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Dr. Sheila Singh is used to explaining complex medical situations in simple terms. The pediatric neurosurgeon at McMaster Children’s Hospital in Hamilton says that lately, she’s seeing too many oranges and grapefruits and fewer ping pong balls.
That’s not good, and it could signal that the COVID-19 pandemic has delayed the diagnosis of many pediatric diseases, sometimes with devastating results.
“You can imagine a tumour that’s the size of a ping pong ball, it’s easier for me to work around and remove it,” she said. “But if that ping pong ball-sized tumour grows to the size of an orange or a grapefruit, the tumour has grown to a size where it’s much more difficult now to deal with.”
Singh told Dr. Brian Goldman, host of White Coat Black Art, that she is now seeing two to three times more oranges and grapefruits than before the pandemic. In other words, the tumours have been left to grow much longer due to delays in diagnosis.
Singh says she believes the delays in diagnosis have been caused by patients staying away from hospitals because:
- They are afraid of catching COVID-19.
- There is a lack of in-person visits with their family doctor.
- There is an anchor bias to look for COVID-19 symptoms to the detriment of flagging other serious diseases.
“There’s no doubt there will be collateral damage,” she said, “and some of that will be death and poor outcomes from diseases that could have had better outcomes.”
Singh says she remembered a recent patient, a young girl who had a tumour that typically grows in one place in the brain. “This little girl came in and this tumour was actually in four places in her brain. And let me put it this way, two out of those four places I’d never seen this brain tumour in before.” Instead of doing one surgery, Singh had to do several risky and difficult operations.
As a pediatric doctor, Singh says that it has been heartbreaking to see some of the children whose cancers have progressed much further than the pre-pandemic norm. “I feel like I’ve been practising in a Third World country. I have seen disease that has spread so far that it’s almost like cases I’ve read about in rural India. It’s been quite difficult and alarming.”
Pediatric cancer specialists at CHEO, formerly the Children’s Hospital of Eastern Ontario, in Ottawa also saw fewer patients coming in the early days of the pandemic, when parents said they feared going to the hospital.
26:30The COVID fallout: tumours as big as oranges
Early signs of widespread diagnosis delays
Early research suggests that later diagnosis of illness in children due to the pandemic may extend to other serious illnesses, not just cancer. In a study published earlier this year in the medical journal Pediatric Diabetes, researchers in Alberta found that more children are being treated for diabetic ketoacidosis, a serious and potentially fatal complication of diabetes.
The authors suggest that parents may have been reluctant to access medical services because of fear of COVID-19 and that “increased virtual visits resulted in reduced face-to-face contact with health-care providers and may have contributed to the under-recognition of the severity of illness.”
Dr. Patrick McDonald says he remembers the challenges of the lockdowns. For much of the pandemic, McDonald headed up the pediatric neurosurgery division at B.C. Children’s Hospital in Vancouver. In the early days of COVID-19, “I think all of us struggled with the issue [of] how do we make sure that families know that they can still access care. It might be a little more challenging, and we might have to do it initially by phone.”
He said that “it’s a legitimate concern that people might not be able to or might not be accessing care in a timely fashion.”
Push for more in-person care
In October, the Ontario Ministry of Health and the College of Physicians and Surgeons of Ontario issued a letter that encouraged doctors to resume in-patient visits over virtual appointments.
“The standard of care is often difficult to meet in a virtual care environment,” the letter stated. “In-person care is essential for certain conditions and services or where physical assessments are necessary to make an appropriate diagnosis or treatment decision.”
That’s particularly true when examining a young patient, Singh stressed. “There’s so much room to miss a diagnosis when you’re staring at a child on a screen.”
One of the common symptoms of a brain tumour in a child is macrocephaly, a technical term for an enlarged head, which Singh said can be a challenge to identify during a virtual visit.
“Depending on the angle at which you’re looking at a child, you might not even notice how big their head is or even be alarmed about it, whereas if that child walked into a room, it’d be the first thing you’d notice about them.”
McDonald says he believes that it may be another year before the full impact of delayed diagnosis due to COVID-19 is really understood. When the data does emerge, he stressed that we need to carefully examine what happened to understand why people may not have sought out the care their children needed.
“There may be another pandemic, and we want to make sure that we learn appropriate lessons for what we did right and what we did wrong in providing adequate care,” he said.
In the meantime, Singh offered two pieces of advice to parents. First, she said, “It’s safe to go to your hospital.” And second, “I would really encourage parents not to accept a virtual visit as being a proper way to diagnose your child.”
Singh stressed that when parents are concerned about their child, an in-person physical examination is imperative to receive a proper diagnosis.
Study suggests Pfizer COVID-19 vaccine only partially protects against Omicron – Toronto Sun
The Omicron variant can partially evade protection from two doses of Pfizer and partner BioNTech’s COVID-19 vaccine, the research head of a laboratory at the Africa Health Research Institute in South Africa said on Tuesday.
But the study showed that blood from people who had received two doses of the vaccine and had a prior infection was mostly able to neutralize the variant, suggesting that booster doses of the vaccine could help to fend off infection.
The Omicron variant, first detected in southern Africa last month, has triggered alarms globally of another surge in infections, with more than two dozen countries from Japan to the United States reporting cases.
The World Health Organization classified it on Nov. 26 as a “variant of concern,” but said there was no evidence to support the need for new vaccines specifically designed to tackle the Omicron variant with its many mutations.
Alex Sigal, a professor at the research institute, said on Twitter there was “a very large drop” in neutralization of the Omicron variant relative to an earlier strain of COVID-19.
A separate lab test by virologist Sandra Ciesek of the University Hospital Frankfurt painted a somewhat bleaker picture.
Exposing the blood of vaccinated individuals to different virus variants, she found that the ability to mount an antibody response to Omicron in people who had three shots of BioNTech/Pfizer was up to 37 times lower than the response to Delta.
An antibody response to Omicron half a year after a two-shot regimen of Pfizer/BioNTech, Moderna or a mixed course of AstraZeneca/BioNTech was not even measurable, Ciesek added.
She posted only selected findings on Twitter, not including the number of samples, and the university said the paper had not yet been published.
“The set of data underscores that it makes sense to develop a vaccine that is adapted to Omicron,” Chiesek tweeted, adding that no conclusion could be drawn about protection against severe disease.
WHO’s chief scientist, Soumya Swaminathan, said a large drop in the antibody response of vaccinated people to Omicron had been expected.
“This does not mean the vaccine will not work – T-cell immunity (is) likely to persist,” she said on Twitter, referring to a cellular immune response that is believed to prevent severe disease as a second line of immune defence.
Researchers including Carsten Watzl of the German Society of Immunology and Penny Ward, visiting professor at King’s College London, said the findings underscored the need to get booster shots because a three-shot course would likely continue to protect against severe disease.
Sigal’s lab tested blood from 12 people who had been vaccinated with two doses of the Pfizer/BioNTech vaccine, according to a manuscript posted on the website for his lab. The preliminary data in the manuscript has not yet been peer reviewed.
Blood from five out of six people who had been vaccinated as well as previously infected with COVID-19 still neutralized the Omicron variant, the manuscript said.
“These results are better than I expected. The more antibodies you got, the more chance you’ll be protected from Omicron,” Sigal said on Twitter.
He said the lab had not tested the variant against blood from people who had received a booster dose, because they are not available in South Africa yet.
According to the manuscript, the lab observed a 41-fold decline in levels of neutralizing antibodies against the Omicron variant.
Sigal said on Twitter that figure is likely to be adjusted after his lab does more experiments.
While neutralizing antibodies are an indicator of the body’s immune response, scientists believe other kinds of cells such as B-cells and T-cells are also stimulated by the vaccines and help protect against the effects of the coronavirus.
The preliminary data does not indicate that the vaccine is less able to prevent severe illness or death. While lab tests are under way, BioNTech CEO Ugur Sahin said last week “we think it’s likely that people will have substantial protection against severe disease caused by Omicron.”
There is not significant data yet on how vaccines from Moderna, Johnson & Johnson and other drugmakers hold up against the new variant. All the manufacturers, including Pfizer and BioNTech, are expected to release their own data within weeks.
BioNTech’s Sahin told NBC News on Tuesday that the drugmaker has data coming on Wednesday or Thursday.
Seven Omicron variant cases in Simcoe County linked to travellers from Nigeria – BayToday.ca
The Simcoe Muskoka District Health Unit says it is investigating a household cluster in Simcoe County with seven confirmed COVID-19 cases that have a strong probability of being the Omicron variant of concern. All the cases are currently isolating at home.
“The cluster is linked to travellers who arrived in Simcoe County from Nigeria in late November,” says a news release.
“Although the health unit is awaiting whole genomic sequencing of the samples which should be available in the next 7 to 14 days, given the travel history and the preliminary laboratory screening results, the likelihood of an Omicron cluster is very high.”
The Unit’s case and contact management team is currently following up with each case to identify close contacts regarding isolation and testing.
“Scientific data about the Omicron variant is still emerging,” said Dr. Charles Gardner, Medical Officer of Health. “Early evidence suggests that the variant might be more transmissible. While we continue to closely monitor this local situation, I urge all residents to remain vigilant about following public health measures, to monitor themselves for symptoms of COVID-19 and seek testing immediately if any should develop, and get vaccinated if they have not already done so.”
The rate of COVID-19 infection among the unvaccinated vaccine-eligible Simcoe Muskoka population is seven times higher than it is for the fully vaccinated population and the rate of COVID-19 hospitalizations is 15 times higher says Gardner. Getting the vaccine can lower the risk of serious illness, hospitalization, and death.
Eating disorder symptoms and self-harm linked to higher levels of depression and anxiety during COVID-19 pandemic – Medical Xpress
Young adults with previous self-harm or eating disorders reported higher levels of depression and anxiety during the pandemic, even when restrictions had eased, according to new research.
The study, led by the University of Bristol and funded by Elizabeth Blackwell Institute, Medical Research Council and Medical Research Foundation, has been published in the Journal of Eating Disorders. It looked at questionnaire information for 2,657 individuals from world-renowned health study Children of the 90s (also known as the Avon Longitudinal Study of Parents and Children) before and during the COVID-19 pandemic.
Researchers analyzed the relationship between previous reports of eating disorder symptoms and self-harm before the pandemic, and mental health problems (symptoms of depression and anxiety) and mental wellbeing during the COVID-19 pandemic. The study also assessed whether lifestyle changes, such as more sleep, relaxation techniques, or visiting green space, could be linked to mental health and wellbeing in young adults with and without previous eating disorder symptoms or self-harm.
Researchers studied questionnaire data from 2017, when the participants were then aged 25 years, as well as data taken during the pandemic in 2020.
At age 25, 32 percent of the 2,657 young adults reported at least one eating disorder symptom, 9 percent reported self-harm, and 5.5 percent reported both an eating disorder symptom and self-harm in the last year.
During the pandemic, those with previously reported eating disorder symptoms and/or self-harm had more symptoms of depression and anxiety, and worse mental wellbeing, compared to individuals without previous symptoms. This remained the case after adjusting for their pre-pandemic levels of depression, anxiety and mental wellbeing.
Lifestyle changes appeared to have little effect on the increased risk for mental health problems in those with prior eating disorder symptoms or self-harm.
Lead author Dr. Naomi Warne, Senior Research Associate at the University’s Centre for Academic Mental Health, said: “Eating disorders and self-harm are common and troubling mental health problems among young adults. In the UK, approximately 1.25 million people are living with an eating disorder and almost 1 in 15 adults report self-harm.
“Our research has highlighted individuals with prior self-harm and eating disorder symptoms are key risk groups and further longitudinal research is needed to understand their ongoing mental health as well as risk and protective factors.
“Individuals with previous eating disorder symptoms and self-harm should be considered vulnerable to depression and anxiety throughout the pandemic and beyond. Funding for rapid and responsive service provision is essential to reduce the impact of the pandemic on those with mental health problems.”
Naomi Warne et al, Disordered eating and self-harm as risk factors for poorer mental health during the COVID-19 pandemic: a UK-based birth cohort study, Journal of Eating Disorders (2021). DOI: 10.1186/s40337-021-00510-9
University of Bristol
Eating disorder symptoms and self-harm linked to higher levels of depression and anxiety during COVID-19 pandemic (2021, December 8)
retrieved 8 December 2021
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