Health
How dissecting superspreading events can help people take COVID-19 measures seriously – CBC.ca
It’s a snapshot of a superspreading event: one person unknowingly infected with COVID-19 transmitted the contagion to 23 other passengers scattered on a tour bus, even those sitting seven rows behind.
The image presented in last month’s study of what happened on a sunny, breezy day in eastern China is dramatic, experts say.
For those who have been studying how the public has responded to messages from authorities during the pandemic, it’s the kind of story that public health officials should harness more often in their communications.
“They tell a very compelling story,” said Prof. Kim Lavoie, who holds the Canada Research Chair in behavioural medicine at the University of Quebec at Montreal. “If you can represent that visually, people get it. People see the good things that happen when I adhere to these policies and the not-so-good things that happen.”
The Chinese study documented what happened in late January during the peak Lunar New Year travel season. The novel coronavirus was spreading in China’s Hubei province when a group of 126 Buddhists living in the community took two buses to a temple ceremony in Ningbo, hundreds of kilometres east of the city of Wuhan, the original epicentre of the coronavirus.
A woman who had recently dined with friends in Hubei rode on one bus. The presumed index case started to have a cough, chills and muscle aches after returning from the temple. She sat, unmasked, for the 100-minute round trip on a vehicle with cooling units recirculating the air. Two windows on each side of the bus were open.
The close, crowded conditions on a bus for a long period with someone who was likely highly contagious — with most of the 68 passengers and driver not wearing masks — suggested “airborne transmission likely contributed to the high attack rate,” the researchers wrote.
The Public Health Agency of Canada said it does not have a definition of superspreading events for this country and instead monitors outbreaks.
Several local medical officers of health across the country also don’t refer to superspreaders. For example, Dr. Elizabeth Richardson, Hamilton’s medical officer of health, was asked Tuesday if the city’s largest current outbreak at a spin studio — one of the worst fitness studio outbreaks in the country — would be considered a superspreader event.
Richardson said the public health department generally doesn’t use that term, instead calling it a “very large outbreak” with a lot of transmission.
Nonetheless, Dr. Kieran Moore, the medical officer of health for Kingston, Ont., and surrounding communities, said that during an outbreak at a nail salon in June that led to 37 cases, a “superspreading event contributed to 38 per cent of total cases.”
Testing rates were at record levels following media attention and public health messaging, Moore said.
Personal approach is more persuasive
Successful public health measures during COVID-19 can also be used to tell a story and illustrate cause and effect for the public, Lavoie said.
The collective sacrifices of individual Canadians succeeded in bending the curve when only essential workers ventured out, cases dropped and then the effective reproductive number fell below one, pausing the disease’s exponential growth during the summer. Australia’s more recent success is another positive example.
To keep people engaged with public health measures over time, Lavoie suggests that governments in Canada share more personally relevant information to help individuals make informed decisions, rather than what she called a “pretty please” approach.
“I think ‘pretty please’ without supporting data is not very compelling, particularly when you’re asking people to make massive sacrifices without demonstrating that the sacrifices are worth it.”
Early on, Dr. Bonnie Henry, British Columbia’s provincial health officer, was praised for clearly showing people what was happening and why, in easy-to-understand terms.
“I honestly believe that had a huge impact,” Lavoie said. “It felt like ‘We respect you, we trust you with the information, and now that you have it, we have confidence you’ll make the right decision.'”
What’s more, when missteps were made initially, such as outbreaks in B.C.’s long-term care homes, Henry took full responsibility, she said.
What motivates people to sacrifice?
Behavioural medicine also suggests that moving away from a one-size-fits-all message to a more personalized approach would work better at motivating people to make important sacrifices.
Lavoie and Simon Bacon, a professor of health, kinesiology and applied physiology at Concordia University in Montreal, have been surveying people throughout the pandemic about what motivates them as part of the iCARE (International COVID-19 Awareness and Responses Evaluation Study) project.
The findings suggest that younger people might be more motivated by the socio-economic fallout of reimposing restrictions rather than risk to their individual health from COVID-19, compared with people over the age of 65.
“Show how long it’s going to take us to pay down the debt, this is how long it’s going to take, the longer we remain in this,” Lavoie said.
Individual goals matter, too.
“I think we do need to have positive messaging,” Lavoie said.
A common message from public health officials is: “We’re all going to get through this.” But to Lavoie, that doesn’t go far enough.
Her version is: “We are going to get out of this only together. This is how and this is why, and this is what’s in store for us the quicker we achieve that,” she said. “We’re all going to benefit. Some of you will benefit by protecting your health. Some of you will benefit by protecting your business. Some of you will benefit by being able to have your dream wedding.”
It’s a numbers game
The field of finance also shows how communicating in terms of time, not case numbers, makes a difference in perception.
Daniela Sele, a PhD candidate at the Center for Law & Economics at ETH Zurich, turned from studying exponential growth in financial decision-making, like compound interest, to the exponential growth of infectious diseases like COVID-19.
Sele found that how numbers are presented matters in how people perceive them.
In a preprint study posted in August, Sele asked about 450 students to estimate how many cases could be avoided through interventions like physical distancing, handwashing and wearing a mask.
Sele and her co-author found people drastically underestimated how many cases could be avoided.
But if the same numbers were framed in terms of doubling time — how long it takes cases to double from, say, 100,000 to 200,000 — people assessed the benefits correctly.
The classic example of framing exactly the same number differently is saying two-thirds of people will survive versus one-third of people will die.
“I think it’s interesting to think about could we talk about how long until the health-care system capacity is reached in our local community?” Sele said. “Because people, according to our data, seem to understand that better than the actual pace of the pandemic.”
WATCH | The role of superspreading events in COVID-19 transmission:
More research into how COVID-19 is spread shows that because not everyone sheds the same amount of virus, many infections are spread by a few people known as superspreaders. 2:01
Prevent superspreading events
Ashleigh Tuite, an infectious disease epidemiologist and mathematical modeller at the University of Toronto’s Dalla Lana School of Public Health, said when it comes to superspreading events like the tour bus in China, a small proportion of people are responsible for a greater share of the transmission.
“You don’t know ahead of time what will result in a superspreading event,” Tuite said.
The message? Like the woman who boarded a tour bus, it’s impossible to know if your silent infection will affect many others, so everyone needs to heed public health precautions.
It’s a combination of biology, such as being at the peak of infectiousness, and performing an activity in a location that’s really conducive to transmission — think indoor, crowded places — that come together to create superspreading events, Tuite said.
Health
Toronto reports 2 more measles cases. Use our tool to check the spread in Canada – Toronto Star
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Canada has seen a concerning rise in measles cases in the first months of 2024.
By the third week of March, the country had already recorded more than three times the number of cases as all of last year. Canada had just 12 cases of measles in 2023, up from three in 2022.
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Cancer Awareness Month
Posted on: Apr 18, 2024
April is Cancer Awareness Month
As we recognize Cancer Awareness Month, we stand together to raise awareness, support those affected, advocate for prevention, early detection, and continued research towards a cure. Cancer is the leading cause of death for Métis women and the second leading cause of death for Métis men. The Otipemisiwak Métis Government of the Métis Nation Within Alberta is working hard to ensure that available supports for Métis Citizens battling cancer are culturally appropriate, comprehensive, and accessible by Métis Albertans at all stages of their cancer journey.
Receiving a cancer diagnosis, whether for yourself or a loved one, can feel overwhelming, leaving you unsure of where to turn for support. In June, our government will be launching the Cancer Supports and Navigation Program which will further support Métis Albertans and their families experiencing cancer by connecting them to OMG-specific cancer resources, external resources, and providing navigation support through the health care system. This program will also include Métis-specific peer support groups for those affected by cancer.
With funding from the Canadian Partnership Against Cancer (CPAC) we have also developed the Métis Cancer Care Course to ensure that Métis Albertans have access to culturally safe and appropriate cancer services. This course is available to cancer care professionals across the country and provides an overview of who Métis people are, our culture, our approaches to health and wellbeing, our experiences with cancer care, and our cancer journey.
Together, we can make a difference in the fight against cancer and ensure equitable access to culturally safe and appropriate care for all Métis Albertans. Please click on the links below to learn more about the supports available for Métis Albertans, including our Compassionate Care: Cancer Transportation program.
I wish you all good health and happiness!
Bobbi Paul-Alook
Secretary of Health & Seniors
Health
Type 2 diabetes is not one-size-fits-all: Subtypes affect complications and treatment options – The Conversation
You may have heard of Ozempic, the “miracle drug” for weight loss, but did you know that it was actually designed as a new treatment to manage diabetes? In Canada, diabetes affects approximately 10 per cent of the general population. Of those cases, 90 per cent have Type 2 diabetes.
This metabolic disorder is characterized by persistent high blood sugar levels, which can be accompanied by secondary health challenges, including a higher risk of stroke and kidney disease.
Locks and keys
In Type 2 diabetes, the body struggles to maintain blood sugar levels in an acceptable range. Every cell in the body needs sugar as an energy source, but too much sugar can be toxic to cells. This equilibrium needs to be tightly controlled and is regulated by a lock and key system.
In the body’s attempt to manage blood sugar levels and ensure that cells receive the right amount of energy, the pancreatic hormone, insulin, functions like a key. Cells cover themselves with locks that respond perfectly to insulin keys to facilitate the entry of sugar into cells.
Unfortunately, this lock and key system doesn’t always perform as expected. The body can encounter difficulties producing an adequate number of insulin keys, and/or the locks can become stubborn and unresponsive to insulin.
All forms of diabetes share the challenge of high blood sugar levels; however, diabetes is not a singular condition; it exists as a spectrum. Although diabetes is broadly categorized into two main types, Type 1 and Type 2, each presents a diversity of subtypes, especially Type 2 diabetes.
These subtypes carry their own characteristics and risks, and do not respond uniformly to the same treatments.
To better serve people living with Type 2 diabetes, and to move away from a “one size fits all” approach, it is beneficial to understand which subtype of Type 2 diabetes a person lives with. When someone needs a blood transfusion, the medical team needs to know the patient’s blood type. It should be the same for diabetes so a tailored and effective game plan can be implemented.
This article explores four unique subtypes of Type 2 diabetes, shedding light on their causes, complications and some of their specific treatment avenues.
Severe insulin-deficient diabetes: We’re missing keys!
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)
Insulin is produced by beta cells, which are found in the pancreas. In the severe insulin-deficient diabetes (SIDD) subtype, the key factories — the beta cells — are on strike. Ultimately, there are fewer keys in the body to unlock the cells and allow entry of sugar from the blood.
SIDD primarily affects younger, leaner individuals, and unfortunately, increases the risk of eye disease and blindness, among other complications. Why the beta cells go on strike remains largely unknown, but since there is an insulin deficiency, treatment often involves insulin injections.
Severe insulin-resistant diabetes: But it’s always locked!
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)
In the severe insulin-resistant diabetes (SIRD) subtype, the locks are overstimulated and start ignoring the keys. As a result, the beta cells produce even more keys to compensate. This can be measured as high levels of insulin in the blood, also known as hyperinsulinemia.
This resistance to insulin is particularly prominent in individuals with higher body weight. Patients with SIRD have an increased risk of complications such as fatty liver disease. There are many treatment avenues for these patients but no consensus about the optimal approach; patients often require high doses of insulin.
Mild obesity-related diabetes: The locks are sticky!
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)
Mild obesity-related (MOD) diabetes represents a nuanced aspect of Type 2 diabetes, often observed in individuals with higher body weight. Unlike more severe subtypes, MOD is characterized by a more measured response to insulin. The locks are “sticky,” so it is challenging for the key to click in place and open the lock. While MOD is connected to body weight, the comparatively less severe nature of MOD distinguishes it from other diabetes subtypes.
To minimize complications, treatment should include maintaining a healthy diet, managing body weight, and incorporating as much aerobic exercise as possible. This is where drugs like Ozempic can be prescribed to control the evolution of the disease, in part by managing body weight.
Mild age-related diabetes: I’m tired of controlling blood sugar!
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)
Mild age-related diabetes (MARD) happens more often in older people and typically starts later in life. With time, the key factory is not as productive, and the locks become stubborn. People with MARD find it tricky to manage their blood sugar, but it usually doesn’t lead to severe complications.
Among the different subtypes of diabetes, MARD is the most common.
Unique locks, varied keys
While efforts have been made to classify diabetes subtypes, new subtypes are still being identified, making proper clinical assessment and treatment plans challenging.
In Canada, unique cases of Type 2 diabetes were identified in Indigenous children from Northern Manitoba and Northwestern Ontario by Dr. Heather Dean and colleagues in the 1980s and 90s. Despite initial skepticism from the scientific community, which typically associated Type 2 diabetes with adults rather than children, clinical teams persisted in identifying this as a distinct subtype of Type 2 diabetes, called childhood-onset Type 2 diabetes.
Read more:
Indigenous community research partnerships can help address health inequities
Childhood-onset Type 2 diabetes is on the rise across Canada, but disproportionately affects Indigenous youth. It is undoubtedly linked to the intergenerational trauma associated with colonization in these communities. While many factors are likely involved, recent studies have discovered that exposure of a fetus to Type 2 diabetes during pregnancy increases the risk that the baby will develop diabetes later in life.
Acknowledging this distinct subtype of Type 2 diabetes in First Nations communities has led to the implementation of a community-based health action plan aimed at addressing the unique challenges faced by Indigenous Peoples. It is hoped that partnered research between communities and researchers will continue to help us understand childhood-onset Type 2 diabetes and how to effectively prevent and treat it.
A mosaic of conditions
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)
Type 2 diabetes is not uniform; it’s a mosaic of conditions, each with its own characteristics. Since diabetes presents so uniquely in every patient, even categorizing into subtypes does not guarantee how the disease will evolve. However, understanding these subtypes is a good starting point to help doctors create personalized plans for people living with the condition.
While Indigenous communities, lower-income households and individuals living with obesity already face a higher risk of developing Type 2 diabetes than the general population, tailored solutions may offer hope for better management. This emphasizes the urgent need for more precise assessments of diabetes subtypes to help customize therapeutic strategies and management strategies. This will improve care for all patients, including those from vulnerable and understudied populations.
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