This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.
Canada’s reluctance to follow evolving real-world data has led to potentially confusing COVID-19 vaccination guidelines that some experts say leave vulnerable seniors at risk in the community and could fuel vaccine hesitancy.
The National Advisory Committee on Immunization (NACI) recommended last week that Canadians over 65 not receive an AstraZeneca-Oxford vaccination despite emerging evidence from countries around the world demonstrating its ability to prevent severe COVID-19 in older adults.
The recommendation led provinces to reorganize their vaccination plans for seniors. The result was people aged 60-64 could receive AstraZeneca-Oxford shots ahead of older age groups, who are at greater risk of hospitalization and death from COVID-19.
Other countries such as France and Germany initially advised those 65 and older not to receive the shot, but overturned their decisions earlier this month after new evidence showed the vaccine significantly reduced hospitalizations in that age group.
One Shoppers Drug Mart location in Toronto’s east end started catering to walk-ins for AstraZeneca-Oxford shots for those aged 60 to 64, which prompted a long lineup near Danforth and Coxwell Avenues on Thursday. (Michael Charles Cole/CBC Toronto)
But the NACI recommendations were based largely on AstraZeneca-Oxford’s clinical trial data and didn’t examine real-world evidence past Dec. 7 — months before the effectiveness of the vaccine was fully realized in other countries for older age groups.
“We are trying to do the best that we can with the data that we have,” NACI chair Dr. Caroline Quach told The National‘s Andrew Chang this week.
She said the volunteer national advisory committee isn’t able to pivot to emerging data quickly.
“We are not a committee that is able to make a recommendation on Monday to be published on the Tuesday.”
Quach confirmed to CBC News on Friday that NACI met this week to discuss revising the AstraZeneca guidelines for those over 65, and said they would likely be updated “in the next few days” as shots continue to roll out across the country for younger age groups.
That decision was based on real-world data from Quebec, B.C., Israel, the U.K. and the U.S. that showed “good effectiveness” of between 70 and 80 per cent from a single dose of the vaccines in preventing severe illness “for up to two months in some studies.”
“People would see a bit of a disconnect,” said Dr. Isaac Bogoch, an infectious diseases physician and member of Ontario’s COVID-19 vaccine task force. “You’ve got to have the trust of the general public.”
Despite some European countries temporarily halting use of the AstraZeneca-Oxford vaccine after 30 cases of blood clots, experts maintain it is still safe to use in Canada. 2:01
Bogoch said NACI needs to be “very careful” with its messaging around vaccination recommendations in an “open, honest and transparent way” with Canadians, in order to avoid eroding trust in vaccines.
“How we word things matters…. If you’re going to make those recommendations, you’ve got to stand up in front of the country and explain why,” he said.
“We’re already getting issues with people who are saying, ‘I’m not going to take the AstraZeneca vaccine, I’m going to wait.’ It’s going to be a challenge.”
Raywat Deonandan, a global health epidemiologist and an associate professor at the University of Ottawa, said the recommendation against the AstraZeneca-Oxford vaccine for seniors sends the “wrong message” to Canadians.
“I’ve got people telling me they don’t want AstraZeneca, so they’ll rather wait until they can get a Pfizer dose,” he said. “We need to get sufficient numbers of doses in the right people so that herd immunity happens and case numbers drop.”
Alyson Kelvin, an assistant professor at Dalhousie University in Halifax and virologist at the Canadian Center for Vaccinology, says there are no safety concerns with AstraZeneca-Oxford for older individuals and that its effectiveness is on par with other vaccines such as Pfizer-BioNTech and Moderna.
Monique Prud’homme, one of the first Albertans to receive the Covishield/AstraZeneca-Oxford vaccine, on Thursday, told Alberta Health Services she is ‘so excited’ and looks forward to someday having her grandchildren stay over, hosting family meals at home, visiting friends and her father. (Alberta Health Services)
“If a vaccine is available to you, it’s really important that you’re taking it,” she said.
And that’s especially true for people over 60, she said.
“This group of individuals makes up about 97 per cent of our COVID-related deaths in Canada, and to keep a vaccine from them … hurts my heart.”
Bogoch said that each of the four vaccines approved in Canada will significantly reduce the risk of hospitalization and death for older Canadians, so it’s important to keep that in context when considering national recommendations.
“We’re in the middle of a public health crisis,” he said. “So the strategy should be to vaccinate as many people over the age of 60 with any of the available vaccines in as short a time frame as possible.”
‘No indication’ AstraZeneca-Oxford vaccine tied to blood clots
Adding to the confusion around the AstraZeneca-Oxford vaccine this week were reports of an undisclosed number of blood clot cases after vaccinations in Europe, which ultimately led Denmark, Norway and Iceland to stop using the vaccine out of an abundance of caution.
Health Canada released a statement Thursday night, more than eight hours after CBC News requested comment, saying “there is no indication that the vaccine caused these events” and the “benefits of the vaccine continue to outweigh its risks.”
The U.K.’s drug regulatory agency said that of the 11 million doses of the AstraZeneca-Oxford vaccine that have been administered, reports of blood clots were no greater than expected in the general public.
WATCH | ‘No cause for alarm’ after Denmark pauses AstraZeneca vaccinations, says doctor:
There’s no reason to be overly worried after Denmark said it was temporarily stopping inoculations with the AstraZeneca COVID-19 vaccine to investigate a small number of blood clots, says infectious disease specialist Dr. Isaac Bogoch. 2:16
Bogoch told CBC News that while it’s important to watch the situation carefully in order to instill confidence in the vaccine’s safety, Canadians have to keep it in context.
“This vaccine has been given to millions and millions of other people globally, including in the United Kingdom,” he said.
“We have not yet heard of any signal amongst the noise for blood clots in any other jurisdiction and there have been other places that have been giving this vaccine for … months.”
Age ‘greatest risk’ factor for COVID-19
Experts say the confusion around vaccine safety recommendations this week is unfortunate, especially given the number of seniors in Canada at risk of severe COVID-19 complications who have yet to be vaccinated.
While long-term care home residents were prioritized in Canada’s vaccine rollout after the first shipments arrived in mid-December, seniors living in the community have only recently been offered a vaccine across much of the country.
“When you actually look at the data about who’s the greatest risk from getting seriously ill and dying from COVID-19, the No. 1 factor is age,” said Dr. Samir Sinha, director of geriatrics for the Sinai Health System and the University Health Network in Toronto.
Carmelo Bolpe, 67, gets his first dose of the Pfizer-BioNTech COVID-19 vaccine at Caboto Terrace in Toronto on Thursday. Nurses from Humber River Hospital were on site as part of an initiative to vaccinate seniors in congregate living settings. (Evan Mitsui/CBC)
Sinha says Canada should have better prioritized community-dwelling seniors in its initial rollout, especially given the significant drop in hospitalizations and deaths among long-term care residents after vaccination.
More than 14,000 long-term care residents have died of COVID-19 in Canada since the pandemic began. Sinha says about 4,000 of those residents were in Ontario, while another 2,000 of the province’s deaths were seniors living in the community.
“We have to remember that, yes, 70 per cent of our deaths in Ontario have been amongst those living in our long-term care retirement homes,” he said. “But another 26 per cent have been among community-dwelling seniors.”
Deonandan says he was “shocked” that age wasn’t more of a priority for initial COVID-19 vaccine rollouts across the country given that it is the single biggest risk factor by far.
“It comes down to, what is the goal that we’re trying to achieve here?” he said.
“The goal should be twofold: to keep the health-care system up and running, and to make the crisis go away, and you get that by focusing on age.”
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NEW YORK (AP) — The U.S. syphilis epidemic slowed dramatically last year, gonorrhea cases fell and chlamydia cases remained below prepandemic levels, according to federal data released Tuesday.
The numbers represented some good news about sexually transmitted diseases, which experienced some alarming increases in past years due to declining condom use, inadequate sex education, and reduced testing and treatment when the COVID-19 pandemic hit.
Last year, cases of the most infectious stages of syphilis fell 10% from the year before — the first substantial decline in more than two decades. Gonorrhea cases dropped 7%, marking a second straight year of decline and bringing the number below what it was in 2019.
“I’m encouraged, and it’s been a long time since I felt that way” about the nation’s epidemic of sexually transmitted infections, said the CDC’s Dr. Jonathan Mermin. “Something is working.”
More than 2.4 million cases of syphilis, gonorrhea and chlamydia were diagnosed and reported last year — 1.6 million cases of chlamydia, 600,000 of gonorrhea, and more than 209,000 of syphilis.
Syphilis is a particular concern. For centuries, it was a common but feared infection that could deform the body and end in death. New cases plummeted in the U.S. starting in the 1940s when infection-fighting antibiotics became widely available, and they trended down for a half century after that. By 2002, however, cases began rising again, with men who have sex with other men being disproportionately affected.
The new report found cases of syphilis in their early, most infectious stages dropped 13% among gay and bisexual men. It was the first such drop since the agency began reporting data for that group in the mid-2000s.
However, there was a 12% increase in the rate of cases of unknown- or later-stage syphilis — a reflection of people infected years ago.
Cases of syphilis in newborns, passed on from infected mothers, also rose. There were nearly 4,000 cases, including 279 stillbirths and infant deaths.
“This means pregnant women are not being tested often enough,” said Dr. Jeffrey Klausner, a professor of medicine at the University of Southern California.
What caused some of the STD trends to improve? Several experts say one contributor is the growing use of an antibiotic as a “morning-after pill.” Studies have shown that taking doxycycline within 72 hours of unprotected sex cuts the risk of developing syphilis, gonorrhea and chlamydia.
In June, the CDC started recommending doxycycline as a morning-after pill, specifically for gay and bisexual men and transgender women who recently had an STD diagnosis. But health departments and organizations in some cities had been giving the pills to people for a couple years.
Some experts believe that the 2022 mpox outbreak — which mainly hit gay and bisexual men — may have had a lingering effect on sexual behavior in 2023, or at least on people’s willingness to get tested when strange sores appeared.
Another factor may have been an increase in the number of health workers testing people for infections, doing contact tracing and connecting people to treatment. Congress gave $1.2 billion to expand the workforce over five years, including $600 million to states, cities and territories that get STD prevention funding from CDC.
Last year had the “most activity with that funding throughout the U.S.,” said David Harvey, executive director of the National Coalition of STD Directors.
However, Congress ended the funds early as a part of last year’s debt ceiling deal, cutting off $400 million. Some people already have lost their jobs, said a spokeswoman for Harvey’s organization.
Still, Harvey said he had reasons for optimism, including the growing use of doxycycline and a push for at-home STD test kits.
Also, there are reasons to think the next presidential administration could get behind STD prevention. In 2019, then-President Donald Trump announced a campaign to “eliminate” the U.S. HIV epidemic by 2030. (Federal health officials later clarified that the actual goal was a huge reduction in new infections — fewer than 3,000 a year.)
There were nearly 32,000 new HIV infections in 2022, the CDC estimates. But a boost in public health funding for HIV could also also help bring down other sexually transmitted infections, experts said.
“When the government puts in resources, puts in money, we see declines in STDs,” Klausner said.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
WASHINGTON (AP) — Scientists can’t know precisely when a volcano is about to erupt, but they can sometimes pick up telltale signs.
That happened two years ago with the world’s largest active volcano. About two months before Mauna Loa spewed rivers of glowing orange molten lava, geologists detected small earthquakes nearby and other signs, and they warned residents on Hawaii‘s Big Island.
Now a study of the volcano’s lava confirms their timeline for when the molten rock below was on the move.
“Volcanoes are tricky because we don’t get to watch directly what’s happening inside – we have to look for other signs,” said Erik Klemetti Gonzalez, a volcano expert at Denison University, who was not involved in the study.
Upswelling ground and increased earthquake activity near the volcano resulted from magma rising from lower levels of Earth’s crust to fill chambers beneath the volcano, said Kendra Lynn, a research geologist at the Hawaiian Volcano Observatory and co-author of a new study in Nature Communications.
When pressure was high enough, the magma broke through brittle surface rock and became lava – and the eruption began in late November 2022. Later, researchers collected samples of volcanic rock for analysis.
The chemical makeup of certain crystals within the lava indicated that around 70 days before the eruption, large quantities of molten rock had moved from around 1.9 miles (3 kilometers) to 3 miles (5 kilometers) under the summit to a mile (2 kilometers) or less beneath, the study found. This matched the timeline the geologists had observed with other signs.
The last time Mauna Loa erupted was in 1984. Most of the U.S. volcanoes that scientists consider to be active are found in Hawaii, Alaska and the West Coast.
Worldwide, around 585 volcanoes are considered active.
Scientists can’t predict eruptions, but they can make a “forecast,” said Ben Andrews, who heads the global volcano program at the Smithsonian Institution and who was not involved in the study.
Andrews compared volcano forecasts to weather forecasts – informed “probabilities” that an event will occur. And better data about the past behavior of specific volcanos can help researchers finetune forecasts of future activity, experts say.
(asterisk)We can look for similar patterns in the future and expect that there’s a higher probability of conditions for an eruption happening,” said Klemetti Gonzalez.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Waymo on Tuesday opened its robotaxi service to anyone who wants a ride around Los Angeles, marking another milestone in the evolution of self-driving car technology since the company began as a secret project at Google 15 years ago.
The expansion comes eight months after Waymo began offering rides in Los Angeles to a limited group of passengers chosen from a waiting list that had ballooned to more than 300,000 people. Now, anyone with the Waymo One smartphone app will be able to request a ride around an 80-square-mile (129-square-kilometer) territory spanning the second largest U.S. city.
After Waymo received approval from California regulators to charge for rides 15 months ago, the company initially chose to launch its operations in San Francisco before offering a limited service in Los Angeles.
Before deciding to compete against conventional ride-hailing pioneers Uber and Lyft in California, Waymo unleashed its robotaxis in Phoenix in 2020 and has been steadily extending the reach of its service in that Arizona city ever since.
Driverless rides are proving to be more than just a novelty. Waymo says it now transports more than 50,000 weekly passengers in its robotaxis, a volume of business numbers that helped the company recently raise $5.6 billion from its corporate parent Alphabet and a list of other investors that included venture capital firm Andreesen Horowitz and financial management firm T. Rowe Price.
“Our service has matured quickly and our riders are embracing the many benefits of fully autonomous driving,” Waymo co-CEO Tekedra Mawakana said in a blog post.
Despite its inroads, Waymo is still believed to be losing money. Although Alphabet doesn’t disclose Waymo’s financial results, the robotaxi is a major part of an “Other Bets” division that had suffered an operating loss of $3.3 billion through the first nine months of this year, down from a setback of $4.2 billion at the same time last year.
But Waymo has come a long way since Google began working on self-driving cars in 2009 as part of project “Chauffeur.” Since its 2016 spinoff from Google, Waymo has established itself as the clear leader in a robotaxi industry that’s getting more congested.
Electric auto pioneer Tesla is aiming to launch a rival “Cybercab” service by 2026, although its CEO Elon Musk said he hopes the company can get the required regulatory clearances to operate in Texas and California by next year.
Tesla’s projected timeline for competing against Waymo has been met with skepticism because Musk has made unfulfilled promises about the company’s self-driving car technology for nearly a decade.
Meanwhile, Waymo’s robotaxis have driven more than 20 million fully autonomous miles and provided more than 2 million rides to passengers without encountering a serious accident that resulted in its operations being sidelined.
That safety record is a stark contrast to one of its early rivals, Cruise, a robotaxi service owned by General Motors. Cruise’s California license was suspended last year after one of its driverless cars in San Francisco dragged a jaywalking pedestrian who had been struck by a different car driven by a human.
Cruise is now trying to rebound by joining forces with Uber to make some of its services available next year in U.S. cities that still haven’t been announced. But Waymo also has forged a similar alliance with Uber to dispatch its robotaxi in Atlanta and Austin, Texas next year.
Another robotaxi service, Amazon’s Zoox, is hoping to begin offering driverless rides to the general public in Las Vegas at some point next year before also launching in San Francisco.
