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How dissecting superspreading events can help people take COVID-19 measures seriously – CBC.ca

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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.

(CBC News)

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.”

(CBC News)

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.

Barbershop manager Georgette Simms gets a haircut from her partner, Jason Carter, at their business, Social Barber Studio, in Brampton, Ont., in July. Positive messaging from public health officials can help people understand that adhering to COVID-19 safety measures can be beneficial, such as by protecting their business. (Evan Mitsui/CBC)

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.

Portraits of Dr. Bonnie Henry, left, B.C.’s provincial health officer, and Dr. Theresa Tam, Canada’s chief public health officer, are dismantled at a picture-framing shop in Vancouver in May. Henry was praised at the time for clearly showing people what was happening during the COVID-19 pandemic and why, in easy-to-understand terms. (Maggie MacPherson/CBC)

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.

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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