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Some health experts questioning advice against wider use of masks to slow spread of COVID-19 – CBC.ca

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Science magazine had been trying for days to speak to the elusive George Gao, head of China’s Centre for Disease Control and Prevention.

When the magazine asked him if he could point to any mistakes that might explain why Western countries were struggling to flatten the coronavirus curve, he didn’t miss a beat.

“The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks,” he said.

“You’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth. Many people have asymptomatic or pre-symptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others.”

That advice is contradicted by the World Health Organization, the government of Canada and federal public health officials like Chief Public Health Officer Dr. Theresa Tam. On its webpage, the WHO says that “if you are healthy, you only need to wear a mask if you are taking care of a person with suspected [COVID-19] infection.”

“Putting a mask on an asymptomatic person is not beneficial, obviously, if you’re not infected,” Tam said Monday. 

Only medical masks such as those labelled N95 are designed and fitted to filter out particles that carry the COVID-19 virus. Other masks, such as surgical masks, are looser fitting and made of material that may reduce concentrations of some aerosol particles.

A 2015 randomized clinical trial found that cloth masks, for example, did not block influenza and respiratory viruses and actually increased the rate of infections among health care workers, and even surgical masks blocked only slightly more than half of virus particles.

Asymptomatic spreaders

Dr. K.K. Cheng, director of the Institute of Applied Health Research at the University of Birmingham in the U.K., said that Tam’s advice makes a dangerous assumption — that an asymptomatic person is not a spreader.

“The important thing about this coronavirus is that some patients start to shed virus, and become infectious, even before they have symptoms,” he said.

“In public health, a principle is we try to limit the source of harmful exposures rather than do mitigation, if we can. Hand-washing is a form of mitigation.

“I’m not suggesting in the least that people should stop washing hands. It’s very important. But if you’re out in public in a supermarket, or in a subway train or on the bus, I think it makes a lot of sense for everyone to wear a mask.”

While officials in the West caution that the explanations for Asian countries’ greater success in controlling the pandemic are complex, officials from the countries themselves — such as Gao and Cheng as well as some South Korean specialists — often point to masks.

Now some European governments are choosing to follow pro-mask policies.

A man wearing a protective mask measures the body temperatures of Austrian soldiers entering the foreign ministry in Vienna. Austria has started requiring masks in some public places, such as supermarkets. (Ronald Zak/The Associated Press)

Austria on Monday banned members of the public from entering a supermarket without one. Austrian Chancellor Sebastian Kurz said that is only the first step toward wider adoption of masks.

Next door, the Czech Republic requires everyone to wear a mask in public. The country has experienced a lower-than-average spread of COVID-19.

The Centers for Disease Control and Prevention in the U.S. is also reportedly considering whether it should revise its guidance on masks, according to the Washington Post. It, too, recommends that only those with symptoms and those caring for them wear masks.

Masks or elbows

Of course, the fact that many countries where mask use is widespread have been more successful at flattening the curve does not necessarily mean that the masks themselves account for the difference. Most experts would point to a mix of factors, including more aggressive testing and tracing of infections and tight controls on movement of the population.

But Cheng said much of the opposition to masks arises because officials in Europe and North America “have never really grasped the point that wearing masks is not primarily to protect the wearer. The original motivation is to protect others.”

“In a severe pandemic, the main objective of any public health intervention is to limit the source of infection, things that are coming out of our respiratory tract,” he told CBC News.

For Cheng, the concern expressed by some public health officials — that people will end up wearing masks that aren’t up to the highest standards — is a red herring.

He said any mouth and nose covering is superior to telling people to cough into their elbows, as the government of Canada does now.

“I just don’t understand that. Really, it’s a simple mechanical thing,” Cheng said. “If people wear masks as a self-protective measure and want to protect themselves from others, then I think you really need a hi-spec mask, and no one has got an oversupply of those.

“But we don’t really need that if everyone practices this.”

The most sophisticated masks must be saved for the health care workers who face the greatest exposure.

Dr. Elaine Shuo Feng is part of an Oxford University team that studied different countries’ approaches to masks. She agrees that health workers must get priority.

“But I don’t think this is a good reason … to tell the public that a face mask is not effective and to work on the supply issue,” she told CBC News. “I think there are a lot of things that you need to do.”

False sense of confidence

Canadian officials have cited the risk that people won’t use masks properly and could expose themselves to greater danger as a result as one of the reasons not to recommend mask wearing for the general public.

“What we worry about is actually the potential negative aspects of wearing masks where people are not protecting their eyes, or you know, other aspects of where a virus could enter your body,” said Tam.

“And that gives you a false sense of confidence, but also, it increases the touching of your face. If you think about it, if you’ve got a mask around your face, sometimes you can’t help it, because you’re just touching parts of your face.”

Cheng said masks, in fact, inhibit contact between the hand and the mouth, and people can be taught to wash their hands after touching them.

“Very few people before this pandemic knew how to wash their hands properly,” he said. “But you don’t go about telling people there’s no point in washing your hands. You show them a video showing them how to wash their hands. 

“It’s not a logical argument, really. It’s not beyond the realm of most people’s IQ to learn how to wear a mask properly.”

The WHO’s guidance on the use of medical masks makes clear that their use alone is insufficient to prevent the spread of COVID-19 without proper hand-washing and other measures to protect against human to human transmission.

Not everyone can self-isolate

Cheng agrees that people with symptoms should not be going out at all. But he said it’s wrong to base advice on the assumption that everyone can self-isolate.

“During this phase when we’re locked down, unfortunately, there are still heroes of our society who’ve got to go to work to keep the country going. Health care workers, bus drivers, supermarket workers,” he said.

A woman wearing a face mask selects whole fish at a supermarket in Kuala Lumpur, Malaysia. Some infectious disease experts in Asia say masks were a key part of slowing down the spread of the novel coronavirus disease. (Vincent Thian/The Associated Press)

Cheng said he doesn’t agree with arguments about creating a false sense of security.

“People have raised the hypothesis that if you ask people to wear a mask, they’ll feel invincible, and then they won’t bother with handwashing, for example,” he said.

“There’s absolutely no evidence that this is the case. I would argue it’s the opposite — that this would heighten one’s sense of caution and hygiene, and it would stop people from touching the mouth.”

Shuo Feng stressed that she does not recommend using self-made masks, which do not block the virus. 

“I think people better stay at home if they could, stay as much as possible and do the best of social distancing,” she said.

“However, there could be situations that people cannot avoid the crowded areas, and in that case, if they cannot get a surgical mask, then having a self-made mask might be better than not wearing a face mask … it might not be as effective as a surgical mask, but at least it provides some protection.”

Open to change?

In her remarks Monday, Tam did seem to suggest that the government was open to reconsidering its advice.

“We are continuing to evaluate. Of course, we can be flexible if we find any new evidence.”

The Centers for Disease Control in the U.S. denied this weekend that it was about to reverse its advice on masks.

But cracks are appearing in the North American public health establishment. Dr. Scott Gottlieb, a former commissioner of the Food and Drug Administration, said the Centers for Disease Control “should be putting out guidelines … on how you can develop a mask on your own.”

The WHO has advised against the use of cotton or gauze masks in any circumstance. Even for medical masks, the WHO provides strict advice on the correct disposal of used masks and recommends against the re-use of single-use masks.

But Cheng said the wider use of masks can be part of the eventual unlocking of society.

“Maybe two months from now, if we’re lucky, we may emerge from this, and we have to think about how we reopen the economy,” he said. 

“We have to reduce social distancing.

“I think everyone wearing a mask for a period of time to be determined would actually help us to get back to normality. People would still have to practise social distancing but without all the schools being closed and so on.”

Shuo Feng said there’s no single approach that will beat the virus, but “now is the right time to talk about face masks and to reconsider the recommendation of face masks to the general population.”

Watch: The National: Clearing up the confusion around whether masks protect against COVID-19

While public health officials tell Canadians not to wear masks unless they’re sick, other countries take a different approach, leading to confusion for some. 2:05

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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