OTTAWA — As the federal government prepares to slap new restrictions on international travel, Health Canada data suggest a worrying uptick of infections directly connected to foreign arrivals.
While travel exposures account for less than two per cent of all Canada’s COVID-19 cases, the number of cases in recent travellers, and people they came into close contact with after arriving, shows continual growth in recent months.
In December, 486 cases of COVID-19 were diagnosed in recent travellers, the most since March and up from 312 in November and 204 in October. Despite mandatory two-week quarantines for international travellers, there were 1,258 COVID-19 cases confirmed in people who had close contact with a recent traveller in December, up from 744 in November and 704 in October.
In the first three weeks of January, 384 travel cases and 607 traveller-contact cases were confirmed.
The figures also correspond with a recent rise in the number of people travelling, at least by air. Land-border arrivals are typically fewer in the winter because of the weather in much of the country, but more people arrived from the U.S. by air in December than any month since March. Arrivals from other international locations were higher in December than any month except August.
Reports of notable Canadians ignoring pleas not to travel during the pandemic in favour of sun-kissed days on foreign beaches angered much of the country in the weeks after Christmas, and led to several high-profile provincial and federal politicians and health officials being fired, demoted or reprimanded.
Between Nov. 30 and Dec. 27, 86,953 people flew into Canada from the United States, and 184,260 arrived by air from other international locations.
Prime Minister Justin Trudeau has been promising for more than a week that the government will bring in stronger measures for international arrivals, as Canada fears the impact of new variants of COVID-19 that have arisen in other countries.
That is on top of a mandatory two-week quarantine for all arrivals, which has been in place since last spring, restricting international flights to just four airports, and a more recent requirement for foreign travellers to provide proof of recent negative COVID-19 tests within three days of boarding planes to Canada.
A spokesman for Health Minister Patty Hajdu said “Canada has some of the strongest border measures in the world” and all future measures will be guided by both science and evidence. Cole Davidson said 6,500 phone calls are made daily to verify travellers are in quarantine, and that 99 per cent of nearly 50,000 checks on quarantine made by police have found people are where they are supposed to be.
There are more than 50 cases of the new coronavirus variants from the United Kingdom and South Africa now confirmed in Canada, most, but not all of them, in people who recently travelled into Canada from those countries. The variants are believed to spread more easily, and in recent days concerns have arisen about whether they are more likely to cause serious illness or death.
Conservative Health Critic Michelle Rempel Garner said while community spread within Canada still accounts for the vast majority of this country’s cases, Canada has to do more at the borders. She said the most effective option is to impose a mandatory rapid COVID-19 test on all arrivals, and have that test repeated midway through the two-week quarantine period.
Rempel Garner said Canada can’t “hermetically seal” our border as island nations like New Zealand have done, so testing all travellers for the virus, screening them all for the variants, and maintaining the quarantine would be effective and more efficient than requiring travellers to quarantine at a hotel for two weeks at their own expense.
Similar rules have been in place in Iceland for months. Singapore began requiring testing at all airports on Jan. 24, along with using drones and electronic surveillance to monitor people in quarantine.
NDP Leader Jagmeet Singh said a trend in more travel-related cases is “alarming” and that Trudeau can’t wait any longer to act to stop it.
“With the catastrophic situation we are in, we cannot afford a spike because of non-essential travel,” Singh said.
This report by The Canadian Press was first published Jan. 28, 2021.
Mia Rabson, The Canadian Press
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A new study offers a closer look at possible factors that may lead to some hospitalized COVID-19 patients being readmitted within a month of discharge.
At roughly nine per cent, researchers say the readmission rate is similar to that seen for other ailments, but socio-economic factors and sex seem to play a bigger role in predicting which patients are most likely to suffer a downturn when sent home.
Research published Monday in the Canadian Medical Association Journal looked at 46,412 adults hospitalized for COVID-19 in Alberta and Ontario during the first part of the pandemic. About 18 per cent — 8,496 patients — died in hospital between January 2020 and October 2021, which was higher than the norm for other respiratory tract infections.
Among those sent home, about nine per cent — 2,759 patients — returned to hospital within 30 days of leaving, while two per cent — 712 patients — died. The deaths include patients who returned to hospital.
The combined rate of readmission or death was similar in each province, at 9.9 per cent or 783 patients in Alberta, and 10.6 per cent or 2,390 patients in Ontario.
For those wondering if the patients were discharged too soon, the report found most spent less than a month in hospital and patients who stayed longer were actually readmitted at a slightly higher rate.
“We initially wondered, ‘Were people being sent home too early?’ … and there was no association between length of stay in hospital and readmission rates, which is reassuring,” co-author Dr. Finlay McAlister, a professor of general internal medicine at the University of Alberta, said from Edmonton.
“So it looked like clinicians were identifying the right patients to send home.”
Examining the peaks
Craig Jenne, an associate professor of microbiology, immunology and infectious diseases at the University of Calgary who was not involved in the research, said the study suggests that the health-care system was able to withstand the pressures of the pandemic.
“We’ve heard a lot about how severe this disease can be and there was always a little bit of fear that, because of health-care capacity, that people were perhaps rushed out of the system,” Jenne said. “There was a significant increase in loss of life but this wasn’t due to system processing of patients.
“Care was not sacrificed despite the really unprecedented pressure put on staff and systems during the peaks of those early waves.”
The study also provides important insight on the power of vaccines in preventing severe outcomes, Jenne said.
Of all the patients admitted with COVID-19 in both provinces, 91 per cent in Alberta and 95 per cent in Ontario were unvaccinated, the study found.
The report found readmitted patients tended to be male, older, and have multiple comorbidities and previous hospital visits and admissions. They were also more likely to be discharged with home care or to a long-term care facility.
McAlister also found socio-economic status was a factor, noting that hospitals traditionally use a scoring system called LACE to predict outcomes by looking at length of stay, age, comorbidities and past emergency room visits, but “that wasn’t as good a predictor for post-COVID patients.”
“Including things like socio-economic status, male sex and where they were actually being discharged to were also big influences. It comes back to the whole message that we’re seeing over and over with COVID: that socio-economic deprivation seems to be even more important for COVID than for other medical conditions.”
McAlister said knowing this could help transition co-ordinators and family doctors decide which patients need extra help when they leave the hospital.
On its own, LACE had only a modest ability to predict readmission or death but adding variables including the patient’s neighbourhood and sex improved accuracy by 12 per cent, adds supporting co-author Dr. Amol Verma, an internal medicine physician at St. Michael’s Hospital in Toronto.
The study did not tease out how much socio-economic status itself was a factor, but did look at postal codes associated with so-called “deprivation” indicators like lower education and income among residents.
Readmission was about the same regardless of neighbourhood, but patients from postal codes that scored high on the deprivation index were more likely to be admitted for COVID-19 to begin with, notes Verma.
Verma adds that relying on postal codes does have limitations in assessing socio-economic status since urban postal codes can have wide variation in their demographic. He also notes the study did not include patients without a postal code.
McAlister said about half of the patients returned because of breathing difficulties, which is the most common diagnosis for readmissions of any type.
He suspected many of those problems would have been difficult to prevent, suggesting “it may just be progression of the underlying disease.”
Looking at readmissions is just the tip of the iceberg.-Dr. Finlay McAlister-Dr. Finlay McAlister
It’s clear, however, that many people who appear to survive COVID are not able to fully put the illness behind them, he added.
“Looking at readmissions is just the tip of the iceberg. There’s some data from the [World Health Organization] that maybe half to two-thirds of individuals who have had COVID severe enough to be hospitalized end up with lung problems or heart problems afterwards, if you do detailed enough testing,” he said.
“If you give patients quality of life scores and symptom questionnaires, they’re reporting much more levels of disability than we’re picking up in analyses of hospitalizations or emergency room visits.”
The research period pre-dates the Omicron surge that appeared in late 2021 but McAlister said there’s no reason to suspect much difference among today’s patients.
He said that while Omicron outcomes have been shown to be less severe than the Delta variant, they are comparable to the wild type of the novel coronavirus that started the pandemic.
“If you’re unvaccinated and you catch Omicron it’s still not a walk in the park,” he said.
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