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SARS survivor, retired paramedic warns front-line workers need protection against coronavirus – CBC.ca

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Severe chills. Aches and pains. Full-body weakness.

Bruce England says those intense symptoms began one night in 2003 after he’d wrapped up a shift as a Toronto paramedic. 

“I couldn’t get out of bed, I couldn’t lift my head. I couldn’t go to the washroom,” he recalled. “I just didn’t have the strength. It was like being hit by a two-by-four and not being able to move.”

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England called his team to report his sudden illness. Soon after, he says two fellow paramedics arrived at his home in full protective suits to take him to a hospital — where he was whisked right into an isolation room.

His eventual diagnosis? SARS, or severe acute respiratory syndrome, the condition caused by a coronavirus that spread through much of the world in the early 2000s, killing hundreds of people and afflicting thousands more.

As concern grows over the recent outbreak of another newly discovered strain of coronavirus, with two cases now identified in Toronto — one officially confirmed, and one presumed due to the results of an early lab test — England says his experience offers lessons for protecting Canadian frontline workers from a new but familiar threat.

Transparency, communication, and access to personal protective equipment are all key to ensuring the safety of paramedics and hospital staff, he said, echoing the recent comments of Canadian health officials who have stressed that protections are indeed in place.

“To me, there’s no question, we’re going to have more patients,” England warned. “And I worry about the health-care workers. They are putting themselves in harm’s way.”

Lessons learned from SARS

Rising concern over the impact of a coronavirus in Canada follows news on Saturday of the country’s first presumptive case.

That since-confirmed case involves a man in his 50s who recently travelled back to Toronto from Wuhan, China — the city thought to be the origin point for the new virus — who is currently in stable condition at Sunnybrook Hospital.

Health officials now believe his wife is the country’s likely second case; she’s currently in self-isolation, with less severe symptoms that haven’t required hospital care, according to provincial health officials.

Another 19 people in the province are also under investigation for possible infection, said Dr. David Williams, Ontario’s chief medical officer, on Monday.

While Canada grapples with a number of infected patients that could potentially rise, Chinese health commission officials said the number of deaths from the virus in Hubei province — where Wuhan is located — has climbed to 76, with four deaths elsewhere in the country, including one in Beijing, and several thousand others infected.

Ontario’s chief medical officer says preparedness is ‘well ahead’ of 2003 and SARS 3:15

During the SARS outbreak, which also originated in China, England said there was a lack of details flowing from both Chinese officials and medical professionals in Canada.

“I think back then what we didn’t have was transparency,” he said. “We weren’t sharing information quickly.”

England stressed the need for ongoing communication between medical professionals and the public, along with ensuring there are adequate supplies of personal protective equipment for personnel who may transporting or treating patients with the new coronavirus.

Previous research also suggests the added importance of isolating patients and implementing hospital-based screening measures.

A nurse in protective gear talks on her phone near an ambulance in Wuhan in central China’s Hubei Province on Sunday. (Chinatopix via AP)

“Canada’s experience with SARS illustrates the importance of identifying and isolating every infected individual in stemming the spread of the disease,” reads a 2004 report on the lessons learned from the National Academy of Sciences.

Early on in the Toronto epidemic, undetected patients went on to infect “scores” of others in several different hospitals, even after increased infection control measures were taken. The province later halted between-hospital patient transfers, created separate SARS hospital units, minimized visitor access, and establishing a screening process. 

“Because the spread of SARS in Toronto was largely restricted to the hospital setting, these precautions were effective in controlling the outbreak,” the report notes.

Protections, ‘screening measures’ in place

In recent days, health officials have stressed efforts are being made to ensure there isn’t a repeat of a SARS-level outbreak in Canada, which chiefly affected health care workers and patients. 

For one thing, the province has implemented “enhanced screening measures” at all emergency medical services’ communication centres to identify potential cases of the cononavirus before dispatching paramedics, said Dr. Barbara Yaffe, associate chief medical officer of health in Ontario, during a Monday news conference.

In recent days, health officials have stressed efforts are being made to ensure there isn’t a repeat of a SARS-level outbreak in Canada, which chiefly affected health-care workers and patients at several Toronto hospitals.  (Michael Wilson/CBC)

Speaking to reporters on Monday, Toronto Mayor John Tory strived to quell fears over the virus, saying front-line workers in the city are “well-protected.”

There are now “detailed protocols” in place at both the paramedic and hospital levels, thanks to sweeping changes made in the aftermath of SARS, he added.

During the emergency call from the man who has since been confirmed as infected with the new coronavirus, for instance, paramedics did use “full personal protective equipment,” according to Dr. Rita Shahin, Toronto’s associate medical officer of health.

Toronto Mayor John Tory is among the officials trying to quell fears over a new coronavirus, saying protections are in place for front-line workers. (Lauren Pelley/CBC News)

Looking back on his time during the SARS outbreak, England wishes a similar procedure had been in place then.

Protective equipment procedures weren’t typically in place during those early days, he noted, and he believes he caught his illness from a patient in a hospital about two weeks before his symptoms showed up.

Now 68 and retired, he said getting hit with the illness in his early ’50s took a toll on his health.

England spent two weeks recovering in hospital and another month at home, but still felt unwell after he returned to work, and eventually shifted out of his front-line duties to work in Toronto’s office of emergency management.

Close to two decades later, England said he still has trouble breathing and experiences numbness in his hands and feet — lingering reminders of his brush with a deadly illness.

His message now for policy makers?

“Communicate with the public and look after the health care workers,” he said. “Remember, they’re the front-line staff — if they get sick, look after them.”

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Study explores the risk of new-onset diabetes mellitus following SARS-CoV-2 infections – News-Medical.Net

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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.

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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.

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.

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Toronto-based infectious disease expert seeing more older patients with flu in hospital

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An infectious diseases physician in Toronto is reporting an increase in the number of older patients he is seeing with seasonal influenza.

Dr. Isaac Bogoch at Toronto General Hospital noted this year’s flu season started early and escalated quickly.

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According to the Public Health Agency of Canada, children under five are still making up the largest age bracket of flu patients in hospital. However, rates among seniors (aged 65 and up) are on the rise.

Bogoch expects the number of flu cases to keep increasing. The season usually peaks in January.

To track the number of flu cases in Durham Region this season, click here.

 

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Breakthrough Infections More Likely in Infliximab Treated IBD Patients Than Those Treated With Vedolizumab

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Patients with inflammatory bowel disease (IBD) treated with infliximab who were vaccinated against SARS-CoV-2 were more likely to have a breakthrough infection than patients treated with vedolizumab, but the benefits of the vaccine are still superior.

A team, led by Zhigang Liu, PhD, Department of Metabolism, Digestion and Reproduction, Imperial College London, determined how infliximab and vedolizumab affect vaccine-induced neutralizing antibodies against highly transmissible omicron (B.1.1.529) BA.1, and BA.4 and BA.5 (hereafter BA.4/5) SARS-CoV-2 variants.

The Treatments

Anti-TNF drugs, including infliximab, are linked to attenuated antibody responses following SARS-CoV-2 vaccination. The variants included in the analysis have the ability to evade host immunity and with emerging sublineages are currently the dominating variants causing the current waves of infection.

In the prospective, multicenter, observation, CLARITY IBD cohort study, the investigators looked at the effect of infliximab and vedolizumab on SARS-CoV-2 infections and vaccinations in patients with IBD.

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The study included patients aged 5 years or older with an IBD diagnosis that were treated with infliximab or vedolizumab for 6 weeks or longer in infusion units at 92 hospitals in the UK. Each participant had uninterrupted biological therapy since recruitment and were not previously diagnosed with a SARS-CoV-2 infection.

Outcomes

The investigators sought primary outcomes of neutralizing antibody responses against SARS-CoV-2 wild-type and omicron subvariants BA.1 and BA.4/5 following 3 doses of a SARS-CoV-2 vaccine.

The team also investigated the risk of breakthrough infections in relation to neutralizing antibody titers using Cox proportional hazard models.

There were 7224 patients with IBD recruited to the study between September 22 and December 23, 2020. Of this group, 1288 had no previous SARS-CoV-2 infections after 3 doses of the vaccine that were established on either infliximab (n = 871) or vedolizumab (n = 417). The median age of the patient population was 46.1 years.

Following 3 doses of SARS-CoV-2 vaccine, 50% neutralizing titers were significantly lower in the infliximab group compared to patients treated with vedolizumab against wild-type (geometric mean, 2062; 95% CI, 1720–2473 vs geometric mean, 3440; 95% CI, 2939–4026; P <0.0001), BA.1 (geographic mean, 107.3; 95% CI, 86.40–133.2 vs geographic mean, 648.9; 95% CI, 523.5–804.5; P <0.0001), and BA.4/5 (geographic mean, 40.63; 95% CI, 31.99–51.60] vs geographic mean, 223.0; 95% CI, 183.1–271.4; P <0.0001) variants.

Breakthrough infections more frequently occurred in patients treated with infliximab (n = 119; 13.7%; 95% CI, 11.5–16.2) than in those treated with vedolizumab (n = 29; 7.0%; 95% CI, 4.8–10.0; P = 0.00040).

The Cox proportional hazard models show time to breakthrough infection after the third vaccine dose in the infliximab group was associated with a higher hazard risk than treatment with vedolizumab (HR, 1.71; 95% CI, 1.08-2.71; P = 0.022).

There was also higher neutralizing antibody titers against BA.4/5 with a lower hazard risk in the group with a breakthrough infection and a longer time to breakthrough infection (HR, 0.87; 95% CI, 0.79-0.95; P = 0.0028).

“Our findings underline the importance of continued SARS-CoV-2 vaccination programs, including second-generation bivalent vaccines, especially in patient subgroups where vaccine immunogenicity and efficacy might be reduced, such as those on anti-TNF therapies,” the authors wrote.

The study, “Neutralizing antibody potency against SARS-CoV-2 wild-type and omicron BA.1 and BA.4/5 variants in patients with inflammatory bowel disease treated with infliximab and vedolizumab after three doses of COVID-19 vaccine (CLARITY IBD): an analysis of a prospective multicenter cohort study,” was published online in The Lancet Gastroenterology & Hepatology.

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