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Drug shortages could 'imperil the lives' of Canadians, doctors warn Ottawa – CTV News

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TORONTO —
A group of some of Canada’s leading doctors and pharmacists have issued an open letter to Prime Minister Justin Trudeau, urging the federal government to address shortages for critical drugs such as Azithromycin, Lorazepam and Remdesivir that could “imperil the lives” of Canadians amid the COVID-19 pandemic

The Critical Drugs Coalition issued the letter on Thursday, asking the government to bring attention and resources to Canada’s drug supply challenges. These challenges have existed for the past decade but doctors say they have been “greatly exacerbated” due to the novel coronavirus.

“We simply cannot afford to jeopardize the lives and wellbeing of our patients due to an inadequate supply of critical drugs,” the letter reads.

Some of the drugs currently in shortage include forms of Azithromycin, Ceftriaxone, Dexamethasone, Lorazepam, Midazolam, Propofol, Remdesivir, Salbutamol and Tocilizumab, among others. The letter says that health-care professionals have also seen shortages in antibiotic drugs, some of which are on the Tier 3 list, including Penicillin G.

According to the letter, 24 out of 32 drugs on Health Canada’s Tier 3 shortage list are essential for treating COVID-19. Medications on the Tier 3 list are drugs experiencing an active significant shortage and have no suitable alternatives.

With these critical drugs typically prescribed for various condition such as epilepsy, high blood pressure, pain, and asthma, many pharmacies across the country have been limiting patients to one month’s worth of medication at a time to discourage people from stockpiling medication amid the uncertainties around the pandemic.

CTV News previously reported that doctors are also experimenting with different treatments using existing medications to help hospitalized COVID-19 patients, which in some cases, have led to misinformed members of the public stockpiling the medicine and causing shortages for patients suffering from other serious diseases requiring the drugs.

“As frontline pharmacists and physicians, we have seen and heard of serious shortages of essential, critical medications. These drugs are often used simultaneously in ORs, ERs and palliative care wards, as well as ICUs,” the letter reads.

While Canada’s ICUs are seeing fewer COVID-19 patients, the Critical Drugs Coalition says the pandemic has placed a burden on their drug supply with patients often requiring weeks of treatment on ventilators.

Deputy Minister of Health Canada Stephen Lucas said in April that the COVID-19 pandemic will likely lead to shortages of drugs and medical devices for Canadians.

Lucas said the federal government has a team dedicated to addressing the problem and is working with regulators in the U.S., Australia and Europe to identify where the supply-chain disruptions are occurring.

The federal government has also issued an interim order to allow certain international drugs that may not fully meet regulatory requirements to be imported and sold in Canada to help address drug shortages. However, pharmacists and physicians say they’re still facing shortages.

CALLS FOR IMMEDIATE ACTION

Health experts behind the letter worry that a likely second wave of infections in Canada will further increase drug shortages and put Canadians lives at risk by compromising the optimal care for their health unless certain measure are put in place.

While the letter is addressed to Trudeau, the Critical Drugs Coalition is calling for immediate action by all levels governments including provincial, territorial, and municipal with national support. The letter said Canada will “perpetually face drug shortages” unless concrete action is taken.

The Critical Drugs Coalition is a grassroots, volunteer-run coalition of physicians, pharmacists and others concerned by drug shortages amid the pandemic. The coalition recommends that Canada find a long-term solution to the problem, starting with the robust stockpiling of critical medications.

“Many of the critical care drugs should be part of the National Strategic Emergency Stockpile. However, it is clear that Canada simply did not have enough stockpiled to meet the demand during the COVID-19 pandemic and that there has been under allocation and underspending for the emergency stockpile,” according to the letter.

Some of Canada’s national medical bodies including the Canadian Medical Association (CMA) and the Canadian Association of Emergency Physicians (CAEP) have also signed the letter.

In order for the stockpiling strategy to be effective, the letter says governments must work closely with hospitals across Canada to establish a comprehensive list of essential medications for hospital-based care. Additionally, it suggests governments develop a plan to obtain medications in a co-ordinated manner to prevent unintended competition.

The letter is also calling for a publicly owned or supported critical drugs manufacturer as a safeguard against future drug shortages.

China and India supply some 80 per cent of the active ingredients and raw materials for many of the medications, and while some drugs are assembled in Canada, none are completely manufactured here from start to finish.

The letter explained that this national manufacturer would specialize in creating the critical drugs on the Critical Medications List, and “would be primarily involved in satisfying significant portions” of national medication demands.

Going forward, the letter is urging greater transparency and communication from governments to the health sector and the public on the supply of critical medicines to ensure drug supply issues are addressed before they pose any serious risks to sick patients.

“We encourage our government to give this urgent issue attention and efforts now, so that Canadians can have the confidence that their healthcare system will be there when they most need it,” the letter said.

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Canada's death toll could hit 16000 by the end of 2020, new modelling warns – CTV News

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TORONTO —
Canada could see as many as 16,000 COVID-19 deaths by the end of the year if current public safety measures don’t change, according to new modelling from the United States that has provided accurate assessments of the American death toll.

But a Canadian pandemic modelling expert says that, while anything is possible, the American model may not be capturing the whole picture in Canada.

The model from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington suggests Canada could see 16,214 deaths by Jan. 1 based on the current situation. If public safety mandates are loosened, such as physical distancing, the death toll could be even higher, hitting a projected 16,743 lives lost.

Universal masking in public spaces could curb those numbers and save thousands of lives, the model suggests, pointing to countries like Singapore that have successfully put in place masking protocols that are 95 per cent effective. Singapore has reported 27 deaths since the start of the pandemic.

If Canada were to successfully implement similar rules, the modelling predicts a death toll of 12,053.

So far Canada has reported 9,256 deaths from COVID-19 and more than 150,000 cases. Prime Minister Justin Trudeau warned earlier this week that the country is at the beginning of a second wave of infections as he urged Canadians to take public health guidance seriously.

Quebec is leading the country with new cases of COVID-19. On Saturday, the province reported another 698 cases, the highest daily infection numbers since May.

Dionne Aleman, an associate professor at the University of Toronto who specializes in mathematical models for pandemic prediction, said the IHME model is “simplistic” and does not account for regional differences across the country.

While a second wave of COVID-19 infections has started, Aleman points out that deaths are not in a second wave. COVID-19 deaths in Canada peaked in April and May, when more than 100 people died in connection with the virus daily. Those numbers have remained much lower in recent months, with five deaths reported on Friday.

“The fact that deaths are not tracking with infections as they did in the first wave indicates that vulnerable individuals are taking more precautions to protect themselves now, and it is reasonable to assume those precautions will continue as the second wave gets worse. This model does not account for the fact that some people are behaving differently from others, and thus, the projected deaths are likely overstated,” Aleman told CTVNews.ca on Saturday over email.

The latest modelling by the Public Health Agency of Canada does not offer predictions to the end of the year, but suggests that, based on current rates, the death toll could steadily rise to 9,300 lives lost by Oct. 2.

The IMHE modelling has proven to be accurate. Earlier this year, the model predicted that the U.S. would hit 200,000 deaths in September, a grim milestone that happened earlier this week. Now, the model predicts the U.S. death toll will nearly double by the end of the year, reaching 371,509 by Jan. 1.

The IMHE model also predicts daily infections — a number that includes people who aren’t tested for COVID-19 — could hit more than 19,000 by the end of the year.

Aleman said it’s important to remember that, even if a person doesn’t die from COVID-19, the consequences of getting sick can be serious.

“There are numerous examples of otherwise healthy individuals with severe reactions to COVID taking several weeks and even months to recover, and there are indications that there could be long-term health consequences,” she said.

“We should view these projections of exponential infection increase with great concern, and we as individuals should take every reasonable precaution to stem this increase before it is too far out of control. Wearing masks is easy and effective, and we should do it.”

Infections may be on the upswing, but Canada’s Chief Public Health Officer Dr. Theresa Tam said Saturday that limiting personal contacts as much as possible can help once again flatten the curve. She encouraged Canadians to take time this weekend to chat with loved ones about how to keep their bubbles safer.

“Even if people attending an event are part of your extended family, as has been the case with some of these private gathering outbreaks, it doesn’t mean they are not infected, even if no one appears to be unwell,” Tam said in a statement.

“Despite the very real concern of a large resurgence in areas where the virus is escalating, there is still reason to be optimistic that we can get things back to the slow burn.”

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B.C. university launches 1st peace and reconciliation centre in Canada – CBC.ca

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The University of the Fraser Valley hopes its new Peace and Reconciliation Centre (PARC) — which the school says is the first of its kind in Canada — will help contribute to a more equitable society.

Professor Keith Carlson, the centre’s chair, said institutions like universities and governments can often reinforce unequal power structures by excluding knowledge and experience from historically-marginalized communities.

The PARC was established to counter that by “bringing new voices to the table,” he told Margaret Gallagher, guest host of CBC’s On the Coast on Thursday. 

Aside from collaborating with academic departments like Peace and Conflict Studies, the PARC will offer funding and scholarships to students and faculty, as well as community members not affiliated with UFV “who are looking for partners and allies to change the world,” said Carlson. 

The Abbotsford-based university says it has received substantial funding from the Oikodome Foundation, a local Christian charity.

UFV launched the PARC Thursday with a virtual event featuring speeches from Steven Point, the first-ever Indigenous chancellor of UBC, and former Ontario Premier Bob Rae, now Canada’s ambassador to the United Nations.

‘Deep listening’

Jacqueline Nolte, dean of UFV’s college of arts, said the university envisions the PARC as a hub for constructive dialogue, research and creative expression aimed at building trust among diverse communities. 

“We will facilitate deep listening and mediation such that all people will feel heard and acknowledged,” she said in a news release. 

The scope of the centre won’t be narrow.

Along with relations between Indigenous people and settlers, Carlson said the centre could address everything from domestic violence to interfaith conflicts in the Middle East and Ireland. 

Carlson, who holds the Canada Research Chair in Indigenous and community-engaged history, echoed Nolte’s words.

“What we’re saying [is] that we value Indigenous ways of knowing,” Carlson said.

“The structures that underlie racism need to be dismantled so that everybody in this country […] will be able to enjoy all the privileges that anybody who’s of European descent [has].”

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Crisis, what crisis? If Canada is in a 2nd COVID wave, N.L. is watching it from afar – CBC.ca

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Prime Minister Justin Trudeau addresses Canadians on the COVID-19 pandemic from Rideau Cottage in Ottawa on April 27. (Sean Kilpatrick/The Canadian Press)

On Wednesday, Canadians tuned in to hear Prime Minister Justin Trudeau make a national address on COVID-19. Trudeau got right to the point.

“The second wave isn’t just starting, it’s already underway,” Trudeau said. “The numbers are clear.”

Given that Trudeau just moments later said, “We’re on the brink of a fall that could be much worse than the spring,” I was expecting him to then lay down the framework for another lockdown.

That didn’t happen. Instead, Trudeau appealed to Canadians to do their part to smash a curve that has been on rapid ascent in some provinces, especially British Columbia, Alberta, Ontario and Quebec.

Are things that bad? Here’s a comparison from the address that ought to have caught attention. “Back on March 13, when we went into lockdown, there were 47 new cases of COVID-19. Yesterday alone, we had well over a thousand.”

There was no sense of panic after Trudeau’s remarks — not across the country, but especially not here. What reaction I did notice locally on social media might be boiled down to “meh.” That is, life is going on, and since Trudeau’s address made for prime-time viewing in our time zone, it felt like a bit of a letdown.

Prime Minister Justin Trudeau gave a rare address to the nation following a throne speech like no other in Canadian history. The address and the speech were both focused on COVID-19. The Liberals also promised job creation and child-care investment. 9:01

Part of this reason surely must be that there are distinct COVID-19 situations in the country, and Newfoundland and Labrador — perhaps accustomed to watching national dramas from both geographic and psychological sidelines all along — is far away from a mounting crisis elsewhere in Canada.

Wildly different experiences in the pandemic

Consider this. In Ontario on Thursday — the day after Trudeau’s address to the nation — 409 cases were reported. A month earlier, on Aug. 24, the number was 105. Quebec reported 582 cases on Thursday; on Aug. 24, that number was just 68.

The national tally has indeed been spiking in recent days. On Thursday, Canada logged 1,341 news cases of COVID-19 — or about 55 an hour. That’s almost one a minute.

Or, to look at it another way, there are on average five new cases surfacing every five or six minutes.

To count the last five cases in Newfoundland and Labrador, you need to go back to Aug. 10. To count the last 10, we go back to July 22.

Passenger traffic at St. John’s International Airport is gradually climbing, but remains a small fraction of normal volumes. (Gary Locke/CBC)

In other words, the pandemic situation here — like all of the other Atlantic provinces and the territories — is entirely different from provinces where cases are spiking. (Manitoba is dealing with double digits, while Saskatchewan’s caseload has been comparatively modest.)

So … have we become complacent?

There’s always that concern everywhere, and we should be no different.

But it’s worth noting that a focal point of Wednesday’s weekly briefing was whether Halloween could go ahead this year. (A provisional yes, said Chief Medical Officer of Health Dr. Janice Fitzgerald, so long as rates do not increase.)

Not only did we not see anxious faces that have been handling briefings in bigger provinces, we learned on Wednesday that the provincial government has stopped sending daily news releases on COVID-19. They’ll resume when there is, well, news — presumably, a new case. Otherwise, data will be updated every afternoon on the dashboard of the province’s COVID-19 website.

Crushing the curve

Newfoundland and Labrador, which had a scary spike in the early spring with a cluster that involved attendance at the Caul’s funeral home in St. John’s, not only planked the curve, but kind of crushed it.

Still, despite a gradual loosening of restrictions brought in through a public health emergency order, we continue to move through the impacts of living with a pandemic. We may be able to shop and move around more easily, but many facets of daily life are quite affected. In the weeks to come, there will be no fall fairs at local churches, no Christmas sales at the Glacier, no big concerts at Mile One. Live performances are resuming, but many chairs (every other row at the Arts & Culture Centre) will be vacant for safety.

The tone of COVID-19 briefings locally has been notably less grim than in some other provinces. Dr. Janice Fitzgerald, the chief medical officer of health, reactions to a question at Wednesday’s briefing on whether she has plans to travel abroad. After chuckling, she said no. (Government of Newfoundland and Labrador)

There will be no conventions, either. Indeed, there has not been that much travel. There was five times the amount of passenger traffic at St. John’s International Airport in August than in April, but that’s only because there was practically no traffic at all in those early weeks of the pandemic.

Consider this chart:

MonthPassengersDecrease from 2019
April 20205,424-95.4%
May 20206,780-94.9%
June 202010,831-92.2%
July 202021,791-87.1%
August 202028,569-84.1%

Source: St. John’s International Airport

Newfoundland and Labrador’s so-called travel ban — which prohibits entry to the province to non-residents (now outside the Maritimes) who do not have previously approved exemptions — continues to be divisive, but I see many people applaud it. Last week, Justice Donald Burrage upheld the ban, even though he also found that the order clearly violates charter rights of movement. Lawyers who argued the case say they are considering an appeal.

Legends of the fall

As I was making a cup of coffee early Friday morning, I noticed something that used to be common (like clockwork, really) in the air over the east end: the distinctive noise of a jet taking off at the airport.

It has occurred to me that the “new normal” of COVID-19 that we’ve all been talking about really means “the normal we are in right now, and it may change quickly.”

We are connected to the rest of the country, and the rest of the planet, and things are fluid.

Trudeau, who used his address to call on people to behave responsively, said the outcome of the second wave is not predetermined.

“What we can change,” he said, “is where we are in October and into the winter. It’s all too likely we won’t be gathering for Thanksgiving, but we still have a shot at Christmas.”

At this end of the country, it would be an understatement to say people want the infection rate to stay as low this fall as it’s been this summer.

It’s also reasonable to think many people are looking forward to a “new normal” that moves closer and closer to the old one.

Read more from CBC Newfoundland and Labrador

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