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'It was shocking because it came so quick': Patients and doctors cope as flu season ramps up – CBC.ca

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Packed emergency wards, filled with feverish, coughing people suffering from the flu. It is a scene being played out at hospitals across the country.

This flu season started a bit earlier than normal and is now moving into high gear, experts say. 

That certainly seemed clear at Humber River Hospital in Toronto on Boxing Day. 

“We saw 510 people come through our emergency room department and our after-hours kids clinic on that day,” said Dr. Tasleem Nimjee, an ER physician at the hospital.

Dr. Tasleem Nimjee, an emergency room physician at Humber River Hospital in Toronto, says the ER and after-hours kids clinic have been very busy. (Craig Chivers/CBC)

What may also be a bit unusual is the presence of both flu strains at the same time. Influenza A mainly affects older people, while influenza B typically targets children and youth. Normally, one strain wanes as the other peaks.

Every year, the flu kills an estimated 3,000 Canadians, often young children, the elderly and those with pre-existing medical conditions such as asthma.

So far, there have been nearly 12,500 confirmed cases of flu across Canada and 10 deaths.

In Manitoba, two families are reeling from the recent deaths of their loved ones. Joanne Ens, 24, died from a bacterial infection after battling the flu for several days, while Blaine Ruppenthal, 17, also died of complications from the flu.

It’s that toll on the body exacted by the flu that worries doctors.

“The flu can complicate pre-existing heart disease, asthma, chronic lung disease, quite often it causes pneumonia and that’s sort of its route of causation. It’s what makes people really sick,” said Dr. Mark Loeb, division director for infectious diseases at McMaster University in Hamilton.

In Ajax, Ont., about 50 kilometres east of Toronto, Wendy Wilson is recovering from a bout of pneumonia that left her with a cracked rib. It started with a sore throat and flu-like symptoms.

“I was afraid to walk fast or move too fast because it was like all of a sudden, I’d start coughing, and I’m feeling like I can’t catch my breath,” she said.

“It was shocking because it came so quick.”

And those symptoms can sometimes worsen, Nimjee said.

“If somebody is really short of breath and not able to manage without assisted support, without oxygen or hydration or need antibiotics through an IV, those would be the people who would be admitted to hospital,” she said.

Ascend the mountain

Yet experts say it’s still too early to gauge the severity of this particular flu season. While doctors at the U.S. Centers for Disease Control and Prevention point to ominous signs, such as widespread flu activity and hospitalizations, as indicators of a bad year, Canadian numbers, so far, don’t bear that out.

Dr. Mark Loeb, division director for infectious diseases at McMaster University in Hamilton, says it’s too early to tell how severe this flu season will prove to be. (Craig Chivers/CBC)

“Based on data up to January 4, 2020, the Public Health Agency of Canada would not characterize the current flu season as severe at this time,” officials told CBC News in an emailed response to questions.

Loeb agreed it’s too early to tell. Typically, flu season runs from mid-November until April.

“Flu epidemics are like a mountain. It’s like an ascension and then you reach a peak and then you descend. Now we’re on the ascension of that mountain and we don’t know exactly where it will peak.”

However, doctors agree on one thing: get the flu shot.

Although this year’s vaccine may not be a perfect match to the current strains, some protection is always better than none, according to Loeb.

“Sometimes prevention is harder for people to understand than treatment.”

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The financial impact of COVID-19 on Manitoba Liquor and Lotteries – CTV News Winnipeg

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WINNIPEG —
Manitoba Liquor and Lotteries Corporation’s net income was $24 million below the budget, according to the province’s fiscal update.

The numbers, released Tuesday, states the lower than anticipated revenue is due to impacts from COVID-19, including declining attendance and the closure of casinos and VLT networks in March.

The Casinos of Winnipeg began experiencing declining attendance in the last month of 2019/20, and on March 18, 2020, the provincial government required all Manitoba casinos to close.

For March 2020, revenues were nearly 70 per cent lower than the same period of 2018/19. 

The annual report said revenue from casinos dropped $8.6 million this year, a 3.4 per cent decline.

During the month of March, bars and restaurants across Manitoba began to close voluntarily due to reduced business, as patrons heeded physical distancing and stay-at-home recommendations. VLT revenues were 40 per cent lower compared to March 2019, and liquor sales to licensees were also down 24 per cent in March 2020 compared to the prior year. 

All other liquor channels experienced strong sales in March 2020, led by Liquor Marts at 29 per cent above March 2019.

Liquor revenue jumped by $13 million, mostly from sales at Liquor Marts.

Cannabis sales nearly doubled, bringing in nearly $51 million in 2020, compared to just under $27 million.

Casinos in Manitoba began reopening on July 25. 

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Coronavirus: 429 new cases as public health officials ‘less optimistic’ than last week – The Irish Times

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A further 429 confirmed cases of Covid-19 were reported by the National Public Health Emergency Team (NPHET) on Wednesday. This brings to 36,155 the total number of cases of the disease in the Republic.

Some 189 of the new cases are in Dublin, and 60 in Cork. There were also 31 cases in Donegal, 28 in Galway, 18 in Kildare, 15 in Wicklow, 15 in Clare, 12 in Limerick, nine in Meath, nine in Louth, seven in Cavan, seven in Longford, six in Laois, five in Offaly, five in Westmeath, with the remaining 14 cases in eight counties.

One further death was reported to NPHET, bringing the total number of deaths to 1,804.

The reproduction number, an indicator of how widely the disease is spreading, now stands at between 1.2 and 1.4, according to Prof Philip Nolan, chair of the NPHET epidemiological modelling advisory group. A reproduction number of less than 1 means an epidemic is dying out; a figure greater than 1 signals it is spreading.

“While we are cautiously optimistic about Dublin, we have seen relatively high case numbers in the last few days, and it will be a number of days yet before the pattern is clear,” Prof Nolan told a briefing on Wednesday.

“Case numbers are clearly rising across the country. We need to remain vigilant, to ensure we do not lose the ground that we have gained across the capital city since we moved to Level 3, and to ensure we do not see further deterioration outside the capital.”

Of the new cases, 203 are men and 226 are women. Sixty-five per cent are under 45 years. Officials say 45 per cent are associated with outbreaks or are close contacts of cases, while 77 cases involved community transmission.

There are currently 130 people with Covid-19 in hospital, including 15 admissions in the past 24 hours, according to acting chief medical officer Dr Ronan Glynn.

“Recently we asked everyone to halve their social contacts,” he said. “Reducing the number of people that we meet – and engaging safely with a small core group – remains the cornerstone of our collective effort to reduce the spread of this virus and its impact on our health and the health of the people that we care about.”

He said that while school-age cases were stable, there had been a sharp rise in cases among 19-24 year-olds and the rise in cases among over-65s was of concern.

Older people were at “grave risk” of a spillover of cases among people of working age, he said.

Rejecting the “narrative” that the disease was less severe of dangerous than before, Prof Nolan said Covid-19 was “as fatal as it ever was to some sectors” while young people were vulnerable “in a different way”.

Public health officials gave examples of recent clusters that have occurred in the west.

One cluster of 30 cases arose after a young couple went away for a weekend and attended a house party. This resulted in six to eight cases, and cases in three to four households. On the second day of their trip, they went with friends to a town centre, resulting in four more cases.

They attended a bar, where six people at an adjacent table, and four staff, tested positive. They then went on to a “drinks venue”, where four more cases occurred.

In another cluster of 24 cases involving intergenerational social mixing, the outbreak started in a small rural place where middle-aged people had gathered. There was socialising in a pub and workplace and further transmission occurred in the pub over the weekend. Fourteen of the cases were directly linked to socialising and 11 involved people aged between 45 and 70. In the outbreak, there were three family clusters, three schools were affected and also one workplace.

A third example arose from two student parties on the same night. There was mixing between the parties, leading to 21 cases among those on attendance. One of these people then had dinner with a university friend, who later went to class. Later 15 out of 26 people in the class tested positive, giving 36 cases in total. The students were masked and observed social distancing, but public health officials believe transmission occurred during break-time.

So far, 87 cases have been detected in schools, out of 4,455 tests carried out, the briefing heard.

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Race for a COVID-19 vaccine raises cost, safety—and trust—issues – The Georgia Straight

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As COVID-19 numbers rise again, the prime minister has re-emerged as a regular fixture at daily government briefings.

On September 25, Justin Trudeau announced that the federal government has signed another agreement to buy a vaccine. This time with AstraZeneca for up to 20 million doses of its COVID–19 vaccine.

That brings the number of agreements signed by the government with vaccine manufacturers to seven. The others are with Sanofi, GlaxoSmithKline, Johnson and Johnson, Novavax, Pfizer, and Moderna.

Three of the companies have vaccine candidates in phase three trials. In all, the government has committed to purchasing some 300 million doses from vaccine manufacturers.

The Trudeau government has also announced its participation in the COVID-19 accine Global Access Facility, or COVAX. It’s part of the World Health Organization’s (WHO) effort to deliver “fair, equitable and timely access to COVID-19 vaccines.”

The Canadian government is contributing $220 million to the facility. Its mandate includes delivering vaccines to “low- and middle-income countries.” Canada’s participation in the effort gives it the option of purchasing another 15 million doses of a vaccine.

“We cannot beat this virus in Canada unless we end it everywhere,” Trudeau says.

But while Trudeau is pushing an international approach to find a vaccine, other countries are going it alone.

The COVAX facility is backed by some 172 countries, but the U.S. is not supporting the effort. Neither is China or Russia.

And while the race to find a COVID-19 vaccine has seen unprecedented cooperation between nations, some experts say it seems to be headed for the kind of scenario that plagued the search for a vaccine for AIDS in the ’80s and ’90s.

Back then, pharmaceutical companies and their research and development backers chased profits, making what treatments became available unaffordable for many, especially in the developing world.

In Canada, where large pharmaceuticals enjoy high-level access in Ottawa, who pays for a COVID-19 vaccine and whether it is subsidized are also emerging questions.

Canadians could be asked to pick up some of the cost.

“There’s a lot of money on the table,” says Thomas Tenkate, an associate professor at Ryerson University’s School of Occupational and Public Health.

He notes that pharmaceutical companies and their shareholders have historically placed a steep price on their research and development of new drugs.

While vaccines developed in the world have been distributed universally—polio comes to mind—the scenario with COVID-19 is shaping up to be much different. In all likelihood there will be multiple manufacturers distributing their own variations of the vaccine in different countries.

“With so many clinical trials on the boil you’ve got to think there will be a range available,” Tenkate says.

Tenkate says most researchers and countries will be looking to see what the U.S. does. “There’s a lot of political pressure in the U.S. to have something done [a vaccine] quickly.”

FDA approval usually opens the floodgates to approvals in other countries. But not necessarily in Canada, where Health Canada rules around the approval of new drugs are notoriously stringent.

At his press conference, Trudeau made a point of stressing that any vaccine approved for distribution in Canada will have to pass Health Canada standards. But that process can also be prone to politics.

Questions of transparency, for example, were recently raised about the government’s own Vaccine Task Force. The task force is made up of infectious disease experts and representatives of pharmaceutical companies. It’s advising the government on what research projects to explore.

Gary Kobinger, director of the Infectious Disease Research Centre at the Université Laval, quit the group last week citing potential conflicts among group members as a reason. “You need people to trust the vaccine,” Kobinger told the CBC.

The government responded by bringing in protocols that require potential conflicts of task force members to be made public.

It usually takes anywhere from five to 10 years to develop a vaccine. But the big money is on a vaccine for COVID-19 by next spring or a little later. That’s a year and a half roughly since the onset of the disease.

Russia is already claiming to have developed a vaccine. The U.S. says it’s close. China has said a vaccine may be ready by November. The predictions are overly optimistic. Most of the larger clinical trials have just started in recent months.

There are some 126 clinical trials on the WHO’s radar. Some 26 involve human trials. Nine of those have reached phase three, but none will be completed until late 2022 at the earliest.

The largest human trial of 60,000 participants by Belgium-based Johnson and Johnson company Janssen Pharmaceutica won’t be completed until 2023, according to documents submitted to WHO.

The company says that it “anticipates the first batches of a COVID-19 vaccine to be available for emergency use authorization in early 2021, if proven to be safe and effective”.

Further monitoring of subjects after the trials are completed will be needed to make sure any side effects are manageable.

Tenkate worries that “corners may have to be cut because of the reduced timelines” to find a vaccine.

Whatever vaccine we end up with in the short term will be more akin to treatment than a cure.

When politicians talk about a vaccine for COVID-19, it’s easy to jump to conclusions, but there is no magic pill. And there won’t be for some time, given that almost 20 years later there is no vaccine for SARS—COVID-19’s, genetic predecessor.

The danger with a COVID vaccine is that we will, in all likelihood, not know enough about the side effects.

Each country will have its own approval process. And while the rules around those “are pretty consistent around the world,” says Tenkate, there are differences. What is greenlighted for sale in Russia may not receive approval in other Western countries.

For Canada, it will come down to “understanding the risks,” Tenkate says, particularly with the possibility of multiple vaccines. “Ultimately, for a lot of people, it’s going to come down to trust.”

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