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More users needed: Lessons from Alberta's coronavirus contact tracing app – CBC.ca

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Alberta’s use of a smartphone app to help slow the spread of the coronavirus may provide other provinces with insight on what to do — and what to avoid — as Canada begins easing restrictions, heightening the need for effective contact tracing.

ABTraceTogether, launched late last week, is the first such app released by a provincial public health authority. An accompanying instructional video explains: “The more people who use the app, the safer everyone will be.”

Early uptake figures and a key design quirk, however, illustrate how challenging it will be to ensure widespread adoption and efficacy in Alberta and elsewhere.

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Contact tracing is the practice of identifying and notifying people at risk of contracting the virus from someone known to have been infected. Anyone who came in close contact with that person is instructed to self-isolate to avoid spreading the virus further.

So far, tracing in Canada has been done manually, with public health staff or volunteers getting in touch with each patient’s recent contacts one by one. An app can speed up that process, and doesn’t require users to remember where they’ve been or, just as importantly, with whom.

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“If there’s some way technology can help… we all want to get out of our houses,” said Richard Lachman, a digital technology and culture researcher at Ryerson University in Toronto. But he warned against treating the software as a “panacea.”

Alberta’s app employs Bluetooth technology to determine with whom a user has spent time (at least 15 minutes in a 24-hour period). But it only works if everyone involved has the app running on their phone and Bluetooth enabled.

Early hurdles

As of Tuesday, ABTraceTogether had been downloaded just over 120,000 times, Alberta Health spokesperson Tom McMillan told CBC News. If each download accounts for a new user, that makes up less than three per cent of the province’s population of around 4.4 million.

A group of British researchers suggested a similar app would only be effective if it were adopted by 56 per cent of the U.K.’s population.

McMillan declined to provide a target figure for Alberta, but said in an email, “Our goal is for as many Albertans to use it as possible.”

Even users who’ve installed the app may have trouble using it effectively. Those running Apple’s mobile operating system, iOS, are advised upon installation to “place your phone upside down or screen side down in your pocket” to keep their screen unlocked while out running essential errands.

An FAQ explains ABTraceTogether doesn’t work properly when running in the background. In other words, it can’t guarantee contact tracing continues while a user opens an email or replies to a text message. “If you need to use other apps, just remember to switch back” afterward, the FAQ states.

Apple teamed up with rival Google to develop contact tracing technology. (Mike Segar/Reuters)

Alberta’s health minister, Tyler Shandro, said Apple has been made aware of the issue.

“We’re looking forward to the fix being able to make its way to the App Store as soon as possible,” he said.

App developers are hopeful a rare joint project by Apple and Google will eventually allow them to streamline apps across iOS and Android devices, letting contact tracing run in the background and making the services more widely available.

How it works

While some previous contact tracing apps relied on GPS data, tracking a user’s every movement, the Bluetooth method is emerging as a more accessible and less intrusive alternative.

James Petrie, a member of an international team developing a similar app called Covid Watch, said earlier iterations of the software focused on GPS tracking, but, “We hit a number of challenges — like how do you share this data between people without identifying them?”

A PhD candidate in applied mathematics at the University of Waterloo in Ontario, Petrie said Bluetooth provides more promise because of its ubiquity among smartphones and its ability for direct communication from one device to another.

That’s how ABTraceTogether works. It was developed using the same code that formed the basis of Singapore’s groundbreaking TraceTogether app. Deloitte and IBM were hired to tweak and rebrand the app for Alberta.

The software exchanges anonymous data with another user’s device when it’s located less than two metres away for several minutes. If someone with the app is diagnosed with COVID-19, they will be asked to consent for other users to be alerted and the information given to manual contact tracers, but the patient would remain anonymous. 

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“Users will merely be informed that they have come into close contact with someone who has tested positive,” said Dr. Deena Hinshaw, Alberta’s chief medical officer of health. 

Unveiling the app last Friday, she took great pains to underscore its privacy features, such as how data remains encrypted on a user’s phone and is only saved for 21 days.

“The use of technology for this purpose may seem intrusive, but downloading the app is completely voluntary and data will not be accessed unless a user provides consent to share their data with [Alberta Health Services],” she said.

Other provinces

Some other provinces have acknowledged they’re considering how to implement digital contact tracing.

A New Brunswick government spokesperson said on Tuesday the province plans to implement an “anonymous privacy-by-design solution” using Bluetooth. Last week, New Brunswick’s privacy commissioner said he expected Premier Blaine Higgs and others to be shown a demonstration of the app within 10 days.

Dr. Deena Hinshaw, Alberta’s top public health doctor, said ABTraceTogether would log interactions between users when they were located less than two metres apart for a period of at least 15 minutes within 24 hours. (Art Raham/CBC)

Newfoundland and Labrador Health Minister John Haggie said earlier this week his province would ensure privacy is respected by seeking advice from experts on the topic.

British Columbia, however, is “not focusing on tracing apps such as these at this time,” according to the Health Ministry.

The patchwork of plans leaves open the possibility that contact tracing apps will be incompatible from one jurisdiction to another, as interprovincial travel slowly resumes.

“It works really well if a lot of people can communicate with the same system,” said Petrie, “so I’m hoping for Canada to see a national app, or at least to have provincial apps that can communicate, but I think that’s still a few weeks or months out.”

Contact tracing app TraceTogether was released by the Singapore government to curb the spread of the coronavirus. (Edgar Su/Reuters)

Ontario Premier Doug Ford has called for a national contact tracing strategy. Prime Minister Justin Trudeau, however, said on Radio-Canada talk show Tout le monde en parle he hasn’t seen the right technology “so far.”

Richard Lachman, an associate professor at Ryerson’s RTA School of Media, pointed out, smartphone apps should only be seen as part of the solution to the ongoing crisis, along with other measures such adequate testing, physical distancing and widespread hand-washing.

“There are much bigger questions that will be required,” he said, “and I don’t want us to get distracted.”

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Measles case reported locally turns out to be negative: health unit

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
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On March 26, the Simcoe Muskoka District Health Unit (SMDHU) was notified by Public Health Ontario’s (PHO) laboratory that due to laboratory error, the case of measles that had been lab-confirmed positive on March 12, based on symptoms and a positive urine measles laboratory result by PHO’s laboratory, is in fact negative for the measles virus.

“With this new information of the negative lab result, we believe that that individual was not infected with measles and that there has not been any public exposure to measles resulting from this individual’s illness,” said Dr. Charles Gardner, medical officer of health. “We recognize that notifying the public of what we believed to be a positive measles case in our area created worry, anxiety and disruption for some, and we regret this.

“We do know that, despite best efforts, on rare occasions laboratory errors can occur. We are working closely with the PHO’s laboratory to do all that we can to ensure that such an incident does not occur again.”

Measles is a highly contagious viral infection that spreads very easily through airborne transmission. The measles virus can live in the air or on surfaces for up to two hours.

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Symptoms of measles begin seven to 21 days after exposure and include fever, runny nose, cough, drowsiness, and red eyes. Small white spots appear on the inside of the mouth and throat but are not always present. Three to seven days after symptoms begin, a red, blotchy rash appears on the face and then progresses down the body.

The risk of transmission to those vaccinated with two doses is low, and when it does occur tends to show a reduction in the severity of these symptoms.

“Although we are relieved for the individual involved, and for all Simcoe-Muskoka residents, that this case has now been confirmed as negative, we know that measles is still active in Ontario at this time and the potential remains for new cases to arise, especially given the increase in Ontarians travelling to areas in the world that have higher numbers of measles cases,” said Dr. Gardner. “This is why we continue to advise individuals to keep up to date with their routine immunizations, including measles, mumps and rubella (MMR) vaccination.”

The risk of measles is low for people who have been fully immunized with two doses of measles vaccine or those born before 1970; however, many children have been delayed in receiving their routine childhood immunizations and people who have not had two doses of measles vaccine are at higher risk of contracting the disease.

People who do get sick usually recover without treatment, but measles can be more severe for infants, pregnant women, and those with compromised immune systems. Possible complications include middle-ear infections, pneumonia, diarrhea, or encephalitis (swelling of the brain) and occasionally death in the very young. Even individuals who are up to date with the measles vaccine should watch for symptoms of measles for 21 days after exposure.

For more information about measles, please visit smdhu.org or call Health Connection at 705-721-7520 or 1-877-721-7520, Monday to Friday between 8:30 a.m. and 4:30 p.m. to speak with a public health professional.

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Kate Middleton Not Alone. Cancer On Rise For People Under 50, Say Experts

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Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery

London:

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When Catherine, Princess of Wales, revealed she was being treated for cancer last week, part of the shock was that an otherwise healthy 42-year-old has a disease that mostly plagues older people.

However, researchers have been increasingly sounding the alarm that more and more people under 50 are getting cancer — and no one knows why.

Across the world, the rate of under-50s diagnosed with 29 common cancers surged by nearly 80 percent between 1990 and 2019, a large study in BMJ Oncology found last year.

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The researchers predicted the number of new cancer cases among younger adults will rise another 30 percent by the end of this decade, with wealthy countries particularly affected.

The increase in cases — and soaring global population — means that the number of deaths among under 50s from cancer has risen by nearly 28 percent over the last 30 years.

This occurred even as the odds of people of all ages surviving cancer have roughly doubled over the last half century.

Shivan Sivakumar, a cancer researcher at the UK’s University of Birmingham, called it an “epidemic” of young adult cancer.

Since Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery earlier this year, Sivakumar and other doctors have spoken out about the uptick in younger cancer patients they have been seeing at their clinics.

While breast cancer remains the most common for people under 50, the researchers expressed particular concern about the rise of gastrointestinal cancers — such as of the colon, pancreas, liver and oesophagus — in younger adults.

Colon cancer is now the leading cause of cancer deaths in men under 50 in the United States, according to the American Cancer Society. For women, it is number two — behind only breast cancer.

One high profile case of colorectal cancer was “Black Panther” actor Chadwick Boseman, who died at the age of 43 in 2020.

Why is this happening?

“We just don’t have the evidence yet” to say exactly what is causing this rise, Sivakumar told AFP, adding it was likely a combination of factors.

Helen Coleman, a cancer epidemiology professor at Queen’s University Belfast who has studied early onset cancer in Northern Ireland, told AFP there were two potential explanations.

One is that people in their 40s were exposed to factors known to cause cancer — such tobacco smoke, alcohol or being obese — at an earlier age than previous generations.

She pointed out that the “obesity epidemic” did not start until the 1980s.

Sivakumar felt that at least part of the puzzle could be explained by obesity.

However, there is “another wave” of under-50 patients who are neither obese nor genetically predisposed still getting cancer, he emphasised, adding that this could not be put down to “statistical chance”.

The other theory, Coleman said, is that “something different” has been going on with her generation.

Fingers have been pointed out a range of possible culprits — including chemicals, new drugs and microplastics — but none have been proven.

Some have suggested that so-called ultra-processed foods could be to blame. “But there’s very little data to back any of that up,” Coleman said.

Another theory is that the food we eat could be changing our gut microbiome.

While there is nothing conclusive yet, Coleman said her own research suggested that cancer causes changes to the microbiome, not the other way around.

Anti-vaxx conspiracy theorists have even tried to blame Covid-19 vaccines.

This is easily disproven, because the rise in young adult cancer has taken place over decades, but the vaccines have only been around for a few years.

What can be done?

To address the rise in younger colorectal cancer, in 2021 the US lowered the recommended age for screening to 45. Other countries have yet to follow suit.

But the researchers hoped that Catherine’s experience would remind people at home that they should consult their doctor if they sense anything is wrong.

“People know their bodies really well,” Sivakumar said.

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“If you really feel that something isn’t right, don’t delay — just get yourself checked out.”

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Almost 3,000 students suspended in Waterloo Region over immunization issues

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Close to 3,000 children attending elementary school across Waterloo Region were suspended from school on Wednesday morning for not having up-to-date immunization records.

The region says Waterloo Public Health suspended 2,969 students under the Immunization of School Pupils Act (ISPA).

For several months, the region has been campaigning for people to get their children’s vaccinations up to date, including sending letters home to parents on a couple of occasions, warning that students’ records needed to be up to date or they would be suspended.

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It announced in January that 32,000 students did not have up-to-date records: 22,000 elementary students and 10,000 high school students.


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“We have made remarkable progress from the original 27,567 immunization notices we sent to parents in November and December 2023,” Dr. Hsiu-Li Wang, medical officer of health, stated.

“Since that time, we have resolved more than 24,500 outdated vaccination records, providing students with valuable protection against these serious and preventable diseases.”

The high school students still have a few weeks to get their records up to date or else face suspension.

The ISPA requires students to have proof-of-vaccination records for diphtheria, polio, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox) and meningitis, which must be on file with public health.

Public health says caregivers whose children are suspended will need to book an appointment at regionofwaterloo.ca/vaccines for clinics, which will be held in Cambridge and Waterloo on weekdays.

“Given the high number of suspensions, it may take several days before you can be seen at an appointment and return your child to school,” a release from the region warns.

“Record submission and questions must be done in person to ensure immediate resolution.”

The last time suspensions over immunizations were issued was in 2019, when 1,032 students were suspended.

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