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New B.C. infections well above national average, with one-third likely COVID-19 'long-haulers' – CTV News Vancouver

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VANCOUVER —
As British Columbia records its highest single-day case count in two months, the province is second only to Saskatchewan in new infections per capita over the past two weeks. Experts are warning more must be done soon, especially with thousands of people facing long-term symptoms.

On Friday, B.C. health officials announced 634 confirmed cases of COVID-19. A federal infobase shows B.C. infections at a rate of 141 per 100,000 residents when averaged over the past two weeks. Saskatchewan posted 186 per 100,000 residents, while the national average was just 108. And, while the majority of provinces showed a continued decline or flattening of infections, only the westernmost province showed significant growth.

“Obviously what we’re doing in British Columbia is not having the desired effect. We cannot have 650 cases a day and we cannot tolerate it until the vaccine kicks in and produces community-based immunity, we’re weeks and months away from that,” said Dr. Brian Conway, president of the Vancouver Infectious Disease Centre.

“All of this is suggestive of less-controlled, if not uncontrolled, community-based (rather than institutional) spread and this is the part of the pandemic that is of most concern,” Conway said. “If that occurs, then we need to intervene in a way that is different from what we are doing now to control (it).”

Only a handful of long-term care and assisted-living facilities declared outbreaks in February, and there haven’t been any in March so far.

While vaccine availability is ramping up and the number of deaths continues to decline, one of the experts on the front line is warning those numbers tell only part of the story.

Many thousands of “long COVID” cases in B.C.

As the months wear on, more and more people are reporting COVID-19 symptoms that persist well beyond their infectious period. Medical professionals treating them at three specialty clinics in Metro Vancouver say B.C. statistics mirror what other countries are observing.

“We don’t know what the absolute prevalence of the ‘long COVID’ disease is now, but we know from the data 75 per cent of hospitalized patients are having ongoing symptoms at 3 months,” said Dr. Zachary Schwartz, who leads the Post-COVID-19 Recovery Clinic at Vancouver General Hospital.

“For outpatients, probably upwards of 30 per cent of people can be still symptomatic at 6 months or 9 months after their infection.”

There isn’t a definition yet of what would qualify someone as a “long-hauler.” Symptoms can be mild to severe and range from tightness or pain in the chest to coughing and trouble breathing. Concussion-like symptoms – such as brain fog and fatigue – and mental health problems have also been reported.

“We do have psychiatrists involved in our networks that are seeing individuals relatively rapidly because we’re seeing both a new onset of mental health disorders like PTSD, anxiety, depression and – in people who have previously been diagnosed – we’re definitely seeing decompensation in some of their mental health as well,” he said.

In Surrey, they’ve only seen 18 patients at the Post-COVID-19 Recovery Clinic at Jim Pattison Outpatient and Surgery Centre, which opened Jan. 8.

A total of 130 patients have been accepted at VGH, where applications are now open for referrals. 

St. Paul’s Hospital has provided the lion’s share of the treatment, with 328 seen by doctors. Providence Health says the hospital is “building capacity both virtually and actually.”

With limited space, patients need a referral for treatment and the facilities are currently only accepting the most severe long-haulers. For those with mild to moderate symptoms, they’re increasingly providing online resources for them to manage their symptoms. 

Warnings from doctors as complacency becomes more common

As the weather warms up and pandemic fatigue has people desperate for company, Conway believes more targeted restrictions may be needed to avoid disaster.

“I’m hoping it’ll be the Whistler approach,” he said, noting that targeted business closures, emphasizing household bubbles and some changes to living situations slashed transmissions by 75 per cent in a month.

“My sense is, what’s going on in Surrey and the surrounding areas in the Fraser Valley is community-based transmission is occurring, so either it’s living situations that need to be changed or people are making decisions in their day-to-day lives that ‘this one time, this one evening, it’s OK to not follow the rules.’”

Conway praised public health officials in other provinces who moderated restrictions based on infections and allowed communities with few cases to carry on, while hotspots in Toronto and Montreal saw crackdowns that brought transmission under control.

“Broad restrictions (in B.C.) are probably not appropriate and people wouldn’t necessarily follow them anyway, they would be resistant, so I think a targeted approach is where we need to pay attention,” he suggested.

With 76,752 people who tested positive for the disease have now classified as “recovered,” Schwartz said it may be more accurate to call them “recovered from acute disease” or “no longer contagious,” since a third of them could still be experiencing symptoms; that’s roughly 25,000 people who could be feeling a faint tightness in the chest, or struggling to get out of bed.

“You don’t want to end up with these symptoms long-term because they’re debilitating … people who cannot get back to school full time, people who cannot get back to work full time,” he said, noting that aside from the personal and family toll that’s taking, it’ll increasingly have an impact on our economy and health-care system.

“When you apply that to a population health level, when you apply that to 500 cases a day just to British Columbia, it starts becoming significant,” Schwartz said. 

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Average age of Quebec COVID-19 patients has dropped by 10 to 15 years, doctors say – National Post

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MONTREAL — Over the past two to three weeks, Dr. Francois Marquis, head of intensive care at Montreal’s Maisonneuve-Rosemont hospital, says he started noticing the average age of COVID-19 patients dropping.

People arriving at the hospital are on average, about 10 to 15 years younger than earlier patients in need of medical care after contracting COVID-19, he said in an interview Wednesday.

“We are starting to see what was very unlikely during the first wave: 30 or 40-year-olds without any previous medical history, people in good health,” Marquis said.

“They’re not seeing a doctor, they’re not taking any kind of medication, they don’t have diabetes, they don’t have high blood pressure — they just get sick.”

Marquis’s observations echo a warning earlier this week from Dr. Theresa Tam, Canada’s chief public health officer, who said health officials across the country are reporting rising numbers of younger patients in hospitals who soon need intensive care.

“Many of them deteriorate quite quickly and have to be admitted to the ICU,” she said.

Dr. Gaston De Serres, an epidemiologist with Quebec’s public health institute, said the proportion of Quebecers over 80 in hospital with COVID-19 has been declining since mid-March — largely due to vaccination.

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He said it’s not just the proportion of hospital patients who are younger that’s increasing, the overall number of younger patients is rising as well. De Serres said there were 40 people between 50 and 59 years old who were hospitalized the week of March 7. During the week of March 28, there were 54.

But hospitalizations are still not rising significantly among people under 30. “It’s younger,” he said of the average age of patients. “It’s not young.”

Ten people between 20 and 29 years old were hospitalized with COVID-19 in Quebec the week of March 28, up from five two weeks earlier, De Serres said.

“If you have more cases, you will clearly have more hospitalizations, but the proportion of all hospitalized cases will remain small because these younger age groups are very low risk of being hospitalized.”

De Serres said he thinks more younger people are getting sick because the coronavirus variants of concern are more transmissible and they lead to more severe illness more frequently.

Mike Benigeri, director of the data bureau at the Institut national d’excellence en sante et services sociaux, a Quebec government health-care research institute, said that over the past two weeks, there has been a 40 per cent increase in the number of people aged 40 to 69 who have been infected with COVID-19. He said the percentage is even higher among people aged 18 to 30.

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Marquis said older people and those with other medical conditions may notice a COVID-19 infection sooner. People who are healthier may not seek medical attention until they’re very ill, he added.

“They will push the limits of endurance up to the point when they say, OK, it’s enough, I really need to go to the hospital,” he said.

Despite the odds of dying being low among younger people, that doesn’t mean the consequences among the small group who do get severely ill are any smaller, he said.

“If you’re that unlucky guy, well, you’re going to die — and you’re not going die 1.5 per cent, you’re going be fully dead.”

Quebec Premier Francois Legault has repeatedly said that with vaccination protecting older people, the province will be able to tolerate more COVID-19 cases.

Dr. Quoc Nguyen, a gerontologist at the Universite de Montreal hospital centre, said while that may be true when it comes to deaths, it may not be the case for ICU capacity.

“When we look at one case in December versus one case in March, it seems that for a single case we have more intensive care than we used to before, but we don’t necessarily have more hospitalization,” he said.

It’s ICU capacity that worries Marquis. His ICU is supposed to have 24 beds, but because staff members have left the health-care system — particularly nurses — it now has a capacity of 14: seven beds dedicated to COVID-19 patients and seven for everyone else.

“I am really afraid that in two weeks we’re going to be in the same place as Ontario is right now and I don’t think that we can deal with that many patients,” he said.

Ontario Premier Doug Ford has imposed a four-week stay-at-home order after a third wave of COVID-19 started to overwhelm the health system.

“They’re going to saturate the ICU availability very, very quickly for a very long time,” Marquis said.

This report by The Canadian Press was first published April 8, 2021.

——

This story was produced with the financial assistance of the Facebook and Canadian Press News Fellowship.

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Canada’s hospitals deploy artificial lungs, scramble for staff as COVID-19 hits younger patients

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artificial lungs

By Anna Mehler Paperny and Allison Martell

TORONTO (Reuters) -Younger Canadians are bearing the brunt of the nation’s latest COVID-19 surge, creating growing demand for artificial lungs and a struggle to maintain staffing in critical care units as hospitals make last-ditch efforts to save patients.

Treatment with artificial lungs, known as extracorporeal membrane oxygenation, or ECMO, is much more likely to be deployed for patients under age 65, explained Marcelo Cypel, surgical director for the extracorporeal life support program at Toronto’s University Health Network (UHN).

Last week, there were a record 19 ECMO patients at UHN, 17 of them with severe COVID-19. When the sickest COVID-19 patients’ lungs fill with fluid and mechanical ventilators can no longer do the job, artificial lungs can save lives.

By Monday, doctors had weaned some off the machines and were down to 14 ECMO patients, 12 of them with COVID-19.

The need for these artificial lungs reflects a change in Canada‘s epidemic, which has taken a turn for the worse, with new cases surging and outbreaks hitting workplaces and schools.

With many seniors vaccinated and new, far more contagious coronavirus variants circulating widely, younger patients are increasingly arriving in intensive care.

“It’s very different now than the first wave, when we saw older people with comorbidities,” Cypel said. “We’re seeing more … young essential workers.”

The ECMO situation is under control for now, but things can change very quickly, Cypel cautioned.

When hospital systems in other countries were overwhelmed, they had to stop using ECMO because it requires a lot of staff – seven or more people to start the treatment.

About 55% of people who receive the therapy survive, Cypel said. However, they are often left with “severe physical limitations” from their extended hospital stay, he added.

Many of Canada‘s provinces are in the grip of a worsening third COVID-19 wave, as they struggle to hasten vaccine rollouts. The country reported more than 6,200 new cases on Monday, with the percentage of people testing positive for the virus up to 3.8%.

‘SEEING BURNOUT’

In British Columbia, where hospitals are bracing for a surge in demand for intensive care unit (ICU) beds caused by the highly concerning P.1 virus variant first discovered in, and now ravaging, Brazil, critical care doctor Del Dorscheid from Vancouver’s St. Paul’s Hospital is more worried about staffing than artificial lung use.

On a given shift, he said, a third of the staff are working overtime.

“They’re working so hard to find bodies to fill those empty spots,” he said. “I wouldn’t say we’re seeing more mistakes. Not yet, anyways. But we are certainly seeing burnout.”

For ICUs, there is no end in sight. As of Tuesday, there were 497 COVID-19 patients in Ontario’s ICUs, a new high. Last week, experts advising the provincial government said that could rise to 800 by the end of April even with a new stay-at-home order – or approach 1,000 without it. The province stopped short of a new stay-at-home order.

New restrictions implemented in Ontario last week change little for hardest-hit areas. In Toronto, patios for outdoor bars and restaurants closed, and a plan to reopen salons was shelved. On Monday, hard-hit Peel, west of Toronto, moved on its own to suspend in-person classes at schools for two weeks.

Canada‘s vaccination rate has picked up after a slow start, with 15% of the population getting at least one shot. But data from the Institute for Clinical Evaluative Sciences shows that the Ontario communities at highest risk of COVID-19 transmission also have the lowest rates of vaccination.

These communities tend to have a high proportion of residents unable to work from home, many of them non-white immigrants holding down jobs at high risk of virus exposure.

Some lack cars to drive to vaccination sites or paid time off to get the vaccine, said Brampton doctor Amanpreet Brar. Some of the hardest-hit neighborhoods lack pharmacies that dispense COVID-19 vaccines.

“It really reflects systemic inequities we see in our society,” said Brar. “They’re considered non-essential, while their work is considered essential.”

(Editing by Denny Thomas and Bill Berkrot)

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Western Canada: B.C. faces vaccine shortfall amid rising cases of COVID-19 variants – The Globe and Mail

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Good morning. Wendy Cox in Vancouver this morning.

As the number of vaccines ramps up across the country, provinces are scrambling to boost their own efforts to get doses into arms. The increased availability of doses is still falling far short of the demand.

British Columbia finally opened its online registration portal on Tuesday, allowing people born in 1950 or earlier to register to get a confirmation code. The code allows them to book an appointment for a shot when they are contacted by e-mail, text or phone.

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But the continued scarcity of the resource was underlined even as British Columbia received more vaccines over the weekend and into this week. About 700,000 British Columbians between the ages of 55 and 65 can expect a chance to book a COVID-19 vaccine at their local pharmacy by the end of the week, but only about 200,000 doses of AstraZeneca are expected to be available.

Meantime, the 300,000 front-line workers who were promised priority access to that stream of vaccine supply in mid-March still have no answers about when they will be back in line as Canadian health officials reconsider the safety of the vaccine for younger populations.

“We do not have enough vaccine to provide it to everybody, but it’s a way of jump-starting that part of the age group,” Bonnie Henry, B.C.’s Provincial Health Officer, said Tuesday.

Meantime, case counts across the country continue to surge, driven by highly contagious variants.

“On present course, the pandemic will blight the spring and shorten the summer for millions of Canadians,” said David Naylor, the co-chair of the federal COVID-19 Immunity Task Force.

The surge “cannot be contained without tough public health measures and a substantial acceleration of the current vaccine rollout.”

Alberta brought in new measures Tuesday, announcing it would reimpose restrictions on restaurants, gyms and other activities as more transmissible and lethal variants spread without restraint.

Premier Jason Kenney said the province will return to the first phase of its reopening plan as Alberta forecast 1,000 people with COVID-19 will be in hospital by the end of the month. Restaurants will be closed for indoor dining as of Friday and gyms must stop group activities Wednesday. Retailers and shopping malls must reduce capacity to 15 per cent of fire code, down from 25 per cent.

Alberta’s retreat comes less than a month after Mr. Kenney bowed to pressure from inside his own caucus to loosen the rules. But the variants of concern, which now make up about 43 per cent of Alberta’s 10,809 active cases, are undoing progress to contain infections and threaten to overwhelm the health care system. Alberta projected 2,000 new daily cases of COVID-19 by the end of the month.

“We must defeat these variants,” Mr. Kenney said. “This wave is here.”

Cases are also climbing in British Columbia, but new restrictions weren’t imposed here.

B.C. posted another 1,068 new cases of COVID-19 on Tuesday, and the province identified more than 200 new cases involving the variants of concern. Health officials blame the rise in cases on social interactions and non-essential travel in defiance of health orders, and expressed alarm at the rising number of younger residents who are now in hospital. Restaurants and bars have been closed for in-dining service since March 30.

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Health Minister Adrian Dix urged British Columbians to follow the existing rules while the mass vaccination program continues to roll out.

On Monday, federal Health Minister Patty Hajdu highlighted the discrepancies between the available shots and the number administered, but on Tuesday she and Prime Minister Justin Trudeau were careful not to directly criticize the premiers.

“We all need to speed up the vaccination process,” Mr. Trudeau said in French.

Ms. Hajdu was not able on Tuesday to say how quickly the federal government expects provinces to administer vaccines once they receive them. The federal public health agency wasn’t able to provide data on how fast shots are being given, and neither were provinces such as Ontario and B.C.

That information is crucial to ensuring an effective vaccination campaign, Dr. Naylor said.

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“You absolutely have to have a sense of your inventory and how fast it’s moving so that you can determine how sites are performing relative to the demand they’re facing,” he said.

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