With COVID-19 activity indicators creeping upwards, Canada’s chief public health officer this week exhorted Canadians to ready their masks.
Reactions on social media ranged from exasperation and accusations that another round of “COVID tyranny” was coming, to “wear the damn mask now.”
The National Post spoke with Dr. Horacio Bach, a clinical assistant professor with the University of British Columbia’s division of infectious diseases, and Dr. Nitin Mohan, a physician epidemiologist at Western University’s Schulich School of Medicine & Dentistry.
As National Post columnist Chris Selley wrote, confidence in public health officials has taken a sharp hit since COVID landed on our shores. Tam’s masking advice shifted during the pandemic’s early waves and while public health advice should be revised as the science evolves, “the dramatic and sometimes contradictory shifts may have induced confusion, or worse, mistrust in the messaging or the authorities providing the messages,” one group wrote.
A Leger survey last September of more than 3,000 adults found the majority (70 per cent) would support reintroducing indoor ask mandates should the pandemic situation worsen. “The strongest predictors of positive attitudes were being fully vaccinated or boosted,” Montreal researchers wrote in a letter in the Canadian Journal of Public Health.
However, Mohan doesn’t anticipate the return of widespread mask mandates. “We have hospital capacity, we have access to therapeutics, not only vaccinations but antivirals and monoclonal antibodies that we did not have in the first and second waves of the pandemic,” he said.
Still, masking is cheap, relatively easy and a “prudent choice” particularly in the fall and winter months as people congregate closer, he said.
“But we’re very much at the phase of the pandemic where individual agency is the primary driver of folks’ decisions,” Mohan said. “It’s for them to choose what’s best for them.”
That masks can reduce the probability of becoming infected with respiratory viruses like COVID-19, influenza and RSV.
What about all this hybrid immunity we have? Omicron caused “unprecedented” numbers of infections, and most people in Canada acquired antibodies against SARS-CoV-2 through natural infection and vaccination, researchers reported.
Even in an “era of hybrid immunity,” the researchers cautioned that there’s the potential for waning antibody levels and new variants of COVID-19 that could escape immune responses.
Reformulated vaccines targeting the XBB.1.5 Omicron offshoot that emerged last year are being rolled out. But Omicron EG.5 (Eris) is now dominant in Canada, and Omicron BA.2.86 (Pirola) has also been detected in Canada.
Variants are popping up like a Whac-a-Mole game. “Sometimes the changes aren’t so dramatic and can be recognized by antibodies” from previous vaccinations or infections, said Bach, of the University of British Columbia.
“The problem that we’ve known from the very beginning of the pandemic, our body cannot keep a high level of antibodies against this virus. You have the booster, you are protected, but over time, the antibodies disappear.”
Antibodies also start to wane after natural infections, Bach said. Today’s vaccines target the spike protein, not the whole virus people are exposed to when infected. But not all parts of the virus are immunogenic, meaning able to prime the immune system to make antibodies, Bach said.
Unlike the ancestral stain, the new variants are affecting the upper airways. Excluding those with underlying diseases, “The infections are not going inside the body,” Bach said, meaning deep inside the lungs. Symptoms today are more cold-like: runny nose, sore throat, sneezing, fatigue, muscle ache.
A Cochrane Review published in March concluded “uncertainty” exists about the effects of face masks, and that the pooled results from randomized controlled trials didn’t show a clear reduction in the spread of respiratory viruses.
The authors, who assessed the effects of other interventions, like isolation, quarantine, and hand hygiene, included 12 trials comparing masks versus no masks, then five trials comparing surgical masks with N95s. (Four in a health-care setting, one in a home setting.)
“Wearing masks in the community probably makes little to no difference to the outcome of laboratory-confirmed influenza/SARS-CoV-2 compared to not wearing masks,” they wrote.
They cautioned against drawing “firm conclusions,” given the limitations of the evidence.
The researchers said potential reasons for the “observed lack of effect” in interrupting the spread of flu or COVID could include a high risk of bias in the trials, poor study design, the quality of masks and how often, and how well, people in the trials actually wore them, especially children. Factors could have included people contaminating masks with their hands or “saturation of masks with saliva from extended use.”
Nevertheless, the study led to a flurry of headlines that “masks don’t work,” prompting the editor-in-chief of the Cochrane Library to issue an apology for the wording used in a “plain language summary” that she said was open to misinterpretation.
“Based on the evidence that I’ve reviewed, based on hospital admissions, based on trends in disease states, I’m comfortable with the guidance that masking is effective,” Mohan said.
“Again, it’s very much on the individual to make that choice for themselves, based on their own risk factors and their interpretation of the information.”
“I have no clue why,” said Bach, who has been yelled at for wearing masks. In Asian cultures, “they go out with a mask. They protect not only themselves but also other people. You cough, you sneeze, you disperse the virus everywhere. They use the mask when they need it, and nobody makes it an issue.”
“I don’t know what will happen if they (public health officials) say you have to use masks again. That will be a big deal.”
People are frustrated COVID is still part of our lives, Bach said. “I don’t think anyone is happy that COVID is a part of our reality this far along in this pandemic.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
The Canadian Press. All rights reserved.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
The Canadian Press. All rights reserved.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
The Canadian Press. All rights reserved.
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