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Alberta doctors scrambling to get cancer surgeries done before 'tidal wave' of COVID-19 patients – CBC.ca

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Health officials and doctors in Alberta are hard at work trying to contain the COVID-19 pandemic, but trend lines in other areas of the world suggest the worst is yet to come — and one doctor says that “tidal wave” of cases is likely to overwhelm the healthcare system.

“Other countries are only a few weeks ahead of us in terms of how this virus spreads through a population,” said Dr. Geoffrey Gotto, a Calgary oncologist specializing in surgery for prostate, kidney and bladder cancers. “We’re anticipating that our hospitals and [intensive care units] and [operating rooms] are going to be completely overwhelmed before the end of April.”

Gotto said elective surgeries, including cancer surgeries, were cancelled on Wednesday so that the most urgent cancer cases could be rebooked and completed before the influx arrives.

“Only the most urgent cancer surgeries are being booked in the next two-week period, and then the plan is to reassess that going forward depending on what happens in the coming weeks,” he said.

In a statement, Alberta Health Services said it was continuing to do emergency urgent surgery for all patients, including cancer patients.

“Any patient who needs surgery or an oncology procedure will receive it. They will be triaged for urgency, just as they would have before the pandemic,” the statement reads. “We acknowledge this is a challenging time for all of us, but especially for our patients.

“AHS is doing all it can to ensure Albertans with urgent health concerns get the care they need.”

AHS said surgeries are being prioritized so that patients with urgent life-threatening complications and highly aggressive cancers go first.

‘I cried and I cried’

The struggle to accommodate the looming health crisis has led to some cancer patients having their surgeries rescheduled, like Cam Forster, who has cervical cancer.

Forster said she received a call earlier this week that her scheduled surgery had been cancelled.

“After I got off the phone, I cried and I cried. My body didn’t know what to do,” she said. “I was mad, I was stressed out, and I’ve been under so much stress regarding the surgery as it is.”

After Forster spoke out, her surgery was rescheduled.

Gotto said doctors and health officials are working to get as many surgeries done as possible, but he is concerned about the “huge amount of anxiety” the changes will cause on patients and their families.

“There are people within AHS and the department of surgery that are working tirelessly, seven days a week, overnight, not sleeping, trying to figure out how to prioritize these surgeries,” Gotto said. “[We need to] get as many of them done as possible before this tidal wave of COVID-19 cases show up [and] basically leads to overcapacity of our hospitals.”

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'Truly sorry': Scientists pull panned Lancet study of Trump-touted drug – National Post

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NEW YORK/LONDON — An influential study that found hydroxychloroquine increased the risk of death in COVID-19 patients has been withdrawn a week after it led to major trials being halted, adding to confusion about a malaria drug championed by U.S. President Donald Trump.

The Lancet medical journal pulled the study after three of its authors retracted it, citing concerns about the quality and veracity of data in it. The World Health Organization (WHO) will resume its hydroxychloroquine trials after pausing them in the wake of the study. Dozens of other trials have resumed or are in process.

The three authors said Surgisphere, the company that provided the data, would not transfer the dataset for an independent review and they “can no longer vouch for the veracity of the primary data sources.”

The fourth author of the study, Dr. Sapan Desai, chief executive of Surgisphere, declined to comment on the retraction.

The Lancet said it “takes issues of scientific integrity extremely seriously” adding: “There are many outstanding questions about Surgisphere and the data that were allegedly included in this study.”

Another study in the New England Journal of Medicine (NEJM) that used Surgisphere data and shared the same lead author, Harvard Medical School Professor Mandeep Mehra, was retracted for the same reason.

The Lancet said reviews of Surgisphere’s research collaborations were urgently needed.

The race to understand and treat the new coronavirus causing the COVID-19 pandemic has accelerated the pace of research and peer-reviewed scientific journals are go-to sources of information for doctors, policymakers and lay people alike.

Chris Chambers, a professor of psychology and an expert at the UK Center for Open Science, said The Lancet and the NEJM – which he described as “ostensibly two of the world’s most prestigious medical journals” – should investigate how the studies got through peer review and editorial checks.

“The failure to resolve such basic concerns about the data” raises “serious questions about the standard of editing” and about the process of peer review, he said.

The Lancet did not immediately respond to a Reuters request for comment. The NEJM could not immediately be reached for comment.

UNANSWERED QUESTIONS

The observational study published in The Lancet on May 22 said it looked at 96,000 hospitalized COVID-19 patients, some treated with the decades-old malaria drug. It claimed that those treated with hydroxychloroquine or the related chloroquine had higher risk of death and heart rhythm problems than patients who were not given the medicines.

“I did not do enough to ensure that the data source was appropriate for this use,” the study’s lead author, Professor Mehra, said in a statement. “For that, and for all the disruptions – both directly and indirectly – I am truly sorry.”

Many scientists voiced concern about the study, which had already been corrected last week because some location data was wrong. Nearly 150 doctors signed an open letter to The Lancet calling the article’s conclusions into question and asking to make public the peer review comments that preceded publication.

Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene & Tropical Medicine said the retraction decision was “correct” but still left unanswered the question about whether hydroxychloroquine is effective in COVID-19.

“It remains the case that the results from randomized trials are necessary to draw reliable conclusions,” he said. (Reporting by Michael Erman, Peter Henderson, Kate Kelland and Josephine Mason Editing by Leslie Adler, Tom Brown, Giles Elgood and Carmel Crimmins)

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Possible link between more overdoses and pandemic isolation: Guelph health officials – CTV News

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GUELPH —
The number of suspect overdose deaths in Guelph since the outbreak of COVID-19 has already surpassed the number of deaths in all of 2019.

Health officials say isolation could be a contributing factor, as staff at the consumption treatment centre have seen about half of the regular users during the time of the pandemic.

“From mid March until just the end of May we’ve seen eight deaths,” said Raechelle Devereaux, executive director of the Guelph Community Health Centre.

In 2018, there were seven overdose deaths in Guelph.

Jade McAfee uses the CTS site and say she’s lost a lot of friends to overdoses.

“It is scary,” she said. “I myself have overdosed 13 times.”

While officials say a toxic supply is to blame for overdoses, the COVID-19 pandemic has added a hurdle when it comes to prevention.

“The same things that are keeping people safe during the pandemic like isolating and staying home are some things that work against us,” said Devereaux.

Registered nurse Danielle Castledine supervises injections and says they would normally see 30 people a day before the pandemic.

“Before we had an intermediate space where people could be before and after,” she said. “So even if they were waiting they were waiting with peer workers and nurses and social workers.”

To help with better spacing, they’ve opened a new booth to decrease wait times and encourage more people to use the services.

“[Before the crisis] you didn’t have to have a mask, get stopped, have your temperature taken when you could blow in and out easily,” said Eric Cunningham, a user of the CTS site.

Staff say the lack of foot traffic at the CTS is a bad sign and worry the alternative is using in isolation, which decreases the likelihood of potentially life-saving intervention.

“It’s better for anybody to not do it alone,” said McAfee.

The health centre says between March 17 and May 30 there were 63 overdoses.

In the same time period last year there were 74, but only one overdose death.

The Guelph Community Health Centre says the team is door knocking at vulnerable apartment and shelters to give more information on harm reduction to help those potential using alone.

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Unmasking the stealth virus behind COVID-19 – CBC.ca

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Scientists have discovered the pandemic-causing coronavirus is unique in short-circuiting the safest way our immune system kills off a virus, which could have implications for treating COVID-19 with interferon.

Interferon describes a family of proteins produced by the body’s immune system in response to an invading viral infection. As the name implies, interferon interferes with the virus’s ability to copy itself.

Interferon drugs are made in the lab and were used for years to treat hepatitis, a liver infection, as well as other diseases that involve the immune system, such as multiple sclerosis and some cancers.

In May, researchers in Hong Kong published the results of their Phase 2 trial on fewer than 150 people who were admitted to hospital with mild or moderate COVID-19. Participants were randomly assigned to a combination of potential antivirals, including interferon, or placebo injections for two weeks.

The findings lent support to the idea of continuing research efforts, including in Canada, to investigate interferon in larger, blinded trials designed to find more definitive answers.

Dr. Jordan Feld, a liver specialist at Toronto General Hospital and senior scientist at U of T, previously used interferon to treat people infected with hepatitis. He’s now leading a Phase 2 clinical trial to test a targeted form of the drug, called peginterferon lambda, in injections compared with saline placebo injections.

“It’s kind of like a stealth virus,” Feld said of SARS-CoV-2, the virus that causes COVID-19.

In this photo illustration, a replica of SARS-CoV-2 is placed next to test tubes with samples of blood being tested for COVID-19. (Robin Utrecht/SOPA Images/LightRocket/Getty)

Normally, when interferon in the body’s white blood cells responds to a viral invader, the interferon sends out a flare signal so nearby cells will work to stop the virus from copying itself or replicating if they, too, should be invaded.

In ferrets infected in the lab (a common animal model for studying respiratory viruses), healthy human lung cells, and in people with COVID-19, doctors and scientists say it seems like the natural interferon “flies under the radar” of the immune system and isn’t activated the way it should be.

Feld said the idea behind giving interferon medications is to provide the body with what it should be making to fend off the infection.

The potential therapeutic approach gained scientific backing last month when a study published in the journal Cell showed a “striking” feature of SARS-CoV-2 infection.

Ben tenOever is a Canadian-born professor of microbiology at the Icahn School of Medicine at Mount Sinai in New York who led the Cell study and has been flooded with e-mail requests from researchers the world over to test experimental drug compounds against the virus.

TenOever said every cell that gets infected has two major jobs:

  1. Fortify its defences and those around it with a “call to arms” mediated by interferon, like sending out an emergency flare for the immune system’s first responders.
  2. Send a “call for reinforcements” for a longer-term response by releasing proteins called chemokines.

Most viruses block both of those roles.

What makes SARS-Cov-2 unique is it blocks the call-to-arms function from interferon only.

Reinforce call to arms with drug?

“Treatment with interferon or drugs that induce interferon, the main character in the call to arms, is probably beneficial,” tenOever said.

“The secret is to do it early,” he said, when people have a mild cough and test positive for the virus and haven’t developed respiratory distress.

But there could also be mild side-effects.

When we’re fighting off a flu virus, blame interferon for feeling so crummy, feverish and achy as your immune system kicks into high gear.

Likewise, interferon drugs, could also lead to flu-like symptoms for a day or two.

Individuals enrolling in COVID-19 clinical trials of interferon based in Toronto, Hamilton, Ont., Harvard in Cambridge, Mass., Stanford in California, Johns Hopkins in Baltimore and elsewhere will need to weigh whether that (potential) shortfall is worth the (potential) payoff of protection from the deadly damage and delivers key answers that only their participation can offer.

Dr. Jordan Feld says the idea behind giving interferon medications is to give the body back what it should be making to fend off COVID-19. (CBC News)

TenOever said what the enormous scientific interest in the publication shows is an incredible demand for biosafety Level 3 labs like his during the pandemic. Without that lab capacity, the fear is that medical researchers won’t be able to run all the experiments they need to do to guide vaccine efforts.

Matthew Miller is an associate professor of infectious disease and immunology at McMaster University who isn’t involved in the clinical trials or studies.

Miller said interferon is what cells use to try to kill off the virus by themselves.

“Its sort of the preferred route,” Miller said, adding interferon is also the safest way for the body to get rid of a virus.

Miller called tenOever’s paper “an important first step in understanding how our body is responding to this particular new virus.”

Speed up recovery

Dr. Sarah Shalhoub, a transplant infectious disease physician at Western University’s medical school, studied the use of interferon to treat another coronavirus infection called Middle East Respiratory Syndrome or MERS.

While interferon hasn’t yet panned out to fight MERS, Shalhoub is optimistic for COVID-19.

“Patients that received interferon beta clear their viruses faster and the duration for hospital admission was also significantly lower,” Shalhoub said of the Hong Kong findings last month.

“It was encouraging in that sense that there might be an effective therapy that’s available on the market that can be repurposed.”

Shalhoub was quick to add a caution. Since no one in either the drug or placebo group died, the mild infections and response to them are difficult to interpret without more research.

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