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.”
WINNIPEG – Some 250 coloured tacks pepper a large-scale world map among bookshelves at Whodunit Mystery Bookstore.
Estonia, Finland, Japan and even Fenwick, Ont., have pins representing places outside Winnipeg where someone has ordered a page-turner from the independent bookstore that specializes in mystery and crime fiction novels.
For 30 years, the store has been offering fans of Agatha Christie’s Hercule Poirot or Arthur Conan Doyle’s Sherlock Holmes a place to get lost in whodunits both old and new.
Jack and Wendy Bumsted bought the shop in the Crescentwood neighbourhood in 2007 from another pair of mystery lovers.
The married couple had been longtime customers of the store. Wendy Bumsted grew up reading Perry Mason novels while her husband was a historian with vast knowledge of the crime fiction genre.
At the time, Jack Bumsted was retiring from teaching at the University of Manitoba when he was looking for his next venture.
“The bookstore came up and we bought it, I think, within a week,” Wendy Bumsted said in an interview.
“It never didn’t seem like a good idea.”
In the years since the Bumsteds took ownership, the family has witnessed the decline in mail-order books, the introduction of online retailers, a relocation to a new space next to the original, a pandemic and the death of beloved co-owner Jack Bumsted in 2020.
But with all the changes that come with owning a small business, customers continue to trust their next mystery fix will come from one of the shelves at Whodunit.
Many still request to be called about books from specific authors, or want to be notified if a new book follows their favourite format. Some arrive at the shop like clockwork each week hoping to get suggestions from Wendy Bumsted or her son on the next big hit.
“She has really excellent instincts on what we should be getting and what we should be promoting,” Micheal Bumsted said of his mother.
Wendy Bumsted suggested the store stock “Thursday Murder Club,” the debut novel from British television host Richard Osman, before it became a bestseller. They ordered more copies than other bookstores in Canada knowing it had the potential to be a hit, said Michael Bumsted.
The store houses more than 18,000 new and used novels. That’s not including the boxes of books that sit in Wendy Bumsted’s tiny office, or the packages that take up space on some of the only available seating there, waiting to be added to the inventory.
Just as the genre has evolved, so has the Bumsteds’ willingness to welcome other subjects on their shelves — despite some pushback from loyal customers and initially the Bumsted patriarch.
For years, Jack Bumsted refused to sell anything outside the crime fiction genre, including his own published books. Instead, he would send potential buyers to another store, but would offer to sign the books if they came back with them.
Wendy Bumsted said that eventually changed in his later years.
Now, about 15 per cent of the store’s stock is of other genres, such as romance or children’s books.
The COVID-19 pandemic forced them to look at expanding their selection, as some customers turned to buying books through the store’s website, which is set up to allow purchasers to get anything from the publishers the Bumsteds have contracts with.
In 2019, the store sold fewer than 100 books online. That number jumped to more than 3,000 in 2020, as retailers had to deal with pandemic lockdowns.
After years of running a successful mail-order business, the store was able to quickly adapt when it had to temporarily shut its doors, said Michael Bumsted.
“We were not a store…that had to figure out how to get books to people when they weren’t here.”
He added being a community bookstore with a niche has helped the family stay in business when other retailers have struggled. Part of that has included building lasting relationships.
“Some people have put it in their wills that their books will come to us,” said Wendy Bumsted.
Some of those collections have included tips on traveling through Asia in the early 2000s or the history of Australian cricket.
Micheal Bumsted said they’ve had to learn to be patient with selling some of these more obscure titles, but eventually the time comes for them to find a new home.
“One of the great things about physical books is that they can be there for you when you are ready for them.”
This report by The Canadian Press was first published on Sept. 15, 2024.
MONTREAL – Canada’s labour minister is praising both Air Canada and the union representing about 5,200 of its pilots for averting a work stoppage that would have disrupted travel for hundreds of thousands of passengers.
Steven MacKinnon’s comments came in a statement shared to social media shortly after Canada’s largest air carrier announced it had reached a tentative labour deal with the Air Line Pilots Association.
MacKinnon thanked both sides and federal mediators, saying the airline and its pilots approached negotiations with “seriousness and a resolve to get a deal.”
The tentative agreement averts a strike or lockout that could have begun as early as Wednesday for Air Canada and Air Canada Rouge, with flight cancellations expected before then.
The airline now says flights will continue as normal while union members vote on the tentative four-year contract.
Air Canada had called on the federal government to intervene in the dispute, but Prime Minister Justin Trudeau said Friday that would only happen if it became clear no negotiated agreement was possible.
This report from The Canadian Press was first published Sept. 15, 2024.
When it comes to plant-based alternatives, Canadians have never had so many options — and nowhere is that choice more abundantly clear than in the milk section of the dairy aisle.
To meet growing demand, companies are investing in new products and technology to keep up with consumer tastes and differentiate themselves from all the other players on the shelf.
“The product mix has just expanded so fast,” said Liza Amlani, co-founder of the Retail Strategy Group.
She said younger generations in particular are driving growth in the plant-based market as they are consuming less dairy and meat.
Commercial sales of dairy milk have been weakening for years, according to research firm Mintel, likely in part because of the rise of plant-based alternatives — even though many Canadians still drink dairy.
The No. 1 reason people opt for plant-based milk is because they see it as healthier than dairy, said Joel Gregoire, Mintel’s associate director for food and drink.
“Plant-based milk, the one thing about it — it’s not new. It’s been around for quite some time. It’s pretty established,” said Gregoire.
Because of that, it serves as an “entry point” for many consumers interested in plant-based alternatives to animal products, he said.
Plant-based milk consumption is expected to continue growing in the coming years, according to Mintel research, with more options available than ever and more consumers opting for a diet that includes both dairy and non-dairy milk.
A 2023 report by Ernst & Young for Protein Industries Canada projected that the plant-based dairy market will reach US$51.3 billion in 2035, at a compound annual growth rate of 9.5 per cent.
Because of this growth opportunity, even well-established dairy or plant-based companies are stepping up their game.
It’s been more than three decades since Saint-Hyacinthe, Que.-based Natura first launched a line of soy beverages. Over the years, the company has rolled out new products to meet rising demand, and earlier this year launched a line of oat beverages that it says are the only ones with a stamp of approval from Celiac Canada.
Competition is tough, said owner and founder Nick Feldman — especially from large American brands, which have the money to ensure their products hit shelves across the country.
Natura has kept growing, though, with a focus on using organic ingredients and localized production from raw materials.
“We’re maybe not appealing to the mass market, but we’re appealing to the natural consumer, to the organic consumer,” Feldman said.
Amlani said brands are increasingly advertising the simplicity of their ingredient lists. She’s also noticing more companies offering different kinds of products, such as coffee creamers.
Companies are also looking to stand out through eye-catching packaging and marketing, added Amlani, and by competing on price.
Besides all the companies competing for shelf space, there are many different kinds of plant-based milk consumers can choose from, such as almond, soy, oat, rice, hazelnut, macadamia, pea, coconut and hemp.
However, one alternative in particular has enjoyed a recent, rapid ascendance in popularity.
“I would say oat is the big up-and-coming product,” said Feldman.
Mintel’s report found the share of Canadians who say they buy oat milk has quadrupled between 2019 and 2023 (though almond is still the most popular).
“There seems to be a very nice marriage of coffee and oat milk,” said Feldman. “The flavour combination is excellent, better than any other non-dairy alternative.”
The beverage’s surge in popularity in cafés is a big part of why it’s ascending so quickly, said Gregoire — its texture and ability to froth makes it a good alternative for lattes and cappuccinos.
It’s also a good example of companies making a strong “use case” for yet another new entrant in a competitive market, he said.
Amid the long-standing brands and new entrants, there’s another — perhaps unexpected — group of players that has been increasingly investing in plant-based milk alternatives: dairy companies.
For example, Danone has owned the Silk and So Delicious brands since an acquisition in 2014, and long-standing U.S. dairy company HP Hood LLC launched Planet Oat in 2018.
Lactalis Canada also recently converted its facility in Sudbury, Ont., to manufacture its new plant-based Enjoy! brand, with beverages made from oats, almonds and hazelnuts.
“As an organization, we obviously follow consumer trends, and have seen the amount of interest in plant-based products, particularly fluid beverages,” said Mark Taylor, president and CEO of Lactalis Canada, whose parent company Lactalis is the largest dairy products company in the world.
The facility was a milk processing plant for six decades, until Lactalis Canada began renovating it in 2022. It now manufactures not only the new brand, but also the company’s existing Sensational Soy brand, and is the company’s first dedicated plant-based facility.
“We’re predominantly a dairy company, and we’ll always predominantly be a dairy company, but we see these products as complementary,” said Taylor.
It makes sense that major dairy companies want to get in on plant-based milk, said Gregoire. The dairy business is large — a “cash cow,” if you will — but not really growing, while plant-based products are seeing a boom.
“If I’m looking for avenues of growth, I don’t want to be left behind,” he said.
Gregoire said there’s a potential for consumers to get confused with so many options, which is why it’s so important for brands to find a way to differentiate themselves, whether it’s with taste, health, or how well the drink froths for a latte.
Competition in a more crowded market is challenging, but Taylor believes it results in better products for consumers.
“It keeps you sharp, and it forces you to be really good at what you’re doing. It drives innovation,” he said.
This report by The Canadian Press was first published Sept. 15, 2024.
