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COVID data void in Canada could hamper understanding of lingering impact: experts

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VANCOUVER — A lack of data tracking Canadians who have had COVID-19 could hinder efforts to understand potential post-infection conditions, such as diabetes and brain fog, experts have warned.

They say the impact of the pandemic on Canadian health systems and society could linger for years but preparing for this is challenged by the data void.

Dr. Kashif Pirzada, an emergency physician at Toronto’s Humber River Hospital, said reliance on at-home rapid testing for COVID-19 is a major hurdle in data collection.

“They’re not centrally tracked and there are very few resources available to these patients,” he said, even though COVID-19 seemed to cause diabetes, brain fog or other conditions “very frequently.”

“If five or 10 per cent of our population becomes disabled, which is some of the rates we’re looking at, that’s going to be a huge issue for our workforce, for overall health,” said Pirzada, who is also an assistant clinical professor at McMaster University.

Dr. Akshay Jain, an endocrinologist in Surrey, B.C., said Canada “might be seeing an avalanche of diabetes cases coming out of the COVID pandemic.”

But Jain said that as far as he knows, Health Canada is not collecting data on the after-effects of COVID-19.

People with mild symptoms often failed to follow up with their doctors, worsening the data situation, said Jain, who also highlighted the reliance on home testing as problematic.

“I just feel that the health-care system as well as the public needs to know about both the immediate short-term as well as the long-term effects of COVID,” Jain said.

“You know, the repercussions of the pandemic will stay with us for many more years. So, I think we need to be cognizant of this and watch out for conditions like diabetes and complications that arise as a result.”

Asked whether and how it was tracking post-COVID-19 conditions and people who had had the illness, Health Canada provided a series of links to information about vaccination, and a daily update of new cases.

“Health systems are the responsibility of each province and territory,” it said.

Jain said studies in the United States and Germany show the risk of developing diabetes is about 46 per cent higher for those who have had COVID-19 compared with those who haven’t been infected.

It’s not clear why people with COVID-19 are developing diabetes, said Jain.

One theory is that COVID-19 causes a “tsunami of inflammation,” which increases insulin resistance, he said, while another is that steroids used to treat severe COVID-19 might lead to diabetes.

About nine per cent of Canadian adults have been diagnosed with diabetes, Jain said. But pre-diabetes and undiagnosed diabetes push the figure to nearly 30 per cent, he said.

“This is already a very high number and then throwing COVID in the mix, these numbers are probably going to go up even higher.”

In October 2020, Madhu Rao of Toronto tested positive for COVID-19. Eighteen months later he said he still “felt breathless every now and then.”

Rao said he worried it was something to do with his heart, because he read COVID-19 was causing cardiac problems.

A checkup revealed instead that he was a “borderline diabetic” with high blood glucose levels, said Rao.

He said he had no issues with his blood sugar before getting COVID-19 and described himself as otherwise healthy and active with weight in the normal range.

His doctor told him that she was seeing a lot of patients with high blood sugar levels and some developing diabetes after COVID-19, and put him on a strict diet, he said.

“She told me all I can do is to keep postponing its onset.”

A November 2020 study in the journal Diabetes, Obesity and Metabolism said 14.4 per cent of COVID-19 patients had been diagnosed with diabetes.

“Recent reports have shown that newly diagnosed diabetes may confer a greater risk for poor prognosis of COVID-19 than no diabetes or pre-existing diabetes,” it said.

“Therefore, COVID-19 patients with newly diagnosed diabetes should be managed early and appropriately and closely monitored for the emergence of full-blown diabetes and other cardiometabolic disorders in the long term.”

Jain said he agreed, and “everyone with mild COVID” should talk to a doctor about whether they should be screened for diabetes.

Another condition commonly associated with COVID-19 is the sense of confusion known as brain fog. An analysis of several studies on the issue in the Journal of the Neurological Sciences in March said up to 32 per cent of patients reported brain fog about three months after getting COVID-19.

Prof. Teresa Liu-Ambrose, the Canada Research Chair at the University of British Columbia’s Djavad Mowafaghian Centre for Brain Health, said there isn’t enough data to know how many Canadians have been affected by the condition, how permanent it is, and what the symptoms and consequences are.

Liu-Ambrose said the Canadian Longitudinal Study on Aging, a long-term countrywide research project, is imaging subjects’ brains and assessing their cognition over the next three years to identify differences between people who had COVID-19 and those who had not.

However, she said memory fog was largely a subjective complaint, so quantifying it could be challenging.

Dr. Jurgen Maslany of Saskatchewan tested positive for COVID-19 in March, then went back to work about two weeks after he thought he had fully recovered.

But after attending a patient he couldn’t remember the details of what they had discussed, and he realized “something was off”.

“And so, I immediately took myself off work because it wasn’t safe,” Maslany said.

There was also a sense of anxiety, although he wasn’t sure if this was a symptom of brain fog or worrying about it.

“It felt like something was just sort of chemically off in my head,” he said.

It took about three weeks for the symptoms to plateau, and now he feels back to normal, he said.

But Liu-Ambrose said no one knows what will happen if brain fog is left untreated.

“Any long-term impact of COVID-19 on the brain and our cognition can be significant,” Liu-Ambrose said.

“These changes could potentially be related or predictive of future decline or dementia risk. We don’t know — but there certainly is that possibility if these subjective complaints are reflective of actual changes in the brain.

“It’s an emerging area that needs to be addressed and needs to be studied to a greater extent.”

Even a modest risk of post-COVID conditions could add up to a substantial burden on health care, given a high number of COVID cases.

Jain, the diabetes expert, said American data showed an additional 18 cases of diabetes per 1,000 people if they had COVID-19.

That could translate into “thousands more Canadians at the risk of developing Type 2 diabetes,” he said, requiring closer monitoring for diabetic complications including heart attack, stroke, kidney damage and vision loss.

“If we look at the entire picture together, we’re looking at a huge burden on the Canadian health care system that we haven’t yet acknowledged but it’s just waiting to happen.”

As for former COVID-19 sufferer, Rao said, it’s probably a good idea to pay attention to every single symptom after getting the illness.

“Had I just ignored it as getting tired physically or something, I wouldn’t have found out that my blood sugar levels are rising.”

Maslany, speaking both as a doctor and a person who experienced the lingering after-effects of COVID-19, said it was “critically important to keep on top” of complications of this disease.

“I am not confident that we’re going to be able to find certain therapeutic options, especially in the short term, but I think it’s important to collect the data,” he said.

“First of all, you can’t analyze and fix a problem unless you have all the proper data.”

This report by The Canadian Press was first published June 4, 2022.

 

Hina Alam, The Canadian Press

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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