder charge against Chauvin to be upgraded to first-degree murder and for the three other officers to be charged.

The family’s autopsy differs from the official autopsy as described in a criminal complaint against the officer. That autopsy included the effects of being restrained, along with underlying health issues and potential intoxicants in Floyd’s system, but also said it found nothing “to support a diagnosis of traumatic asphyxia or strangulation.” The family’s autopsy found no evidence of heart disease and concluded he had been healthy.

Floyd, a 46-year-old black man who was in handcuffs at the time, died after Chauvin, who is white, ignored bystander shouts to get off him and Floyd’s cries that he couldn’t breathe. His death sparked days of protests in Minneapolis and around the U.S.

The official autopsy last week provided no details about intoxicants.

Curfews extended

New York imposed an 11 p.m. ET curfew Monday as the nation’s biggest city tried to head off another night of destruction erupting amid protests over Floyd’s death. New York is joining other cities around the country in imposing such measures after days of violence.

Washington, D.C. has extended its curfew for another night. It went into effect at 7 p.m., and police used tear gas and rushed crowds of peaceful protesters near the White House to clear the way for U.S. President Donald Trump to walk to a nearby church for a photo opportunity. Once Trump was back at the White House, the peaceful gathering resumed, and people marched on the National Mall and D.C. streets. Police made no further move to clear them, despite the curfew. 

Police clear the area around Lafayette Park and the White House as demonstrators gather to protest the death of George Floyd, Monday, June 1, 2020, in Washington. (Alex Brandon/The Associated Press)

Prior to the brief walk, Trump said in a statement from the White House Rose Garden that he will deploy the military unless states move to end the protests. 

Police in Philadelphia fired non-lethal bullets and tear gas at hundreds of protesters who spilled onto an interstate highway in the heart of the city Monday, just before a 6 p.m. curfew took effect.

Seattle also imposed a third night of curfew, beginning at 6 p.m. local time. San Francisco said it would have a second night of curfew, beginning at 8 p.m. local time.

Brother pleads for peace

Earlier Monday, Floyd’s brother Terrence pleaded for peace in the streets, saying violence is “not going to bring my brother back at all,” as U.S. cities hoped another night of violence could be avoided with the country already buckling because of the coronavirus outbreak and the Depression-level unemployment it has caused.

The U.S. has been convulsed by angry demonstrations from coast to coast for the past week in some of the most widespread racial unrest in the U.S. since the 1960s. Spurred by the death of Floyd in Minneapolis, protesters have taken to the streets to decry the killings of black people by police.

Floyd made an emotional plea for peace at the site where his brother died.

“Let’s switch it up ya’ll. Let’s switch it up. Do this peacefully, please,” he said.

Terrence Floyd, brother of George Floyd, speaks Monday at the makeshift memorial in Minneapolis. (Lucas Jackson/Reuters)

Wearing a face mask with the image of his brother’s face on it, Terrence Floyd spent several minutes of silence at the flowers and other memorials that have sprung up to his brother before speaking.

Floyd said his family is “a peaceful family. My family is God-fearing.” And he said, “in every case of police brutality the same thing has been happening. You have protests, you destroy stuff … so they want us to destroy ourselves. Let’s do this another way.”

The crowd chanted, “What’s his name? George Floyd” and “One down, three to go,” referring to the other three officers involved in the arrest. Protesters are demanding they be prosecuted, too. All four were fired.

The gathering was part rally and part impromptu eulogy as Floyd urged people to stop the violence and use their power at the ballot box to vote.

WATCH | Minneapolis community organizer talks about how to achieve real change through protests:

CBC News Network’s Michael Serapio speaks with Mike Griffin, a community organizer in Minneapolis. 6:14

‘Small number’ of protesters violent

While most of the demonstrations have been peaceful, others have descended into violence, leaving neighbourhoods in shambles, stores ransacked and cars burned, despite curfews around the country and the deployment of thousands of National Guard members in at least 15 states.

Even as police in some places tried to calm tensions by kneeling or marching in solidarity, officers elsewhere were accused of the very type of harsh treatment at the heart of the unrest.

In Fort Lauderdale, Fla., an officer was suspended for pushing a kneeling woman to the ground during a protest. In Atlanta, two officers were fired after bashing in the window of a car and using a stun gun on the occupants. In Los Angeles, a police SUV accelerated into several protesters, knocking two people to the ground.

In New York, the police commissioner said about six incidents were being investigated by the department’s internal affairs bureau, including a weekend confrontation in Brooklyn in which two police vehicles appeared to plow through a group of protesters. In another incident, an officer pointed a gun at protesters, drawing condemnation from the mayor.

WATCH: Keith Mayes on what it could take to stop the violent protests:

Ian Hanomansing talks to Keith Mayes, a professor at the department of African American and African studies at the University of Minnesota, about race relations in the Minneapolis–St. Paul area and what it could take to stop the violent protests. 2:04

Around the country, political leaders Monday girded for the possibility of more of what unfolded over the weekend: protesters hurling rocks and Molotov cocktails at police in Philadelphia, setting a fire near the White House and smashing their way into Los Angeles stores, running off with as much as they could carry.

Terrence Floyd, brother of George Floyd, sat several minutes at the makeshift memorial outside the store where he was arrested and later pinned to the ground. Outside of camera view, hundreds kneeled down in silence. (Lucas Jackson/Reuters)

At least 5,600 people have been arrested for offences such as stealing, blocking highways and breaking curfew, according to a tally compiled by AP journalists from police department news releases, police agency Twitter activity and media reports. In Minneapolis, where Floyd died, some 155 arrests have taken place. Some of the biggest cities in the U.S. have also made a significant number of arrests, including nearly 800 in New York City and more than 900 in Los Angeles.

But officers around the country were also accused of treating protesters with the same kind of heavy-handed tactics that contributed to the unrest in the first place.

Cities struggled to keep police in line.

Police officers and National Guard soldiers enforcing a curfew in Louisville, Ky., killed a man early Monday when they returned fire after someone in a large group shot at them, police said. By Monday afternoon, the city’s police chief was fired, after the mayor learned that officers involved in a shooting that killed the popular owner of a barbecue spot failed to activate body cameras during the chaotic scene.

The U.S. attorney said federal authorities will join state police in investigating the fatal shooting.

In Indianapolis, two people were reported dead in bursts of downtown violence over the weekend, adding to deaths recorded in Detroit and Minneapolis.

Former vice-president Joe Biden, the Democratic presidential candidate, wrote a post online expressing empathy for those despairing about Floyd’s killing. On Monday, he met with community leaders at a black church in his hometown of Wilmington, Del.

“The vice-president came to hear from us. This is a homeboy,” said Sylvester Beaman, pastor of the Bethel AME church.

Trump told the nation’s governors in a video conference that they “look like fools” for not deploying even more National Guard members. “Most of you are weak,” he said.

Minnesota Gov. Tim Walz, a Democrat, rejected Trump’s call for the use of force. He said he told Trump during the meeting: “No one is laughing here. We’re in pain. We’re crying.”

WATCH l Moments of panic as truck drives into crowd in Minneapolis:

Protesters demonstrating against the death of George Floyd flee as a truck drives through a crowd on a Minneapolis highway 1:10

Meanwhile, Walz said separately Monday that it appeared the driver of a semitrailer who rolled into the midst of thousands of people who had gathered on a closed Minneapolis freeway on Sunday was confused and didn’t mean to injure anyone.

Walz said Monday he was “breathless” as he watched the scene unfold and he thought he was going to see “dozens or hundreds” of people killed. But he said preliminary information suggests the driver somehow got ahead of traffic officials as they were closing the freeway down in sections. He noted the driver braked as he rolled past protesters.

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House calls, revisited: Mobile medical team provides in-home care to help take pressure off hospitals

COVID-19 has forced a change to health care in Renfrew County, Ont., and it might just be one Canadians want to keep and other nations want to emulate.

Just over an hour-and-a-half drive from Ottawa, in Ontario’s largest county, people are getting medical attention right inside their homes.

This is an idea born of fear, anxiety and disease. When the pandemic started marching around the globe, Renfrew County chief paramedic and director of emergency services Michael Nolan started looking for solutions. He knew there was a need to protect hospital emergency rooms from overcrowding, and he also realized family doctors would not be able to work solely out of clinics the way they traditionally had.

Within 12 days of the first conversation, VTAC was live.

It’s a joint effort with partners from across the health care system, led by primary care physicians, community paramedics, public health and hospitals.

Dr. Jonathan Fitzsimon, the Chief of Medicine at Arnprior Regional Health and one of the physicians who helped spearhead the program, describes how it works. “If you don’t have a family doctor, or if you can’t access your family doctor, then you can call a virtual triage assessment centre or VTAC. It’s a free phone single number — you can call us and we will link you with a family physician or nurse practitioner.

“You then get an appointment, usually within a few hours.”

Patients can have their appointments over the phone or a video link. About 80 per cent of those calls can be dealt with by a physician or nurse practitioner without requiring a face-to-face visit. If a visit is required, people with the necessary expertise are dispatched.

A paramedic at VTAC’s call centre speaks with a patient. About 80 per cent of the issues VTAC is contacted about can be dealt with on the phone or by video link without requiring an in-person visit. (CBC)

“The difference we’ve got is we’ve linked in with our community paramedics, so we’re working hand-in-glove with primary care doctors and community paramedics. We will send the community paramedic to your home,” says Fitzsimon.

He stresses that people should still be calling 9-1-1 if they are experiencing an emergency, such as a heart attack or a stroke, major bleeding or severe breathing problems. VTAC is for all the other concerns that might have a person wondering if they should try to get an appointment with a doctor or go to the ER.

‘I was happy at home and out of the hospital’

The effect of having paramedics essentially make house calls is profound for those receiving the care.

Renfrew resident Kim Groves is blunt, saying that he’s sure his life was saved by the VTAC team. Groves tested positive for COVID-19 and was desperately sick, but was able to recover at home thanks to the paramedics, particularly Matt Rousselle, who made that so.

“I think I would’ve kicked the bucket if it hadn’t been for him,” Groves says. “I couldn’t even get off the couch. I was right done.”

The paramedics moved him from the couch to his bed, made him comfortable, checked his condition to ensure he didn’t need more extensive treatment, and gave him an I.V.

“That doesn’t happen with paramedics too often … so yeah, I was happy at home and out of the hospital,” Groves says.

Renfrew County paramedic Matt Rouselle, left, pays a visit to Kim Groves who recovered from COVID-19 at home with help from VTAC. (CBC)

Proper access to the proper health services is key. It’s about not leaving anyone behind, according to Nolan.

“Everybody has access to a family physician, 24 hours a day seven days a week,” says Nolan.

“We’ve been able to prove that keeping you home while you’re sick is safe, is affordable, and is in fact what the population is telling us they want the future to look like.”

COVID-19 has effectively cut through the red tape and allowed good ideas to get put into action. But the funding taps could get turned off. And questions remain about how effective a plan like this would be in a large urban centre.

Even so, Nolan says the future of delivering health care can’t be a matter of “back to normal.” He maintains the way health care used to be delivered is not the way it should be delivered.

The future, simply, could be better.

A VTAC paramedic conducts a medical checkup on a Renfrew County resident at her own home, helping to reduce the pressure on local medical clinics and emergency rooms. (CBC)

He is constantly exchanging ideas with paramedics from other countries. The best ideas win, like the suggestion from Europe of wrapping the inside of ambulances to make them easier to disinfect. And several other nations have asked about the VTAC system and its feasibility.

“COVID is an absolute tipping point,” says Nolan.

“I think it is the call to action of our generation … to make the health care system better and to acknowledge the important role that paramedics have in that journey.”

Human contact

What does that better health care system potentially look like?

It involves going above and beyond simple medical checks. In some cases the human contact the VTAC team provides to those who are isolated is as important to their wellbeing as the medical care.

Consider this scene that unfolded while CBC News was with a VTAC team. At a seniors residence in Renfrew County, the windows of the residents’ bedrooms are decorated with signs reading We miss you, we love you. So far, COVID-19 has been kept out of the residence, but those signs remind that surviving is not the same thing as living.

Virtual triage assessment centre (VTAC) paramedics put on personal protective equipment outside before visiting a seniors residence in Renfrew County, Ont. (CBC)

With a “no visitor” policy, the appearance of paramedics like caped superheroes in their PPE is totally welcome. All inside know the paramedics are not here because something’s happened, they’re here to ensure it doesn’t. There are more residents to be swabbed to test for COVID-19, just in case.

Since journalists can’t go in, the VTAC team wore disinfected cameras strapped to their chests, and with permission of the residents we got a glimpse of interactions both loving and necessary.

Resident Stan Broski is there with his wife who has dementia. “I’m feeling fine, but I’m 88 and my legs are 108,” he offers.

Stan Broski and his wife Joan are residents at Miramichi Lodge in Pembroke, Ont. He spoke to CBC’s Adrienne Arsenault over the phone from his room with the help of the paramedics. 0:16

And he’s clearly happy to see the paramedics, even if they bring that impossibly long swab.

“I’ve been here four years and this is the most excitement I’ve seen,” he jokes.

He talks proudly to the VTAC team of his son who is a doctor in St. Catharines, of missing everyone he loves. And loved. “I miss my mother,” he says.

Further down the hall is Joan Walsh.

“How are you, my dear? We’re going to make this as smooth as possible,” says paramedic Chris Day.

He has seen a lot through his job. Not long ago he sat with a patient who wanted to die at home, but was alone. Day was able to connect the family via videoconferencing and be the surrogate caring soul holding the man’s hand. The family sent him a beautiful note, one of those traumatic treasures of COVID-19.

With Walsh, though, there are lots of smiles behind those masks. She seems fine — no cough or runny nose, and the COVID-19 test is quick.

“It was alright,” she says.

Joan Walsh is a resident at Miramichi Lodge in Pembroke. She tells CBC’s Adrienne Arsenault she misses her family. 0:41

The paramedics help her to the window and put a phone close so she can talk to us outside.

“I’m an awful book reader, so I read a lot of books,” Walsh tells us.

“I have eight children,” she adds, “five sons in the valley and three daughters. I tell them all the time I love them, and they tell me they love me too … I don’t know what else to say.”

That’s all there is to say. The little things are the big things now, like care that takes its time and paramedics who go out of their way.

Now the test, to see if this Renfrew County experiment survives in a post-COVID world.

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Brazil becomes a global epicentre for COVID-19, as political turmoil hampers medical response

With cases rising rapidly, a military general with no medical experience leading the Ministry of Health, and a president admitting there’s no proof his preferred treatment will work, Brazil has become one of the countries hardest hit by the coronavirus. 

As health systems, from Sao Paulo to the Amazon, strain under the growing number of cases, policy experts say there’s little hope that the country can change course when the president is one of their biggest obstacles.

“It’s unbelievable what’s happening in Brazil. When the biggest science denier in the country is the president himself, what can we scientists do?” said Natalia Pasternak, a microbiologist and researcher at the Institute of Biomedical Sciences at the University of Sao Paulo.

Brazilian President Jair Bolsonaro has been among the world leaders most dismissive of the coronavirus, initially downplaying it as a “little flu,” then later responding “so what” when asked about the country’s rising death toll.

His own Ministry of Health had opposed him, promoting physical distancing and quarantines, but Bolsonaro fired popular Health Minister Luiz Henrique Mandetta in April, and then forced his replacement Nelson Teich to resign last week. Both were trained doctors. 

“I don’t see any hope in the short term,” Pasternak said. “I think the numbers are going to keep piling up and a lot of people are going to die until we solve the political situation.”

‘A grave situation’

The World Health Organization (WHO) now considers South America the new epicentre of the pandemic, in large part because this week Brazil overtook the United Kingdom for third place in the overall number of COVID-19 cases. 

Brazil has more than 310,000 cases and more than 20,000 deaths, according to statistics kept by Johns Hopkins University. The country’s Ministry of Health believes the numbers are likely higher because of a lack of effective testing.

WATCH | Bolsonaro minimizes COVID-19 surge in Brazil, promotes hydroxychloroquine:

The number of coronavirus cases is surging in Brazil, but President Jair Bolsonaro continues to minimize the situation. Bolsonaro is also advocating the use of hydroxychloroquine, an unproven treatment also promoted by U.S. President Donald Trump. 2:01

“Are people dying? Yes they are, and I regret that. But many more are going to die if the economy continues to be destroyed because of these (lockdowns),” Bolsonaro said earlier this month.

On Thursday, Brazil reported more than 18,500 infections, while also suffering a record 1,188 daily coronavirus deaths, eclipsing its previous high set earlier in the week. 

“It’s a very grave situation,” said Humberto Costa, a Brazilian senator and former health minister under former president Luiz Inácio Lula da Silva. 

In Sao Paulo, the country’s largest city, fresh graves continue to be dug up in the sprawling Formosa cemetery. Health officials say they’re losing the battle against the virus and the system will be overrun. City and state officials moved holidays up from June and July to this weekend to create an extended break to encourage physical distancing.

In Manaus, the largest city in the Amazon rainforest, the mayor is warning that Indigenous tribes will be decimated by the coronavirus. Amazonas state, where Manaus is located, is one of the hardest hit regions of the country.

“I fear genocide and I want to denounce this thing to the whole world. We have here a government that does not care about the lives of the Indians,” Manaus Mayor Arthur Virgilio Neto said. 

‘Politicizing the Problem’

While other countries have waited for some signs of the virus slowing down before reopening the economy, Bolsonaro has continually pushed for Brazilians to get back to work, putting him at odds with state governors and mayors trying to curb the spread through lockdowns and quarantines.

“He denies the severity of the disease and he only makes political calculations about what’s best for him,” Costa said.

Observers say Bolsonaro is thinking first about re-election in two years, promoting an economic agenda that resonates with the country’s poorest, who can’t afford to isolate themselves at home.

A health-care worker is seen at a field hospital set up to treat patients suffering from the coronavirus in Guarulhos, Sao Paulo state, Brazil, on May 12. (Amanda Perobelli/Reuters)

“He’s following his instinct that the economy needs to reopen and the country cannot face an economic crisis so deep,” said Marcio Coimbra, a political strategist in the capital, Brasilia.

“The middle class and upper class are against the president,” Coimbra said. “But on the other side, the poor people who need to work, they are there supporting the president.”

Costa said Bolsonaro’s actions now are laying the groundwork for what will happen in a few months’ time if the country’s economy continues to suffer because of lockdowns meant to stop the spread of COVID-19.

Bolsonaro “will say, ‘I told you that the virus was a little problem, the governors and mayors made the wrong measures,'” Costa said. 

‘Problems at the Health Ministry’

Some of Bolsonaro’s highest profile clashes have been with his own Ministry of Health. In April, he fired Health Minister Luis Henrique Mandetta who had gained in popularity with his daily technical briefings.

His replacement, Nelson Teich, resigned last week, after refusing to promote Bolsonaro’s desire for wider use of the anti-malaria drug hydroxychloroquine as a treatment for COVID-19. Interim Health Minister Eduardo Pazuello immediately approved the plan, going against the recommendations of WHO experts in Brazil.

WATCH | Brazil’s worsening COVID-19 crisis:

Brazil’s worsening COVID-19 crisis SUMMARY: Brazil’s already weak health-care system and an incoherent response from its political leaders to the COVID-19 pandemic have made it much more difficult for the country’s hospitals to deal with the growing number of cases, says Oliver Stuenkel, a professor and author from the Getulio Vargas Foundation in  Sao Paulo. 6:42

 “We are at war: Worse than being defeated is the shame of not having fought,” Bolsonaro wrote in a post on his official Facebook page in response to his critics. 

Pazuello is a military general known as a logistics expert, with no health background. Costa said Pazuello is staffing the ministry with people with military experience, rather than health expertise, which will further hamper the country’s efforts to fight the virus.

“They are politicizing the problem, it’s not a question of science, it’s not a question of medicine, it’s just a question of politics,” Costa said.

Like his ally U.S. President Donald Trump, Bolsonaro has pushed hydroxychloroquine as a solution to the pandemic, despite admitting that there’s no proof it works.

Health policy expert Miguel Lago said Bolsonaro’s support for the drug is more about politics than medicine. 

“Bolsonaro is a very smart politician and he’s trying to understand what can fit a narrative where he appears to be a great leader,” said Lago, executive director of the Institute for Health Policy Studies, a non-profit group based in Rio de Janeiro. 

Profanity-laced video

On Friday, a profanity-laced video showing Bolsonaro expressing frustration at his inability to get information from police and vowing to change cabinet ministers if needed to protect his family was released at the order of a Supreme Court justice.

The two-hour video of a cabinet meeting, with portions redacted, was released as part of a probe into allegations that the president was trying to improperly meddle in the federal police, a claim made by former Justice Minister Sergio Moro when he resigned last month.

Moro told investigators that Bolsonaro openly demanded he make changes in key federal police positions, including the head of the agency. Moro resigned after Bolsonaro fired the federal police director-general without consulting him.

The video shows the president complaining, “I already tried to change our security in Rio de Janeiro and I couldn’t. That is over. I will not wait [for them] to [profanity] my entire family just for fun, or a friend of mine.”

Bolsonaro has insisted he was referring to the head of his security detail, though he had successfully changed that position recently. Moro said the president was alluding to the head of police operations in Rio, who presumably might have been involved in investigations into the president’s sons, who live there.

Hope in local governments

Lago said the only hope for Brazil’s efforts lies in state governors and local politicians ignoring directives from the president. States have enforced their own measures in defiance of Bolsonaro’s views, including mandatory masks in public and limits on traffic in major cities 

“After two months, we shouldn’t be expecting anything good from the federal government in the sense we should only rely on our local governments.” 

A Kambeba Indigenous woman sits as she waits to be tested for the coronavirus on the banks of the Negro river at the village Tres Unidos, Amazon state, Brazil on May 21. (Bruno Kelly/Reuters)

Impeachment has been discussed in Brazil. The speaker of the lower house, Rodrigo Maia, has more than 30 requests to remove Bolsonaro, but hasn’t acted on them.

The president has maintained control of a fractured Congress, by striking a deal with a centrist group of parties that represent about 40 per cent of votes. 

“If he keeps delivering power for votes in Congress, he’ll be able to stay in power until the end of his term,” Coimbra said.

‘No light at the end of the tunnel’

Costa said the peak of COVID-19 cases could come sometime in the middle of June; some projections show Brazil could end up with more than 100,000 dead and more than a million people infected.

According to statistics from the Brazlian tech company Inloco, just over 42 per cent of Brazilians are practising physical distancing, down from a high of around 62 per cent around the end of March.

WATCH | Bolsonaro minimizes COVID-19 surge in Brazil, promotes hydroxychloroquine:

More than 16,000 people have died due to COVID-19 in Brazil. 0:46

Pasternak said the president’s example, holding rallies, shaking hands and hugging supporters, sends the wrong message to Brazilians who look to him for leadership. She worries about the direction the country is headed.

“I don’t see any light at the end of the tunnel right now.”

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Canadians should wear masks when physical distancing is difficult, says chief medical officer

Canada’s chief public health officer says Canadians should wear a mask as an “added layer of protection” whenever physical distancing is not possible.

Dr. Theresa Tam provided the updated advice during her daily news conference in Ottawa today.

“For the spring and summer months, strict adherence to the public health basics of physical distancing, handwashing and cough etiquette must continue as the bare minimum,” she said.

“In addition, where COVID-19 activity is occurring, use of non-medical masks or face coverings is recommended as an added layer of protection when physical distancing is difficult to maintain. And staying home when sick is a must, always and everywhere.”

Watch: Chief Public Health Officer explains mask guideline

Dr. Theresa Tam, Canada’s chief public health officer, is now recommending that Canadians wear masks in public as an “added layer of protection” whenever physical distancing is not possible. 2:27

Tam said the new guideline comes as provinces begin to allow businesses and services to reopen, bringing more people out of their homes.

Asked if the recommendation should have come earlier in the pandemic emergency, Tam said public health advice has been evolving based on the science. That advice is also now responding to the fact that, with more provinces taking cautious steps toward reopening their economies, more Canadians are coming into closer proximity to one another in public.

“We need to flexibly change our measures as we get more information,” she said.

Tam said the advice coming from her office today is a “specific recommendation,” while the previous language was “more permissive.”

The position taken by Tam’s office at the start was that masks can protect others — so if someone is showing symptoms and needs to go out, they need to cover their face. As officials learned more about asymptomatic and pre-symptomatic carriers and their potential role in transmission, the advice on masks changed.

Asked if the federal government could issue a directive to make mask-wearing in public mandatory, Tam said it remains a recommendation at the national level — but provinces and communities could make their own decisions based on local conditions.

She also warned that wearing a mask won’t protect an individual from infection on its own, and stressed that physical distancing remains fundamental.

Prime Minister Justin Trudeau wears a mask at a repatriation ceremony for six Canadian Armed Forces members killed in a helicopter crash off of Greece Wednesday, May 6, 2020. (Frank Gunn/The Canadian Press)

PM to wear mask in public

Tam said measures to suppress the disease through the summer are essential to buy more time for research and innovation on medical therapies and vaccine development.

Earlier today, Prime Minister Justin Trudeau said he has started wearing a mask in public in situations where he could be in close proximity to people.

“That’s my personal choice. I think that’s what is aligned with what public health is recommending,” he said. “I think we all need to adjust to what works in our circumstances and keep safety at the forefront of what we’re doing.”

Watch: Prime Minister Justin Trudeau on his decision to wear a mask in public

Prime Minister Justin Trudeau says wearing a mask is his personal choice and he wears one whenever he’s unable to keep two metres’ distance from others. 1:04

Trudeau said he will wear a mask to in-person sittings of Parliament but will remove his mask once at his desk to engage in parliamentary debate.

He was first seen wearing a mask in public during a May 6 Canadian Armed Forces repatriation ceremony.

Trudeau said again that the best measures to limit the spread of COVID-19 are to stay two metres apart, to stay at home whenever possible and to wash hands regularly and frequently.

Singh following health advice

NDP Leader Jagmeet Singh will be wearing a mask outside of his home “in times when physical distancing is hard or not possible,” says a statement from his office.

“From the beginning of this crisis, he had followed public health experts’ advice and will continue to do so,” says the statement.

Asked if Conservative Leader Andrew Scheer is wearing a mask, a party spokesperson said: “A number of our MPs have made the personal decision to wear masks on the Hill. Conservative MPs will continue to follow public health guidelines.”

The World Health Organization (WHO) has not formally recommended wearing masks and has said the evidence is inconclusive on whether people who are asymptomatic should wear them.

But many experts say masks should be mandatory because they can reduce the amount of airborne droplets that can carry the virus.

Several countries, including Spain, have made wearing masks compulsory in cases where the two-metre physical distancing rule can’t be observed.

Today, Ontario’s provincial government said passengers on public transit should wear masks.

Watch: Trudeau arrives  on Parliament Hill wearing a mask

Prime Minister Justin Trudeau is seen walking into West Block on Parliament Hill wearing a personal mask. He said his ‘personal choice’ to wear a mask in public is aligned with health recommendations. 0:23

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