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Demand spikes for COVID-19 treatment that's saving lives but is in limited supply in Canada –



Tony Passarelli was used to having a bit of breathing trouble.

The 52-year-old’s asthma often flares up in the spring, but this past March, something felt different. He started wheezing, and several rounds of antibiotics didn’t solve whatever was ailing him.

Later that month, his wife of more than 25 years, Linda, fell ill as well. Then she tested positive for the virus behind COVID-19. While she isolated in a room at the couple’s Bolton, Ont., home, Tony took a turn for the worse, and his wheezing became a cough that just wouldn’t quit. 

He headed to the nearest emergency department — Headwaters Health Care Centre in Orangeville — on March 29.

“They just said I had pneumonia,” Tony said, “and that they were going to keep me.”

That’s the last thing he remembers.

What happened next, according to the soft-spoken father of three, was a weeks-long ordeal with COVID-19.

After passing out in the hospital, he wound up intubated in an intensive care unit, was transferred to Etobicoke General Hospital in Toronto, suffered round after round of fevers and infections, then became so ill that doctors thought there was nothing more they could do to keep him alive.

“There’s nothing else left,” Linda recalled being told by one of the ICU physicians in early April.

Then came a sliver of hope.

Tony qualified for an ECMO treatment — or extracorporeal membrane oxygenation — which could be his last chance at survival.

‘High level’ of demand

Roughly 40 Canadian hospitals have access to at least one ECMO machine, representing just three per cent of all hospital sites across Canada — though it’s unclear how many machines in total the country has access to.

Offered at only a handful of Ontario hospital sites, with the bulk of the machines at Toronto General Hospital, it’s a form of life support that uses a pump to circulate blood through a machine that replaces the work of someone’s lungs and, in some cases, their heart.

The machine removes carbon dioxide, then sends oxygen-filled blood back into the bloodstream, giving damaged lungs a chance to rest and recover.

Passarelli relaxes at home after he spent time in three separate Ontario hospitals while battling COVID-19. In the pandemic’s first wave in Ontario, 34 COVID-19 patients were given ECMO treatment, and more than half survived. (Submitted by Linda Passarelli)

Patients who qualify for the treatment are usually under 65 and have few pre-existing health conditions, ensuring they have the best shot at surviving.

Linda credits the device with saving her husband’s life, and she’s not alone. In the pandemic’s first wave in Ontario, 34 COVID-19 patients were given this potentially life-saving treatment, and more than half survived.

Now, as coronavirus infections are surging to record-breaking levels, there’s concern that demand is quickly rising again for ECMO — this time as Toronto General juggles both COVID-19 cases and other patients requiring the last-resort approach that’s in limited supply, including those hospitalized for lung transplants.

“It’s a pretty high level,” said Dr. Marcelo Cypel, surgical director for the University Health Network’s extracorporeal life support program, which includes the ECMO treatment at the network’s Toronto General site.

Dr. Marcelo Cypel is the surgical director for the University Health Network’s extracorporeal life support program in Toronto, which handles ECMO treatments. (Submitted by University Health Network)

In just the last two weeks, Cypel said, at least a dozen COVID-19 patients have been hooked up to ECMO machines. 

At the time of his interview with CBC News on Tuesday, nine of the hospital’s 11 intensive care admissions were being given the treatment, using nearly a third of the hospital’s 30 ECMO machines — a supply that was increased this year to brace for the earlier influx of COVID-19 patients.

“We are working at our full ICU capacity right now already,” Cypel said. “And that’s a concern, because we continue to receive referrals every day.”

ECMO team ‘may have to slow down’

While the first coronavirus wave saw the cancellation of thousands of elective surgeries and other procedures to make room for COVID-19 patients, Cypel said in the second wave, his team is handling another influx of the sickest of those patients, as well as anyone needing ECMO for other reasons.

But he worries that may not be sustainable much longer.

If recent provincial lockdowns for Toronto and Peel Region don’t put a dent in case growth and ICU admissions, Cypel said, the ECMO team “may have to slow down,” which could affect patients waiting for other crucial hospital services such as transplants.

That’s a situation Renee Alkass finds alarming, since she once had the treatment herself for a non-COVID medical issue.

In 2017, long before the COVID-19 pandemic, the University of Guelph student developed an ear infection that spiralled into acute respiratory distress syndrome (ARDS). After struggling to breathe, Alkass was hospitalized, and doctors discovered that both of her lungs were filled with fluid.

After suffering from fluid in her lungs during a strange infection in 2017, Renee Alkass was sent to Toronto General Hospital, where she spent 18 days on an ECMO machine. (Submitted by Renee Alkass)

She wound up being sent to Toronto General and was on ECMO for 18 days during her stay.

“I can’t even fathom to understand what everyone must be feeling,” said the 21-year-old, who has since recovered from ARDS and was eventually diagnosed with a rare autoimmune disorder.

“And I do hope that there’s a light at the end of all this and things start looking up from here, and there isn’t such a stretch or this need.”

When asked if the province has any plans to address the recent demand for ECMO at Toronto General, provincial officials didn’t outline any.

Instead, a spokesperson told CBC News the decision to use it is a clinical one, with the Ministry of Health providing dedicated funding to the hospital for patients who require the treatment.

“The hospital can expense the ministry for costs related to treating patients with COVID-19 … if it is above and beyond their funding allocation,” the ministry said in a statement.

“So, it’s not expected that the needs of patients with COVID-19 will impact the use of the therapy for other patients.”

1 in 10 ICU beds have COVID-19 patients

But Anthony Dale, president and CEO of the Ontario Hospital Association, said the pressure on the ECMO program is just one example of the impact from rising numbers of COVID-19 hospitalizations and ICU admissions.

Roughly one in every 10 intensive care beds in Ontario is now occupied by someone infected with the virus, he recently noted.

“What people simply have to appreciate is that critical care is the most complex care that you can access in an Ontario hospital, and it’s located in only certain hospitals,” Dale said. “And it’s totally dependent on having access to the right kinds of health professionals with the right kind of technology.”

Both Dale and Cypel say the key to lowering demand for limited treatments like ECMO is simply reducing the amount of community spread of COVID-19.

“I don’t want people to only see how serious this is when the province’s hospitals are facing an even more destabilizing crisis,” Dale said.

“Right now I know it’s hidden from you. But I assure you that right now hospitals, especially in major urban centres, are bracing for serious impact over the next two to four weeks.”

The Passarellis, with their three children and Tony’s mother, at home in Bolton, Ont., north of Toronto, after he returned home in May. Tony now uses an oxygen machine to help him breathe (Submitted by Linda Passarelli)

‘We’re so blessed that he was picked’

When Tony Passarelli finally woke up at Toronto General, months before the second surge of COVID-19 cases, he had no idea a machine had helped him get to that point.

“I just remember one of the nurses there saying, ‘Do you know where you are? Do you know what day it is?’ Groggily I said, ‘I’m in the hospital, but day-wise, no,'” he recalled. “She said the date — which I don’t remember — and she says, ‘You’ve been here three weeks.'”

Tony soon learned more alarming details: His entire family in Bolton, northwest of Toronto, including his three children and mother, all wound up having confirmed or likely infections of the virus.

And he found out there was a long recovery ahead. Tony’s motor skills weren’t working, and he couldn’t eat or drink on his own. He was transferred back to Etobicoke General and discharged in early May, and he now uses an oxygen machine to help him breathe.

But he’s alive, Linda said, and that’s enough.

“Our family’s a family right now because of the ECMO,” she added.

What scares the couple now? The realization that there’s high demand for only a limited number of machines across the entire province.

“The fact that there are so few, and there’s such a demand … that is incredibly scary,” Linda said.

“We’re regular people; we’re so blessed that he was picked and he’s here today.”

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Freeland hints at potential hotel quarantines for returning travellers – CTV News



Deputy Prime Minister Chrystia Freeland says the federal government is “looking seriously” at tougher travel measures to fight the COVID-19 pandemic, including mandatory hotel quarantines for air travellers returning from non-essential trips abroad.

Freeland’s remarks build on Prime Minister Justin Trudeau’s leaving the door open earlier this month to tighter restrictions, sparking questions about how a stricter isolation regime would roll out relative to other countries.

Successful pandemic repellers from South Korea to Australia and New Zealand require 14-day hotel quarantines for passengers arriving from abroad.

Dr. Zain Chagla, an infectious disease physician at St. Joseph’s hospital in Hamilton, says the move would deter leisure travel, and could include scheduled testing that allows guests who come up negative to go home earlier.

Federal data suggests only a small fraction of COVID-19 cases are linked to travel, but there is still virtually no testing at the border and many recent cases do not have an identified source.

NDP Leader Jagmeet Singh says the government should consider mandatory hotel quarantines as well as outright bans on non-essential international travel, which Quebec Premier Francois Legault has also called for.

This report by The Canadian Press was first published Jan. 25, 2021.

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The latest news on COVID-19 developments in Canada for Monday, Jan. 25, 2021 – News 1130



The latest news on COVID-19 developments in Canada (all times eastern):

10:35 a.m.

There are 1,958 new cases of COVID-19 reported in Ontario today and 43 more deaths attributed to the novel coronavirus.

Health Minister Christine Elliott says 727 of the new cases are in Toronto, 365 in Peel Region, and 157 in York Region.

She says nearly 36,000 tests were completed since Sunday’s report.

Ontario also reports that 2,448 more cases of COVID-19 are considered resolved.

This report by The Canadian Press was first published Jan. 25, 2021.

The Canadian Press

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Commons returns with opposition leaders slamming COVID-19 vaccine program –



Canada’s opposition leaders attacked the federal Liberal government’s COVID-19 vaccination program today in their first encounter in the House of Commons following the winter break.

Vaccine deliveries will grind to a halt this week as a shutdown at Pfizer’s plant in Belgium disrupts shipments from that company.

Conservative Leader Erin O’Toole said that while the prime minister promised a steady supply of the Pfizer-BioNTech shots in the first three months of 2021, the country’s inoculation efforts are now “in jeopardy” and provinces are scrambling to meet vaccination targets.

The delivery delay is already prompting some provinces — notably Alberta and Ontario — to warn that they will have to curtail vaccination appointments in the weeks ahead as they direct the existing supplies of the two-dose Pfizer vaccine to patients who need their second shots.

“We want to see our government succeed but this prime minister has abandoned us. The Liberal plan for vaccines must be reviewed by all of Parliament. We must work together to improve the Liberal vaccine plan and get Canadians back to work,” O’Toole said.

“We wish we could trust the prime minister but this situation demands Parliament’s urgent attention.”

Canada will receive no doses of the Pfizer product this week, and a dramatically reduced shipment next week, as the company retools its plant to pump out many more shots this year than planned.

O’Toole said the Liberal government should have prepared for delivery disruptions like this one with a contingency plan to prevent the provinces from running dry.

Maj.-Gen. Dany Fortin, the military commander leading vaccine logistics at the Public Health Agency of Canada, has said Pfizer deliveries will be reduced by roughly 50 per cent over a four-week period — and Canada doesn’t know for certain how many doses will arrive over that time period.

The Health Canada website that tracks vaccines has been scrubbed of all Pfizer delivery forecasts, citing “changes to manufacturing timelines.”

“Unknown means there is no real plan,” O’Toole said. “Canadians are worried. We’re in the second wave of the pandemic, there’s U.K. strains and this week we’re receiving zero Pfizer vaccines.”

Moderna, which delivers shots to Canada every three weeks, is expected to deliver roughly 230,000 doses over the first week of February.

Later in question period, Prime Minister Justin Trudeau acknowledged the “ongoing challenges” with the global supply vaccine chain but said Canada is expecting “hundreds of thousands” of Pfizer doses, some in February. He said Canada expects to have enough doses on hand this year to vaccinate every Canadian who wants a shot by the end of September.

Michelle Rempel Garner, the Conservative health critic, questioned that promise, saying that Canada needs to start getting through tens of thousands of vaccinations each day to reach that target.

With only 100,000 people fully vaccinated so far, Canada would have to administer well over 200,000 shots a day for the next 248 days to fully vaccinate Canadians with the two-dose Pfizer and Moderna products.

O’Toole said the Liberal government never should have partnered with the Chinese firm CanSino Biologics to develop a vaccine — a collaboration that was derailed last summer when China refused to ship vaccine samples to Canada for clinical trial testing.

After that partnership was shelved, O’Toole said, Canada then turned to procuring promising vaccine candidates from U.S. firms like Pfizer and Moderna.

Public Services and Procurement Minister Anita Anand has disputed this version of events. Speaking to reporters in December, Anand said the CanSino deal fell within former industry minister Navdeep Bains’ portfolio, not her own, and nothing about the project prevented her from negotiating with other companies.

Anand has said she started talks with the companies behind promising vaccine candidates in July — companies that were recommended by the COVID-19 Vaccine Task Force — before Canada walked away from the ill-fated CanSino partnership in late August. Canada was among the first countries in the world to sign deals with Pfizer and Moderna.

“Engagement and negotiations with COVID-19 vaccine suppliers began in early July 2020, following the receipt of recommendations from the vaccine task force in June,” a spokesperson for the minister told CBC News.

O’Toole said Canada should have sought domestic manufacturing of vaccine candidates to avoid having to depend on other countries for supply. The government did not pursue domestic manufacturing rights for the AstraZeneca product.

Asked what he’d do to jump-start the stalled vaccination campaign, O’Toole said he would encourage Trudeau to obtain doses from the Pfizer manufacturing plant in Kalamazoo, Mich., which is not experiencing the same disruptions as the Belgian facility and is only 220 kilometres away from the Detroit-Windsor border crossing.

“There are vaccines being made not far from us, in Kalamazoo. Did the prime minister ask for the ability to have that plant used, not just rely on the retooled plant in Belgium?” O’Toole said. “There are a lot of options here, but there’s never any leadership from Mr. Trudeau.”

Anand has said the Michigan facility’s product is earmarked for the American market in the first quarter of this year.

While there will be significant delivery disruptions over the next month, Anand has said that Canada still expects to receive 4 million doses of the Pfizer product and 2 million Moderna shots in the first three months of this year. That would be enough to vaccinate 3 million people by the end of March.

NDP Leader Jagmeet Singh pointed out that the prime minister and his office are mired in a scandal of their own making over the abrupt resignation of former governor general Julie Payette amid reports of workplace harassment.

“The focus should be on the pandemic and the struggles that we’re going through. This has become a distraction,” Singh said of the Payette affair. “The focus … should be entirely on making sure people are vaccinated.”

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