Health
'I don't want to be scared anymore:' physical distancing tough for the blind – National Post
The physical distancing rules put in place across Canadian society are supposed to shield everyone from the ravages of COVID-19, but Nick D’Ambrosio doesn’t feel protected.
Maintaining a two-metre distance from members of the public is a challenge for the 49-year-old, who has lost most of his eyesight and now travels with a white cane.
Neither that mobility aid nor his remaining vision are up to the task of keeping him at a safe distance from others, either in the Montreal-area drug store where he’s stocked shelves for 22 years or while running essential errands further afield.
Other potentially protective measures — such as the widespread distribution of hand sanitizer dispensers or the installation of floor markers intended to manage crowds in public spaces — also leave him and other Canadians living with vision loss on the margins, D’Ambrosio said. Sometimes the only way to locate the new additions involves soliciting sighted assistance from strangers — thereby further increasing exposure to the novel coronavirus.
D’Ambrosio said he’s fortunate to have supportive colleagues and loved ones who help mitigate his personal risk, but the additional barriers add another dimension of anxiety for blind Canadians navigating an already troubling time.
I’ve been scared for a good portion of my life and I don’t want to be scared anymore
“I’ve been scared for a good portion of my life and I don’t want to be scared anymore,” D’Ambrosio said in a telephone interview. “But does the anxiety linger in me at times? I’d be lying to you if I say no.”
While the ravages of COVID-19 are being felt across all of society, a growing chorus of voices has been sounding the alarm about the virus’s impact on people with disabilities around the world.
Earlier this month, United Nations Secretary General Antonio Guterres called for governments to place greater focus on the unique needs of their disabled citizens.
“People with disabilities are among the hardest hit by COVID-19,” Guterres said in a statement. “They face a lack of accessible public health information, significant barriers to implement basic hygiene measures, and inaccessible health facilities. If they contract COVID-19, many are more likely to develop severe health conditions, which may result in death.”
Canadians living with vision loss are among those feeling a disproportionate impact from both the virus and the measures meant to protect against it, according to a recent survey commissioned by the Canadian Council of the Blind.
The online questionnaire, surveying more than 500 blind, partially sighted and deafblind Canadians, identified myriad concerns involving nearly all facets of everyday life.
Nearly half the respondents said they did not feel safe when leaving their home since the pandemic began, largely due to difficulties observing physical distancing protocols or failure of the able-bodied population to maintain a safe distance. Other concerns included the accessibility of COVID-19 testing sites, the ability to use public transit safely, heightened economic vulnerability and the increased toll that social isolation will take on mental health.
Council President Louise Gillis said blind Canadians have even been subjected to public scorn, being “hollered at” for inadvertently running afoul of public health measures that are inherently difficult for them to observe.
In nearly every case, she said, the community’s fears stem from pre-existing systemic issues now exacerbated by COVID-19.
“We seem to be more vulnerable when something happens,” she said.
For Penny Leclair, who is deafblind, vulnerability comes from an increased sense of isolation and the withdrawal of key social supports over the course of the pandemic.
The 68-year-old North Bay, Ont., resident said she feels excluded from many of the workarounds most of society is turning to for social connection, such as video conferencing and other platforms that rely on sound and sight.
She’s also cut off from the intervener services she relied on before the outbreak, since they’ve been scaled back and concentrated on people living alone.
Delegating all outside tasks to her husband, she said, has left her wrestling with both a loss of independence and powerful feelings of isolation.
“For deafblind people, touch is a must and dependence on an intervener is a part of life — not social,” Leclair said in an email interview. “The intervener is not just a family support person, they are eyes and ears for deafblind people.”
For deafblind people, touch is a must and dependence on an intervener is a part of life
For Barbara Amberstone, a legally blind Indigenous elder living in Victoria, the greatest frustration comes from proposed coping solutions that she said leave large swaths of the community on the margins.
Most efforts to respond to COVID-19 have involved the use of technology, she said, noting everything from reading government information to maintaining social connection depends on an internet connection and accessible hardware and software. Such reliance on tech is further entrenched in the vision loss community, she added.
But Amberstone said those who can’t afford or access the technology, including those living in poverty or remote parts of the country, are now coping with an additional layer of isolation on top of those already imposed by the pandemic.
“It’s so privileged,” Amberstone said of the national response. “There’s so much that poor people and disabled people are left out of.”
The council report found public awareness and more effective messaging from all levels of government are needed to limit the effects of COVID-19 and its aftermath on the vision loss community.
D’Ambrosio agrees, saying the unique challenges he and his peers all face can’t be ignored forever.
“Right now we’re at the very early stages and things are changing daily,” he said. “So I don’t know if this is the new norm, I don’t know if this will persist … but eventually our rights will have to be heard.”
A business plan for a new BC Cancer Centre at Nanaimo Regional General Hospital has been approved by the province.
Health Minister Adrian Dix says the state-of-the-art cancer facility will benefit patients in Nanaimo and the surrounding region through the latest medical technology.
The facility will have 12 exam rooms, four consultation rooms and space for medical physicists and radiation therapists, medical imaging and radiation treatment of cancer patients.
The procurement process is underway, and construction is expected to begin in 2025 and be complete in 2028.
Upgrades to NRGH have also been approved, such as a new single-storey addition to the ambulatory care building and expanded pharmacy.
Dix says Nanaimo’s population is growing rapidly and aging, and stronger health services in the region, so people get the health care they need closer to home.
Health
Outdated cancer screening guidelines jeopardizing early detection, doctors say – Powell River Peak
A group of doctors say Canadian cancer screening guidelines set by a national task force are out-of-date and putting people at risk because their cancers aren’t detected early enough.
“I’m faced with treating too many patients dying of prostate cancer on a daily basis due to delayed diagnosis,” Dr. Fred Saad, a urological oncologist and director of prostate cancer research at the Montreal Cancer Institute, said at a news conference in Ottawa on Monday.
The Canadian Task Force on Preventive Health Care, established by the Public Health Agency of Canada, sets clinical guidelines to help family doctors and nurse practitioners decide whether and when to recommend screening and other prevention and early detection health-care measures to their patients.
Its members include primary-care physicians and nurse practitioners, as well as specialists, a spokesperson for the task force said in an email Monday.
But Saad and other doctors associated with the Coalition for Responsible Healthcare Guidelines, which organized the news conference, said the task force’s screening guidelines for breast, prostate, lung and cervical cancer are largely based on older research and conflict with the opinions of specialists in those areas.
For example, the task force recommends against wide use of the prostate specific antigen test, commonly known as a PSA test, for men who haven’t already had prostate cancer. Saad called that advice, which dates back to 2014, “outdated” and “overly simplistic.”
The task force’s recommendation is based on the harms of getting false positive results that lead to unnecessary biopsies and treatment, he said.
But that reasoning falsely assumes that everyone who gets a positive PSA test will automatically get a biopsy, Saad said.
“We are way beyond the era of every abnormal screening test leading to a biopsy and every biopsy leading to treatment,” he said, noting that MRIs can be used to avoid some biopsies.
“Canadian men deserve (to) have the right to decide what is important to them, and family physicians need to stop being confused by recommendations that go against logic and evidence.”
Dr. Martin Yaffe, co-director of the Imaging Research Program at the Ontario Institute for Cancer Research, raised similar concerns about the task force’s breast cancer screening guideline, which doesn’t endorse mammograms for women younger than 50.
That’s despite the fact that the U.S. task force says women 40 and older may decide to get one after discussing the risks and benefits with their primary-care provider.
The Canadian task force is due to update its guidance on breast cancer screening in the coming months, but Yaffe said he’s still concerned.
“The task force leadership demonstrates a strong bias against earlier detection of disease,” he said.
Like Saad, Yaffe believes it puts too much emphasis on the potential harm of false positive results.
“It’s very hard for us and for patients to balance this idea of being called back and being anxious transiently for a few days while things are sorted out, compared to the chance of having cancer go undetected and you end up either dying from it or being treated for very advanced disease.”
But Dr. Eddy Lang, a member of the task force, said the harms of false positives should not be underestimated.
“We’ve certainly recommended in favour of screening when the benefits clearly outweigh the harms,” said Lang, who is an emergency physician and a professor at the University of Calgary’s medical school.
“But we’re cautious and balanced and want to make sure that we consider all perspectives.”
For example, some men get prostate cancer that doesn’t progress, Lang said, but if they undergo treatments they face risks including possible urinary incontinence and erectile dysfunction.
Lang also said the task force monitors research “all the time for important studies that will change our recommendations.”
“And if one of them comes along, we prioritize the updating of that particular guideline,” he said.
The Canadian Cancer Society pulled its endorsement from the task force’s website in December 2022, saying it hadn’t acted quickly enough to review and update its breast cancer screening guidelines to consider including women between 40 and 50.
“(The Canadian Cancer Society) believes there is an obligation to ensure guidelines are keeping pace with the changing environment and new research findings to ensure people in Canada are supported with preventative health care,” it said in an emailed statement Monday evening.
Some provinces have implemented more proactive early detection programs, including screening for breast cancer at younger ages, using human papillomavirus (HPV) testing to screen for cervical cancer and implementing CT scanning to screen for lung cancer, doctors with the Coalition for Responsible Healthcare Guidelines said.
But that leads to “piecemeal” screening systems and unequal access across the country, said Dr. Shushiela Appavoo, a radiologist with the University of Alberta.
Plus, many primary-care providers rely on the national task force guidelines in their discussions with patients, she said.
“The strongest association … with a woman actually going for her breast cancer screen is whether or not her doctor recommends it to her. So if her doctor is not recommending it to her, it doesn’t matter what the provincial guideline allows,” Appavoo said.
In addition to updating its guideline for breast cancer screening this spring, the task force is due to review its guidelines for cervical cancer screening in 2025 and for lung cancer and prostate cancer screening in 2026, according to its website.
This report by The Canadian Press was first published April 16, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
Nicole Ireland, The Canadian Press
Premature opioid-related deaths doubled in Canada after the onset of COVID-19 pandemic, and more than one in four deaths occurred in young adults, a new study suggested.
“The intersection of the COVID-19 pandemic with the drug toxicity crisis in Canada has created an urgent need to better understand the patterns of opioid-related deaths across the country to inform targeted public health responses,” the study authors wrote.
Some Canadian provinces were disproportionately affected by the crisis, they noted. For example, in Alberta, close to half of all deaths among people aged 20-39 years were opioid-related.
“Although the finding that the early loss of life was increasing over time was expected, the magnitude of this burden across Canada surprised me,” lead author Shaleesa Ledlie, MPH, a PhD candidate at the Leslie Dan Faculty of Pharmacy of the University of Toronto, Toronto, Ontario, Canada, told Medscape Medical News.
In addition to the increase in Alberta, she said, “in Manitoba, opioid-related death rates and the associated years of life lost increased almost fivefold between 2019 and 2021. This really reinforces the urgency of this issue across Canada and identifies regions where focused attention might be warranted.”
The study was published online on April 15 in Canadian Medical Association Journal.
Significant Increases
Researchers conducted a repeated cross-sectional analysis of accidental opioid-related deaths from 2019 through 2021 in nine Canadian provinces and territories. All provinces and territories for which age- and sex-stratified data were available at the time of the study were included: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia, and the Northwest Territories. These areas represent 98% of Canada’s population.
Deaths were determined to be accidental or intentional by the coroner or medical examiner in each province or territory who investigated the death, according to Ledlie.
The primary outcome was the burden of premature opioid-related death, measured by potential years of life lost (YLL). The secondary outcome was the proportion of deaths attributable to opioids.
Overall, the annual YLL from opioid-related deaths doubled during the study period, from 3.5 YLL per 1000 population in 2019 to 7.0 YLL per 1000 in 2021.
In 2021, the highest burdens of death were observed among men (9.9 YLL per 1000) and young adults aged 20-29 years (12.8 YLL per 1000) and 30-39 years (16.5 YLL per 1000).
More than 70% of all opioid-related deaths occurred among men each year (73.9% in 2021), and about 25% of deaths occurred among people between the ages of 30 and 39 years (29.5% in 2021).
Geographic Variation
The annual increases by age and sex in each province and territory were generally consistent with the overall analysis. The observed changes in YLL over time varied geographically, however. They ranged from a 0.8-fold decrease in Nova Scotia (1581 YLL in 2019 to 1324 YLL in 2021) to a 4.7-fold increase in Manitoba (2434 YLL in 2019 to 11,543 YLL in 2021).
In 2021, the rate of YLL ranged from a low of 1.4 per 1000 in Nova Scotia to a high of 15.6 per 1000 in Alberta, whereas the absolute number of YLL ranged from 93 in the Northwest Territories to 111,633 in Ontario.
Between 2019 and 2021, the average percentage of all deaths attributed to opioids increased in all age groups. In 2019, 1.7% of deaths among people younger than 85 years were related to opioids. This proportion increased to 3.2% of deaths in 2021.
The largest relative increase between 2019 and 2021 (50.3%) was among young people. Opioid-attributable deaths increased from 19.3% to 29.0% among those aged 30-39 years. This change was followed by a 48.0% increase among those aged 20-29 years from 19.8% to 29.3%.
The authors noted that the study was limited by their inability to examine four provinces and territories for which the numbers of opioid-related deaths were suppressed because of small counts (ie, < 5). However, sensitivity analyses suggested that the demographic distribution of these deaths followed a pattern like that of the overall results.
More Information Needed
Commenting on the study for Medscape Medical News, S. Monty Ghosh, MD, MPH, an assistant professor at the University of Alberta, clinical assistant professor at the University of Calgary, and co-medical lead of Alberta Health Services’ Rapid Access Addiction Medicine program in Calgary, said, “The study was fairly robust in its evaluation. Their approach statistically is sound and makes sense, given the quality of data they received.” Ghosh did not participate in the analysis.
It would be important to know whether the premature deaths were polysubstance related, he noted. “More nuanced data in Alberta demonstrated that most of the deaths are related to polysubstance use on top of fentanyl. This includes alcohol, meth, as well as substance contaminants such as benzodiazepines, and more lately (outside of the research period), xylazine.”
Furthermore, Ghosh added, “It would be good to see more demographic information around the youth in Alberta. For instance, were they housed or unhoused? Are they Indigenous? Anecdotally, we know that blue-collar workers, especially those in Alberta who work in construction and oil rigs, have a disproportionate rate of substance use and at times substance death. This was seen in British Columbia and Ontario.”
What’s Being Done
The government of Alberta is responding to these data, said Ghosh. For example, in 2022, specialized funding was provided to enable young adults to access gold-standard opioid agonist treatment. The treatment was rolled out through Alberta’s Virtual Opioid Dependency Program (VODP) and other community-based addiction programs. “This [program] still needs to be more focused on homeless youth, however, who may not have access to technology or other resources.”
Furthermore, the government recently announced a $1.55-billion plan to continue building the Alberta Recovery model, he said. “This is the largest investment seen in our province. Safer supply or prescribed alternatives is very controversial in Alberta and thus is not an option available to this population.”
In addition, he said, the Ministry of Seniors and Community Social Services recently began “coordinated work with other ministries to support vulnerable and equity-deserving populations around this issue, including creating navigation centers for housing, income support, and access to treatment through the VODP.”
Ledlie noted that various policies and programs have been developed in response to the ongoing drug toxicity crisis. Some were included in a recent review that her team conducted to summarize the evidence from Canadian safer opioid supply programs. “We found that in general, these programs had positive impacts on clients, including reduced rates of opioid toxicities and improvements in quality of life.”
“Because most healthcare is coordinated at the provincial or territorial level, the investments into, and accessibility of, treatment and harm-reduction services tend to vary across Canada,” she said. “Even in regions where these programs exist, we know that they are not always accessible for various reasons, such as a lack of resources preventing widespread expansion and geographic barriers in more remote and rural regions.”
“One example of a simple yet life-saving harm reduction measure that has been effectively implemented by most provincial and territorial governments is the availability of publicly funded naloxone kits,” she added. “Given the widespread societal impacts of opioid toxicities described in our study, we believe it is pivotal for all levels of government to coordinate to ensure equitable access to evidence-based services across the country, while still providing the opportunity to tailor and adapt those responses to the unique needs of local communities.”
The study was supported by grants from the Ontario Ministry of Health and the Canadian Institutes of Health Research. Ledlie is supported by an Ontario Graduate Scholarship and the Network for Improving Health Systems Trainee Award. Ledlie and Ghosh declared no relevant financial relationships.
Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.
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