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.
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.
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.
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.
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.
