The data breach of the Canadian laboratory testing company LifeLabs is one of “several wake-up calls” for security and privacy challenges that come with the push for a medical system in which eHealth plays a significant role.
“The medical field for us is one of the worst when it comes to cyber security practices,” said David Kennedy, cyber security expert and founder and CEO of TrustedSec, an information security consulting firm.
“What’s interesting about the large push for electronic patient health-care information that you put online is that a lot of these organizations are not designed to withstand attacks.”
Many health-care organizations and professionals are big advocates for eHealth. On its website, Heath Canada describes eHealth as “an essential element of health-care renewal,” which will “result in benefits to Canadians through improvements in system accessibility, quality and efficiency.”
The Electronic Health Record, for example, allows the sharing of necessary information between care providers across medical disciplines and institutions.
But on Monday, LifeLabs — Canada’s largest provider of general diagnostic and specialty laboratory testing services — announced that a cyberattack on its computer systems had forced the company to pay a ransom to retrieve the sensitive information of millions of customers.
LifeLabs president Charles Brown wrote that information related to about 15 million customers, mainly in British Columbia and Ontario, may have been accessed during the breach.
Other security breaches
And that attack was just the most recent breach in Canada. Just months ago, hackers crippled the computer systems of three Ontario hospitals.
Meanwhile, in Alberta, breaches have included the disappearance of an unencrypted hard drive containing the personal health information of 650 patients at the Mazankowski Alberta Heart Institute in August, and the inappropriate access of 2,158 electronic health records by Alberta Public Laboratories staff at the Red Deer Regional Hospital Centre earlier this year.
“We’ve probably had several wake-up calls, but it still seems like lots of folks are asleep at the wheel,” said Beau Woods, a cyber safety innovation fellow with the U.S. think-tank Atlantic Council.
Woods suggested it was troubling that Brown didn’t know whether or not the LifeLabs records were encrypted.
“Whether or not encrypted records would have protected the data in this case is to be seen,” he said. “The fact that the CEO, even after probably talking to IT can’t say whether the records are encrypted, says that there’s some kind of fundamental breakdown in governance.”
Hackers like to target hospitals and medical facilities, which are often on very tight IT budgets, said David Masson, director of enterprise security for Darktrace, a cyber AI company.
“They know they’ll be struggling to actually secure their IT networks. So they will see them as easy targets. And that’s why they go after them,” Masson said.
So security usually falls by the wayside in many cases for most organizations. Security ends up being a very small percentage if any in most hospitals, most health-care providers.– David Kennedy, founder and CEO of TrustedSec
One of the problems is that medical institutions see themselves solely as health-care providers, meaning IT security doesn’t get the focus it needs, TrustedSec’s Kennedy said.
“So security usually falls by the wayside in many cases for most organizations. Security ends up being a very small percentage if any in most hospitals, most health-care providers that we see out there today.”
Tom Keenan, a University of Calgary professor who specializes in cyber security and researched the issue of electronic health records, said not all hospitals are lax when it comes to IT security, and that it varies across Canada how well hospitals treat the issue.
While human error is often the weakest link, another factor, he said, is that people who build these systems also sell optional extras for security.
‘Take extra measures’
In one particular case he studied, the people who ran the health authority knew they had vulnerabilities and bought an extra auditing package, but never installed it.
“We can take extra measures,” he said. “We need to tighten things up.“
Despite the security issues, Keenan said there’s no need to pause when it comes to the push for eHealth, but just beef up security.
“We don’t want to slow it down. If anything, we want to speed it up,” he said. “Full steam ahead but with due regard to caution.”
“I trust my lab, but I would also like them to publish periodically [that they’ve] been audited by a third-party cyber security company.“
There’s a lot of cyber hygiene things that you could do that aren’t expensive — that actually can be less costly than not doing them.– Beau Woods, cyber security expert
As well, medical facilities should hire cyber security firms to conduct penetration tests, to determine the vulnerability of their system, he said.
Woods, the cyber security expert, said there are some simple remedies for medical facilities, like updating their software or having multi-factor authentication.
“There’s a lot of cyber hygiene things that you could do that aren’t expensive — that actually can be less costly than not doing them,” he said. “Not looking at cost of breaches and things like that, just operationally less costly and more secure.”
Sandy Buchman, president of the Canadian Medical Association, said he believes in terms of the human component of security, hospitals are making “extreme efforts” to protect patient privacy.
‘Breaks down trust’
But he said he understands how incidents like the LifeLabs data breach can shake a patient’s trust.
“It could be something way beyond a physician or hospital’s control, like these cyberattacks that are occurring, but it still breaks down trust in the overall system.
The medical community has to be diligent and press for the improvements needed in the security of personal health information, he said.
“We have to be better as a health-care community in demanding that. I’m not a cyber security expert. I know we can’t let off the pressure — to be pressing for this at all times in whatever ways are technologically possible.”
Declining case numbers show Alberta restrictions working, Dr. Deena Hinshaw says – CBC.ca
Declining numbers of cases and positive tests for COVID-19 in Alberta show that restrictions put in place last year have been effective, the province’s top doctor says.
Alberta reported 21 more COVID-19 deaths on Wednesday and 669 new cases of the illness.
Laboratories conducted about 14,900 tests over the past 24 hours putting the positivity rate at about 4.5 per cent.
“It’s very encouraging to see our positivity rate steadily declining since the peak in December,” Dr. Deena Hinshaw, the province’s chief medical officer of health, said Wednesday at a news conference.
“And I would say that the data that we have indicates that the restrictions put in place in November and December have achieved, so far, their intended outcome.”
It’s critical that the province maintain enough restrictions to continue to drive those numbers down, Hinshaw said, given the high number of people still being treated in hospitals.
“We need to build on our collective success by going slowly toward allowing some additional activities and not experiencing a rebound if we open too quickly,” she said.
Hospitalizations remain high
Hospitals in the province are treating 744 patients for the disease, including 124 in ICU beds.
“It is important to remember that it is the number of people currently in hospital that I am providing, not all those who have ever needed hospital care since the spring,” Hinshaw said.
“To put this into context, over the last 10 years, we have had an average of just over 1,500 total hospital admissions for influenza annually. For COVID-19, the comparable number comes from less than a year of data. More than 5,000 people have needed hospital care since the pandemic began for COVID-19 in Alberta.”
A total of 5,086 people with COVID-19 have been treated in hospitals since the pandemic began last March.
That represents about 4.3 per cent of the total cases, which now sits at 118,436.
Of those, 106,387 were listed as recovered and 10,565 were active.
Of the patients hospitalized with the illness so far, 816 have ended up in ICU beds.
Far greater toll on older people
Slightly more than one per cent of all people infected have died.
Alberta Health data shows the illness has taken a far greater toll on older people. To date, 1,265 of the 1,484 reported deaths (85 per cent) have been people aged 70 and older.
A total of 109,089 people under the age of 70 have contracted the illness. In all, 218 of them have died, a rate of .0.19 per cent.
To date, 9,347 people aged 70 or older have become sick. In all, 1,265 of them have died, a rate of 13.5 per cent.
Older people also have a much higher chance of ending up in hospital. Those in their 20s who contract the illness have about a one in 100 chance of being hospitalized. Those aged 60 and older have about one in six chance.
Here’s a breakdown by age of those who have been infected, and those who had symptoms serious enough to require hospitalization.
- Under one, 644 cases, 34 hospitalized, 10 in ICU. (Hospitalization rate, 5.3 per cent)
- one to four, 3,671 cases, 14 hospitalized, two in ICU. (Hospitalization rate, 0.4 per cent)
- five to nine, 5,094 cases, eight hospitalized, two in ICU. (Hospitalization rate, 0.2 per cent)
- 10 to 19, 13,606 cases, 68 hospitalized, nine in ICU. (Hospitalization rate, 0.5 per cent)
- 20 to 29, 22,025 cases, 241 hospitalized, 25 in ICU. (Hospitalization rate, 1.1 per cent)
- 30 to 39, 22,470 cases, 388 hospitalized, 40 in ICU. (Hospitalization rate, 1.7 per cent)
- 40 to 49, 18,678 cases, 489 hospitalized, 92 in ICU. (Hospitalization rate, 2.6 per cent)
- 50 to 59, 14,075 cases, 721 hospitalized, 164 in ICU. (Hospitalization rate, 5.1 per cent)
- 60 to 69, 8,788 cases, 879 hospitalized, 239 in ICU. (Hospitalization rate, 10.0 per cent)
- 70 to 79, 4,370 cases, 952 hospitalized, 172 in ICU. (Hospitalization rate, 21.8 per cent)
- 80+, 4,977 cases, 1,291 hospitalized, 60 in ICU. (Hospitalization rate, 25.9 per cent)
A total of 95,243 doses of vaccine have been administered in the province.
Ottawa to delay second doses of COVID-19 vaccine as supply dwindles
The City of Ottawa says it has to delay second doses of the Pfizer-BioNTech vaccine for some people who have already received their first shot due to a temporary shortage of vaccines.
Anthony Di Monte, general manager of emergency and protective services, said Wednesday some long-term care home and retirement home staff, residents and essential caregivers will have to wait up to 27 days, or nearly a week longer than the 21-day period that’s recommended.
For others who received their first vaccine, they may have to wait up to 42 days, he said.
The federal government announced on Friday Canada would be getting fewer COVID-19 vaccines from Pfizer-BioNTech over the next few weeks because the company has to make changes to a production line in Belgium to grow its manufacturing capacity.
In Ottawa, that means the city will be getting no new Pfizer-BioNTech vaccines next week, said Di Monte. The supply the city does have will be focused on ensuring that those who are due for a booster will get their second shot as soon as possible.
The first dose of vaccines have already been administered to more than 92 per cent of long-term care home residents in Ottawa at all 28 facilities. Residents at one at-risk retirement home and one congregant living setting have also been vaccinated, said Di Monte.
“Our next step is to administer the second dose to those individuals who have already received their first dose of the vaccine. Depending on the vaccine supply we receive from the province, which we know will be minimal in the next few weeks, we will then shift our focus to the high-risk retirement homes,” said Di Monte.
Ottawa has 36 high-risk retirement homes and so far, only the one has received doses of the vaccine.
Dr. Vera Etches, Ottawa’s medical officer of health, said delays beyond 21-day gap are permitted under guidelines established by the National Advisory Committee on Immunization.
“The recommendation is of course to follow the dosing schedule as much as we can,” she said. “But in the context of limited supply … jurisdictions can maximize the number of individuals that are getting the benefit from the vaccine by going ahead with the first dose and delaying the second dose.”
While there isn’t data to show what effects waiting up to 42 days may have on the COVID-19 vaccine efficacy, typically delays in booster shots do not affect the durability of vaccines, she said.
Quebec vaccine plan may be rethought after troubling Israeli data, says provincial advisor – CTV News Montreal
Quebec could change its vaccine strategy based on new data out of Israel about the efficacy of the first dose, on its own, of the Pfizer COVID-19 vaccine, says a top advisor in the province.
Israel just provided the world with its first large-scale, real-world hint of how effective the first dose of the Pfizer vaccine is before the booster, and it doesn’t seem reassuring for places that have delayed the second shot, including Quebec and the United Kingdom.
“We not only monitor the data that comes from Quebec but also what is observed around the world,” said Dr. Gaston De Serres, a chief advisor on Quebec’s vaccine strategy,
“Yes, we are looking at the data from Israel and the [Quebec immunization committee] could make recommendations based on this data if necessary,” he said.
Data on 200,000 elderly Israelis suggests that the first shot alone only lowered infections by 33 per cent—about a third of the roughly 90-per-cent rate that many experts around the world have predicted.
It’s “concerning in terms of the single-dose policy decision,” said a U.K. scientist, John Robertson, who had previously written about his concerns about the U.K.’s decision, like Quebec’s, to delay booster shots.
Importantly, Israel is not delaying boosters. It’s following the timeline set out by Pfizer and giving the second, or “booster,” shot 21 days after the first.
The data doesn’t call into question how well the two doses together work. The trial data showed that together, both doses are 95 per cent effective.
But the Pfizer trial wasn’t meant to prove the efficacy of the first dose alone, so the estimates on how well it works without the booster have all been just that—estimates—with scientists looking back at the data and trying to gauge whether delaying the second shots will work.
Delaying the boosters, as Quebec is doing for up to 90 days, is meant to give more people a first shot and some heightened, if imperfect, immunity.
Israel’s new numbers suggest that even when giving the shots on schedule, the elderly people in question didn’t have nearly the protection that was predicted in the short time before they got the booster.
The data doesn’t help with a bigger uncertainty in places like Quebec: whether, and how much, that first-dose protection could last after the 21-day mark if the booster isn’t given. Pfizer says its trial provided no data on this, and the Israel numbers don’t fill that gap either.
ISRAEL’S FINDINGS SO FAR
Israel has moved very quickly on vaccination, inoculating 2.2 million Israelis over the last month. It made an agreement to get rapid delivery of the Pfizer-BioNTech vaccine in return for tracking the effects and sending the manufacturer detailed data.
Two Israeli experts have spoken about the results in recent days.
According to Israeli news channel i24 News, the leader of the country’s vaccine drive, Nachman Ash, told Israeli Hebrew-language outlet Army Radio that “many people have been infected between the first and second injections of the vaccine,” and that it was “less effective than we thought.”
Ran Balicer, an Israeli doctor and epidemiologist, and an adviser to the World Health Organization, spoke to the UK outlet Sky News, explaining more about what was found.
“We compared 200,000 people above the age of 60 that were vaccinated,” the outlet quoted Balicer as saying.
“We took a comparison group of 200,000 people, same age, not vaccinated, that were matched to this group on various variables,” he said.
Scientists then compared the daily rate of positive COVID-19 cases between the two groups. They found at first, unsurprisingly, there was no difference in the first two weeks after the shot—the vaccine takes about two weeks to kick in.
After that, starting at 14 days post-vaccination, “a drop of 33 per cent in [positive cases] was witnessed in the vaccinated group and not in the unvaccinated,” Balicer told Sky News.
He called it “really good news,” considering the group did have much more protection than their unvaccinated peers.
SHORT OF ESTIMATES, THOUGH MANY QUESTIONS
However, that number fell far short of the estimate in recent weeks: Dr. De Serres in Quebec, as well as the UK vaccine advisory committee and many other experts, had all said they believed the first shot would be about 90 per cent effective, at least for several weeks, allowing them to delay the booster.
Pfizer has maintained that its trial data only showed a rate of 52.4 per cent efficacity before the second shot and that it knows nothing about what would happen past 21 days.
One question remains around how well the single dose worked to help people fight off serious infections, even if they tested positive for the virus—a key measure. On Wednesday afternoon, Israel’s Minister of Health said Ash’s comments had been taken “out of context” on this.
The minister clarified that Ash had been discussing how Israel “[has] yet to see a decrease in the number of severely ill patients,” not infections, according to the BBC.
And Balicer suggested the surprise in Israel’s data may have come partly from the fact that those studied so far have all been elderly, whereas Pfizer’s trial subjects were a mix of ages. The immune systems of the elderly aren’t as strong as those of younger people.
Balicer said he expects the Israeli numbers to rise once more young people are included in the group studied.
He also said that real-world data is not the same as trial data—and on the upside, Israel’s data proves beyond a doubt that the vaccine does work, and on the same kind of timeline the Pfizer trial showed.
“This is not the ideal setting of a randomized controlled trial where everything from coaching maintenance to selection of the population of interest is done in a very meticulous way,” he said.
“This is the real world. And so by seeing the real-world impact so early on in the same direction and in the same timing as we’ve seen in the clinical trials is something that makes us very hopeful.”
According to the BBC, Balicer also said that after the first 33-per-cent drop in infections, the rate of cases continued to drop—meaning immunity appeared to keep growing stronger, in those vaccinated with the first dose—but it was too soon to know more.
QUEBEC URGED TO TAKE A SECOND LOOK
Robertson, a professor of surgery at the University of Nottingham, said Wednesday that he thinks the Israeli results provide strong evidence for Quebec and similar jurisdictions to change course if they’ve delayed second doses.
Earlier this month, Robertson co-published an opinion piece for the BMJ British medical journal arguing that delaying the second dose wasn’t based in firm science.
“The personal and population risks have even greater relevance and urgency for Quebec given the real-life data reported from Israel,” he said Wednesday.
“The second dose should be given on Day 22 as in the Phase 3 trials and approved by regulatory agencies worldwide.”
Pfizer said it has no comment yet on the new data and can only speak about the results of its Phase 3 trial.
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