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'It matters to families': Canada does not keep track of probable cases of COVID-19 –



This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

When Vicente Perez was admitted to a Toronto hospital for suspected COVID-19 on May 2, the first question he asked his family was about Florencia, his wife of 70 years.

“Where is she? I don’t know how to call her,” his granddaughter, Cindy Perez, remembers him saying over the phone. “She doesn’t know where I am.”

His family didn’t have the heart to tell him that she had died just hours before.

Florencia and Vicente lived at home in Toronto with their adult son, who had fallen ill just two weeks earlier from what their family doctor thought was a sinus infection.

The couple in their 80s took care of their son, who had not been instructed to self-quarantine, bringing him food and tea as his condition failed to improve. 

But when Florencia came down with a sore throat on April 28, they worried it could be COVID-19.

Her symptoms quickly worsened, and four days later she died in bed next to Vicente.

“It all happened just very quick,” Cindy said. “It went from nothing to all of a sudden symptoms, and she died that Saturday morning.” 

Vicente was extremely disoriented when paramedics arrived, and they quickly determined his oxygen levels were low.

He was immediately taken to Humber River Hospital in Toronto, where he tested positive for COVID-19 that night. 

“They admitted him into the hospital that very day,” Cindy said. “And what was really, really sad is that because he was already very disoriented, he never knew that my grandma passed.” 

Vicente had bone marrow cancer and Parkinson’s disease, and his condition worsened over the following weeks. 

He died alone in hospital on May 21. 

After seven decades together, Vicente and Florencia passed away just weeks apart. 

The stark difference between their deaths is Vicente tested positive for COVID-19 before he died and so was included in Canada’s national case count. But Florencia wasn’t tested, so her death wasn’t reflected. 

Canada only records lab-confirmed cases nationally

Canada does not record probable COVID-19 cases and deaths across the country despite international guidelines to do so, and experts say we may never know how many cases have been missed.

The World Health Organization released a set of guidelines in April calling on countries to track both confirmed and suspected cases of COVID-19 as a way to monitor the total impact of the disease worldwide.

“The WHO has issued very clear guidelines that you don’t need a test to be able to diagnose a COVID death,” said Dr. Prabhat Jha, professor of epidemiology at the Dalla Lana School of Public Health at the University of Toronto.

“The bad news is that Canada is too slow in reporting that second type of death.”

Both Ontario and Quebec said in statements to CBC News that the case numbers they release information on are based entirely on lab-confirmed tests.  (Evan Mitsui/CBC)

Unlike Canada, countries like New Zealand, Portugal and the U.K. have routinely released information on these probable cases throughout the pandemic. 

A spokesperson for the U.K.’s Office for National Statistics told CBC News it records a doctor’s declaration of COVID-19 on a patient’s death certificate, even when a test isn’t available, and that the data could be useful for future research. 

But most Canadian provinces haven’t publicly released data on these probable COVID-19 deaths and cases, even separately from the confirmed ones, instead focusing solely on people with positive test results.

A spokesperson for the Public Health Agency of Canada said in a statement to CBC that without a positive test for COVID-19, a probable case does not meet its national surveillance reporting criteria. 

That means if someone dies of COVID-19 before testing positive, even when it’s marked as the cause of death on their death certificate, that case isn’t necessarily reflected anywhere in our national numbers. 

And that’s exactly what happened to Florencia Perez. 

B.C. tracks probable COVID-19 cases, deaths

Ultimately, it’s up to the provinces and territories to decide if they should report those numbers publicly — and at least one does. 

British Columbia not only counts probable COVID-19 cases and deaths, but it conducts antibody and post-mortem testing to find those who may have been missed. 

“This is something that we felt was important early on to try and get a good sense of the overall impact and who’s been impacted,” B.C.’s Provincial Health Officer Dr. Bonnie Henry said in an interview with CBC. 

“That helps us understand deaths in the community that we might not have recognized.” 

The BC Centre for Disease Control has made data on probable cases public, while the BC Coroners Service said it has so far identified five additional cases of COVID-19 from people who had been tested after their deaths.

Henry said because there is a lag in processing the death certificate data, it can take several months before those cases can be found. 

“That’s our system, unfortunately,” she said. “It’s unfortunately one of those things that we can only look at retrospectively, but we do want to be able to determine the overall impact of COVID on the province.”

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‘Each of those people who have been ill reflect the pain on their entire family, their community,’ says B.C.’s provincial health officer. 1:33

Henry said identifying these missing cases may take more time, but it’s important to provide families who have lost loved ones to COVID-19 with an added layer of closure.

“The impact on our seniors and elders has been so profound — particularly people in long-term care,” she said. 

“Finding that balance of trying to protect that community but also give people who are in the important final stages of their life the respect and the care that they need — that’s the most challenging part of this whole outbreak for sure.” 

Hardest-hit provinces release no data

But in Quebec and Ontario, Canada’s two hardest-hit provinces, this type of surveillance isn’t being publicly recorded. 

Both Public Health Ontario and the Quebec Ministry of Health and Social Services said in statements to CBC that the case numbers they release are based entirely on lab-confirmed tests. 

Dr. Michael Gardam, an infectious disease specialist and chief of staff at Humber River Hospital, who is a veteran of the SARS and H1N1 outbreaks, said he doesn’t think that approach goes far enough.

“We clearly know there were more cases. This is an underestimate,” he said. 

“I just in general would like more transparency from the numbers, more transparency from public health — just put all the information out there.” 

Gardam said the daily lab-confirmed case numbers should have a “big asterisk” beside them that indicates “we know there are more cases than that.” 

Dr. Bonnie Henry said identifying missing cases may take more time, but it’s important to provide families who have lost loved ones to COVID-19 with an added layer of closure. (Ben Nelms/CBC)

Dr. Michael Warner, medical director of critical care at Michael Garron Hospital in Toronto, has personally diagnosed patients with probable COVID-19 despite negative test results or those that were unable to get tested before dying. 

“Unfortunately, many cases I think have already been lost because it was at the beginning of the pandemic when we lost so many patients in long-term care homes, and it’s unclear whether we can go back,” he said.

“It matters to families because they want to know how or why their loved one passed away, and I think we owe it to them.”

Dr. Allison McGeer, an infectious diseases specialist at Toronto’s Mount Sinai Hospital who worked on the front lines of the SARS epidemic in 2003, said one reason the data isn’t recorded is because officials feel the numbers could be taken the wrong way. 

“The one thing that public-health people don’t want to do is be seen to be inflating the number of cases,” she said. 

“They tend to be conservative because it’s always tempting to accuse them afterwards of inflating numbers and making it look worse.” 

Slow reporting systems partially to blame

Tracking these cases through death certificates is also more work for an already slow reporting system, especially in Ontario, which relies on outdated technology like fax machines and the manual reporting of cases. 

In response to ongoing criticism, the province announced Thursday it would finally be overhauling its antiquated system of reporting diseases. 

But while Ontario may soon be able to track confirmed cases faster, there appears to be no plan for the province or other parts of the country to release data on probable cases and deaths any time soon.

For Cindy Perez, that adds more pain to an already painful situation. 

“The fact that she’s not accounted for in the numbers, it’s unfair because she did suffer from the disease,” Cindy said, referring to her grandmother. 

“People should know that there have been so many people that have gone unaccounted for that have been victims to this.”

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Canada not ready for second wave of COVID-19, Senate committee says –



Canada is ill-prepared for a second wave of COVID-19, says a Senate committee, calling on the federal Liberals to deliver a plan by Labour Day to help people and communities hit hardest by the pandemic. 

Seniors, in particular, are a focus of the report from the Senate’s social affairs committee, from those in long-term care homes to those with low incomes. 

Just this week, the Liberals rolled out one-time special payments of $300 to the more than six million people who receive old-age security, and $200 more for the 2.2 million who also receive the guaranteed income supplement. 

The income supports are meant to help seniors facing increased costs as a result of the pandemic, such as more frequent prescription fees and delivery charges for groceries.  Senators on the committee wrote of evidence of “financial insecurity and increased vulnerability” for low-income seniors as a result of the first wave of the novel coronavirus. 

A potential second wave, which could coincide with the annual flu season that starts in the fall, would make the situation even worse for these seniors “without concrete and timely government action,” the report says. 

Senators say the Liberals should deliver a plan to help low-income seniors, among other populations vulnerable to economic shocks like new immigrants, no later than the end of August, and contain short- and long-term options. 

The report also says the federal government needs to pay urgent attention to seniors in long-term care homes where outbreaks and deaths in the pandemic have been concentrated. 

The document made public Thursday morning is the committee’s first set of observations on the government’s response to the pandemic, with a final report expected later this year. 

Before then, the Liberals are planning to provide another economic update like the one delivered Wednesday, or possibly a full budget. 

Healthcare and pharmacare

The government shelved plans to deliver one at the end of March when the House of Commons went on extended hiatus due to the pandemic. 

The long-awaited economic “snapshot,” as the Liberals styled it, said federal spending is closing in on $600 billion this fiscal year. That means a deficit of $343 billion, fuelled by emergency pandemic aid that the government budgets at over $230 billion. 

The Chartered Professional Accountants of Canada said the spending figures demand a “full and transparent assessment” to see what worked, what didn’t and what needs to change for an economic recovery. 

Hassan Yussuff, president of the Canadian Labour Congress, said the Liberals should take back up their promise to create a national pharmacare system as the government considers its next steps. 

A federal advisory council last year calculated the cost of a program at over $15 billion annually, depending on its design. 

“The last thing we want to have is Canadians in frail health as we’re dealing with this pandemic and I think the government really needs to think of that,” Yussuff said in an interview Wednesday. 

“Had it not been for the health care system we have right now,” he added later, “think of how this country would have fared in this pandemic.” 

The Senate committee’s report also notes the national emergency stockpile of personal protective gear like masks, gowns and gloves wasn’t managed well over the years, nor sufficiently stocked when the pandemic struck. 

Committee members added concerns that military members could be deployed without sufficient personal protective equipment because of “inconsistencies from international procurement.”

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Coronavirus: Canada adds 370 new cases, 12 deaths Thursday – Global News



Canada’s total coronavirus case count went up by 370 Thursday and its deaths by 12.

The country now has 106,783 cases total with 27,460 of them active, and 8,749 deaths total.

Quebec, the hardest-hit province in Canada, reported 137 new COVID-19 cases, bringing its total to 56,216.

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Six new deaths were also reported, though four of them occurred before July 1. There have now been 5,609 deaths due to the virus in the province.

There are currently 308 people hospitalized in the province, down 23 from Wednesday, and 27 are in intensive care.

Ontario reported 170 new cases on Thursday, with 86 of them originating in the Windsor-Essex region as the province targets temporary farmworkers for testing.

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Coronavirus: Federal health officials say ‘limit or no transmission’ of COVID-19 in most parts of Canada

The province now has 36,348 cases total with 31,977 of them recovered, or 88 per cent. Overall, the new daily infection numbers have been on the decline over the past several weeks.

There are currently 123 patients hospitalized, with 31 of them in intensive care (down by four the previous day) and 23 patients on a ventilator (down by three).

Ontario has seen 2,703 deaths after three more were reported Thursday.

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Ontario reports 170 new coronavirus cases, 86 from Windsor-Essex; total cases at 36,348

In Alberta, meanwhile, three new deaths were announced Thursday, all linked to a coronavirus outbreak at Edmonton’s Misericordia Hospital.

The deaths bring the total number of COVID-19 fatalities in the province to 161, while 37 new COVID-19 cases have been confirmed in the province over the past 24 hours. Currently, there are 584 active cases in Alberta.

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Of the total 8,519 confirmed COVID-19 cases, 7,774 have recovered.

Canada’s greatest coronavirus threat comes from U.S.

Canada’s greatest coronavirus threat comes from U.S.

British Columbia reported 20 new cases Thursday, bringing its total to 3,028, nine of which were not tested but are considered epidemiologically-linked.

More than 88 per cent of those patients have fully recovered, while 175 cases remain active.

Seventeen of those cases are in hospital, four of them in critical care.

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20 new COVID-19 cases in B.C., no new deaths

In Saskatchewan, five new cases were added to bring its total to 813, while 750 of them have recovered, up by four from yesterday.

There have been 15 COVID-19-related deaths in the province.

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There are currently 48 active cases in the province, health officials said. Active cases are total cases less recoveries and deaths.

For the ninth straight day, no new COVID-19 cases were reported in Manitoba, keeping its total cases to 325 — 11 of which are presumptive cases — with four active cases. Seven Manitobans have died.

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New Brunswick reported one new case of the coronavirus on Thursday in the Fredericton region, and said it was a travel-related case and the individual is self-isolating.

The province said the number of confirmed cases in New Brunswick is 166 and 163 people have recovered. There have been two deaths, and there is one active case.

No new cases or deaths were announced in the rest of the Atlantic or Canada’s territories.

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— With files from Gabby Rodrigues, Phil Heidenreich, Thomas Piller, Shane Gibson, Kalina Laframboise, Aya Al-Hakim and Simon Little

© 2020 Global News, a division of Corus Entertainment Inc.

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Canada pushes back on U.S. Congress members’ call to reopen border amid coronavirus – Global News



The federal government is softly pushing back against an effort from U.S. Congress members to reopen the border with Canada amid the ongoing coronavirus pandemic, saying any decision will be made “by Canadians, for Canadians.”

A bipartisan group of 29 federal lawmakers led by New York representatives Blaine Higgins and Elise Stefanik sent a letter to Public Safety Minister Bill Blair and Acting Homeland Security Secretary Chad Wolf late last week, urging both countries to “immediately craft a comprehensive framework for phased reopening of the border.”

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The group also calls for interim measures to ease restrictions on family members and property owners, particularly those with property only accessible through cross-border travel, and “restore the social bond that unites our two nations.”

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“We hope that our legacy of binational cooperation would lend to the development of a thorough plan to protect the health of our shared communities and reinvigorate them in this time of recovery,” the letter reads.

The Canada-U.S. border was shut down to all but essential travel, including transportation of goods and work-related travel, on March 21. The closure has been extended by 30-day periods after assessments of the COVID-19 pandemic in both countries, pushing the deadline most recently to July 21.

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‘We’re very concerned’: Dr. Bonnie Henry on COVID-19 transmission coming from U.S.

The Congress members argue those regular extensions have created “unnecessary tension” and uncertainty for individuals and the shared economy,

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“Continuing to extend border restrictions at 30-day intervals is untenable for the communities that have been separated from family and unable to tend to their property for over three months,” the group argues.

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Higgins, a Democrat, and Republican member Stefanik are co-chairs of the Northern Border Caucus, which focuses on cross-border commerce and investment as well as border infrastructure.

In response to the letter, a spokesperson for the office of Deputy Prime Minister Chrystia Freeland said while conversations between Canada and the U.S. about the border are ongoing, “both sides agree that the current measures in place” have “worked well.”

“Our absolute priority is the health and safety of Canadians,” Katherine Cuplinskas said in an email. “That is why we want to be clear that decisions about Canada’s border are made by Canadians, for Canadians.”

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Coronavirus: Why reopening the Canada-US border too soon could mean a ‘second wave’

Cuplinskas did not give any suggestion either way as to whether the July 21 deadline will be extended yet again.

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Public polling has suggested Canadians are mostly supportive of the decision to keep the U.S. border closed to limit the spread of COVID-19, and has remained steadfast as cases have surged south of the border at an alarming rate.

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The U.S. topped three million infections Wednesday, just 28 days after crossing the two-million mark — cutting by nearly half the time it took to grow from a million to two million cases.

Spikes in several states have lead to continuous record-breaking daily case counts, which have been blamed in part on aggressive moves to reopen local economies.

A Globe and Mail/Nanos poll released Monday, three days after Higgins’ and Stefaniuk’s letter was sent to Blair and Wolf, found 81 per cent of those surveyed want the border to remain closed “for the foreseeable future.”

© 2020 Global News, a division of Corus Entertainment Inc.

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