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Breakthrough Infections and the Delta Variant: What to Know – The New York Times

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Scientific understanding of the coronavirus variant is changing quickly. Here’s a recap of the most important findings.

Citing new evidence that vaccinated Americans with so-called breakthrough infections can carry as much coronavirus as unvaccinated people do, the Centers for Disease Control and Prevention last month urged residents of high-transmission areas to wear masks in public indoor spaces, regardless of their vaccination status.

The announcement reversed the agency’s recommendation in May that vaccinated people could forgo masks. The vaccines remain highly effective at preventing severe illness and death, but the highly contagious Delta variant and persistent vaccine refusal have taken the country in an unexpected direction. Infections have spiked to the highest levels in six months.

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“If the war hadn’t changed, I wouldn’t have felt the need to take such a widely unpopular action,” Dr. Rochelle Walensky, the C.D.C.’s director, said in an email.

Dr. Walensky has repeatedly said that breakthrough infections are extremely rare. But the agency does not tally national figures on breakthrough infections that don’t result in hospitalization or death, and, in any event, its numbers lag by a few weeks. The exact incidence of these infections, as well as their outcomes, is unknown.

Breakthrough infections seemed to be vanishingly rare when previous versions of the coronavirus dominated in the United States. But recent outbreaks suggest that the numbers may be higher with the arrival of the Delta variant.

“A modest percentage of people who are fully vaccinated will still get Covid-19 if they are exposed to the virus that causes it,” Dr. Walensky said in the email.

Still, most vaccinated people with a breakthrough infection are likely to have mild symptoms. And they may even benefit, in the long run: Every exposure to the virus is an opportunity for the immune system to strengthen its defenses against variants that may emerge in the future.

Booster shots and mild natural infections can both increase the immunity initially gained from the vaccines, said Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health. “This is why young adults and adults don’t get sick — it’s because as a kid you get an opportunity to see these pathogens over and over and over,” he said.

The vaccines were intended to prevent hospitalization and death, the worst outcomes of infection, in large part the result of damage to the lungs and other organs. The vaccines produce antibodies in the blood that prevent the coronavirus from taking root in those organs.

But the infection begins when people inhale or ingest the virus through the nose or the throat. Some antibodies produced by the vaccines do seem to be present in nasal secretions and saliva, and were probably enough to thwart previous variants of the virus. Delta offers a tougher challenge.

Early in the infection, when people are most likely to be contagious, the Delta variant seems to replicate in amounts that are perhaps 1,000 times as much as those seen in people infected with other variants, defeating immune defenses in the nose and throat.

“It’s just way more virus that’s going to potentially overwhelm that initial firewall,” said Jennifer Gommerman, an immunologist at the University of Toronto.

To prevent both severe illness and infections, the vaccines would need to produce long-lasting antibodies in the blood and the nose. “That’s a really tall ask for a vaccine,” Dr. Gommerman said.

It’s unclear exactly how common breakthrough infections are; most estimates rely on figures predating the Delta variant’s rise in the United States. There is also too little testing in the country to get an accurate assessment.

“I think that if we started to test people just randomly on the street, we would find a lot more people who test positive,” said Dr. Abraar Karan, an infectious diseases fellow at Stanford.

Some experts believe breakthrough infections are likelier after exposure to the Delta variant than to prior forms of the virus. Even when more recent data becomes available, however, it still is likely to show that a vast majority of hospitalizations and deaths from Covid-19 occur in unvaccinated people.

“Epidemiologically and clinically, I’ve still not seen really any severe cases among fully vaccinated people who are immunocompetent,” Dr. Karan said. “The pattern that I’m seeing is still primarily unvaccinated who are making it to the I.C.U.”

The C.D.C. reports that as of Aug. 2, more than 7,500 people with breakthrough infections had been hospitalized or had died. And a New York Times analysis of data from 40 states shows that fully immunized people accounted for less than 5 percent of hospitalizations and less than 6 percent of deaths from Covid-19.

Mike Kai Chen for The New York Times

Breakthrough infections are unlikely to pose a serious health threat to most people who are fully immunized. The risk is greater for people around them who are unprotected — either because they are unvaccinated, or because their immune defenses are weakened by age or certain medical conditions.

Vaccinated people are certainly less likely than the unvaccinated to become infected. But on those occasions, vaccinated people can carry as much virus in their nose and throat as unvaccinated people, according to new data from the C.D.C.

The virus should not last very long, because antibodies and immune cells will quickly rally to suppress it. But infected people can transmit the virus to others very early, even before they feel symptoms.

So breakthrough infections could contribute to viral spread in a community, if less often and for a shorter period of time than infections in unvaccinated people. It’s just one more way for the virus to find unvaccinated people.

“Long Covid” is a poorly understood set of symptoms that can plague people for several months after an active infection has ended. While those symptoms eventually resolve in many patients, “there are this subset of people who have long Covid who just aren’t able to recover at all,” said Akiko Iwasaki, an immunologist at Yale University.

Only a couple of small studies have investigated how common or severe long Covid may be after breakthrough infections. It is likely to be rare, some experts say, because breakthrough infections are uncommon to begin with and shorter in duration.

In one study in Israel, about seven of 36 people with breakthrough infections had persistent symptoms for more than six weeks. And in a survey of Covid-19 survivors, 24 of 44 people with a symptomatic breakthrough infection reported lingering problems.

“We really need a wider national or even international survey,” Dr. Iwasaki said.

If you get through a breakthrough infection relatively unscathed, you are likely to walk away with more robust protection against variants. The infection essentially acts as a booster shot, researchers say, strengthening your immune system’s ability to recognize and fight the virus.

Studies have shown that when people who recover from Covid-19 receive even one dose of a vaccine, their antibody levels skyrocket. “I expect similar things would happen when you have a breakthrough infection,” Dr. Iwasaki said.

The vaccines train the immune system to recognize a piece of the original virus, a strategy that may leave us vulnerable to future variants. But every exposure broadens the repertoire of immunity, Dr. Mina said.

Eventually, through booster shots or through repeated infections, our bodies will gain an education in the virus sufficient to counter versions with new mutations, he said, adding, “But we’re not there yet.”

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Secrets of 'SuperAgers' who possess brains as sharp as people 20 to 30 years younger – CNN

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Editor’s Note: Sign up for CNN’s Fitness, But Better newsletter series. Our seven-part guide will help you ease into a healthy routine, backed by experts.



CNN
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Despite volunteering and working out at the gym several days each week, socializing frequently with friends and family, reading all manner of books and doing daily crossword puzzles, 85-year-old Carol Siegler is restless.

“I’m bored. I feel like a Corvette being used as a grocery cart,” said Siegler, who lives in the Chicago suburb of Palatine.

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Walk this number of steps each day to cut your risk of dementia

Siegler is a cognitive “SuperAger,” possessing a brain as sharp as people 20 to 30 years younger. She is part of an elite group enrolled in the Northwestern SuperAging Research Program, which has been studying the elderly with superior memories for 14 years. The program is part of the Mesulam Center for Cognitive Neurology and Alzheimer’s Disease at Northwestern University Feinberg School of Medicine in Chicago.

“I’ve auditioned twice for ‘Jeopardy!’ and did well enough on it to be invited to the live auditions. Then Covid hit,” said Siegler.

“Who knows how well I would have done,” she added with a chuckle. “What I have told my children and anybody else who asked me: ‘I may know an awful lot about Beethoven and Liszt, but I know very little about Beyoncé and Lizzo.’”

SuperAger Carol Seigler is shown with her grandchildren (from left): Alex Siegler, 23; Elizabeth Siegler, 27; Carol Siegler, 85; Megan Boyle, 18; Conor Boyle, 17; Jacob Siegler, 29.

What is a SuperAger?

To be a SuperAger, a term coined by the Northwestern researchers, a person must be over 80 and undergo extensive cognitive testing. Acceptance in the study only occurs if the person’s memory is as good or better than cognitively normal people in their 50s and 60s.

Brain stimulation improves short-term memory in older adults for a month, study finds

“SuperAgers are required to have outstanding episodic memory — the ability to recall everyday events and past personal experiences — but then SuperAgers just need to have at least average performance on the other cognitive tests,” said cognitive neuroscientist Emily Rogalski, a professor of psychiatry and behavioral sciences at Feinberg School of Medicine.

Only about 10% of people who apply to the program meet those criteria, said Rogalski, who developed the SuperAger project.

“It’s important to point out when we compare the SuperAgers to the average agers, they have similar levels of IQ, so the differences we’re seeing are not just due to intelligence,” she said.

Once accepted, colorful 3D scans are taken of the brain and cognitive testing and brain scans are repeated every year or so. Analysis of the data over the years have yielded fascinating results.

Bigger, tau-free neurons

Most people’s brains shrink as they grow older. In SuperAgers, however, studies have shown the cortex, responsible for thinking, decision-making and memory, remains much thicker and shrinks more slowly than those of people in their 50s and 60s.

Your walking speed could indicate dementia

A SuperAger’s brain, usually donated to the research program by participants after death, also has bigger, healthier cells in the entorhinal cortex. It’s “one of the first areas of the brain to get ‘hit’ by Alzheimer’s disease,” said Tamar Gefen, an assistant professor of psychiatry and behavioral sciences at Northwestern, in an email.

The entorhinal cortex has direct connections to another key memory center, the hippocampus, and “is essential for memory and learning,” said Gefen, the lead author of a November study comparing the brains of deceased SuperAgers with those of older and younger cognitively normal people and people diagnosed with early Alzheimer’s.

SuperAger brains had three times fewer tau tangles, or abnormal formations of protein within nerve cells, than the brains of cognitively healthy controls, the study also found. Tau tangles are a hallmark sign of Alzheimer’s and other dementias.

“We believe that larger neurons in the entorhinal cortex suggest that they are more ‘structurally sound’ and can perhaps withstand neurofibrillary tau tangle formation,” Gefen said.

Gefen also found the brains of SuperAgers had many more von economo neurons, a rare type of brain cell, which so far has been found in humans, great apes, elephants, whales, dolphins and songbirds. The corkscrew-like von economo neurons are thought to allow rapid communication across the brain. Another theory is that the neurons give humans and great apes an intuitive advantage in social situations.

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The von economo neurons were found in the anterior cingulate cortex, which forms a collar in the front of the brain linking the cognitive, reasoning side with the emotional, feeling side. The anterior cingulate is thought to be important for regulating emotions and paying attention — another key to good memory.

Taken together, these discoveries appear to point to a genetic link to becoming a SuperAger, Gefen said. However, she added: “The only way to confirm whether SuperAgers are born with larger entorhinal neurons would be to measure these neurons from birth until death. That obviously isn’t possible.”

Can environment play a role?

SuperAgers share similar traits, said Rogalski, who is also the associate director of the Mesulam Center for Cognitive Neurology and Alzheimer Disease at Feinberg. These folks stay active physically. They tend to be positive. They challenge their brain every day, reading or learning something new — many continue to work into their 80s. SuperAgers are also social butterflies, surrounded by family and friends, and can often be found volunteering in the community.

“When we compare SuperAgers to normal agers we see that they tend to endorse more positive relations with others,” Rogalski said.

“This social connectedness may be a feature of SuperAgers that distinguishes them from those who are still doing well but who are what we would call an average or normal ager,” she said.

Carol Seigler learned to read at a young age.

Looking back at her life, Carol Siegler recognizes many SuperAger traits. As a young child during the Great Depression, she taught herself to spell and play piano. She learned to read Hebrew at her grandfather’s knee, poring over his weekly Yiddish newspaper.

“I have a great memory. I’ve always had it,” Siegler said. “I was always the kid that you could say, ‘Hey, what’s Sofia’s phone number?’ and I would just know it off the top of my head.”

She graduated from high school at 16 and immediately went to college. Siegler got her pilot’s license at age 23 and later started a family business in her basement that grew to have 100 employees. At 82, she won the American Crossword Puzzle Tournament for her age group, which she said she entered “as a gag.”

Long life comes from eating right, studies say. Here’s how to begin

After seeing an advertisement for the SuperAger program on television, Siegler thought it too sounded like fun. Being chosen as a SuperAger was a thrill, Siegler said, but she is aware she was born lucky.

“Somebody with the same abilities or talents as a SuperAger who lived in a place where there was very little way to express them, might never know that he or she had them,” she said. “And that is a true shame.”

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Doctors urge parents to get routine vaccines for kids following pandemic disruptions – CP24

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Preventable diseases like measles could follow trends seen elsewhere in the world and spread quickly in Canada due to a drop in routine vaccinations during the COVID-19 pandemic, say pediatricians who are urging parents to ensure their kids are fully immunized.

Provinces and territories log data on vaccinations provided in the community against infectious diseases like measles, diphtheria, polio and whooping cough, as well as vaccines against other illnesses administered in school immunization clinics.

Although much current data doesn’t cover years beyond 2019, provinces with more recent figures are already seeing a dramatic decline in routine vaccinations.

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Pediatricians are concerned about possible outbreaks of preventable diseases if too many children were underimmunized or not vaccinated at all while public health clinics focused on COVID-19 vaccines. Widespread school closures and vaccine disinformation that swayed some parents against immunization efforts complicated matters still further.

Recent data from Public Health Ontario shows that for 12-year-olds, vaccination against the liver infection hepatitis B plummeted to about 17 per cent in the 2020 to 2021 school year, compared with 67 per cent in the school year ending in 2019.

For human papillomavirus, or HPV, which can cause cancer, the vaccination numbers were even lower, plunging to 0.8 per cent last year, compared with 58 per cent in 2019. For the meningococcal vaccine, which helps protect against four types of the bacteria that cause a rare disease, vaccinations fell to about 17 per cent from 80 per cent over the same time. Risks of the potentially deadly illness include meningitis, an infection of the lining of the brain and spinal cord.

“The large decline in coverage in 2019-20 and 2020-21 illustrates the impact of the COVID-19 pandemic, as there was limited capacity to deliver school-based immunization programs,” Public Health Ontario said in a statement.

It said data for uptake of vaccines aimed at protecting younger kids against measles, for example, is not available beyond 2019, and a report on later numbers is expected to be released next spring.

Dr. Monika Naus, medical director of Immunization Programs and Vaccine Preventable Diseases Service at the BC Centre for Disease Control, said in-school vaccines, starting in Grade 6, were delayed, but work is underway to return to pre-pandemic levels.

Younger children missed appointments at doctors’ offices while physicians were seeing patients virtually and public health clinics, which mostly administer routine vaccines for kids outside of the Lower Mainland region of the province, were busy with COVID-19 shots, Naus said.

Dr. Sam Wong, director of medical affairs for the Canadian Paediatric Society, said disinformation and vaccine hesitancy during the pandemic, “combined with the failure of the public health system” to provide routine vaccines, mean certain populations could be left vulnerable to highly contagious diseases like measles, which spreads through coughing and sneezing.

“You could walk into a room an hour after someone’s been in there and potentially get infected,” he said.

“We’re worried, as a group of health-care providers, that if you have lower rates of vaccinations that you’re more likely to have localized outbreaks of vaccine-preventable illnesses such as measles or mumps and chickenpox,” Wong said.

Wong said it’s important for doctors and parents to discuss the importance of routine vaccinations that have been proven effective for decades, adding some people believe young kids’ immune systems are not ready so they’d rather wait until they’re older.

“But that’s why you want to give the vaccine, because their immune system is not able to fight off infections,” he said.

“Some parents don’t want to even have discussions with me about it. But if there is an opening, I’m happy to talk about it,” said Wong, who works in Yellowknife, Edmonton and Victoria.

The Public Health Agency of Canada said Canadian studies have found immunization coverage declined during the pandemic for the measles, mumps and rubella vaccine.

Quebec saw a 39 per cent drop in April 2020 compared with 2019, the agency said, with the greatest impact seen in children aged 18 months.

In Alberta, the agency said vaccination for those diseases declined by 10 per cent in April 2020 compared with the same month a year earlier. Coverage for Ontario children under two decreased by 1.7 per cent, it added.

“The Public Health Agency of Canada continues to work with provinces and territories on an ongoing basis to understand the impact of the pandemic on routine immunization coverage across Canada, and to improve the availability of high-quality data to inform immunization programs,” it said in a statement.

It is currently in discussions with all jurisdictions on ways to monitor coverage of vaccines, similar to a surveillance system used for COVID-19 vaccines, the agency said.

Nova Scotia Health said its last report on childhood vaccines was completed three years ago, and numbers have fallen during the pandemic.

“Anecdotally, we know there was a drop in childhood vaccination, but we do not have the specific numbers available at this time,” it said in a statement.

However, the school immunization program is aiming to help students catch up on vaccines that were missed early in the pandemic, mostly through doctors’ offices, it said, adding that getting an appointment was a challenge for some families.

“We know that a substantial number of Nova Scotians do not have a family doctor. Public Health often works with local primary care clinics to provide vaccines to those who do not have a family doctor and some public health offices will offer clinics to this population.”

Last week, the World Health Organization and the United States Centers for Disease Control and Prevention released a statement saying a record high of nearly 40 million children missed first and second doses of the measles vaccine in 2021 due to disruptions in immunization programs since the start of the pandemic.

The two groups said there were an estimated nine million measles cases and 128,000 related deaths worldwide in 2021, and 22 countries experienced large outbreaks.

Dr. Noni MacDonald, a professor of pediatrics and infectious diseases at Dalhousie University in Halifax, said a national registry that could quickly tell doctors which children have not been vaccinated is essential in Canada.

“I feel like I’m banging my head against a brick wall,” she said of her efforts to call for that change.

“How can we do proper health-care planning when we don’t have the data?”

Canada is an “outlier” that lags behind most European countries on the measles vaccine, she said, adding a coverage rate of 95 per cent is needed to create so-called herd immunity against the highly infectious disease.

Canada recently had 84 per cent uptake of the second dose of the measles vaccine. MacDonald said Australia, in comparison, had 94 per cent based on the most recent data from the WHO. She used the two countries as an example because they had a similar number of births — 368,000 in Canada, and 300,000 in Australia in 2021.

“We are just not in the same league, and we should be embarrassed.”

This report by The Canadian Press was first published Nov. 27, 2022.

This story was produced with financial assistance from the Canadian Medical Association. 

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Cobourg resident first at Peterborough Regional Health Centre to receive new cancer treatment

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Two years ago, Cobourg resident Stuart Morley became the first-ever patient at Peterborough Regional Health Centre (PRHC) to receive life-changing cancer treatment by interventional radiology-radiofrequency ablation for a tumour on his kidney. (Photo courtesy of PRHC Foundation)

Two years ago, a doctor looked at a CT scan of Stuart Morley’s kidney and saw a tumour. It was small — only 15 millimetres — but the Cobourg resident was over 80 years old, so major surgery wasn’t the best option for him. Instead, he was a candidate for a minimally invasive interventional radiology procedure.

Stuart became the first-ever patient at Peterborough Regional Health Centre (PRHC) to receive life-changing cancer treatment by interventional radiology-radiofrequency ablation.

The amateur photographer and retired radiographer tells how PRHC’s Dr. Kebby King put a metal probe through a small cut in his skin and, using a CT to guide her, found the tumour and dissolved it with radio waves.

Interventional radiologist Dr. Kebby King (right) and registered technologist Saara King prepare for a minimally invasive interventional radiology procedure at Peterborough Regional Health Centre (PRHC). Often described as 'the future of medicine', it's used to diagnose and treat a wide range of emergency and chronic health conditions, such as cancer and other illnesses, without the use of conventional surgery. (Photo courtesy of PRHC Foundation)
Interventional radiologist Dr. Kebby King (right) and registered technologist Saara King prepare for a minimally invasive interventional radiology procedure at Peterborough Regional Health Centre (PRHC). Often described as ‘the future of medicine’, it’s used to diagnose and treat a wide range of emergency and chronic health conditions, such as cancer and other illnesses, without the use of conventional surgery. (Photo courtesy of PRHC Foundation)

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“It was amazing,” Stuart recalls. “I felt no pain and I was able to go home later that afternoon. Now I’m back taking photos and looking forward to travelling the world again. I worked in diagnostic imaging for 12 years. But back in the ’60s, we could never have imagined the kinds of things doctors can do these days.”

Interventional radiology is often described as ‘the future of medicine’. It’s used to diagnose and treat a wide range of emergency and chronic health conditions such as cancer and other illnesses, without the use of conventional surgery and the associated pain, complications, and longer hospital stays.

For patients in the Peterborough region, this means they can go home sooner, with less pain and less risk, all without having to travel far away.

VIDEO: Interventional Radiology is helping to revolutionize cancer care at PRHC

Interventional radiologist Dr. King describes that difference as “night and day.”

It’s remarkable how many life-threatening health conditions can be diagnosed and treated with this innovative specialty. It can be used to biopsy or treat tumours like Stuart’s, put in ports for chemotherapy, or stop bleeding — in as little as an hour.

Dr. King and her colleagues already perform 6,000 interventional radiology procedures each year at PRHC, and the need for this kind of care is only growing in our region. PRHC’s interventional radiology suites are 14 years old, however, and are too small to fit new advanced technology and the staff required to use it.

Interventional radiologist Dr. Kebby King (right) and registered technologist Saara King at Peterborough Regional Health Centre (PRHC). Dr. King and her colleagues perform 6,000 interventional radiology procedures a year for patients like Stuart Morley from across the region. To meet the growing need for this service, PRHC's facilities must be upgraded with a $6 million investment. (Photo courtesy of PRHC Foundation)
Interventional radiologist Dr. Kebby King (right) and registered technologist Saara King at Peterborough Regional Health Centre (PRHC). Dr. King and her colleagues perform 6,000 interventional radiology procedures a year for patients like Stuart Morley from across the region. To meet the growing need for this service, PRHC’s facilities must be upgraded with a $6 million investment. (Photo courtesy of PRHC Foundation)

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A $6 million investment in state-of-the-art equipment, upgraded suites, and an expanded recovery room is essential to meeting the need — so more patients with more complex conditions can be diagnosed and treated close to home.

Grateful for the great care he received and determined to help pave the way for new ground-breaking therapies to be offered at PRHC in the near future, Stuart donated to the PRHC Foundation for the first time. He wants to support the interventional radiology renovation and upgrade, and he knows that the government doesn’t fund hospital equipment.

“Our regional hospital needs our help,” Stuart says. “I’m asking everyone to join me in donating to support the interventional radiology facilities. Pictures can save lives. I know this because medical imaging saved mine. Now, our donations will help others. Thank you for helping to give people like me a brighter future.”

Grateful for the great care he received at Peterborough Regional Health Centre (PRHC) two years ago and determined to help pave the way for new ground-breaking therapies to be offered at PRHC in the near future, Cobourg resident Stuart Morley donated to the PRHC Foundation and is encouraging others to do the same. (Photo courtesy of PRHC Foundation)
Grateful for the great care he received at Peterborough Regional Health Centre (PRHC) two years ago and determined to help pave the way for new ground-breaking therapies to be offered at PRHC in the near future, Cobourg resident Stuart Morley donated to the PRHC Foundation and is encouraging others to do the same. (Photo courtesy of PRHC Foundation)

Not only do donations fund state-of-the-art technology not funded by the government, fuel innovation, and bring new services to our region, they also help PRHC attract and retain the best and brightest healthcare professionals. Doctors, nurses and staff want to do their jobs to the best of their abilities, and advanced equipment and innovative treatments support them in doing that.

This holiday season, donors and grateful patients like Stuart can help ensure PRHC’s frontline workers have the tools they need to provide expert, compassionate care, and receive some good cheer. Tribute donations can include a message of thanks or best wishes to a hospital department or individual physician, nurse or staff member when made online at prhcfoundation.ca or by phone at 705-876-5000.

To donate, find out more about interventional radiology, or share your own PRHC grateful patient story, please visit prhcfoundation.ca or call 705-876-5000.

This branded editorial was published in partnership with the PRHC Foundation. If your organization or business is interested in a branded editorial, contact us.

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