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Canada ending requirements for COVID-19 vaccines, ArriveCan app at border Sept. 30

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OTTAWA — The last of Canada’s COVID-19 border restrictions will disappear at the end of this month with the expiry of a cabinet order affecting mandatory vaccinations, testing and quarantine of international travellers.

That expiry also spells the end of insisting travellers use the ArriveCan app to input their vaccine status and test results, though the app will live on as an optional tool for customs and immigration.

It doesn’t yet deal with whether passengers must wear masks on domestic and international trains and planes because that rule is contained in a separate order issued by the minister of transport.

Two senior government sources aware of the decision confirmed the cabinet order maintaining COVID-19 border measures will not be renewed when it expires on Sept. 30.

The sources spoke to The Canadian Press on the condition they not be named because they were not authorized to speak publicly. While the Liberal cabinet did meet Thursday afternoon, cabinet approval is not required to allow the order to expire.

One of the sources said Prime Minister Justin Trudeau, before the cabinet meeting took place, signed off on the decision not to renew the rules.

The change means international travellers will no longer have to prove they are fully vaccinated against COVID-19. Under the current rule, Canadians returning to the country who aren’t vaccinated must show a negative COVID-19 test result before arriving, and undergo further testing after arrival. They also must quarantine for 14 days.

Foreigners who aren’t vaccinated are simply banned from Canada unless they fall into specific categories, such as airline or boat crew members, those who need essential medical treatment, diplomats and temporary foreign workers.

The cabinet order also spells out that vaccinated travellers will be selected for random COVID-19 testing, and requires travellers to submit their vaccine proof and test results electronically.

The only way to do that is through the ArriveCan app.

All of that will end when the clock strikes midnight on Oct. 1.

Tourism Minister Randy Boissonnault would not confirm the decision Thursday afternoon, but he said if the order is allowed to expire, that would also eliminate the only mandatory component for the ArriveCan app.

“So the mandatory piece is the vaccine piece, and because that’s how people prove it through the ArriveCan, that’s how the order is written, from what I remember,” he said on his way into the cabinet meeting.

ArriveCan has morphed into a digitized border arrival tool, and now people flying into certain airports can use it to fill out their customs and immigration form instead of the paper version.

Boissonnault said that is in keeping with the digitization of border forms in a number of countries, including Europe, and long term will make for faster, smoother border experiences.

“If we’re going to want to go from 22 million visitors in 2019, to something closer to 30 million by 2030, we’re going to have to have a digital border,” he said.

The order’s expiration also means the minister of health will no longer be able to quickly bar citizens of specific countries facing COVID-19 outbreaks from coming to Canada. That measure was used to ban people from India and certain African countries at various points, moves criticized by some as racist.

Canada’s COVID-19 border measures have been evolving since the pandemic began in March 2020.

For more than a year, Canada invoked a mandatory 14-day quarantine for all returning Canadians, and for a time required quarantine to be fully or partially completed in specific hotels.

Between March 2020 and August 2021, foreign nationals couldn’t enter Canada period with some exemptions for critical workers including airline crew, health workers, and truck drivers.

In July 2021, once all Canadian adults and teenagers could access vaccines, the government stopped requiring quarantine for fully-vaccinated Canadian travellers.

In August 2021 they opened the border to fully vaccinated Americans, and in September 2021 the border was opened to fully vaccinated citizens from all countries.

Border measures have become heavily politicized, with the Conservatives demanding Trudeau lift them all, and Leader Pierre Poilievre made ending them a key policy in his recent leadership campaign.

Deputy Conservative leader Melissa Lantsman and the party’s Quebec lieutenant, Pierre Paul-Hus, said in a joint statement Wednesday that ending the measures within weeks of Poilievre winning the leadership was convenient.

“Ever since it was introduced, the ArriveCan app has killed jobs, suffocated economies all over the country, and told visitors they weren’t welcome in Canada,” they said. “Along with unscientific vaccine mandates and mandatory random testing, ArriveCan created the longest delays ever seen at Canada’s airports.”

Delays at airports were partially blamed on ArriveCan, as some travellers who struggled to get it to work, or couldn’t or wouldn’t use it, backed up lines. However, the delays have also been blamed on labour shortages affecting everything from airport workers to security and border guards.

Dr. Zain Chagla, an infectious disease specialist, has been arguing against mandatory vaccinations and testing at the border for months. In an interview Thursday he said testing asymptomatic travellers at the border is expensive and not as useful as testing symptomatic people in the community.

He said without testing everyone, the policy won’t prevent further spread of COVID-19.

The government had long pointed to the random testing as a way to screen for the arrival of new variants but Chagla said there are also better and more convenient ways to look for those as well.

This report by The Canadian Press was first published Sept. 22, 2022.

 

Mia Rabson and Laura Osman, The Canadian Press

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'Similar strategy' needed for global CVD prevention in men, women: PURE – Healio

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September 23, 2022

2 min read

Disclosures:
One author reports receiving speaker and consultant fees from Bayer and Janssen for work unrelated to this study. Walli-Attaei and the other authors report no relevant financial disclosures.

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The magnitude of associations with major CVD for most risk factors are similar in women and men, despite sex differences in risk factor levels, according to an analysis of the PURE study.

In a comprehensive overview of the prevalence of metabolic, behavioral and psychosocial risk factors for CVD in women and men globally, researchers also found that diet was more strongly associated with CVD in women than in men. However, high concentrations of non-HDL and related lipids and symptoms of depression were more strongly associated with risk for CVD in men than in women. Patterns remained consistent across countries regardless of income level.

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Source: Adobe Stock

“Existing studies, mostly from high-income countries, have reported that hypertension, diabetes, and smoking are more strongly associated with cardiovascular disease in women than in men,” Marjan Walli-Attaei, PhD, a research fellow at the Population Health Research Institute of McMaster University and Hamilton Health Sciences, and colleagues wrote in The Lancet. “Such findings would imply that women would benefit to a greater extent in reducing cardiovascular disease risk from control of these risk factors than would men. However, the burden of cardiovascular disease is greatest in low-income and middle-income countries, for which prospective data on the association of risk factors with cardiovascular disease are sparse, with a paucity of analysis by sex.”

Marjan Walli-Attaei

Walli-Attaei and colleagues analyzed data from 155,724 adults aged 35 to 70 years at baseline without a history of CVD enrolled in the PURE study, which included participants from 21 high-, middle- and low-income countries, and followed them for approximately 10 years (58% women; mean baseline age, 50 years). Researchers recorded information on participants’ metabolic, behavioral and psychosocial risk factors; all participants had at least one follow-up visit. The primary outcome was a composite of major CV events, defined as CV death, MI, stroke and HF. Researchers reported the prevalence of each risk factor in women and men, HRs and population-attributable fractions associated with major CVD.

As of the data cutoff of Sept. 13, 2021, researchers observed 4,280 major CVD events in women (age-standardized incidence rate, 5 events per 1,000 person-years) and 4,911 in men (age-standardized incidence rate, 8.2 per 1,000 person-years).

Compared with men, women presented with a more favorable CV risk profile, especially at younger ages. HRs for metabolic risk factors were similar in women and men, except for non-HDL, for which high non-HDL was associated with an HR for major CVD of 1.11 in women (95% CI, 1.01-1.21) and 1.28 in men (95% CI, 1.19-1.39; P for interaction = .0037), with a consistent pattern for higher risk among men than women with other lipid markers.

Researchers also observed that maintaining a diet with a PURE score of 4 or lower (score range, 0-8) was more strongly associated with major CVD in women than in men, with HRs of 1.17 (95% CI, 1.08-1.26) and 1.07 (95% CI, 0.99-1.15; P for interaction = .0065), respectively.

In contrast, symptoms of depression were more strongly associated with CVD in men than in women, with the HRs for symptoms of depression being higher in men than in women (P for interaction = .0002). “The HRs of other behavioral and psychosocial risk factors, as well as grip strength and household air pollution, were similar among women and men,” the researchers wrote.

The total population-attributable fractions associated with behavioral and psychosocial risk factors were greater in men than in women (15.7% vs. 8.4%) mostly due to the larger contribution of smoking to population-attributable fractions in men (10.7%) vs. women (1.3%).

“Our results emphasize the importance of a similar strategy for the prevention of cardiovascular disease in both sexes,” the researchers wrote. “However, the increased risk of cardiovascular disease in men might be substantially attenuated with better reductions in tobacco use and lipid concentrations.”

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Blood Clot Risk Remains Higher Almost a Year After COVID – The Suburban Newspaper

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FRIDAY, Sept. 23, 2022 (HealthDay News) — An increased risk of blood clots persists for close to a year after a COVID-19 infection, a large study shows.

The health records of 48 million unvaccinated adults in the United Kingdom suggest that the pandemic’s first wave in 2020 may have led to an additional 10,500 cases of heart attack, stroke and other blood clot complications such as deep vein thrombosis, in England and Wales alone.

The risk of blood clots continues for at least 49 weeks after infection, the study found.

“We have shown that even people who were not hospitalized faced a higher risk of blood clots in the first wave,” said study co-leader Angela Wood, associate director of the British Heart Foundation Data Science Centre.

“While the risk to individuals remains small, the effect on the public’s health could be substantial and strategies to prevent vascular events will be important as we continue through the pandemic,” Wood said in a news release from Health Data Research UK, which sponsors the center.

Researchers found that the risks did lessen over time.

Patients were 21 times more likely to have a heart attack or stroke in the week after their COVID diagnosis. After four weeks, the risk was 3.9 times greater than usual.

Heart attacks and strokes are mainly caused by blood clots blocking arteries.

The risk of clots in veins was 33 times greater in the week after COVID diagnosis, dropping to eight times greater after four weeks. Conditions caused by these clots include deep vein thrombosis and pulmonary embolism, which can be fatal.

By 26 to 49 weeks after a COVID diagnosis, the risk dropped to 1.3 times more likely for clots in arteries and 1.8 times more likely for clots in veins, the study showed.

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While people who were not hospitalized had a lower risk, it was not zero, the study found.

Overall, individual risk remains low, the authors said. Men over 80 years of age are at highest risk.

“We are reassured that the risk drops quite quickly — particularly for heart attacks and strokes — but the finding that it remains elevated for some time highlights the longer-term effects of COVID-19 that we are only beginning to understand,” said study co-leader Jonathan Sterne, director of the NIHR Bristol Biomedical Research Center and of Health Data Research UK South West.

The authors said steps such as giving high-risk patients blood pressure-lowering medication could help reduce cases of serious clots.

Researchers are now studying newer data to understand how vaccination and the impact of new COVID variants may affect blood clotting risks.

The findings were recently published in the journal Circulation.

More information

The U.S. Centers for Disease Control and Prevention has more on blood clots.

SOURCE: Health Data Research UK, news release, Sept. 20, 2022

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MPs, Senators debate requirements for medically assisted dying with mental disorders

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OTTAWA — An expert told a special joint committee of the House of Commons and Senate that people with mental disorders can suffer for decades, and their distress is equally as valid as someone suffering physical pain.

People suffering solely from mental disorders are due to become eligible for assisted dying in March, and Dr. Justine Dembo, a psychiatrist and medical assistance in dying assessor, also cautioned the committee about perpetuating stigma about mental illness.

Mental health advocates warn it is harder to predict the outcomes and treatments of mental illnesses, and a wish to die is often a symptom, but an expert panel earlier this year said existing eligibility criteria and safeguards in medically assisted dying legislation would be adequate.

Both arguments were made today by a handful of witnesses appearing before the committee, which is deliberating what policies to recommend to lawmakers ahead of the March deadline.

Ellen Cohen, a coordinator advocate for the National Mental Health Inclusion Network, told committee members Canada needs laws to help patients, not hurt them.

“I don’t believe there were any safeguards recommended,” she said.

She resigned from the federal government’s expert panel on MAID and mental illness in December 2021. She said there was no space to identify how vulnerable people could be protected.

The panel released its report May 13, concluding that existing eligibility criteria and safeguards would be adequate “so long as those are interpreted appropriately to take into consideration the specificity of mental disorders.”

Dembo, who was one of the expert panel members, said following those guidelines for people with mental disorders “would ensure an extremely comprehensive, thorough and cautious approach.”

She told the committee people with mental disorders can suffer for decades.

“To say someone with mental illness just shouldn’t be eligible, with that big of a blanket statement, where people don’t even get the chance to be assessed as individuals unique in their circumstances, to me is very stigmatizing,” she said.

While the interim report released earlier this year stops short of making recommendations of its own,  it concludes by urging the government to take steps to implement the recommendations of the expert panel “in a timely matter.”

A final report from the committee, complete with recommendations that address other areas including access for mature minors, advance requests, the state of palliative care and the protection of people with disabilities, is due on Oct. 17.

Cohen called the timeline for the legislation to be expanded by March unrealistic.

“I’d like to see this government push this deadline back,” she said.

But Dembo disagreed, telling MPs and senators that assessors are already gaining experience following the existing guidelines.

“Whether or not March 2023 is a realistic deadline depends on how committed and efficient various provincial bodies and local bodies can be in implementing guidelines based on the panel report. I’m hoping they can do that,” she said.

The committee’s review was mandated in the MAID legislation that required that a parliamentary review be initiated five years after the law came into effect in 2016. The committee began its work in 2021 before it was dissolved ahead of the federal election last fall.

The panel and the committee use the terminology “mental disorders,” rather than “mental illness,” stating in their reports that there is no standard definition for the latter and its use could cause confusion.

Conservative MPs on the committee offered a dissenting interim report earlier this year, saying it would be “problematic” to simply endorse the panel’s recommendations.

The MPs argued there are “far too many unanswered questions” on the subject, and nothing precludes the committee from revisiting whether assisted dying should be offered to this category of people at all.

“Legislation of this nature needs to be guided by science, and not ideology,” the Conservatives wrote in May, warning that an outcome that could “facilitate the deaths of Canadians who could have gotten better” would be completely unacceptable.

This report by The Canadian Press was first published Sept. 23, 2022

 

The Canadian Press

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