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.
When Vicente Perez was admitted to a Toronto hospital for suspected COVID-19 on May 2, the first question he asked his family was about Florencia, his wife of 70 years.
“Where is she? I don’t know how to call her,” his granddaughter, Cindy Perez, remembers him saying over the phone. “She doesn’t know where I am.”
His family didn’t have the heart to tell him that she had died just hours before.
Florencia and Vicente lived at home in Toronto with their adult son, who had fallen ill just two weeks earlier from what their family doctor thought was a sinus infection.
The couple in their 80s took care of their son, who had not been instructed to self-quarantine, bringing him food and tea as his condition failed to improve.
But when Florencia came down with a sore throat on April 28, they worried it could be COVID-19.
Her symptoms quickly worsened, and four days later she died in bed next to Vicente.
“It all happened just very quick,” Cindy said. “It went from nothing to all of a sudden symptoms, and she died that Saturday morning.”
Vicente was extremely disoriented when paramedics arrived, and they quickly determined his oxygen levels were low.
He was immediately taken to Humber River Hospital in Toronto, where he tested positive for COVID-19 that night.
“They admitted him into the hospital that very day,” Cindy said. “And what was really, really sad is that because he was already very disoriented, he never knew that my grandma passed.”
Vicente had bone marrow cancer and Parkinson’s disease, and his condition worsened over the following weeks.
He died alone in hospital on May 21.
After seven decades together, Vicente and Florencia passed away just weeks apart.
The stark difference between their deaths is Vicente tested positive for COVID-19 before he died and so was included in Canada’s national case count. But Florencia wasn’t tested, so her death wasn’t reflected.
Canada only records lab-confirmed cases nationally
Canada does not record probable COVID-19 cases and deaths across the country despite international guidelines to do so, and experts say we may never know how many cases have been missed.
The World Health Organization released a set of guidelines in April calling on countries to track both confirmed and suspected cases of COVID-19 as a way to monitor the total impact of the disease worldwide.
“The WHO has issued very clear guidelines that you don’t need a test to be able to diagnose a COVID death,” said Dr. Prabhat Jha, professor of epidemiology at the Dalla Lana School of Public Health at the University of Toronto.
“The bad news is that Canada is too slow in reporting that second type of death.”
Both Ontario and Quebec said in statements to CBC News that the case numbers they release information on are based entirely on lab-confirmed tests. (Evan Mitsui/CBC)
Unlike Canada, countries like New Zealand, Portugal and the U.K. have routinely released information on these probable cases throughout the pandemic.
A spokesperson for the U.K.’s Office for National Statistics told CBC News it records a doctor’s declaration of COVID-19 on a patient’s death certificate, even when a test isn’t available, and that the data could be useful for future research.
But most Canadian provinces haven’t publicly released data on these probable COVID-19 deaths and cases, even separately from the confirmed ones, instead focusing solely on people with positive test results.
A spokesperson for the Public Health Agency of Canada said in a statement to CBC that without a positive test for COVID-19, a probable case does not meet its national surveillance reporting criteria.
That means if someone dies of COVID-19 before testing positive, even when it’s marked as the cause of death on their death certificate, that case isn’t necessarily reflected anywhere in our national numbers.
And that’s exactly what happened to Florencia Perez.
B.C. tracks probable COVID-19 cases, deaths
Ultimately, it’s up to the provinces and territories to decide if they should report those numbers publicly — and at least one does.
British Columbia not only counts probable COVID-19 cases and deaths, but it conducts antibody and post-mortem testing to find those who may have been missed.
“This is something that we felt was important early on to try and get a good sense of the overall impact and who’s been impacted,” B.C.’s Provincial Health Officer Dr. Bonnie Henry said in an interview with CBC.
“That helps us understand deaths in the community that we might not have recognized.”
The BC Centre for Disease Control has made data on probable cases public, while the BC Coroners Service said it has so far identified five additional cases of COVID-19 from people who had been tested after their deaths.
Henry said because there is a lag in processing the death certificate data, it can take several months before those cases can be found.
“That’s our system, unfortunately,” she said. “It’s unfortunately one of those things that we can only look at retrospectively, but we do want to be able to determine the overall impact of COVID on the province.”
WATCH | Dr. Bonnie Henry shares her views on a grim milestone:
‘Each of those people who have been ill reflect the pain on their entire family, their community,’ says B.C.’s provincial health officer. 1:33
Henry said identifying these missing cases may take more time, but it’s important to provide families who have lost loved ones to COVID-19 with an added layer of closure.
“The impact on our seniors and elders has been so profound — particularly people in long-term care,” she said.
“Finding that balance of trying to protect that community but also give people who are in the important final stages of their life the respect and the care that they need — that’s the most challenging part of this whole outbreak for sure.”
Hardest-hit provinces release no data
But in Quebec and Ontario, Canada’s two hardest-hit provinces, this type of surveillance isn’t being publicly recorded.
Both Public Health Ontario and the Quebec Ministry of Health and Social Services said in statements to CBC that the case numbers they release are based entirely on lab-confirmed tests.
Dr. Michael Gardam, an infectious disease specialist and chief of staff at Humber River Hospital, who is a veteran of the SARS and H1N1 outbreaks, said he doesn’t think that approach goes far enough.
“We clearly know there were more cases. This is an underestimate,” he said.
“I just in general would like more transparency from the numbers, more transparency from public health — just put all the information out there.”
Gardam said the daily lab-confirmed case numbers should have a “big asterisk” beside them that indicates “we know there are more cases than that.”
Dr. Bonnie Henry said identifying missing cases may take more time, but it’s important to provide families who have lost loved ones to COVID-19 with an added layer of closure. (Ben Nelms/CBC)
Dr. Michael Warner, medical director of critical care at Michael Garron Hospital in Toronto, has personally diagnosed patients with probable COVID-19 despite negative test results or those that were unable to get tested before dying.
“Unfortunately, many cases I think have already been lost because it was at the beginning of the pandemic when we lost so many patients in long-term care homes, and it’s unclear whether we can go back,” he said.
“It matters to families because they want to know how or why their loved one passed away, and I think we owe it to them.”
Dr. Allison McGeer, an infectious diseases specialist at Toronto’s Mount Sinai Hospital who worked on the front lines of the SARS epidemic in 2003, said one reason the data isn’t recorded is because officials feel the numbers could be taken the wrong way.
“The one thing that public-health people don’t want to do is be seen to be inflating the number of cases,” she said.
“They tend to be conservative because it’s always tempting to accuse them afterwards of inflating numbers and making it look worse.”
Slow reporting systems partially to blame
Tracking these cases through death certificates is also more work for an already slow reporting system, especially in Ontario, which relies on outdated technology like fax machines and the manual reporting of cases.
In response to ongoing criticism, the province announced Thursday it would finally be overhauling its antiquated system of reporting diseases.
But while Ontario may soon be able to track confirmed cases faster, there appears to be no plan for the province or other parts of the country to release data on probable cases and deaths any time soon.
For Cindy Perez, that adds more pain to an already painful situation.
“The fact that she’s not accounted for in the numbers, it’s unfair because she did suffer from the disease,” Cindy said, referring to her grandmother.
“People should know that there have been so many people that have gone unaccounted for that have been victims to this.”
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WINNIPEG – Some 250 coloured tacks pepper a large-scale world map among bookshelves at Whodunit Mystery Bookstore.
Estonia, Finland, Japan and even Fenwick, Ont., have pins representing places outside Winnipeg where someone has ordered a page-turner from the independent bookstore that specializes in mystery and crime fiction novels.
For 30 years, the store has been offering fans of Agatha Christie’s Hercule Poirot or Arthur Conan Doyle’s Sherlock Holmes a place to get lost in whodunits both old and new.
Jack and Wendy Bumsted bought the shop in the Crescentwood neighbourhood in 2007 from another pair of mystery lovers.
The married couple had been longtime customers of the store. Wendy Bumsted grew up reading Perry Mason novels while her husband was a historian with vast knowledge of the crime fiction genre.
At the time, Jack Bumsted was retiring from teaching at the University of Manitoba when he was looking for his next venture.
“The bookstore came up and we bought it, I think, within a week,” Wendy Bumsted said in an interview.
“It never didn’t seem like a good idea.”
In the years since the Bumsteds took ownership, the family has witnessed the decline in mail-order books, the introduction of online retailers, a relocation to a new space next to the original, a pandemic and the death of beloved co-owner Jack Bumsted in 2020.
But with all the changes that come with owning a small business, customers continue to trust their next mystery fix will come from one of the shelves at Whodunit.
Many still request to be called about books from specific authors, or want to be notified if a new book follows their favourite format. Some arrive at the shop like clockwork each week hoping to get suggestions from Wendy Bumsted or her son on the next big hit.
“She has really excellent instincts on what we should be getting and what we should be promoting,” Micheal Bumsted said of his mother.
Wendy Bumsted suggested the store stock “Thursday Murder Club,” the debut novel from British television host Richard Osman, before it became a bestseller. They ordered more copies than other bookstores in Canada knowing it had the potential to be a hit, said Michael Bumsted.
The store houses more than 18,000 new and used novels. That’s not including the boxes of books that sit in Wendy Bumsted’s tiny office, or the packages that take up space on some of the only available seating there, waiting to be added to the inventory.
Just as the genre has evolved, so has the Bumsteds’ willingness to welcome other subjects on their shelves — despite some pushback from loyal customers and initially the Bumsted patriarch.
For years, Jack Bumsted refused to sell anything outside the crime fiction genre, including his own published books. Instead, he would send potential buyers to another store, but would offer to sign the books if they came back with them.
Wendy Bumsted said that eventually changed in his later years.
Now, about 15 per cent of the store’s stock is of other genres, such as romance or children’s books.
The COVID-19 pandemic forced them to look at expanding their selection, as some customers turned to buying books through the store’s website, which is set up to allow purchasers to get anything from the publishers the Bumsteds have contracts with.
In 2019, the store sold fewer than 100 books online. That number jumped to more than 3,000 in 2020, as retailers had to deal with pandemic lockdowns.
After years of running a successful mail-order business, the store was able to quickly adapt when it had to temporarily shut its doors, said Michael Bumsted.
“We were not a store…that had to figure out how to get books to people when they weren’t here.”
He added being a community bookstore with a niche has helped the family stay in business when other retailers have struggled. Part of that has included building lasting relationships.
“Some people have put it in their wills that their books will come to us,” said Wendy Bumsted.
Some of those collections have included tips on traveling through Asia in the early 2000s or the history of Australian cricket.
Micheal Bumsted said they’ve had to learn to be patient with selling some of these more obscure titles, but eventually the time comes for them to find a new home.
“One of the great things about physical books is that they can be there for you when you are ready for them.”
This report by The Canadian Press was first published on Sept. 15, 2024.
MONTREAL – Canada’s labour minister is praising both Air Canada and the union representing about 5,200 of its pilots for averting a work stoppage that would have disrupted travel for hundreds of thousands of passengers.
Steven MacKinnon’s comments came in a statement shared to social media shortly after Canada’s largest air carrier announced it had reached a tentative labour deal with the Air Line Pilots Association.
MacKinnon thanked both sides and federal mediators, saying the airline and its pilots approached negotiations with “seriousness and a resolve to get a deal.”
The tentative agreement averts a strike or lockout that could have begun as early as Wednesday for Air Canada and Air Canada Rouge, with flight cancellations expected before then.
The airline now says flights will continue as normal while union members vote on the tentative four-year contract.
Air Canada had called on the federal government to intervene in the dispute, but Prime Minister Justin Trudeau said Friday that would only happen if it became clear no negotiated agreement was possible.
This report from The Canadian Press was first published Sept. 15, 2024.
When it comes to plant-based alternatives, Canadians have never had so many options — and nowhere is that choice more abundantly clear than in the milk section of the dairy aisle.
To meet growing demand, companies are investing in new products and technology to keep up with consumer tastes and differentiate themselves from all the other players on the shelf.
“The product mix has just expanded so fast,” said Liza Amlani, co-founder of the Retail Strategy Group.
She said younger generations in particular are driving growth in the plant-based market as they are consuming less dairy and meat.
Commercial sales of dairy milk have been weakening for years, according to research firm Mintel, likely in part because of the rise of plant-based alternatives — even though many Canadians still drink dairy.
The No. 1 reason people opt for plant-based milk is because they see it as healthier than dairy, said Joel Gregoire, Mintel’s associate director for food and drink.
“Plant-based milk, the one thing about it — it’s not new. It’s been around for quite some time. It’s pretty established,” said Gregoire.
Because of that, it serves as an “entry point” for many consumers interested in plant-based alternatives to animal products, he said.
Plant-based milk consumption is expected to continue growing in the coming years, according to Mintel research, with more options available than ever and more consumers opting for a diet that includes both dairy and non-dairy milk.
A 2023 report by Ernst & Young for Protein Industries Canada projected that the plant-based dairy market will reach US$51.3 billion in 2035, at a compound annual growth rate of 9.5 per cent.
Because of this growth opportunity, even well-established dairy or plant-based companies are stepping up their game.
It’s been more than three decades since Saint-Hyacinthe, Que.-based Natura first launched a line of soy beverages. Over the years, the company has rolled out new products to meet rising demand, and earlier this year launched a line of oat beverages that it says are the only ones with a stamp of approval from Celiac Canada.
Competition is tough, said owner and founder Nick Feldman — especially from large American brands, which have the money to ensure their products hit shelves across the country.
Natura has kept growing, though, with a focus on using organic ingredients and localized production from raw materials.
“We’re maybe not appealing to the mass market, but we’re appealing to the natural consumer, to the organic consumer,” Feldman said.
Amlani said brands are increasingly advertising the simplicity of their ingredient lists. She’s also noticing more companies offering different kinds of products, such as coffee creamers.
Companies are also looking to stand out through eye-catching packaging and marketing, added Amlani, and by competing on price.
Besides all the companies competing for shelf space, there are many different kinds of plant-based milk consumers can choose from, such as almond, soy, oat, rice, hazelnut, macadamia, pea, coconut and hemp.
However, one alternative in particular has enjoyed a recent, rapid ascendance in popularity.
“I would say oat is the big up-and-coming product,” said Feldman.
Mintel’s report found the share of Canadians who say they buy oat milk has quadrupled between 2019 and 2023 (though almond is still the most popular).
“There seems to be a very nice marriage of coffee and oat milk,” said Feldman. “The flavour combination is excellent, better than any other non-dairy alternative.”
The beverage’s surge in popularity in cafés is a big part of why it’s ascending so quickly, said Gregoire — its texture and ability to froth makes it a good alternative for lattes and cappuccinos.
It’s also a good example of companies making a strong “use case” for yet another new entrant in a competitive market, he said.
Amid the long-standing brands and new entrants, there’s another — perhaps unexpected — group of players that has been increasingly investing in plant-based milk alternatives: dairy companies.
For example, Danone has owned the Silk and So Delicious brands since an acquisition in 2014, and long-standing U.S. dairy company HP Hood LLC launched Planet Oat in 2018.
Lactalis Canada also recently converted its facility in Sudbury, Ont., to manufacture its new plant-based Enjoy! brand, with beverages made from oats, almonds and hazelnuts.
“As an organization, we obviously follow consumer trends, and have seen the amount of interest in plant-based products, particularly fluid beverages,” said Mark Taylor, president and CEO of Lactalis Canada, whose parent company Lactalis is the largest dairy products company in the world.
The facility was a milk processing plant for six decades, until Lactalis Canada began renovating it in 2022. It now manufactures not only the new brand, but also the company’s existing Sensational Soy brand, and is the company’s first dedicated plant-based facility.
“We’re predominantly a dairy company, and we’ll always predominantly be a dairy company, but we see these products as complementary,” said Taylor.
It makes sense that major dairy companies want to get in on plant-based milk, said Gregoire. The dairy business is large — a “cash cow,” if you will — but not really growing, while plant-based products are seeing a boom.
“If I’m looking for avenues of growth, I don’t want to be left behind,” he said.
Gregoire said there’s a potential for consumers to get confused with so many options, which is why it’s so important for brands to find a way to differentiate themselves, whether it’s with taste, health, or how well the drink froths for a latte.
Competition in a more crowded market is challenging, but Taylor believes it results in better products for consumers.
“It keeps you sharp, and it forces you to be really good at what you’re doing. It drives innovation,” he said.
This report by The Canadian Press was first published Sept. 15, 2024.
