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Hospitals in Canada face COVID-19 ‘storm’

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To slow the spread of COVID-19, provinces have closed schools, urged people to stay home and shut businesses to varying degrees — responses that differ with the degree of community spread in each place.

Tedros Adhanom Ghebreyesus, the World Health Organization’s director general, said Wednesday that staying home buys time and reduces pressure on health systems.

“Aggressive measures to find, isolate, test, treat and trace are not only the best and fastest way out of extreme social and economic restrictions — they’re also the best way to prevent them,” he said.

But the WHO doesn’t give specific recommendations on what businesses are essential, and because public health is a provincial responsibility, “essential” means different things in different parts of the country.

For example, Prince Edward Island originally ordered government-run liquor stores to close as part of social distancing efforts, while they remained open in Ontario. (And P.E.I. changed its decision on Wednesday.)

Dr. Lynora Saxinger, an infectious disease physician at the University of Alberta, called it a symptom of the Canadian system.

“I think it would be much better to have standardized understandings of what essential is and then people between provinces would not have to question, ‘Well, why do you consider a liquor store crucial?'”  Saxinger said. “It is, from the point of view of public messaging and consistency, a bit of a weakness.”

 

Lynn Valley Care Centre in North Vancouver has been particularly hard hit by a major outbreak of COVID-19. (Ben Nelms/CBC)

 

Doctors and public health officials are bracing for an onslaught of new cases from people exposed before the border and social distancing measures began.

“It’s this kind of calm before the storm,” she said. “In other areas, we see the storm is starting. We have a more mature epidemic happening in B.C.”

Dr. Stephanie Smith, director of infection prevention and control at U of A, said given that it takes up to 14 days for symptoms of COVID-19 to appear, it is too early to tell how much of an effect the physical distancing measures and closures are having in Canada.

“It’s become very clear that the earlier you can institute these measures, the better off you’re going to be,” Smith said.

Like trying to gather up water with your hands

In Toronto, Dr. Michael Gardam is concerned people who feel well will relax on physical distancing measures.

“This is not something that we can relax after two weeks,” he warned.

Gardam, the hospital’s chief of staff and infectious disease physician, is scrambling to stockpile masks to protect his staff at Humber River Hospital.

He’s also trying to source ventilators and juggle teleconferences as people question plans based on the results of the latest COVID-19 study from across the globe.

“It feels like you’re trying to gather up water with your hands,” Gardam said. “For those of us in health care its hell. We haven’t hit our surge yet. People are already tired and it hasn’t started.”

 

Lisa De Virgilio poses in a protective face mask with the phrase ‘andra tutto bene’ that means ‘everything will be ok’, sewn onto it, following an outbreak of the coronavirus disease (COVID-19), in Molfetta, southern Italy, on Wednesday. (Alessandro Garofalo/Reuters)

 

Dr. Saverio Stranges, a professor of epidemiology at Western University is watching the pandemic unfold in London, Ont., and his own birthplace — Italy.

“If we start from the assumption that everyone can be potentially infected now, then we will be able to embrace these measures of social distancing,” he said.

The Italian experience with COVID-19 is extremely dramatic, he said, with intensive care physicians facing agonizing life-and-death decisions in overrun hospitals. Morgues are piling up with victims of the pandemic.

By contrast, South Korea and Taiwan have been able to scale up testing and tracing contacts of those who are infected.

Stranges said such measures are crucial in containing an outbreak like COVID-19 that spreads in the community.

But in Western countries, the number of cases are underestimated because only those with clear symptoms are tested.

Compared with Italy, Stranges sees an advantage in Canada’s vast geography.

“A good number of people live in detached homes, as opposed to Italian or European countries where the vast majority of people live in apartment buildings,” he said. “That is an important difference.”

Stranges said he didn’t want to generalize, but noted that Italy and Canada also tend to differ in family structures in terms of grandparents living with their children.

Graph shows how new cases of COVID-19 can quickly overwhelm a health-care system if precautions aren’t taken 0:26

People over the age of 65 face an increased risk of death from COVID-19 compared with other age groups, although everyone is susceptible in a pandemic.

He estimated that as of a few days ago, Canada was about 17 days behind Italy in terms of the epidemic curve of growth of new illnesses.

That means the worst moments of the outbreak in Canada may still lie ahead.

“This is the time when we need to comply with this measure of social distancing,” Stranges said.

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

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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.

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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.

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

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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.

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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.

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

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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.

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