Demand spikes for COVID-19 treatment that's saving lives but is in limited supply in Canada - CBC.ca | Canada News Media
Connect with us

News

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

Published

 on


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.”

Let’s block ads! (Why?)



Source link

Continue Reading

News

STD epidemic slows as new syphilis and gonorrhea cases fall in US

Published

 on

 

NEW YORK (AP) — The U.S. syphilis epidemic slowed dramatically last year, gonorrhea cases fell and chlamydia cases remained below prepandemic levels, according to federal data released Tuesday.

The numbers represented some good news about sexually transmitted diseases, which experienced some alarming increases in past years due to declining condom use, inadequate sex education, and reduced testing and treatment when the COVID-19 pandemic hit.

Last year, cases of the most infectious stages of syphilis fell 10% from the year before — the first substantial decline in more than two decades. Gonorrhea cases dropped 7%, marking a second straight year of decline and bringing the number below what it was in 2019.

“I’m encouraged, and it’s been a long time since I felt that way” about the nation’s epidemic of sexually transmitted infections, said the CDC’s Dr. Jonathan Mermin. “Something is working.”

More than 2.4 million cases of syphilis, gonorrhea and chlamydia were diagnosed and reported last year — 1.6 million cases of chlamydia, 600,000 of gonorrhea, and more than 209,000 of syphilis.

Syphilis is a particular concern. For centuries, it was a common but feared infection that could deform the body and end in death. New cases plummeted in the U.S. starting in the 1940s when infection-fighting antibiotics became widely available, and they trended down for a half century after that. By 2002, however, cases began rising again, with men who have sex with other men being disproportionately affected.

The new report found cases of syphilis in their early, most infectious stages dropped 13% among gay and bisexual men. It was the first such drop since the agency began reporting data for that group in the mid-2000s.

However, there was a 12% increase in the rate of cases of unknown- or later-stage syphilis — a reflection of people infected years ago.

Cases of syphilis in newborns, passed on from infected mothers, also rose. There were nearly 4,000 cases, including 279 stillbirths and infant deaths.

“This means pregnant women are not being tested often enough,” said Dr. Jeffrey Klausner, a professor of medicine at the University of Southern California.

What caused some of the STD trends to improve? Several experts say one contributor is the growing use of an antibiotic as a “morning-after pill.” Studies have shown that taking doxycycline within 72 hours of unprotected sex cuts the risk of developing syphilis, gonorrhea and chlamydia.

In June, the CDC started recommending doxycycline as a morning-after pill, specifically for gay and bisexual men and transgender women who recently had an STD diagnosis. But health departments and organizations in some cities had been giving the pills to people for a couple years.

Some experts believe that the 2022 mpox outbreak — which mainly hit gay and bisexual men — may have had a lingering effect on sexual behavior in 2023, or at least on people’s willingness to get tested when strange sores appeared.

Another factor may have been an increase in the number of health workers testing people for infections, doing contact tracing and connecting people to treatment. Congress gave $1.2 billion to expand the workforce over five years, including $600 million to states, cities and territories that get STD prevention funding from CDC.

Last year had the “most activity with that funding throughout the U.S.,” said David Harvey, executive director of the National Coalition of STD Directors.

However, Congress ended the funds early as a part of last year’s debt ceiling deal, cutting off $400 million. Some people already have lost their jobs, said a spokeswoman for Harvey’s organization.

Still, Harvey said he had reasons for optimism, including the growing use of doxycycline and a push for at-home STD test kits.

Also, there are reasons to think the next presidential administration could get behind STD prevention. In 2019, then-President Donald Trump announced a campaign to “eliminate” the U.S. HIV epidemic by 2030. (Federal health officials later clarified that the actual goal was a huge reduction in new infections — fewer than 3,000 a year.)

There were nearly 32,000 new HIV infections in 2022, the CDC estimates. But a boost in public health funding for HIV could also also help bring down other sexually transmitted infections, experts said.

“When the government puts in resources, puts in money, we see declines in STDs,” Klausner said.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

Source link

Continue Reading

News

World’s largest active volcano Mauna Loa showed telltale warning signs before erupting in 2022

Published

 on

 

WASHINGTON (AP) — Scientists can’t know precisely when a volcano is about to erupt, but they can sometimes pick up telltale signs.

That happened two years ago with the world’s largest active volcano. About two months before Mauna Loa spewed rivers of glowing orange molten lava, geologists detected small earthquakes nearby and other signs, and they warned residents on Hawaii‘s Big Island.

Now a study of the volcano’s lava confirms their timeline for when the molten rock below was on the move.

“Volcanoes are tricky because we don’t get to watch directly what’s happening inside – we have to look for other signs,” said Erik Klemetti Gonzalez, a volcano expert at Denison University, who was not involved in the study.

Upswelling ground and increased earthquake activity near the volcano resulted from magma rising from lower levels of Earth’s crust to fill chambers beneath the volcano, said Kendra Lynn, a research geologist at the Hawaiian Volcano Observatory and co-author of a new study in Nature Communications.

When pressure was high enough, the magma broke through brittle surface rock and became lava – and the eruption began in late November 2022. Later, researchers collected samples of volcanic rock for analysis.

The chemical makeup of certain crystals within the lava indicated that around 70 days before the eruption, large quantities of molten rock had moved from around 1.9 miles (3 kilometers) to 3 miles (5 kilometers) under the summit to a mile (2 kilometers) or less beneath, the study found. This matched the timeline the geologists had observed with other signs.

The last time Mauna Loa erupted was in 1984. Most of the U.S. volcanoes that scientists consider to be active are found in Hawaii, Alaska and the West Coast.

Worldwide, around 585 volcanoes are considered active.

Scientists can’t predict eruptions, but they can make a “forecast,” said Ben Andrews, who heads the global volcano program at the Smithsonian Institution and who was not involved in the study.

Andrews compared volcano forecasts to weather forecasts – informed “probabilities” that an event will occur. And better data about the past behavior of specific volcanos can help researchers finetune forecasts of future activity, experts say.

(asterisk)We can look for similar patterns in the future and expect that there’s a higher probability of conditions for an eruption happening,” said Klemetti Gonzalez.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

Source link

Continue Reading

News

Waymo’s robotaxis now open to anyone who wants a driverless ride in Los Angeles

Published

 on

 

Waymo on Tuesday opened its robotaxi service to anyone who wants a ride around Los Angeles, marking another milestone in the evolution of self-driving car technology since the company began as a secret project at Google 15 years ago.

The expansion comes eight months after Waymo began offering rides in Los Angeles to a limited group of passengers chosen from a waiting list that had ballooned to more than 300,000 people. Now, anyone with the Waymo One smartphone app will be able to request a ride around an 80-square-mile (129-square-kilometer) territory spanning the second largest U.S. city.

After Waymo received approval from California regulators to charge for rides 15 months ago, the company initially chose to launch its operations in San Francisco before offering a limited service in Los Angeles.

Before deciding to compete against conventional ride-hailing pioneers Uber and Lyft in California, Waymo unleashed its robotaxis in Phoenix in 2020 and has been steadily extending the reach of its service in that Arizona city ever since.

Driverless rides are proving to be more than just a novelty. Waymo says it now transports more than 50,000 weekly passengers in its robotaxis, a volume of business numbers that helped the company recently raise $5.6 billion from its corporate parent Alphabet and a list of other investors that included venture capital firm Andreesen Horowitz and financial management firm T. Rowe Price.

“Our service has matured quickly and our riders are embracing the many benefits of fully autonomous driving,” Waymo co-CEO Tekedra Mawakana said in a blog post.

Despite its inroads, Waymo is still believed to be losing money. Although Alphabet doesn’t disclose Waymo’s financial results, the robotaxi is a major part of an “Other Bets” division that had suffered an operating loss of $3.3 billion through the first nine months of this year, down from a setback of $4.2 billion at the same time last year.

But Waymo has come a long way since Google began working on self-driving cars in 2009 as part of project “Chauffeur.” Since its 2016 spinoff from Google, Waymo has established itself as the clear leader in a robotaxi industry that’s getting more congested.

Electric auto pioneer Tesla is aiming to launch a rival “Cybercab” service by 2026, although its CEO Elon Musk said he hopes the company can get the required regulatory clearances to operate in Texas and California by next year.

Tesla’s projected timeline for competing against Waymo has been met with skepticism because Musk has made unfulfilled promises about the company’s self-driving car technology for nearly a decade.

Meanwhile, Waymo’s robotaxis have driven more than 20 million fully autonomous miles and provided more than 2 million rides to passengers without encountering a serious accident that resulted in its operations being sidelined.

That safety record is a stark contrast to one of its early rivals, Cruise, a robotaxi service owned by General Motors. Cruise’s California license was suspended last year after one of its driverless cars in San Francisco dragged a jaywalking pedestrian who had been struck by a different car driven by a human.

Cruise is now trying to rebound by joining forces with Uber to make some of its services available next year in U.S. cities that still haven’t been announced. But Waymo also has forged a similar alliance with Uber to dispatch its robotaxi in Atlanta and Austin, Texas next year.

Another robotaxi service, Amazon’s Zoox, is hoping to begin offering driverless rides to the general public in Las Vegas at some point next year before also launching in San Francisco.

The Canadian Press. All rights reserved.

Source link

Continue Reading

Trending

Exit mobile version