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AstraZeneca doses set to arrive tomorrow — but questions remain about who gets them first

The first batch of Canada’s supply of the AstraZeneca-Oxford vaccine is set to arrive tomorrow — but public health officials still have some distribution issues to sort out before they can deliver those shots.

Health Canada approved the AstraZeneca product last Friday. The National Advisory Committee on Immunization (NACI), the independent panel that sets the guidelines for vaccine deployment, is not recommending that these shots be used in people aged 65 and over.

While Health Canada has determined the product is safe to use on all adults, NACI said there isn’t enough clinical trial data available to determine how effective this product is in preventing COVID-19 infection among people in this older cohort.

Health officials will be under pressure to quickly establish priorities for distribution of the AstraZeneca shots because 300,000 of the 500,000 doses set to arrive this week from the Serum Institute of India will expire in just a month’s time.

Dr. Theresa Tam, Canada’s chief public health officer, said NACI is prepared to update its guidance “as they see more and more real world data accumulating,” but for now the AstraZeneca product should be directed at younger Canadians.

“Don’t read their recommendations as sort of static. But this is what they’ve recommended at this point,” Tam said. “Just watch this space.”

It’s up to the provinces and territories to decide how to put these AstraZeneca shots to use. Some scheduling adjustments will be required because most jurisdictions are focused on vaccinating the elderly at this early stage of the immunization campaign.

Tam said some of the groups that were “potentially prioritized a little bit later on” will have a chance to get their shots earlier than planned because of the NACI guidance.

Most provinces have said that — after the elderly, front line health care workers and Indigenous adults are vaccinated — essential workers and people who face a greater risk of illness should be next in line for the second phase of shots.

Maj.-Gen. Dany Fortin, the military commander leading the federal government’s vaccine logistics, said the shots will be “expedited as quickly as possible” to prevent wastage.

WATCH: Procurement Minister Anita Anand says AstraZeneca shots will arrive Wednesday

Procurement Minister Anita Anand says the first shipment of AstraZeneca’s COVID-19 vaccine is scheduled to arrive in Canada on March 3. 1:06

Asked why Canada purchased vaccines that are set to expire during the first week of April, Procurement Minister Anita Anand said the federal government was responding to demands from the provinces to acquire more shots.

“They have repeatedly told the federal government that they want vaccines as soon as possible and that they’re ready to administer vaccines,” she said.

Beyond the question of who will get these shots, there’s a debate over just how long people should wait between the first and second doses.

NACI has recommended that provinces and territories follow the guidelines set by the manufacturers and approved by Health Canada regulators: 21 days between shots for the Pfizer product, 28 days for Moderna and between four and 12 weeks for the AstraZeneca doses.

Some provinces, notably Quebec, have ignored these guidelines from the beginning, preferring instead to administer as many first doses as possible to tamp down infection risk.

NACI ‘considering evidence’ on dosing intervals

Dr. Bonnie Henry, B.C.’s provincial health officer, announced Monday that the province would be extending the interval between doses for all three products to 16 weeks.

Tam said NACI is now “considering evidence” from the latest scientific studies about the intervals between shots and will provide an updated recommendation sometime this week.

Christine Elliott, Ontario’s health minister, said that while public health officials in her province have complied with NACI guidelines, they would shift gears to deploy first doses to more people if vaccine experts give them the green light to delay those second doses.

“We are anxiously awaiting NACI’s review of this to determine what they have to say and their recommendations,” Elliott said. “We want to make sure that the decisions that Ontario makes are based on science.”

Tam said data from B.C. and Quebec suggest there may be good reasons to wait longer.

“They’re vaccinating seniors in long-term care facilities and so on and we’re seeing quite a high level of protection. It also seems that the protection is obviously lasting even after the first dose,” she said.

In a recent analysis paper published in the New England Journal of Medicine, Dr. Danuta Skowronski of the British Columbia Centre for Disease Control and Dr. Gaston De Serres from the Institut national de sante publique du Quebec suggested that a single shot of the Pfizer vaccine might be almost as good as two.

The doctors found that, by waiting two weeks after vaccination to start measuring the rate of new infections, researchers recorded 92 per cent fewer COVID-19 cases among those who had received a single dose of the vaccine compared to those who got a placebo.

“With such a highly protective first dose, the benefits derived from a scarce supply of vaccine could be maximized by deferring second doses until all priority group members are offered at least one dose,” the doctors wrote in their paper.

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CBC | Health News

Google Told Stadia Developers They Were Making ‘Great Progress,’ Then Fired Them

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Google’s decision to kill Stadia’s game development and shut down its studio came as a surprise to everyone, especially its employees. A leaked email shows that that the VP of Stadia and general manager Phil Harrison sent an email on January 27 lauding everyone for the ‘great progress’ Stadia had made thus far. Five days later, Harrison announced Google would no longer be developing its own games, effective immediately.

Kotaku reports that Harrison held a contentious conference call with Stadia developers several days later. When pressed to explain the difference in tone between his January 27 email and the Feb 1 announcement, Harrison admitted nothing had changed between those two dates. “We knew,” Harrison said.

Officially, Harrison claims that Google quit the game development business because Microsoft bought Bethesda and because the cost of game development continues to rise. Sources claim Harrison also referenced the difficulties of working during the pandemic as one reason why Google shut down development. These answers strain credulity. Are we to believe that Google launched itself into game development without bothering to read a single article on the difficulty of launching into the console space? The cost of making games is literally always going up. Here’s the data:

Adjusted for inflation, the price of making games goes up roughly 10x every decade and has for the past 26 years. This is not new data.

I found this in under five minutes. The idea that Google launched Stadia without conducting some minimum due diligence is insulting. Furthermore, Stadia only launched 14 months ago. Google’s game development effort is reportedly under two years old. That’s not enough time for any game studio to create a brand-new AAA game. There are reports that developer headcounts were frozen all throughout 2020, indicating someone at Google had misgivings about Stadia from the get-go. It sounds as if Stadia never had Google’s full support, which is exactly the kind of half-baked effort everyone was afraid Stadia would turn out to be.

There is a profound and growing disconnect between Google and the concerns of actual humans who use its products. Google’s customer service has been infamously nonexistent for years, but things came to a head earlier this month when the developer of Terraria, a game with tens of millions of Android customers, announced he’d canceled the Stadia version of his game because he couldn’t get in touch with anyone at Google who could explain the total account ban affecting his company.

Getting locked out of your Google account without any known reason or apparent recourse isn’t just something that happens to little people. It happens to developers who partner with Google to sell software. Now, we know it happens to developers who trust Google as an employer, too. The company makes a lot of noise about wanting ethical AI experts on-staff, only to fire them the first time they raise questions about ongoing projects.

Google is not honest with the public about its own goals, motivations, or priorities. At times, it’s self-evidently not honest with its staff, either. The company repeatedly pledges to support projects like Stadia, then drops the entire concept of developing its own games with zero warning to anyone, even its own employees.

This isn’t just a question of shading the truth in a self-evidently favorable way. Every company does that. Consider: When Apple announces new hardware, speculation revolves around cost. When Microsoft announces a new feature, speculation revolves around how well it’ll work. If Facebook announces a new product, the discussion revolves around privacy.

When Google launches a new product, speculation revolves around how long it’ll be before the company kills it.

It’s unfortunate to learn Google treats at least some of its employees with the same disdain it treats everyone else, but it certainly isn’t surprising. Google used to be known for what it built. Now, it’s mostly noteworthy for what it quits.

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What are the coronavirus variants and how should we respond to them? Your COVID-19 questions answered

We’re answering your questions about the pandemic. Send yours to COVID@cbc.ca, and we’ll answer as many as we can. We publish a selection of answers online and also put some questions to the experts during The National and on CBC News Network. So far, we’ve received almost 67,000 emails from all corners of the country.

Canada’s chief public health officer, Dr. Theresa Tam, warned Wednesday that variant strains of the coronavirus had been found in eight provinces, and that they could quickly reverse the gains the country has made in recent weeks in the battle against COVID-19.

At least two of three variants of concern are spreading in Canada, in some cases with no known link to travel, and have already led to devastating outbreaks in long-term care homes.

Here’s a look at some of the most common questions Canadians have about the variants.

Have a question or something to say? CBC News is live in the comments now.

What is it about the new coronavirus variants that makes them more transmissible?

As a virus infects people, it can mutate as it makes copies of itself. Some mutations can be harmful to a virus, causing it to die out. Others can offer an advantage and help it spread.

“Not every mutation is created equal,” Mary Petrone, who studies infectious diseases at Yale University, told The Associated Press. “The virus is going to get lucky now and again.”

There are many variants circulating around the world, but health experts are primarily concerned with the emergence of three

  • B117, first discovered in the U.K., which has “a large number” of mutations, according to the U.S. Centers for Disease Control and Prevention (CDC).
  • B1351, first discovered in South Africa, which shares some of the same mutations as B117.
  • P1, which was first discovered in Japan, in four travellers who had been in Brazil. 

Dr. Eric Topol, a U.S. physician, scientist and clinical trials expert who heads the Scripps Research Translational Institute in California, told CBC News in January that the variant first found in the U.K. exhibits changes in the spike protein — a key component of how the coronavirus binds to human cells.

He said those changes are likely behind its higher transmission, with the altered spike protein potentially allowing the coronavirus to infect cells more easily. The other two variants of concern also have changes to the spike protein.

WATCH | Dr. Bonnie Henry ‘confident’ variant transmission isn’t widespread:

B.C.’s provincial health officer says the province is aiming to control the spread of more infectious coronavirus variants over the next few weeks as it ramps up vaccinations. 1:14

If the variants are more contagious, do we need to distance more?

Ashleigh Tuite, an infectious diseases epidemiologist and assistant professor at the University of Toronto’s Dalla Lana School of Public Health, noted to CBC’s Adam Miller earlier this month that the 15-minute exposure time and two-metre distance guidelines from the federal government are “arbitrary.” 

“The new variants, I think, provide us with a reason to re-evaluate those rules and I think that’s something that hasn’t necessarily been well-communicated to the public,” she said. “There’s nothing magical about that distance that was based on science, that’s based on sort of what we know about how airborne pathogens are spread. But I think the science has evolved, or at least our thinking has evolved.” 

Erring on the side of caution makes sense, she said.

Dr. Lucas Castellani, an infectious diseases specialist at Sault Area Hospital, told CBC News Network on Feb. 2 that there’s no set distance the virus can travel, regardless of variants.

“We know it potentially can go farther and there are a lot of factors involved,” he said in regards to a question about smoking or vaping during the pandemic. “How heavy the person has been breathing, how good the ventilation is in the room or the space you’re in.”

At the same time, Castellani said he suspected based on the mutations that it’s not a case of the virus hanging in the air longer or travelling farther.

“Based on the type of mutations they have, it is unlikely that those are the types of characteristics that are leading to the change that we’re seeing,” he said.

WATCH | With COVID-19 variants, questions of whether guidelines go far enough:

The spread of the highly transmissible COVID-19 variant first found in the U.K. has some Canadian doctors wondering if our current distancing recommendations are enough. 2:02

Should we be wearing better masks?

Yes. Experts say we should consider finding better quality masks, wearing two at a time and/or wearing them more often.

In fact, the CDC released new guidance on Wednesday that said a lab experiment had found two masks meant double the protection.

The CDC said a cloth mask worn over a surgical mask can tighten the gaps around the mask’s edges that can let virus particles in.

The researchers found that wearing one mask — surgical or cloth — blocked around 40 per cent of the particles coming in during an experiment. When a cloth mask was worn on top of a surgical mask, about 80 per cent were blocked.

WATCH | COVID variants can cause cases to increase exponentially, Ontario health official says:

There is obvious community transmission of COVID-19 variants, according to York Region Medical Officer of Health Dr. Karim Kurji, who says the virus needs to be contained as it has the capacity to increase case numbers exponentially. 7:51

Canada recommends the use of three-layer non-medical masks with a filter layer to prevent the spread of the virus, but has not updated its recommendations since November, before the emergence of the new variants. 

Dr. Zain Chagla, an infectious diseases physician at St. Joseph’s Healthcare Hamilton, told CBC News that while three-layer non-medical masks are a good “minimum standard,” Canadians should opt for masks that offer better protection whenever possible.

Those include surgical masks, which are a step below N95s and KN95s and come in three different filtration levels determined by the American Society for Testing and Materials (ASTM).

“When I go to the grocery store now, I wear my very best mask,” said Linsey Marr, one of the top aerosol scientists in the world and an expert on the airborne transmission of viruses at Virginia Tech. “Before I was wearing an OK mask that was comfortable and easy.”

She said a cloth mask can “easily filter out half of particles, maybe more, but we’re at the point where we need better performance.” 

WATCH | Must detect variant COVID-19 cases quickly to stop spread, immunologist says:

In order to limit the spread of COVID-19 variants, cases must be detected quickly to ensure isolation occurs, says microbiologist and immunologist Craig Jenne. 3:21

Erin Bromage, a biology professor and immunologist at the University of Massachusetts, Dartmouth, who studies infectious diseases, said a tight-fitting mask is more important than ever due to the emergence of variants.

“It’s not that double-masking provides extra protection if the mask was fitting well,” he said. “Double-masking helps the mask that is closest to your skin fit more snugly, meaning more air goes through that mask.”

If you’re already wearing a high-quality mask that fits well, with air going through the material rather than out the sides, Bromage said there’s no extra benefit in throwing an extra mask on top.  

He recommends looking at yourself in the mirror before you go out to make sure your mask isn’t too loose fitting.

“I really want people to look at them and think, is all the air going through the material? And if it’s not, work out a way to do that,” he said. “And that may be putting a second mask on or finding a different mask that fits their face.” 

WATCH | Simple hacks to make your face mask more effective:

Canadian respirologist Dr. Samir Gupta explains the latest COVID-19 mask recommendations and demonstrates simple hacks to make yours more effective. 2:38

Are the variants more deadly?

It’s possible. There is some evidence the variant first found in the U.K. carries a higher risk of death than the original strain, the British government’s chief scientific adviser said in January.

“The verdict is still slightly out but theoretically, yes, it’s possible,” Castellani, the infectious diseases specialist at Sault Area Hospital, told CBC News. “And unfortunately that’s the way viruses work and the way mutations potentially catch up with us.”

WATCH | The race between COVID-19 vaccines and variants continues despite concern about efficacy:

South Africa has halted its rollout of the AstraZeneca COVID-19 vaccine after a study showed it offered minimal protection against mild infection from a variant spreading there. While experts say it’s cause for concern, they say vaccines can be reconfigured to protect against mutations. 2:01

Is it possible to be re-infected from any of the variants?

“Yes, it is possible to be re-infected,” Castellani said on Tuesday. “We’re seeing that in some parts of the world, in particular South Africa, that some individuals are in fact being re-infected with the virus. It’s felt that once you get the immunity from the virus it may last for some time, but not everyone’s will last the same as the next person.”

Dr. James Hamblin, a Yale University public health policy lecturer and a writer with the Atlantic, told CBC’s Front  Burner that a raging outbreak in the Brazilian city of Manaus also pointed toward re-infection.

“It’s been very tragic there: places running out of oxygen, people being buried in mass graves,” he said. 

The city was hit so hard by the coronavirus in the spring that researchers estimated that 76 per cent of the population had been infected, which makes the severity of this recent outbreak unexpected and concerning.

Hamblin said the leading theory is that it’s a combination of fading immunity given that the first surge in Manaus was about nine months ago, along with the dangers of the P1 variant. 

The variant “shares a mutation that the South Africa variant also has, which gives it a propensity to evade immune responses.”

Front Burner21:02A mutating virus and the need for global herd immunity

Does giving one dose of the vaccine and waiting beyond recommended days for the second dose help the virus adapt?

“It can,” said Dr. Isaac Bogoch, a Toronto-based infectious diseases specialist and member of Ontario’s vaccine task force, in an interview with CBC News Network on Monday. 

He said the concern is if you only give one dose of a two-dose vaccine regimen you can create an environment that allows the virus to “selectively evade that protection, and that’s certainly a theoretical concern.”

However, he said, in Canada most people will get the second dose on the optimum day (21 or 28, depending on the vaccine), and if not, within the recommended 42 days. 

Is there concern that 14 days is not long enough to quarantine and protect others from virus variants?

Bogoch said that while the variants of concern may have greater transmissibility or the ability to evade vaccination more readily, the incubation time or duration of the illness hasn’t changed.  

“Obviously we have to be open-minded, we have to be humble, there might be new data that results in a change in policy, but I think the 14-day [quarantine] should be fine for now.”

However, Alberta did strengthen its quarantine rules, because the variants are more easily spread through households.

“If cases choose to stay home during their isolation periods [rather than other isolation options], their household contacts will need to stay at home as well in quarantine, until 14 days have passed from the end of the case’s isolation period, for a total of 24 days,” said Dr. Deena Hinshaw, Alberta’s chief medical officer of health, during a news conference last week.

“Given how easily this variant is spreading in homes, this enhancement is necessary to prevent spread in the community.”

WATCH | AstraZeneca vaccine can be used against coronavirus variant first found in South Africa, says WHO:

WHO’s expert advisory group says there is a ‘plausible expectation’ that the AstraZeneca vaccine will be effective against severe disease from the coronavirus variant found in South Africa, despite a small study that prompted concerns. 2:09

We’re answering your questions every night on The National. Last night, we asked our experts about the impact of stress — nearly one year into the pandemic.

A physician and psychiatrist talk about the impact that stress is having on mental and physical health a year into the COVID-19 pandemic and what the longer-term effects might be. 6:10

Have questions about this story? We’re answering as many as we can in the comments.

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CBC | Health News

Silver price surges amid investor frenzy — but Reddit says it isn’t them

Silver broke above $ 30 US an ounce for the first time since 2013 on Monday, the latest asset to see a pop in a volatile few weeks on markets.

Colin Cieszynski, chief market strategist with SIA Wealth Management in Toronto, said silver has apparently become the next asset to get caught up in the GameStop frenzy.

“The most significant move this morning has been in silver, which was a trending topic in the media and on Reddit over the weekend with a lot of chatter (both for and against) that it could be the next market to become active in the wake of GameStop’s big move last week,” he said. 

A Reddit group known as WallStreetBets, managed to help drive up the price of Gamestop shares 1,600 per cent in the past two weeks, costing short sellers billions on the process.

Spot silver leapt more than 11 per cent in London to $ 30.03 an ounce and was on track for its biggest one-day rise since 2008, taking gains to about 19 per cent since last Wednesday.

The jump set off a rally in silver-mining stocks from Sydney to London.

The action in silver, following thousands of Reddit posts and hundreds of YouTube videos suggests that a rise in the physical price could hurt large investors with bearish bets, also marks a foray into a much bigger and more liquid market than individual stocks.

However, within the Reddit forum WallStreetBets, some members were adamant targeting silver is not their next strategy. They said outsiders are trying to pump the stock, and it appears to be working. 

Analysts who monitor silver markets say there is more to the story than small investors rushing in.

“The asset is traded by a variety of institutional players and it is very likely that those parties have joined the move to push the metal higher,” wrote Boris Schlossberg of BK Asset Management.

On Twitter, #silversqueeze was trending as investors turned their attention to silver, but some members of the WallStreetBets forum on Reddit insisted this was not their latest strategy. (Dado Ruvic/Reuters)

“I would look at the silver rally the same way as I would the GameStop saga — from the point of view of market stability, for now it’s not an immediate concern, but if we see sharp moves, we could see some deleveraging in markets,” said Antoine Bouvet, a rates strategist at ING.

“This reducing of risk through deleveraging could potentially boost demand for bonds if it is causing excess volatility.”

In the first signs of deleveraging, Goldman Sachs said the amount of position-covering last week by U.S. hedge funds, buying and selling, was the highest since the financial crisis more than a decade ago.

Nevertheless, their market exposure to stocks remains near record levels, the investment bank warned.

Rise of new trading platforms

The rush to silver and GameStop-like stocks has been testing limitations in newer trading platforms and processing venues, frustrating retail traders who are unable to feed their hunger to buy and sell more frequently.

The feverish silver-buying has hit a glitch, with large U.S. broker Apmex warning of processing delays while it secures more bullion. The Money Metals online exchange suspended trade until mid-morning Monday.

Trading volumes in small miners’ stocks in Australia were unprecedented and jumps in some exploration firms, which do not actually produce silver, topped 90 per cent.

Similar hiccups were seen in equities last week. GameStop, AMC and a few other volatile stocks saw temporary buying restrictions in trading apps like Robinhood, as frenzied buying led to trading apps putting on curbs.

“The Reddit crowd has turned its sights on a bigger whale in terms of trying to catalyze something of a short squeeze in the silver market,” said Kyle Rodda, an analyst at brokerage IG Markets in Melbourne.

“This is their big, bold Moby Dick moment.”

Stock in video game retailer GameStop saw huge increases last week as a cadre of retail investors mobilized to buy it up. (Carlo Allegri/Reuters)

Another ‘short squeeze’

The popularity of dabbling in stock markets has grown during the COVID-19 pandemic as volatility, stimulus checks and lockdowns have driven account openings and investment.

The craze hit fever pitch last week when the GameStop pile-on resulted in a “short squeeze,” turning price gains stratospheric as hedge funds with bets against the stock desperately bought it at high prices to close their positions.

Now it is silver’s turn and once again the scale of buying is catching the professionals by surprise.

Online discussions turned to silver late last week as Reddit posts suggested higher prices could hurt banks with large short positions, and that buying easy-to-access exchange-traded silver funds could quickly ramp up the metal’s value.

Retail traders poured a record $ 39.1 million Cdn into Australian ETF Securities’ Physical Silver fund by the afternoon. A silver ETF in Japan surged 11 per cent.

So far, the Redditors are rolling on. Several of the renegade traders are millionaires on paper and their hedge fund adversaries are nursing their wounds. Melvin Capital, which bet against GameStop, lost 53 per cent on its portfolio in January.

The trading app Robinhood has exploded in popularity this year by offering free trading, fuelling a boom in retail investor activity. (Brendan McDermid/Reuters)

Robinhood, the Redditors’ main broker, has also backed down and lifted some of the buying restrictions it imposed last week, although limits remain on eight companies, including GameStop, AMC Entertainment and BlackBerry.

However, with regulators circling both Robinhood and the Redditors’ forums, the battle is far from over.

“I’ll tell you one thing, [I] absolute guarantee this ends in tears,” said Michael McCarthy, chief market strategist at CMC Markets (Australia). “I just don’t know when.” 

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60% of COVID-19 long-haulers say government is ‘absolutely ignoring them,’ Marketplace questionnaire finds

Susie Goulding said she feels like she’s living with a “broken brain.” 

Some days, she can’t remember her dog’s name. Other days, she can’t remember how to make a phone call from her car.

“It’s like a computer that’s processing,” said Goulding, who lives in Oakville, Ont. “It’s spinning and I’m just waiting for the information to come to my brain, but it doesn’t come.”

Goulding started experiencing symptoms of COVID-19 in March 2020. She was not tested during her initial illness because her symptoms didn’t match up with early testing criteria. She said her doctor has since made a working diagnosis of COVID-19 based on her ongoing symptoms. 

Today, she is just one of a growing number of Canadians who say they’re suffering from so-called long COVID, a condition where people who contract even a mild case of COVID-19 experience symptoms for weeks or months after their initial illness.

Recent research has found that one in three of those who contract COVID-19 can go on to develop persistent symptoms, with studies citing heart, lung and cognitive issues, as well as debilitating fatigue and pain. They’ve come to be known as COVID long-haulers, and based on these recent statistics, Canada could have more than 200,000 of them at this point in the pandemic.

WATCH | Woman with long COVID describes struggle accessing medical care:

Susie Goulding says she feels like she’s living with a ‘broken brain.’ She started experiencing symptoms of COVID-19 in March 2020 and has paid hundreds of dollars for private medical treatment because, she says, she hasn’t been able to access the care she needs in the public system. 1:00

It’s a growing population that Goulding said is struggling to access the medical care it needs to recover.   

“You’re not being protected by this umbrella of Canadian health care that we’re accustomed to,” said Goulding. “It just sort of proves the fact that they’re absolutely ignoring us.”

While extra health-care dollars have been invested in treating COVID-19 across Canada, experts say the country lags behind others when it comes to allocating resources for the treatment of those with long-COVID symptoms, specifically.

To investigate where gaps in health care for long-haulers may exist in Canada, CBC Marketplace launched a nationwide questionnaire designed in consultation with medical experts. 

Responses were gathered from over 1,000 Canadian long-haulers through an online questionnaire conducted by Marketplace from Dec. 9, 2020 to Jan. 6, 2021. It was circulated among members of the COVID Long-Haulers Support Group Canada Facebook group, among others. 

More than 60 per cent reported that they have not been able to access the care they believe they need to recover.

Symptoms experienced by respondents to our questionnaire include:

  • Cognitive issues, such as brain fog and memory loss. 

  • Lung issues, such as shortness of breath and chest pain. 

  • Pain, such as joint pain and body pain.

  • Fatigue.

Shortage of Canadian clinics treating long COVID

St. Paul’s Hospital in Vancouver is home to the Post-COVID-19 Recovery Clinic, aimed at providing specialized care and followup for people who were diagnosed with COVID-19 and are now in recovery. (Maggie MacPherson/CBC)

In the U.K., the National Health Service (NHS) England is spending at least 10 million pounds, or $ 17.3 million Cdn, to open 81 long COVID specialist clinics across the country. U.K. Health Secretary Matt Hancock said “they will bring together doctors, nurses, therapists and other NHS staff like physiotherapists.”

Meanwhile, Canada has six in-person post-COVID clinics that take on long-haulers: two in Ontario, three in the greater Vancouver area, and one in Sherbrooke, Que. These clinics are funded through hospital operating budgets, charitable donations and research dollars.

Because these clinics have limited capacity and often run as part of research studies, they only accept patients with a confirmed diagnosis of COVID-19. Many long-haulers say this has left them shut out. 

Tracey Thompson, a long-hauler who first presented with symptoms last May, also didn’t meet the provincial criteria for COVID-19 testing when she first got sick. “Because I hadn’t been out of the country. I wasn’t eligible for testing,” she said.

Since then she has spent a lot of time at home with her fingers crossed, hoping for what she calls the holy grail of treatment. 

“I wake up every day and I hope that there’s going to be some news about something like the [U.K.’s clinics] opening up in Canada,” said Thompson. “[Here], there’s no cohesive or sort of holistic care plan for people with long COVID.”

CBC Marketplace’s investigation revealed that more than 54 per cent of long-haulers who were not tested for COVID-19 with a PCR swab test said it was because testing was not available to them when they got sick. Another 34 per cent who weren’t tested said it was because they did not meet the provincial standards for testing at the time.

Back in April, assessment centre physicians told CBC News that they had been directed to use their testing capacity for priority groups like health-care workers and not members of the general public, even if they were symptomatic. 

At one point, centres were turning away between 25 and 30 per cent of people who showed up with a referral. Now, it’s too late for long-haulers who contracted COVID-19 early on in the pandemic to get tested. 

A lack of sufficient medical support to treat long COVID patients could become a problem, said Dr. Angela Cheung, Professor of Medicine at the University of Toronto and co-lead of the Canadian COVID-19 Prospective Cohort Study (CANCOV), which is evaluating early to one-year outcomes in patients with COVID-19.

“The hospitals are overwhelmed, and in some ways the [post-COVID] clinics are overwhelmed, too,” said Cheung. If Canada doesn’t properly look after long-haulers, “we would have a lot of people feeling not well [who] can’t go back to work.”

WATCH | Why Canada’s support for COVID-19 long-haulers is lagging: 

Canadians who experience symptoms of COVID-19 for weeks or months after first getting ill told CBC’s Marketplace and The National they are struggling to access the medical care they need. Countries such as the U.K., meanwhile, are funding specific health-care services for those known as long-haulers. 4:31

‘They don’t  believe you’ without a positive test

Over 50 per cent of long-haulers told Marketplace that one or more physicians did not believe them when they presented with symptoms, and nearly 40 per cent said their doctor told them they were suffering from anxiety or depression and not COVID-19. 

Abrar Faiyaz, a business student at Seneca College who began experiencing symptoms last March, was not tested for COVID-19 because of limited testing at the time reserved for people who had travelled out of the country. Some of his doctors have suspected he has post-viral syndrome, he said, and his symptoms are consistent with long COVID. However, he has still had to convince other doctors that he’s sick in order to get referred for medical testing despite suffering from brain fog and debilitating back pain since his initial sickness.

“I’m 22, had no prior illness, was extremely healthy and extremely fit,” said Faiyaz. “If people can’t see that you’re ill, they don’t believe you.” 

Abrar Faiyaz, photographed at left in March 2020 and pictured at right January 2021. Faiyaz said he doesn’t feel or look his age anymore. He said that, given the choice, he would rather have his legs broken five or six times than contract COVID. (Submitted by Abrar Faiyaz)

Other respondents said they had been brushed off and dismissed by their doctors, or were repeatedly denied antibody testing. One respondent told Marketplace the lack of care they’d received made them feel so helpless, they considered suicide.

To help inform physicians, the U.K.’s National Institute for Health and Care Excellence recently published guidelines that advise doctors on diagnosing and treating patients with long COVID. The guidelines also discourage physicians from relying on a positive COVID-19 test for diagnosis or referral to specialists and long-COVID clinics. No such guidelines exist in Canada.

Dr. Jessi Dobyns, a family physician from Peterborough, Ont., believes more education and guidelines for doctors could help. 

She became sick with common symptoms of COVID-19 four days after seeing a patient who was later confirmed to have the virus. She said PPE was not in place for general practitioners at the time. She was tested twice after becoming symptomatic, but both times the test came back negative. The federal government’s online information portal about testing notes that a test’s accuracy “can vary” depending on when it was taken.

Dobyns has been experiencing symptoms of long COVID for ten months, and said she has not been able to get medical help from a post-COVID clinic.  

“If somebody had a typical COVID-like illness and they’ve developed persistent symptoms, [treat it] as COVID,” said Dobyns. “If it walks like a duck and it talks like a duck, that’s most likely what it is.”

Physicians and health-care providers need “clinical definitions” in order to effectively treat patients. 

“We need boxes that we can say, ‘oh, that sounds like this,'” said Dobyns. “And I don’t think we always do well … when we see something that just doesn’t make sense.” 

Paying for treatment out of pocket

For long-haulers who haven’t been accepted to a post-COVID clinic, the cost of paying for care themselves can be in the thousands of dollars. 

Dr. Mark Bayley, medical director of brain and spinal cord rehabilitation at the Toronto Rehabilitation Institute of the University Health Network, provides rehabilitation such as physiotherapy and occupational therapy to post-COVID patients referred by Toronto’s University Health Network hospitals. Treatments there are covered by the province. 

Bayley said the same course of treatment privately could cost as much as $ 1,500. 

More than 45 per cent of questionnaire respondents told Marketplace they’ve spent their own money on treatment, with 31 per cent of those respondents spending over $ 1,000 on followup care not covered by private health insurance. Some spent $ 10,000 or more.

Private MRIs and CAT scans, naturopathy treatments, rehabilitation, occupational therapy and equipment for monitoring their own symptoms at home are some of the costs long-haulers told Marketplace they had incurred in an effort to treat themselves.  

WATCH | Full ‘Canada’s forgotten patients’ Marketplace episode:

Sick for months, and stuck paying thousands in medical bills. The truth about how Canada is failing Covid long-haulers. Plus, will getting rid of sulphites in wine get rid of your hangover? 22:31

Federal government isn’t tracking long COVID 

Health Canada told Marketplace that there is insufficient data on COVID long-haulers to determine how common these long-term effects are among Canadians, as well as the spectrum of complications.

As the majority of the questionnaire respondents reside in Ontario, Marketplace also contacted Ontario’s Minister of Health Christine Elliott to ask what the province is doing to support COVID long-haulers.  

In a written statement she said that Ontario is spending $ 2.5 billion more in the hospital sector during COVID, but did not address the issue of long-haulers specifically.

Cheung said she’d like to see multidisciplinary post-COVID clinics set up in all provinces and funding support to run these clinics, because Canada is “definitely lagging behind.”

For long-haulers like Dobyns, help can’t come fast enough.

“We need people who are thinking about health-care systems and policy and the economy to figure out, like, what are we going to do with this bill [and this] tsunami of disability that is coming.” 

Watch full episodes of Marketplace on CBC Gem.

At the time of publication, CBC counted six clinics that are treating long-haulers confirmed to have had COVID-19:

  • ONTARIO — The University Health Network Clinic at Toronto Western Hospital and the Urgent COVID-19 Care Clinic at the London Health Science.
  • BRITISH COLUMBIA — A collaborative network of three clinics including one at the Vancouver General Hospital, St. Paul’s Hospital in Vancouver and the Jim Pattison Outpatient Care and Surgery Centre in Surrey.
  • QUEBEC — La Clinique Ambulatoire Post-COVID du CIUSSS-CHUS.

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‘They call us every day’: COVID-19 case monitors are a lifeline, but provinces vary in how they use them

When Shaleen Erwin became sick with COVID-19 in November, the pregnant mother from Springside, Sask., wasn’t surprised that she had a hacking cough and slept 16 hours a day.

What astonished her was that she received a phone call every day from a public health worker at the Saskatchewan Health Authority (SHA) to check on her, her husband and their three-year-old son — all of whom had contracted the virus.

“I was blown away…. It’s hours and hours of time, and time is such a valuable resource,” Erwin, 33, said. “I think there’s this misconception that if you’re not using an ICU bed or you’re not using oxygen, that you’re not using resources.”

Provincial public health authorities are advised by the Public Health Agency of Canada to contact people with COVID-19 at home every day to monitor both their symptoms and compliance with isolation rules, depending on available resources to make those phone calls. Some provinces, including Saskatchewan and Manitoba, are attempting daily phone calls while others, such as Alberta, are not.

Ontario’s Ministry of Health advises public health units to notify people of their COVID-19 positive status with a phone call, then make followup phone calls on Day 5 and Day 10, at a minimum. On other days, the person is supposed to receive at least a text message or email.

Shaleen Erwin, 33, of Springside, Sask., became sick with COVID-19 when she was five months’ pregnant. She was surprised to receive a daily phone call at home from a public health worker. (Submitted by Shaleen Erwin)

Thousands of 10-minute phone calls a day

If contact tracers, who investigate the spread of the virus, are considered the public health detectives, then case monitors are the parents — checking on how you are and making sure you follow the rules.

Pamela de Bruin, clinical standards and professional practice lead with the SHA who does planning in public health surveillance, said the health authority uses a database to investigate, track and actively monitor positive cases and close contacts.

She said the “standard of care” is a daily phone call to every person in the province with COVID-19 — currently 4,121 people — except to those already receiving care inside long-term care homes, hospitals or jails. They monitor symptoms, check on compliance and offer access to resources, such as mental health services.

“There are many social barriers that can come up when people have to be isolated for a long period of time, and they may be faced with making a choice between getting groceries or staying isolated,” de Bruin said, adding that public health workers are able to connect people with resources and services to help them comply with mandatory isolation.

A public health nurse conducts a contact-tracing phone call in Wyoming in July. Public health workers with the Saskatchewan Health Authority make 10-minute phone calls to active cases each day, requiring more than 600 staff hours. (Mike Moore/Gillette News Record/The Associated Press)

The 10-minute phone calls to active cases require more than 600 staff hours a day. The SHA uses 66 people from Statistics Canada for case-monitoring calls, as well as some nurses and licensed health workers.

“We’re constantly evaluating the capacity against the number of cases,” de Bruin said, adding that the SHA has so far been able to meet the demand, and she believes it’s a worthwhile use of resources.

“We’re speaking to an individual, but when we implement measures, like all public health measures, we’re looking for an impact at a population level.”

University of Saskatchewan medical student Helen Tang drew this illustration after working as a contact tracer for the SHA. She discovered that the financial, emotional and mental burden on people with COVID-19 was often worse than their physical symptoms. (Helen Tang)

In addition to active cases, the SHA makes a daily call to monitor their close contacts who have symptoms or comorbidities, as well as close contacts who are red-flagged in the database as being potentially non-compliant with public health restrictions.

“Sometimes right at the first [notification] call, we have indication to believe someone might not be compliant. Sometimes they tell us. And so those would be called daily,” de Bruin said.

Alberta doesn’t have active monitoring

In Alberta, where there are roughly 12,230 active cases at the moment, Alberta Health Services (AHS) does not actively monitor people who are sick with COVID-19 at home. Instead, from the start of the pandemic, it has advised people to seek medical attention from a doctor or call 811 or 911, depending on their condition.

That was sufficient for Talana Hargreaves, a 38-year-old mother of three from Edmonton whose entire family tested positive for COVID-19 in November. She was initially concerned by the lack of personal followup from AHS but was eventually satisfied with a one-hour phone call from a contact tracer.

The Hargreaves family at their Edmonton home in December after recovering from COVID-19. From left, Hayden, Talana, Landon, Carys and Jack, along with dogs Amigo and Monica. (Submitted by Talana Hargreaves)

Hargreaves, who had spent a lot of time researching COVID-19 online and following news reports, discussed her family’s mild symptoms with their doctor and didn’t have any questions about the isolation rules.

“My partner and I are both conscientious rule-followers,” she said. “I think that COVID check-in could actually be very valuable for some people who honestly don’t know what they should be doing.”

She said she is more concerned about the backlog of contact tracing in the province and allocating resources to investigating cases.

“They still don’t know where roughly 50 per cent of our positive cases have come from … so even though it would be nice to have that followup, I don’t know that it’s realistic at this point,” Hargreaves said.

Health worker sent thermometer to home

Jony Rahaman, a Regina restaurant owner who tested positive for COVID-19 in early October, did not have mild symptoms. He felt like he was choking to death.

Rahaman, 36, said the public health workers who called his family were like “guardian angels.”

“They call us every day,” he said. “Me and my wife, especially my wife, would wait for their call because we had so many questions. They’re so patient.”

Anti-mask protesters rally outside the Saskatchewan Legislative Building in Regina on Dec. 12. Provincial health authorities have been advised by the Public Health Agency of Canada to contact people with COVID-19 at home every day to monitor their symptoms and compliance with isolation rules. (Cory Coleman/CBC)

The family didn’t have a thermometer to check their temperatures, so a public health worker sent one to their home.

Rahaman — who contracted COVID-19 before the rest of his family — initially self-isolated in his bedroom away from his wife, Sabina, and two children and could barely speak to them through the door.

“It was terrifying,” he said. “My wife was crying on the other side of the door, kids were crying on the other side of the door and I couldn’t breathe.”

During one phone call, a public health worker called an ambulance for him.

“They’re, like, my lifesaver,” Rahaman said.

Removing barriers to compliance

The SHA’s de Bruin said providing equipment, such as a thermometer, isn’t the norm, but she noted that each case is unique, and the goal is to remove barriers to compliance.

“I have heard the types of ends of the Earth that some of this staff have gone to, and it doesn’t surprise me one bit,” she said.

At five months’ pregnant in November, Shaleen Erwin was nervous about having the disease and scared by what she found online when she did a Google search for “pregnant covid.” The constant access to public health workers was comforting, she said.

Erwin said some of the questions from public health workers who called were likely “subtle” checks on whether her family was following the rules, which they were, but she “never felt like it was accusatory.”

Now fully recovered, she has watched the case count climb in Saskatchewan and thinks about all of the phone calls happening every day.

“People see [case] numbers and they think, ‘Oh, 99 per cent of people will be OK,’ but don’t assume that that means that you’re not a burden on the health system,” she said.

WATCH | Premier explains Saskatchewan’s slow rollout of vaccines:

Saskatchewan Premier Scott Moe admits the province’s rollout of the COVID-19 vaccine has been slow, but he says inoculations will continue to increase in the weeks ahead. 2:07

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Indian farmers continue protest against new laws as police allow them into capital

Thousands of angry Indian farmers protesting against new agricultural laws were allowed to enter the national capital late Friday after they clashed with police who had blocked them at the outskirts of the city.

The farmers, who fear the new laws will reduce their earnings and give more power to corporations, will be escorted to a protest site in New Delhi, police in a statement. It was not immediately clear where the protests would be held.

For the last two months, farmer unions unwilling to accept the laws, which were passed in September, have camped on highways in Punjab and Haryana states.

They say the laws could cause the government to stop buying grain at guaranteed prices and result in their being exploited by corporations that would buy their crops at cheap prices.

The government has said the laws are aimed at reforming agriculture by giving farmers the freedom to market their produce and boosting production through private investment.

The farmers began their march to the capital on Thursday to mount pressure on Prime Minister Narendra Modi’s government to abolish the laws, but were stopped by large numbers of security personnel in riot gear on the boundary between New Delhi and Haryana state.

They resumed their march early Friday, unfazed by overnight rain and chilly winter temperatures.

Clashes with police outside New Delhi

Heading toward New Delhi on tractors and cars, the farmers were again blocked by police at the capital’s fringes. This led to clashes between the farmers and police, who used tear gas, water cannons and baton charges to push them back.

In response, farmers used tractors to clear walls of concrete, shipping containers and parked trucks set up by police on roads leading to the capital.

Some protesters also threw stones at the police and waved the flags of farmer unions. There were no immediate reports of injuries.

Police use water cannons to disperse protesting farmers on Friday. (Anushree Fadnavis/Reuters)

“We are fighting for our rights. We won’t rest until we reach the capital and force the government to abolish these black laws,” said Majhinder Singh Dhaliwal, a leader.

Earlier, in a bid to stop the protesters from riding commuter trains into the capital, the Delhi Metro suspended some services. Traffic slowed to a crawl as vehicles were checked along state boundaries, leading to huge jams on some highways.

Punjab Chief Minister Amarinder Singh urged the federal government to initiate talks with leaders of the farmers. Many of the protesting farmers are from Punjab, one of the largest agricultural states in India.

“The voice of farmers cannot be muzzled indefinitely,” Singh wrote on Twitter.

The protesting farmers said the new laws, passed in September, could cause the government to stop buying grain at guaranteed prices and result in their being exploited by corporations. (Anushree Fadnavis/Reuters)

Negotiations between the leaders of farmer unions and the government to defuse the standoff have been unsuccessful. Farmers say they will continue to protest until the government rolls back the laws; opposition parties and some Modi allies have called the laws anti-farmer and pro-corporation.

Farmers have long been seen as integral to India, where agriculture supports more than half of the country’s 1.3 billion people. But they have also seen their economic clout diminish over the last three decades. Once accounting for a third of India’s gross domestic product, they now produce only 15 per cent of the country’s $ 2.9 trillion US economy.

Farmers often complain of being ignored and hold frequent protests to demand better crop prices, more loan waivers and irrigation systems to guarantee water during dry spells.

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One Standard to (Maybe) Rule Them All: Intel Debuts Thunderbolt 4

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About five years ago, the computer industry brought forth a new USB cable standard, conceived with the best of intentions and dedicated to the proposition that all ports should be equal. Then, all hell broke loose.

In perhaps the most perfect example of getting exactly what one asked for (which wasn’t at all what anybody wanted), the USB-IF working group created USB-C, a truly universal cable standard, with a dizzying number of internal implementation options and a very real problem: Plugging the wrong cable into your USB-C device can literally fry it.

Five years later, Intel is cleaning up the implementation mess of USB-C, at least in part. The latest edition of Thunderbolt, Thunderbolt 4, will exist as a superset of Thunderbolt 3 and USB4. Importantly, here’s what this means for cable compatibility: If a cable is Thunderbolt 4 compatible, it can interface with every other cable standard.

While this doesn’t get us back to the happy era of knowing a micro-USB cable was a micro-USB cable, it at least offers a version of it. Of course, this does depend on USB4 / TB4 devices becoming available, which is going to take a little while.

Intel is launching TB4 with Tiger Lake, its upcoming refresh to the 10nm Ice Lake platform. Tiger Lake has been generating some positive buzz about its expected performance, both on CPU and GPU, but we don’t have firm details on the platform yet.

The new JHL8340 and JHL8540 are codenamed Maple Ridge, while the device controller is Goshen Ridge. Power and size requirements are apparently largely identical to TB3, and the first Tiger Lake devices to carry the standard are expected to also be part of the Project Athena program.

Unfortunately, at least for now, TB4 looks like it might be an Intel-only technology. While you can buy AMD motherboards with Thunderbolt support — it’s rare, but it exists — TB4 is going to require DMA protection and Intel achieves this using its own Intel VT-d (Intel Virtualization Technology for Directed I/O). VT-d is not an open standard and Intel’s own slide states that the technology is required to enable TB4.

TB4 offers a respite from the cable conundrums of USB-C and the so-bad-it-feels-deliberate branding of the USB-IF. “USB 3.2 Gen 2×2” is the kind of branding only a motherboard OEM could love. What we’re less-than-excited about, however, is the apparent lack of support for AMD implementations.

Thunderbolt is an Intel technology and Intel has the right to build standards that are only available for its own chips. Thunderbolt availability on AMD hardware has always been the exception, not the rule. At the same time, however, the USB-C ecosystem is something of a trainwreck and connectivity standards always do better when supported by multiple companies and hardware platforms. Nvidia has shipped ray tracing-capable GPUs since 2018, but it’s no accident that the feature is being talked up far more in 2020, now that AMD will be bringing its own compatible hardware to the console and PC GPU markets.

If Intel wants TB4 to become a universal standard, at some point, it’s going to have to share enough of the tech to allow other companies to create compatible implementations.

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We Might Be Able to Stop Killer Asteroids By Tethering Them Together

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Earth has been in the crosshairs of dangerously large asteroids in the past, and it will be again. The impact of such objects has historically led to mass extinctions, but there’s a chance humanity could work to stop such an event. Various methods of deflecting Potentially Hazardous Asteroids (PHAs) have been suggested, but an international team of researchers has a deceptively simple suggestion: Tie them to another space rock

Astronomers around the world scan the skies in search of dangerous space rocks on a collision course. Luckily, we haven’t found any on course for an impact, but that could change at any time. The key to all the proposed methods of deflecting asteroids is having enough time to implement a plan. If we learn about the threat a week in advance, it’s game over no matter what we do. Even with time to prepare, many proposals come with their own risks. For example, techniques that rely on high-energy impacts or explosives to destroy or deflect the object risk breaking it into parts that could hit Earth anyway. 

The team behind the new study suggests simply tethering a small asteroid to a larger, more dangerous one. The orbit of PHAs, like all objects in space, is a function of gravity. These objects swing around the solar system endlessly, unless they get caught in another object’s gravity and spiral into a collision. If we know far enough in advance an asteroid is headed for Earth, we can use gravity to our advantage. Connecting a smaller space rock to the dangerous one with a harness would create a binary system with a different center of mass. Over time, the asteroid’s orbit would change and avert disaster. 

This is all purely theoretical, but the team did produce a compelling simulation using the asteroid Bennu as an example. We know a great deal about Bennu thanks to the recent NASA OSIRIS-REx mission to collect samples from the surface. The simulation examined how Bennu would behave under several collision conditions, and then added the mass of another asteroid between 1,000 and 3,000 kilometers away with masses between 1/1000 and 1/10,000 of the PHA. 

The study claims that tethering these objects together is sufficient to alter the orbit of a PHA and avoid collision over the course of years. However, we’d better hope the solar system waits a bit longer to throw an asteroid our way. While this approach is novel and low-risk, we don’t have the technology to capture an asteroid (even a small one). Connecting two objects with a 1,000-kilometer tether may also be too great of an engineering feat. At least for now.

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Ontario’s Doug Ford says he relies on COVID-19 experts, but his government won’t identify them

Back at the beginning of April, Doug Ford made a promise to his province.

Faced with a rapidly expanding COVID-19 outbreak and a populace already chafing under shutdowns and restrictions, the Ontario premier agreed to share the scientific modelling of potential illnesses and deaths with the public. And he pledged full transparency going forward.

“You deserve the same information I have. You deserve to see the same data I see when I’m making decisions,” Ford told the camera during his daily Queen’s Park briefing on April 2.

“You deserve to know what I know when you’re making decisions for yourself, your family and community,”

More than two months later, the novel coronavirus remains a pressing crisis, having sickened almost 31,000 people in the province and caused close to 2,500 deaths. 

But while Ford continues to invoke “expert advice” to explain his government’s U-turns on things such as testing protocols and the provincial reopening strategy, there has been little disclosure of who is providing it and just what they are saying. 

This situation leaves both medical professionals and laypeople struggling to understand why Ontario is making the choices it’s making and where the science might be leading us, critics say. 

“I don’t think [Ford] has an expert on speed dial,” said Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto’s Faculty of Information.

“The decision making tells me it is not being driven by expertise.”

Command Table mystery

The premier often says that he is deferring to the advice he is receiving from Dr. David Williams, the province’s chief medical officer, and the COVID-19 Command Table, the government’s top advisory body on the disease, which reports directly to Christine Elliott, the minister of health. 

Williams counts a joint masters in epidemiology and community health among his four degrees from the University of Toronto. However, it appears that he might be the only person sitting around the table with a specialized background in infectious diseases and outbreaks. 

The co-leaders of the command group, Matt Anderson, president and CEO of Ontario Health, and Helen Angus, the deputy minister of health, both have vast experience in health-care administration but no scientific credentials. Anderson studied English at the University of New Brunswick, went on to obtain a masters in health administration before starting his career in information technology. Angus holds a master of science degree in planning from U of T.

The CBC asked both the Ministry of Health and Elliott’s office for the names of the other Command Table members. They weren’t provided, but the government says that representatives from several “relevant” ministries, such as Long-Term Care, Seniors and Accessibility, and the solicitor general also participate in the discussions.

A flow-chart of Ontario’s COVID-19 response, released in early March, suggests that it’s mostly deputy ministers. If so, the Command Table also counts bureaucrats with backgrounds in history, public relations and a former high-ranking Toronto cop among its members.

A flow chart detailing the Ontario government’s complex and multi-faceted response to the COVID-19 crisis. (Government of Ontario)

A ministry spokesperson told the CBC that the Command Table also draws on “external experts who each serve voluntarily” but declined to identify them. 

Apart from some colleagues who participated in the early modelling of the disease, Furness said he doesn’t know anyone who has been asked to advise the government. He finds this situation curious given that so much expertise is concentrated in the hospitals and educational institutions in downtown Toronto, a stone’s throw from Queen’s Park.

“You don’t even need bus fare,” he said.

As the crisis drags on, he says, he has been mystified by the Ontario government’s reluctance to embrace random sentinel testing to try and get ahead of the disease and its failure to collect important sign post data, such as race and income, from those who have already fallen ill.

And he says some aspects of the first phase of reopening — such as allowing household cleaners and staff to return to their jobs — made no sense at all. 

“I mean who is sitting around the table saying we’ve got to let butlers get back to work?” Furness said 

Curious decisions with little explanation

Dr. Dominik Mertz, an associate professor at McMaster University’s medical school and expert on infection control, says he knows some people who have consulted on COVID at the local level, but he remains in the dark about what is going on provincially.

“I would love to know who’s advising them and what that advice was. And what the underlying assumptions are,” said Mertz. “I feel like sometimes the left hand doesn’t know what the right hand is doing.”

He points to choices such as allowing adults to play golf and tennis but keeping playgrounds shut to children. And in particular, he wonders how the government came up with the oft-cited provincial benchmark of fewer than 200 new cases a day for a further loosening of lockdown rules and why this metric suddenly seemed to have been abandoned as Ontario moved toward a regional approach to reopening. 

WATCH | Premier Ford announces regional approach to stage two of reopening Ontario:

Twenty-four of Ontario’s 34 public health units will be allowed to move into Phase 2 on Friday. The remaining 10, concentrated primarily in the Greater Toronto and Hamilton Area (GTHA) and near the U.S.-Canada border, will need to wait until new daily case numbers consistently decrease. 3:17

For weeks now, the Hamilton area has been on a “low burn,” says Mertz, averaging fewer than 10 new cases a day. Yet it is being lumped in with areas such as Toronto and Peel, which have much higher case rates, and denied permission to move to Stage 2 of the province’s reopening plan.

“I don’t know what the rationale is,” said Mertz. “I doubt that things will be any better locally in a few weeks, or months, from now.”

Mertz says a more scientific approach to reopening might look at things such as local health care and ICU capacity or the per capita rates of infection, rather than just the raw case numbers. 

The province does employ its own epidemiologists and infectious disease experts, particularly within Public Health Ontario (PHO), which is mandated to provide scientific and technical advice to the entire health sector. 

The government’s COVID response flow chart suggests PHO is playing a lead role in crafting strategy on things such as testing, surveillance and care and treatment. But those plans have never been communicated to the public. 

Ford says he has a ‘host’ of unnamed doctors

After the publication of this story Tuesday morning, Health Minister Christine Elliott tweeted out the names of seven doctors who are sitting on her ministry’s public health measures table.

At his COVID19 update later in the day, Ford took umbrage at what he called an “unfair” and “insulting” story. The premier said that there are a “host” of doctors providing expert advice to the province, but again declined address specifics. 

“We’ve brought a number of doctors … a lot of doctors. Personally, they don’t want their names out there,” Ford said.

“To say every single doctor involved, I’d give you a list of over a hundred doctors …  they don’t want their names out there,” he added, citing privacy concerns. 

However, both the opposition New Democrats and Liberals are now demanding that his government reveal where its expert advice is coming from. 

“Ontarians deserve to know exactly how Premier Doug Ford is justifying his decisions about Ontario’s response to COVID-19. That includes basic information like who is sitting at the ‘Command Table,'” NDP Leader Andrea Horwath said in a news release. “Ontarians have worked hard and sacrificed in the battle against COVID-19 – they deserve all the facts.”

That sentiment was echoed by the new Liberal Leader Steven Del Duca. 

“Time and time again Doug Ford has insisted he is getting the best help possible from the experts – but who are the experts? Doug Ford won’t say. How is that open and transparent?” Del Duca asked. “If Doug Ford won’t reveal the team of experts he relies on – how can we trust his plans to move forward?”

Part of the problem might be the system that has been set up to fight Ontario’s COVID-19 outbreak. 

Dr. Andrew Morris, an infectious disease specialist at Toronto’s Sinai Health and University Health Network, said the superstructure that Ontario created to tackle the coronavirus in early March, amid fears of supply shortages and overwhelmed hospitals, no longer seems fit for purpose. It’s far too opaque and bureaucratic, he said, to deal with the stubborn reality of a disease that will only be subdued through exhaustive tracing and testing, and continued social distancing.

“It’s not the right structure because it certainly doesn’t account for the blind spots that we’ve already identified,” said Morris. “We know that there have been challenges around behaviour change and communicating with the public.

“We’re asking a lot of the public. They deserve to have as much access to information as possible.” 

Dr. Andrew Morris, an infectious diseases specialist at Toronto’s Sinai Health and University Health Network, says the Ontario government’s COVID-19 response has been far too opaque and bureaucratic. (Turgut Yeter/CBC)

In response to the CBC’s questions about where the premier and the COVID Command Table are getting their expert, technical advice, the Ministry of Health did provide one outside name — Steini Brown, dean of the Dalla Lana School of Public Health at the University of Toronto. He is chairing a pair of scientific tables on modelling and evidence synthesis.

Brown declined a request for an interview but did respond to a series of emailed questions describing his role as largely administrative, clearing obstacles for the unnamed scientists who are doing “the hard work.”

Brown says the round tables he oversees have provided “numerical estimates and evidence syntheses” that have affected Ontario government policy but that they aren’t making specific recommendations. The reopening benchmark of 200 new cases a day, for example, didn’t come from his experts, he says.

Asked how the Ford government might improve its response to the COVID-19 crisis, Brown suggested greater openness. 

“There is so much misinformation on COVID-19 that the more transparency we have around scientific advice and progress of the pandemic, the stronger foundation we’ll have for engaging the public in the fight,” he wrote.

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