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More Canadians could face late-stage cancer tied to diagnosis delays during COVID pandemic – CBC News

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It all started with a stomach bug.

That’s what Cheryl-Anne Labrador-Summers thought, anyway. It was October 2020, not long after she’d moved to the tranquil lakeside Ontario community of Georgina, and instead of relaxing with her family like she’d planned, the mother of three was struggling to figure out why she kept experiencing strange, unexplained stomach cramps.

Labrador-Summers tried to visit her family physician, but the office was shuttered because of the COVID-19 pandemic. So she searched for another clinic — only to be offered a phone appointment rather than an in-person assessment. She wound up being told that her grumbling digestive system was likely caused by a mild gastrointestinal illness.

By January, the 58-year-old had a distended stomach, looking — in her own words — “about nine months pregnant.” Again, she reached out to a physician, went for some tests, then headed to the nearest emergency department.

After finally seeing a doctor face to face for the first time in months, she learned the real cause of her discomfort: an intestinal blockage caused by cancer.

“It ended up being a nine-centimetre tumour, and it had completely blocked off my lower bowel,” she said.

An emergency surgery left Labrador-Summers with 55 staples along her torso and a months-long recovery before she could begin oral chemotherapy. Her question now is unanswerable but painful to consider: Could that ordeal have been prevented, or at least minimized, by an earlier diagnosis?

“Had I maybe been able to see the doctors earlier, I would not be in Stage 3,” she said. “I might have been a Stage 2.”

Photos show Labrador-Summers with a distended stomach before her emergency surgery, left, and the 55 staples along her torso following the procedure. (Supplied by Cheryl-Anne Labrador-Summers)

951,000 fewer cancer screenings in Ontario

More Canadians could experience late-stage cancer diagnoses in the years ahead, medical experts warn, forecasting a looming crisis tied to the ongoing COVID-19 pandemic. 

“We expect to see more advanced stages of presentation over the next couple of years, as well as impacts on cancer treatments,” said oncologist Dr. Timothy Hanna, a clinician scientist at the Cancer Research Institute at Queen’s University in Kingston, Ont.

“We know that time is of the essence for people with cancer. And when people are waiting for a diagnosis or for treatment, this has been associated with increased risks of advanced stage and worse survival.”

One review of Ontario’s breast, lung, colon, and cervical cancer screening programs showed that in 2020 there were 41 per cent — or more than 951,000 — fewer screening tests conducted compared with the year before.

Screening volumes rebounded after May 2020, but were still 20 per cent lower compared to pre-pandemic levels.

WATCH | Late-stage cancer being diagnosed in Canadian ERs:

ERs faced with late-stage cancer diagnoses amid pandemic

4 days ago

Duration 2:11

Hospital emergency rooms are seeing a wave of patients being diagnosed with late-stage cancer after the COVID-19 pandemic forced many doctors’ offices to close or pivot to virtual appointments, leading to fewer cancer screenings.

That drop in screenings translates into fewer invasive cancer diagnoses, including roughly 1,400 to 1,500 fewer breast cancers, wrote Dr. Anna N. Wilkinson, an assistant professor in the department of family medicine at the University of Ottawa, in a May commentary piece for the journal Canadian Family Physician.

“The impact of COVID-19 on cancer is far-reaching: screening backlogs, delayed workup of symptomatic patients and abnormal screening results, and delays in cancer treatment and research, all exacerbated by patient apprehension to be seen in person,” she wrote.

“It is clear that there is not only a lost cohort of screened patients but also a subset of missed cancer diagnoses due to delays in patient presentation and assessment,” leading to those cancers being diagnosed at a more advanced stage. 

Tough accessing care in a ‘timely way’

The slowdown in colonoscopies may already be leading to more serious cases of colorectal cancer in Ontario, for instance, suggests a paper published in the Journal of the Canadian Association of Gastroenterology.

“Patients who were treated after the COVID-19 pandemic began were significantly more likely to present emergently to hospital. This means that they were more likely to present with bowel perforation, or severe bowel obstruction, requiring immediate life-saving surgery,” said the study’s lead author, Dr. Catherine Forse, in a call with CBC News.

“In addition, we found that patients were more likely to have large tumours.”

Dr. Lisa Salamon, an emergency room physician with the Scarborough Health Network, is pictured outside Birchmount Hospital, in Scarborough, Ont. (Evan Mitsui/CBC)

In some cases — like Labrador-Summers’s situation — Canadians learned alarming news about their health in hospital emergency departments after struggling to receive in-patient care through other avenues.

Shuttered family physician offices, a shift to telemedicine, and some patients’ fears surrounding COVID-19 may all have played a role.

“It became harder for patients to access care and to access it in a timely way,” Hanna said.

“At the same time, there were real risks — and there are real risks for leaving home to go anywhere, particularly to go to an outpatient clinic or a hospital in order to get checked out.”

Dr. Lisa Salamon, an emergency physician with the Scarborough Health Network in Toronto, said she’s now diagnosing more patients with serious cancers, including several just in the last few months.

“So previously, it may have been localized or something small, but now we’re actually seeing metastatic cancer that we’re diagnosing,” she explained.

Lessons for future pandemics

Health policy expert Laura Greer is dealing with Stage four, metastatic breast cancer herself after waiting more than five months for a routine mammogram she was initially due for in the spring of 2021 — a precautionary measure given that her mother had breast cancer as well.

Unlike an early-stage diagnosis, Greer’s cancer is only treatable, not curable.

“It was an example of what happens when you don’t have the regular screening, or those wellness visits,” said the Toronto resident and mother of two. 

“I most likely would have had earlier-stage cancer if it had been sooner.”

Health policy expert Laura Greer is dealing with Stage 4, metastatic breast cancer after waiting more than five months for a routine mammogram she was due for in the spring of 2021. (Esteban Cuevas/CBC News)

Pausing access to care and screenings for other health conditions can have dire impacts on patients, according to Greer, offering lessons for how policy-makers tackle future pandemics.

“We need to make sure that we’ve got enough capacity in our health system to be able to flex, and that’s what we really didn’t have going into this,” she said.

For Labrador-Summers, it’s hard to forget the moment her life changed while she was alone in an emergency department, learning a terrifying diagnosis from a physician she’d just met. Her mind raced with questions about the future and concerns for her family.

Labrador-Summers’s husband and one of her sons kiss her on the dock near their lakeside home in Georgina, Ont. (Ousama Farag/CBC News)

“My older son had just told us they were expecting a child, and I just wanted to be there for them. And I didn’t know what next steps were. And we had lost my mom to cancer a few years back — to us, cancer was always terminal,” she recalled.

“So again, I’m alone, trying to process all of this.”

A screening following Labrador-Summers’ surgery and chemotherapy treatment wound up finding more cancer. 

“It’s now life-threatening,” she said.

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Health Minister Adrian Dix must come clean on why B.C. is restricting fourth COVID-19 vaccinations – The Georgia Straight

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Former senior civil servant and diplomat Norman Spector shared a fascinating article with me this weekend from the Ottawa Citizen.

A family physician in the national capital, Dr. Nili Kaplan-Myrth, hoped to conduct mass vaccinations for people who want a fourth dose of COVID-19 but don’t qualify under Ontario’s rules.

She reportedly wanted to create a large outdoor “jabalooza” clinic but health officials refused to provide her with vaccines.

Ontario restricts access to fourth shots of COVID-19 vaccines to those who are 60 years of age or older.

Next door in Quebec, people can get fourth shots if they are 18 and older.

“I am receiving lots of individual requests for help,” Kaplan-Myrth tweeted on Sunday (June 26). “I can’t give you the vaccine at this time, but hands up (and DM) if you as plaintiffs want to bring this to court as a group. Would require a litigation team.”

There’s a tremendous amount of scientific data showing that COVID-19 vaccines lessen the severity of COVID-19. They reduce the likelihood of dying or being hospitalized from the disease.

However, COVID-19 vaccine effectiveness wanes over time. This is why Kaplan-Myrth is such a strong advocate for booster shots. She believes that these boosters are particularly important when so many people are not wearing masks indoors.

Keep in mind that COVID-19 initially presents as a respiratory infection.

In some cases, however, it causes serious brain injuries and cardiovascular problems. It’s especially dangerous for the immunocompromised, who are at higher risk of suffering severe COVID-19.

That’s because the virus that causes COVID-19 not only damages blood vessels and triggers blood clots, but also disrupts the immune system. Researchers have even linked immune dysfunction to serious brain injuries, which is explained in the video below.

Video of Here’s what we know about COVID-19’s impact on the brain

Video: Here’s what we know about COVID-19’s impact on the brain.

B.C. doesn’t want most under-70s to get fourth shots

In the face of all of this, B.C. continues adopting a hard line on the distribution of fourth vaccine doses.

This is the case even after Global News B.C. reporter Richard Zussman revealed that 226,000 doses intended for the vaccine-hesitant will expire at the end of July.

In B.C., you have to be 70 years of age or older and have gone six months since a previous COVID-19 vaccination to qualify for a fourth dose.

There are exceptions: Indigenous people, for example, can get a fourth dose if they’re 55 or older.

Below, you can read other exceptions listed by the B.C. Centre for Disease Control for those between the ages of 60 and 69.

The B.C. Centre for Disease Control listed these exemptions, which qualify someone from 60 to 69 years old for a fourth COVID-19 vaccination.

However, when the Georgia Straight asked the Ministry of Health about who qualified for a fourth COVID-19 vaccination, it did not include what’s written after the letter “d”: “Caregiver of a frail elderly or moderately to severely immunosuppressed person”.

So it remains unclear in B.C. if a person between 60 and 69 who is a caregiver for either a frail elderly person or a moderately to severely immunosuppressed person is able to receive a fourth COVID-19 vaccination.

Yet it seems pretty clear from the exemptions above that if you are a cancer survivor or have kidney disease or have heart disease or have multiple sclerosis or have had a transplant and you’re under 70 in B.C., you will not qualify for a fourth COVID-19 vaccination under existing rules.

Why is B.C. being more restrictive with COVID-19 booster shots than Ontario, Quebec, Saskatchewan (where you only need to be 50-plus), as well as the entire United States?

Health Minister Adrian Dix needs to come clean on that.

What possible justification is there for withholding a fourth COVID-19 shot for British Columbians under 70, especially the immune-compromised, when 226,000 vaccine doses are set to expire next month?

Why is Dix so convinced that he knows better than the governments of Ontario, Quebec, and Saskatchewan?

We don’t know the answer.

That’s in part because our pusillanimous B.C. Liberal MLAs refuse to hold the provincial NDP government accountable for its COVID-19 policies.

Some on social media are speculating that the booster shots are being withheld as part of a population-level experiment—conducted without the people’s consent—on the efficacy of delaying second booster shots.

Dix and provincial health officer Dr. Bonnie Henry, through their actions, are giving oxygen to this hypothesis.

Who knows? There might even be a scientific justification for withholding booster shots.

But in the absence of evidence provided by the B.C. government, the health minister must get in front of a microphone on Monday (June 27) and provide a coherent explanation.

Failure to do so will only fuel more suspicion about the motives behind the government’s policy.

Perhaps it’s worth noting that in January 2021, Science published a study involving 188 people, which offered a glimmer of hope.

It showed that more than 95 percent of those who had recovered from COVID-19 had immune systems demonstrating “durable” memories of the virus, lasting up to eight months.

This prompted speculation on the National Institutes of Health website that the immune systems of those who are vaccinated would have lasting memories of the virus.

But a study of 188 people is insufficient as the basis for an entire provincewide policy.

Some might wonder if the government isn’t making fourth doses of COVID-19 vaccines available to those under 70 because of the cost of distribution or due to the labour shortage in the health-care sector.

Others might suspect it’s because the B.C. government thinks everyone is going to get COVID-19 anyway, so why bother?

If that’s the real reason, it’s a monumental disservice to those with compromised immunity. This should demand a response from Human Rights Commissioner Kasari Govender that goes well beyond writing a letter to Henry. Like by holding a public inquiry under section 47.15 of the B.C. Human Rights Code.

In the meantime, show us the evidence, Minister Dix, for why so many British Columbians are being denied a fourth COVID-19 vaccination.

And if you’re unwilling to do that, then please step aside so another health minister can do this in your place.

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Frank Bures: COVID shots for tots | Column | winonadailynews.com – Winona Daily News

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They are finally here! Vaccinations against COVID-19 were at last approved for the youngest people ages 6 months to 5 years old. Studies in children have been done showing definite protective benefits and no major adverse reactions occurring. The first step was the FDA approval after an advisory panel deliberated the week of June 13 — only 2 days — to vote unanimously to recommend authorization, stating the benefits outweigh any risks for young kids.

The CDC signed off on the vaccines June 18 with another unanimous vote. The two vaccines consist of the Pfizer mRNA version in adults, but a much-reduced dose of 3 micrograms instead of 30 micrograms, given in three doses to induce a high level of antibodies equivalent to young adults. The first two doses are spaced three weeks apart, and the third at least two months later. The study found only 10 COVID cases in the three-dose group and seven in the placebo group for an efficacy of 80%. The study included only a small number of patients. Most of the infectious disease and pediatrician experts cautioned not to lose sight of the fact that the vaccines were saving children’s lives.

People are also reading…

The Moderna mRNA vaccine is the same as the adult one but only a quarter of the dose at 25 micrograms in a two-dose series given four weeks apart. Both this and the Pfizer vaccine achieved the same levels of immunity that have protected young adults against severe disease. None of the developed COVID vaccines have achieved the ideal of elimination of the infection. But they have saved many lives.

In children, the risk from COVID is very real, even though hospitalization and deaths are lower than in adults. In children ages 1-4, COVID is the fifth leading cause of death. One source that looked at the period from January 2020 through May 2022 said 202 kids in this age group died from COVID. Another source quoted 480 kids dead from COVID. That’s more deaths per year than hepatitis, meningitis, rotavirus, and other common infectious diseases each caused before routine vaccinations for them were recommended. And the risk wasn’t limited to any particular group. More than half of the youngsters hospitalized due to COVID had no underlying conditions.

These vaccines have proven to be some of the safest of any for adults. In the preliminary studies in this age group the adverse reactions/side effects were mostly mild and short lived, much like those in adults, and similar to those from other vaccines. The main one was pain and redness or tenderness at the injection site. There might be some irritability, fatigue, or sleepiness, loss of appetite, headache, abdominal pain or discomfort, mild diarrhea, vomiting. But everyone got better quickly! Fevers were uncommon and mild in the participants. Those can be treated with acetaminophen.

A pediatric infectious disease specialist at Children’s Hospital, Denver, Colo., said it’s important to keep in mind that COVID-19 is now one of the vaccine-preventable diseases with the highest mortality rate. Hospitalization rates for children with COVID were five times higher during the recent wave than the worst previous points of the pandemic. Katherine Poehling, director of pediatric population health at Wake forest School of Medicine, said, “I am struck by these numbers. I’m also concerned there’s a real underappreciation of the potential severity.” FDA commissioner Robert Califf said, “Any death of a child is tragic, and should be prevented if possible.”

It’s a guarantee that, if a respiratory germ gets into a home, it gets into everyone living there. It may not take hold in each individual to create what we call disease for a host of reasons, but the microbe made the rounds, positive test or not. That includes every kid kissing you or sharing food with you.

The COVID variants currently crawling down our craws are killing fewer Americans daily than during any other period except the summer of 2021. But the country is now recording 10 times as many cases as it was at that time, indicating that a smaller number of cases are causing deaths. But COVID is still killing an average of 314 people a day. These darling little Petri (not “peach tree”) dishes we parents and grandparents love to hug and kiss can be vectors of so many viruses. The vaccines are a tool to help prevent that spread and contagion. It’s an incomplete tool, but it’s part of a larger effort to stop infections, along with hand washing, etc.

Maybe you could liken it to a fork among our eating utensils. We could eat most everything on the plate with that fork, but a knife and spoon sure help us to divide and down the delectables we can’t spear. The vaccines are essentially safe and a valuable tool. One preventable child’s death is one too many. Get your tot shot!

Dr. Bures, a semi-retired dermatologist, since 1978 has worked Winona, La Crosse, Viroqua and Red Wing. He also plays clarinet in the Winona Municipal Band and a couple dixieland groups. And he does enjoy a good pun.

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Moderna COVID-19 shots now an option for older kids in U.S. – CGTN

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A vial of the Moderna COVID-19 vaccine for children six months through five years old is seen, June 21, 2022. /AP

A vial of the Moderna COVID-19 vaccine for children six months through five years old is seen, June 21, 2022. /AP

There is now a second COVID-19 option for kids aged six to 17 in the U.S. 

The U.S. Centers for Disease Control and Prevention (CDC) on Friday announced it is recommending Moderna shots as an option for school-age kids and teens. This group has been able to get shots made by Pfizer since last year.

CDC sets the federal government’s vaccine guidance for U.S. doctors and their patients. 

Last week, the Food and Drug Administration authorized the shots – full-strength doses for children ages 12 to 17 and half-strength for those six to 11. The doses are to be given about a month apart. An expert advisory panel this week voted unanimously to recommend that CDC endorse the Moderna shots, too. 

Moderna officials have said they expect to later offer a booster to all kids aged six to 17.

Source(s): AP

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