- Quebec announces a presumptive case of COVID-19.
- Health minister says containment will delay — but not prevent — a coronavirus outbreak in Canada.
- Italy issues decree calling for school closures, event cancellations and social distancing.
- Iran says COVID-19 death toll hits 107, reports 3,513 cases. Canadians urged to avoid all travel to Iran in updated travel advisory.
Nations around the world girded for months of disruptions from the novel coronavirus Thursday as its unrelenting spread brought ballooning infections, economic fallout and sweeping containment measures.
“Countries should be preparing for sustained community transmission,” Tedros Adhanom Ghebreyesus, head of the World Health Organization, said of the virus outbreak.
In places around the globe, a split was developing. China has been issuing daily reports of new infections that are drastically down from their highs, factories there are gradually reopening and there is a growing sense that normalcy might not be that far off. Meanwhile, countries elsewhere are seeing escalating caseloads and a litany of cancellations, closures, travel bans and supply shortages.
There are about 17 times as many new infections outside China as in it, WHO said, with widening outbreaks in South Korea, Italy and Iran responsible for a majority of them.
“We are seeing this rapid escalation around the world,” said Dr. Leana Wen, a public health professor at George Washington University in Washington, D.C. “At this point I believe things will get much worse before they get better.”
South Africa on Thursday confirmed a case of coronavirus, the health ministry said, the country’s first case of the deadly disease sweeping through the world.
“The patient is a 38-year-old male who travelled to Italy with his wife. They were part of a group of 10 people and they arrived back in South Africa on March 1, 2020,” the ministry said. Read on for a look at what’s happening in Canada and the U.S, as well as some of the hard-hit regions around the world.
Here’s what’s happening in Canada
Health officials in Quebec announced a presumptive coronavirus case early Thursday morning. If confirmed, it would be the second case in the province.
The news out of Quebec comes after B.C. announced on Wednesday that its 13th COVID-19 patient — a woman in her 80s with several underlying conditions — is in critical condition in a Vancouver hospital.
Health Minister Patty Hajdu said Wednesday that health officials in Canada are working to slow the spread of COVID-19. But she also cautioned Canadians to prepare for the “eventuality” of an outbreak here.
“This is a virus that knows no borders, and that is growing. Each day there are countries that have new cases and new outbreaks and new situations,” Hajdu said.
“We know that eventually this is likely something that we’ll see in one of our communities.”
The Public Health Agency of Canada, which assesses the situation on an ongoing basis, says the risk in Canada is low.
If Quebec’s latest case is confirmed, it will bring Canada’s reported cases of COVID-19 to 35 — with most of the cases in Ontario and B.C.
Here’s what’s happening in the U.S.
The U.S. death toll rose to 11 on Wednesday as new cases emerged around New York City and Los Angeles.
California Gov. Gavin Newsom declared a statewide emergency after the first death in the state from the virus. The House of Representatives approved an $8.3 billion US bill to combat the virus and develop vaccines.
Here’s what’s happening in mainland China and Hong Kong
China reported 139 new cases and 31 deaths, raising its totals to 80,409 cases and 3,012 deaths. The number of cases was higher than Wednesday’s figure, but new deaths were lower, as the illness continues to decline in the country.
While hardest-hit Hubei province had most of the new cases and deaths, hospitals there released another 1,923 patients who were declared cured.
Chinese President Xi Jinping’s state visit to Japan has been postponed so both countries can fight the coronavirus outbreak, Japan’s chief government spokesman said Thursday.
Here’s what’s happening in Italy and Europe
Italy’s government has adopted a decree with emergency new measures to contain the coronavirus as it struggles against the worst outbreak in Europe, which has killed at least 107 in less than two weeks. The decree covers everything from how to handle public events to protocol for how people can access emergency departments.
Here’s a look at some of the key points of the Italian decree:
People in Italy are being told not to hug or shake hands and to keep a “safe distance” of at least a metre from other people.
Public events that don’t allow for the one-metre safety limit — for example, theatres and cinemas — are to be suspended. Sporting events must be played behind closed doors.
All schools and universities are closed until at least mid-March. Training for doctors and health workers, however, continues. Government is loosening rules for home working, encouraging people who can work from home to do so.
Travellers who have visited so-called red zone areas can be told to self-isolate at home for two weeks.
In Switzerland, a 74-year-old woman died after contracting the novel coronavirus, the country’s first death from the rapidly spreading disease outbreak. She was a high-risk patient suffering from chronic disease, authorities said.
In Germany, the number of cases jumped by 109 within a day, a public health institute said on Thursday. As of Thursday morning, there were 349 cases spread across all but one federal state, up from 240 on Wednesday morning and compared with 262 on Wednesday afternoon, the Robert Koch Institute said.
Britain, which has so far reported 90 cases of COVID-19, said Thursday it will move to the second phase of its four-phase plan to fight the novel coronavirus. The government set out a plan earlier this week that called for containing the virus, delaying its transmission, researching its origins and mitigating its impact.
Prime Minister Boris Johnson said he is optimistic that Britain is well prepared to cope with the spread of the virus, but early on Thursday regional airline Flybe became one of the first big corporate casualties of the outbreak.
Here’s what’s happening in Iran and the Middle East
Iran will set up checkpoints to limit travel between major cities and urged citizens on Thursday to reduce their use of paper money to fight a spreading outbreak of the novel coronavirus, which has killed at least 107 people across the Islamic Republic.
The announcement in Iran came as Palestinian authorities said the storied Nativity Church in the biblical city of Bethlehem, built atop the spot where Christians believe Jesus was born, will close indefinitely later in the day over coronavirus fears. The church was expected to draw tens of thousands of visitors and worshipers next month for the Easter holiday.
These mark the latest disruptions of life due to the virus across the Mideast, which has seen over 3,740 confirmed cases.
Iran’s Health Minister Saeed Namaki announced his country’s new restrictions at a televised press conference. He added that schools and universities will remain closed through Nowruz, the Persian New Year, on March 20.
He said people should stay in their vehicles at gas stations and allow attendants to fill their gas tanks to avoid the spread of the virus.
Canada on Thursday updated its travel advice for Iran to urge people to avoid all travel to the country.
Here’s what’s happening in South Korea
South Korea declared a “special care zone” on Thursday around a second city hit hard by the coronavirus, and the U.S. military confirmed two new cases among relatives of its troops in the country, which is battling the biggest outbreak outside China.
The “special care zone” is around Gyeongsan, a city of about 275,000 people 250 kilometres southeast of Seoul, promising extra resources such as face masks. Gyeongsan has seen a spike in cases in recent days, many of them linked to a fringe Christian group at the centre of South Korea’s outbreak. Similar zones have been declared around neighbouring Daegu city and Cheongdo County.
About 75 per cent of all cases in South Korea are in and around Daegu, its fourth-largest city, according to the Korea Centers for Disease Control and Prevention (KCDC).
“Every day is sad and tough like a war. But our Daegu citizens are showing surprise wisdom and courage,” Daegu Mayor Kwon Young-jin told reporters on Thursday.
Here’s what’s happening in Japan
Japan said Thursday it will impose 14-day quarantine on people arriving from China and South Korea to prevent spread of the virus.
Earlier, Olympics minister Seiko Hashimoto signalled the Summer Games would go ahead as planned in July and August, even as the outbreak spread to new regions.
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A new study offers a closer look at possible factors that may lead to some hospitalized COVID-19 patients being readmitted within a month of discharge.
At roughly nine per cent, researchers say the readmission rate is similar to that seen for other ailments, but socio-economic factors and sex seem to play a bigger role in predicting which patients are most likely to suffer a downturn when sent home.
Research published Monday in the Canadian Medical Association Journal looked at 46,412 adults hospitalized for COVID-19 in Alberta and Ontario during the first part of the pandemic. About 18 per cent — 8,496 patients — died in hospital between January 2020 and October 2021, which was higher than the norm for other respiratory tract infections.
Among those sent home, about nine per cent — 2,759 patients — returned to hospital within 30 days of leaving, while two per cent — 712 patients — died. The deaths include patients who returned to hospital.
The combined rate of readmission or death was similar in each province, at 9.9 per cent or 783 patients in Alberta, and 10.6 per cent or 2,390 patients in Ontario.
For those wondering if the patients were discharged too soon, the report found most spent less than a month in hospital and patients who stayed longer were actually readmitted at a slightly higher rate.
“We initially wondered, ‘Were people being sent home too early?’ … and there was no association between length of stay in hospital and readmission rates, which is reassuring,” co-author Dr. Finlay McAlister, a professor of general internal medicine at the University of Alberta, said from Edmonton.
“So it looked like clinicians were identifying the right patients to send home.”
Examining the peaks
Craig Jenne, an associate professor of microbiology, immunology and infectious diseases at the University of Calgary who was not involved in the research, said the study suggests that the health-care system was able to withstand the pressures of the pandemic.
“We’ve heard a lot about how severe this disease can be and there was always a little bit of fear that, because of health-care capacity, that people were perhaps rushed out of the system,” Jenne said. “There was a significant increase in loss of life but this wasn’t due to system processing of patients.
“Care was not sacrificed despite the really unprecedented pressure put on staff and systems during the peaks of those early waves.”
The study also provides important insight on the power of vaccines in preventing severe outcomes, Jenne said.
Of all the patients admitted with COVID-19 in both provinces, 91 per cent in Alberta and 95 per cent in Ontario were unvaccinated, the study found.
The report found readmitted patients tended to be male, older, and have multiple comorbidities and previous hospital visits and admissions. They were also more likely to be discharged with home care or to a long-term care facility.
McAlister also found socio-economic status was a factor, noting that hospitals traditionally use a scoring system called LACE to predict outcomes by looking at length of stay, age, comorbidities and past emergency room visits, but “that wasn’t as good a predictor for post-COVID patients.”
“Including things like socio-economic status, male sex and where they were actually being discharged to were also big influences. It comes back to the whole message that we’re seeing over and over with COVID: that socio-economic deprivation seems to be even more important for COVID than for other medical conditions.”
McAlister said knowing this could help transition co-ordinators and family doctors decide which patients need extra help when they leave the hospital.
On its own, LACE had only a modest ability to predict readmission or death but adding variables including the patient’s neighbourhood and sex improved accuracy by 12 per cent, adds supporting co-author Dr. Amol Verma, an internal medicine physician at St. Michael’s Hospital in Toronto.
The study did not tease out how much socio-economic status itself was a factor, but did look at postal codes associated with so-called “deprivation” indicators like lower education and income among residents.
Readmission was about the same regardless of neighbourhood, but patients from postal codes that scored high on the deprivation index were more likely to be admitted for COVID-19 to begin with, notes Verma.
Verma adds that relying on postal codes does have limitations in assessing socio-economic status since urban postal codes can have wide variation in their demographic. He also notes the study did not include patients without a postal code.
McAlister said about half of the patients returned because of breathing difficulties, which is the most common diagnosis for readmissions of any type.
He suspected many of those problems would have been difficult to prevent, suggesting “it may just be progression of the underlying disease.”
Looking at readmissions is just the tip of the iceberg.-Dr. Finlay McAlister-Dr. Finlay McAlister
It’s clear, however, that many people who appear to survive COVID are not able to fully put the illness behind them, he added.
“Looking at readmissions is just the tip of the iceberg. There’s some data from the [World Health Organization] that maybe half to two-thirds of individuals who have had COVID severe enough to be hospitalized end up with lung problems or heart problems afterwards, if you do detailed enough testing,” he said.
“If you give patients quality of life scores and symptom questionnaires, they’re reporting much more levels of disability than we’re picking up in analyses of hospitalizations or emergency room visits.”
The research period pre-dates the Omicron surge that appeared in late 2021 but McAlister said there’s no reason to suspect much difference among today’s patients.
He said that while Omicron outcomes have been shown to be less severe than the Delta variant, they are comparable to the wild type of the novel coronavirus that started the pandemic.
“If you’re unvaccinated and you catch Omicron it’s still not a walk in the park,” he said.
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