I asked Dr Rishi Ghosh (intensivist at SAH) and Dr Greg Berg, our pulmonologist, about COVID-19 treatment in our Sault Area Hospital.
Dr Ghosh said, “We’ve had several COVID patients come through the ICU, some from Southern Ontario, a few local and several from Manitoba.
Our treatment has been fairly similar to what’s being offered elsewhere in Ontario which is Remdesavir and Roche’s arthritis drug Actemra (tocilizumab), a monoclonal antibody against IL-6 (not a monoclonal drug against the virus itself).
In addition Dexamethasone is given to all of our Covid patients.”
Rishi added “It is difficult to comment on whether these actually made a difference due to our small sample size and varied degree of co-morbidities in the patients.”
I also asked Dr Greg Berg about Regeneron’s monoclonal antibodies and whether or not they were available at SAH.
Clinical trials show that Regeneron’s monoclonal antibody treatment, a cocktail of two antibodies called Casirivimab and Imdevimab, called REGEN-COV, reduces COVID-19-related hospitalization or deaths in high-risk patients by about 70%.
And when given to an exposed person – like someone living with an infected person – the monoclonal antibodies reduced their risk of developing an infection with symptoms by 85%.
When the antibodies bind to the Coronavirus spike protein, they block the virus from entering the body’s cells.
If the virus can’t enter cells, it can’t make copies of itself and continue spreading within the body.
If a person is already sick, monoclonal antibodies prevent them from having severe symptoms that lead to hospitalization, intubation, ICU admission and death.
If someone has been exposed, monoclonal antibodies can fend off the virus to prevent them from becoming sick in the first place.
Monoclonal antibodies were first authorized as an IV infusion and are most commonly given at infusion centers.
But a recent study showed they can also be given as a shot subcutaneously into the belly when an IV isn’t as accessible.
On 21 November 2020, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for REGEN-COV, Casirivimab and Imdevimab, to be administered together for the treatment of mild to moderate COVID-19 in people 12 years of age or older weighing at least 40 kilograms (88 lb) with positive results of direct SARS-CoV-2 viral testing and who are at high risk for progressing to severe COVID-19.
This includes those who are 65 years of age or older or who have certain chronic medical conditions.
On 12 January 2021, the United States government agreed to purchase 1.25 million doses of the drug for $2.625 billion, at USD$2,100 per dose.
On 14 September, another 1.4 million doses were purchased for the same price, totalling $2.94 billion.
REGEN-COV is indicated to be used only as post-exposure prophylaxis for adults and paediatric individuals (12 years of age and older weighing at least 40 kg) who are:
– at high risk for progression to severe COVID-19, including hospitalization or death, and
– not fully vaccinated or who are not expected to mount an adequate immune response to complete SARS-CoV-2 vaccination (for example, people with immunocompromising conditions, including those taking immunosuppressive medications), and
– have been exposed to an individual infected with SARS-CoV-2 consistent with close contact criteria per Centers for Disease Control and Prevention (CDC), or
– who are at high risk of exposure to an individual infected with SARS-CoV-2 because of occurrence of SARS-CoV-2 infection in other individuals in the same institutional setting, for example, nursing homes or prisons (there is currently an outbreak of 3 cases on a medical ward in SAH)
REGEN-COV is not authorized for people who are hospitalized due to COVID-19 or require oxygen therapy due to COVID-19.
A benefit of Casirivimab and Imdevimab treatment had not been shown in people hospitalized due to COVID-19 (until the study in the UK in June).
Monoclonal antibodies, such as Casirivimab and Imdevimab, may be associated with worse clinical outcomes when administered to hospitalized people with COVID-19 requiring high flow oxygen or mechanical ventilation.
But in June, a large UK study of almost 10,000 patients, showed that REGEN-COV reduced deaths in hospitalized patients whose own immune systems had failed to produce a response.
It found that the antibody therapy reduced by 20% the 28-day mortality of people admitted to hospital with COVID-19 whose immune system had not mounted an antibody response.
Famously, Donald Trump was treated with REGEN-COV in October 2020, when he was admitted with COVID.
Trump received 8 drugs including Dexamethasone, Remdesavir, Regeneron’s monoclonal antibody cocktail, Zinc, Famotidine, Vitamin D, Melatonin and ASA.
The U.S. has purchased nearly three million doses at a cost of around USD$2,100 each and is making the treatment available to all patients for free.
In the U.S., some states have set up dedicated antibody treatment centres for REGEN-COV infusion for COVID-19 patients.
In Florida, state-run monoclonal antibody infusion clinics have been swamped with unvaccinated COVID patients seeking the free treatments.
Data showed that Regeneron’s drug has the potential to provide long-lasting immunity from COVID-19 infection, making it particularly helpful for immunocompromised people and those unresponsive to vaccines.
Regeneron Pharmaceuticals Inc said on Nov. 8 that a single dose of its antibody cocktail reduced the risk of contracting COVID-19 by 81.6%, in the two to eight months period following the drug’s administration.
The antibody therapy, REGEN-COV, is currently authorized in the United States to treat people at high risk of exposure in settings such as nursing homes or prisons.
And the World Health Organization endorsed the medication for some patients at high risk of hospitalization.
But in Canada, this and other drugs, known as monoclonal antibody treatments, are hardly being used — even though doctors say they would be an incredibly useful addition to their COVID-fighting arsenal.
“This new antibody cocktail is the one that is probably the most promising for people with mild COVID-19 and also seems to be promising for people who are hospitalized with COVID-19, who are naïve to the virus: so they haven’t been vaccinated or they haven’t been infected before,” said Dr. Amol Verma, a physician and scientist at St. Michael’s Hospital and the University of Toronto.
These drugs are a direct shot of antibodies targeting the virus that causes COVID-19, he said, designed to help people who have already been infected better fight it off, and lessening the chance that they may have to be hospitalized.
“From everything that we know so far, and we have several studies on this, it’s remarkably effective,” said Dr. Andrew Morris, an infectious diseases physician at Sinai Health and University Health Network and professor at the University of Toronto.
But although he thinks it’s useful, Dr Morris said, “In Canada, we just don’t have enough of it.”
According to the Public Health Agency of Canada, Canada has received 6,000 doses of the antibody cocktail, with another 3,000 doses due to come in October – far less than the U.S.’s order of 3 million doses.
Almost every province contacted reported limited supply, with some like New Brunswick saying the treatment wasn’t available at all. There are a few reasons why these treatments aren’t broadly used in Canada, said Dr. Theresa Tam, chief public health officer of Canada, at a press conference this summer.
“It’s not really fundamentally about cost. There’s access, but also feasibility of delivery,” she said.
“For example, one of the antibody combinations used to have to be given intravenously. And there’s new data to show that you can actually give it under the skin now, and that might then increase the viability of the use of these medications in the frontline setting.”
The logistics of actually giving the medication to people are definitely a barrier, said Dr. Donald Vinh, an infectious disease specialist and medical microbiologist at the McGill University Health Centre.
“These antibodies, because they require an intravenous infusion, necessarily required an infusion centre,” he said.
“And infusion centres are usually done in a hospital setting where you bring people in and you have dedicated health-care personnel who put an intravenous into that person and they give them the medications and they make sure they don’t have any reactions.”
In the middle of a pandemic, there were issues finding personnel to do this, he said, and with making sure that the antibody patients – who have active COVID-19 – are kept away from other people in the hospital.
“Now you’re bringing these people who are infected into a hospital setting, which is obviously not a good thing because you don’t want them exposing other people with a virus,” he said.
In the U.S., some states have set up dedicated antibody treatment centres for COVID-19 patients.
Dr Vinh is hoping to do something similar in Canada, in a dedicated area of the McGill University Health Centre in Montreal, with negative pressure rooms and specially trained staff to ensure that infections don’t spread.
Like Dr Tam, he thinks that new ways of delivering the drug subcutaneously will help solve logistical problems too.
Canada should “absolutely” use monoclonal antibody treatments more, Dr Morris said.
“I think it is problematic that we haven’t been using the therapies yet or if we have, it’s been minimal. I see it as a very, very important part of our strategy of keeping people out of hospital and out of ICUs.”
While Dr Vinh said vaccination is still the most important strategy for fighting the pandemic, antibody treatments have their place.
“These monoclonal antibodies are a welcome addition. They are not a silver bullet,” he said. But for people who get vaccinated but still get infected with COVID-19 and are at risk of complications, they are another tool, he added.
“We can’t just sit idly by and let them get infected and deteriorate. If they’ve done their part to get the vaccine, we need to do our part to make sure that we still protect them as much as we can.”
Dr Greg Berg said that REGEN-COV hasn’t been used in SAH because it has to be shipped from Toronto, it has to be used as early in the disease as possible and there’s no place in SAH to give it.
“Patients present late.
This lady that died was unvaxxed and whole family anti-vaxxer
Plus she presented really late.
So I checked on the antibody thing. We are getting them.
I know when the spring there was just a study and we had to get them from Toronto but they’ve been approved so we are getting them
But they have to be given early on often and outpatient settings.
So that is a bit of a challenge.
We don’t really have a place in the hospital to give COVID patients medication.
So I don’t know what we’re going to do plus Medical Day Care is always full.”
A 9th patient died of COVID in SAH last week.
There have been 661 confirmed cases in SSM since March 2020, with 113 active cases, and 7 hospitalised as of Nov. 12.
One patient who died of COVID this past summer was an acquaintance.
He picked up COVID on an airplane trip from Toronto and presented to SAH very early in his illness.
The obvious question is, would the outcome have been far different if he had received Regeneron’s monoclonal antibody treatment??
Breakthrough COVID-19 cases happen in people who are fully vaccinated, and they seem to happen more frequently now that the delta variant is circulating widely.
A study in Washington state gathered data from over 4 million fully vaccinated people.
The data showed a rate of about 1 in 5,000 experienced a breakthrough infection between January 17 and August 21, 2021.
More recently, some populations have shown breakthrough infection rates of approximately 1 in 100 fully vaccinated people.
In a large study in Israel of 1,497 fully vaccinated (with 2 doses of Pfizer mRNA vaccine) health care workers, 39 SARS-CoV-2 breakthrough infections were documented, for a rate of 2.8 cases per 100 fully vaccinated patients.
Of these 39 positives, 29 had high viral loads and 7 went on to develop “Long COVID”.
Although any fully vaccinated person can experience a breakthrough infection, people with weakened immune systems caused by certain medical conditions or treatments (including organ transplants, HIV and some cancers and chemotherapy) are more likely to have breakthrough infections.
It is important to differentiate between “Breakthrough COVID Infection” and “Breakthrough COVID Disease.”
A new study from the CDC published last Friday finds that people who are vaccinated were five times less likely to develop symptoms of COVID-19, the disease..
Those who did develop symptoms were 10 times less likely to be hospitalized and die from the disease.
Around 7,000 Americans and 450 Canadians who were fully vaccinated have died from COVID-19.
Doctors note it remains rare, and that getting the vaccine is still extremely important as it protects you and others from the disease.
“When we’re hearing about some individuals who are dying who happen to have been fully vaccinated, it starts creating doubt in the minds of others about whether the vaccine is even worth it at all,” said Dr. Samir Sinha, director of geriatrics at Sinai Health and the University Health Network in Toronto.
“But we do know that those who are vaccinated have a far, far, far lower chance of potentially getting sick and even dying than those who are unvaccinated,” he said.
At least one large study suggests that being vaccinated reduces the chance that you will end up with lingering symptoms of COVID-19, sometimes referred to as “Long COVID.”
The Public Health Agency of Canada estimates that fully vaccinated individuals are 79% less likely to be hospitalized with COVID-19 and 62% less likely to die as a result of their illness.
Only 1.54% of deaths were in fully vaccinated people, their data shows.
In the US, of 759,000 COVID deaths, 7,000 were in fully vaccinated individuals – 0.92%.
“There are a group of people who have either conditions or treatments for their conditions that compromised their immune system and prevent them from being able to even adequately respond to the vaccine to begin with,” Dr Vinh said.
Elderly people have weaker reactions to the vaccine.
“The people I’m concerned about now are the older people,” he said. “We recognize now that antibody levels do decline. And then in older people, there’s a chance that they may not be able to fight infection if they get it.”
According to data from the CDC, 85% of fully vaccinated Americans who died from COVID-19 were aged 65 or older.
I am over 65.
I have been doubly vaccinated for COVID.
If I were to acquire COVID, the chances for severe illness, intubation, ICU admission and death would be very low.
But not zero.
REGEN-COV is available at Sault Michigan’s War Memorial Hospital ER.
Would it be wise then, “out of an abundance of caution”, to cross the bridge and go to Sault Michigan’s War Memorial Hospital ER to get an infusion of monoclonal antibodies???
FLUVOXAMINE
But there may be an easier, far less expensive alternative – Fluvoxamine (Luvox), an antidepressant (an SSRI – a Selective Serotonin Re-uptake Inhibitor) given to symptomatic COVID patients, reduces deaths by 90% and the need for ICU treatment by 67% and hospitalization by 32%.
Cost for generic 10 day course of Fluvoxamine – $4.
On 0ct. 27, the prestigious medical journal, the Lancet published the results of the “TOGETHER” trial for acutely symptomatic patients with COVID-19, to assess the efficacy of Fluvoxamine versus placebo in preventing hospitalisation.
This placebo-controlled, randomised trial done among high-risk symptomatic Brazilian adults confirmed positive for SARS-CoV-2 included eligible patients from 11 clinical sites in Brazil with a known risk factor for progression to severe disease.
The study was spearheaded by principal investigator Ed Mills and other researchers associated with McMaster University in Ontario.
The team included world-renowned clinical trial experts from McMaster, including Dr. Gordon Guyatt, credited with coining the term “evidence-based medicine.”
It was part of their larger Together trial that tested a number of potential drug treatments against COVID.
The researchers looked at the rate of hospitalization among patients with test-confirmed infection.
Patients were randomly assigned (1:1) to either Fluvoxamine (100 mg twice daily for 10 days) or placebo (or other treatment groups).
The trial team, site staff, and patients were masked to treatment allocation.
The study team screened 9,803 potential participants for this trial and selected 3,323 participants.
The trial was initiated on June 2, 2020 and ran to Aug 5, 2021, when the trial arms were stopped because of the superiority of the Fluvoxamine arm.
741 patients were allocated to fluvoxamine and 756 to placebo.
1,826 patients were assigned to groups who received other drugs – e.g. 739 received Ivermectin, 239 Hydroxychloroquine, 215 Metformin. The other studied drugs, including Metformin, Vitamin D, Zinc, and much-debated candidates such as Hydroxychloroquine and IVERMECTIN, showed NO DETECTABLE BENEFIT.
But the study found that 77 of the 739 subjects who were randomly selected to receive fluvoxamine ended up spending more than six hours in an emergency department or being admitted to hospital, compared to 108 of the 733 who were administered a placebo, a 32% reduction among those receiving Fluvoxamine compared to those who did not.
Studies on Fluvoxamine were precipitated by the observation in 2020 that psychiatric patients on SSRIs in France were not getting sick with Covid-19 at the same rate or with the same severity.
A large observational study from France involved 7,230 hospitalised COVID-19 patients, and reported a reduction in intubation or death with use of SSRIs.
Studies have shown that Fluvoxamine, a Selective Serotonin Re-uptake Inhibitor (SSRI) with high affinity for the σ-1 receptor, S1R, reduces damaging aspects of the inflammatory response during sepsis through the S1R-IRE1 pathway, and prevents cytokine storm.
Fluvoxamine was then tested by Drs. Eric Lenze and Angela Reiersen at George Washington University in St. Louis in a double-blind randomized clinical trial published in the Journal of the American Medical Association on Nov. 12, 2020
152 trial participants, diagnosed with mild COVID-19 were randomized to receive either Fluvoxamine or placebo.
Of the 80 participants who received Fluvoxamine, NONE hit the endpoint of clinical deterioration, which was defined as oxygen saturation of 92% or lower, along with difficulty breathing or hospitalization for pneumonia.
By comparison, 6 of 72 patients, or 8.3%, who took placebo tablets worsened and needed hospitalization, researchers reported in November in the Journal of the American Medical Association.
Big Pharma has come out with 2 new highly-touted – and expensive – antiviral drugs for COVID.
Merck has priced Molnupiravir (Lagevrio) at US$700 for a 5 day course.
Taken orally within 3 days of symptoms starting.
50% effective in preventing hospitalisation and death. Pfizer’s Paxlovid, another antiviral, taken orally, was given to patients at high risk.
Paxlovid is a combination of two different drugs – the HIV drug Ritonavir and an experimental protease inhibitor.
A five day course, given within three days of symptoms starting, reduced hospitalisation by 89% and there were no deaths in the Paxlovid treatment arm.
There were 10 deaths in the untreated arm of 385 persons.
Pfizer has not yet announced pricing but they have said it will be “affordable”.
US$500?
Fluvoxamine might be considered by doctors for off-label use to treat COVID-19 patients early in their disease.
Even if vaccines or other therapeutics are used as a first line of defence, Fluvoxamine may dramatically decrease the odds that someone will need to be hospitalized.
Fluvoxamine is inexpensive, it’s safe, widely available, it’s generic and it’s oral, easy to use.
Doctors can prescribe drugs approved as a treatment for one condition to treat another condition off-label, using their clinical judgment.
“Off-label” use means that a drug is being used in a way that has not been reviewed and authorized by Health Canada.
“It’s USD$2,100 for a dose for a monoclonal antibody,” Ed Mills said.
“Fluvoxamine costs $4.”
The supply chain, too, is simpler.
Fluvoxamine doesn’t need to be kept in a freezer, doesn’t expire quickly, and can be mass-manufactured cheaply.
It’s been around for decades (developed in 1983, in Canada since 1994) so its safety profile is well-known.
If it continues to show health benefits for Covid-19 patients, making it widely available in poor countries could help them weather the delta variant currently surging.
So in that sense it could be a world-wide drug.
But Fluvoxamine is generic and dirt cheap, so Big Pharma has no motivation to push it.
Skinstitut Holiday Gift Kits take the stress out of gifting
Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.
In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.
“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.
There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.
Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.
Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.
In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.
Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?
It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.
Here’s how you can prepare your digital life for your survivors:
Apple
The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.
For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.
You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.
Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.
Google
Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.
When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.
You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.
There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.
Facebook and Instagram
Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.
When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.
The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.
You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.
TikTok
The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.
Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.
X
It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.
Passwords
Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?
Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.
But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.
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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.
The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.
New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.
The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.
Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.
Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.
“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.
“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”
McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.
But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.
The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.
He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.
“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.
“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.
McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”
McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.
He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.
“Early identification of reading difficulty can truly change the trajectory of a child’s life.”
This report by The Canadian Press was first published Oct. 23, 2024.
