Canada has not needed to declare an emergency over the monkeypox virus the same way the United States and the World Health Organization have as mechanisms are already in place to tackle the outbreak, the country’s top doctor said Friday.

Dr. Theresa Tam’s comments came a week after the U.S. declared a public health emergency in response to the monkeypox outbreak, which followed the WHO declaring monkeypox a global health emergency last month.

“There’s a very different approach in terms of accessing authorities and funding in the United States compared to Canada,” said Tam during a virtual news conference.

“We have different approaches … with the provinces being able to declare crises, emergencies at their level,” she added.

Tam noted that when the COVID-19 pandemic first hit Canada over two years ago, there was no actual declaration at the federal level for a public health emergency under the Emergencies Act.

“For monkeypox, we’ve been already doing all the things that the U.S. is also doing — being able to mobilize vaccines, being able to mobilize therapeutics,” she said, adding that the local and provincial authorities have the flexibility to do what they need to respond.

“Health Canada regulatory authorities are there for emergency purposes as far as needed as well,” Tam said.

4:16
About 50% of monkeypox vaccine supply used, Canada passes 1,000 cases: Tam

In Canada, as of August 10, 1,059 monkeypox cases have been reported across the country, with Ontario leading the case count with 511 infections, followed by Quebec with 426.

To date, there have been 28 hospitalizations, including two ICU admissions, due to monkeypox, but no deaths in Canada.

Tam said there were some “early signs” that cases are slowing down in the country, but it’s “a little too soon to tell.”

The growing threat of monkeypox has raised alarm in countries, including Canada, not accustomed to seeing such a surge as much still remains unknown about the viral infectious disease.

0:49
‘Too soon to tell’ if monkeypox plateauing in Canada, but some early signs of slow down

Globally, more than 31,000 cases have been confirmed in 91 countries, according to the WHO. Tam said this represents a 19 per cent increase in global cases over one week.

On July 23, WHO’s chief declared monkeypox a public health emergency of international concern, citing the unprecedented rapid spread of the virus to many countries; the risk it poses to human health, and the potential for interference with international traffic.

Under the International Health Regulations (IHR), when a “public health emergency of international concern” is declared, international efforts are required to stop the spread of the virus. This could include sharing vaccines and treatments among countries and taking travel-related measures.

In Canada, the federal government has deployed to provinces and territories more than 99,000 doses of the Bavarian Nordic’s Imvamune or MVA-BN vaccine, normally used to treat smallpox.

More than 50,000 people have been vaccinated, as of August 11, said Tam.

U.S. health officials on Tuesday authorized a plan to stretch the nation’s limited supply of monkeypox vaccine by giving people just one-fifth the usual dose, citing research suggesting that the reduced amount is about as effective.

Tam said it was “an important approach to explore” and gather information to see if the same can be implemented in Canada.

“But for now, we are working together with the National Advisory Committee on Immunization for really pushing out the approach of one-dose first to reach as many people as possible in our most highly-affected populations,” she said.

1:52
Experts urge Canadian officials to take more action on monkeypox spread

Monkeypox is primarily transmitted through prolonged close contact with an infected person and the majority of cases reported in the current outbreak involve men who had intimate sexual contact with other men.

The current outbreak in Canada is largely from person-to person spread, said Tam, but the virus can also spread through direct contact with contaminated objects such clothing, sheets or other personal items.

Symptoms of monkeypox include a painful rash that could last between 14 and 28 days, which can be accompanied by fever, chills, headache, swollen lymph nodes, muscle pain, joint pain, back pain or exhaustion.

1:23
Monkeypox: Canada exploring fractional vaccine doses, but focused on 1st dose push

— with files from the Associated Press 

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Good evening. The coronavirus newsletter now publishes Mondays and Fridays.

Top headlines:

1. Pregnant women who received mRNA COVID-19 vaccines were not more likely to experience miscarriage, stillbirth or other severe health events compared to unvaccinated pregnant women, a new study says
2. ‘It’s hard to explain how much we’ve seen and how much we’ve been through’: A growing number of health professionals have been harassed and abused by individuals promoting COVID-19 conspiracies online and in person – despite a federal law that makes it illegal
3. The Canadian economy was losing between $2.6-billion and $5.2-billion a week as a result of the countrywide trucker convoy blockades, newly disclosed cabinet documents show

An increasing number of health agencies have changed how they’re reporting data on the coronavirus. A look at the current numbers in Canada for reported cases, deaths from COVID-19 and for hospitalizations can be found here.

COVID-19 updates from Canada and the world

• With pregnant women having a lower vaccination rate than the general population, a new study sheds light on the safety of mRNA COVID-19 vaccines when administered to expectant moms. Vaccinated pregnant women were not more likely to experience miscarriage, stillbirth or other severe health events compared with unvaccinated pregnant women, according to the study. “If you get sick with the infection, it actually has really adverse effects on pregnant people,” said Julie Bettinger, senior study author and a pediatrics professor at the University of British Columbia.
• Nurses and doctors say the spread of pandemic-related conspiracy theories and false information is increasingly turning people against the health care system, causing them to reject vaccines and exposing health professionals to a barrage of abuse.
• Ottawa produced an internal estimate of the GDP impact of countrywide blockades, projecting that they caused economic losses of 0.1 per cent to 0.2 per cent of GDP per week, newly disclosed cabinet documents show. The documents also included the revelation that the Prime Minister’s national security adviser, Jody Thomas, told the full cabinet on the evening of Feb. 13 that there was a potential for a breakthrough with the protesters who had blockaded downtown streets in Ottawa for weeks. Prime Minister Justin Trudeau and his cabinet invoked the Emergencies Act the next day.
• Moderna is announcing that it has agreed to purchase land in a biotechnology park near Montreal, to serve as the site of its biomanufacturing facility for its mRNA vaccines, including COVID-19 vaccines.
• The U.S.’s Centers for Disease Control and Prevention relaxed its COVID-19 guidelines yesterday – dropping the recommendation that Americans quarantine themselves if they come into close contact with an infected person.
• The European health regulator has started a rolling review of a variant-adapted COVID-19 vaccine from Pfizer and BioNTech – adding that officials plan to use bivalent shots in their autumn vaccination campaign, with most cases in the region now linked to the BA.5 variant.
• North Korea’s Kim Jong-un declared victory in the battle against COVID-19 yesterday, even though the country has never confirmed how many people caught COVID-19, apparently lacking testing supplies.

Looking for more top headlines? Subscribe to our Morning Update and Evening Update newsletters to get caught up on our latest stories.

Pandemic recovery

• The pandemic has changed a lot about how we work, but it hasn’t changed when we are most productive, according to the results of a new survey. Daniel Pink, author of When: The Scientific Secrets of Perfect Timing, says that these patterns provide a strong argument for greater autonomy and flexibility in the workplace. While research has proven that workers are equally or more productive when they get to choose their work location, he believes there’s even more productivity to be gained by providing employees with greater control over when they work.
• Outdoors activities were among the many things that got more expensive and difficult to enjoy when the pandemic hit. Here’s a list of a few relatively low- and medium-cost outdoor activities to pursue, as the pandemic heads further into recovery.
• New Zealand welcomed the first cruise ship to the country since the coronavirus pandemic began, signalling a long-sought return to normalcy for the nation’s tourism industry.
• Manulife missed analyst profit expectations after a $1.6-billion drop in earnings owing to market turmoil and extended COVID-19 restrictions in Asia.

Want in-depth analysis on what governments are doing with your tax dollars? Subscribe to our Tax & Spend newsletter.

Globe opinion

John Ibbitson: Pierre Poilievre’s goal to block COVID-19 vaccine mandates doesn’t reconcile with public harm it would cause

Campbell Clark: The convoy wasn’t leaving town – but that’s not the Emergencies Act question

David Parkinson: The Great Resignation has arrived in Canada

Want to hear more from our columnists? Subscribe to the Opinion newsletter, and get it in your inbox, Monday to Saturday.

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Information centre

Thank you for subscribing to our Coronavirus Update Newsletter. As the pandemic eases, we plan to wind this down and eventually cease sending, but have many other newsletters to keep you informed, including Globe Climate, Carrick on Money and Breaking News.

Reach out to us: audience@globeandmail.com

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This is an excerpt from Second Opinion, a weekly analysis of health and medical science news. If you haven’t subscribed yet, you can do that by clicking here.

A new analysis of the cause of depression has seemingly upended what we know about this common condition and challenged the use of antidepressants. But it may also leave patients with more questions than answers as the science evolves.

A systematic umbrella review of 17 studies published in Molecular Psychology on July 20 looked at the decades-old theory that depression is caused by low serotonin, and found there was “no consistent evidence” of “an association between serotonin and depression.”

The theory that depression is caused by a chemical imbalance in the brain has been around since the 1960s. But for years, many experts have doubted this, feeling it oversimplified a complex condition.

“The serotonin theory is very old and has been very popular since the ’90s, when the pharmaceutical industry started promoting it,” said Dr. Joanna Moncrieff, a psychiatry professor at University College London and lead author of the study.

“But since about 2005, probably a bit before then, there’s been sort of rumours that actually the evidence isn’t very strong, or it’s inconsistent. Some studies are positive, some studies are negative, but no one’s really got that evidence together anywhere.”

Moncrieff and her team set out to challenge the serotonin theory in a systematic review of available research. They also went a step further in their conclusion by suggesting that antidepressants are ineffective at treating depression — and have largely worked as a placebo.

“Evidence from placebo-controlled trials show that antidepressants are a little bit better than a sugar tablet,” she said. “And if that little difference is not to do with rectifying a chemical imbalance, improving low serotonin levels, what is it to do with?”

The research paints a compelling picture that depression isn’t caused by low serotonin alone. Many experts say this is already widely accepted and that it’s also true that antidepressants can be extremely beneficial to some patients — even if we don’t know exactly why.

So where does this leave patients and physicians, and could the analysis impact the way we treat depression in the future?

Are antidepressants effective against depression?

Antidepressants are widely believed to affect the behaviour of neurotransmitters, chemical messengers in the brain like serotonin and dopamine, in a way that can alter emotions and mood to help improve the symptoms of depression in some patients.

WATCH | Living alone during pandemic can worsen anxiety, depression:

People with depression can face a wide range of symptoms, including persistent feelings of sadness and desperation, changes in appetite, sleep deprivation, fatigue, irritability and loss of interest in hobbies and social connections that can impact everyday life.

While it’s unclear exactly how antidepressants work at a biological level to alleviate those symptoms, it’s clear that they can still be hugely helpful to some patients.

“It’s a typical discovery in medicine — you find a drug that works, but you don’t quite know why,” said Dr. Phil Cowen, a professor of psychopharmacology at the University of Oxford.

“[The review] is a debunking exercise and in a way, they’re criticizing older studies that were hard to do,” he said. “These [older] studies, clearly, were very indirect and they’re messy, and I don’t think anyone thought that they were that great.”

Moncrieff’s team found that some depressed patients actually had higher serotonin levels in certain areas of the brain, and in some cases the long-term use of antidepressants could actually lower the amount of serotonin — though the findings were “inconsistent.”

“I think it makes a huge difference, because how [antidepressants] work actually influences whether they work,” she said. “It influences how helpful we think they are.”

The findings have caused a major stir in the media and scientific community, with hundreds of news outlets covering the study — quickly landing it in the top five per cent of all research scored by Altmetric, a company that analyzes where published research is shared.

Findings of this perceived magnitude can have a seismic impact on the way we understand and treat a widespread condition like depression, which affects an estimated one in eight Canadians at some point in their lives.

While the research questions the very nature of what we know about depression, many doctors are hesitant to change the way we treat it.

Antidepressants can be ‘lifesaver’ for some

Dr. David Juurlink, head of clinical pharmacology at Sunnybrook Health Sciences Centre in Toronto, said he’s not surprised by the findings, because the chemical imbalance theory for depression is now widely seen as an “obvious oversimplification” for a complex condition.

“Although I think doctors prescribe serotonin-enhancing antidepressants far too often, in part because of this oversimplification, it’s important to acknowledge that they really do improve the well-being of some patients,” he said in an email.

“How exactly they do that isn’t as clear-cut as we’ve been led to believe.”

Dr. David Gratzer, a psychiatrist and attending physician at the Centre for Addiction and Mental Health (CAMH) in Toronto, said he wasn’t surprised by the findings — just that they got as much attention as they did.

“This suggestion that depression is all about serotonin all the time hasn’t been accepted by psychiatrists for many years, probably many decades,” he said, adding that the researchers are “terribly biased” in their assessment of antidepressants.

“Their paper shows things are much more complicated than serotonin — no surprise — and then they turn around and say, ‘You see, that’s another example of the fact that antidepressants don’t really work.’ One doesn’t necessarily give rise to the other.”

Gratzer said he still prescribes antidepressants regularly as a treatment option for depression, and has no plans to stop doing so based on the research.

“That’s not going to change. These medications work,” he said.

“An antidepressant is not necessarily [recommended] in everyone who has depression — some people might in fact do better with talking therapy — but it is certainly a tool in our tool kit and, to be blunt, it’s a lifesaver for some of our patients.”

Research calls antidepressants into question

Moncrieff said the research found that another way in which antidepressants may function is by desensitizing the brain to negative emotions associated with depression. In theory, that could also impact other feelings.

She said one of the effects previous studies have reported in patients is “emotional numbing,” where they not only don’t have unwanted emotions like depression and anxiety, but positive emotions like joy and happiness.

“There may be some people that feel that that’s an effect they want. But I think generally, people aren’t going to want to be emotionally numbed, not for long periods, anyway, and so I think it totally changes the sorts of decisions people might make about antidepressants,” said Moncrieff.

Chris Davey, the head of the department of psychiatry at the University of Melbourne, said in an email that undermining the confidence that people with depression have in their treatments can be “very damaging.”

“People will stop their medications suddenly, without supervision,” he said, “which can cause dramatic deteriorations in their mental health.”

Davey said he is concerned that the paper diminished a treatment option that can be incredibly beneficial to some patients, especially when alternatives may not always be available to those at risk of severe depression.

WATCH | Research shows exercise can help alleviate pandemic depression:

Research shows how exercise helped fight pandemic depression

7 months ago

Duration 2:04

A study conducted by B.C. researchers during the COVID-19 pandemic showed how exercise, especially a combination of yoga and high-intensity exercise, helped fight depression – backing up decades of research on how exercise improves mental health.

“This [research] shouldn’t make any difference to the treatment of depression. I hope it makes people realize that depression is a very complex condition, and that there are no simple explanations for it,” Davey said.

“Everyone should know that improving their diet, exercising more and paying attention to their sleep can be helpful. Everyone should have access to psychotherapy. And for those people for whom those things don’t help, that’s when we think about medications.”

Gratzer said there are many new areas of research into treatment options for depression that can be beneficial, including novel ways of delivering psychotherapy, emerging medications and discoveries like the use of ketamine. 

Ketamine is a general anesthetic first approved in Canada in the 1960s for medical or veterinary surgery, as well as a psychedelic party drug sold on the illicit market. It’s also increasingly being used as a fast-acting and effective treatment for depression in low doses, by working to restore synapses in the brain that are destroyed by stress.

There’s “an understanding that certain life experiences might be more connected, and so research is very active. Maybe at the end of the day, we’ll understand depression isn’t one illness,” Gratzer said.

“As is often the case with mental health care, these are early days.”

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