The dispatches from the front lines of the COVID-19 outbreak in northern Italy are chilling.
“Nurses with tears in their eyes because we can’t save everyone … Every ventilator becomes like gold.”
That was the message last week from Dr. Daniele Macchini, an Italian physician whose lengthy Facebook post was published in a local newspaper, translated into English and circulated on social media.
“And there are no more surgeons, urologists, orthopedists; we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us,” he wrote.
Three professors from the University of Milan also sent a letter warning doctors in the rest of Europe to “get ready,” because 10 per cent of patients who test positive for COVID-19 end up needing intensive care.
“This situation is like a bomb that explodes, and you’re simply overwhelmed by an incredible number of patients,” another Italian physician, Dr. Giacomo Grasselli, told the CBC News Network this week.
WATCH | Italian doctor says coronavirus is like a bomb that exploded:
Doctor at epicentre of Italian outbreak says coronavirus is a potential disaster for the entire world. 6:57
Grasselli is co-ordinating the intensive care response in Milan, the largest city in the country’s hard-hit northern region. All of Italy’s 60 million people are now under a sweeping lockdown, subject to travel and social restrictions aimed at curbing the spread of Europe’s worst outbreak of coronavirus.
“We’re living this now,” said Grasselli. “My mission is not only to take care of Italian patients, but also to tell other people in the world how to get ready for this.”
There’s still time to ‘flatten the curve’
Canada still has time to avoid such a situation, experts say.
As the global number of coronavirus cases nears 120,000 people in 115 countries, chances of stopping its spread are now considered unlikely. So public health officials have turned their attention to slowing it down.
And the key is to “flatten the curve” — a reference to an epidemiological graph of a disease outbreak.
A large spike on that graph, representing a sudden increase in people with infections, can be catastrophic even for health-care systems in highly developed countries like Canada.
PHAC is using this graph to demonstrate the impact public health measures can have in ‘flattening’ the curve of a disease, slowing down virus transmission and easing pressure on the health-care system. (Public Health Agency of Canada)
“If you can slow it down enough and flatten the curve, so the same number of people get infected, but over a much longer period of time, then … what you’re allowing is that the capacity will not be exceeded,” said Dr. Anand Kumar, a critical care physician at Winnipeg’s Health Science Centre.
“And that protects the community, so that an ICU bed will be available when it’s needed.”
Most healthy people will experience a mild COVID-19 infection because their immune system will protect them. But so far, the experience in Italy and China suggests that as many as 10 per cent of people infected can require critical care.
That creates an urgent need for beds in intensive care units, along with ventilation, dialysis and other life support technology. It also requires qualified health-care specialists to manage patients — excess capacity that Canadian hospitals just don’t have.
We’re at capacity most of the time.– Dr. Robert Fowler, critical care physician and researcher
Most of the country’s hospitals are already operating at 100 per cent capacity, a largely normal situation in Canada’s health-care system.
“We’ve got a system that is designed to meet what our usual demands are,” said Dr. Robert Fowler, a critical care physician at Toronto’s Sunnybrook Hospital. “We’re at capacity most of the time.”
Add to that the extra load from this year’s bad flu season, and suddenly, even in Canada, there’s a risk that care might not be available when patients need it.
“Ideally, you prevent people from being infected — but you certainly don’t want to have everybody infected at once,” said Fowler. “We don’t want to overwhelm the system.”
But the Italians warn that could happen.
“If you do not stop the spread of the disease, your health system — no matter how good, how efficient, how modern it is — sooner or later will collapse,” said Grasselli. “Because the number of patients is too high for the resources we have everywhere in the world.”
That’s why in Canada (and elsewhere) large events are being cancelled, some people are being told to work from home, and some students will be taking courses online for a few weeks. It’s a temporary public health strategy aimed at slowing the potential spread and buying time.
“That’s what people are trying to do to try to prevent the spread right now so we don’t get overwhelmed,” said Fowler. “And it’s going to very much depend on how effective we are at preventing transmission in the community.”
Dr. Anand Kumar is a critical care physician at Winnipeg’s Health Sciences Centre. He said ‘flattening the curve’ of COVID-19 infections in Canada will ensure that critical care beds are available for everyone who needs one. (John Woods/Canadian Press)
Another complicating factor is the fact that there is no vaccine and there are no drugs to treat COVID-19.
“In this particular circumstance, we’re not going to have a vaccine for at least a year, if not a year-and-a-half,” said Kumar. “And there’s no known antiviral drug for coronavirus, so essentially all we can offer is supportive care.
“If you get mildly ill, there’s not something we can give you to stop you from getting severely ill. So what’s going to happen is going to happen. And we’re just going to have to try to support patients as best we can.”
The importance of beds, ventilators
Fowler led a team of researchers that conducteda survey of Canada’s critical-care capacity after the 2009 H1N1 epidemic. At the time, there were about 3,200 ICU beds and almost 5,000 mechanical ventilators spread out in 286 hospitals across Canada.
Ventilators are mechanical breathing machines that will be critical for COVID-19 patients whose lungs are so badly damaged they have trouble getting enough oxygen.
The survey concluded that intensive care resources vary widely across Canada and “during times of increased demand, may result in geographic differences in the ability to care for critically ill patients.”
Ontario, for example, had an extra 209 ventilators stockpiled and spread out across the province as of last August, according to one provincial document.
Canada’s hospitals are counting their ventilators, used to assist breathing in critically ill patients. Experts warn that Canadian hospitals have limited space and capacity. That’s why slowing the spread of COVID-19 is important to preserve that capacity. (Craig Chivers/CBC)
“The physical space within a hospital to care for people is, I think, probably even more challenging beyond the physical number of ventilators,” said Fowler.
Kumar is particularly concerned about the number of qualified staff to handle a possible surge in patients.
“The bottleneck is in manpower, even more than physical space and even ventilators,” he said. “I think everybody is contingency planning for the possibilities.”
Some of the challenges now relate to approaching the management of COVID-19 on a national scale — and being ready to help regions that are hit harder, experts say. That may involve moving equipment and health-care workers to where they are most urgently needed.
“There’s patchiness in where these outbreaks hit,” said Fowler. That means doctors and nurses can be completely overwhelmed in one place, but it can be business as usual in the rest of the country.
In Italy, health-care workers are already talking about the grim reality of “triaging” under strained circumstances, which means they’re being forced to choose between life and what might have been a preventable death for some people, based on the availability of ventilators and ICU beds.
Canada has studied the concept of such triaging, but Fowler said so far no system has been established.
“In Canada, we don’t really have a working example of what that would look like and we haven’t had to do that,” he said.
“We shouldn’t be having that conversation ahead of the conversation about when a place gets busy, how can we bring support.”
SAINT PAUL, Minn. – The debate between Tim Walz and JD Vance began with a focus on Donald Trump’s record in office as the vice-presidential hopefuls were quick to take an attack dog approach to defending their presidential partner on the ticket.
In response to a question about increasing turmoil in the Middle East, Walz, the 60-year-old Democratic governor of Minnesota, criticized Trump’s record on foreign policy and said “a near 80-year-old Donald Trump talking about crowd sizes” is not what is needed.
Vance, the 40-year-old Republican senator from Ohio, responded “Donald Trump actually delivered stability in the world.”
Republicans and Democrats are both hoping Tuesday’s matchup will demonstrate their vice-presidential candidate’s ability to connect with voters in battleground states that will play a critical role in deciding the U.S. election in November.
“They will both be trying to connect with those key Midwestern voters, that’s part of why each one of them was chosen,” said Matthew Lebo, a specialist in U.S. politics at Western University in London, Ont.
“Thinking about especially male voters in those key Midwestern swing states: Pennsylvania, Wisconsin and Michigan.”
Those states swung Republican when Trump won the 2016 election, and in 2020 they helped put President Joe Biden in the White House.
Walz has embraced his folksy, plain-spoken demeanour since he joined the ticket earlier this summer. He’s leaned into his Midwestern roots and the title “Coach Walz” from his former football coach days.
The strategy has seen him garner high favourability in polls but he will be facing a formidable opponent in Vance, who has become a mainstay on cable news shows since he was announced as Trump’s running mate in July.
Formerly a Trump critic, Vance was elected to the U.S. Senate in 2022 after becoming one of the former president’s loudest supporters.
Before entering the political sphere, Vance rose to fame with the 2016 publication of his memoir, “Hillbilly Elegy.” The Republican vice-presidential hopeful opened the debate talking about his life and struggles growing up.
Both men are expected to play on their working-class narratives during the debate to give credibility to their party’s plans for the economy and inflation.
“Vance is brilliant and I’m expecting good things from him,” said Alec Beck, chairman of the fifth congressional district for the Republican Party of Minnesota, at a watch party in New Hope.
“And our governor is very good on his feet, even though he’s not on our team, I give the devil his due. He has a lot of skills in this area.”
Political experts have said Vice-President Kamala Harris dominated the presidential debate last month by prodding Trump into tirades that strayed far from his intended goals of focusing on immigration and the economy.
Aaron Kall, the director of debate for the University of Michigan, said it’s unlikely Vance will fall for the same strategy, and he expects Tuesday night’s debate will lean more into policy.
But that doesn’t mean there won’t be barbs.
Walz was given credit for coining the label “weird” to describe his Republican opponents and the attack has stuck to Vance, with numerous viral videos and memes targeting the senator’s past comments and encounters with voters.
“They really couldn’t be more diametrically opposed, kind of like Harris and Trump,” Kall said.
“I think there’s going to be a lot of fireworks, given their personalities.”
This report by The Canadian Press was first published Oct. 1, 2024.
OTTAWA – The Liberal government survived a second non-confidence vote in as many weeks Tuesday, once again putting off the possibility Canada would be plunged into an immediate election campaign.
Though the Liberals are in the clear for another day, the Bloc Québécois made it clear they may not be so fortunate the next time the Conservatives bring a non-confidence motion before the House of Commons.
Members of Parliament voted on a Conservative motion Tuesday afternoon that called for MPs to declare they have lost faith in Prime Minister Justin Trudeau and his nine-year-old government.
The Liberals, NDP and Bloc Québécois voted against the motion, as they did with a similar motion last week.
Last month, the NDP ended a supply-and-confidence agreement that had stabilized the minority government for more than two years. New Democrats now will vote on a case-by-case basis but have given no ultimatums for their support.
Bloc Leader Yves-François Blanchet has given the Liberals until Oct. 29 to green-light his party’s pension bill, which is estimated to cost about $16 billion over five years.
In exchange, his party will “not unplug the government that isn’t doing well,” he said in French on Tuesday.
“If the government doesn’t accept our request, well, we’ll understand what that means and we’ll begin negotiations that might not be pleasant, but the end will be clear,” Blanchet said in his speech to the House Tuesday, promising in that case to work with other opposition parties to bring the government down.
Acquiescing to the Bloc’s demands, however, will only buy the government a few months of support.
The NDP and Conservatives already voted in favour of the Bloc’s pension bill at second reading, which would increase old age security payments by 10 per cent for seniors aged 65 to 74.
Because it’s a spending bill, the governing Liberals need to support the legislation. They have not yet said whether they will negotiate with the Bloc.
The Liberals increased old age security payments by 10 per cent for people over the age of 75 in 2022, with the intention of targeting the most vulnerable seniors.
Despite all the attention on the political threat to the Liberals, Bloc MP Yves Perron said the vote on the bill is a question of human dignity for seniors.
Instead of debating the motion, Kevin Lamoureux, the parliamentary secretary to the Liberal House leader, outlined other ways his party has supported seniors since it was elected in 2015, including by creating a national dental-care program for low- and middle-income Canadians and drafting national pharmacare legislation.
“These programs are of great benefit to our seniors. Unfortunately, the Bloc have made the decision to vote against these programs,” said Lamoureaux.
Liberal House leader Karina Gould would not comment on the Bloc’s motion Tuesday except to say that she looked forward to the debate.
NDP MP Bonita Zarrillo called the Liberals “cruel and callous” for withholding financial support for the Bloc bill. The vote on the Bloc’s motion is expected later this week.
This report by The Canadian Press was first published on Oct. 1, 2024.
MONTREAL – When Chris Boucher first played an NBA pre-season game in his home city in 2018, he was a raw talent trying to crack the Toronto Raptors roster.
Six years later, the 31-year-old is back in Montreal as the longest-serving Raptor — and the only remaining player from the 2019 championship team.
“It’s been nuts. It’s been crazy,” said Boucher, reflecting on his journey as the Raptors opened training camp at the Université du Québec à Montréal on Tuesday.
“People thought that surely I would only do a year or two, but now it’s been six or seven years, and I’ve been here longer than anyone else on that team,” he added to a pack of French-Canadian reporters there to greet the homegrown talent.
Toronto’s camp — which includes an open practice at McGill University on Friday night — runs through Sunday’s Raptors versus Washington Wizards pre-season matchup at Montreal’s Bell Centre.
Although Boucher has reached veteran status, he’s still playing for his next contract.
Boucher is entering the final year of his deal after watching his role on the Raptors diminish last season, but says he isn’t concerned following a constructive off-season where he worked closely with head coach Darko Rajaković.
“I’m not worried. I’ve put in a lot of work,” Boucher said. “I’ve talked with the coach, I’ve talked with the GM, we’ve spent a lot of time figuring out what I can do.
“The team is young, and I’ve put myself in a good position to change what happened last year.”
As he prepares to play in front of friends and family this week, Boucher is focused on having a solid camp after averaging 6.4 points and 14.1 minutes last season — his lowest numbers in years. He also played just 50 games because he sustained a knee injury in March.
Over the off-season, Boucher said he trained with Rajaković on his playmaking and understanding of the game.
They also worked on improving his mindset and “trying to get me to a better place,” and the head coach took notice.
“We had amazing and heart-to-heart conversations this summer, and I was really impressed with Chris, what he achieved,” Rajaković said. “He worked on his body, he got stronger, he added a couple of pounds of muscle, he was disciplined, he came in the gym, he put in a lot of work.
“That gives me a lot of confidence that he’s ready for the next step, that he’s ready to grow and he’s ready to fit in with our team.”
Rajaković said the season would dictate Boucher’s role and minutes, but he expects the Canadian to help younger players with his leadership while crashing the boards and playing disruptive defence when he’s on the floor.
“I want all 15 guys to put me in a really tough situation to make decisions about who’s going to be playing,” Rajaković said. “Chris is doing an amazing job, and I can see him doing a very important job for our team this year.”
Boucher may be in his 30s, but likes to remind people that he picked up the game far later than most.
“There are a lot of people who have been playing since they were eight or nine years old, but I started when I was 20,” said Boucher, who went undrafted in the NBA.
DAVION’S DEFENCE
Raptors president Masai Ujiri said Monday that the Raptors’ defence being among the league’s worst last season was “not something we’re proud of.”
Off-season acquisition Davion Mitchell wants to be part of the solution.
“That’s the reason I’m in this league,” the point guard said. “Playing defence, putting pressure on the ball, disrupting people offensively … that’s the reason why I’m here.”
The 26-year-old Mitchell, a ninth-overall draft pick in 2021, averaged 5.3 points and 1.9 assists with the Sacramento Kings last season, but has a reputation for his smothering on-ball defence.
“He has a good track history of doing that on a high, high level. My conversations with Davion go even further,” Rajaković said. “He needs to be better off ball … getting in the right spots, not falling asleep for a half of a second, just being as disruptive off the ball as much he is on the ball.”
BARNES EXCUSED
The Raptors excused star forward Scottie Barnes from the start of training camp due to personal reasons. Barnes did not travel with the team to Montreal, but the Raptors said he was expected to join the team later in the week.
Barnes, 23, averaged 19.9 points, 8.2 rebounds and 6.1 assists in his third NBA campaign last season and earned his first all-star selection.
Rajaković said he expects the team’s centrepiece to get up to speed in no time once he’s back.
“Scottie spent a lot of time around the team this year, we have communication daily,” Rajaković said. “He’s an extremely smart player, so he’s going to be able to pick that up very quickly.”
This report by The Canadian Press was first published Oct. 1, 2024.
