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Local hospitals could face strain as early viral infections swamp pediatrics

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An early surge in viral infections could indicate tough months ahead for already-struggling local hospitals, the Canadian Paediatric Society said Thursday, as some children’s hospitals are running over capacity and reporting high wait times.

Dr. Sam Wong, the association’s director of medical affairs, said pediatric units across Canada are seeing increased admissions and heavier workloads as hospitals report an earlier than usual season of common respiratory illnesses, combined with influenza and COVID-19.

In communities without dedicated pediatric centres, Wong said local hospitals that are already strained by long waits and staff shortages could see more children coming through their emergency departments.

“So, I’m quite concerned that as we move further into the viral season that things are going to get worse,” he said.

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“If you don’t have a pediatric emergency and you’re running a general emergency in a smaller centre, those increased numbers of kids coming through will stress the system.”

The Yellowknife-based pediatrician said some doctors believe the increase in admissions could be linked to a large number of kids, previously shielded by COVID-related public health restrictions, now being exposed to some viral infections for the first time.

CHEO, the Ottawa pediatric hospital, said Wednesday it had to cancel some surgeries as it reports a higher number of patients with respiratory syncytial virus, on top of flu and COVID admissions. The hospital said its intensive care and inpatient units were at 129 per cent and 134 per cent capacity, respectively, on Tuesday.

Montreal’s two dedicated children’s hospitals were alsorunning well over capacity on Thursday afternoon, with Quebec leading the country in reported test positivity rates for respiratory syncytial virus, a common respiratory illness.

It’s concerning to see a surge of those infections hitting hospitals in October, Wong said, when those infections typically “really start up in December.”

“Honestly, I hope I’m wrong, but I have a bad feeling that we will have a rough, rough viral season this year,” he said.

The Quebec government announced this week it was setting up a crisis unit in the Montreal region to deal with overflowing emergency rooms.

At the Montreal Children’s Hospital, where some patients are waiting 16 hours to see a doctor, staff have been redeployed and some surgeries are being cancelled to help alleviate ER pressures, said Dr. Suzanne Vaillancourt.

“Something we have to do, which is hard on everybody, is temporarily reduce the number of children that are going for surgery, because post-op, they take up beds as well, so the trickle-down effect is huge,” said Vaillancourt, associate director of the emergency department.

“It’s really the RSV that seems to be giving us a run for our money now and that’s mostly just because a lot of these children need support, they need breathing support, they need hospitalization to be hydrated or help with oxygen needs.”

Vaillancourt said the hospital is prepared to help general hospitals in other parts of the province treat sick kids. Pediatric emergency physicians are available 24 hours a day to give colleagues advice, she said, and the two children’s hospitals in Montreal are able to take young patients who need more complex care than can be provided.

“It’s a system that’s well used, and hopefully, they really feel that they can get the advice and care that they need and when the child needs an escalation of care, then they come to us,” she said, adding that hospitals outside of Montreal may not have the ability to put a child on a ventilator.

ERs across Canada, and especially in smaller communities, have had to reduce hours and temporarily close, sometimes for days at a time, in recent months as the health-care system contends with labour shortages.

Data released Thursday by Statistics Canada said health-care and social assistance sectors hit a record-breaking 152,000 job vacancies in August.

“I don’t think any of the systems, in particular acute care, have had a moment to even take a breath since the last two years of COVID,” said Nancy Walton, a professor at Toronto Metropolitan University’s nursing school.

—Jordan Omstead and Jacob Serebrin, The Canadian Press

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Aid group with Canadian funding leads mission to deliver medical supplies in Ukraine

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POLTAVA, Ukraine — As the Toyota Tundra following a tractor trailer loaded with humanitarian aid heads into dangerous territory in eastern Ukraine, “Promiscuous” by Nelly Furtado and Timbaland plays over the speakers.

The small convoy transporting 20 tonnes of medical supplies is headed for Balakliya in a part of the country that was retaken by the Ukrainian army in September after six months of brutal Russian occupation. Their mission to help the devastated region crosses areas where Russian shelling continues. In Kupiansk, not far from Balakliya, shells continue to rain down.

At the wheel of the Tundra last Friday was Dr. Christian Carrer, a pediatrician from France. With his partner Tetyana Grebenchykova, he runs the Association internationale de coopération médicale, a non-governmental organization that receives support from the Canada-Ukraine Foundation and the Ontario government.

It will take the vehicles, which also include a minivan ahead of the tractor trailer, five hours to travel from a warehouse in Poltava to Balakliya, a distance of barely 200 kilometres. The roads are pockmarked from fallen bombs, and there are frequent stops at military checkpoints on guard against Russian infiltration.

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The strapping pediatrician with the face of an old adventurer has been on the ground since 2014, helping people in the Donbas region after it was invaded by the Russians. Last January, he suspected Ukraine’s menacing neighbour was planning something.

“There were strange gatherings and constant provocations,” Carrer said as he drove. “Everyone knew that clearly, something was going to happen.”

His organization started ensuring various supplies, in particular bandages, were positioned ahead of the feared assault. The last hospital received its delivery on Feb. 24, he said, the day the Russians launched their war.

“The people funding us had confidence in us because we sensed the attack,” he said.

Canada is the third most generous contributor to his group, which has also drawn donations from French, American and British sources.

The organization is well stocked and knows the terrain, and it focuses its aid in a few administrative regions in the northeast of the country. It has more than 800 items available, general or specialized medicines that hospitals and pharmacies in disaster zones can order.

Even in regions that have officially been liberated, the needs remain desperate.

The road crosses sprawling plains, and in one village after another, homes have been destroyed and gas stations and other businesses are shuttered. Crops remain unharvested in the fields. The tires make a constant purring noise as they drive over asphalt perforated by constant tank traffic.

Signs of the suffering and destruction of war are everywhere, and residents have little left to survive on. The occupiers emptied pharmacies and pillaged hospitals.

The convoy passes Chuhuiv, a municipality where the Association internationale de coopération médicale positioned medical supplies ahead of the war but that was later occupied. “The Russians took everything,” says Carrer, who has lived in Ukraine since 2006.

He describes the health condition of those who lived for weeks in shelters as pitiful, looking like “zombies.” Some are even losing their teeth, and he said visiting physicians are shocked by what they find.

As a pediatrician, he is especially worried about the state of pregnant women, young mothers and their children: a large part of that day’s delivery is destined for them.

Once in Balakliya, a desolated city with some buildings completely gutted, the aid valued at $4 million is unloaded in an old warehouse. It will later be distributed among eight municipalities in the area. A small welcoming committee includes the administrative head of Izyum district to the south, Stepan Maselski.

“This aid is very important because we are still at war,” Maselski said in an interview. “The invader destroyed our infrastructures. Just two days ago, we didn’t have electricity or water. The occupation was painful — no medicine, no medical supplies, no good food.”

A forklift empties pallets from the tractor trailer, containing cases and cases of medicine to treat chronic illnesses, epilepsy and heart problems, anesthetics for surgeries, surgical equipment, bandages, gloves, stethoscopes and diapers, among other items. There is also baby formula because infant malnutrition is widespread, Carrer says.

“Often women who give birth have trouble nursing because of the stress and the situation,” he explained. He said Ontario has provided vitamins, and the impact was practically miraculous.

There are also supply kits for those left homeless and even boxes of pet food, which is in short supply.

A special big red bag, which resembles an insulated delivery bag, is handed to Paulina, a medical official who intervenes in the provision of urgent care across the region. It is a kit conceived by doctors in California to treat people in war zones, whether for injuries caused by a landmine or for heart attacks. Paulina says the supplies are of superior quality and they are badly needed.

Suddenly the unloading operation is halted when the forklift breaks down. But the Ukrainians are creative: they tow the old forklift out of the way with a tractor — like their compatriots were often seen doing with Russian tanks on viral videos — and build a wobbly wooden ramp to complete the unloading.

Counting on Ukrainians’ ability to adapt, Carrer’s group has also delivered large numbers of warm blankets as well as small wood-burning stoves manufactured in the Poltava region for residents who have no way to heat their homes due to power outages.

Carrer says there are complex  reasons why the Ukrainian government is struggling to provide basic services in liberated territories. For one thing, he explains, the budget for health spending was cut by about one fifth to fund the war effort. And the annual provision of equipment and funding for the health system comes in February or March, which was when the Russians invaded. The number of refugees has also drained local resources.

“The needs are enormous in all the hospitals,” he says. “And now it’s serious. We see hospitals that are at the end of their tether. We used to deliver two boxes, and now we deliver whole pallets, basic supplies like plaster, gloves, cotton.”

Night falls quickly, and it is cold. The rig is empty, and it is time to leave so the group can make it through all the checkpoints on the way back to Poltava. Carrer knows his group will likely have to return soon with another load.

“Either a good soul is there to help, or they’ll call us back in a month …. We are the first to help, and perhaps the last to help.”

This report by The Canadian Press was first published Nov. 28, 2022.

— Patrice Bergeron is a Quebec-based journalist with The Canadian Press. In addition to two decades of political and general news experience, he was a CP war correspondent in Afghanistan in 2009.

 

Patrice Bergeron, The Canadian Press

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COVID-19 Outbreak Declared at Southbridge Roseview

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November 28, 2022 – The Thunder Bay District Health Unit (TBDHU) and Southbridge Care Homes confirm that the COVID-19 outbreak previously declared at Southbridge Roseview has been updated to include Cheshire and Renaissance Units only, Primrose Unit has been resolved.

TBDHU has initiated a thorough assessment of the situation. Further measures will be taken as needed to manage this situation.

Prior to the outbreak, significant measures were already in place to reduce likelihood of transmission of the virus within the facility. For additional information about COVID-19 and the TBDHU area, please see the TBDHU Website.

-30-

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For more information – Health Unit Media: news@tbdhu.com.

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Monkeypox vaccine modelling study provides road map for vaccination

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A modelling study to explore optimal allocation of vaccine against monkeypox virus (MPXV) provides a road map for public health to maximize the impact of a limited supply of vaccines.

The article, led by Unity Health Toronto researchers and published in CMAJ (Canadian Medical Association Journal), confirms that prioritizing vaccines to larger networks with more initial infections and greater potential for spread is best.

“We hope that these insights can then be applied by policy makers across diverse and dynamic epidemic contexts across Canada and beyond, to maximize infections averted early in an epidemic with limited vaccine supply,” writes Dr. Sharmistha Mishra, MAP Centre for Urban Health Solutions, Unity Health Toronto.

As of November 4, 2022, there were 1,444 cases of MPXV in Canada. Early in the epidemic, a very limited supply of smallpox vaccines was available to vaccinate in populations experiencing disproportionate risks, including gay, bisexual and other men who have sex with men (GBMSM).

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Researchers modelled two hypothetical cities as interconnected networks with a combined GBMSM community size of 100,000. The team then varied the characteristics of the two cities across a range of plausible settings, and simulated roll-out of 5,000 vaccine doses shortly after the first detected case of MPXV.

They found that the strongest factors for optimal vaccine allocation between the cities were the relative reproduction number (epidemic potential) in each city, share of initial cases, and city (or network) size. If a larger city had greater epidemic potential and most of the initial cases, it was best to allocate the majority of vaccines to that city. The team varied the reproduction number with a single parameter, but they highlight how many factors could influence local epidemic potential, including the density and characteristics of the sexual network, access to prevention and care, and the underlying social and structural contexts that shape sexual networks and shape access.

Jesse Knight

“Under our modelling assumptions, we found that vaccines could generally avert more infections when prioritized to a larger network, a network with more initial infections, and a network with greater epidemic potential. Our findings further highlight the importance of global vaccine equity in responding to outbreaks, and also in preventing them in the first place” writes Jesse Knight, lead author and PhD candidate at University of Toronto and MAP Centre for Urban Health Solutions, Unity Health Toronto.

The study emphasizes the interconnectedness of regions and that a population-level perspective is necessary.

“Strategic prioritization of a limited vaccine supply by network-level risk factors can maximize infections averted over short time horizons in the context of an emerging epidemic, such as the current global monkeypox outbreak,” conclude the authors.

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