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Why doctors say we need to cast a wider net for COVID-19 in Canada – CBC.ca

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This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar 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 first case of coronavirus not linked to travel suggests we need to expand our surveillance systems to prevent an explosion of new cases, infectious disease experts say.

The latest case of COVID-19 in British Columbia, a woman in her 50s who has no recent travel history to affected regions worldwide or contact with infected individuals, signals a shift in the spread of the virus in Canada. 

“There’s likely at least one other person out there who has this disease or had this disease, and we need to find them,” B.C. provincial health officer Dr. Bonnie Henry said Thursday.

Dr. Isaac Bogoch, an infectious disease physician at Toronto General Hospital, said this means there could be more cases in the province that are likely being missed by current screening measures. 

“There is some degree of transmission in B.C.,” he said. “We don’t know the size and scale of it, but it’s definitely there and the goal for surveillance systems would be to help shed light on what the degree of community transmission is.” 

B.C.’s provincial health officer, Dr. Bonnie Henry, said health officials are looking for at least one other person in the community who has or had the illness. (Ben Nelms/CBC)

Bogoch said Friday that while it’s been important to have systems in place to screen for patients travelling from affected regions, the concern now is how sensitive those systems are at picking up new cases in the community. 

“Clearly something is happening under the radar of the surveillance system,” he said. 

“It doesn’t mean the surveillance system is bad, it just means that there might be low levels of transmission or the surveillance system has not cast a wide enough net yet.” 

Currently, most health-care workers in Canada are screening only people who show up with flu-like symptoms such as fever and dry cough and say they’ve travelled to any of seven places  — China, Japan, Hong Kong, Italy, Iran, Singapore and South Korea.

An ambulance transports a patient from the Life Care Center of Kirkland, the long-term care facility linked to confirmed coronavirus cases in Washington state. (David Ryder/Reuters)

“We’ve been looking for people coming into the country with it; we have not been doing widespread community screening,” said Dr. Michael Gardam, an infectious disease specialist at Humber River Hospital in Toronto. 

“But, with the announcement from British Columbia, obviously that is going to continue to ramp up.” 

U.S. case a concern for Canada

Given B.C.’s proximity to Washington state, provincial health officials are working closely with their U.S. counterparts. 

Henry, the provincial medical officer of health, said one of the eight new cases in B.C. is a resident of Seattle who was visiting relatives in the Fraser Health region when she tested positive. 

“Clearly that is of concern with us,” she said. 

But part of what Henry calls the “disease detective work” to trace where the visitor may have contracted COVID-19 south of the border also depends on decoding the genetic sequence of the virus from Washington state’s “patient zero” — the initial patient. 

The traditional public-health approach relies on finding cases by interviewing someone who is infected and tracing those they’ve been in close contact with. Now, scientists also use genetic fingerprinting of the virus to complement efforts to find and isolate patients quickly. 

“If all community-based transmission can be traced back to a patient zero early on in an outbreak, that’s usually a good sign,” said Matthew Miller, who studies viruses and the immune responses to them at McMaster University in Hamilton, Ont.

The problem is that once the virus is spreading without a clear link to the source of the disease, tracking patient zero becomes less useful for containment purposes.

Canada isn’t there yet, Miller said, which is why community surveillance for COVID-19 takes on more importance right now. That’s why some hospitals across the country are moving toward testing all patients with flu-like symptoms.

Bogoch said expanding the list of countries to screen travellers from would be ineffective compared to community screening, because the list of places will become unmanageable. 

“It’s just going to be an extreme challenge to be able to detect all the imported cases,” he said. 

“At which point we’re just going to see more and more community-acquired cases in Canada.” 

WATCH | WHO chief worries ‘lean and mean’ hospitals lack ability to deal with emergencies

WHO director-general Tedros Adhanom Ghebreyesus says hospitals in wealthy nations try to operate efficiently, which could mean they don’t have enough capacity to deal with emergencies such as the COVID-19 outbreak. 1:48

Dr. Jerome Leis, medical director of infection prevention and control at Toronto’s Sunnybrook Hospital, led a study in the Canadian Medical Association Journal Friday on what the early Canadian experience screening for COVID-19 shows us about how to prepare for a pandemic.

Leis said curbing community spread limits the number of infections and reduces the proportion of patients who fall critically ill.

“Hospitals throughout Ontario have stepped up the surveillance … and so we’re testing individuals that have not travelled,” Leis said. “I think we should be stepping it up further.”

In the event of a pandemic with widespread community spread, it’s “simply not feasible, nor is it safe,” to test everyone, he said. 

“It will lead to overcrowding of hospitals and emergency departments,” he added. “That could just further increase the risk of exposure as people are diverted to hallways and have long wait times to be seen.”

Instead, Leis recommends building capacity both in hospitals for those who are critically ill with COVID-19 as well as in the community for the majority who have mild illness. 

“Hospitals are not the best place to be assessed and tested for COVID-19,” said Leis. 

“We really need to be changing the conversation from a hospital-driven model for people that are concerned about COVID-19, to one that is better supported in the community for the people who don’t need hospitalizations.” 


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With grief lingering, Blue Jackets GM Waddell places focus on hockey in wake of Gaudreau’s death

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BUFFALO, N.Y. (AP) — Hearing the familiar sounds of clacking sticks and pucks banging off the boards and glass while watching Columbus Blue Jackets prospects from the stands of a cold rink on a warm late-summer afternoon was not enough to wash away the lingering residuals of grief for Don Waddell on Saturday.

That, the Blue Jackets’ general manager acknowledged, will take more time than anyone can guess — weeks, months, perhaps an entire season and beyond.

What mattered is how spending the weekend attending the Sabres Prospects Challenge represented a start to what Waddell called among the first steps in refocusing on hockey and the future in the aftermath of the deaths of Columbus star Johnny Gaudreau and his brother, Matthew, who were struck by a suspected drunken driver while riding bicycles on Aug 29.

“We got to play hockey,” Waddell said. “We’re not going to forget about Johnny and his family, the Gaudreau family.”

He then reflected on the speech Johnny Gaudreau’s wife, Meredith, made during the brothers’ funeral on Monday, by urging those in mourning to move forward as she will while focusing on raising their children.

“Everybody knows that Johnny wants them to play hockey,” Waddell said. “And everybody’s rallying around that.”

The resumption of hockey in Columbus began last week, when most Blue Jackets players returned to their facility to be together and lean on each other at the urging of Waddell and team captain Boone Jenner. And it will continue on Thursday, when the team opens training camp, exactly three weeks since the Gaudreaus were killed.

“Tragic. Senseless. But now we got to focus on trying to get our team ready to play hockey this year,” Waddell said. “We all mourn and heal differently, but I think as a team being together like that is going to be critical for them to get moving forward.”

Tragedy is no stranger to Waddell or the Blue Jackets.

Waddell was general manager of the then-Atlanta Thrashers in 2003 when Dany Heatley lost control of his car and struck a wall, with the crash killing passenger and teammate Dan Snyder. In 2021, Blue Jackets goalie Matiss Kivlenieks died during a July Fourth fireworks accident.

Waddell placed the emphasis on himself and coach Dean Evason — both newcomers to Columbus this offseason — to guide the team through what will be an emotional season.

“Now, do I think there’s going to be some dark days? I won’t be surprised,” Waddell said.

Reminders of the Gaudreaus’ deaths remain apparent, and reflected in Buffalo on Friday night. A moment of silence was held in tribute to the brothers before the opening faceoff of a game between the Blue Jackets and Sabres.

Afterward, Columbus prospect Gavin Brindley recalled the times he spent with Johnny Gaudreau in Columbus and as teammates representing the United States at the world hockey championships in the Czech Republic in May.

“He was one of the biggest mentors for me at the world championships,” Brindley said. “I couldn’t tell you how many times we hung out with Meredith, pictures on my phone. It’s just so hard to look back and see that kind of stuff.”

The NHL and NHL Players’ Association are providing the Blue Jackets help in the form of grief counseling, crowd security at vigils and addressing hockey issues, such as potentially altering the league’s salary cap rules to provide Columbus relief from having to reach the NHL minimum payroll because of the void left by Gaudreau’s contract.

“The Blue Jackets, I don’t think anybody’s focused from an organizational standpoint, from a hockey standpoint as to what comes next, because I think everybody’s still in shock,” NHL Commissioner Gary Bettman told The Associated Press last week. “I don’t think anybody’s focused right now other than on the grieving part, which is understandable.”

Much of the burden has fallen to Waddell, who has been in discussions with the NHL and the NHLPA and dealing with outreach programs with the Blue Jackets’ partner OhioHealth, while also overseeing preparations for training camp and gauging his prospects in Buffalo.

There’s also his roster to attend to, which he said has two openings at forward, one involving Justin Danforth, who may miss the start of the season because of a wrist injury. Waddell didn’t have to mention the second opening.

Tiring and emotional as it’s been, Waddell found comfort being in his element, a rink, and looking ahead to the start of training camp.

“The guys are in really good shape. We’ve done a lot of testing already and they’re eager to get going,” Waddell said. “We have a reason to play for. And we’ll make the best of it.”

The Blue Jackets later Sunday signed veteran winger James van Riemsdyk to a one-year contract worth $900,000.

“James van Riemsdyk has been a very consistent, productive player throughout his career,” Waddell said. “Bringing him to Columbus will not only provide depth to our group up front, but also valuable leadership and another veteran presence in our dressing room.”

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AP Hockey Writer Stephen Whyno in New York contributed to this report.

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PSG says defender Nuno Mendes target of racial abuse after a French league game

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PARIS (AP) — Paris Saint-Germain defender Nuno Mendes was the target of abusive and racist comments on social media after a French league game.

The club condemned the abuse and expressed its “full support” Sunday for the Portugal left back, who was targeted following PSG’s 3-1 win against Brest on Saturday.

Mendes, who is Black, shared on his Instagram account a racist message he received.

During the match, Mendes brought down Ludovic Ajorque in the box for a penalty that Romain Del Castillo converted to give Brest the lead.

“Paris Saint-Germain doesn’t tolerate racism, antisemitism or any other form of discrimination,” the club said. “The racial insults directed at Nuno Mendes are totally unacceptable … we are working with the relevant authorities and associations to ensure those responsible are held accountable for their actions.”

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Slovenia’s Tadej Pogacar wins Grand Prix Cycliste de Montreal

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MONTREAL – Tadej Pogacar was so dominant on Sunday, Canada’s Michael Woods called it a race for second.

Pogacar, a three-time Tour de France champion from Slovenia, pedalled to a resounding victory at the Grand Prix Cycliste de Montreal.

The UAE Team Emirates leader crossed the finish line 24 seconds ahead of Spain’s Pello Bilbao of Bahrain — Victorious to win the demanding 209.1-kilometre race on a sunny, 28 C day in Montreal. France’s Julian Alaphilippe of Soudal Quick-Step was third.

“He’s the greatest rider of all time, he’s a formidable opponent,” said Woods, who finished 45 seconds behind the leader in eighth. “If you’re not at your very, very best, then you can forget racing with him, and today was kind of representative of that.

“He’s at such a different level that if you follow him, it can be lights out.”

Pogacar slowed down before the last turn to celebrate with the crowd, high-five fans on Avenue du Parc and cruise past the finish line with his arms in the air after more than five hours on the bike.

The 25-year-old joined Belgium’s Greg Van Avermaet as the only multi-time winners in Montreal after claiming the race in 2022. He also redeemed a seventh-place finish at the Quebec City Grand Prix on Friday.

“I was disappointed, because I had such good legs that I didn’t do better than seventh,” Pogacar said. “To bounce back after seventh to victory here, it’s just an incredible feeling.”

It’s Pogacar’s latest win in a dominant year that includes victories at the Tour de France and Giro d’Italia.

Ottawa’s Woods (Israel Premier-Tech) tied a career-best in front of the home crowd in Montreal, but hoped for more after claiming a stage at the Spanish Vuelta two weeks ago.

“I wanted a better result,” the 37-year-old rider said. “My goal was a podium, but at the same time I’m happy with the performance. In bike racing, you can’t always get the result you want and I felt like I raced really well, I animated the race, I felt like I was up there.”

Pogacar completed the 17 climbs up and down Mount Royal near downtown in five hours 28 minutes 15 seconds.

He made his move with 23.3 kilometres to go, leaving the peloton in his dust as he pedalled into the lead — one he never relinquished.

Bilbao, Alaphilippe, Alex Aranburu (Movistar Team) and Bart Lemmen (Visma–Lease) chased in a group behind him, with Bilbao ultimately separating himself from the pack. But he never came close to catching Pogacar, who built a 35-second lead with one lap left to go.

“It was still a really hard race today, but the team was on point,” Pogacar said. “We did really how we planned, and the race situation was good for us. We make it hard in the last final laps, and they set me up for a (takeover) two laps to go, and it was all perfect.”

Ottawa’s Derek Gee, who placed ninth in this year’s Tour de France, finished 48th in Montreal, and called it a “hard day” in the heat.

“I think everyone knows when you see Tadej on the start line that it’s just going to be full gas,” Gee said.

Israel Premier-Tech teammate Hugo Houle of Sainte-Perpétue, Que., was 51st.

Houle said he heard Pogacar inform his teammates on the radio that he was ready to attack with two laps left in the race.

“I said then, well, clearly it’s over for me,” Houle said. “You see, cycling isn’t that complicated.”

Australia’s Michael Matthews won the Quebec City GP for a record third time on Friday, but did not finish in Montreal. The two races are the only North American events on the UCI World Tour.

Michael Leonard of Oakville, Ont., and Gil Gelders and Dries De Bondt of Belgium broke away from the peloton during the second lap. Leonard led the majority of the race before losing pace with 45 kilometres to go.

Only 89 of 169 riders from 24 teams — including the Canadian national team — completed the gruelling race that features 4,573 metres in total altitude.

Next up, the riders will head to the world championships in Zurich, Switzerland from Sept. 21 to 29.

Pogacar will try to join Eddy Merckx (1974) and Stephen Roche (1987) as the only men to win three major titles in a season — known as the Triple Crown.

“Today gave me a lot of confidence, motivation,” Pogacar said. “I think we are ready for world championships.”

This report by The Canadian Press was first published Sept. 15, 2024.



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