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Detecting the young silent spreaders of coronavirus as Canadian schools reopen

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With just weeks to go until schools reopen across Canada, one uncertainty that remains is how effectively children can spread the coronavirus that causes COVID-19 to others — even when they don’t show symptoms.

“It’s now clear the idea that children don’t often get infected and don’t transmit the virus is mistaken,” said University of Western Australia epidemiologist Zoe Hyde.

“We know that children can transmit the virus, but we don’t yet know whether they can transmit as effectively as adults.”

While Canada has had fewer than 10,000 COVID-19 cases in those under the age of 19, including only one case where a child with the COVID-19 disease has died, experts say schools are uncharted territory because they have remained closed in much of the country during the pandemic.

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Hyde argued in a new preprint article in the Medical Journal of Australia, which has not yet been peer reviewed, that while evidence shows children generally have less severe illness from the virus — it’s wrong to assume they play a smaller role in spreading it.

“Children are much more likely to have mild or even asymptomatic infections than adults, and so they’ve gone under the radar,” she told CBC News.

“However, as community transmission has grown in some countries, the virus has finally started to make its way into younger age groups, and large outbreaks in schools have followed.”

An outbreak at a school in Chile found younger children and teachers were more likely to be infected, while Israel saw an explosion of coronavirus cases after it moved to reopen schools quickly despite cases in the community being low.

An article published in JAMA Pediatrics last month also found children at a hospital in Chicago carried a similar amount of virus in their upper respiratory tracts as adults.

While that doesn’t necessarily mean they can spread the infectious virus as effectively, it did find kids aged five and under with mild COVID-19 symptoms had 10 to 100 times as much of the virus in their systems as older children and adults, so they could still be “important drivers” of the virus in the general population.

Could schools cause a surge of COVID-19 cases in Canada?

Given what we know and don’t know about the way in which children can spread the coronavirus, one question remains top of mind — will reopening schools next month put students, teachers and the wider community at greater risk?

Raywat Deonandan, a global health epidemiologist and an associate professor at the University of Ottawa, said much of the research to date on how kids spread the virus is flawed because it was done while schools were already closed and cases in the community were low.

“We don’t really know to a large extent what happens in the school arena,” he said. “You cannot reliably conclude that child transmission is unlikely.”

 

Canada’s federal guidelines for returning students to school focus heavily on isolating those with symptoms but make little mention of asymptomatic transmission. (Shutterstock/Halfpoint)

 

Another caveat is that the research also focused largely on children with COVID-19 who were symptomatic, which Deonandan said leaves many questions unanswered for younger kids who are much less likely to show symptoms.

Ashleigh Tuite, an infectious diseases epidemiologist and assistant professor at the University of Toronto’s Dalla Lana School of Public Health, said that there is an increased risk of spread in schools because children’s social circles are generally wider than adults.

“If you have 30 people in a classroom and each of those children has a social circle of 10 people and you have a case introduced into that classroom setting, you’re potentially talking about having to think about disease transmission among 300 people,” she said.

“We’re dramatically increasing the size of our social networks as we have this return to school, and if you have an initial case that is introduced into that setting in a child who’s asymptomatic, it may take time until you recognize that there’s transmission happening.”

Is Canada doing enough to stop asymptomatic spread in schools?

Canada’s federal guidelines for returning students to school focus heavily on isolating those with symptoms but make little mention of asymptomatic transmission. They also concede COVID-19 in children is “not fully understood” and “evidence may change with time.”

“From the very beginning of the epidemic, we have completely dropped the ball on understanding the role of asymptomatic transmission of this infection,” said Dr. Isaac Bogoch, an infectious diseases physician at Toronto General Hospital.

“To date, seven months in, we still don’t have a very good understanding of the proportion of people that are truly asymptomatic.”

Despite that lack of understanding, Bogoch says the current back-to-school protocols in place could work to address any potential asymptomatic spread in the classroom.

“If an asymptomatic person is going to school and they have a mask on the entire time and they’re washing their hands religiously and they’re separated two metres from other people, it’s far less likely that they’re going to transmit this infection to other people,” he said.

But new modelling from the federal government warns of the potential for a “fall peak” in coronavirus cases, adding that “closed and crowded indoor settings where physical distancing is a challenge pose high risk for outbreaks.”

WATCH | Potential ‘fall peak’ in cases of coronavirus infections:

Chief public health officer Dr. Theresa Tam says her team is striving for a best-case scenario but preparing for the worst: a so-called “fall peak” of COVID-19 cases across the country. 1:06

Rapid testing would be ‘a tremendous benefit’

Besides focusing on increased ventilation, physical distancing, masks and avoiding crowded indoor spaces as essential aspects of reopening schools safely, one other key element that could help curb spread before it starts is rapid testing.

“If there was a rapid test, that would really identify people that have enough virus in their system that they’re capable of transmitting it to others,” said Bogoch.

“This would be a tremendous benefit, because you could identify people who are at risk of transmitting this infection and prevent them from going to work or from going to school and infecting others.”

But Canada does not yet have access to this type of testing technology called antigen tests, which could allow schools to test entire classrooms quickly with results in about 30 minutes.

“Right now, trying to test people on a regular basis, and children in particular and teachers is not part of the approach,” Canada’s Chief Public Health Officer Dr. Theresa Tam said in a press briefing this week.

“If you had a case in your school, we expect rapid response in terms of testing and looking at contacts, but right now the technology in Canada doesn’t support that kind of approach.”

 

Chief Public Health Officer Dr. Theresa Tam says Canada is ‘actively pursuing’ rapid testing technologies, but to date no such tests have been approved by Health Canada. (Justin Tang/The Canadian Press)

 

Surveillance testing could help catch asymptomatic cases

The U.S. Food and Drug Administration recently authorized emergency use of antigen tests in the United States this month, which are already being rolled out in schools from kindergarten to Grade 12 in states such as Arkansas.

Tam said Canada is “actively pursuing” a similar technology for use here, but no antigen tests have yet been approved by Health Canada.

In absence of that, randomly testing classrooms with our current technology through what’s known as surveillance testing could help catch asymptomatic cases in schools before they spread.

But no provincial or territorial back-to-school plans in Canada have focused on surveillance testing in the classroom in order to monitor and curb potential asymptomatic spread.

“We definitely need to be doing surveillance testing in schools,” said Hyde. “At the very least, we need to be doing this kind of testing to get the data we need to work out how safe schools are.”

Some provinces, such as British Columbia and Newfoundland and Labrador, have opted to delay the start of their school year in order to better prepare for reopening in the pandemic. But others, like Canada’s most populous province, have opted to push ahead amid the uncertainty.

 

 

Ontario’s Chief Medical Officer of Health Dr. David Williams said Thursday there was a negligible risk of sending students back to school, citing low rates of transmission in the province.

“If there was a risk, I would not be recommending the schools are being opened under the current situation,” he said during a news conference. “Therefore, at this time, I don’t see those risks.”

Some experts disagree, citing flawed research that hasn’t provided a clear picture of asymptomatic transmission in children and the fact that COVID-19 has largely gone untested in Canadian schools with a second wave expected in the coming months.

“It’s inevitable. I think we are going to see a rise in cases, and it’s probably going to come in the fall. And I don’t think that’s lost on many people that are following this closely,” Bogoch said.

“We have to ensure that there’s good early detection systems in place so that we can rapidly identify outbreaks and respond to them before they spiral out of control.”

Source: – CBC.ca

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We all experience stress. How we handle it is key to our health, say experts – CBC.ca

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The Dose24:36What’s the connection between stress and my health and well-being?

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It could be a morning traffic jam. A deadline at work. A conflict with a family member. Taking care of kids and aging parents. 

Stressful situations are all around us, and experts say how we manage stress is key to preventing it from causing long-term health problems — both physical and mental. 

Short-term stress doesn’t have to be negative, but research shows that ongoing stress wears away at the body’s systems and can lead to an increased risk of heart attack, stroke, Type 2 Diabetes, and mental health challenges.

“It’s like walking around with a ten or fifteen-pound weight continually on your back and not being able to shed that weight,” psychologist Dr. Zindel Segal told Dr. Brian Goldman, host of CBC’s The Dose

There are techniques and strategies to decrease that stressful load, however, and lessen the impact of stress on the body and the mind. 

Is stress good or bad? 

Stress means that we are unable to use our personal or social resources to meet the demands being placed on us, said Dr. Eli Puterman, a health psychologist and associate professor in the school of kinesiology at UBC. 

But not all stress is bad stress, said Puterman. 

“It sometimes can motivate you to also move in the direction of, ‘Let’s change our goals,'” he said. 

From an evolutionary perspective, our bodies are engineered to handle stress, said Segal, a distinguished professor of psychology and mood disorders at the University of Toronto Scarborough. 

But after the stress response, we need a period of rest and recovery, which allows the body to recoup the resources that were used up during the stressful situation. 

Chronic stress is when we’re unable to step out of the situation and take advantage of our own natural capacity to restore, said Segal. 

It’s a system that is “stuck in the fifth gear without the ability to downshift,” he said. 

Connecting with your senses

The first step to managing stress is recognizing it, said Segal, and that means tuning into our bodies. 

“Are you noticing that maybe your heart is racing, or that your palms are sweating, or that your temple and forehead are pounding?” he said. 

Grounding techniques can anchor us in the present moment and help pull us away from intrusive thoughts or feelings to take a broader view of the situation, said Segal. 

Deep breathing and meditation can both help you tune into your senses during stressful moments. (Maggie MacPherson/CBC)

“One of the things that we lose the ability to connect with is the sensory world,” he said, which is why so many techniques for managing stress are about reconnecting with your senses. 

“Sensations are a way of actually helping us step out of thinking, to ground ourselves.” 

A breath of fresh air 

Doing yoga, meditating, exercising and deep breathing can all help ground us in our bodies and change our perspectives on stress, said Segal. 

However, stress can cause barriers to being physically active, said Puterman, so he prefers to think about moving our bodies as opposed to exercising. 

“Getting outside and going for some walks for 10, 15 minutes per day can help us start having those moments where we’re taking care of our bodies,” he said. 

LISTEN | Try this guided exercise in box breathing with Dr. Zindel Segal: 

The Dose1:50A guided exercise in box breathing

One simple exercise Segal recommends is a technique called box breathing. Here’s how to try it: 

  • Sit in a chair and notice the sensations of sitting: the feet pressing down into the floor, the hands folded in the lap or on the thighs. 
  • Breathe in for four beats (visualize the left side of the box). 
  • Hold for four beats (visualize the top of the box).
  • Breathe out for four beats (visualize the right side of the box). 
  • Hold for four beats (visualize the bottom of the box). 
  • Repeat as many times as you like. 

What stress does to the body 

It may be easy to understand how stress can take an emotional and mental toll, but research also shows that stress can have an impact on our physical health — including an increased risk of heart attack or stroke. 

“In the short term, it rapidly increases your blood pressure, which can potentially result in a tear in the plaque that is in your arteries and then subsequently cause a heart attack or a stroke,” said Dr. Hassan Mir, a cardiologist at the Ottawa Heart Institute. 

When we’re feeling stress, it activates our sympathetic nervous system, the part of our nervous system that carries signals related to our fight-or-flight response. 

That can cause an increase in our blood pressure and heart rate, said Mir. 

Another reaction to acute stress is a condition called takotsubo cardiomyopathy, or a weakened heart muscle, he said.

“When you’re really stressed, you can have this release of adrenaline in your body,” Mir said. 

WATCH We can’t avoid stress, but we can learn how to deal with it: 

Stress can create long-term health impacts: ‘It’s all about how you cope,’ says psychologist

6 months ago

Duration 1:49

Mir has seen people who come into the hospital because their partner had a cardiac arrest, and then they suddenly get rushed to the ER because it looks like they’re having a heart attack. 

“You go and look inside and the coronary arteries look completely fine, but their heart muscle looks like it’s completely weakened,” Mir said. 

If you’re frequently activating your sympathetic nervous system due to stress, that can cause other issues in the body, said Puterman. 

“If you’re starting to shift your baseline of the functioning of your physiology, you’re now entering the state where now you have too much cortisol that’s then activating too much glucose release,” he said. 

Too much glucose released into the body can cause people to enter a pre-diabetes state, said Puterman. 

How much stress is too much?  

A little bit of stress could help us handle more stressful events in the future, a theory called the inoculation hypothesis, said Puterman. 

“Some stress on a daily basis or in life actually inoculates you to future exposures to stressors,” he said. 

But there are some telltale signs that the stress you’re experiencing is causing harmful effects, said Puterman. They include: 

  • Not sleeping well.
  • Not getting as much exercise as usual.
  • Consuming more alcohol or drugs.
  • Withdrawing from others socially.
  • Getting into more arguments with family or friends.

The trick is finding that sweet spot, said Segal, between having enough stress and too much. 

“We don’t want to tip over into a point where the stress that we’re facing is overwhelming,” Segal said. 

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Medical officer encourages measles vaccinations as global cases rise – SteinbachOnline.com

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As cases of measles are increasing in parts of Canada and around the world, Manitobans are reminded that staying up to date on their vaccinations is one of the most important ways to prevent and reduce the risk of measles and other serious illnesses. 

Measles is very contagious, says Dr. Mahmoud Khodaveisi, Medical Officer of Health for Southern Health-Santé Sud. 

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The most recognized symptom of measles is a red, blotchy rash, which often begins on the face and spreads down the body. Other common symptoms include fever, runny nose, cough, drowsiness, irritability and red eyes. Measles is a serious illness, especially for young children, and can result in lung and brain infections and other conditions that lead to serious complications or death. 

Although there have been no recent confirmed cases of measles in our province since 2019, there is increasing concern as the number of cases are rising in Canada and around the world. 

Dr. Khodaveisi says that before the vaccine was available, measles was a significant cause of childhood illness, and as a result, people born before 1970 are considered immune to measles as they were likely exposed growing up. 

As part of Manitoba’s routine immunization schedule, children can receive two doses of a vaccine that protects against measles, first at 12 months and again between the ages of four and six. Together, these doses provide 97 per cent protection against measles. 

The province reports that the most recent data available shows that about 80 per cent of children in Manitoba have received one dose of the vaccine that protects against measles by age two. Nearly 75 per cent of children have received two doses of the vaccine by age seven and this rate increases to over 88 per cent by the age of 17. 

The province has sent information out about measles to health-care providers. 

Measles is a reportable disease, meaning public health must be informed about cases by laboratories and health-care providers. Once a case is reported, public health will launch an investigation. This includes identifying close contacts, offering vaccination where appropriate and notifying the public of relevant exposures if needed. 

Manitoba’s immunization registry was established in 1988, so records for anyone who has received immunizations since then should be contained in the registry. 

If you are not sure if you or your children have been vaccinated, immunization records can be requested online at https://forms.gov.mb.ca/immunization-update-request/. Alternatively, you can contact your local public health office or contact your health-care provider.

-With files from Corny Rempel. 

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Measles in Toronto: 2nd case confirmed

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A second lab-confirmed case of measles has been identified in Toronto.

The city’s public health agency said that an infant who recently returned from travel has contracted the disease. The child is recovering at home.

The first Toronto case was identified on Feb. 16.

Toronto Public Health is warning that anyone who attended the Agincourt Public Library between 1 p.m. and 5:30 p.m. on March 11 may have been exposed. Individuals should monitor for symptoms until April 1 and double check that their vaccinations are up to date.

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Symptoms of measles include red rashes, fever, cough, runny nose, red eyes and fatigue. Individuals can also get unusual white spots in their mouth.

The number of measles infections in Ontario so far this year has already surpassed the total number of cases reported in 2023.

As of March 13, Public Health Ontario had confirmed at least eight cases of measles across the province. Cases have been identified in Peel Region, Hamilton, Brant County and Windsor-Essex County.

Of those infections, six were related to travel and two had an unknown source of exposure.

In 2023, there were seven cases of measles confirmed in Ontario.

Canada-wide data is less detailed, with the Public Health Agency of Canada reporting 17 cases of measles as of March 2, along with one case of congenital rubella syndrome.

 

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