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ICU beds main challenge in COVID-19 projections – The Telegram

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ST. JOHN’S, N.L. —

Peter Jackson

Local Journalism Initiative Reporter

The short-term outlook for COVID-19 spread in Newfoundland and Labrador looks promising under current health emergency measures.

But even the best-case long-term projections suggest a likely squeeze for intensive care unit (ICU) beds by the fall.

The projections were presented to reporters and to the public Wednesday by Dr. Proton Rahman, a clinical scientist with Eastern Health. The information was assembled through various local agencies with help from the University of Toronto and the Canadian Institute of Health Information (CIHI).

Even with current emergency health measures, long-term modelling showed the province needing about 200 ICU beds at peak coronavirus levels in November. That’s three times what is currently available, although there would still be enough ventilators.

Overall bed capacity would not be exceeded in this scenario, but Rahman said ICU care depends primarily on the number of nurses and specialists available.

“It’s not just about beds,” he said. “With each individual bed there’s human resources involved, such as respiratory technicians, which is going to be critical to this. We really have to rethink, to some extent, how to deliver these services.”

A more dire scenario presented Wednesday, in which half the population got sick, showed catastrophic results, with not nearly enough beds, staff or ventilators to go around.

“We will simply not be able to cope without drastic changes, and even then it is unlikely we would be successful,” Health Minister Dr. John Haggie said during a later video address.

Insufficient data

Rahman warned that the CIHI models are likely “off a fair bit.”

“We’re looking well beyond the time frame that we have any certainty about.”

He said Newfoundland and Labrador is at least three weeks behind other provinces in terms of usable date.

In particular, while tragic in themselves, the fact there has only been two deaths so far makes it impossible to offer accurate projections of mortality rates.

He said the higher rates of high blood pressure and diabetes in this province don’t bode well, since those underlying conditions increase the chance of severe symptoms or death.

But the virus can affect anyone.

“The experience that’s been reported in numerous states in America and also in Canada (is that) a lot of young, healthy people are actually ending up in the ICU. Most don’t, but it can happen to anyone,” Rahman said. “The people that we’re worried about the most are the old, the vulnerable, people with multiple medical conditions, but anyone can get in trouble and you really have to respect what this virus can do.”

Rahman said the Caul’s Funeral Home cluster — a mid-March exposure that accounts for 75 per cent of subsequent COVID-18 hospitalizations — also makes it difficult to interpret the province’s numbers with any accuracy.

Models are usually based on more evenly distributed infections.

Buying time

Rahman said emergency measures imposed by the province could buy time to accommodate demand ahead of the surge.

“The time is key in terms of the health care capacity to be able to manage large amounts of patients,” he said. “The other reason why time is important, if we’re looking at an 18-month to two-year time period, lots could happen in terms of maybe a potential therapy, something that’s been repurposed in terms of a drug coming into it, some antibodies that you can take or possibly a vaccine. You’re buying time for potentially a therapy and you’re also buying time in terms of our health care capacity to adapt to this.”

Rahman wouldn’t speculate on how long current health measures would be in place, especially if the peak doesn’t arrive until November.

But he cited a scenario posed by some experts in which individual measures could be lifted temporarily and re-imposed if the number of cases rises again.

Chief Medical Officer of Health Dr. Janice Fitzgerald was not available for questions during the Wednesday evening briefing.

For now, Rahman said, it’s important to stay put.

“It just takes one small indiscretion to create a large increase,” he said.

“So, please, please follow the health guidelines put in place by Dr. Fitzgerald.”

With files from David Maher

Peter Jackson is a Local Initiative Reporter covering health care for The Telegram

peter.jackson@thetelegram.com

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Worldwide coronavirus cases cross 161.42 million, death toll at 3,488,751

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More than 161.42 million people have been reported to be infected by the novel coronavirus globally and 3,488,751​ have died, according to a Reuters tally.

Infections have been reported in more than 210 countries and territories since the first cases were identified in China in December 2019.

Interactive graphic tracking global spread of coronavirus: open https://tmsnrt.rs/2FThSv7 in an external browser.

Eikon users can click  for a case tracker.

The following table lists the top 50 countries by the number of reported cases. A complete list is available with the above links.

COUNTRIES AND TOTAL DEATHS CONFIRMED DEATHS PER

TERRITORIES CASES 10,000

INHABITANTS

United States 584,768 32,926,288 17.9

India 262,317 24,046,809 1.94

Brazil 430,417 15,433,989 20.55

France 107,423 5,848,154 16.04

Turkey 44,301 5,095,390 5.38

Russia 254,590 4,922,901 17.62

United Kingdom 127,668 4,446,824 19.21

Italy 123,927 4,146,722 20.51

Spain 79,339 3,604,799 16.95

Germany 85,903 3,579,871 10.36

Argentina 69,254 3,242,103 15.56

Colombia 79,760 3,067,879 16.06

Poland 71,311 2,849,014 18.78

Iran 76,433 2,732,152 9.34

Mexico 219,901 2,375,115 17.43

Ukraine 47,620 2,143,448 10.67

Peru 65,316 1,873,316 20.02

Indonesia 47,823 1,734,285 1.79

Czech Republic 29,857 1,651,178 28.09

South Africa 55,012 1,605,252 9.52

Netherlands 17,423 1,589,282 10.11

Canada 24,825 1,312,408 6.7

Chile 27,520 1,266,601 14.69

Iraq 15,910 1,134,859 4.14

Philippines 18,958 1,131,467 1.78

Romania 29,413 1,070,605 15.11

Sweden 14,275 1,037,126 14.03

Belgium 24,645 1,026,473 21.56

Pakistan 19,384 873,220 0.91

Portugal 16,999 841,379 16.53

Israel 6,379 839,076 7.18

Hungary 29,041 796,390 29.71

Bangladesh 12,102 779,535 0.75

Jordan 9,203 722,754 9.24

Serbia 6,646 705,185 9.52

Switzerland 10,179 679,510 11.96

Japan 11,396 673,821 0.9

Austria 10,455 635,780 11.83

United Arab Emirates 1,626 543,610 1.69

Lebanon 7,569 534,968 11.05

Morocco 9,091 514,670 2.52

Malaysia 1,822 462,190 0.58

Nepal 4,669 439,658 1.66

Saudi Arabia 7,134 431,432 2.12

Bulgaria 17,194 413,320 24.48

Ecuador 19,442 405,783 11.38

Slovakia 12,168 387,162 22.34

Greece 11,322 373,881 10.55

Belarus 2,681 373,351 2.83

Panama 6,288 369,455 15.05

Source: Reuters tally based on statements from health ministries and government officials

Generated at 10:00 GMT.

 

(Editing by David Clarke)

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Canada plots course to fully vaccinated return to gatherings in fall

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Canada on Friday said there would be a gradual return to a world with indoor sports and family gatherings as more people get vaccinated, but it did not go as far as the United States in telling people they could eventually ditch their masks.

Canada has administered one dose of a COVID-19 vaccine to just over half its adult population, and the country may be over the worst of its current third wave of infections, Chief Public Health Officer Theresa Tam said.

On Thursday, the U.S. Centers for Disease Control and Prevention (CDC) advised that fully vaccinated people do not need to wear masks outdoors and can avoid wearing them indoors in most places, guidance the agency said will allow life to begin to return to normal.

On Friday, Canada‘s public health agency offered guidelines to the 10 provinces, which are responsible for public health restrictions.

The agency says once 75% of Canadians have had a single dose and 20% are fully vaccinated, some restrictions can be relaxed to allow small, outdoor gatherings with family and friends, camping, and picnics.

Once 75% of those eligible are fully vaccinated in the fall, indoor sports and family gatherings can be allowed again.

“I think masks might be the last layer of that multi-layer protection that we’ll advise people to remove,” Tam told reporters, noting that in Canada colder temperatures meant people would start spending more time indoors in the fall.

“We are taking a bit of a different approach to the United States,” she added. While in most of Canada masks are not required outdoors, they are mandatory indoors.

Less than 4% of Canada‘s adult population has been fully vaccinated compared to more than 36% of Americans.

Prime Minister Justin Trudeau, who has promised that everyone who wants to can be fully vaccinated by September, this week spoke of a “one-dose summer” and a “two-dose fall” without explaining what that might look like.

 

(Reporting by Steve Scherer and David Ljunggren; Editing by Hugh Lawson)

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Delayed 2nd Pfizer/BioNTech shot boosts antibodies in elderly; COVID-19 obesity risk higher for men

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The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Delaying second Pfizer/BioNTech dose boosts antibodies in elderly

Delaying the second dose of the Pfizer/BioNTech COVID-19 vaccine beyond the originally recommended three-week gap used by the companies in clinical trials appears to induce a stronger antibody response in the elderly, UK researchers found. Shortly after the vaccine became available, UK health officials advised that the second dose should be given 12 weeks after the first to allow more people to get protected by a first dose early on. In a new paper seen by Reuters and expected to appear on medRxiv on Friday ahead of peer review, researchers found that among 175 people ages 80 to 99, those who got their second dose at 12 weeks had antibody responses that were 3.5 times higher than those who got it after three weeks. Antibodies are only one part of the immune system, and vaccines also generate T cells that fight infections. The peak T cell responses were higher in the group with a three-week interval between doses, and the authors cautioned against drawing conclusions on how protected individuals were based on which dosing schedule they received. (https://reut.rs/3wjPK9B)

Impact of obesity on COVID-19 risks may be greater in men

The known increased risk of severe COVID-19 and death linked to obesity may be even more pronounced for men than women, new data suggest. Researchers studied 3,530 hospitalized COVID-19 patients with an average age of 65, including 1,469 who were obese. In men, moderate obesity was associated with a significantly higher risk of developing severe disease, needing mechanical breathing assistance and dying from COVID-19. (The threshold for moderate obesity is a body mass index (BMI) of 35. In an 5-foot, five-inch tall (1.65 m) adult, that would correspond to a weight of 210 pounds (95 kg). In women, however, only a BMI of 40 or higher, indicating severe obesity, was linked with the increased risks. In a report published in European Journal of Clinical Microbiology & Infectious Diseases, the researchers note that while obesity is known to be linked with body-wide inflammation, patients’ levels of inflammatory proteins did not appear to explain the association between obesity and severe illness. For now, they conclude, “particular attention should be paid” to protecting patients with obesity from the coronavirus, “with priority to vaccination access, remote work, telemedicine, and other measures given the higher risk of adverse outcomes once they are diagnosed with COVID-19.” (https://bit.ly/3eO6GiA)

COVID-19 testing rates low among symptomatic Americans

Sick Americans appear to be passing up opportunities to get tested for coronavirus and thus are likely unknowingly spreading the infection throughout their communities, new research shows. Among 37,000 adults across the United States who participated in a smartphone app survey between March and October 2020, nearly 2,700 reported at least one episode of fever and chills. But according to a report published in JAMA Network Open, only a small fraction reported receiving a COVID-19 test result within seven days of the onset of illness. At first, as tests became more accessible, the numbers improved. In early April 2020, less than 10% of survey participants reporting illness with fever received test results within a week. By late July, that proportion had increased to 24.1%. Throughout the summer and fall, as tests became easier to find, the number of sick participants who reported getting tested remained flat. By late October, only 26% reported receiving a test result within a week of febrile illness. “It’s shocking to me that when people have a fever they’re still not getting tested,” said coauthor Dr. Mark Pletcher of the University of California, San Francisco. “Tests are easy to come by. People might have coronavirus, might be spreading it to their friends and neighbors, and they’re not getting tested.” (https://bit.ly/2QUyMzf)

Open  in an external browser for a Reuters graphic on vaccines in development.

 

(Reporting by Nancy Lapid, Alistair Smout and Ronnie Cohen; Editing by Bill Berkrot

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