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Quebec expands COVID-19 lockdown, and worry in Ontario over hospitals

The latest:

New COVID-19 restrictions will go into effect in Quebec Monday evening as the province tries to deal with rising COVID-19 case numbers involving more contagious variants.

The provincial government said the curfew will move from 9:30 p.m. to 8 p.m. ET Monday evening in the regional municipalities of Beauce-Sartigan, Bellechasse, Les Etchemins, Nouvelle-Beauce and Robert-Cliche.

Non-essential businesses will have to close starting Monday evening, as will restaurant dining rooms. Schools will also have to close for in-person learning. The measures will be in place until at least April 12, the province said.

The Quebec government imposed the same restrictions on three other cities last week, including Quebec City and Gatineau.

Quebec reported 1,252 new cases of COVID-19 and four additional deaths on Monday. According to a provincial dashboard, hospitalizations stood at 503, with 123 in intensive care.

The expanded restrictions in parts of Quebec come as several provinces face mounting COVID-19 case numbers and increasing hospitalizations, prompting concern about strain on health-care systems.

Ontario on Monday reported figures covering two days, for a total of 5,979 new cases of COVID-19 and 22 additional deaths.

According to figures released Monday, hospitalizations in Ontario stood at 942, with 494 people in “ICU due to COVID-related critical illness.” Of those in ICU, 469 were still testing positive for COVID-19, the update said.

In Toronto, Mayor John Tory said the city is working on a plan to vaccinate high-risk people at their places of work.

-From The Canadian Press and CBC News, last updated at 12:40 p.m. ET


What’s happening across Canada


People stand outside a coronavirus disease (COVID-19) test centre at London Bridge Station, in London, Britain, April 5, 2021. (Hannah McKay/Reuters)

As of 12:40 p.m. ET on Monday, Canada had reported 1,011,238 confirmed cases of COVID-19, with 61,007 considered active. A CBC News tally of deaths stood at 23,088.

In Atlantic Canada, Nova Scotia reported three new cases of COVID-19 on Monday.

In New Brunswick, health officials reported 10 new cases of COVID-19 on Monday.  Fourteen patients are hospitalized with the disease, including eight in intensive care, the province said.

The update came a day after health officials said a hospital in northwestern New Brunswick is nearing its capacity for acute care patients, according to a statement released by the Vitalité Health Network over the weekend. 

“The evolution of the variant and its atypical behaviours are creating problems that exceed the pessimistic projections that had been made for that region,” the statement from the organization’s president and CEO Dr. France Desrosiers said. “The Edmundston Regional Hospital will soon reach its maximum capacity in terms of patients requiring acute care.”

Desrosiers, who praised the efforts of front-line workers and health-care staff, noted that the transfer of patients to other facilities “is imminent.”

Prince Edward Island and Newfoundland and Labrador had not yet reported updated figures Monday.

Across the North, there were no new cases reported in Nunavut, the Northwest Territories or Yukon on Sunday.

WATCH | Nunavut premier celebrates turning a COVID-19 corner:

Arviat once hosted Nunavut’s worst COVID-19 outbreak. But with almost one-third of the territory’s population fully immunized and travel restrictions easing, Premier Joe Savikataaq visited his hometown to share his appreciation with those who helped turn the corner. 2:17

In the Prairie provinces, Manitoba did not provide an update on COVID-19 on Sunday.

In Saskatchewan, health officials reported 221 new cases of COVID-19 and three additional deaths. Hospitalizations stood at 194, with 44 people in intensive care due to COVID-19, the highest figure recorded in the province.

In Alberta, a preliminary estimate of new case numbers reported Sunday stood at 950, the province’s top doctor said in a tweet. Dr. Deena Hinshaw said hospitalizations remained stable, noting that health officials would provide an update on Monday.

WATCH | COVID-19 ‘disaster’ on the doorstep,’ says Calgary ER physician:

Calgary is in the midst of explosive COVID-19 growth, which is driven by variants, says Dr. Joe Vipond, an emergency room physician. He says leaders have been slow to respond to this ‘five-alarm fire.’ 5:55

British Columbia will provide updated case numbers later Monday. Businesses putting staff and patrons at risk by remaining open in defiance of COVID-19 rules will face consequences, the province’s public safety minister said Sunday as the province works to bring surging infections under control.

The warning from Mike Farnworth comes after a Vancouver restaurant that flouted restrictions by serving patrons indoors was slapped with a closure notice on Saturday, which its owner has indicated she intends to ignore.

“Harassment of enforcement officials will not be tolerated, and closure orders by Vancouver Coastal Health or any other health authority must be respected,” Farnworth said in a statement.

-From CBC News and The Canadian Press, last updated at 11:45 a.m. ET


What’s happening around the world


Quebec reported 1,154 new cases of COVID-19 on Sunday and nine additional deaths. (Graham Hughes/The Canadian Press)

As of early Monday afternoon, more than 131.4 million cases of COVID-19 had been reported worldwide, according to a tracking tool maintained by Johns Hopkins University. The global death toll stood at more than 2.8 million.

In the Americas, starting Monday, any adult in Florida is eligible to receive the coronavirus vaccine. In addition, the state announced that teens ages 16 and 17 can also get the vaccine with parental permission.

Johnson & Johnson is taking over “full responsibility” for a subcontractor’s Baltimore facility that produces the drug substance for its single-dose COVID-19 vaccine after an embarrassing mix-up. The company said it’s adding leaders in operations and quality control to the Emergent BioSolutions plant to supervise the work of its vaccine line.

It comes after enough drug substance for about 15 million doses was contaminated by human error at the plant. The issue was flagged to federal regulators, who have yet to approve any doses from the Baltimore plant, last week.

J&J has delivered about 20 million doses from another plant to the federal government already and says it expects to deliver about 80 million more by the end of May.

LISTEN | ‘I call it … one endless Wednesday’: More than one year in, pandemic burnout is real, author says:

Front Burner21:48Pandemic burnout is real

Today on Front Burner, Anne Helen Petersen explains the forces behind burnout and why more and more Canadians are struggling with it one year into a global pandemic that has altered the way many of us work and live. 21:48

In the Asia-Pacific region, the Philippine government extended a lockdown by another week Monday after an alarming spike in coronavirus infections continued to surge and started to overwhelm many hospitals in the capital and outlying regions.

President Rodrigo Duterte placed Metropolitan Manila and four outlying provinces, a region of more than 25 million people, under lockdown last week as daily infections breached 10,000. Roman Catholic leaders shifted Holy Week and Easter events online after all public gatherings, including in places of worship, were temporarily banned.

Bangladesh began enforcing a weeklong nationwide lockdown Monday, shutting shopping malls and transportation as authorities try to stop a surge in coronavirus infections and deaths.

The decision came after health authorities said that they were facing overwhelming pressure in intensive care units in recent weeks because of severe infections. This is the second time the South Asian nation has enforced a virus lockdown after the first last March.

India has reported its biggest single-day spike in confirmed coronavirus cases since the pandemic began, and officials in the hard-hit state home to Mumbai are returning to the closure of some businesses and places of worship in a bid to slow the spread.


Medical workers fill a box with traditional Easter cakes known as Colomba as they prepare to tour the COVID-19 ward of the GVM Maria Pia Hospital in Turin on Sunday. (Marco Bertorello/AFP/Getty Images)

The Health Ministry on Monday reported 103,558 new COVID-19 infections in the last 24 hours, topping the previous peak of 97,894 daily cases recorded in late September. Fatalities rose by 478, raising the country’s death toll to 165,101.

India now has a seven-day rolling average of more than 73,000 cases per day and infections in the country are being reported faster than anywhere else in the world.

In the Middle East, Iran’s capital is once again facing the highest level of restrictions imposed to curb the spread of the coronavirus as the country struggles with a new surge in daily deaths. State media said the measure on Monday is the third time Tehran has faced a so-called code red since the pandemic began. A code red involves a ban on any travel by personal cars to and from cities and limits working hours of many businesses and offices to prevent the spread of the virus.

About 50 cities and towns are in code red, with only 23 in code blue, or “safe” status, out of the country’s total of more than 800 cities and towns. The rest are in orange and yellow status, which involve fewer restrictions.

The report comes as Iran’s daily death toll again reached three digits, after months of being under 100. On Sunday, 161 deaths were reported, bringing the registered death toll in Iran to more than 63,000, the highest in the Middle East. Iran has reported some 1.9 million confirmed cases of the virus

Also on Monday, Iran said it received the first shipment of COVID-19 vaccines from the Netherlands through the global COVAX initiative. 

In Africa, South Africa’s health minister said Sunday that the number of confirmed cases in the country — the hardest-hit on the continent — stood at more than 1.5 million, with nearly 53,000 recorded deaths.

In Europe, British Prime Minister Boris Johnson said on Monday his government was hopeful that non-essential international travel would restart from May 17, but did not want to underestimate the growing number of COVID-19 cases elsewhere. He said a task force would report later this week to set out what might be a “reasonable” plan.


A health worker administers the Covishield vaccine for COVID-19 at a residential area in Ahmedabad, India, on Sunday. (Ajit Solanki/The Associated Press)

France’s health minister warned Monday that the number of COVID-19 patients in the country’s intensive care units could reach levels seen during the first crisis a year ago. France’s hospitals have already surpassed the number of coronavirus ICU patients seen during the second surge in November, and Olivier Veran said on TF1 television that “it’s possible we could approach” the ICU saturation levels of April 2020.

Portugal on Sunday extended until April 15 restrictions on travel via land and sea to Spain that had been due to end this weekend.

Bank of Italy Governor Ignazio Visco told the Financial Times newspaper that the biggest threat to a global economic recovery is the irregular pace at which countries are vaccinating their populations against COVID-19.

-From The Associated Press, Reuters and CBC News, last updated at 12:40 p.m. ET


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


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Visitors to B.C. care homes deemed ‘essential’ move to front of vaccine line — others wait and worry

Jody Vance said her heart skipped a beat when she got an unexpected phone call from the long-term care facility where her elderly father lives.

She braced herself for bad news, but instead the voice on the other end told her something so many Canadians would love to hear: a dose of the Pfizer-BionTech COVID-19 vaccine was being set aside for her.

“It was kind of was a little bit surreal,” she said. “It felt like hope.”

Vance got the shot because staff at the long-term care facility in Delta, B.C., declared her an “essential” visitor for her 82-year-old father. Driving him to emergency cancer surgeries during the pandemic made her eligible for such status.

To Vance, the main benefit of being vaccinated is that her dad won’t need to be isolated from her for his own protection. 

B.C. is one of the few provinces — Ontario and Nova Scotia are taking a similar approach — ushering essential visitors to the front of the vaccine line as a priority group. It’s up to the discretion of each facility to determine who is considered essential.

There is no cap in B.C. on the number of approved essential visitors, but only one will be allowed at a time with exceptions made for end-of-life care.

Those left to wait say they are also left to wonder if the delay could ultimately be too long.


Visiting loved ones in long-term care during the COVID-19 pandemic often means no physical contact. (Ben Nelms/CBC)

A frustrating process

“I don’t know how long she’ll be with us,” said Niovi Patsicakis, speaking about her 98-year-old mother, who lives at Evergreen Long-Term Care in White Rock.

Patsicakis said her mom has been mostly confined to her room in the facility for nearly three months, and Patsicakis hasn’t been able to visit since before Christmas. She said she fears the lack of in-person mother-daughter visits has affected her mom’s health.

But unlike Vance, Patsicakis said she has not been deemed essential by her mom’s long-term care facility. 

According to the B.C. Centre for Disease Control (BCCDC), essential visits include those for compassionate care reasons such as critical illness, hospice care, end of life and medical assistance in dying. They can also include visits by a person who assists with feeding, mobility and communication needs.

WATCH | British Columbians with loved ones in long-term care talk about their experiences trying to get vaccine priority: 

As the vaccine rolls out in long-term care homes across the country, some provinces, including British Columbia, are also prioritizing essential caregivers for a shot to benefit residents and staff. But there’s some inconsistency about who qualifies as essential. 2:03

The B.C. Health Ministry has also said a clergy member can be designated as an essential visitor.

Health authority and facility staff, in collaboration with the long-term care resident, determine who gets essential visitor status, according to BCCDC in guidelines published on Jan. 7.

Patsicakis’ visits in the past have tended to be social in nature, but Patsicakis said her mother’s health seems to be deteriorating since their loss of contact.

“I can see a huge difference in how mom has gotten much worse,” said Patsicakis. “Her language skills have weakened as well as her mood. Sometimes, she’s confused or doesn’t want to get out of bed.”

Trying to get an essential designation has been difficult and frustrating, she said.


Niovi Patsicakis, right, says she has tried multiple times to be designated as an essential visitor so she can spend time with her mom, Sophie Patsicakis, left, who is 98 years old and in a long-term care facility in White Rock, B.C. (Submitted by Niovi Patsicakis)

Patsicakis said essential visitors to Evergreen are evaluated by a group that includes facility faculty and a representative from the local health authority, Fraser Health. She said she wrote Evergreen administration three times to plead her case and filed a complaint with an advocate at the health authority’s patient quality care office.

She said she requested Evergreen’s decision be sent to her in writing in November and never received it. As of Jan. 20, she said hadn’t heard anything from Fraser Health either.

“I know so many people are devastated,” she said, adding she is part of a social media group of others like herself who are supporting one another as best they can.

The National Institute on Ageing said families in British Columbia are enduring the most restrictive long-term care home visitation policies in the country.


B.C. Seniors Advocate Isobel Mackenzie says decisions around who qualifies as an essential or designated visitor can be arbitrary because care-home residents and their families don’t have an association that represents them. (Maggie MacPherson/CBC)

B.C. Seniors Advocate Isobel Mackenzie said the lack of an association that represents residents and their families at the 300 care homes in B.C. means they don’t have a voice in policy discussions between the government and care-home operators.

She said care home operators seem to be arbitrarily deciding who qualifies as an essential or designated visitor.


Patricia Grinsteed, 91, who survived COVID-19, touches hands with her daughter through a glass barrier at the Lynn Valley Care Centre in North Vancouver, B.C. in June. (Ben Nelms/CBC)

Dr. Bonnie Henry, B.C.’s provincial health officer, provided the latest numbers of people who had qualified as essential visitors during a press event on Jan. 18.

Henry said about 8,000 people have met the criteria and will receive a vaccination during the province’s first phase of a four-phase immunization program, which is underway. There are approximately 30,000 people living in long-term care facilities

“The default, we believe, should be that every person, every resident who has a person who can care for them, should have a designated essential visitor, but that has been a challenge to operationalize,” said Henry.

Applications for essential status are available on the provincial health ministry’s website. There is an appeal process for people who do not like the initial decision.

One Abbotsford long-term care home operator said the more people who are designated essential, the better.

“Because of staffing levels, this gives us that extra layer of assistance — they are doing things like supporting their loved one with feeding or mobility,” said Dan Levitt, executive director of Tabor Village. “So they need that vaccine, and that’ll make a big difference for all of us.”


B.C. Health Minister, Adrian Dix, said by March, when residents and staff at long-term care facilities have had both doses of a COVID-19 vaccine, people will have more social visiting access to their loved ones and some daily activities put on hold will begin to resume for residents. (Mike McArthur/CBC)

During a Friday press briefing, B.C. Health Minister Adrian Dix addressed the frustration felt by people disappointed to hear they are not considered essential.

“Everyone should feel that their participation, their social life, their visiting of their loved ones is essential,” he said.

Dix said vaccinating residents and staff in long-term care and assisted living facilities now could lead to eased restrictions around social visits by March, when all residents and staff are expected to have received both doses of their vaccines.

“It’s going to allow a lot of things to happen, including more visits from family members and loved ones and friends,” he said.

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CBC | Health News

U.K. scientists worry vaccines may not protect against coronavirus variant found in South Africa

U.K. scientists expressed concern on Monday that COVID-19 vaccines being rolled out in Britain may not be able to protect against a new variant of the coronavirus that emerged in South Africa and has spread internationally.

Both Britain and South Africa have detected new, more transmissible variants of the COVID-19-causing virus in recent weeks that have driven a surge in cases. British Health Secretary Matt Hancock said on Monday he was now very worried about the variant identified in South Africa.

Simon Clarke, an associate professor in cellular microbiology at the University of Reading, said that while both variants had some new features in common, the one found in South Africa “has a number additional mutations … which are concerning.”

He said these included more extensive alterations to a key part of the virus known as the spike protein — which the virus uses to infect human cells — and “may make the virus less susceptible to the immune response triggered by the vaccines.”

Lawrence Young, a virologist and professor of molecular oncology at Warwick University, also noted that the variant detected in South African has “multiple spike mutations.”

“The accumulation of more spike mutations in the South African variant are more of a concern and could lead to some escape from immune protection,” he said.

Scientists including BioNTech CEO Ugur Sahin and John Bell, Regius Professor of Medicine at the University of Oxford, have said they are testing the vaccines against the new variants and say they could make any required tweaks in around six weeks.

Greater concentration of virus particles with variants

Public Health England said there was currently no evidence to suggest COVID-19 vaccines would not protect against the mutated virus variants. Britain’s health ministry did not immediately respond to requests for comment.

The world’s richest countries have started vaccinating their populations to safeguard against a disease that has killed 1.8 million people and crushed the global economy.

There are currently 60 vaccine candidates in trials, including those already being rolled out from AstraZeneca and Oxford, Pfizer-BioNTech, Moderna, Russia’s Sputnik V and China’s Sinopharm.

WATCH | The unknowns of single vaccine dosing:

According to epidemiologist Dr. Christopher Labos, the efficacy of giving people just one shot, or a half dose of a coronavirus vaccine, is unknown as there is no hard clinical data. 7:16

Scientists say both the variants from South Africa and the U.K. are associated with a higher viral load, meaning a greater concentration of virus particles in patients’ bodies, possibly contributing to increased transmission.

Oxford’s Bell, who advises the U.K. government’s vaccine task force, said on Sunday he thought vaccines would work on the variant from the U.K., but said there was a “big question mark” as to whether they would work on the variant from South Africa.

BioNTech’s Sahin told Germany’s Der Spiegel in an interview published on Friday that their vaccine, which uses messenger RNA to instruct the human immune system to fight the virus, should be able to protect against the variant found in the U.K.

“We are testing whether our vaccine can also neutralize this variant and will soon know more,” he said.

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CBC | World News

Should I worry who I let into my social bubble? Your COVID-19 questions answered

We’re breaking down what you need to know about the pandemic. Send us your questions via email at COVID@cbc.ca and we’ll answer as many as we can. We’ll publish a selection of answers every weekday on our website, and we’re also putting some of your questions to the experts on the air during The National and on CBC News Network. So far we’ve received more than 46,000 emails from all corners of the country.

Should I be worried about bringing front-line workers into my social bubble?

Some provinces are allowing people to expand their so-called social bubbles, made up of friends and family they can be physically close to and even hug. 

That has several Canadians writing to us with concerns about who they should be letting in. Brent and Kim J. are wondering if including front-line workers like doctors, nurses and grocery store employees is risky.

We spoke to a few experts who agreed the important factor to consider is how careful these workers are with reducing transmission of the virus.

“Ostracizing front-line workers is a dreadful idea,” said Colin Furness, an infection control epidemiologist and assistant professor at the University of Toronto. “I’d say that people’s observable behaviours around COVID vigilance matter more than their occupation.”

Furness said this could include their transition from work to non-work clothes, mask-wearing, and physical distancing habits. 

If there is little community spread, most front-line occupations “won’t be so risky,” he adds. 

WATCH | Ontario residents allowed to build social bubbles of 10:

As new daily cases of COVID-19 continue to decline in Ontario, the Ford government is allowing people anywhere in the province to build “social circles” of up to 10 people that can include family and friends. 1:54

Dr.  Zain Chagla, infectious disease physician at St. Joseph’s Healthcare Hamilton, points out that while people have “labelled front-line workers as the highest risk of infection,” it’s worth considering that “it’s because we tested those people much more than others.”

“That shouldn’t necessarily be an exclusion on principle,” he added. 

Of course, if somebody in the circle is experiencing symptoms, experts are encouraging them to get tested and only re-enter the bubble when they receive a negative result.

Can we still have a social bubble of 10 people if our child is in daycare with other kids?

This question comes from Melissa P., who lives in Ontario, and is wondering if the province’s updated social bubble rules still apply to her family.

Ontarians can create social circles of up to 10 people, but the catch is that all 10 people need to commit to this one bubble and can’t be a part of other ones.  

This is causing some confusion among parents putting their children in daycare — and it’s receiving different interpretations among experts.


Some daycares around the country are opening. But some experts and parents are concerned about how this will affect social bubbles and circles. (Marina von Stackelberg/CBC)

Dr. Mustafa Hirji, medical officer for Niagara Region, said he believes sending a child to daycare would not affect the family’s ability to have a social bubble of 10 people outside of that. 

“My understanding is that it’s not intended to include a workplace or a daycare,” he said. “You may well be going to a daycare where right away there’s more than 10 people and of course you’re going to be over your 10-person limit. I think it’s really meant for outside of those kinds of settings.”

On the flip side, Chagla said there are some risks with this bubble concept.

“It assumes that everyone’s contacts are relatively stable and that they’re only really interacting with each other.”

Chagla explains that putting a child into a congregate setting like a daycare, where there is a possible risk of exposure to a number of different people, may actually “paradoxically work against” the social bubbles.

“I think that bubble concept does break down when we get back to school or put kids in daycare,” he said.

Can people in my social bubble sleep over?

With social bubbles expanding and kids going stir-crazy at home, parents like Sherri C. are asking if sleepovers are OK.

If the person sleeping over is in your bubble, the short answer is yes.

Depending on where you live, people within a social bubble are not required to physically distance from each other. So having someone from your circle sleep over is technically allowed.

Experts say the important thing is to make sure the people you let in are still taking precautions in their life outside that bubble. That means keeping a distance of at least two metres from other people, and when that’s not possible, wearing a non-medical mask or face covering in public places.

“You are pooling risk, so you need to trust that those in your circle, who you will not physically distance from, are being as careful as you are in interacting with people not in your bubble,” Furness said.


Thursday we answered questions about the safest way to travel.

Keep your questions coming by emailing us at COVID@cbc.ca.

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CBC | Health News

COVID-19 border closures worry Americans who come to Canada to buy insulin

When Travis Paulson drove from his home in northern Minnesota to the Canadian border last month, he thought he’d have little trouble crossing over to buy his insulin.

Paulson, a Type 1 diabetic, has made the trip many times for himself and others as the price of the lifesaving drug has skyrocketed in the United States over the last decade. A vial in Canada costs roughly $ 25 US, a fraction of the $ 350 to $ 400 he would be charged in his home country.

Paulson called Canada Border Services ahead of time to see if he’d still be able to come into Canada. Travel between the two countries has been restricted during the COVID-19 pandemic, but Paulson said he was told he could still make the trip if he only went to the pharmacy and came back the same day.

But when he arrived at the border near Fort Frances, Ont., he said he was told there had been a policy change that very morning — and he couldn’t come into Canada because his trip was not deemed essential.

“It’s devastating because your life depends on it. You’re literally being denied the air that you need to breathe,” said Paulson, the director of the diabetes organization Northern Minnesota Advocacy Group.

“Every few hours you need it, every day. And that you might not be able to get it, I would say it’s a little terrifying.”


When coming to Canada, Paulson often buys insulin for himself and for others. (Submitted by Travis Paulson)

Many Americans rely on going up north to buy insulin, where it is roughly a tenth of the price. Canada’s Patented Medicine Prices Review Board, a federal agency that establishes the maximum price that can be charged for patented drugs, keeps the prices affordable.

But the COVID-19 border restrictions have meant that option is no longer available.

While some pharmaceutical companies in the U.S. are offering programs for cheaper insulin during the pandemic, advocates say still not enough is being done to make it affordable.

A spokesperson for the Canada Border Services Agency said Americans may be allowed to enter the country to purchase medications, but the agency offers little clarity on who will be allowed in and when.

“Entry to Canada is decided on a case-by-case basis and based on the information made available to the border services officer at the time of entry,” spokesperson Judith Gadbois-St-Cyr said in an email.

Until at least June 21, there is a temporary restriction on all non-essential travel between Canada and the U.S. That could be further prolonged if deemed necessary, Gadbois-St-Cyr said.


Transport trucks approach the Canada/USA border crossing in Windsor, Ont., in March. The border closure between the two countries has been extended until at least June 21. (Rob Gurdebeke/The Canadian Press)

Quinn Nystrom, a long-time diabetes and affordable health-care advocate in Minnesota, said she’s received several calls since the border closures began, including one from a panicked mother.

“She said her nine-year-old son was on his last insulin pen,” Nystrom said, adding that the woman’s husband had been planning a trip to Canada in the spring to buy more.

“They were just completely distraught over it.”


Quinn Nystrom holds the insulin she bought on her trip to Canada in the spring of 2019. (Submitted by Quinn Nystrom)

Nystrom gained international attention last year for organizing and taking part in several Caravans to Canada — trips to show just how easy and affordable it is to buy insulin outside of the U.S.

A Type 1 diabetic herself, Nystrom went to her congressman, Pete Stauber, last spring, begging him to protect people with pre-existing conditions and vote to help lower the cost of insulin.

“He promised me he would do that. And after leaving his office and following up with him over the next couple of months, he unfortunately voted against those things,” she said.

“It was so unfortunate to me that I decided to file and run against him.”

On Sunday, Nystrom won the Democratic nomination in Minnesota’s 8th congressional district and will be up against Stauber on the ballot in November.


The small group drove five hours from Minnesota to Ontario to buy insulin at one-tenth the cost in the spring of 2019. Travis Paulson and Quinn Nystrom are on the left, and Nicole Smith-Holt and Lija Greensied are on the right. (Rachel Nystrom)

Access to affordable insulin can be a matter of life and death for Americans.

Nicole Smith-Holt’s son died in June 2017 at just 26 years old, less than a month after he aged off of his parents’ insurance plan. He couldn’t afford the cost at a pharmacy in Minnesota and chose instead to ration his insulin.

Smith-Holt said the border closures to Canada and Mexico put up “one more barrier” for struggling Americans, especially as many of them have lost their jobs and therefore their insurance during the pandemic.

“People are going to start rationing and people are going to suffer some very long-term health effects or possibly death,” she said.

“A Type 1 diabetic really should not be lowering their dosage or missing doses. It proved fatal for Alec and countless other people.”

But Alec Smith’s family, friends and supporters worked to make sure his death wasn’t in vain.


Nicole Smith-Holt with her son, Alec Smith, who died in 2017 from diabetes complications after rationing his insulin when he couldn’t afford it. (Submitted by Nicole Smith-Holt)

On July 1, the Alec Smith Insulin Affordability Act will come into effect in Minnesota. It will allow people who cannot afford their insulin to access a 30-day supply at their pharmacy for just $ 35. 

The new law also streamlines the process to access insulin in the long-term and manufacturers can be fined up to $ 3.6 million for not participating in the program.

“It means that we’re going to have the ability to save lives,” Smith-Holt said. 

“People right now, especially during this COVID-19 pandemic, are really struggling. It’s going to be a lifeline for people.”

Pharmaceutical companies making pandemic programs

Since the pandemic started, some pharmaceutical companies in the United States have created programs to help struggling diabetics. 

Eli Lilly, the U.S. manufacturer of fast-acting insulin Humalog, created a program in April to help those without insurance access a month’s supply for $ 35.

But these programs are difficult to apply for, advocates say, and often many people don’t meet the criteria to be eligible.

It’s also just a temporary solution, Nystrom said, adding that the issue of insulin affordability won’t go away when the pandemic does.


Several American groups made international headlines in 2019 for the Caravan to Canada, and launched a social media campaign under the hashtag #Insulin4all. (Submitted by Lija Greenseid)

With few options due to border restrictions, some Americans, like Paulson, are turning to online Canadian pharmacies. 

Some Canadian pharmacies will ship insulin to the U.S., but the National Association of Pharmacy Regulatory Authorities in Ottawa said it’s important to verify the legitimacy of an outlet if ordering online by checking with the province’s regulating body

One of the most well-known pharmacies to Americans is Mark’s Marine Pharmacy in Vancouver, just 40 kilometres from the U.S. border. It ships insulin to people across the U.S., but requires a doctor’s prescription to do so — a requirement in America.

People also turn to GoFundMe, social media and “underground networks.”


Lija Greenseid stands at a pharmacy in Fort Frances, Ont., last spring holding insulin for her teenage daughter. Greenseid organized the Caravan to Canada on the first weekend in May 2019 to buy cheaper insulin. (Submitted by Lija Greenseid)

Lija Greenseid, an insulin advocate in St. Paul, Minn., and mother of a 14-year-old daughter who has Type 1 diabetes, said people in local diabetes Facebook groups will share extra insulin if they switch brands and even give up unused vials if someone has died.

“That’s another strange consequence of our health-care system,” said Greenseid, who organized a Caravan to Canada last spring. 

While some insurance companies have now capped their deductibles at $ 25 a month, the list price for insulin in the U.S. hasn’t been cut.

‘The ultimate goal is to be like Canada’

Greenseid had always been comforted by the knowledge that Canada was a short drive away. It’s an option no longer there.

“What is reassuring is knowing that there is an insulin underground network of people who get insulin and give it to people who need it. That’s always there.” Greenseid said.

Nystrom said Americans don’t want to have to rely on outside countries to get affordable medications — and she hopes to make that possible if elected in November.

“The ultimate goal is to be like Canada, where somebody can just go to a pharmacy and pick up insulin for $ 30 US. That’s our goal,” she said.

“So people don’t have to rely on a pharmaceutical company deciding to be charitable.”

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CBC | Health News

Too early to worry coronavirus will further delay Tokyo Games: Global health expert

It is premature to think the novel coronavirus outbreak will further delay the Tokyo Olympics, which have already been postponed a year, Brian McCloskey, an expert on global health security and outbreak prevention told Reuters.

Under increasing pressure from athletes, the International Olympic Committee (IOC) and Tokyo Games organizers last month postponed the 2020 Games for one year as the coronavirus spread, shutting down global sport.

Yet as countries try to beat back the pandemic, with experts predicting a vaccine is still 12-18 months away, questions have begun to surface as to whether a year’s delay is sufficient time to stage the Games in a safe environment.

“I think that’s probably a little bit premature in the sense that we’ve got 15 months more of planning and preparing for the Olympics in 2021,” McCloskey said. “So, I think it’s premature to say it’s unrealistic [that the Olympics cannot be held in 2021].

“Clearly, having a vaccine would be extremely helpful, not just for the Olympics, but for all of us. But even without a vaccine I think there are other mitigation measures we will look at to make sure we can run the Games safely.

“So, it’s a challenge, but I’d say it’s too soon to say it can’t happen.”

WATCH | IOC’s Dick Pound believes in Olympic movement amid tough times: 

CBC Sports’ Scott Russell spoke with International Olympic Committee member Dick Pound about the power of the Olympics and why it’s important to still hold the 2020 Games. 4:00

The number of confirmed novel coronavirus cases in Japan rose to 10,000 on Saturday, public broadcaster NHK said, just days after a state of emergency was extended to the entire nation in an attempt to slow the spread of the virus.

Just over 200 people have died from the virus in Japan.

“This year for Tokyo, it got to the point where the amount of mitigation that would have been needed was more than we could ask the Japanese government to do when the Japanese government needed to be focusing on looking after its population,” said McCloskey, a member of the World Health Organization Novel Coronavirus-19 Mass Gatherings Expert Group.

“But that could well have changed by next year. So, it’s quite possible that the outbreak will be at a level where it’s manageable without any particular risk.

“Or it may be that the vaccine arrives, it may be there’s treatment available. So, we just need to think through the options and not jump to too many conclusions too quickly.”

McCloskey’s wait-and-see approach sounds similar to the one taken by the IOC before it decided to postpone the Games amid mounting criticism.

WATCH | Sebastian Coe warns athletes about doping ‘short cuts’ during pandemic: 

Scott Russell of CBC Sports spoke with Sebastian Coe, the president of World Athletics, about the state of sport and athlete testing while in isolation. 3:33

Athletes were angry at being left in a state of limbo by the IOC and Tokyo organizers and while the postponement has provided a cushion, the clock is once again ticking.

Sports leagues and federations around the world are preparing to emerge from the outbreak and return to action with most seemingly resigned to the fact they will be played in empty arenas and stadiums until it is safe for fans to come back.

“So, we can run through to this time next year,” said McCloskey, looking ahead to a 2021 Summer Games. “After that it gets more problematic because people have spent a lot of money, athletes have to make up their mind whether they can come or not.

“So, it gets more and more difficult the closer you get. But I’d say there’s a willingness and an enthusiasm to make sure it happens properly.

“So, people will try hard and I think they’ll hang on to the last minute to see whether it’s safe to go.”

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Coronavirus: Italy passes 10,000 infections as clusters spur worry in U.S.

The latest:

Expanding clusters of the new coronavirus were eyed warily Wednesday as the outbreak upended daily life and reshaped everything from the presidential race in the United States to Pope Francis’s travel.

In the U.S., the caseload passed 1,000, and outbreaks on both sides of the country were stirring alarm, while in Europe, an increasingly locked-down Italy counted more than 10,000 infections and recorded soaring deaths among its aging population.

“Right now, the epicentre — the new China — is Europe,” said Robert Redfield, the head of the U.S. Centers for Disease Control and Prevention.

Rome’s usual boisterous hum was reduced to a whisper as Italy’s 62 million people were told to mostly stay home. Though shops, cafes and restaurants remained open, police around the country were enforcing rules that customers stay one metre apart and certain businesses shutter by 6 p.m.

Authorities said 631 people have died of COVID-19 in Italy, with an increase of 168 fatalities recorded Tuesday. The health crisis was dealing a serious blow to the country’s economy — the third-largest of the 19 countries using the euro — and threatened instability worldwide.

Markets across Asia dropped Wednesday despite Wall Street’s gains a day earlier. Investors seemed encouraged by promises by U.S. President Donald Trump of a relief package to cushion economic pain from the outbreak. Governments around Asia and elsewhere have also announced billions of dollars in stimulus funds, including packages revealed in Japan on Tuesday and Australia on Wednesday.

“Investors are still worried that those fiscal stimulus packages may not be able to contain the virus outbreak as well as to mitigate the impact on the economy,” said Louis Wong of Philip Capital Management.

For most, the coronavirus causes only mild or moderate symptoms, such as fever and cough. But for a few, especially older adults and people with existing health problems, it can cause more severe illnesses, including pneumonia. More than 119,000 people have been infected worldwide and over 4,200 have died.

The virus has disrupted travel, closed schools and halted manufacturing in places around the globe. Here’s a look at what’s happening in Canada, the U.S. and some of the hard-hit regions around the world.

Here’s what’s happening in Canada

British Columbia reported seven new cases of COVID-19 and two are linked to community transmission, while neighbouring Washington state continues to see a rapid spread of coronavirus. 1:49

Prime Minister Justin Trudeau is expected to offer details around a planned federal support package for people and businesses facing “immediate pressures” from the coronavirus and the disruption it’s causing in the economy.

The Public Agency of Canada, which has been continually assessing the risk from the outbreak, says that the risk to the general population in Canada is low, but notes “this could change rapidly.”

Dr. Theresa Tam, Canada’s chief public health officer, notes that some people face an increased risk.


As of early Wednesday morning, Canada has reported 97 cases of COVID-19, including:

Here’s what’s happening in the U.S.

In the U.S., dozens of cases were being tied to a conference in Boston, and leaders in multiple states were announcing curbs on large events. Colleges around the country emptied their classrooms as they moved to online instruction and uncertainty surrounded the upcoming opening of the Major League Baseball season and college basketball’s championships. Even the famed buffets of Las Vegas were affected, with some of the Strip’s biggest being closed in a precautionary measure.

“It’s terrifying,” said Silvana Gomez, a student at Harvard University, where undergraduates were told to leave campus by Sunday. “I’m definitely very scared right now about what the next couple days, the next couple weeks look like.”

New York’s governor said National Guard troops would scrub public places and deliver food to a suburb where infections have spiked. In Washington state, where a Seattle-area nursing home was the centre of an outbreak, officials said the virus had spread to at least 10 other long-term care facilities. In California, thousands of restless passengers remained stuck aboard a cruise ship, waiting for their turn to disembark to begin quarantines.

Two men vying to take on Trump in the U.S. presidential election abruptly cancelled rallies Tuesday and left open the possibility that future campaign events could be impacted, too. Trump’s campaign insisted it would proceed as normal, though Vice-President Mike Pence conceded future rallies would be evaluated “on a day to day basis.”

Here’s what’s happening in Italy and Europe

Italy’s lockdown measures to try to beat the coronavirus are reducing its economic output by around 10 per cent to 15 per cent, Lorenzo Codogno, a former Italian Treasury chief economist, said on Tuesday.

Prime Minister Giuseppe Conte unexpectedly expanded the so-called red zone to the entire country on Monday night, introducing the most severe controls on a Western nation since the Second World War and raising fears for the future, especially among small businesses.

As of Tuesday, France, Spain and Germany have more than 1,000 cases each. 

Here’s what’s happening in Iran and the Middle East

Iran’s death toll jumped on Tuesday to 291 and infections rose to more than 8,000. The UN called on Iran to free all prisoners temporarily, a day after Iran’s judiciary chief said it had temporarily freed about 70,000.


A civil defence worker wearing a protective suit sprays disinfectant in Baghdad’s main market as a precaution against the novel coronavirus on Tuesday. (Hadi Mizban/The Associated Press)

Bahrain’s health ministry said on Wednesday 77 new coronavirus cases had been recorded among citizens evacuated from Iran by plane on Tuesday. The new cases brought the total number of coronavirus cases recorded by Bahraini health authorities to date to 189, 30 of whom have recovered. No deaths have been recorded.

All Gulf Arab states have recorded infections but no deaths.

Here’s what’s happening in China

In China, where the novel virus first cropped up, officials said they’d counted only 24 new cases on Wednesday. In a reversal of positions, China is seeing new cases brought in from overseas.

In Beijing, the capital, all the new cases of COVID-19 reported on Wednesday came from outside the country, five from Italy and one from the United States. “The epidemic situation is at a low level and the prevention and control are continuously going well,” said Mi Feng, spokesperson for the National Health Commission.

Here’s what’s happening in South Korea and Japan

The other major outbreak site in Asia, South Korea, continued to report improving numbers, too, with 242 new cases announced Wednesday. Still, a cluster of infections connected to a call centre in one of the busiest areas of that country’s capital was raising alarms.

More than half of South Korea’s 51 million people live in the Seoul metropolitan area.

So far, 93 people have tested positive among the call centre’s employees and their families, Seoul Mayor Park Won-soon said Wednesday in a briefing broadcast over YouTube. The number could grow as tests are being done on more than 550 co-workers who worked on other floors of the Korea Building in Seoul’s Guro district.

Health workers in white protective suits scrambled to sanitize the nearby Sindorim subway station, which is used by more than 404,000 commuters per day, according to Seoul Metro.

While most of the infected workers live in Seoul, some of them commute from nearby cities such as Incheon and Bucheon, raising concern about a broader spread through public transit.

Call centre workers may be vulnerable because they work long hours in crowded and confined spaces, said Yoon Tae-ho, an official from South Korea’s health ministry.

Jung Eun-kyeong, director of South Korea’s Centers for Disease Control and Prevention, said it would be difficult to track infections if they spread to buses and subways. She said it’s “most critical” that public transit operators vigorously sanitize handles, bars and anything passengers frequently touch with the threat of local transmissions growing.

Park said Seoul is investigating the working conditions of more than 400 call centres in the city and will push employers to allow more employees to work from home. The mayor said authorities were responding actively to prevent the cluster from intensifying like South Korea’s earlier clusters around the southeastern city of Daegu.

Here’s a look at what’s happening in some other areas as COVID-19 spreads

  • India ramped up travel restrictions and closed a border with neighbouring Myanmar to counter the coronavirus outbreak, as countries across South Asia reported a rise in cases on Wednesday.

  • In Afghanistan, the number of confirmed cases rose to seven from four, the country’s health ministry said.

  • Democratic Republic of Congo confirmed its first case of coronavirus on Tuesday, bringing the number of countries in sub-Saharan Africa hit by the epidemic to seven.

  • Indonesia says a foreigner has become its first fatality from COVID-19. Achmad Yurianto, the government spokesperson on efforts to contain the coronavirus, said Wednesday the 53-year-old woman had diabetes and lung disease and had contracted the virus abroad.

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Having rejected Trump’s peace plan, Palestinians worry ‘what will happen next?’

Palestinian farmers who cultivate tomatoes and cucumbers in greenhouses in the Jordan Valley always keep one eye on their crops, which provide their livelihoods. But they also look toward the city they revere — and fear losing.

Massoud Abu Thabbet worries the peace plan put forward last week by U.S. President Donald Trump will mean he’ll lose the land his family has farmed for generations.

He rejects Trump’s promise that the deal would improve the Palestinian economy.

“Even if they paved these roads with gold, we will not accept. How can we have streets full of gold and then I cannot get to my Jerusalem to pray?” said Abu Thabbet.

Jerusalem is home to the third-holiest site in Islam, the Noble Sanctuary, where the al-Aqsa mosque sits. Known also as the Temple Mount, the site is considered the holiest place of worship for Jews.

For Palestinians, al-Aqsa is a national as well as a religious shrine. They insist that any future Palestinian state would have East Jerusalem as its capital and would include the mosque.

Palestinians say the status of Jerusalem is the main obstacle to their acceptance of Trump’s plan.


For Abu Thabbet and many other Palestinians, the status of the holy city of Jerusalem is the main obstacle to their acceptance of Trump’s proposed peace plan. (Irris Makler/CBC)

There are other elements that it would be difficult for them to sign onto, including the recognition of Israel as a Jewish state and the decision not to allow the return of any Palestinian refugees to their ancestral homes inside Israel.

But they say the most painful proposal is the decision to designate Jerusalem as Israel’s capital.

This part of Washington’s plan is not accepted internationally, as most countries, including Canada, consider that Jerusalem’s status should be settled by negotiations between the parties.

The plan, which Trump has long called the “deal of the century,” proposes granting the Palestinians limited self-rule in parts of the West Bank, while allowing Israel ultimately to retain the settlements it has built there and also to annex the Jordan Valley.

‘Declaration of war’

The Palestinians rejected the plan outright, with President Mahmoud Abbas saying “1,000 times no” and PLO official Elias Zananiri declaring it “nothing less than a declaration of war on the Palestinian people.”

Abbas had already broken off contact with this Washington administration when it recognized Jerusalem as the capital of Israel in 2017.

After that, there was no Palestinian input into the negotiations for the Trump plan, and no Palestinian presence in the East Room in the White House when the plan was announced.


Trump unveiled his long-awaited Mideast peace plan at the White House last week, alongside a beaming Benjamin Netanyahu. It presented a vision that matched the Israeli leader’s hardline, nationalist views but fell short of Palestinian ambitions. (Susan Walsh/The Associated Press)

Some Israeli analysts have suggested that Trump’s deal was in fact geared towards Israeli annexation of the Jordan Valley and other areas of the West Bank.

Barak Ravid, diplomatic correspondent for Israel’s Channel 13 news, argued this was the case because no Palestinian leader, no matter how moderate, could agree to Trump’s terms.

“It’s a non-starter. So you could infer that the aim of this plan is to enable Israel to annex the Jordan Valley and the Jewish settlements in the West Bank, while everything else stays the same,” he said. “And that has been the response from many on the Israeli right.”

The Jordan Valley is an arid region covering almost one-quarter of the occupied West Bank, bordering the Kingdom of Jordan. It’s sparsely populated, with around 52,000 Palestinians and about 8,000 Jewish settlers, according to separate figures from Israeli and Palestinian official surveys from 2018 and 2017 respectively.


The Jordan Valley is a sparsely populated farming region that makes up about one-quarter of the West Bank. (Irris Makler/CBC)

Israel argues that, as the gateway to Jordan, Iraq and Saudi Arabia, the region is of strategic importance.

Announcing his intention to annex it last month, Netanyahu said the Jordan Valley was vital to Israel’s security.

“This is our essential safety belt in the east. This is the eastern defensive wall.”

But Israel did not take this step at any time since it captured the West Bank in 1967 because of international opposition, including from Jordan across the border, one of only two Arab countries to sign a peace deal with Israel.

‘Best deal’

Amos Gilad, a former chief of Israeli military intelligence, declared Trump’s plan to be the “best deal” any U.S. president has ever offered Israel.

“Israel should grab this deal with both hands,” said Gilad, director of the Institute for Policy and Strategy at the Interdisciplinary Center in Herzliya.

Both Israel’s largest political parties, the right-wing Likud party and the centrist Blue and White party, have said they favour annexing the Jordan Valley, even before upcoming elections in March 2020.

Washington has so far put a brake on unilateral Israeli actions. Trump’s senior adviser, his son-in-law Jared Kushner, said they did not want to see any annexations before the Israeli elections.

Complex relations

The Jewish settlement of B’kaot is perched on the ridge above the mosque in the village of Frush Bet Dajan, where Massoud Abu Thabbet’s greenhouses are located.

Relations between Jewish settlers and Palestinian villagers, both mostly farmers, are complex.

Hazem Abu Muntaser sings the call to prayer at the mosque every Friday. He also runs a grocery store across the road. There’s a TV in the corner, but no cash register. He collects the money in a drawer.


Hazem Abu Muntaser runs a grocery store in the Jordan Valley and says he worries about a potential annexation. (Irris Makler/CBC)

“The ‘deal of the century’ annexing the Jordan Valley will make a siege around us. Tomorrow, if it happens, they’re going to say, ‘You have to be back at 7 p.m.,’ they’re going to interfere in our life,” said Abu Muntaser.

His son, Nur, agreed.

“Look what they do to us now. Imagine how it will be if we are part of them. There are Israeli soldiers patrolling here all the time and the settlers want our water and our land. They are already charging us for water now. What will happen next?”

Traditional diplomatic formula

Days after Trump unveiled his plan, the Palestinians called for an emergency meeting of the Arab League in order to respond to it.

Abbas spoke at length and said he knew he couldn’t agree to the plan when Washington announced East Jerusalem was part of Israel. “It will not be recorded in my history that I gave up on Jerusalem,” he said.

The Arab League fell in behind the Palestinians and unanimously condemned Washington’s deal, reverting to the traditional formula of a peace deal based on the two-state solution.

Two days later, the Organization of Islamic Co-operation (OIC) also rejected the Washington plan.


Local workers are shown in a greenhouse in Frush Bet Dajan, preparing tomatoes and cucumbers for sale. (Irris Makler/CBC)

Washington had been hoping that it had some Arab support, as ambassadors from Bahrain, Oman and the United Arab Emirates had attended Trump’s news conference in Washington.

In off-the-record briefings, Washington officials criticized this “old-fashioned” thinking.

In the Palestinian village of Frush Bet Dajan on the first Friday after Washington released its plan, the number of worshippers at their small mosque was swelled by visitors from other towns.


The local mosque in the village of Frush Bet Dajan, in the Jordan Valley, is shown. (Irris Makler/CBC)

Farrah Ghaleb made the 70-kilometre round trip from his home in Ramallah.

“This week I’m coming here, and many Palestinians are coming here, to let the world know that this is our Palestinian land and that Trump doesn’t have the right to give it to Israel or to Netanyahu,” Ghaleb said.

When he moved the U.S. Embassy to Jerusalem in 2018, Trump said he had taken the issue of Jerusalem “off the table.”

But the strength of Palestinian reaction to Trump’s new deal, and the breadth of Arab support for the Palestinians, show how much the issue of Jerusalem remains at the heart of the conflict.

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Rural doctors worry proposed changes could lead to ‘brain drain’

In the southeast corner of Saskatchewan is a town called Wawota. The town, known for its colourful collection of fire hydrants painted to resemble cartoon characters like Garfield, is home to nearly 550 residents, according to the 2011 census.

“It’s a good community and good people around here. Everyone helps one another out,” said 84-year-old Clarence Lamontagne, a resident of the town and a former building contractor.

But one of the struggles of rural life — in this, and in multiple other communities across the prairies — is limited access to health care.

Wawota has a local medical clinic, but physicians from Arcola, Sask., are only on site on Mondays and Fridays, and see patients by appointment only.

“These doctors come in two days a week and they’re gone. So if you’re sick at night, you can’t go to your health clinic,” Lamontagne said. “You must go 30 miles away.” 


Wawota, Sask., has a population of approximately 543 residents, according to 2011 figures from Statistics Canada. Residents can book medical appointments on Mondays and Fridays at the Wawota Medical Clinic. (Google Street View)

It wasn’t always so challenging in Wawota. In the early 1990s, Wawota had its own hospital with doctors who lived and worked in the community.

“When we got all these cuts, our town was going lower and lower,” Lamontagne said. “Of course, when you lose a hospital, then you also lose your drug store, and you lose this and that. 

“Then people start going to bigger communities for health reasons. It hurts your area.”

Doctor Matthew McIsaac, who has practiced in various rural communities across Alberta and currently works out of Banff and Canmore, was born in Wawota.

He said cuts to rural health implemented by Janice MacKinnon in 1993, then Saskatchewan’s finance minister for the NDP government, led to a “brain drain” in Wawota.

“It killed rural areas, including [Wawota]. We had lost our [family] practitioner to illness. His replacements came and did not stick around due to the pay cuts,” he said. “They couldn’t find anybody to provide any long-term coverage, and eventually we lost our hospital.”

Since that time, McIsaac said the population of the town has dwindled by about 200 people.

“There is evidence, historically, that things like this kill small-town medicine,” he said. 

This year, MacKinnon was tapped by the Alberta government to lead a six-person panel evaluating the province’s finances. In the report emerging from that panel, various recommendations were made to help Alberta to balance its budget, including proposing pay cuts for physicians.

A move to Alberta

Eventually, McIsaac also left Wawota, but kept working in rural communities throughout rural Alberta, including in Coronation, Beaverlodge and Milk River.

Due to higher funding, McIsaac said his time practicing in Alberta was always more fulfilling compared to working in Saskatchewan, as he could take time to help a patient fully and provide complete care.

There are challenges associated with being a rural doctor, McIsaac said — it can be lonely and it can be high-pressure, given the responsibility laid on a limited number of physicians.


Matthew McIsaac is a sport medicine and emergency physician who currently works out of Banff and Canmore. (Matt McIsaac)

So when McIsaac heard about changes proposed by the Alberta government — that would affect how doctors schedule, bill, and interact with their patients, he said it “blew [his] mind.”

“It seems like the government is completely non-thinking and quite hubristic with their approach here, in believing that they’ve found an answer,” McIsaac said. “Or, there’s this cynical view that they actually want to sacrifice rural care.”

Changes proposed by the Alberta government were communicated to the Alberta Medical Association (AMA) on Nov. 14. Rural doctors say those changes, among others, would disproportionately affect their practices. 

Earlier this year, Alberta Health Services reduced the amount it pays doctors to be on call after funding was reduced to its specialist-on-call program by $ 10 million per year.

“They cut that without warning quite recently and already the family physicians were quite up in arms, because that’s a big part of their livelihood,” McIsaac said. “But the second thing that’s come now is this proposal that the complex modifier fees get cut.” 

Under the proposals, doctors would be paid the same for a 25-minute visit as they are for a 15-minute visit, and funding would be cut for complex care plans.

“These physicians working in rural centres are looking to face between, at the low end, a 10 per cent cut up to a 40 per cent cut for some of them in their billing, almost immediately, because of this,” McIsaac said. “So you’ve just been cut in terms of your night call, and now you’ll see [complex modifier fees cut]. Then, you’re suddenly on par with places like British Columbia, or Ontario, or Saskatchewan, which is the goal of the government.

“Well, to live in a place that is remote and rural, or to move to a place like Penticton or Kelowna or Victoria seems like a no-brainer when the pay is equal and when the cost of living is not much different.”

Some say advanced skills also threatened

Michael Beach is a family physician with training in anesthesia who practices in Drumheller, Alta., and said those working in rural settings with advanced skills would be “very disproportionately impacted” by the changes.


Michael Beach said there was a strong chance he would leave Alberta were proposed doctors’ changes to be implemented. (Michael Beach)

“It impacts us the same way as a lot of the urban doctors, but there are a few things that impact us even more so and threaten those advanced skills in the rural setting,” Beach said.

The reduction of call stipends would make a big impact, Beach said, calling them a “huge incentive” to work in rural Alberta.

Steve Buick, a spokesperson for Health Minister Tyler Shandro, wrote in a statement that those incentives were left over from former regions that competed for doctors by paying them extra.

“A decade ago we had an overall shortage, today we don’t,” he wrote. “We don’t need to pay much higher rates than other provinces when we don’t have a shortage anymore. We can make some modest reductions.”


The Alberta Medical Association has requested feedback from its members while it formulates a response to a collection of proposals from the Alberta government, including changes related to eliminating clinical stipends. (CBC)

But Beach said that while he understood what’s being argued — that doctors are working full-time during their call shift, and should not get a stipend on top of being paid continually — he said that only applies in urban settings.

“That’s not true in the rural setting at all. When we’re on these call shifts, we’re not continually providing fee for service work throughout,” he said. “For the duration of time this whole week that I’ve been on my call shift, I can’t leave Drumheller, I can’t go for a walk with my wife that’s a half-hour away from my home and my car, because I could get called at any moment to go do [anesthesia].”

Right now, we’re going to wait and see, but our minds are very open to leaving [Alberta].– Michael Beach, Drumheller family physician

Plus, according to Beach, the whole reason doctors take positions in rural Alberta is because of call stipends. 

“If you lose those, in my opinion you’re going to lose a lot of people who say, ‘It’s just no longer worth the effect on my personal life and family life and lifestyle to continue to provide this service for no compensation whatsoever,'” he said. “You’re looking at a potentially large reduction in some of those services in a lot of these smaller centres.”

The spending question

Alberta today spends the second-most on healthcare, behind only Newfoundland. In his statement, Buick said government would listen to proposals offered by the AMA related to getting costs in line to other provinces.

“Some people are overreacting to our proposals and saying doctors won’t be able to do good primary care. The proposals are common sense and aligned with other provinces,” Buick wrote. “They don’t limit physicians’ ability to provide high-quality care, they just reduce the excess amounts we’ve been paying.”

The proposals are common sense and aligned with other provinces.– Steve Buick, spokesperson for Health Minister Tyler Shandro, in a statement

In a joint statement attributed to AMA president Christine Molnar and AMA rural medicine president Edward Aasman, cuts proposed by government to rural medicine could be “immense.”

“The effect would be absolutely devastating on those practices,” the statement reads. “Rural practices are already struggling to remain stable, including attracting and retaining physicians. If implemented, these proposals could severely threaten the viability of those practices.”

With all the proposed changes considered, Beach estimated he would be looking at at least a 30 per cent reduction in his salary.

“My wife and I have actually sat down and looked at it and said, ‘If all of these things come to fruition, would we stay in Alberta?'” Beach said. “Right now, we’re going to wait and see, but our minds are very open to leaving if [these changes go through].”

Addressing potential rural shortages

Even if AMA negotiations don’t go as planned, the Alberta government may have a card up its sleeve to address any shortage of rural doctors that would result from funding changes.

Bill 21, otherwise known as the Ensuring Fiscal Sustainability Act, allows the province to tell new doctors where they must practise medicine in Alberta, based on the recommendations of an expert panel.

Beach said he found that move counterintuitive, given the possible impact of changes being proposed.

“The reason why a lot of things were put in place over the last 20, 30 years, is because we had such a shortage of rural doctors. We had to find ways to incentivize people to come,” he said. “That started to work, and now we’re taking steps back. Forcing peoples’ hands on where they’re going to go simply isn’t going to work.

“All that’s going to happen is, trainees will just finish off their medical education and say, ‘if I don’t want to work in rural Alberta, I’ll just go to another province.'”

The AMA is currently developing its response to the proposed changes, and plans to submit its feedback prior to the Dec. 20 deadline.

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Doctors worry as anti-vaccination messages escalate from social media misinformation to personal threats

As anti-vaccination groups fight back against public health campaigns to promote immunization in the face of measles outbreaks, some Canadian doctors say the battle has escalated beyond social media platforms to personal threats and attacks.

“The pitchforks are coming out,” said Dr. Anna Wolak, a family physician in Vancouver who has publicly spoken out on social media about the importance of vaccination — both as a doctor and the mother of three children.  

Although most patients and many people in the community have been supportive, Wolak said she has also been subjected to furious comments — both in person and through social media.  

“Patients have come in and told me that they can’t believe I would deliberately poison my children,” Wolak said in an email to CBC News.

“Some of those have threatened to report me to the [provincial regulatory] college because they consider me a threat to children.”

Promoting false claims

Anti-vaccination groups promote false claims linking vaccines to childhood illnesses or injury. Some of those beliefs stem from a research paper in the 1990s that wrongly suggested vaccines could cause autism. That study was debunked years ago and the author stripped of his medical licence. Other adverse reactions to vaccines have been proven to be very rare.

Wolak worries about what people with anti-vaccination views will say in front of her children. She remembers an especially hateful comment someone made at an event she was attending. 

“[They said] I really hope that your kids get a vaccine injury and then you’ll know exactly what sort of poison you’re talking about,” she recalled.  

Although those interactions have been hurtful, Wolak said she has not received any “overt threats” of physical harm — something that has happened in recent months to at least two other Canadian doctors.  

I WILL make sure you NEVER support vaccines EVER AGAIN!– Email threat to two Canadian doctors

One of the recipients of the threats is in Toronto. The other is in Eastern Canada. They say they have both received a steady stream of emails ranging from harassment to threats — about 200 of which came from the same email address — since the fall. 

CBC News has agreed to protect the identities of both doctors because they are afraid they will be the target of further threats. 

One email sent to both of them said: “Come at my son with another vaccine and I WILL make sure you NEVER support vaccines EVER AGAIN! This email isn’t even CLOSE TO LISTENING TO ME IN PERSON!”

“Signed, A Momma With Claws OUT!”

The eastern Canadian doctor received additional emails and voicemails. The doctor said they include threats of killing and dismemberment.

‘Deeply unpleasant’

That doctor has received angry emails before from anti-vaccination advocates and ignored them, but said these were different.

“These were not trivial threats,” the doctor said. “I can’t change the science … and to be unable to stand up and tell what the science is and not have somebody threaten you in a very nasty way is deeply unpleasant.” 

The Toronto-based public health doctor said the emails she received were upsetting — but the fact that people are trying to silence those promoting life-saving immunization is even more concerning.   

“It’s not about me,” she said. “It’s emblematic of the larger system under attack. It’s putting kids at risk.”

Dr. Gigi Osler, president of the Canadian Medical Association, says threats against doctors by people opposed to vaccination are ‘unacceptable’ and says it’s vital for Canada’s physicians to keep educating people about vaccine effectiveness and safety. (Dennis Cleary/CBC)

The threats to both doctors were reported to police.

Both physicians said police told them the IP addresses for the emails were in the U.S.

CBC News contacted Toronto Police — which confirmed a report had been filed — as well as the RCMP and the municipal police force in Eastern Canada where the death threats occurred. None of them would confirm whether there is an ongoing investigation or provide any details. 

There are more established anti-vaccination groups in the U.S. than in Canada. The most prominent organizations characterize themselves as advocating for “vaccine choice” or representing people who have been “vaccine injured,” rather than being against vaccinations.  

Recently, measles outbreaks have prompted some government officials in the U.S. to call for mandatory vaccinations, which has enraged anti-vaccination groups, prompting rallies and increased outcries on social media.  

Demonstrators at the ‘March for Medical Freedom’ in February protested a bill that would eliminate non-medical exemptions from vaccination in Washington state. (Lindsey Wasson/Reuters)

American physicians, including pediatricians, have received threats from anti-vaccination believers, although the American Academy of Pediatrics was unable to confirm how many cases they are aware of. 

The goal is to shut you up.– Dr. Paul Offit , pediatrician, Children’s Hospital of Philadelphia

Pediatrician Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, said he has received harassing and threatening emails for years, ranging from messages calling him evil and accusing him of conspiring with “big pharma” to death threats.  

“The goal is to shut you up,” he said. “And it certainly works. There are a number of people who choose not to stand up in this arena because they know that it means that they’re going to be personally targeted.” 

Offit continues to put himself in that difficult position, he said, because the consequences of children not being vaccinated against preventable diseases, including measles, is worse. 

“We’re getting to the point now where children could once again die from measles,” he said. “You just have to do the right thing.”

Del Bigtree, a prominent anti-vaccine activist in the U.S., told CBC News he would “absolutely … discourage any sort of aggressive talk or violence of any kind.”

Bigtree also said he didn’t believe the threats would have come from anyone who was affiliated with his movement. 

Offit doesn’t believe anti-vaccination groups are making threats against doctors as part of a co-ordinated strategy — but he does think that they create the fervour that may set certain individuals off. 

“They just whip up the base, you know? They use these really mean-spirited terms, they make it personal. They directed that, essentially, by setting you up as an evil person,” he said. “But I don’t think it’s an organized effort.”

Threats ‘not acceptable’

Regardless of where the threats against the Canadian doctors originate, they are “extremely concerning and a matter for the police,” said Dr. Gigi Osler, president of the Canadian Medical Association.  

“Threats to personal safety for anybody is not acceptable and in particular towards doctors who are trying to speak out on behalf of the health of their patients and the health of Canadians.”

Dr. Nadia Alam, a family physician and outgoing president of the Ontario Medical Association, worries that threats against doctors will silence important conversations about vaccination. (Ontario Medical Association)

Dr. Nadia Alam, a family physician in Georgetown, Ont., and outgoing president of the Ontario Medical Association, said she’s concerned about the possible chilling effect such threats could have on getting accurate information about vaccines to parents. 

“I … worry that this may impact physicians from speaking out.  And it shouldn’t. Because at the end of the day, educating the public is a core part of our job,” she said. 

“Parents in my clinic are more confused than ever about the risks and benefits [about vaccines]. And they’re coming in with information that’s frankly incorrect.”

The Toronto-based public health doctor who received the threats shares Alam’s concern, noting that the return of measles after the disease was eliminated through vaccination in many European countries is “horrifying.”

“Easily we could end up in the same boat,” she said. 

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