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Raptors’ COVID-19 issues worsen, forcing postponement of Sunday game against Bulls

After dodging COVID-19 for almost half of the NBA season, the Toronto Raptors have been dealt a big blow.

The NBA called off Toronto’s game against the visiting Chicago Bulls on Sunday night due to COVID-19 health and safety protocols.

In a shortened NBA season reeling from COVID-19 cases and game cancellations, it’s the first game cancellation for the Raptors.

The league said the Raptors are dealing with positive test results, and combined with contact tracing issues, won’t have the league-required eight players available Sunday.

Toronto was missing head coach Nick Nurse, five members of his staff and star forward Pascal Siakam for Friday’s 122-111 victory over Houston.

The Raptors-Bulls game is the 30th to be postponed so far this season because of COVID-19 testing or contact tracing but the first time Toronto has had to reschedule.

It was the first postponement this season for Toronto, which is playing its home games in Tampa, Fla., because of Canada’s border regulations around COVID-19, and health and safety measures in Toronto. Chicago has now had four of its games pushed back, all because its opponent for each of those contests was going through a virus-related problem.

The only teams that have not had a game postponed by virus issues so far this season are Brooklyn, Los Angeles Clippers and Los Angeles Lakers.

Players, staff tested twice daily

Toronto used 12 players on Friday and had 14 listed as available to play. For Sunday’s game, Siakam was the only player who had been listed on Saturday’s injury report as out because of health and safety protocols, which indicates results returned Saturday either showed more problems, or the contact tracing investigations showed players had been exposed to someone who tested positive for COVID-19 and may have to quarantine.

The names of players or staff members affected were not revealed.

WATCH | Lowry leads Nurse, Siakam-less Raps past Rockets:

Toronto defeats Houston 122-111, Nick Nurse and 5 other members of the coaching staff along with Pascal Siakam were not at the game because of health and safety protocols. 1:23

Players and staff are tested twice daily.

The Raptors announced Nurse and most of his staff would miss Friday’s game a few hours before tip-off.

At the time, Toronto general manager Bobby Webster said it wasn’t clear Siakam’s situation was linked to the coaches.

“The NBA is being extremely careful here,” Webster said. “It’s early in what’s going on here, so I think we’re all being conscientious and not taking any risks … We’ll see what tomorrow brings us.”

WATCH | CBC Sports’ Vivek Jacob discusses Fred VanVleet’s all-star snub:

Vivek Jacob is joined by Raptors reporter William Lou, to discuss Fred VanVleet not being selected to the 2021 All-Star Game and the Raptors getting back to the .500 mark after a slow 2-8 start to the season. 4:40

The Raptors’ staff was already shorthanded, given Chris Finch left the team earlier this week to become head coach of the Minnesota Timberwolves.

Adrian Griffin, Jama Mahlalela and Jon Goodwillie make up the remainder of Nurse’s coaching staff.

About half the league’s teams are allowing a small number of fans into arenas for games, but testing protocols and other rules have been stiffened as the season has gone on in the interest of safety. The league has been able to play about 94 per cent of its scheduled games so far this season, which NBA commissioner Adam Silver and some players have touted as some measure of success to this point.

Scheduled to host Pistons on Tuesday

“Hopefully, going forward, we can continue it,” Miami forward Kelly Olynyk said Sunday. “Obviously, we’d love to see fans back in the arenas, travel, all that kind of stuff be permitted and allowed when it’s safe to do so. But right now, we’re still trying to get the games in as safely as we can.”

The Raptors are scheduled to host Detroit on Tuesday at Amalie Arena in Tampa, Fla., before wrapping up their first-half schedule on Thursday in Boston.

The NBA released its schedule for the second half of the season last week, and those jam-packed lists — some teams are slotted to play 40 times in a span of 68 days — includes games postponed in the first half because of the virus and the February ice storm that caused a handful of postponements in Texas.

The Raptors were already scheduled to play 35 games in 66 days in the season’s second half, including a gruelling four-game western road trip that sees Toronto play four games in six days at Denver, Utah and Los Angeles against the Clippers and Lakers.

Rescheduling more games will get even tougher from here, and the notion of not every team playing its full 72-game allotment this season seems like a distinct possibility.

During the season’s second half, which runs from March 10 through May 16, the Raptors and Bulls share 19 days without a game on their schedules. But without moving several other games around, the only possible date they could play without creating a back-to-back-to-back — or even a back-to-back-to-back-to-back — for either team is April 8.

Toronto opens the second half of the season on March 11 against the visiting Atlanta Hawks.

Florida added 5,539 coronavirus cases and 118 deaths on Sunday. The state has had more than 1.9 million cases since the pandemic’s arrival last March.

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Surgery and scan backlogs set to worsen without government funding, CMA says

Ongoing surgical and diagnostic backlogs will only worsen without immediate government help to address a strained health-care system, says the Canadian Medical Association, which found average wait-times increased by one-to-two months for the most common procedures in the first wave.

The CMA said Monday it would take $ 1.3 billion in additional funds to tackle delays sidelined from January to June because they were deemed non-essential during the pandemic.

A study ordered by the organization looked at the six most commonly delayed procedures:

  • CT and MRI scans.
  • Hip and knee replacements.
  • Cataract surgeries.
  • Coronary artery bypass grafts.

The procedures all plummeted in April, when almost no cataract or knee replacements took place.

Although procedures gradually began to rebound in June, the report found more than 270,000 people had their MRI scans — which can detect serious disease or injury — delayed by a national average of nearly eight months, more than seven weeks longer than before the pandemic. Those waiting for knee replacement surgeries had to wait an average of 14 months, about two months longer than before the pandemic.

“The impact on wait times is just going to be the worst-ever in our system,” CMA president Dr. Ann Collins said as she called on the federal and provincial governments to develop a plan to restore backlogs to pre-pandemic levels in one year.

“It’s going to have serious consequences the longer this pandemic goes on.”

Almost half of the delayed procedures were CT scans, while about a third were MRI scans, which are often used to diagnose potential cancers, follow-up on cancer treatment and screen for breast cancer as well as diagnose joint pain.

WATCH | Managing the surgery backlog from COVID-19:

By the time the COVID-19 pandemic is finally over, Canadian doctors could face another health care crisis due to a massive backlog of surgeries and procedures that will strain an already stretched system. 2:04

The rise in CT scan backlogs varied wildly across the country, from a 14 per cent increase in Alberta to a 75 per cent increase in Ontario.

Ontario also saw the biggest delays in MRI scans and still had the most ground to cover in June when many parts of the country began resuming health services.

Nationally, the backlog included 249,088 CT scans with a 3.5 month-long wait, which was 33 days longer than before the pandemic.

While Collins said she believes every effort has been made to triage patients, it’s very possible that an “unfortunate unintended consequence” could be untold numbers of missed cancers, diseases and declining health that would eventually demand more complex care than if they had been caught earlier.

Critical procedures to walk and work

Even designating some procedures like hip replacements “non-essential” is a misnomer, said Collins.

“To the patient who’s having great difficulty walking, who can no longer go up the steps in their home, that is a critical procedure,” she says, noting delayed care could also limit ability to work, increase reliance on caregivers and pain killers and strain families emotionally and financially.

All non-essential surgeries were halted early in the pandemic to limit the spread of COVID-19 and ensure hospitals had the capacity to respond to a possible surge in infections.

But any one of the delayed procedures could become urgent over time, especially as the second wave further delays care for people who may have been waiting since before the pandemic, said Collins.

And that could lead to more strain on hospitals by requiring bigger surgeries and longer recovery times, not to mention additional pressures on other health-care workers including home care staff and physiotherapists, said Collins.

Almost half of the delayed procedures were CT scans, while about a third were MRI scans. (CBC)

“If a patient’s presenting later in their disease process they almost certainly will require more resources treatment-wise and care-wise in general,” said Collins.

The study found the six procedures plummeted to their lowest point in April and began a rebound in May in June as services gradually returned, however a sizeable backlog remained. It did not take into account the current second wave engulfing some hospitals.

The study estimates that an additional 307,498 procedures would need to be performed over a 12-month period to clear the backlog — a 6.1 per cent increase compared to what would have been expected over the course of a year.

Of the six backlogged procedures studied in June, the increased wait was greatest for cataract patients who waited an additional 75 days for surgery, for a total average of 331 days.

Worst yet to come?

Collins said she didn’t expect the health-care system to rebound fully for at least a year, noting the numbers don’t include data on all of the halted procedures, nor those procedures or screenings that might have resulted from patients who cancelled their doctor’s appointment over COVID-19 fears.

The CMA said the suggested investment is a conservative estimate that doesn’t include increased costs in personal protective equipment, additional cleaning measures and any new policy guidelines that would further reduce capacity.

HealthCareCAN president Paul-Emile Cloutier said the study only presents a snapshot of time during those first months of the pandemic and doesn’t fully forecast the pressures he expects will mount.

His fear is that “at one point, the system will crack.”

“I believe that the worst is yet to come with the second wave of COVID-19,” said Cloutier, whose group advocates for health organizations and hospitals across Canada.

“For me, the greater concern is the human costs behind their figure…. [Health-care staff] are exhausted. They’re tired. They have worked extremely hard and double shifts constantly during the first wave of COVID-19.”

The report landed as hundreds of health-care and support workers walked off the job in Alberta, forcing the government to cancel all non-urgent surgeries.

The job action involving aides and support staff came amid tensions with the United Conservative Party government who vowed to slash up to 11,000 health jobs to save money during the pandemic. Some of the cuts are to come from further contracting out of laundry and lab services, with assurances that nurses and front-line clinical staff would not be affected.

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CBC | Health News

Superbugs set to worsen amid COVID-19 pandemic

A leading Canadian microbiologist is sounding an alarm about overuse of precious antibiotics among the world’s more than 8.7 million cases of COVID-19.

So many people have been seriously sickened by COVID-19 that they need to be cared for in hospital, such as with oxygen. Doctors commonly prescribe antibiotics for people with COVID-19 in hospital.

Eric Brown, a professor at the McMaster University’s Institute of Infectious Disease Research, has concerns about how COVID-19 could drive up antibiotic resistance in bacteria that aren’t killed by standard drugs.

“The biggest concern is for those who have COVID-19 who maybe don’t need an antibiotic,” he said.

Canadian infectious disease physicians say guidelines suggest a limited role for antibiotics in COVID-19 cases. Once it’s clear that the person has COVID and there’s no bacterial infection, then the antibiotic treatments should be stopped to avoid encouraging another infection in the same patient.

Bacterial resistance rates could lead to more deaths

Earlier this month, the director general of the World Health Organization, Tedros Adhanom Ghebreyesus, also expressed similar concerns.

“The COVID-19 pandemic has led to an increased use of antibiotics, which ultimately will lead to higher bacterial resistance rates that will impact the burden of disease and deaths during the pandemic and beyond,” he said.

Brown said the long-term ramifications of the increase are unknown. They could jeopardize use of antimicrobials to prevent infections after surgeries like hip replacements, C-sections and organ transplants if bacteria in patients are resistant to them, he said.

The solution has two parts, he said: Stewardship — that is, only using antibiotics when needed — and discovering new antibiotics.

Yet scientists have not discovered any truly new classes of antibiotics in more than 50 years.

Two mustard-coloured, rod-shaped, carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteria are shown interacting with green-coloured, human white blood cells, specifically a neutrophil. (National Institute of Allergy and Infectious Diseases)

The Canada Council for the Arts recently awarded Brown a prestigious Killam Fellowship worth $ 70,000 a year for two years, which will allow the scientist to devote himself full time to a laboratory research project studying superbugs.

Brown hopes to change that by finding new antibiotics for what he called the top three dreaded superbugs on WHO’s list. All three are classified as Gram-negative bacteria, which are characterized by having surfaces that are difficult for antibiotics to penetrate.

“There are a lot of clever approaches superbugs have to avoid antibiotics, and some of them are encoded by genes that are shared among pathogens,” he said. “That’s why antibiotic resistance can spread so widely.”

Designer drug innovation

A biochemist by training, Brown is looking for a needle in a haystack among half a million chemicals that could crack the nut of the dreaded bacteria. Then, designer drugs could either kill the bacteria directly or slow them in their tracks.

“No one’s really taken this approach,” he said.

Brown is not daunted by how a new drug typically takes about 10 to 15 years from the discovery phase through clinical trials for safety and efficacy and on to the market.

His lab plans a series of experiments on screened compounds followed by chemical tinkering to improve potency of leading candidates for preclinical testing to decide whether an experimental drug, if found, should be tested in people.

Even then, challenges await.

“There isn’t another therapeutic area in medicine where you would come up with what we call a designer drug and everybody would say, ‘OK, that’s fantastic. Let’s almost never use it,'” Brown said.

Normally, pharmaceutical companies want to sell as much of their product as possible. But that’s not necessarily the best model for antibiotics.

The risk of infection during routine surgeries would go through the roof if there weren’t antibiotics available to treat infections, according to Eric Brown, a professor at McMaster University who is studying superbugs. (CBC)

Instead, physicians in North America want to conserve antibiotics of last resort for increasingly resistant infections.

Dangerous trend needs to be countered

As the pandemic unfolds, doctors are still generally overprescribing antibiotics in many parts of the world.

But in low- and middle-income countries in Asia, Africa and South America, much less is known about how many antibiotics are prescribed by family physicians and why.

To start filling the gap, Dr. Giorgia Sulis, an infectious disease physician and doctoral candidate in epidemiology at McGill University, reviewed 10,000 studies with her team.

They whittled that down to just 16 studies with enough prescription details to gain a glimpse into the overuse problem with antibiotics. Their findings were published in the journal PLOS Medicine last week.

Sulis and her co-authors said they found the proportion of primary care patients seeking care for any reason who were prescribed antibiotics often exceeded 50 per cent, compared with the WHO’s recommendation of less than 30 per cent for such patients.

When critical antibiotics are held reserve in Canada, they’re used with caution in hospitals only, Sulis said.

A chart showing the pills that make up drug-resistant tuberculosis treatment in South Africa. (Aleksandra Sagan/The Canadian Press)

Brown, who was not involved in the review, said it’s “terrifying” to think about the “suspiciously high number” of antibiotics that were flagged.

Both Brown and Sulis recognize another consideration: the infectious disease burden in other parts of the world is also much higher than in Canada.

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CBC | Health News

Some people flee, others restock before Australian wildfires worsen

Thousands of tourists fled Australia’s wildfire-ravaged eastern coast Thursday ahead of worsening conditions as the military started to evacuate people trapped on the shore further south.

Cooler weather since Tuesday has aided firefighting and allowed people to replenish supplies. Vehicles formed long lines at gas stations and supermarkets, and traffic was gridlocked as highways reopened. But fire conditions were expected to deteriorate Saturday as high temperatures and strong winds are forecast to return.

“There is every potential that the conditions on Saturday will be as bad or worse than we saw” on Tuesday, New South Wales Rural Fire Service Deputy Commissioner Rob Rogers said.

Authorities said 381 homes had been destroyed on the New South Wales southern coast this week and at least eight people have died this week in the state and neighbouring Victoria, Australia’s two most-populous states, where more than 200 fires are currently burning.

Fires have also been burning in Western Australia, South Australia and Tasmania.

Worst on record

The early and devastating start to Australia’s summer wildfires has led authorities to rate this season the worst on record. About five million hectares of land have burned, at least 17 people have been killed and more than 1,400 homes have been destroyed.

Prime Minster Scott Morrison said the crisis was likely to last for months.

“It will continue to go on until we can get some decent rain that can deal with some of the fires that have been burning for many, many months,” Morrison told reporters on Thursday.

New South Wales authorities on Thursday morning ordered tourists to leave a 250-kilometre (155-mile) zone along the picturesque south coast. State Transport Minister Andrew Constance said it is the “largest mass relocation of people out of the region that we’ve ever seen.”

New South Wales premier Gladys Berejiklian declared a seven-day state of emergency starting Friday, which grants the New South Wales Rural Fire Service commissioner more control and power.

It’s the third state of emergency for New South Wales in the past two months, after previously not being implemented since 2013.

“We don’t take these decisions lightly but we also want to make sure we’re taking every single precaution to be prepared for what could be a horrible day on Saturday,” Berejiklian said.

A statewide total fire ban will be in place on Friday and Saturday.

In Victoria, where 83 homes have burned this week, the military was helping thousands of people who fled to the shore as a wildfire threatened their homes Tuesday in the coastal town of Mallacoota. Food, water, fuel and medical expertise were being delivered and about 500 people were going to be evacuated from the town by a naval ship.

“We think around 3,000 tourists and 1,000 locals are there. Not all of those will want to leave, not all can get on the vessel at one time,” Victoria Premier Daniel Andrews told the Australian Broadcasting Corporation.

A contingent of 39 firefighters from the United States and Canada landed in Melbourne on Thursday to help with the catastrophe.

Smoke from the wildfires made the air quality in the national capital, Canberra, the world’s worst in a ranking index Thursday and was blowing into New Zealand.

A resident waters his garden wearing a mask as smoke shrouds the Australian capital of Canberra on Thursday. (Mark Baker/Associated Press)

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Attacks may worsen Ebola epidemic in Congo, officials warn

Aid workers at the epicentre of the worst Ebola epidemic in the history of Congo say they are facing a spike in attacks and threats, slowing their work and potentially triggering a surge of new cases.

While two Doctors Without Borders facilities treating Ebola patients in North Kivu province were attacked last week, aid workers said they are only the latest in a series of violent events. 

Three Canadians — one doctor and two nurses — were working in those centres but are safe, a spokesperson for the organization said.  

One of the facilities has since reopened.

"We had at least 10 cars that were broken into in Katwa," said Michel Yao, incident manager for the World Health Organization (WHO), referring to an attack last month in an area in the eastern trading hub of Butembo — a city with strong links to neighbouring Uganda.

"There are increasing attacks on different teams," Yao told the Thomson Reuters Foundation, the charitable arm of Reuters that covers humanitarian news, by telephone from Butembo.

He cited the difficult conditions faced by aid staff working on disinfection, safe burials, support of health facilities, and those providing vaccinations to treat Ebola.

A health worker dressed in a protective suit walks past burned structures after attackers set fire to an Ebola treatment centre run by Doctors without Borders in the east Congolese town of Katwa. (Meinie Nicolai/MSF/Reuters)

The current Ebola epidemic, first declared in August, is believed to have killed at least 561 people so far and infected over 300 more.

It is unclear who exactly is behind the attacks, said Jean-Philippe Marcoux, country director for the Mercy Corps charity in Congo.

"It's a minority of groups but sometimes they react violently and target response workers," Marcoux said. "To a certain extent, Ebola has been politicized during the run up to [December's presidential] elections."

Some communities believe the Ebola response to be part of a political conspiracy to control or exclude the local population from the electoral process, he said.

In some neighbourhoods, locals ignore potentially life-saving precautions, Marcoux added.

"They refuse treatment, they refuse followups, they refuse vaccinations and they refuse assistance for the [safe] burials."

"The teams and staff are very scared," WHO's Yao said. "When our team enters [certain areas], they are suddenly surrounded by hostile people who are even armed."

"We saw bullet marks on the wall," Yao added, referring to the attack on the Ebola treatment centre in Butembo last week. 

The centre was set on fire while an extended gun battle between the attackers and security forces ensued, health officials said.

The torching of the two centres prompted Doctors without Borders to suspend medical activities.

"It will definitively affect the prognosis of people surviving Ebola," Yao said.

"The fear is that if we cannot work in the coming days and weeks, we will have a major surge of cases in Butembo. I cannot exclude re-infection in places where the outbreak has been brought under control. This is really our fear."

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