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People are getting reinfected with COVID-19. What that means for 'herd immunity' and vaccines – National Post

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“It very well might be very rare. But it very well might not be as rare as we think. We just need a better surveillance system for it.”

From a public health perspective, “People who have had COVID-19 should behave and be treated as if they had not had the virus,” Pandori said, “because now we know it’s at least possible to be re-infected and for the infection to lead to significant illness.” People who have tested positive should continue taking precautions, including distancing, masking and hand washing.

Dr. Mark Pandori: “We don’t necessarily have a system that’s well designed to find reinfection cases.” Photo by Brin Reynolds/UNR Med.

Not all reported cases of reinfections have involved infections that were worse the second time. In the Nevada case, it’s possible the infectious dose the second time was overwhelmingly high. “You can be really unlucky and just get slammed by a very high viral load,” Pandori said.

It’s possible the reinfection was caused by a version of the virus that was more virulent, or at least more virulent to the Nevada man. The strains of SARS-CoV-2 between the two cases not only had different genetic fingerprints, it may be that they behaved differently in the body.

“The virus that came out of the gate earlier in the year is not the same virus, identically, as the one circulating in North America right now,” Pandori said.

But the takeaway is not that a vaccine won’t work or that people won’t develop natural immunity.

Vaccine-based immunity is very different, Pandori said. “It can be guided and boosted in ways that our natural immunity is not.

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What you need to know about COVID-19 in Ottawa on Wednesday, Oct. 28 – CBC.ca

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Recent developments:

What’s the latest?

An Ontario advocacy group would like everyone to stop assuming there’s a shortage of nurses and start talking about the need for full-time jobs and better working conditions, specifically in long-term care.

A CBC Ottawa survey of educators across the region reveals mounting levels of stress that have many contemplating another career or early retirement.

WATCH | An Ottawa Grade 1 teacher’s story:

Ottawa-Carleton District School Board teacher Lisa Levitan on the stress she and other educators are feeling amid the pandemic. 0:56

How many cases are there?

As of Tuesday’s update from Ottawa Public Health (OPH), 6,694 Ottawa residents have tested positive for COVID-19.

There are 706 known active cases, 5,671 resolved cases and 317 deaths.

Public health officials have reported nearly 10,300 COVID-19 cases across eastern Ontario and western Quebec, with more than 8,600 of them resolved.

Seventy-six people with COVID-19 have died elsewhere in eastern Ontario, along with 41 in western Quebec.

What can I do?

Both Ontario and Quebec are telling people to limit close contact only to those they live with or one other home if people live alone to slow the spread of the coronavirus.

In Ottawa — which has been rolled back to a modified Stage 2 — and Gatineau, Que., health officials are asking residents not to leave home unless it’s essential. 

Indoor dining at restaurants has been prohibited, while gyms, cinemas and performing arts venues are all closed.

Ottawa’s medical officer of health Dr. Vera Etches says there are encouraging late-October signs the spread is slowing, but people should be wary of blind spots such as taking a lunch break at work or carpooling.

WATCH | How to further slow Ottawa’s spread:

Dr. Vera Etches, medical officer of health, says Ottawa’s numbers are dropping, though people are still gathering with extended family or socializing before and after team sports. 0:52

OPH and some eastern Ontario health units are urging people not to have a Halloween party with other households or go trick-or-treating.

The province’s chief medical officer of health says Ontarians should listen to local officials, but as a rule of thumb, if trick-or-treating is allowed, people should stick to their neighbourhood and do it outside with their household only.

Gatineau and parts of the Outaouais are on red alert, which means restaurants and bars can’t serve people indoors, organized sports are suspended and theatres must close.

Quebecers are also urged not to travel to Ontario or between regions at different levels on its scale except for essential reasons.

Even though most of the region has been declared a red zone, Premier François Legault said kids can trick-or-treat as long as they don’t go with friends and precautions are taken when giving out candy.

What about schools?

There have been more than 180 schools in the wider Ottawa-Gatineau region with a confirmed case of COVID-19:

Few have had outbreaks, which are declared by a health unit in Ontario when there’s a reasonable chance someone who has tested positive caught COVID-19 during a school activity.

As of mid-October, a small fraction of Ottawa students and staff had tested positive.

Distancing and isolating

The novel coronavirus primarily spreads through droplets when an infected person coughs, sneezes, breathes or speaks onto someone or something.

People can be contagious without symptoms.

This means people should take precautions such as staying home when sick, keeping hands and frequently touched surfaces clean, socializing outdoors as much as possible and maintaining distance from anyone they don’t live with — even with a mask on.

Masks are mandatory in indoor public settings in Ontario and Quebec and are recommended outdoors when people can’t distance from others.

A woman in a mask looks at the temporary Prismatica public art installation on Sparks Street in Ottawa on its last day this past Sunday. (Trevor Pritchard/CBC)

Anyone with symptoms or who’s ordered to do so by their local public health unit should self-isolate. The duration is subject to a range stipulated by health officials in both Ontario and Quebec.

Health Canada recommends older adults and people with underlying medical conditions and/or weakened immune systems stay home as much as possible. 

Anyone who has travelled recently outside Canada must go straight home and stay there for 14 days.

WATCH | COVID-19 and Vitamin D:

Several clinical trials are trying to determine whether vitamin D could be effective in helping to treat or prevent COVID-19, while a new study shows many patients in a Spanish hospital had a vitamin D deficiency. 1:58

What are the symptoms of COVID-19?

COVID-19 can range from a cold-like illness to a severe lung infection, with common symptoms including fever, a cough, vomiting and the loss of taste or smell. 

Less common symptoms include chills, headaches and pink eye. Children can develop a rash.

If you have severe symptoms, call 911.

Mental health can also be affected by the pandemic and resources are available to help.

Where to get tested

In eastern Ontario:

Ontario recommends only getting tested if you have symptoms, or if you’ve been told to by your health unit or the province.

Anyone seeking a test should now book an appointment. Different sites in the area have different ways to book, including over the phone or going in person to get a time slot.

Testing numbers have been lower than the groups running it would like and they want people to know there are often same-day appointments available.

People without symptoms, but who are part of the province’s targeted testing strategy, can make an appointment at select pharmacies.

Ottawa has five permanent test sites, with additional mobile sites deployed wherever demand is particularly high.

Pedestrians cross Wellington Street in Ottawa Oct. 26, during the COVID-19 pandemic. (Sean Kilpatrick/Canadian Press)

The Eastern Ontario Health Unit has sites in Alexandria, Cornwall, Hawkesbury, Limoges, Rockland and Winchester.

The Leeds, Grenville and Lanark health unit has permanent sites in Almonte, Brockville, Kemptville and Smiths Falls.

Kingston’s test site is at the Beechgrove Complex. The area’s other test site is in Napanee. Both are open seven days a week.

WATCH | Signs of waning antibody immunity to COVID-19 over time:

A new study out of the U.K. has found COVID-19 antibodies can disappear quickly from people who’ve had the virus, which experts say makes herd immunity unlikely without a vaccine. 3:33

People can arrange a test in Bancroft and Picton by calling the centre or Belleville and Trenton online.

Renfrew County residents should call their family doctor or 1-844-727-6404 for a test or with questions, COVID-19-related or not. Test clinic locations are posted weekly.

In western Quebec:

Tests are strongly recommended for people with symptoms or who have been in contact with someone with symptoms.

Outaouais residents can make an appointment in Gatineau seven days a week at 135 blvd. Saint-Raymond or 617 avenue Buckingham.

They can now check the approximate wait time for the Saint-Raymond site.

There are recurring clinics by appointment in communities such as Gracefield, Val-des-Monts and Fort-Coulonge.

Call 1-877-644-4545 with questions, including if walk-in testing is available nearby.

WATCH | Canada passes 10,000 COVID-19 deaths:

Canada has surpassed 10,000 deaths from COVID-19 since the pandemic began. But behind that number there’s much loss, some lessons learned and fears of worse to come. 2:04

First Nations, Inuit and Métis:

Akwesasne has a COVID-19 test site available by appointment only. It expects to bring back its mobile site in the spring.

Anyone returning to the community on the Canadian side of the international border who’s been farther than 160 kilometres away — or visited Montreal — for non-essential reasons is asked to self-isolate for 14 days.

People in Pikwakanagan can book a COVID-19 test by calling 613-625-2259. 

Anyone in Tyendinaga who’s interested in a test can call 613-967-3603.

Inuit in Ottawa can call the Akausivik Inuit Family Health Team at 613-740-0999 for service, including testing, in Inuktitut or English on weekdays.

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Is more testing behind the record numbers of COVID-19 cases in Canada? Your testing questions answered – CBC.ca

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We’re answering your questions about the pandemic. Send yours to COVID@cbc.ca, and we’ll answer as many as we can. We publish a selection of answers online and also put some questions to the experts during The National and on CBC News Network. So far, we’ve received more than 55,000 emails from all corners of the country.

COVID-19 testing is a crucial part of tracking and managing the pandemic. It has become a part of daily life that’s often necessary for returning to work or school or for keeping friends and family safe. 

But it also generates a lot of confusing news and advice from case counts to wait times to ever-changing instructions about who needs to get tested, when, how and why.

It’s no wonder CBC readers have lots of questions. We checked with experts to get some of the answers.

Is the present spike in COVID-19 cases in Canada related to the increase in testing?

Many provinces have been breaking daily new case records for COVID-19, including British Columbia, Alberta, SaskatchewanManitobaOntario, and Quebec. But these provinces are all running more tests now than they were at the previous peak in the spring when a shortage of tests meant even people with very typical COVID-19 symptoms couldn’t get tested. So, are the increased case counts simply due to more testing? For the most part, no. But the amount of testing does make a difference.

For Ontario, the new records are partly due to the increase in testing, said Dr. Sumon Chakrabarti, an infectious disease specialist with Trillium Health Partners in Mississauga, Ont., in an interview with CBC News Network.

Ontario completed over 48,000 tests on Oct. 7 (two days before setting a record of 949 cases in one day) — about quadruple the 12,000 it ran on April 24 when the province hit a spring peak of 640 cases. 

At that time, Chakrabarti estimates about three-quarters of cases were being missed, and there were likely closer to 2,500 cases a day in late April.

However, the real number of cases in Canada is definitely higher than it’s been since the spring peak. 

All things being equal, if you test more of the population, you will end up testing more people with COVID-19, which will cause the case counts to go up, but you will typically test even more people without COVID-19, causing the percentage of positive tests to decrease, said Cynthia Carr, founder of the Winnipeg-based epidemiology consulting firm EPI Research Inc.

But in fact, the percentage of tests that come back positive is increasing in many places, including Manitoba. In that province, the real number of cases is “definitely an increase relative to the spring.” 

And in Ottawa, SARS-CoV-2 virus levels in waste water in recent weeks are the highest they’ve been since testing began in June. That’s a measure of COVID-19 prevalence independent of the amount of testing at testing centres, said Raywat Deonandan, an associate professor of epidemiology at the University of Ottawa. 

The good news? Coronavirus levels in waste water seem to be going down since the province imposed stricter restrictions on social gatherings in the city before Thanksgiving.

WATCH | How sewage can be used to track COVID-19:

Wastewater samples from sewage are being used to determine the existence of COVID-19 in communities and could give advance warning of where a second wave is taking shape. 2:03

If we can test feces in waste water for coronavirus, why are we still doing invasive nasal swabs?

Having your nose swabbed can feel really uncomfortable, but Dr. Matthew Cheng, an assistant professor of medicine at McGill University, said there are practical reasons for it:

  • Public health doctors are more interested in knowing if the virus is in the respiratory tract, which the nose is part of, as it’s mainly spread via the respiratory tract.

  • Lab protocols are optimized to process lots of respiratory samples and having other kinds of samples could slow down analysis.

He said that there’s lots of work underway to be able to quickly analyze respiratory tract samples that are easy for people to collect themselves, such as “swish and gargle” saliva tests. Lastly, many people may not find collecting a stool sample easier than getting a swab in the nose.

WATCH | A closer look at saliva-based tests:

Instead of waiting in a long line for a COVID-19 test that involves getting a swab stuck up the nose and sometimes waiting days for results, scientists are developing saliva-based tests and produce results in minutes. Is the future of testing more comfortable and done at home? 5:58

How long are test samples good for?

With backlogs in testing in Ontario this fall, at least one local health director has complained about tests spoiling and having to be redone after they weren’t processed within 72 hours. Dr. Robert Cushman, acting medical director of Renfrew County and District Health Unit in Ontario, reported that the testing lab told him that about 10 tests had to be redone due to delays in processing.

So how long do they last?

It depends on how the swab is stored after collection, said Allison McGeer, an infectious disease specialist at Toronto’s Mount Sinai Hospital, but generally speaking, it should last weeks.

Benoît Hébert, a Quebec-based biotechnology consultant, said most biological samples including nasopharyngeal swabs can be stored at regular fridge temperatures for up to 72 hours and should be deep frozen if there is any delay in testing or shipping.

According to Public Health Ontario, tests have about a 95 per cent accuracy rate as long as the test is processed within seven days of collection, and the sample is taken using a nasopharyngeal swab.

As of mid-October, more than half the tests in Ontario were processed within two days, the Health Ministry told CBC News in an email. It said that accredited labs conducting testing must have equipment in place to keep specimens at a stable temperature before testing, and it recommends freezing samples to preserve them.

“In the event a laboratory would report a specimen as expired, they would contact the testing site to ensure that re-collection occurs,” the ministry said.

WATCH | A closer look at rapid COVID-19 testing:

Doctors answer viewer questions about COVID-19 testing in Canada, including how effective it is and who should be tested. 4:58

I got COVID-19 and isolated for the required time. But I’m still testing positive. What does that mean? 

“Many people have these lingering positive tests,” acknowledged Chakrabarti, and that can happen weeks or months after they recover. But at that point, he said, “they’re not actually contagious.”

Dr. Zain Chagla, medical director of infection control at St. Joseph’s Healthcare in Hamilton, explained that’s because COVID-19 tests detect genetic material from the virus, which can be shed from your body even when all the viruses are dead.

So how long is a COVID-19 patient contagious?

Chagla said that researchers trying to culture live virus from patients have found there are minimal amounts in most people 10 days after they experience their first symptoms and after 20 days in critically ill patients. That suggests they’re not contagious after those periods.

“There’s also been no case reports of people being infected by others who are 10+ days into their illness,” Chagla added in an email.

That’s why 10 days (instead of 14 days) is now the standard time recommended to self-isolate after your symptoms start in places such as Ontario and B.C. 

It also means long-haulers, people who are still experiencing symptoms months after they got infected, are not contagious.

WATCH | Doctors take questions and give answers about COVID-19 testing:

There is a growing push to have Canada focus on COVID-19 tests that detect who is contagious rather than who is positive for the virus. These tests are available elsewhere in the world, cheaper and can be done at home, but they aren’t approved in Canada. 6:05

I’ve recovered from COVID-19, but my boss says I need to test negative before I can return to work. Can they ask me for one?

Given that people can test positive for weeks or months after recovery and aren’t contagious, a request like this may be frustrating.

But the answer is yes.

Even if you’ve completed isolation and public health has cleared you, employment lawyer Howard Levitt said it’s within your employer’s rights to require a negative test — and they’re not obliged to pay you if you’re unable to work. 

“Safety trumps privacy. That’s the bottom line,” said Levitt, noting that employers could ask for a negative test result every two weeks, if they wanted to, needing no other reason than ensuring a safe workplace. 

So what can workers do?

You could try talking with your boss or getting a doctor’s note, said Maggie Campbell, a partner at Vancouver law firm Roper Greyell. 

Other than that, Levitt says there isn’t much you can do. You can offer to work from home, if possible, or you could take your employer to court, but he cautioned that courts may not be in workers’ favour in the current climate. 

“Employees should understand that anything an employer is doing to protect other employees of theirs will be seen very sympathetically by the courts.”

However, companies should be up-to-date with the latest public health guidelines, he said. 

If your employer sends you home without pay while awaiting a negative test result, you could apply for Canada Recovery Sickness Benefit, providing you are eligible.

WATCH | Labour lawyer answers questions about work during pandemic:

Employment lawyer Howard Levitt answers your question about work during the COVID-19 pandemic, including when it’s in your best interest to refuse to go back to work. 14:13

I have symptoms but tested negative. Do I still have to self-isolate?

It’s always best to check with your health-care provider or local public health unit for advice specific to your personal situation. But symptomatic individuals may be advised to continue isolating for the remainder of the isolation period, even if they get a negative result. 

That’s because a negative result isn’t a guarantee that you don’t have the virus.

According to Dr. Kelly MacDonald, head of the infectious disease program at the University of Manitoba, the nasal swab test is accurate 99 per cent of the time in a laboratory setting, but in a clinical setting errors can happen when the sample is taken. For example, the swabbing may not be done properly. 

A negative test could also mean that you were tested too early before viral levels are high enough to be reliably measured

Ultimately, context is important, and your doctor or local health unit would form their advice on a number of factors, including whether there was exposure to a known case, the kind of symptoms you have, how long you’ve had them and whether you’re a student, or you work with vulnerable individuals, for example.

And even if you don’t have COVID-19, you could still be contagious with something else — perhaps the flu — in which case, the same public health advice to stay home when sick would still apply.

On the other hand, if you get a positive test, you almost certainly have COVID-19 — the false positive rate is very low — less than one per cent of tests overall, estimates Dr. Philippe Lagacé-Wiens, a medical microbiologist at St. Boniface Hospital in Winnipeg.

WATCH | Why people with COVID-19 symptoms should be reassessed if they test negative:

Infectious disease physician Dr. Isaac Bogoch discusses new research on the rate of ‘false negatives’ in coronavirus tests and why people with persistent COVID-19 symptoms should be reassessed even if they test negative.  2:24

If you’re a contact of someone who tested positive, why are you supposed to get tested within 2 weeks of exposure? Wouldn’t the virus still be developing?

While it can take up to 14 days for symptoms to develop, Charkrabarti said that most people start to develop symptoms within seven days.

“And you can actually test positive a couple of days before that,” he said.

So ideally, you should wait about three to four days after exposure before getting tested, he recommends. 

However, any result could still be a false negative, so if you were exposed, you should remain in quarantine for 14 days even if you test negative.

Are tests at pharmacies as accurate as those at provincial testing centres?

Two provinces have been offering tests in pharmacies to people without COVID-19 symptoms: Alberta and Ontario.

In general, people with no symptoms are more likely to get a false negative than those with symptoms, but it’s not known by how much.

In Alberta, the tests are identical to those offered at provincial testing sites and analyzed at the same labs, the provincial Health Ministry says. That means they should have similar accuracy to tests of asymptomatic people at testing centres. However, Alberta announced on Oct. 20 that it would stop testing asymptomatic people with no known exposure to COVID-19 — the only people who could get tested in pharmacies.

In Ontario, there are some differences between pharmacy tests and those offered at provincial testing centres. Pharmacy tests use shorter nasal swabs instead of the long nasopharyngeal swabs, and they’re sent to the California lab of Quest Diagnostics instead of in-province labs, says the provincial Health Ministry.

Chagla says the sensitivity may be slightly lower with the shorter swabs, but this shouldn’t be a big risk, as the probability of asymptomatic people having COVID-19 is lower than people with symptoms, especially if they haven’t been exposed.

WATCH | How pharmacy testing works in Ontario:

CBC’s Tahmina Aziz speaks with Thibert and outlines the criteria Windsorites must meet to be tested in a pharmacy. 1:45

I think I had COVID-19, but I’m better now. Can I be tested to confirm?

The nose swabs at testing centres can only detect current or very recent infections, not whether you’ve been previously infected. To find that out, you need an antibody test. Such tests are available 14 days after active infection, with a doctor’s prescription, in some provinces. Dynacare offers the service in Ontario and Quebec. Ichor Blood Services offers it in some communities in Alberta, Ontario and New Brunswick. The fee is typically $70 to $80.

However, studies have shown that even among those infected, antibodies fade with time, and it happens far more quickly in those who never showed symptoms.

WATCH | A closer look at the 1st antibody test Health Canada approved in May:

Health Canada says it has authorized the first COVID-19 serological test for use in the country to detect antibodies specific to the virus.   3:09

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School Flu Vaccine Information Coming Soon – VOCM

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The regional health authorities are starting to distribute information on free flu shots for students in the school system.

The provincial government announced earlier this month that it would be providing flu shots in schools and long-term care homes to help encourage influenza vaccination rates.

Public health officials are most concerned about the possible strain to the health care system caused by the flu and COVID-19. The flu can seriously affect vulnerable patients. It’s spread was suddenly halted earlier this year due to public health measures imposed.

This year all school staff and students from grades 4 to 12 will be offered flu vaccines at school. Parents will not be accommodated in schools and are being encouraged to make an appointment for their own flu shot at a flu clinic, or through their doctor or local pharmacy. Parents will not be permitted to enter the school to support or comfort their child. If the child does require support, parents are encouraged to take their child to a flu clinic.

Consent forms are in the process of being distributed over the coming days.

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