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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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London-Middlesex may enter Stage 3 of reopening near the end of July: MLHU – Globalnews.ca

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London-Middlesex is on its way to enter Stage 3 of Ontario’s novel coronavirus reopening plan, according to London’s chief medical officer of health.

Dr. Chris Mackie said Monday that he’s hopeful the region will be given the green light to move ahead with the province’s reopening plan within the next few weeks.

“I think (we) could see a move to Stage 3 over the next two to three weeks. I would not be surprised at all to see that,” said Mackie.

Read more:
Dr. Chris Mackie no longer CEO amid management changes at Middlesex-London Health Unit

“I also think that it’s likely the province will choose to do a regional approach as they did with the Stage 2 reopening.”

Mackie also commented on Leamington and Kingsville in Essex county entering Stage 2 as of Tuesday, saying it is a sign that “this region is really getting COVID-19 under control.”

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According to the Province of Ontario, in Stage 3 the province will consider opening more workplaces, dine-in restaurants, and indoor and outdoor recreational facilities, including playgrounds.

Read more:
154 new coronavirus cases, 0 deaths in Ontario; total cases at 35,948

Casinos, fitness facilities and amusement parks are also on the list, all with added public health measures in place.

London-Middlesex has not seen any new cases of COVID-19 for two days in a row. The last reported death in the region related to the virus was June 12.

As of Monday, there are 630 confirmed cases in the region, which includes 57 deaths and 515 recoveries.






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Coronavirus: Ontario health minister says there’s ‘hope’ for move to stage 3 soon


Coronavirus: Ontario health minister says there’s ‘hope’ for move to stage 3 soon

© 2020 Global News, a division of Corus Entertainment Inc.

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VCH warns of COVID-19 exposure at Downtown Vancouver club – Vancouver Is Awesome

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Vancouver Coastal Health is notifying people who visited the bar and nightclub areas of the Hotel Belmont about a possible exposure to COVID-19 during the nights of Monday, June 27 and Wednesday, June 29.

In a release, VCH states that individuals who tested positive for COVID-19 attended these areas of the Hotel Belmont (654 Nelson Street) on those dates.

However, the health authority adds that there is no known risk to anyone who attended the Hotel Belmont outside these two dates. In addition, there is no ongoing risk to the community.

As a precaution, VCH advises people who attended the bar and nightclub areas of the Hotel Belmont during the nights of Monday, June 27 and Wednesday, June 29 to monitor themselves for 14 days. As long as they remain healthy and do not develop symptoms, there is no need to self-isolate and they should continue with their usual daily activities.

If you have no symptoms, testing is not recommended because it is not accurate or useful. If you develop any of these symptoms of COVID-19, please seek COVID-19 testing and immediately self-isolate. Please call ahead and wear a mask when seeking testing. 

In June, VCH warned of a possible exposure to COVID-19 to people who were at Brandi’s Exotic Show Lounge between 9 p.m. and 3 a.m. from June 21 to 24. It says a number of people who tested positive for COVID-19 attended the lounge on those dates. However, the club has since passed a health inspection and reopened. 

COVID-19 is spread by respiratory droplets when a person who is sick coughs or sneezes. It can also be spread when a healthy person touches an object or surface (e.g. a doorknob or a table) with the virus on it, and then touches their mouth, nose or eyes before washing their hands. Most people who get COVID-19 have only mild disease, but a few people can get very sick and may need to go to hospital. The symptoms of COVID-19 may include fatigue, loss of appetite, fever, cough, sore throat, fatigue, runny nose, sore throat loss of smell and/or diarrhea.

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Scientists warn of overlooked danger from coronavirus-spreading airborne microdroplets – CTV News

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TORONTO —
Physical distancing and frequent handwashing are not enough to fully protect against airborne transmission of the novel coronavirus, hundreds of scientists say.

Virus-carrying microdroplets pose more of a danger than is currently being communicated, the scientists argue in a new medical commentary, and the result is that poor ventilation is easing the path of the pandemic.

The commentary has been accepted for publication in the journal Clinical Infectious Diseases. It is signed by 239 scientists from 32 countries and a wide variety of science and engineering disciplines, according to a statement from the Queensland University of Technology (QUT) in Australia.

“We are concerned that people may think they are fully protected by following the current recommendations, but in fact, additional airborne precautions are needed to further reduce the spread of the virus,” lead author and QUT air quality expert Lidia Morawska said in the statement.

MICRODROPLETS EXPLAINED

It is not controversial to say that the virus that causes COVID-19 can spread through exhaled airborne droplets. This is why physical distancing was one of the earliest individual measures urged to stop the spread of the virus, because putting space between people allows for particles to fall to the ground rather than latch on to another person.

It is also normal for viruses to be passed through droplets. Measles, for example, has an airborne transmission pathway that poses far more of a danger than has thus far been found with COVID-19.

“I can be in a room with measles, and leave, and somebody walks in hours later and they can get measles,” Dr. Sumon Chakrabati, an infectious diseases physician based in Missisauga, Ont., said Monday on CTV News Channel.

The World Health Organization says the droplets that carry SARS-CoV-2 can be spread through actions including coughing, sneezing and speaking, and recommends that everyone keep a one-metre distance from others. Many countries, including Canada, have gone farther, recommending a distance of two metres.

However, there are signs that the smallest microdroplets can travel beyond the two-metre limit. One American study found that they can move three metres in 12 seconds, and a fourth metre as they linger in the air for up to a minute. Morawska said that there is significant evidence that microdroplets can travel even farther – into the tens of metres – especially when indoors.

“Studies by the signatories and other scientists have demonstrated beyond any reasonable doubt that viruses are exhaled in microdroplets small enough to remain aloft in the air and pose a risk of exposure beyond [one to two metres] by an infected person,” she said.

“Hand-washing and social distancing are appropriate, but … insufficient to provide protection from virus-carrying respiratory microdroplets released into the air by infected people.”

‘IS THERE A DANGER THERE?’

Advice from public health experts in Canada and elsewhere has largely downplayed the risk of airborne transmission of the virus, even as evidence mounts that it is a real threat. In one study cited in the commentary as an example, droplets were found to be the most likely source of transmission among three dining parties at a restaurant in China, in a case where surveillance video footage showed no direct or indirect contact between the groups.

The debate over droplets has been playing out since the pandemic took hold. Dr. Colin Furness, a Toronto-based infection control epidemiologist, described it as “a pretty serious fight, intellectually,” but said the commentary is unlikely to lead to significant changes in virus protection thinking.

“The concern is ‘Are we ignoring those small droplets? Is there a danger there? Are our interventions maybe not enough?'” he said Monday on CTV News Channel.

“It could be that a smaller dose, those smaller droplets, actually matter for [COVID-19] because it’s so good at getting a toehold in your body once it gets in there.”

In Chakrabati’s view, the possibility of airborne transmission is overshadowed by the evidence that Canada and other countries have been able to slow the spread of the virus with the current precautions and restrictions.

“Are there situations where the two metres is a bit too little, for example a karaoke bar or a choir, where you’re singing and your voice is propelling? Perhaps,” he said.

“But I think for the most part, the recommendations that have been there since the beginning are the ones that are truly preventing the spread of this virus.”

REDUCING THE RISK

Morawska said that effective ventilation systems are the best way to reduce the spread of microdroplets. She said the most effective systems minimize the use of recirculated air by bringing in as much clean air from outdoors as possible, and that even opening doors and windows can make a major difference.

These ventilation techniques can be augmented with the use of air filtration and exhaust devices, as well as ultraviolet (UV) lights that kill germs. Another way to lessen the risk of microdroplet transmission is to avoid situations of overcrowding, especially on public transport and in public buildings, Morawka said.

Furness agreed with the suggestion to use UV lights in air filtration systems, saying that there could be a “renaissance” in this practice because the light can be effective against the virus in a way that physical filters cannot.

“I think we will probably see a resurgence in the use of UV light within air circulation systems, because UV light will kill viruses and it doesn’t really matter how small they are,” he said.

Face masks do not play a role in protecting against microdroplets, Furness said, because the droplets are so small that they can fit through the holes in most masks.

“If we were really concerned about aerosol, if we were really concerned about airborne, we would also be finding that wearing face coverings typically didn’t have that much of an effect – but the evidence says that they do,” he said.

“It’s not that we dramatically need to change what we are doing, it’s a question of trying to better understand our adversary and better understand what some of those risks may be.”

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