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SARS lessons help Canada prep for COVID-19, but hospital capacity a worry – Yahoo News Canada

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SARS lessons help Canada prep for COVID-19, but hospital capacity a worry

OTTAWA — Canadian medical experts say the country’s already overstretched emergency rooms would find it difficult to cope if a true outbreak of the novel coronavirus, or COVID-19, were to take hold in Canada.

So far, the virus has been relatively contained to mainland China, thanks in part to one of the largest quarantines in modern history.

“We must not look back and regret that we failed to take advantage of the window of opportunity that we have now,” Dr. Tedros Adhanom Ghebreyesus, director general of the World Health Organization, said in a message to all the world’s countries Friday.

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The risk of contracting the virus in Canada right now is extremely low, and public health officials have been lauded for their efforts to detect and isolate the nine cases confirmed in the country so far.

The hundreds of patients across the country who have tested negative for the virus are also a sign that containment efforts are working as they should.

But Canada’s most recent case in British Columbia has raised fears about where and how the disease is being transmitted abroad. Unlike others who’ve imported the virus from China or from people who have recently been to China, the woman in her 30s contracted the illness while in Iran.

“Any imported cases linked to Iran could be an indicator that there is more widespread transmission than we know about,” said Canada’s chief medical officer Dr. Theresa Tam Friday.

Canada has taken major steps to prevent the kind of shock that befell Ontario during the outbreak of the coronavirus known as SARS in 2003 that led to 44 deaths. Creating the Public Health Agency of Canada, which Tam heads, is one of them.

The country is now better co-ordinated, has increased its lab-testing capabilities and is prepared to trace people’s contacts to find people who might have caught a contagious illness without knowing it.

But once the number of incoming cases reaches a critical mass, the approach must change, according to infectious-diseases physician Dr. Isaac Bogoch of Toronto’s University Health Network.

He likens the response to trying to catch fly balls in the outfield: as the number of balls in the air increases, they become harder and harder to snag.

“Every health care system has limits,” Bogoch says. “The question is, if we start getting inundated with cases, how stretched can we get?”

Many emergency-room doctors argue Canada’s ERs are already as stretched as they can get and are worried about what would happen if they suddenly had to start treating COVID-19 cases en masse.

From the public-health perspective, the greatest challenge may be as simple communicating across all parts of the health system across the country, said Dr. Jasmine Pawa, president of the Public Health Physicians of Canada.

“We cover a very wide geographic area,” she said, though she added that Canada has made great strides over the course of the SARS experience and the H1N1 flu outbreak in 2009.

Dr. Alan Drummond of the Canadian Association of Emergency Physicians, who works at the hospital in Perth, Ont., says he doesn’t want to fearmonger, especially considering all the lessons Canada has learned from past outbreaks, but the reality of life in the ER gives him pause.

“Our day-to-day experience in crowded hospitals, unable to get the right patient in the right bed on a day-to-day basis … makes us really question what the integrity of our health-care system would be like in a major severe pandemic,” Drummond says.

He envisions that a disease like COVID-19, if it spread widely, would have a major impact, including the possibility of cancelled surgeries and moving stable patients out of hospitals who would otherwise stay.

“I think there would have to be hard decisions made about who lives and who dies, given our limited availability by both speciality and (intensive-care) beds and we would probably see some degree of health-care rationing,” he says.

The problem may be even more pronounced because of Canada’s aging population, he said. The virus tends to hit older people harder, according to observations made in China and abroad, and is also particularly dangerous for people with other health problems.

Older people also tend to stay admitted in hospital beds even when they are in relatively stable condition because of a lack of long-term-care beds across the country.

That keeps emergency rooms from being able to move acute patients out of the ER and into those beds, limiting hospitals’ capacity to handle new cases.

Tam agreed Friday that hospital capacity is a “critical aspect” of Canada’s preparedness for a potential coronavirus outbreak, but said even very bad flu seasons can have a similar effect on emergency rooms.

“If we can delay the impact of the coronavirus until a certain period, when there’s less influenza for example, that would also be very helpful,” she said.

She also suggested people who are concerned about the possibility that they’re developing COVID-19 symptoms should call ahead to a hospital so they can make proper arrangements for containment and isolation.

Canada is doing its best, along with every other country in the world, to seize this time of relative containment and plan ahead, Tam said.

This report by The Canadian Press was first published Feb. 22, 2020.

Laura Osman, The Canadian Press

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At least five B.C. children died from influenza last month, as mortalities spike

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At least five children died last month in British Columbia from influenza as a rise of early season respiratory illnesses added strain to the beleaguered healthcare system.

The figure marks a departure from the average of two to three annual flu deaths among children in the province between 2015 and 2019, data from the BC Coroners Service shows.

“Public health is monitoring the situation closely and is reminding people of the steps they can take to protect themselves, their children and their loved ones against the flu,” the B.C. Centre for Disease Control said in a statement.

“It is important to know that death associated with influenza in previously healthy children continues to be rare.”

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The centre said it is aware of a sixth reported flu death among children and youth under 19, but it was not immediately clear why the sixth wasn’t included in the coroners’ figures.

Provincial Health Officer Dr. Bonnie Henry said the children who died included one who was younger than five years old, three who were between five and nine, and two adolescents who were between 15 and 19.

“Early findings indicate some of the children experienced secondary bacterial infections contributing to severe illness, which can be a complication of influenza,” Henry said in a statement Thursday.

The deaths in British Columbia suggest figures could tick up across the country given the common challenges facing health systems this respiratory season. Alberta has also recorded the deaths of two children with influenza so far this season.

Before the COVID-19 pandemic, an average of five to six kids died per flu season across Canada, data collected from 12 hospitals across the country shows.

The national data was collected between 2010 and 2019 by IMPACT, a national surveillance network administered by the Canadian Paediatric Association. It was included in a research paper published in March in “The Lancet Regional Health — Americas” journal that also found no deaths from the flu among children in either 2020 or 2021.

No one from either IMPACT or the B.C. Centre for Disease Control was immediately available for an interview.

On Monday, Henry said that after two years of low flu rates, mostly due to COVID-19 pandemic restrictions, the province is seeing a “dramatic increase” in illness and it arrived sooner than normal.

She urged parents to get their children vaccinated against the flu.

On Thursday, British Columbia’s Health Ministry announced a “blitz” of walk-in flu clinics that will open across the province Friday through Sunday. Flu vaccines are free to all kids aged six months and older in B.C.

The B.C. Centre for Disease Control said getting the shot is particularly important for those at risk of severe outcomes, including those with chronic medical conditions like heart, lung, kidney or liver disorders and diseases, those with conditions that cause difficulty breathing or swallowing, those who need to take Aspirin for long periods of time and those who are very obese.

The BC Coroners Service said its data is preliminary and subject to change while investigations are completed.

The cases include those where influenza was identified as an immediate, pre-existing or underlying cause of death, or as a significant condition.

Henry said updates on pediatric influenza-related deaths will be posted weekly as part of the respiratory surveillance summaries on the B.C. Centre for Disease Control website.

This report by The Canadian Press was first published Dec. 8, 2022.

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Cough and cold medication shortage to end next year, pharmacists association says

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Children’s Tylenol returning slowly to retail outlets in town

Parents with sick kids might be able to take a break from crushing adult Tylenol and mixing it with apple sauce if they hurry quickly to a local pharmacy.

Children’s Tylenol (acetaminophen) in liquid form began arriving at retail outlets in late November, but in such limited quantities that pharmacists are keeping them behind the counter and limiting them to one bottle per customer.

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A Shopper’s Drug Mart pharmacist The Daily Press spoke with on Tuesday wouldn’t say how much they’d received but advised to hurry while quantities last. A Rexall pharmacist is only selling children’s Tylenol to parents with sick kids, not to those just preparing for a rainy day.

Adam Chappell, owner and pharmacist at Parma Right in The 101 Mall, told The Daily Press he was expecting nine retail-sized bottles of children’s Tylenol last Wednesday, which he also planned to keep behind the counter and limit to one bottle per customer.

He predicts that more will become available, but that there will be extended shortages in the short term. Pharmacies are being allocated small amounts by the manufacturers, to spread out supply.

The shortage makes it difficult for parents to control fevers in their children, leading to more doctor visits, he said.

“We had more public health measures in place with COVID, so we had 1½ to two years where we really didn’t see much influenza or common cold,” said Chappell, whose independent pharmacy opened in November.

“So now we’re seeing everything all at once because we’re now socializing more. It’s that time of year, so we’re starting to see more influenza, cough and colds and COVID is still circulating. I think it’s a combination of higher use and some lingering logistical issues.”

Shelves sit half empty in the adult cough and cold section at the Shopper’s Drug Mart at 227 Algonquin Blvd. E. on Tuesday. The shortage is expected to end between January and March of 2023, said Jen Belcher with the Pharmacists Association of Ontario. The timing would coincide with the end of the cold and flu season.NICOLE STOFFMAN/The Daily Press
Shelves sit half empty in the adult cough and cold section at the Shopper’s Drug Mart at 227 Algonquin Blvd. E. on Tuesday. The shortage is expected to end between January and March of 2023, said Jen Belcher with the Pharmacists Association of Ontario. The timing would coincide with the end of the cold and flu season.NICOLE STOFFMAN/The Daily Press jpg, TD

A children’s drug shortage began in the spring and worsened in the summer when an early onset of flu and respiratory syncytial virus was made worse by COVID-19, which presents as a cold. Parents began stocking up.

When local manufacturers could not keep up with demand, Health Canada arranged to import supply from the United States and Australia, whose first shipment in early November went straight to hospitals, in part because the labels were not bilingual, Postmedia reported.

Health Canada has authorized 500,000 bottles of imported children’s acetaminophen for retail to arrive in December, and domestic supply is starting to recover, Jen Belcher with the Ontario Pharmacists Association told The Daily Press in a telephone interview.

“The demand really hasn’t abated, and manufacturing really hasn’t been able to keep up from a straight capacity standpoint, rather than a supply interruption with a lack of ingredients,” she said, when asked to respond to a claim by the German pharmacist’s association.

That organization asserts pandemic lockdowns in China are blocking exports of the raw ingredients used for medications, Postmedia reported Nov. 16.

If lockdowns in China continue, however, she conceded it could interrupt the ingredient supply in the long-term.  There is also a global reliance on India for the raw ingredients used in over-the-counter medication.

Canadian manufacturers can tap various international suppliers if approved by Health Canada, Belcher said.

Children’s Advil (ibuprofen), an anti-inflammatory, continues to be in short supply in pharmacies, but available in hospital. Neither Belcher nor Chappell has heard reports of Health Canada planning to import it for retail outlets.

Adult Tylenol and Advil remain plentiful.

Chappell recommends that parents speak to their pharmacist to determine a dosage of adult pills based on the child’s weight and symptoms. They can be crushed and added to yogurt, apple sauce or chocolate syrup.

If parents can wait a few days for the package to arrive, they can order a supply for their child from a compounding pharmacist, who is qualified to make custom medications including liquid formulations. There are several compounding pharmacists in Sudbury, but none in Timmins.

Adults in Timmins who have come down with a cold or flu lately may also have been surprised to see empty shelves in the adult cough and cold section of their local pharmacy.

“When it comes to cough and cold medication for both adults and children, we’re not seeing an imported supply of those. Those are short and have been for quite some time due to this high level of demand, small amounts have been trickling through the supply chain but it hasn’t been enough to keep up with demand,” said Belcher.

She expects the adult cough and cold medication shortage to end sometime between January and March, 2023, just in time for the end of flu season.

A quick check of the adult cough and cold section of four downtown pharmacies on Tuesday showed partially empty shelves, but there was still a variety of medication to choose from.

Belcher said pharmacists have lots of experience finding alternatives for patients, if necessary.

“While the over-the-counter medications in short supply are the most visible representation of the challenges to our supply chain, pharmacy teams have been managing very high levels of drug shortages, some critical, where there are really few or no alternative options,” she said, adding that up to 20 per cent of the team’s day is spent managing shortages.

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Study explores the risk of new-onset diabetes mellitus following SARS-CoV-2 infections

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In a recent study posted to the medRxiv* preprint server, researchers evaluated individuals who had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and were diagnosed with diabetes mellitus within six months of the onset of coronavirus disease 2019 (COVID-19) to understand the temporal relationship between SARS-CoV-2 infections and diabetes mellitus.

Study: Are fewer cases of diabetes mellitus diagnosed in the months after SARS-CoV-2 infection? Image Credit: Africa Studio/Shutterstock

Background

Recent research indicates a potential increase in the new-onset diabetes mellitus diagnoses after SARS-CoV-2 infections. While the causative mechanisms are not clearly understood, various hypotheses suggest the roles of stress-induced hyperglycemia during SARS-CoV-2 infections, changes in the innate immune system, virus-induced damage or changes to the beta cells or vasculature of the pancreas, as well as the side effects of the treatment in the increased incidence of diabetes mellitus diagnoses.

Furthermore, the drastic lifestyle changes brought about by the COVID-19 pandemic have decreased physical activity and increased obesity. The stress induced by the pandemic has also increased endogenous cortisol levels, a known risk factor for diabetes mellitus. Examining the temporal relationship between SARS-CoV-2 infections and new-onset cases of diabetes mellitus will help develop effective screening and therapeutic strategies.

About the study

In the present study, the team conducted a nationwide analysis using electronic health records aggregated in the National COVID Cohort Collaborative (N3C) database in the United States (U.S.). They analyzed all individuals with SARS-CoV-2 infections and type 2 diabetes mellitus between March 2020 and February 2022. Data from the health records for the six months preceding and following the SARS-CoV-2 infections were included to avoid selection and ascertainment bias.

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SARS-CoV-2 infections were confirmed based on the International Classification of Diseases, Tenth Revision (ICD-10) code, or laboratory test results. New-onset diabetes mellitus cases were defined as those that did not have an ICD code for diabetes mellitus in their electronic health records before September 2019. The incidence of diabetes mellitus was then analyzed concerning SARS-CoV-2 infections.

Results

The results reported a sharp increase in new-onset diabetes mellitus diagnoses in the 30 days following SARS-CoV-2 infections, with the incidence of new diagnoses decreasing in the post-acute stage up to approximately a year after the infection. Surprisingly, the number of new-onset diabetes mellitus cases in the months following SARS-CoV-2 infections is lower than in the months preceding the infection.

The authors believe that the increase in healthcare interactions brought about due to the COVID-19 pandemic might explain the notable increase in diabetes mellitus diagnoses in the time surrounding SARS-CoV-2 infections. New patients might have been tested for hemoglobin A1C or glucose levels during their first interaction with the healthcare system, the results of which might have then been used to diagnose diabetes mellitus.

Additionally, SARS-CoV-2 infection-induced physiological stress could have triggered diabetes mellitus in high-risk individuals who might have developed the disease later in life without COVID-19.

According to the authors, the overall risk of developing diabetes mellitus has increased, irrespective of SARS-CoV-2 infections, due to the drastic decrease in physical activity, weight gain, and the stress induced by the COVID-19 pandemic. Furthermore, a longer follow-up period might report an increased incidence in new-onset diabetes mellitus cases, with the SARS-CoV-2 infection precipitating disease development in individuals who might not have otherwise developed diabetes.

Conclusions

To summarize, the researchers conducted a cross-sectional, nationwide analysis of individuals in the U.S. to understand the temporal relationship between diagnoses of new-onset diabetes mellitus and SARS-CoV-2 infections. The results reported a spike in diabetes mellitus diagnoses in the one month following SARS-CoV-2 infections, followed by a marked decrease in the number of diagnoses for up to a year after the infection.

The authors believe that the sudden increase in diabetes diagnoses could be due to increased healthcare interactions brought about by the COVID-19 pandemic. The new-onset diabetes mellitus cases could also be a reaction to the physiological stress induced by SARS-CoV-2 infections.

Furthermore, the drastic lifestyle changes brought about by the COVID-19 pandemic might be responsible for the high incidence of diabetes mellitus, irrespective of SARS-CoV-2 infections. However, extensive research is required to understand the epidemiology and mechanisms connecting SARS-CoV-2 infections with new-onset diabetes mellitus.

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

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