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A coronavirus outbreak could be devastating for poorer countries – CNN

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The flu-like respiratory illness is highly contagious and the outbreak has overwhelmed hospitals in the Chinese city of Wuhan, where it was first identified. Chinese authorities have shut down entire cities, suspended public transport and closed schools, businesses and factories in an effort to contain it.
“Our greatest concern is the potential for the virus to spread to countries with weaker health systems and which are ill-prepared to deal with it,” said WHO director general Tedros Adhanom Ghebreyesus, when he announced the decision on January 30.
Since then, the number of confirmed cases reported in mainland China has more than quadrupled to more than 44,653. As of Wednesday morning, more than 1,100 people had died from the virus, while 4,740 patients had recovered and been discharged from hospital.
The virus has spread across Asia and into Europe and the United States, with more than 500 confirmed cases in over two dozen countries and territories, with just two deaths outside mainland China.
While the majority of cases outside of mainland China have so far been connected to travelers from China, or those who have have recently been there, a small but growing number of patients have caught the virus locally.
That’s worrying, because if self-sustaining outbreaks start occurring in nations with poor healthcare systems, the impact could be devastating.
“It’s an enormous concern,” said Jeremy Konyndyk, senior policy fellow at the Center for Global Development.
“We still don’t have a clear picture of how likely that is, but given transmissions dynamics in China and the speed with which cases have emerged in other countries, global spread seems highly plausible.”

If China is struggling, how will other nations cope?

China is ranked 51st out of 195 countries globally for its outbreak readiness, according to the Global Health Security Index. That’s not on par with the wealthiest countries in the world, but far higher than many low-income nations.
Authorities in China have suspended public transport and sealed off entire cities at the epicenter of the outbreak, effectively putting 60 million people on lockdown. They’ve built two new hospitals in less than two weeks, and dispatched thousands of medical workers to Wuhan.
Yet despite these unprecedented efforts, the country is struggling to keep the rapidly expanding outbreak under control.
First-hand accounts from medical staff and patients in Wuhan show China’s already overburdened health system is on its knees. Hospitals, overwhelmed with the sick, are running out of beds and supplies. Exhausted doctors and nurses are risking their lives and becoming infected with the virus themselves.
People have spoken of sick family members turned away from hospitals, delays in testing and wards packed with feverish patients and limited screening or quarantine.
“If China is struggling to contain this, weaker countries will have an even harder time. And that suggests that the kind of transmission we’re seeing in China might soon be mirrored elsewhere,” said Konyndyk.

Where are the biggest concerns?

Countries close to China in Southeast and East Asia have borne the brunt of the infections outside of the mainland, with Japan, South Korea, Vietnam and Thailand seeing local transmissions.
Some of those nations with coronavirus infections and their neighbors are among the poorest and most disaster-prone countries in the world.
Experts have raised fears that the health care infrastructure in these countries could crumble under the weight of an outbreak, and severely damage their economies, cause mass displacement and lead to other non-virus deaths.
Natural disasters in the Philippines already cause millions of dollars in damage and displace thousands each year.
Powerful typhoons and a series of earthquakes battered the country in 2019, and this year a volcanic eruption in southern Luzon Island is still posing a threat to nearby residents. A dengue epidemic last summer killed more than 1,000 people and infected more than 250,000, demonstrating the strain on its health service.
To date, one person has died in the Philippines from coronavirus — the first death outside mainland China — and three people have been confirmed to have contracted the virus.
The Asia-Pacific region is home to 60% of the world’s population — many of those countries are low or middle-income nations that are quickly industrializing.
According to the Global Preparedness Monitoring Board’s 2019 report “A World At Risk,” rapid urbanization can hasten the spread of disease during an outbreak.
Population booms and the migration of millions of people from rural areas to overcrowded cities with underdeveloped infrastructure and a lack of sanitation could further aggravate the spread of viruses.
India, with its population of 1.3 billion people, is one of the most rapidly developing countries in the world. By 2050, a United Nations report predicts India will have an additional 416 million urban residents. There have been three confirmed coronavirus cases in India, all three are students who had traveled from Wuhan.
While millions of people have lifted themselves out of poverty in India over the past 20 years, millions of others have been left behind.
Densely-packed city slums where thousands of people live in close proximity to one another in often sub-standard conditions could make it difficult to control a virulent viral outbreak.
Smaller, sparsely populated nations in the Pacific Ocean are also extremely vulnerable to an outbreak, though coronavirus has not been confirmed on any of these territories.
Samoa is still reeling from a measles epidemic that infected 5,707 people and killed 83, many of them children. The Samoan government declared a state of emergency in December and shut schools and government services while launching a mass vaccination campaign.
Samoan Prime Minister Tuilaepa Sailele Malielegaoi said recently that “another infectious disease outbreak will have catastrophic effects on the whole of Samoa.”
Some countries have not yet reported any cases, including Indonesia, a nation of 264 million, which typically receives large numbers of Chinese tourists. Likewise, no confirmed cases have been reported in Myanmar, which borders China, India, Bangladesh, Thailand and Laos.
An outbreak in Myanmar, for example, could strain a country that’s still grappling with the legacy of decades of brutal military rule, where one in four people live in poverty, and infectious diseases such as tuberculosis are among the leading causes of death.

Frontline workers risk their lives

One of the biggest concerns of a global spread would be the threat of contagion to frontline health workers, said Konyndyk from the Center for Global Development.
“Infection prevention procedures in the developing world tend to be poorly managed and weakly resourced,” he said.
During the Ebola outbreaks in West Africa in 2014 and the Democratic Republic of Congo in 2019, health workers were between 21 and 32 times more likely to be infected than people in the general population, according to a report by the WHO.
“Health worker infections are a huge blow, because beyond adding to case counts, they degrade the health system’s capacity to fight the outbreak and they undermine the health system’s work on a range of other health risks as well,” Konyndyk said.
Community distrust of medical workers in some places could be disastrous, potentially leading more deaths and further spreading the virus.
When Ebola struck last year in the DRC, fear, rumors and mistrust of public health authorities and politicians meant people stayed home instead of going for treatment. Despite millions of dollars in funding and an effective experimental vaccine, Ebola spread to new provinces and re-infected areas thought to be rid of the virus.
“Spread of this novel coronavirus to such an area would easily overwhelm their testing and treatment capabilities without international assistance,” said Courtney Kansler, Senior Health Intelligence Analyst with WorldAware.
“Venezuela is another good example, where there is a near-complete lack of basic medical services and healthcare infrastructure nationwide,” she said.
Currently there is no evidence of confirmed coronavirus cases on the African continent or in South America.

World not ready for a pandemic

The WHO has appealed for a coordinated international response to help stop the outbreak from spreading, and for wealthier countries to support those with weaker health systems.
But as more countries shut their borders to travelers from China, there are concerns the restrictions will hinder sharing of public health data, or disrupt supply chains.
The WHO has not declared a pandemic — which is essentially when there’s a sustained spread of the disease in numerous countries.
But while there have been big advances in transparency, data sharing, and research tools, “the world remains meaningfully unready for a dangerous pandemic,” said Konyndyk.
“Our existing medical and public health systems would be overwhelmed rapidly and there is no clear plan-B scenario for what countries should do once that happens,” he said.

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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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