Health officials in the United States this week cut COVID-19 isolation restrictions for asymptomatic Americans from 10 to five days, leading some Canadians to wonder whether similar recommendations could be adopted here.
The Centers for Disease Control and Prevention said its new guidance is in keeping with evidence that people with COVID-19 are most infectious in the two days before and three days after symptoms develop.
While some experts say the move is necessary to curb strain on hospitals as more and more staff become infected or exposed to the highly transmissible Omicron variant, others argue the approach is flawed, and “fraught with danger.”
“If somebody tested positive and a few days later … you had to sit next to them on the subway, how would you feel?” said Raywat Deonandan, an epidemiologist with the University of Ottawa.
“A certain number of days is not sufficient (when) we’re looking for indication of non-infectious status.”
Dr. Zain Chagla, an infectious disease expert with McMaster University, said the CDC guidance is meant to avoid “secondary consequences” of having large numbers of essential workers isolating for 10 days.
Halving recommendations for isolation and quarantine isn’t the perfect solution, Chagla said, noting the infectious period with COVID-19 “is not set in stone.” But the move is realistic, he added.
“The reality of the situation is we have to be a little bit pragmatic about what’s coming and the number of people that will be infected or exposed to COVID-19,” he said.
How likely is Canada to adopt similar guidelines?
The Public Health Agency of Canada said in an email Wednesday it was aware of the new CDC guidance, adding it would “inform Canadians should there be an update to (Canada’s) recommendations in the future.”
Quebec said Tuesday certain health workers who have tested positive for COVID-19 will be allowed to stay on the job — on a case-by-case basis — a move the province said is necessary to keep the health-care system operational.
Alberta Premier Jason Kenney said Tuesday there was no immediate plan to follow Quebec’s decision.
Manitoba said Monday it may consider similar recommendations if there is further strain on its health system while Ontario said it’s also contemplating shortening isolation and quarantine.
Cynthia Carr, an epidemiologist in Winnipeg, said whatever guidance provinces adopt should focus on symptoms rather than the calendar to determine when to drop isolation measures.
“You don’t just lock in on the five days, you lock in on how you’re feeling,” she said. “If you have any symptoms at all that is absolutely the most important factor, even if guidelines were to change in Canada.”
What’s the science behind the CDC guidelines?
The CDC website says the change is “motivated by science” of when transmission is most likely to occur.
The reduced isolation is meant only for those who are asymptomatic after five days, the agency says, adding it should also be followed by five days of wearing a mask in public.
Deonandan said the guidance is based on pre-Omicron data, however, and the contagious period of the new variant could differ from previous strains. The window of contagiousness will also vary from person to person, he added.
“That’s worrying,” Deonandan said. “It’s entirely possible that many cases will not be experiencing the average number of days of infectiousness.”
Carr said it’s still unknown whether the period of infectiousness changes with Omicron, but a person’s own degree of contagiousness depends on factors including their immune system.
She added the incubation period with Omicron — the time between infection and symptom-onset — appears to be shorter than previous strains.
“That would stand to reason that your infectious period is very close to the point at which you are infected,” she said.
How do you know if you’re no longer contagious?
Deonandan said one of the biggest flaws with the CDC’s guidelines is that it doesn’t require a negative test at the five-day mark, adding the best way to determine whether the virus is still present and potentially transmissible is through repeated testing.
But what if you don’t have access to multiple tests?
During times when supply is low, Deonandan said rapid tests may need to be reserved for health-care workers to ensure they can safely return to work after an infection.
Carr said the CDC’s argument for shortened isolation stems from their data, which suggests 85 to 90 per cent of transmission happens in that five-day time period. But since asymptomatic people can’t be sure they’ve cleared the virus without a test, they should still rely on risk-mitigation strategies, including wearing a tight-fitting mask in public.
Those who have symptoms at the five-day mark shouldn’t end their isolation, she added.
What do you do if you think you have COVID-19?
Securing a timely appointment for a PCR test is becoming more difficult with many jurisdictions reaching testing capacity, and health experts warn daily case counts are likely much higher than what’s being reported.
Health Canada’s website says people should contact their “local health authority” for advice about testing if they think they have COVID-19 or have been exposed to someone who recently tested positive.
Some provinces are starting to rely more heavily on rapid tests to help alleviate strain on testing centres.
Manitoba this week said it would make take-home, self-administered rapid tests available at provincial testing sites and only ask people to return for a PCR if their take-home test is positive.
Is Omicron producing a more mild illness?
Early research suggests omicron may cause milder illnesses than earlier versions of the virus. But the sheer number of people becoming infected threatens to crush hospital capacity, experts say.
Carr said early data on Omicron stemmed from cases in mostly younger populations who weren’t at risk for hospitalization, and more data is needed before scientists can definitively say the variant is less severe.
She noted that even a 40 to 60 per cent reduction in hospitalization with Omicron could be negated by the sheer transmissibility of the variant.
“The reduction in risk might not be enough to account for the escalation in cases,” Carr said.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
