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Canada is 'playing chicken' with COVID-19 by reopening while variants are spreading widely – CBC.ca

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This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.


Much of Canada is lifting lockdown measures and reopening risky indoor settings while experts warn fast-spreading coronavirus variants threaten to jeopardize recent progress and trigger a brutal third wave.

On the same day Manitoba announced its first case of the variant initially detected in the United Kingdom, the province also said it would reopen restaurants, gyms, places of worship, museums, art galleries, tattoo parlours, nail salons and libraries.  

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That variant, also known as B117, is estimated to be at least 50 per cent more transmissible and potentially more deadly and led to strict lockdowns in countries like Denmark, Ireland and the U.K., where it quickly became a dominant strain. 

Alberta, which already has 149 cases of B117 and seven cases of the variant first identified in South Africa, also decided to reopen restaurants, bars and gyms this week despite the rapid rise in variant cases.

“It’s kind of like we’re playing chicken with COVID, which never struck me as being a great idea,” said Dr. Lynora Saxinger, an infectious diseases physician and an associate professor at the University of Alberta faculty of medicine in Edmonton. 

“There’s been enough demonstrated risk from the variants being able to become dominant strains over a period of time in multiple jurisdictions that I would have preferred to hold steady and monitor for a period longer.” 

Meanwhile, those variants have caused a surge in cases so rapid in Newfoundland and Labrador, the province has imposed new lockdown measures and cancelled in-person voting for today’s election.

An election campaign sign is shown in St. John’s on Thursday. The outbreak has led to a lockdown of the Newfoundland and Labrador capital, and the suspension of in-person voting across the province. (Paul Daly/The Canadian Press)

Balancing return to ‘normal’ with threat of variants

Saxinger says that while Alberta and other provinces have done an effective job of monitoring for the variants as they emerge, she expects the number of variant cases will no doubt continue to grow as the economy reopens.

“Opening indoor dining is a mistake — plain and simple,” said Dr. Irfan Dhalla, a physician and University of Toronto medical professor who is also a vice-president at Unity Health Toronto. 

“It’s pretty obvious that if we just went back to normal there would be a third wave and it would be absolutely brutal.”

Dhalla says officials are trying to answer the tricky question of how close to normal they can get, while trying to balance keeping cases low in the face of fast-spreading variants. 

“Nobody knows the answer to that question with certainty, but I think everything we’ve seen over the last year tells us it’s better to err on the side of caution,” he said. 

“The prudent thing to do would be to go slow and see what happens after a few weeks.”

Despite keeping its provincewide curfew in place, Quebec has also begun reopening businesses, museums, hair salons and malls — even though gathering in them will not be permitted.

Ontario also began rolling back restrictions this week, lifting stay at home orders in much of the province, allowing for non-essential businesses and even ski hills to reopen, while committing to further loosening measures in the coming weeks. 

“This is not the time to really begin pulling back on restrictions,” Dr. Gerald Evans, chair of infectious disease in the department of medicine at Queen’s University in Kingston, Ont., told The Current this week.

Signs for COVID-19 protocols are displayed as skiers and snowboarders hit the slopes at Mount Pakenham ski hill in Eastern Ontario as the business reopens on Thursday. (Sean Kilpatrick/The Canadian Press)

“Our expectation, when we look at the experience of other countries that have had that variant introduced, is we’re going to see a rise up in numbers and so you don’t want to complicate that by now suddenly rolling back restrictions.” 

The decision to loosen restrictions in Ontario came at the same time health experts warned in a provincial scientific briefing that the spread of variants threatened to trigger a third wave of the pandemic, which could in turn lead to a third lockdown.

“We need to be watching how this unfolds and how it plays out before we make too many changes all at once,” said Dr. Susy Hota, an infectious disease specialist at the University Health Network and an associate professor of medicine at the University of Toronto. 

“The overall numbers look to be going down, but these variants are emerging and they will likely emerge rapidly and our ability to control transmission might change with that.” 

Outbreak in Newfoundland sparked by B117

In a cautionary tale for the rest of the country, health officials in Newfoundand and Labrador confirmed late Friday that a massive outbreak of COVID-19 in St. John’s this week was caused by B117, leading strict lockdown measures to be reimposed.

The province reported 50 new cases of COVID-19 Friday, with the vast majority in the St. John’s region. Thousands of people are in isolation, while others faced renewed lockdown measures that shuttered schools and non-essential businesses.

Bruce Chaulk, the province’s chief electoral officer, announced during a press conference Friday that in-person voting in all 40 districts across the province had been suspended and the election would be solely by mail due to the outbreak.

“We know that if not controlled, it becomes a predominant strain within weeks of first appearance,” said Dr. Janice Fitzgerald, the province’s chief medical officer of health.

“This is concerning and serious. But we have the ability to overcome it.”

There are 260 active cases in the province, with 244 of those reported in the last five days. In contrast, the province had 395 total cases of COVID-19 in all of 2020.

“I actually worry more about those areas that have been spared through most of the pandemic,” said Hota.

“You don’t know what it’s like to deal with COVID until it hits you — and it hits hard.” 

WATCH | Provinces reach for mix of reopening, COVID-19 precautions:

Three provinces — Ontario, Quebec and Alberta — have announced the easing of restrictions, some immediate, some phased in. Strict measures have reduced COVID-19 caseloads and some experts warn relaxing them could bring another spike in cases. 2:39

‘Mixed messaging’ between health experts, provinces 

All of the provinces that moved toward reopening this week cited reduced caseloads as reasoning for their strategies, despite the fact that cases of the variants continue to rise. 

At least three provinces have confirmed community spread of the variants and there have been more than 450 variant cases in Canada to date.

But at the federal level, dire warnings about reopening amid the spread of variants seems to conflict with what’s happening on the ground.

“Resurgence will happen really fast, so this is the time to be vigilant against the variants,” Canada’s Chief Public Health officer Dr. Theresa Tam said during a press conference Friday. 

“We need to really be very cautious about easing public health measures at this time while vaccination is just beginning to accelerate.” 

Dhalla says there’s a growing disconnect between provincial politicians and medical officers of health across the country, which is only adding to confusion for the public. 

Customers enjoy indoor dining at Hunter’s Country Kitchen in Carstairs, Alta., Monday, as Alberta begins a plan to ease restrictions. (Jeff McIntosh/The Canadian Press)

“I think what we’re also starting to see is a little bit of mixed messaging again,” he said.

For example, in Toronto — where a stay-at-home order is in place until at least Feb. 22 — the medical officer of health said this week the city was on the verge of a “new pandemic” due to the spread of variants in the city, which has already found cases of variants first identified in the U.K., South Africa and Brazil. 

“It was inevitable the variants of concern would emerge in Toronto,” Dr. Eileen de Villa said during a press conference.

“We are in a position of great uncertainty with respect to variants but what we know is alarming. I understand the value of preparing for the time we can lift restrictions. From a public health perspective in Toronto, that time is not now.” 

Threat of variants kept restrictions in some provinces

British Columbia said last week it would be extending its public health restrictions indefinitely, despite recent signs that the province is driving transmission down even with at least 40 cases of variants detected. 

“Right now, we need to stay the path,” Provincial Health Officer Dr. Bonnie Henry said. “We need to protect the progress we have made and not squander our progress.”

A Vancouver waiter delivers wine to masked diners outdoors. In B.C., restrictions on gathering with people outside your household that were imposed in November remain in place with no end date. (Ben Nelms/CBC)

New Brunswick is another province sticking with strict public health measures despite having just four confirmed cases of B117. Parts of the province are under lockdown and non-essential travel discouraged in other regions.

“They are going to come to New Brunswick, if they’re not already here,” said chief medical officer of health Dr. Jennifer Russell of the variants late last month after measures were imposed.

“We are in the middle of the second wave right now, but the third wave is going to be upon us very soon and that third wave is much worse than the first and second combined and this third wave is as a result of these new more transmissible, more contagious variants.”

Dr. David Fisman, an epidemiologist at the University of Toronto’s Dalla Lana School of Public Health, says Canada is already starting to see the early warnings of a surge driven by variants and his research predicts a third wave could come as early as March.

“[B117] is doing here what it’s done in Denmark and the U.K. — the new strains are starting to outcompete the old strains,” he said. “Even though it’s a small minority of strains, they’re spreading better here than the old variants are spreading.” 

Saxinger says stronger action needs to be taken “extremely early” to prevent a devastating third wave from variants in Canada and hesitating to act could jeopardize our ability to drive case numbers down — even with strict public health measures that have worked in the past. 

“The leash just has to be very, very short,” she said. 

“Because there’s no way we’re going to have enough vaccines into all the vulnerable populations over the next few months to be able to avert preventable deaths if there’s another big surge.” 


To read the entire Second Opinion newsletter every Saturday morning, subscribe by clicking here.

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Measles case reported locally turns out to be negative: health unit

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
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On March 26, the Simcoe Muskoka District Health Unit (SMDHU) was notified by Public Health Ontario’s (PHO) laboratory that due to laboratory error, the case of measles that had been lab-confirmed positive on March 12, based on symptoms and a positive urine measles laboratory result by PHO’s laboratory, is in fact negative for the measles virus.

“With this new information of the negative lab result, we believe that that individual was not infected with measles and that there has not been any public exposure to measles resulting from this individual’s illness,” said Dr. Charles Gardner, medical officer of health. “We recognize that notifying the public of what we believed to be a positive measles case in our area created worry, anxiety and disruption for some, and we regret this.

“We do know that, despite best efforts, on rare occasions laboratory errors can occur. We are working closely with the PHO’s laboratory to do all that we can to ensure that such an incident does not occur again.”

Measles is a highly contagious viral infection that spreads very easily through airborne transmission. The measles virus can live in the air or on surfaces for up to two hours.

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Symptoms of measles begin seven to 21 days after exposure and include fever, runny nose, cough, drowsiness, and red eyes. Small white spots appear on the inside of the mouth and throat but are not always present. Three to seven days after symptoms begin, a red, blotchy rash appears on the face and then progresses down the body.

The risk of transmission to those vaccinated with two doses is low, and when it does occur tends to show a reduction in the severity of these symptoms.

“Although we are relieved for the individual involved, and for all Simcoe-Muskoka residents, that this case has now been confirmed as negative, we know that measles is still active in Ontario at this time and the potential remains for new cases to arise, especially given the increase in Ontarians travelling to areas in the world that have higher numbers of measles cases,” said Dr. Gardner. “This is why we continue to advise individuals to keep up to date with their routine immunizations, including measles, mumps and rubella (MMR) vaccination.”

The risk of measles is low for people who have been fully immunized with two doses of measles vaccine or those born before 1970; however, many children have been delayed in receiving their routine childhood immunizations and people who have not had two doses of measles vaccine are at higher risk of contracting the disease.

People who do get sick usually recover without treatment, but measles can be more severe for infants, pregnant women, and those with compromised immune systems. Possible complications include middle-ear infections, pneumonia, diarrhea, or encephalitis (swelling of the brain) and occasionally death in the very young. Even individuals who are up to date with the measles vaccine should watch for symptoms of measles for 21 days after exposure.

For more information about measles, please visit smdhu.org or call Health Connection at 705-721-7520 or 1-877-721-7520, Monday to Friday between 8:30 a.m. and 4:30 p.m. to speak with a public health professional.

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Kate Middleton Not Alone. Cancer On Rise For People Under 50, Say Experts

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Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery

London:

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When Catherine, Princess of Wales, revealed she was being treated for cancer last week, part of the shock was that an otherwise healthy 42-year-old has a disease that mostly plagues older people.

However, researchers have been increasingly sounding the alarm that more and more people under 50 are getting cancer — and no one knows why.

Across the world, the rate of under-50s diagnosed with 29 common cancers surged by nearly 80 percent between 1990 and 2019, a large study in BMJ Oncology found last year.

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The researchers predicted the number of new cancer cases among younger adults will rise another 30 percent by the end of this decade, with wealthy countries particularly affected.

The increase in cases — and soaring global population — means that the number of deaths among under 50s from cancer has risen by nearly 28 percent over the last 30 years.

This occurred even as the odds of people of all ages surviving cancer have roughly doubled over the last half century.

Shivan Sivakumar, a cancer researcher at the UK’s University of Birmingham, called it an “epidemic” of young adult cancer.

Since Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery earlier this year, Sivakumar and other doctors have spoken out about the uptick in younger cancer patients they have been seeing at their clinics.

While breast cancer remains the most common for people under 50, the researchers expressed particular concern about the rise of gastrointestinal cancers — such as of the colon, pancreas, liver and oesophagus — in younger adults.

Colon cancer is now the leading cause of cancer deaths in men under 50 in the United States, according to the American Cancer Society. For women, it is number two — behind only breast cancer.

One high profile case of colorectal cancer was “Black Panther” actor Chadwick Boseman, who died at the age of 43 in 2020.

Why is this happening?

“We just don’t have the evidence yet” to say exactly what is causing this rise, Sivakumar told AFP, adding it was likely a combination of factors.

Helen Coleman, a cancer epidemiology professor at Queen’s University Belfast who has studied early onset cancer in Northern Ireland, told AFP there were two potential explanations.

One is that people in their 40s were exposed to factors known to cause cancer — such tobacco smoke, alcohol or being obese — at an earlier age than previous generations.

She pointed out that the “obesity epidemic” did not start until the 1980s.

Sivakumar felt that at least part of the puzzle could be explained by obesity.

However, there is “another wave” of under-50 patients who are neither obese nor genetically predisposed still getting cancer, he emphasised, adding that this could not be put down to “statistical chance”.

The other theory, Coleman said, is that “something different” has been going on with her generation.

Fingers have been pointed out a range of possible culprits — including chemicals, new drugs and microplastics — but none have been proven.

Some have suggested that so-called ultra-processed foods could be to blame. “But there’s very little data to back any of that up,” Coleman said.

Another theory is that the food we eat could be changing our gut microbiome.

While there is nothing conclusive yet, Coleman said her own research suggested that cancer causes changes to the microbiome, not the other way around.

Anti-vaxx conspiracy theorists have even tried to blame Covid-19 vaccines.

This is easily disproven, because the rise in young adult cancer has taken place over decades, but the vaccines have only been around for a few years.

What can be done?

To address the rise in younger colorectal cancer, in 2021 the US lowered the recommended age for screening to 45. Other countries have yet to follow suit.

But the researchers hoped that Catherine’s experience would remind people at home that they should consult their doctor if they sense anything is wrong.

“People know their bodies really well,” Sivakumar said.

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“If you really feel that something isn’t right, don’t delay — just get yourself checked out.”

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Almost 3,000 students suspended in Waterloo Region over immunization issues

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Close to 3,000 children attending elementary school across Waterloo Region were suspended from school on Wednesday morning for not having up-to-date immunization records.

The region says Waterloo Public Health suspended 2,969 students under the Immunization of School Pupils Act (ISPA).

For several months, the region has been campaigning for people to get their children’s vaccinations up to date, including sending letters home to parents on a couple of occasions, warning that students’ records needed to be up to date or they would be suspended.

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It announced in January that 32,000 students did not have up-to-date records: 22,000 elementary students and 10,000 high school students.


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“We have made remarkable progress from the original 27,567 immunization notices we sent to parents in November and December 2023,” Dr. Hsiu-Li Wang, medical officer of health, stated.

“Since that time, we have resolved more than 24,500 outdated vaccination records, providing students with valuable protection against these serious and preventable diseases.”

The high school students still have a few weeks to get their records up to date or else face suspension.

The ISPA requires students to have proof-of-vaccination records for diphtheria, polio, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox) and meningitis, which must be on file with public health.

Public health says caregivers whose children are suspended will need to book an appointment at regionofwaterloo.ca/vaccines for clinics, which will be held in Cambridge and Waterloo on weekdays.

“Given the high number of suspensions, it may take several days before you can be seen at an appointment and return your child to school,” a release from the region warns.

“Record submission and questions must be done in person to ensure immediate resolution.”

The last time suspensions over immunizations were issued was in 2019, when 1,032 students were suspended.

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