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COVID-19 variant-driven third wave hits middle-aged adults hard – The Globe and Mail

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People line up at a COVID-19 testing clinic in Montreal on March 24, 2021.

Ryan Remiorz/The Canadian Press

Canada’s third wave of COVID-19 is escalating at an alarming rate, driven by variants that are sending more middle-aged people to hospital, just as the country’s immunization experts recommend against giving the AstraZeneca vaccine to anyone under the age of 55.

Cases are increasing at such a fast clip in British Columbia that the government has imposed the strictest restrictions since the beginning of the pandemic. In Ontario, a new report shows variant infections are sending more people in their 40s and 50s to intensive-care units than earlier incarnations of the coronavirus.

“The third wave is really different, especially from the first wave,” said Katharina Plenk, chief and medical director of the department of medicine at Cortellucci Vaughan Hospital, a facility north of Toronto designated for COVID-19 patients. “Definitely there is a signal there that this is affecting a younger population. This is obviously something that hits close to home, and it’s been very scary to see.”

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COVID-19 case rates among

select provinces

Rate per 100,000 people,

seven-day moving average

British Columbia

Other provinces

Lowest point

since peak

40.6

The highest rate

of all provinces

Saskatchewan

13

Highest rate among

provinces during

the first wave

THE GLOBE AND MAIL, SOURCE: PROVINCIAL GOVERNMENTS

COVID-19 case rates among select provinces

Rate per 100,000 people, seven-day moving average

British Columbia

40.6

The highest rate

of all provinces

Other

provinces

Lowest point

since peak

Saskatchewan

13

Highest rate among

provinces during

the first wave

THE GLOBE AND MAIL, SOURCE: PROVINCIAL GOVERNMENTS

COVID-19 case rates among select provinces

Rate per 100,000 people, seven-day moving average

British Columbia

40.6

The highest rate

of all provinces

Other provinces

Lowest point

since peak

Saskatchewan

13

Highest rate among

provinces during

the first wave

THE GLOBE AND MAIL, SOURCE: PROVINCIAL GOVERNMENTS

The age profile of people with severe COVID-19 is also shifting because of vaccines, which have contributed to a steep drop in infections and deaths among residents of nursing and retirement homes, the chief victims of previous waves.

But Canada’s vaccination efforts were dealt a fresh blow on Monday. The expert group that advises the country on immunization policy called for a pause in injections of the AstraZeneca shot to anyone under 55 – one day before Canada was scheduled to receive 1.5 million doses of the vaccine from the United States.

The National Advisory Committee on Immunization issued the new recommendation after rare cases of serious and unusual blood clots in European recipients, particularly women, under 55.

Although no such cases have been reported in Canada, Shelley Deeks, the vice-chair of NACI, said it made sense to stop giving the shot to younger people as a “precautionary measure,” while Health Canada investigates.

Health Canada itself has approved AstraZeneca for all adults, but officials said Monday they would now require manufacturers to conduct a “detailed assessment” of the benefits and risks by age and sex.

Provincial leaders said they would follow NACI’s guidance and direct their AstraZeneca doses to people 55 and older, but experts predicted the fog of uncertainty that has engulfed the AstraZeneca vaccine for weeks was bound to hurt uptake.

Lisa Richardson, a physician with Toronto’s University Health Network who works on vaccine hesitancy, said she agreed with the advisory committee’s recommendation. But, Dr. Richardson said, the real challenge will now be figuring out how to communicate why the decision makes scientific sense and why the vaccine still remains a good choice for those who are 55 and over.

“To have to backtrack and explain this … it is going to be a setback for this vaccine, which we know is an effective one,” she added.

Canada vaccine tracker: How many COVID-19 doses have been administered so far?

Most European countries that suspended using the AstraZeneca vaccine resumed administering the shot after the European Medicines Agency concluded on March 18 that the vaccine was safe. However, agency officials said they could not rule out a connection between the vaccine and a rare clotting disorder.

In recent days, a German-led research team found the disorder is comparable to one that is known to sometimes occur in reaction to the blood thinner heparin. In that case, heparin occasionally binds with a protein that is normally associated with blood platelets, the body’s natural clotting agents. The unusual combination alerts the immune system to produce antibodies that eventually end up triggering the platelets to form clots.

The vaccine-associated cases seen in Europe exhibit a similar syndrome, which the team in a study has dubbed vaccine-induced prothrombotic immune thrombocytopenia, or VIPIT. Similar antibodies were found in four out of four cases for which the team had blood samples.

The team’s results are documented in a study that has been posted online but is still undergoing peer review.

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“I’m confident that this is the explanation for these unusual cases,” said Ted Warkentin, a professor of pathology and molecular medicine at McMaster University who was a co-author on the study.

The disorder is extremely rare and can be tested for and treated if patients report problems after vaccination. Dr. Warkentin said a lab at McMaster is now prepared to do the necessary testing should any cases arise in Canada.

Some countries said the vaccine would be used only for older citizens since the risk of not being vaccinated grows steeply with age. But countries have varied on their cutoff age. France settled on 55, while Sweden and Finland are only giving the vaccine to people older than 65 and Iceland to those 70 and up.

COVID-19 cases and deaths in Canada

Rate per 100,000 population,

7-day moving average

0.5

0.4

0.3

0.2

0.1

0

25

20

15

10

5

0

THE GLOBE AND MAIL, SOURCE: PROVINCIAL GOVERNMENTS

COVID-19 cases and deaths in Canada

Rate per 100,000 population, 7-day moving average

0.5

0.4

0.3

0.2

0.1

0

25

20

15

10

5

0

April

2020

January

2021

THE GLOBE AND MAIL, SOURCE: PROVINCIAL GOVERNMENTS

COVID-19 cases and deaths in Canada

Rate per 100,000 population, 7-day movingaverage

0.5

0.4

0.3

0.2

0.1

0

25

20

15

10

5

0

April

2020

January

2021

THE GLOBE AND MAIL, SOURCE: PROVINCIAL GOVERNMENTS

Coronavirus tracker: How many COVID-19 cases are there in Canada and worldwide? The latest maps and charts

Meanwhile, Canada is now reporting more than 4,000 new cases of COVID-19 a day, on average, up from about 2,500 in early March, according to the Public Health Agency of Canada. Deaths have dropped to an average of 29 a day, down significantly from a second-wave high that topped an average of 160 a day in late January.

When it comes to infections, the Canada’s reversal of fortunes is being driven by faster-spreading variants of the coronavirus, particularly the B.1.1.7 variant first identified in Britain.

B.C. recorded 2,518 new COVID-19 cases from Friday to Sunday – about the same as in the first two months of the pandemic.

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The surge prompted the government to impose a provincewide “circuit-breaker.” For three weeks beginning Tuesday, dine-in service at bars and restaurants, all indoor adult group fitness activities, and worship services – which were just permitted to reopen on a limited basis – are all prohibited.

The Whistler Blackcomb ski resort is also required to close over the same period to address transmission within the community.

B.C. Provincial Health Officer Bonnie Henry acknowledged variants were behind the spike. Of 2,233 confirmed variant cases, 1,915 are the B.1.1.7 variant most commonly associated with Britain, she said. But confirmed cases of the P.1 variant commonly associated with Brazil increased to 270 on Monday, up from 13 on March 9. There are currently 413 confirmed active variant cases in B.C.

“That is also a concern because we know this variant is not only more transmissible but has been shown in some parts of the world to be less amenable to the vaccine,” Dr. Henry said.

In Ontario, cases that have screened positive for a variant of concern now make up an estimated 67 per cent of all cases, according to the province’s COVID-19 Science Advisory Table.

Science table members have also found B.1.1.7 to be more dangerous, reinforcing research from Britain and Denmark on the lethality of the new variants.

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In a new brief published Monday, the group concluded that, compared with early versions of the coronavirus, the variants of concern increase the risk of hospital admission, ICU admission and death by 63 per cent, 103 per cent and 56 per cent, respectively.

Ontario’s daily case counts are as high now as they were when Premier Doug Ford’s government ordered a provincewide lockdown on Boxing Day. More COVID-19 patients are in hospitals and ICUs now than they were then. But the percentage of coronavirus patients in ICUs who are younger than 60 is about 50 per cent higher than it was around Christmas.

Dr. Plenk of Cortellucci Vaughan sees evidence of that in her hospital. On Monday afternoon, one-third of the 30 coronavirus patients in its ICU were younger than 60. Two were in their 40s, and one in his or her 30s, Dr. Plenk said.

“We have a lot of patients who are factory workers or essential workers and their whole family is sick,” she added. “Before, the household infectivity rate was 30 per cent. Now, if one person has it, the whole family has it.”

Peter Juni, scientific director of Ontario’s COVID-19 Science Advisory Table, said the longer the Ontario government waits to renew and strengthen its public-health measures, the more “painful” an eventual lockdown will be.

“Every day we delay we just increase the burden for the health care system and we ensure, with everyday that we wait, that the restrictions will need to be longer,” he said. “That’s the challenge here.”

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With a report from Laura Stone in Toronto

The large number of COVID-19 infections in some places makes it more likely for new variants of the virus to emerge. Science Reporter Ivan Semeniuk explains how vaccines may not be as effective against these new strains, making it a race to control and track the spread of variants before they become a dangerous new outbreak. The Globe and Mail

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CANADA STOCKS – TSX falls 0.14% to 19,201.28

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* The Toronto Stock Exchange’s TSX falls 0.14 percent to 19,201.28

* Leading the index were Stantec Inc <STN.TO​>, up 3.4%, Imperial Oil Ltd​, up 3.3%, and Corus Entertainment Inc​, higher by 2.9%.

* Lagging shares were Aphria Inc​​, down 14.2%, Village Farms International Inc​, down 9.9%, and Aurora Cannabis Inc​, lower by 9.4%.

* On the TSX 91 issues rose and 134 fell as a 0.7-to-1 ratio favored decliners. There were 24 new highs and no new lows, with total volume of 228.0 million shares.

* The most heavily traded shares by volume were Toronto-dominion Bank, Royal Bank Of Canada and Suncor Energy Inc.

* The TSX’s energy group fell 0.32 points, or 0.3%, while the financials sector climbed 2.46 points, or 0.7%.

* West Texas Intermediate crude futures rose 0.52%, or $0.31, to $59.63 a barrel. Brent crude  rose 0.4%, or $0.25, to $63.2 [O/R]

* The TSX is up 10.1% for the year.

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Air Canada signs C$5.9 billion government aid package, agrees to buy Airbus, Boeing jets

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By David Ljunggren and Allison Lampert

OTTAWA/MONTREAL (Reuters) -Air Canada, struggling with a collapse in traffic due to the COVID-19 pandemic, reached a deal on Monday on a long-awaited aid package with the federal government that would allow it to access up to C$5.9 billion ($4.69 billion) in funds.

The agreement – the largest individual coronavirus-related loan that Ottawa has arranged with a company – was announced after the airline industry criticized Prime Minister Justin Trudeau’s Liberal government for dawdling. The United States and France acted much more quickly to help major carriers.

Canada‘s largest carrier, which last year cut over half its workforce, or 20,000 jobs, and other airlines have been negotiating with the government for months on a coronavirus aid package.

In February, Air Canada reported a net loss for 2020 of C$4.65 billion, compared with a 2019 profit of C$1.48 billion.

As part of the deal, Air Canada agreed to ban share buybacks and dividends, cap annual compensation for senior executives at C$1 million a year and preserve jobs at the current level, which is 14,859.

It will also proceed with planned purchases of 33 Airbus SE 220 airliners and 40 Boeing Co 737 MAX airliners.

Chris Murray, managing director, equity research at ATB Capital Markets, said the deal took into account the “specific needs of Air Canada in the short and medium term without being overly onerous.”

He added: “It gives them some flexibility in drawing down additional liquidity as needed.”

Transport Minister Omar Alghabra said the government was still in negotiations with other airlines about possible aid.

Canada, the world’s second-largest nation by area, depends heavily on civil aviation to keep remote communities connected.

Opposition politicians fretted that further delays in announcing aid could result in permanent damage to the country.

Air Canada said it would resume services on nearly all of the routes it had suspended because of COVID-19.

‘SIGNIFICANT LAYER OF INSURANCE’

The deal removes a potential political challenge for the Liberals, who insiders say are set to trigger an election later this year.

The government has agreed to buy C$500 million worth of shares in the airline, at C$23.1793 each, or a 14.2% discount to Monday’s close, a roughly 6% stake.

“Maintaining a competitive airline sector and good jobs is crucially important,” Finance Minister Chrystia Freeland told reporters, adding the equity stake would allow taxpayers to benefit when the airline’s fortunes recovered.

The Canadian government previously approved similar loans for four other companies worth up to C$1.billion, including up to C$375 million to low-cost airline Sunwing Vacations Inc. The government has paid out C$73.47 billion under its wage subsidy program and C$46.11 billion in loans to hard-hit small businesses.

Michael Rousseau, Air Canada‘s president and chief executive officer, said the liquidity “provides a significant layer of insurance for Air Canada.”

Jerry Dias, head of the Unifor private-sector union, described the announcement as “a good deal for everybody.”

Unifor represents more than 16,000 members working in the air transportation sector.

But the Canadian Union of Public Employees, which represents roughly 10,000 Air Canada flight attendants, said the package protected the jobs of current workers rather than the 7,500 members of its union who had been let go by the carrier.

($1=1.2567 Canadian dollars)

(Reporting by David Ljunggren in Ottawa and Allison Lampert in Montreal; Additional reporting by Julie Gordon in Ottawa and Munsif Vengattil in Bengaluru; Editing by Dan Grebler and Peter Cooney)

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U.K. advises limiting AstraZeneca in under-30s amid clot worry

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LONDON —
British authorities recommended Wednesday that the AstraZeneca COVID-19 vaccine not be given to adults under 30 where possible because of strengthening evidence that the shot may be linked to rare blood clots.

The recommendation came as regulators both in the United Kingdom and the European Union emphasized that the benefits of receiving the vaccine continue to outweigh the risks for most people — even though the European Medicines Agency said it had found a “possible link” between the shot and the rare clots. British authorities recommended that people under 30 be offered alternatives to AstraZeneca. But the EMA advised no such age restrictions, leaving it up to its member-countries to decide whether to limit its use.

Several countries have already imposed limits on who can receive the vaccine, and any restrictions are closely watched since the vaccine, which is cheaper and easier to store than many others, is critical to global immunization campaigns and is a pillar of the UN-backed program known as COVAX that aims to get vaccines to some of the world’s poorest countries.

“This is a course correction, there’s no question about that,” Jonathan Van-Tam, England’s deputy chief medical officer, said during a press briefing. “But it is, in a sense, in medicine quite normal for physicians to alter their preferences for how patients are treated over time.”

Van-Tam said the effect on Britain’s vaccination timetable — one of the speediest in the world — should be “zero or negligible,” assuming the National Health Service receives expected deliveries of other vaccines, including those produced by Pfizer and Moderna.

EU and U.K. regulators held simultaneous press conferences Wednesday afternoon to announce the results of investigations into reports of blood clots that sparked concern about the rollout of the AstraZeneca vaccine.

The EU agency described the clots as “very rare” side effects. Dr Sabine Straus, chair of EMA’s Safety Committee, said the best data is coming from Germany where there is one report of the rare clots for every 100,000 doses given, although she noted far fewer reports in the U.K. Still, that’s less than the clot risk that healthy women face from birth control pills, noted another expert, Dr. Peter Arlett.

The agency said most of the cases reported have occurred in women under 60 within two weeks of vaccination — but based on the currently available evidence, it was not able to identify specific risk factors. Experts reviewed several dozen cases that came mainly from Europe and the U.K., where around 25 million people have received the AstraZeneca vaccine.

“The reported cases of unusual blood clotting following vaccination with the AstraZeneca vaccine should be listed as possible side effects of the vaccine,” said Emer Cooke, the agency’s executive director. “The risk of mortality from COVID is much greater than the risk of mortality from these side effects.”

Arlett said there is no information suggesting an increased risk from the other major COVID-19 vaccines.

The EMA’s investigation focused on unusual types of blood clots that are occurring along with low blood platelets. One rare clot type appears in multiple blood vessels and the other in veins that drain blood from the brain.

While the benefits of the vaccine still outweigh the risks, that assessment is “more finely balanced” among younger people who are less likely to become seriously ill with COVID-19, the U.K’s Van-Tam said.

“We are not advising a stop to any vaccination for any individual in any age group,” said Wei Shen Lim, who chairs Britain’s Joint Committee on Vaccination and Immunization. “We are advising a preference for one vaccine over another vaccine for a particular age group, really out of the utmost caution rather than because we have any serious safety concerns.”

In March, more than a dozen countries, mostly in Europe, suspended their use of AstraZeneca over the blood clot issue. Most restarted — some with age restrictions — after the EMA said countries should continue using the potentially life-saving vaccine.

Britain, which relies heavily on AstraZeneca, however, continued to use it.

The suspensions were seen as particularly damaging for AstraZeneca because they came after repeated missteps in how the company reported data on the vaccine’s effectiveness and concerns over how well its shot worked in older people. That has led to frequently changing advice in some countries on who can take the vaccine, raising worries that AstraZeneca’s credibility could be permanently damaged, spurring more vaccine hesitancy and prolonging the pandemic.

Dr. Peter English, who formerly chaired the British Medical Association’s Public Health Medicine Committee, said the back-and-forth over the AstraZeneca vaccine globally could have serious consequences.

“We can’t afford not to use this vaccine if we are going to end the pandemic,” he said.

In some countries, authorities have already noted hesitance toward the AstraZeneca shot.

“People come and they are reluctant to take the AstraZeneca vaccine, they ask us if we also use anything else,” said Florentina Nastase, a doctor and co-ordinator at a vaccination centre in Bucharest, Romania. “There were cases in which people (scheduled for the AstraZeneca) didn’t show up, there were cases when people came to the centre and saw that we use only AstraZeneca and refused (to be inoculated).”

Meanwhile, the governor of Italy’s northern Veneto region had said earlier Wednesday that any decision to change the guidance on AstraZeneca would cause major disruptions to immunizations — at a time when Europe is already struggling to ramp them up — and could create more confusion about the shot.

“If they do like Germany, and allow Astra Zeneca only to people over 65, that would be absurd. Before it was only for people under 55. Put yourself in the place of citizens, it is hard to understand anything,” Luca Zaia told reporters.

The latest suspension of AstraZeneca came in Spain’s Castilla y Leon region, where health chief Veronica Casado said Wednesday that “the principle of prudence” drove her to put a temporary hold on the vaccine that she still backed as being both effective and necessary.

French health authorities had said they, too, were awaiting EMA’s conclusions, as were some officials in Asia.

On Wednesday, South Korea said it would temporarily suspend the use of AstraZeneca’s vaccine in people 60 and younger. In that age group, the country is only currently vaccinating health workers and people in long-term care settings.

The Korea Disease Control and Prevention Agency said it would also pause a vaccine rollout to school nurses and teachers that was to begin on Thursday, while awaiting the outcome of the EMA’s review.

But some experts urged perspective. Prof Anthony Harnden, the deputy chair of Britain’s vaccination committee, said that the program has saved at least 6,000 lives in the first three months and will help pave the way back to normal life.

“What is clear it that for the vast majority of people the benefits of the Oxford AZ vaccine far outweigh any extremely small risk,” he said. “And the Oxford AZ vaccine will continue to save many from suffering the devastating effects that can result from a COVID infection.”

Source: – CTV News

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