Fifteen years ago, scientists discovered a cave in southern China that held viruses almost identical to the one that has killed nearly 500 people today and the ones that caused the SARS and MERS outbreaks decades ago.
The cave, whose exact location is being kept secret, is inhabited by wild bats that have been found to carry a “rich gene pool of SARS-related coronaviruses,” said Peter Daszark, the president of EcoHealth Alliance, a U.S. nonprofit organization that monitors wildlife diseases that could pose a pandemic risk.
Daszark said that one of the 500 or so virus strains discovered in 2004 is 96 per cent similar to the novel coronavirus that has infected 28,000 people and killed 560 since the outbreak began in December.
“What we’re saying is that this cluster of viruses is a high risk,” Daszark said.
The cave was discovered as part of the team’s efforts to track viruses similar to SARS in 2003, after the epidemic had struck, Daszark explained. At the time, people believed civets had caused the outbreak, but Daszark’s team disputed that notion.
A captured mouse-eared bat being handled for sample collection in a cave in Guangdong Province, China.
EcoHealth Alliance
Bats host a much higher number of zoonotic viruses than other mammals, many of which have caused human disease and outbreaks. A 2019 study warned that bats could cause the next coronavirus epidemic in China, due to their geographic proximity to several urban hotspots. This cave, for example, is located 60 kilometres from the city of Kunming in the Yunnan province of China.
After the SARS epidemic, the team did not find many bats in the wildlife market, Daszark said, but noticed that people were “hunting them in the wild and selling directly to restaurants.” It collected faeces from bats that lived in the cave and tested them.
“We found viruses in bats that could infect human cells in a lab,” he said.
The team then tested the viral strains on mice to see whether they would cause a SARS-like disease. They did.
Scientists record sample collection near bat cave, Guangdong Province, China. Scientists took samples from bat faeces and tested them for viruses in the lab.
EcoHealth Alliance
Finally, the team drew samples from people who lived near the bat caves and found that three per cent of them had developed antibodies to the viruses — proving that the strains can and have infected humans in the past.
“So that was a red flag,” Daszark said.
But a lack of funding prevented scientists from researching the virus now known to be a close relative of the 2019 novel coronavirus.
“It’s not that we didn’t find it interesting,” Daszark said. “It went back into the freezer because we didn’t have enough money.”
Instead, the researchers focused on the strains that most resembled SARS and flagged those as most high risk to authorities.
The team published its results in a number of accredited academic journals and Daszark argued for the viruses to be added to the WHO’s top pathogens of high risk to human health.
After flagging the viruses, the team went back to the same regions in China to interview people in rural communities and learn who was at highest risk in contact with wildlife. “We published that information, too, and now if you go to some of those caves, there’s a sign up that says don’t go in, no entry. That’s the sort of thing that the government does,” he explained.
This cave, he said, has since been redeveloped but declined to elaborate.
“(WHO) took it seriously. The Chinese government took it seriously,” Daszark said. China has attempted to ban the trade and has even banned consumption of wildlife from government banquets, which is “a big thing,” he added.
However, it’s tough to block all the ways, such as the wildlife trade, that these viruses “spill over” into human populations. Behaviours like these, he explained are “culturally deep in our population habits.… These things go back 5,000 years of history, it’s not straightforward. You can’t just ban it and it goes away.”
This picture taken on January 15, 2020 shows cleaners (C) sweeping the floor at a market in Beijing. – The World Health Organisation (WHO) said on January 20 it believed an animal source was the “primary source” of the outbreak.
NICOLAS ASFOURI / AFP
Scientists studying the current coronavirus outbreak have not yet narrowed down how the disease spread to humans. If there was enough funding, however, Daszark believes that further research on the strain might have made a difference to preventing or minimizing the impact of the current outbreak. The funding could have supported efforts to sequence the virus genome, test it on animal models and then, depending on results, flag it as a “high risk factor” to respective authorities.
“You can’t say for sure” whether the current pandemic would have been prevented, he stressed. “We also don’t know for sure that blocking, you know, talking to communities and trying to get this reduced contact would actually stop an outbreak. But every little bit helps,” he said.
There also isn’t enough large-scale support or funding to finance efforts to prevent pandemics from occurring in the future — a long-term, yet realistic endeavour, said Daszark.
Last year, PREDICT, a U.S. federal program to identify wildlife viruses that could infect humans was shut down by the government due to “the ascension of risk-averse bureaucrats,” according to Dennis Carroll, the former director of the United States Agency of International Development.
Over the past decade, the initiative had discovered more than 1,000 new viruses, including a new strain of Ebola. It also trained people and created medical infrastructure in several developing countries to prepare for potential outbreaks.
USAID also funded the $200 million Global Virome Project, an international effort launched in 2016 to identify and catalogue 99 per cent of “all zoonotic viruses with epidemic/pandemic potential.”
A man drags a handcart across a road on February 5, 2020 in Wuhan, Hubei province, China. Flights, trains and public transport including buses, subway and ferry services have suffered disruption for two weeks.
Getty Images
GVP estimates that there are about 1.5 million viruses present in wildlife, some of which could pose a risk to human health. The organization needs between $1.2 billion and $3.4 billion to find them — a minimum of $125 million a year.
It looks like a big number. Yet, CNN reported that the coronavirus outbreak could cost China $60 billion in lost economic growth. After SARS broke in 2003, an estimated $40 billion was lost in productivity.
“It’s hard to maybe fight for something that you don’t know about when there are other things that are killing people,” said Goldstein, a UC Davis virologist, who works with the GVP. “But examples like these just explain why we need to continue investing in both of these streams.”
While “it’s hard to say what will prevent an outbreak,” once authorities can understand where and when people are coming into contact with a potentially risky virus, and the kind of population behaviours that initiate contact, “you can think about how to prevent that or how to reduce contact,” she said.
Daszark also argued that there are economic benefits to initiatives that could prevent future pandemics. “We did an analysis on the return of investment of reducing the number of outbreaks,” he said. “For every dollar you spend on that, well, you get a $9 return on investment. It really does make economic sense as well as good public health.”
“We need a proper concerted effort,” he said, and there might be more of a willingness to “think more strategically” after this outbreak.
“But the problem is between our breaks, in a year from now, the momentum may have gone — as it often does.”
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.
Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.
Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.
LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.
The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.
Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.
This report by The Canadian Press was first published Oct. 15, 2024.
Rana Van Tuyl was about 12 weeks pregnant when she got devastating news at her ultrasound appointment in December 2020.
Her fetus’s heartbeat had stopped.
“We were both shattered,” says Van Tuyl, who lives in Nanaimo, B.C., with her partner. Her doctor said she could surgically or medically pass the pregnancy and she chose the medical option, a combination of two drugs taken at home.
“That was the last I heard from our maternity physician, with no further followup,” she says.
But complications followed. She bled for a month and required a surgical procedure to remove pregnancy tissue her body had retained.
Looking back, Van Tuyl says she wishes she had followup care and mental health support as the couple grieved.
Her story is not an anomaly. Miscarriages affect one in five pregnancies in Canada, yet there is often a disconnect between the medical view of early pregnancy loss as something that is easily managed and the reality of the patients’ own traumatizing experiences, according to a paper published Tuesday in the Canadian Medical Association Journal.
An accompanying editorial says it’s time to invest in early pregnancy assessment clinics that can provide proper care during and after a miscarriage, which can have devastating effects.
The editorial and a review of medical literature on early pregnancy loss say patients seeking help in emergency departments often receive “suboptimal” care. Non-critical miscarriage cases drop to the bottom of the triage list, resulting in longer wait times that make patients feel like they are “wasting” health-care providers’ time. Many of those patients are discharged without a followup plan, the editorial says.
But not all miscarriages need to be treated in the emergency room, says Dr. Modupe Tunde-Byass, one of the authors of the literature review and an obstetrician/gynecologist at Toronto’s North York General Hospital.
She says patients should be referred to early pregnancy assessment clinics, which provide compassionate care that accounts for the psychological impact of pregnancy loss – including grief, guilt, anxiety and post-traumatic stress.
But while North York General Hospital and a patchwork of other health-care providers in the country have clinics dedicated to miscarriage care, Tunde-Byass says that’s not widely adopted – and it should be.
She’s been thinking about this gap in the Canadian health-care system for a long time, ever since her medical training almost four decades ago in the United Kingdom, where she says early pregnancy assessment centres are common.
“One of the things that we did at North York was to have a clinic to provide care for our patients, and also to try to bridge that gap,” says Tunde-Byass.
Provincial agency Health Quality Ontario acknowledged in 2019 the need for these services in a list of ways to better manage early pregnancy complications and loss.
“Five years on, little if any progress has been made toward achieving this goal,” Dr. Catherine Varner, an emergency physician, wrote in the CMAJ editorial. “Early pregnancy assessment services remain a pipe dream for many, especially in rural Canada.”
The quality standard released in Ontario did, however, prompt a registered nurse to apply for funding to open an early pregnancy assessment clinic at St. Joseph’s Healthcare Hamilton in 2021.
Jessica Desjardins says that after taking patient referrals from the hospital’s emergency room, the team quickly realized that they would need a bigger space and more people to provide care. The clinic now operates five days a week.
“We’ve been often hearing from our patients that early pregnancy loss and experiencing early pregnancy complications is a really confusing, overwhelming, isolating time for them, and (it) often felt really difficult to know where to go for care and where to get comprehensive, well-rounded care,” she says.
At the Hamilton clinic, Desjardins says patients are brought into a quiet area to talk and make decisions with providers – “not only (from) a physical perspective, but also keeping in mind the psychosocial piece that comes along with loss and the grief that’s a piece of that.”
Ashley Hilliard says attending an early pregnancy assessment clinic at The Ottawa Hospital was the “best case scenario” after the worst case scenario.
In 2020, she was about eight weeks pregnant when her fetus died and she hemorrhaged after taking medication to pass the pregnancy at home.
Shortly after Hilliard was rushed to the emergency room, she was assigned an OB-GYN at an early pregnancy assessment clinic who directed and monitored her care, calling her with blood test results and sending her for ultrasounds when bleeding and cramping persisted.
“That was super helpful to have somebody to go through just that, somebody who does this all the time,” says Hilliard.
“It was really validating.”
This report by The Canadian Press was first published Oct. 15, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
