Canada is emerging from months of lockdown, but key questions remain unanswered about where Canadians are getting infected with COVID-19 and why case levels remain high in our hardest-hit provinces.
Ontario and Quebec have seen their rate of new cases plateau in recent weeks, still in the hundreds each day, and have little information on the source of infection or what effect reopening will have.
“It’s scary. There’s a large sense of unknown there,” said Dr. Michael Gardam, an infectious disease specialist and chief of staff at Humber River Hospital in Toronto, who is a veteran of SARS and H1N1.
“And there’s no way around the fact that this is uncomfortable.”
Even local health officials have concerns about lifting lockdown measures.
Dr. Lawrence Loh, the Medical Officer of Health for Peel Region, west of Toronto, said this week the province’s move to reopen was “out of step” with the “continuing risk” of the coronavirus pandemic, and recommended delaying easing restrictions.
“We have seen our new cases starting to plateau, but we have just not seen a decline in line with the province’s own framework for reopening at this point,” he said, adding the region had 20 per cent of all new COVID-19 cases in Ontario last week.
He notes the recent new case levels in the province — between 300 and 500 each day — mirror the levels in the early days of lockdown.
That concern was echoed by Dr. Chris Mackie, the Medical Officer of Health and CEO for the Middlesex London Health Unit in London, Ont., who said the region may need to “reconsider” reopening after case counts rose this week.
“We should not be seeing these sorts of numbers at this stage,” he said, adding the local increase, as well as the provincial one, is higher than it should be.
“If this continues on for the next few days, we might have to reconsider some of the loosening of public health measures.”
The Ontario Ministry of Health could not provide CBC News with a clear picture of where exactly people are getting infected in the province.
“This is ongoing work,” a spokesperson said in a statement, and said the issue was being examined by Ontario’s Chief Medical Officer of Health Dr. David Williams.
“Dr. Williams has asked the local public health units to collect more specific information from new cases about the possible sources of transmission.”
Experts say lifting lockdown measures without a clear picture of where new cases are coming from, and while testing is not at capacity, is cause for concern.
“We’re only ever measuring the tip of the iceberg, and so there’s a bunch of cases out there that we don’t know about, and presumably those cases are transmitting,” Gardam said.
“Because you’re not testing everybody, you are going to get cases where you don’t know where they came from.”
Dr. Irfan Dhalla, a physician and University of Toronto medical professor who is also a vice-president at Unity Health Toronto, said Ontario needs to proceed with caution.
“I would be nervous about some elements of the reopening strategy in some areas of the province,” he said.
“We need to redouble our efforts to continually improve our understanding of where ongoing transmission is occurring so that we can reopen safely.”
Quebec forges ahead with reopening
In Quebec, the number of new cases remains the highest in the country, with an 720 new cases and 82 deaths reported Thursday.
Quebec’s Director of Public Health Dr. Horacio Arruda said he’s still not satisfied with the number of people getting tested in the province, falling well below the capacity to test 20,000 per day.
And the province’s latest public health data provides no clear information on why infection continues to occur even after months of lockdown.
Despite this, Quebec is moving ahead with reopening soon.
As of Friday, people from up to three different households in the province will be allowed to gather outside in groups of 10 as long as they maintain physical distancing.
And starting June 1, the province will allow a number of personal care services such as dental clinics and massage therapy to reopen.
Hairdressers, manicurists and other beauty care services will be allowed to open on the same date — but not in the greater Montreal and Joliette areas, where there are still significant COVID-19 outbreaks.
“This has to be done while ensuring everyone’s protection — the protection of workers and clients as well,” Health Minister Danielle McCann said Wednesday. “So there will be rigorous prevention measures set up.”
Quebec’s public health strategic adviser, Dr. Richard Massé, said visits to these types of service providers can be carried out safely if both the providers and the clients respect the rules.
“If it’s done properly, there is a very good level of protection,” he said.
No clarity on source of COVID-19 infections
But the level of uncertainty over where infections are happening in Ontario and Quebec as lockdown measures lift is compounded by the fact that a large number of cases in Canada have no known source of infection.
The federal government can only provide basic information on where infection is occurring for less than half of our more than 80,000 COVID-19 cases — and even that data is incomplete.
The latest available update from the Public Health Agency of Canada found 3,787 COVID-19 cases had travelled outside of Canada; 24,848 are from “domestic acquisition”; while a further 10,433 have “information pending.”
But not all parts of the country have the same problem.
Alberta has expanded testing to asymptomatic close contacts of positive COVID-19 cases in an effort to find and isolate new cases before they turn into outbreaks.
While British Columbia, which looked like it could be among Canada’s hardest-hit provinces early on in the pandemic, now appears to be one of the best positioned to reopen.
So should parts of the country be moving toward reopening even if they can’t answer those key questions?
“Everybody would like them answered, but I think it’s just not possible in the current circumstances to be able to think that we can,” said Dr. Allison McGeer, an infectious disease expert and a professor at the University of Toronto’s Dalla Lana School of Public Health.
“So if we can’t do that, then the question becomes: Do we sit forever? Or do we move with everybody else in reducing precautions and watch to see what will happen?”
Ontario says its first phase of reopening is focused on “low-risk workplaces,” and that public health officials will “carefully monitor each stage.”
If the first stage of the gradual reopening of Ontario is successful, it will move toward second and third stages. If not, public health measures will need to be “adjusted and/or tightened.”
There’s really no way of knowing what the future holds for any part of the country as lockdown measures lift, McGeer says.
“The only way you can answer that question is by trying it out. There’s not a rulebook. You can’t know what’s going to happen when you do this,” she said.
“I hope that we all know, as Ontarians, as Canadians, that this step forward might be reversed, but we’re going to try it out and we’re going to see what happens.”
1 step forward, 2 steps back?
But Canada should consider whether reopening then backtracking could ultimately set us back further.
South Korea was forced to take a step back from its reopening strategy last week after a cluster of cases at a nightclub district in Seoul called into question whether the country lifted certain lockdown restrictions too soon.
The incident led to an outbreak of more than 100 new cases and ultimately forced the country to shut down thousands of nightclubs indefinitely to prevent a spike in new cases.
“If you don’t have to backtrack at all, then it probably suggests that we waited too long to reopen,” said Dhalla.
“What we don’t want to have happen are large outbreaks that result in lots of people needing to be cared for in hospital and people dying, but I think it’s inevitable that we will learn as we go.”
McGeer said although it may not be palatable for Canadians to think about lockdown measures being reimposed if things don’t go well, it may be part of our new reality as we test the waters of reopening.
“Honestly, I think it’s the best we can hope for. We don’t want to stay in lockdown unless it’s essential that we stay in lockdown,” she said.
“But if we can allow more activity and not get into trouble, then that’s what we should be doing.”
She said Canadians should brace themselves for the possibility of lockdown measures being lifted then reimposed for the foreseeable future until an effective treatment for or vaccine against COVID-19 is developed.
“As long as we know that’s where we’re going and what’s going to happen, I think people will be happier with being allowed to do some things for a while rather than staying in lockdown for the whole time,” she said.
“But it’s really important that people know that this might happen — that we might have to go back.”
Kamloops ranch that refused vaccinated guest but kept their deposit now says they'll issue $3.2K refund – CBC.ca
A ranch owner in Kamloops, B.C., has been criticized by the province’s solicitor general for refusing to accept a vaccinated international traveller.
The Equinisity Ranch in Kamloops, in the province’s central Interior, is run by owner Liz Mitten Ryan. She told CBC News she catered almost exclusively to international travellers, including from England, Switzerland and Australia.
In a report in The Guardian, published Thursday, a prospective traveller called J.W. York said they had booked a $3,200 retreat (£2,000) with Ryan in May 2020, but the trip was put off due to lockdowns and other pandemic restrictions.
According to York, they were told recently they were not welcome at Equinisity anymore because they were fully vaccinated against COVID — and they would not be receiving a refund due to ranch policy.
Ryan confirmed that the ranch had a “no vax” policy for patrons, even though international travellers have to be fully vaccinated to enter Canada. The Guardian article quoted her as saying that vaccines were a “bioweapon depopulation tool” that could transfer to animals.
The entire episode was called “outrageous” by B.C. Solicitor General Mike Farnworth.
“I have asked my ministry, the consumer protection branch, to look into this,” he told CBC News.
“This is just wrong. Like, you want to subscribe to a wack job conspiracy theory. That’s your business. But you don’t rip people off like this. It’s unethical.”
Refunds will happen, says owner’s husband
In a statement, Kevin Ryan — Liz Ryan’s husband — said the ranch would eventually send refunds to customers.
“For personal reasons for this summer, [Liz] has implemented a policy of non-vaccinated guests only,” the statement read. “Not, I stress, realizing any regulations were being broken.
“Due to the current public interest in this situation, and the subsequent informed discussions, she now realizes that it is appropriate the deposit, in this case, needs to be returned to comply with said regulation.”
Ryan told CBC News all deposits “of a similar status” would be returned by the end of the month.
On its website, Equinisity says it provides “a unique journey” for patrons to find “true healing” through meditation, horse riding and other activities. Ryan says his wife had been running the establishment for over 15 years.
Their pricing guide shows that individual patrons can expect to pay $2,800 for an eight-day retreat, while couples can expect to pay $2,400 each.
Before her husband’s statement about refunds, Liz Ryan had suggested that any vaccinated traveller sell their booking. She also said her ranch had been shut down for two years, the longest such span of her career, due to border restrictions.
Farnworth told CBC News that Equinisity’s stance against vaccinated travellers would give international travellers a bad impression of the province.
“It sends a terrible message in terms of tourism here in British Columbia and Canada,” he said. “Because, let’s face it, this person that took this trip is now going to tell their friend … ‘Why would you want to come here?'”
Farnworth said his staff would be investigating if the ranch had received any COVID relief funding, and that the ranch would not be eligible in any case, given the requirements placed on vaccinated travellers.
“I don’t think it’s particularly good business practice,” he said.
How Canada’s new NOC will affect Express Entry eligibility – Canada Immigration News
Immigration, Refugees and Citizenship Canada (IRCC) currently uses NOC 2016 to determine the eligibility of occupations under its temporary and permanent residency programs. However, IRCC must switch to NOC 2021 starting in November as per Canadian law.
The NOC is managed by Employment and Social Development Canada (ESDC) and Statistics Canada, which revise the system every 10 years. NOC 2021 will introduce new terminology and a revised classification structure that will affect IRCC programs.
As a result of these changes, the following 16 occupations will become eligible under Express Entry:
- Payroll administrators;
- Dental assistants and dental laboratory assistants;
- Nurse aides, orderlies and patient service associates;
- Pharmacy technical assistants and pharmacy assistants;
- Elementary and secondary school teacher assistants;
- Sheriffs and bailiffs;
- Correctional service officers;
- By-law enforcement and other regulatory officers;
- Estheticians, electrologists and related occupations;
- Residential and commercial installers and servicers;
- Pest controllers and fumigators;
- Other repairers and servicers;
- Transport truck drivers;
- Bus drivers, subway operators and other transit operators;
- Heavy equipment operators; and
- Aircraft assemblers and aircraft assembly inspectors.
There will also be three occupations that will become ineligible, including:
- other performers;
- program leaders and instructors in recreation, sport and fitness; and
- tailors, dressmakers, furriers and milliners.
These three occupations will remain eligible for programs with broader occupational eligibility criteria, such as some streams of the Provincial Nominee Program.
The major change to NOC 2021 is the current four-category “skill level” structure has been overhauled and replaced by a new six-category system. The new system outlines the level of Training, Education, Experience and Responsibilities (TEER) required to enter each occupation.
The previous NOC had four skill levels. NOC A represented jobs that tend to require university degrees, NOC B included jobs in the skilled trades or that require a college diploma, NOC C covered jobs that require intermediate skills or job-specific training, and NOC D was for labour jobs that require on-the-job training.
In September 2020, IRCC’s Executive Committee decided that the new TEER structure will be adopted as follows:
|NOC 2016||NOC 2021|
|Skill Type 0||TEER 0|
|Skill Level A||TEER 1|
|Skill Level B||TEER 2|
|Skill Level B||TEER 3|
|Skill Level C||TEER 4|
|Skill Level D||TEER 5|
NOC 2021 will use a five-tier hierarchical system to classify occupations. Also, occupations will now have a five-digit codification system instead of the current four-digit system. The TEER system has six categories, 0, 1, 2, 3, 4, and 5.
Statistics Canada explains there are two main reasons why the skill type model is being replaced by the TEER system. First, the TEER system aims to provide more clarity on the level of education and work experience required to work in an occupation. Second, the skill type model creates artificial categorizations between low- and high-skilled jobs. Implementing TEER is intended to give stakeholders a better sense of the skills required for each occupation.
This Statistics Canada tool allows you to see how your current NOC corresponds with NOC 2021.
© CIC News All Rights Reserved. Visit CanadaVisa.com to discover your Canadian immigration options.
More Canadians could face late-stage cancer tied to diagnosis delays during COVID pandemic – CBC News
It all started with a stomach bug.
That’s what Cheryl-Anne Labrador-Summers thought, anyway. It was October 2020, not long after she’d moved to the tranquil lakeside Ontario community of Georgina, and instead of relaxing with her family like she’d planned, the mother of three was struggling to figure out why she kept experiencing strange, unexplained stomach cramps.
Labrador-Summers tried to visit her family physician, but the office was shuttered because of the COVID-19 pandemic. So she searched for another clinic — only to be offered a phone appointment rather than an in-person assessment. She wound up being told that her grumbling digestive system was likely caused by a mild gastrointestinal illness.
By January, the 58-year-old had a distended stomach, looking — in her own words — “about nine months pregnant.” Again, she reached out to a physician, went for some tests, then headed to the nearest emergency department.
After finally seeing a doctor face to face for the first time in months, she learned the real cause of her discomfort: an intestinal blockage caused by cancer.
“It ended up being a nine-centimetre tumour, and it had completely blocked off my lower bowel,” she said.
An emergency surgery left Labrador-Summers with 55 staples along her torso and a months-long recovery before she could begin oral chemotherapy. Her question now is unanswerable but painful to consider: Could that ordeal have been prevented, or at least minimized, by an earlier diagnosis?
“Had I maybe been able to see the doctors earlier, I would not be in Stage 3,” she said. “I might have been a Stage 2.”
951,000 fewer cancer screenings in Ontario
More Canadians could experience late-stage cancer diagnoses in the years ahead, medical experts warn, forecasting a looming crisis tied to the ongoing COVID-19 pandemic.
“We expect to see more advanced stages of presentation over the next couple of years, as well as impacts on cancer treatments,” said oncologist Dr. Timothy Hanna, a clinician scientist at the Cancer Research Institute at Queen’s University in Kingston, Ont.
“We know that time is of the essence for people with cancer. And when people are waiting for a diagnosis or for treatment, this has been associated with increased risks of advanced stage and worse survival.”
One review of Ontario’s breast, lung, colon, and cervical cancer screening programs showed that in 2020 there were 41 per cent — or more than 951,000 — fewer screening tests conducted compared with the year before.
Screening volumes rebounded after May 2020, but were still 20 per cent lower compared to pre-pandemic levels.
WATCH | Late-stage cancer being diagnosed in Canadian ERs:
That drop in screenings translates into fewer invasive cancer diagnoses, including roughly 1,400 to 1,500 fewer breast cancers, wrote Dr. Anna N. Wilkinson, an assistant professor in the department of family medicine at the University of Ottawa, in a May commentary piece for the journal Canadian Family Physician.
“The impact of COVID-19 on cancer is far-reaching: screening backlogs, delayed workup of symptomatic patients and abnormal screening results, and delays in cancer treatment and research, all exacerbated by patient apprehension to be seen in person,” she wrote.
“It is clear that there is not only a lost cohort of screened patients but also a subset of missed cancer diagnoses due to delays in patient presentation and assessment,” leading to those cancers being diagnosed at a more advanced stage.
Tough accessing care in a ‘timely way’
The slowdown in colonoscopies may already be leading to more serious cases of colorectal cancer in Ontario, for instance, suggests a paper published in the Journal of the Canadian Association of Gastroenterology.
“Patients who were treated after the COVID-19 pandemic began were significantly more likely to present emergently to hospital. This means that they were more likely to present with bowel perforation, or severe bowel obstruction, requiring immediate life-saving surgery,” said the study’s lead author, Dr. Catherine Forse, in a call with CBC News.
“In addition, we found that patients were more likely to have large tumours.”
In some cases — like Labrador-Summers’s situation — Canadians learned alarming news about their health in hospital emergency departments after struggling to receive in-patient care through other avenues.
Shuttered family physician offices, a shift to telemedicine, and some patients’ fears surrounding COVID-19 may all have played a role.
“It became harder for patients to access care and to access it in a timely way,” Hanna said.
“At the same time, there were real risks — and there are real risks for leaving home to go anywhere, particularly to go to an outpatient clinic or a hospital in order to get checked out.”
Dr. Lisa Salamon, an emergency physician with the Scarborough Health Network in Toronto, said she’s now diagnosing more patients with serious cancers, including several just in the last few months.
“So previously, it may have been localized or something small, but now we’re actually seeing metastatic cancer that we’re diagnosing,” she explained.
Lessons for future pandemics
Health policy expert Laura Greer is dealing with Stage four, metastatic breast cancer herself after waiting more than five months for a routine mammogram she was initially due for in the spring of 2021 — a precautionary measure given that her mother had breast cancer as well.
Unlike an early-stage diagnosis, Greer’s cancer is only treatable, not curable.
“It was an example of what happens when you don’t have the regular screening, or those wellness visits,” said the Toronto resident and mother of two.
“I most likely would have had earlier-stage cancer if it had been sooner.”
Pausing access to care and screenings for other health conditions can have dire impacts on patients, according to Greer, offering lessons for how policy-makers tackle future pandemics.
“We need to make sure that we’ve got enough capacity in our health system to be able to flex, and that’s what we really didn’t have going into this,” she said.
For Labrador-Summers, it’s hard to forget the moment her life changed while she was alone in an emergency department, learning a terrifying diagnosis from a physician she’d just met. Her mind raced with questions about the future and concerns for her family.
“My older son had just told us they were expecting a child, and I just wanted to be there for them. And I didn’t know what next steps were. And we had lost my mom to cancer a few years back — to us, cancer was always terminal,” she recalled.
“So again, I’m alone, trying to process all of this.”
A screening following Labrador-Summers’ surgery and chemotherapy treatment wound up finding more cancer.
“It’s now life-threatening,” she said.
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