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Ontario builds first-of-its-kind screening program to help children with hearing loss – The Globe and Mail

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18-month-old Francesca Jones plays at home with her father Will and mother Julia Tirabasso in early December.

Melissa Tait

When the wail of a fire alarm broke the night-time quiet of the hospital and her new baby did not stir, Julia Tirabasso knew something was wrong.

“I felt like it was the loudest sound I’d ever heard,” Ms. Tirabasso said, “And she slept through it.”

If her daughter, Francesca, had been born at another time or in a province other than Ontario, Ms. Tirabasso and her husband, William Jones, might never have found out exactly why their daughter could not hear the piercing alarm.

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Instead, within weeks of Francesca’s birth on May 25, 2018, Ms. Tirabasso and Mr. Jones learned that a common viral infection, passed from mother to baby in utero, had made their daughter deaf in both ears.

Francesca’s case was the first to be caught by the pilot phase of a new screening program in Ontario that, as of last July, expanded to become the first in the world to offer all parents the opportunity to have their newborns tested for congenital cytomegalovirus, or cCMV, the most common non-genetic cause of permanent hearing loss in children. The province has already caught 70 cases of congenital CMV infection, 53 of them since the program became universal.

The earlier that children with hearing loss are given hearing aids or cochlear implants, the likelier they are to learn to speak. For a cost of $600,000 a year, Ontario has built a program that should catch most children with cCMV-related hearing loss in time to dramatically improve their lives, raising questions about why other parts of Canada have yet to follow Ontario’s lead.

“People are looking very closely at what’s happening in Ontario,” said Sharon Cushing, an otolaryngologist at Toronto’s Hospital for Sick Children who helped craft Ontario’s cCMV screening program. “I travel all over the world, and they’re amazed at what we’re doing.”

For Francesca, early detection of her cCMV infection helped make it possible for her to become one of the youngest babies in the province to receive cochlear implants, electronic devices that partly restore hearing. She was nearly six months old when the implants were turned on for the first time, on Dec. 10, 2018.

Francesca Jones received cochlear implants when she was just five-months-old, one of the youngest in Ontario. At six months they were “turned on” and the video of baby Francesca reacting to her mother’s voice for the first time went viral. We visit the family one year on to see how Francesca is doing.

In a CBC news clip that has been viewed online nearly four million times, Francesca is quietly chewing on a rubber giraffe when a loud beep played by audiologist Susan Druker catches her attention. Francesca looks up and smiles.

Ms. Tirabasso leans in: “Ciao, Francesca.” Mr. Jones chimes in with, “Hi, Francesca.” The little girl rewards her parents with a wide grin. They both laugh with joy and relief.

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Getting to that moment was a journey that began not long after an outwardly healthy Francesca was born at Toronto’s Mount Sinai hospital.

Her case was caught during a pilot program that drew on two existing, but separate, screening programs for newborns: The Infant Hearing Program, which screens for hearing loss, and Newborn Screening Ontario, which co-ordinates the testing of heel-prick blood samples for more than 25 different diseases.

Until last year, Newborn Screening Ontario did not regularly test for congenital CMV.

Francesca is seen at an appointment with audiologist Susan Druker at Hospital for Sick Children in Toronto.

Melissa Tait

Most of the time, cytomegalovirus is no more dangerous than the common cold. But if a pregnant woman catches the virus through saliva or other bodily fluids and passes it on to her baby in utero, CMV infection can sometimes cause serious health problems. Symptoms range from the obvious – a small head, jaundice or a telltale rash – to the invisible, such as mild hearing loss that worsens over time.

If cCMV infection is identified quickly – ideally within the first four weeks of life – babies can be offered antivirals that work better the earlier they are started. Doctors can also monitor babies for hearing loss, which is especially important in cases where newborns with cCMV appear perfectly healthy.

“These children may, for a variety of reasons, pass their hearing screen at birth, but still be at risk,” said Jessica Dunn, medical lead for the CMV component of the new screening program and an infectious disease doctor at CHEO, a children’s health centre in Ottawa.

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Dr. Dunn said that, with the exception of Ontario’s new universal program, the Canadian health-care system has generally done a poor job of catching cCMV.

One University of Alberta study published in 2014 found that, between 2005 and 2008, Canadian pediatricians reported only 49 cases of congenital CMV, or 4.5 cases for every 100,000 births – a much lower birth prevalence than would be expected based on previous studies.

“The most likely explanation for the low reporting rate is missed diagnosis,” the study, published in the journal Paediatric Child Health, found.

Hoping to remedy that, Newborn Screening Ontario modified an existing blood test to detect cCMV in the dried blood spot, obtained from the heel prick, that NSO already collected from 99 per cent of the approximately 143,000 babies born in the province every year.

Once developed, the test cost about $2 a sample.

During the pilot phase, beginning in May, 2018, parents were offered the chance to opt-in to cCMV testing only after their children failed a full hearing screening test. Once the program became universal, last July, all parents were able to opt-in to testing for cCMV and three genetic risk factors for hearing loss, even if their children passed the initial hearing screen.

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Once Francesca tested positive for cCMV infection, Toronto’s Hospital for Sick Children immediately set up a day’s worth of appointments for the stunned couple and their one-month-old baby, whisking them from an infectious diseases doctor to an ear, nose and throat specialist and on to the audiology department.

“I was crying all day,” Ms. Tirabasso said. But she also found reason for hope. Dr. Cushing told Ms. Tirabasso and Mr. Jones that the health system had a “toolbox,” full of ways to help Francesca.

With guidance from 11 different types of doctors and health-care workers, including an auditory verbal therapist, an occupational therapist, a family support worker and an in-home teacher, Francesca, now 18 months old, can sing her alphabet, count, make animal sounds and mimic her parents as they read to her.

Ms. Tirabasso reads to her daughter.

Melissa Tait

“Do you want to read?” Ms. Tirabasso asked her daughter on a recent afternoon, holding up a board book titled Little Blue Truck.

“Read!” Francesca replied. As Little Blue Truck drove around his farm, Francesca repeated his signature sound, “Beep beep!” and quacked, neighed and mooed along with the animals. “All done!” Francesca said as she shut the book.

Softly, she called out for “Papa!” then switched to Mr. Jones’s lap. He read the opening of a Dr. Seuss book. “One fish, two fish, red fish, blue fish, black fish, blue fish, old fish …” Francesca interjected, “new fish.”

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“You’ve never said that before,” Mr. Jones said, clearly tickled.

To get Francesca to this point, where she comprehends words and speaks as well as any hearing toddler, has taken an all-encompassing effort by Ms. Tirabasso, a lawyer, and Mr. Jones, a product manager for a medical-device company.

They talk to Francesca constantly, narrating as they serve her tomatoes and cheese for dinner in their apartment north of downtown Toronto. Taped to the walls of the apartment are notes with tips from a language therapist: “6 sounds everyday e, a, ouu, mmm, siii, shh; use word ‘sandwiches’; Don’t feed her with full plate. Empty plate + ask her what she wants.”

When Francesca was younger, they hid around corners and rang bells, banged wooden spoons against pots and softly shook rice inside Tupperware containers, watching to see if Francesca could follow the source of the sounds.

If not for the small gadgets above Francesca’s ears, you might never guess that, when the external portion of the cochlear devices are removed for bath or bedtime, Francesca can’t hear at all.

Marlene Bagatto, an audiology professor and researcher at University of Western Ontario who chairs the Canadian Infant Hearing Task Force, said all Canadian children with hearing loss deserve the kind of early intervention that has helped Francesca to develop language. “The best chance you have for developing spoken language really well is up to age two. Earlier is better,” she says.

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The task force’s 2019 report card on Canadian early hearing detection and intervention programs rated only Alberta, British Columbia, Northwest Territories, Nova Scotia, Ontario and Yukon as having programs “sufficient” to identify hearing loss in babies and intervene to improve their odds of developing language. And only Ontario offers universal screening for cCMV. “It’s not okay for babies in this country,” Dr. Bagatto said.

Francesca Jones at The Hospital for Sick Children in Toronto after an appointment with the audiologist in early December.

Melissa Tait

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COVID-19 testing now available in some Ontario pharmacies – Global News

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TORONTO — Some Ontario pharmacies will begin offering COVID-19 tests today as the province tries to ease the burden on busy assessment centres.

Up to 60 pharmacies are offering the appointment-only tests to certain asymptomatic individuals, such as those with loved ones in long-term care homes, close contacts of a case or high-risk workers.

Read more:
Ontario announces COVID-19 testing to be expanded to pharmacies

Meanwhile, the government announced yesterday that the province’s assessment centres will now focus on testing those with symptoms, exposure to a case and people involved in outbreak investigations.

Premier Doug Ford had previously said anyone who wanted a test could get one at an assessment centre but changed that message yesterday.

Read more:
The 38 Toronto-area pharmacies where you can get a coronavirus test starting Friday

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That means some people with no symptoms who are simply seeking reassurance they don’t have the virus will not be able to access testing offered by the province.

Ford is also expected to announce another part of the province’s fall pandemic preparedness plan today.






2:52
Coronavirus: Ontario health officials explain COVID-19 test being used in pharmacies


Coronavirus: Ontario health officials explain COVID-19 test being used in pharmacies

© 2020 The Canadian Press

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Manitoba murder trial to continue with 11 jurors after one shows COVID-19 symptoms. – Richmond News

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WINNIPEG — A murder trial in Manitoba will continue with 11 jurors after one was discharged because he was showing COVID-19 symptoms.

Kane Moar is charged with second-degree murder in the 2018 stabbing death of 34-year-old Ricardo Hibi.

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Deliberations were to begin Wednesday but were delayed after the juror was turned away at the courthouse and went to be tested.

The other jurors were sent home and advised to self-isolate until the man’s test results are complete.

Queen’s Bench Justice Vic Toews told the jury Thursday he received advice from public health that it is safe and prudent to continue.

Toews says even if the juror tests positive, it doesn’t mean the remaining jurors would need to self-isolate given the steps taken in court, which include physical distancing.

“It is not prudent to wait any longer,” said Toews.

Moar, 23, is accused of killing Hibi at the foster home he ran for boys.

Jury trials were suspended across the country in the spring as the justice system grappled with how to handle the pandemic.

They resumed in Manitoba earlier this month with Moar’s trial.

The court put several protocols in place. Jury selections have been held in a large convention centre, there has been physical distancing in courtrooms and masks became mandatory after an employee at the Winnipeg courthouse tested positive for the novel coronavirus.

Toews said Wednesday that he was optimistic that jurors would soon hear his charge in the case before beginning deliberations on a verdict. (CTV Winnipeg, The Canadian Press)

This report by The Canadian Press was first published Sept. 24, 2020.

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Daily new COVID-19 cases triple in past month; more schools hit – Kamloops This Week

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TORONTO — A dramatic tripling of daily new cases of COVID-19 in the past month, mostly among young people, has prompted the prime minister to declare the arrival of the second wave of the pandemic and that Canadians likely won’t be able to gather for Thanksgiving.

“In our four biggest provinces, the second wave isn’t just starting, it’s already underway,” Justin Trudeau said Wednesday evening in a rare television address to the nation.

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“We’re on the brink of a fall that could be much worse than the spring.”

Trudeau said Canadians can’t do anything to change the numbers now, or even tomorrow.

“But what we can change is where we are in October, and into the winter,” he said.

“It’s all too likely we won’t be gathering for Thanksgiving, but we still have a shot at Christmas.”

Canada’s chief public health officer, Dr. Theresa Tam, said the country had seen an average of more than 1,100 new cases of the novel coronavirus a day this past week compared with about 380 a day in mid-August.

“Canada is at a crossroads with the COVID-19 epidemic trajectory,” Tam said before Trudeau’s address. “Unless public health and individual protective measures are strengthened and we work together to slow the spread of the virus, the situation is on track for a big resurgence in a number of provinces.”

While the new cases were primarily among young adults, more than 400 schools in Quebec and another 153 in Ontario reported at least one case of the illness. The figures from the group COVID Ecoles Quebec and the Ontario government came as authorities seek ways to curb the spread of COVID-19 among younger people.

Data from Ontario show cases among those in their 20s have risen sharply in the past month, with one expert attributing the increase in part to the reopening of schools and universities.

In an effort to tackle the problem, several provinces, cities and universities have warned of stiff fines for violating anti-COVID restrictions. However, Quebec said it would not allow police to enter homes without a warrant to break up gatherings that violate the measures.

The worrisome upward trend in new cases came as the federal Liberal government laid out its plan to take on the second wave.

“To prevent small clusters from becoming major outbreaks, communities may need to enact short-term closure orders,” the government said in its throne speech.

Stringent lockdowns in the spring caused unprecedented economic disruption, prompting the government to spend tens of billions of dollars on supports as unemployment skyrocketed.

The throne speech promised, among other things, an extension of the federal wage-subsidy program until next summer, more aid for businesses and help to boost testing capacity. People in various cities have waited for hours or even days for virus testing. Safety concerns led a hospital in Kitchener, Ont., to close its drive-thru testing centre as people arrived in the wee hours.

In all, COVID-19 has killed about 9,250 people in Canada, while the cumulative case count has been edging toward the 150,000 mark.

Quebec, with more than 69,000 cases, accounts for about 48 per cent of the total cases but 63 per cent of the deaths. Ontario’s more than 48,000 reported cases account for 33 per cent nationally, and 31 per cent of fatalities

On Wednesday, Quebec reported 471 new cases. Another four reported deaths from the novel coronavirus brought the province’s total fatalities to 5,809.

Ontario, which has shown a steady increase in new cases since mid-August, after months of declines, reported 335 new cases Wednesday and another three deaths. Almost 70 per cent of new infections were in people under the age of 40.

Concern is also mounting as more long-term care homes in Ontario, brutally hit by the virus earlier in the year, report outbreaks. Almost 70 per cent of fatalities have been among those aged 80 and older and another 27 per cent were 60 to 79 years of age.

While older people and those with underlying health conditions are more susceptible to severe illnesses from SARS-CoV-2, younger people can spread the disease — often before showing any symptoms.

“When there’s so much in the community, it can escalate into the populations with more vulnerability,” Dr. Vera Etches, medical officer of health in Ottawa, one of the harder hit cities, said.

Ontario data indicates new cases among people in their 20s have reached similar levels to those seen among people in their 80s in mid-April. Along with school reopenings, Dr. Brian Ward, a professor of medicine at McGill University, cited bars and parties as key factors, along with a “general sense of invulnerability” among younger people.

“COVID fatigue also clearly plays a role,” Ward said.

Winnipeg, for example, accounted for 30 of Manitoba’s 42 new cases reported Wednesday, with possible exposures at restaurants, bars and a pub trivia night, the province said.

Trudeau sympathized with Canadians feeling the stress of a second wave, but urged people to be strong.

“‘Can’t’ will not define us,” he said.

“We can bend the curve. We can build a stronger future. We can define the change.”

This report by The Canadian Press was first published Sept. 23, 2020.

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