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A virus in transition, what happens next? – The Spokesman Review

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Francisco R. Velázquez, M.D., S.M., FCAP

By Francisco R. Velázquez, M.D., S.M., FCAP

The question, “What is next?” has been at the forefront of all discussions since the first case of COVID-19 was identified in late 2019. It seems surreal that it has been over two years. For many of us, it feels like it has been much longer.

At the beginning, we knew extraordinarily little. Now, the amount of data, scientific research, clinical advances and therapeutics is disproportionate to the length of time. In other words, it usually takes a lot longer to have all the knowledge and tools we currently have. Progress has not been easy, and we should appreciate the work of the many. At the end of the day, we have a microbe that has caused disease, turmoil and death. And those are undeniable facts.

Throughout the pandemic, we have experienced the progression through several variants of the COVID-19 virus, cycling through various letters of the Greek alphabet in the past 12 months with each one having a different level of impact in our community. We saw a rapid increase in cases over the past two months due to the omicron variant, the last variant of concern to make its way here. Now, the number of cases reported daily is finally decreasing, following the trend we have seen throughout the pandemic in which Eastern Washington communities lag a couple of weeks behind the more populated communities of Western Washington.

Although it is promising to see cases falling, we still have some work to do and need some time to stabilize hospital capacity. The impact of the omicron surge has been significant to an already challenged health care environment. In nonpandemic times, hospitalizations generally decrease around the summer months and then increase through the winter with flu season. It was a predictable cycle. But for the past two years, our health care systems have been operating at or near capacity. Recovery will take place, but there is still work to be done.

So, what happens next? Some things we know. For example, given the moderate levels of immunization in the community and the high number of recent infections, there is some protective effect in the short term. We need to continue our vaccination efforts as vaccines and boosters have clearly demonstrated a protective effect thus far, even with the highly transmissible omicron variants. The three-prong approach to decreasing potential disease transmission using testing, vaccines and public health measures will still play a critical role as we go forward.

As we move toward spring, how testing, vaccines and public health measures are applied will change proportionally to the overall improvement in disease metrics, barring the appearance of a new variant with a higher clinical impact. The thought of moving to more of an endemic approach is top of mind for most of us. Just to be clear, let us look at the difference between these terms. In general, an epidemic is a disease that affects many people within a community, population or region. In the initial stages of COVID-19 when the disease was limited to a province in China, it was an epidemic. Pandemics have a passport, meaning they travel and spread over many countries or continents. COVID-19 is truly a global pandemic. The Centers for Disease Control and Prevention has defined the term endemic as “the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area.”

One of the misconceptions of endemic is that it means the infection or disease is milder. Endemic does not imply a lack of morbidity or even mortality. It means a more predictable and potentially manageable presence. Think about the flu, which causes as many as 50,000 deaths a year. Also remember that endemic has a geographical connotation; what is endemic in the United States may or may not be endemic in other parts of the world. Chickenpox is seen at predictable rates in school age children in the U.S., while malaria is endemic in parts of Africa. Remember that communicable diseases can arise anywhere in the world as we have seen with the many variants. It’s the reason why we track and follow happenings elsewhere.

We have come a long way, and there is light at the end of the tunnel. If we remain vigilant by continuing to gather data and research as the virus evolves and diligent with public health measures, vaccines and testing to manage the virus, we will make it on the other side of this tunnel into the brighter, more normal, light.

Francisco R. Velázquez, M.D., S.M., FCAP, is the Spokane Regional Health District health officer.

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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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.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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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.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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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.

The Canadian Press. All rights reserved.

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