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Should masks be mandatory in public to stop the spread of COVID-19? – CBC.ca

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This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.


A growing chorus of experts is calling for the widespread use of masks to slow the spread of COVID-19 and suggesting it may be a key factor in why some countries seemingly have their outbreaks under control while others are completely overwhelmed. 

The World Health Organization does not officially recommend the general public use masks as a way to reduce spreading the virus, only saying that if they do decide to use masks, they should do so “safely and properly.” 

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“We encourage countries that are considering the use of masks for the general population to study their effectiveness, so we can all learn from their experience,” a spokesperson for WHO said in a statement to CBC News. 

“Currently, there is insufficient evidence for or against the use of any type of mask among healthy people in public settings. As new information and evidence about masks and non-medical masks emerges, WHO will update existing guidance.”

WHO does recommend medical masks, respirators and other personal protective equipment (PPE) in health care settings, but says only people who are sick or caring for a sick person at home should use them in the community. 

WATCH | An epidemiologist explains why masks are effective for asymptomatic carriers

‘The point of the mask,’ says Christopher Labos, ‘is to protect others from you,’ especially if you are an asymptomatic carrier of the virus. 2:58

“Masks alone cannot stop the pandemic. Countries must continue to find, test, isolate and treat every case and trace every contact,” WHO Director-General Tedros Adhanom Ghebreyesus said earlier this month. 

“Mask or no mask, there are proven things all of us can do to protect ourselves and others: keep your distance, clean your hands, cough or sneeze into your elbow, and avoid touching your face.”

WHO’s recommendations on masks not ‘logical’

But the specific language WHO uses has come under fire from experts who suggest that even non-medical masks could be beneficial in curbing the spread of the virus — or, at the very least, couldn’t hurt.

Babak Javid, a professor at the Tsinghua University School of Medicine in Beijing and a consultant in infectious diseases at Cambridge University Hospitals in the U.K., thinks there’s a double standard in WHO’s messaging. 

Yes, he says, “there’s no direct evidence that masks can prevent transmission.” 

“But there’s no direct evidence that hand-washing can prevent the transmission of COVID or lockdowns can prevent the transmission of COVID because none of those trials have ever been done in the context of COVID.” 

One infectious disease expert says WHO’s recommendation on masks doesn’t take into account the significant number of asymptomatic or pre-symptomatic carriers of the virus in the general population. (Evan Mitsui/CBC)

Javid said there is a “logical gap” in WHO’s recommendation, because it doesn’t take into account the significant number of asymptomatic or pre-symptomatic carriers of the virus in the general population, also known as “silent spreaders.” 

Asymptomatic carriers are those who show no symptoms, while pre-symptomatic carriers are people who have not yet displayed symptoms — usually in the first few days of infection.

“What I think is indisputable is that the face covering can reduce the amount of both droplets and virus that we can transmit,” he said.  

Research on virus’s spread suggests masks could help

Emerging research has revealed more about how the virus spreads from person to person, suggesting it doesn’t just transmit through coughing but also through simply talking.

A U.S. National Institutes of Health study published as a research letter in the New England Journal of Medicine this week provided visual evidence that “speech-generated droplets” can become suspended in the air and inhaled by other people, potentially exposing them to viruses like the one responsible for COVID-19. 

That provides some preliminary evidence that the potentially deadly coronavirus, also known as SARS-CoV-2, could be transmitted between people just by speaking normally.

Emerging research has revealed more about how the virus spreads from person to person, suggesting it doesn’t just transmit through coughing but also through simply talking. (Evan Mitsui/CBC)

“There’s plenty of research showing that even just when we talk and breathe, we release these very small respiratory droplets, smaller than we can see,” said Dr. Linsey Marr, an expert in the transmission of viruses by aerosol at Virginia Tech in Blacksburg, Virginia. 

“Masks really could help make a difference because they will — if you are sick without knowing it — block those droplets from flying into the air and then staying in the air or contaminating surfaces.” 

A paper by researchers in China set to be published in July in the U.S. Centers for Disease Control and Prevention’s journal Emerging Infectious Diseases, found an infected individual without symptoms was apparently able to spread the virus to nine others at a restaurant in Guangzhou, China. 

The direction the air-conditioning system was blowing may have helped transport the virus particles to other diners, who otherwise had no contact with one another, while those elsewhere in the restaurant who weren’t near the airflow didn’t get sick. 

The study has limitations because the findings were not corroborated with experiments to simulate the airborne transmission. Still, the research is raising concern.

“That was pretty strong evidence for the potential that transmission is happening through these microscopic respiratory droplets that can stay floating in the air for a long enough time to kind of go back and forth over the tables,” Marr said. 

Should masks be mandatory in public? 

Last week, Transport Canada made it mandatory for all air passengers to wear non-medical masks or face coverings over their mouth and nose during travel. 

Passengers on boats are “encouraged to wear non-medical masks or face coverings whenever possible,” while train or bus riders are also “strongly encouraged” to do the same. 

The Public Health Agency of Canada says non-medical masks are ‘not a substitute for physical distancing and hand-washing,’ but can protect those nearby ‘even if you have no symptoms.’ (Evan Mitsui/CBC)

But the Public Health Agency of Canada only recently changed course on its recommendations to Canadians on the effectiveness of non-medical masks, previously saying masks should only be worn by health care workers.

“Wearing a non-medical mask is an additional measure that you can take to protect others around you,” Canada’s Chief Public Health Officer Dr. Theresa Tam said on April 6 — while warning that a non-medical mask doesn’t necessarily protect the person wearing it.

“A non-medical mask can reduce the chance of your respiratory droplets coming into contact with others or landing on surfaces,” Tam said. “The science is not certain, but we need to do everything that we can and it seems a sensible thing to do.”

PHAC also says non-medical masks are “not a substitute for physical distancing and hand-washing,” but can protect those nearby “even if you have no symptoms.” 

Last week, Transport Canada made it mandatory for all air passengers to wear non-medical masks or face coverings during travel and ‘strongly encouraged’ passengers on boats, trains and buses to do the same. (Ben Nelms/CBC)

But some experts say that given that significant role asymptomatic and pre-symptomatic carriers of the virus play in the spread of the virus, Canada should be mandating the use of non-medical masks in public, the way other countries have. 

“Public health officials are saying there’s no evidence that the mask is going to keep you from getting the disease, but I also think it’s important to recognize that absence of evidence is not evidence of absence,” said Dr. Joe Vipond, a Calgary emergency department physician. 

“Even a small decrease in the risk of me getting the disease is still really important from a population level.”

Evidence from other countries 

Asian countries that have successfully dropped their curve of new COVID-19 cases, like South Korea, Taiwan and China, all have widespread mask usage, while the Czech Republic recently implemented mandatory mask measures and saw case fatality rates drop, Vipond wrote in a recent op-ed for Maclean’s magazine

There are numerous factors as to why a given country can become overwhelmed by the virus, including the onset of outbreaks, the accuracy of reporting, backlogs in testing, the age of the population and the effectiveness of containment measures. 

But Javid said that while this is still just correlative evidence, it could be one reason why countries like Taiwan, which doesn’t have total lockdown measures in place but does have widespread mask usage, has a much lower incidence of COVID-19 than other countries like Sweden, for example, where masks are less commonly used.

Jeremy Howard, a University of San Francisco researcher and the co-founder of Masks 4 All, said Japan is another example of a densely populated region with widespread public mask wearing and low levels of COVID-19 despite not prioritizing physical distancing or testing compared with a place like New York.

“There’s all this evidence, which strongly suggests, as part of the suite of tools we have available, wearing a mask appears to be astonishingly powerful, and the cost is nearly zero,” he said.

“And when we compare the level of evidence we have to something like washing hands, it’s vastly, vastly, vastly, vastly higher.” 

While masks are not a “magic bullet” in curbing the spread of the virus and more research still needs to be done on their effectiveness, Javid said they can be used in conjunction with other measures like physical distancing and widespread testing to slow the spread.  

“To get over the COVID problem we’re going to need a multi-pronged approach. To me, what’s attractive about masks is that they’re cheap, they’re probably effective and they allow economic activity,” he said. 

“We can’t stay in lockdown forever, so to me, the downsides are so minimal compared to the potential upsides.” 

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Measles case reported locally turns out to be negative: health unit

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
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On March 26, the Simcoe Muskoka District Health Unit (SMDHU) was notified by Public Health Ontario’s (PHO) laboratory that due to laboratory error, the case of measles that had been lab-confirmed positive on March 12, based on symptoms and a positive urine measles laboratory result by PHO’s laboratory, is in fact negative for the measles virus.

“With this new information of the negative lab result, we believe that that individual was not infected with measles and that there has not been any public exposure to measles resulting from this individual’s illness,” said Dr. Charles Gardner, medical officer of health. “We recognize that notifying the public of what we believed to be a positive measles case in our area created worry, anxiety and disruption for some, and we regret this.

“We do know that, despite best efforts, on rare occasions laboratory errors can occur. We are working closely with the PHO’s laboratory to do all that we can to ensure that such an incident does not occur again.”

Measles is a highly contagious viral infection that spreads very easily through airborne transmission. The measles virus can live in the air or on surfaces for up to two hours.

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Symptoms of measles begin seven to 21 days after exposure and include fever, runny nose, cough, drowsiness, and red eyes. Small white spots appear on the inside of the mouth and throat but are not always present. Three to seven days after symptoms begin, a red, blotchy rash appears on the face and then progresses down the body.

The risk of transmission to those vaccinated with two doses is low, and when it does occur tends to show a reduction in the severity of these symptoms.

“Although we are relieved for the individual involved, and for all Simcoe-Muskoka residents, that this case has now been confirmed as negative, we know that measles is still active in Ontario at this time and the potential remains for new cases to arise, especially given the increase in Ontarians travelling to areas in the world that have higher numbers of measles cases,” said Dr. Gardner. “This is why we continue to advise individuals to keep up to date with their routine immunizations, including measles, mumps and rubella (MMR) vaccination.”

The risk of measles is low for people who have been fully immunized with two doses of measles vaccine or those born before 1970; however, many children have been delayed in receiving their routine childhood immunizations and people who have not had two doses of measles vaccine are at higher risk of contracting the disease.

People who do get sick usually recover without treatment, but measles can be more severe for infants, pregnant women, and those with compromised immune systems. Possible complications include middle-ear infections, pneumonia, diarrhea, or encephalitis (swelling of the brain) and occasionally death in the very young. Even individuals who are up to date with the measles vaccine should watch for symptoms of measles for 21 days after exposure.

For more information about measles, please visit smdhu.org or call Health Connection at 705-721-7520 or 1-877-721-7520, Monday to Friday between 8:30 a.m. and 4:30 p.m. to speak with a public health professional.

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Kate Middleton Not Alone. Cancer On Rise For People Under 50, Say Experts

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Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery

London:

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When Catherine, Princess of Wales, revealed she was being treated for cancer last week, part of the shock was that an otherwise healthy 42-year-old has a disease that mostly plagues older people.

However, researchers have been increasingly sounding the alarm that more and more people under 50 are getting cancer — and no one knows why.

Across the world, the rate of under-50s diagnosed with 29 common cancers surged by nearly 80 percent between 1990 and 2019, a large study in BMJ Oncology found last year.

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The researchers predicted the number of new cancer cases among younger adults will rise another 30 percent by the end of this decade, with wealthy countries particularly affected.

The increase in cases — and soaring global population — means that the number of deaths among under 50s from cancer has risen by nearly 28 percent over the last 30 years.

This occurred even as the odds of people of all ages surviving cancer have roughly doubled over the last half century.

Shivan Sivakumar, a cancer researcher at the UK’s University of Birmingham, called it an “epidemic” of young adult cancer.

Since Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery earlier this year, Sivakumar and other doctors have spoken out about the uptick in younger cancer patients they have been seeing at their clinics.

While breast cancer remains the most common for people under 50, the researchers expressed particular concern about the rise of gastrointestinal cancers — such as of the colon, pancreas, liver and oesophagus — in younger adults.

Colon cancer is now the leading cause of cancer deaths in men under 50 in the United States, according to the American Cancer Society. For women, it is number two — behind only breast cancer.

One high profile case of colorectal cancer was “Black Panther” actor Chadwick Boseman, who died at the age of 43 in 2020.

Why is this happening?

“We just don’t have the evidence yet” to say exactly what is causing this rise, Sivakumar told AFP, adding it was likely a combination of factors.

Helen Coleman, a cancer epidemiology professor at Queen’s University Belfast who has studied early onset cancer in Northern Ireland, told AFP there were two potential explanations.

One is that people in their 40s were exposed to factors known to cause cancer — such tobacco smoke, alcohol or being obese — at an earlier age than previous generations.

She pointed out that the “obesity epidemic” did not start until the 1980s.

Sivakumar felt that at least part of the puzzle could be explained by obesity.

However, there is “another wave” of under-50 patients who are neither obese nor genetically predisposed still getting cancer, he emphasised, adding that this could not be put down to “statistical chance”.

The other theory, Coleman said, is that “something different” has been going on with her generation.

Fingers have been pointed out a range of possible culprits — including chemicals, new drugs and microplastics — but none have been proven.

Some have suggested that so-called ultra-processed foods could be to blame. “But there’s very little data to back any of that up,” Coleman said.

Another theory is that the food we eat could be changing our gut microbiome.

While there is nothing conclusive yet, Coleman said her own research suggested that cancer causes changes to the microbiome, not the other way around.

Anti-vaxx conspiracy theorists have even tried to blame Covid-19 vaccines.

This is easily disproven, because the rise in young adult cancer has taken place over decades, but the vaccines have only been around for a few years.

What can be done?

To address the rise in younger colorectal cancer, in 2021 the US lowered the recommended age for screening to 45. Other countries have yet to follow suit.

But the researchers hoped that Catherine’s experience would remind people at home that they should consult their doctor if they sense anything is wrong.

“People know their bodies really well,” Sivakumar said.

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Almost 3,000 students suspended in Waterloo Region over immunization issues

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Close to 3,000 children attending elementary school across Waterloo Region were suspended from school on Wednesday morning for not having up-to-date immunization records.

The region says Waterloo Public Health suspended 2,969 students under the Immunization of School Pupils Act (ISPA).

For several months, the region has been campaigning for people to get their children’s vaccinations up to date, including sending letters home to parents on a couple of occasions, warning that students’ records needed to be up to date or they would be suspended.

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It announced in January that 32,000 students did not have up-to-date records: 22,000 elementary students and 10,000 high school students.


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“We have made remarkable progress from the original 27,567 immunization notices we sent to parents in November and December 2023,” Dr. Hsiu-Li Wang, medical officer of health, stated.

“Since that time, we have resolved more than 24,500 outdated vaccination records, providing students with valuable protection against these serious and preventable diseases.”

The high school students still have a few weeks to get their records up to date or else face suspension.

The ISPA requires students to have proof-of-vaccination records for diphtheria, polio, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox) and meningitis, which must be on file with public health.

Public health says caregivers whose children are suspended will need to book an appointment at regionofwaterloo.ca/vaccines for clinics, which will be held in Cambridge and Waterloo on weekdays.

“Given the high number of suspensions, it may take several days before you can be seen at an appointment and return your child to school,” a release from the region warns.

“Record submission and questions must be done in person to ensure immediate resolution.”

The last time suspensions over immunizations were issued was in 2019, when 1,032 students were suspended.

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