Nova Scotia’s top public health officer clashed with a health-care workers’ union Wednesday after it aired concerns from nurses working at a Halifax nursing home beset by COVID-19.
Two more deaths related to virus were reported Wednesday at Northwood, bringing the total toll at that facility to eight.
Northwood reported Wednesday afternoon that 20 more residents and three more staff have been confirmed with COVID-19, bringing the total to 132 residents and 43 staff.
The Nova Scotia Government and General Employees Union, which represents about 40 nurses who have been seconded to the nursing home to help combat the outbreak, issued a news release Wednesday calling infection control and staff protection measures at Northwood “horrible.”
The nurses have told the union that there’s not enough personal protective equipment and both negative and positive seniors are clustered together on some units.
“Our members are telling us it was like walking into a war zone,” said NSGEU President Jason MacLean said in the release.
At a news briefing Wednesday, Dr. Robert Strang, Nova Scotia’s chief medical officer of health, said the province is working with the union to address “staffing challenges.”
But he upbraided the union for “fear-mongering” with the news release.
“I had a conversation with an infection control practitioner from the health authority who’s on the front lines right now at Northwood today, I’ve worked with her for about 15 years,” Strang said.
]“I completely trust her judgment. She says there is no validity to the concerns that the NSGEU is raising around infection control. I really question, I’m very concerned about the way the NSGEU has taken their concerns publicly – they’re using frankly fear-mongering and hyperbole in the way that they’re describing this situation.”
In an interview Wednesday, MacLean described Strang’s remarks as “unfortunate” attack on a union for speaking up for their members, who have been moved out of their usual hospital workplaces to work at Northwood under a provincial order.
“It’s evident that the Department of Health and Wellness is out of touch with what’s truly happening on the ground at Northwood. And it’s scary. … I have been working with the Department of Health and Wellness and it’s been getting us nowhere.”
The union says long-term-care residents are being allowed to move freely in the nursing home. At the news conference, Strang attributed that to confusion about residents of the assisted living part of the home, who are allowed to come and go.
“Strang doesn’t have that right at all,” MacLean said. “Again it’s unfortunate that they’re out of touch with what’s going on there but the members of NSGEU that were forced to go over there know what’s going on over there and they have no reason to lie.
“They’re not looking to leave there. They’re just looking to do the work with the proper equipment they need to do the work.”
As of Tuesday, there were 10 licensed long-term care homes and unlicensed seniors’ facilities in Nova Scotia with cases of COVID-19, involving 148 residents and 65 staff, the Health Department said in a news release Wednesday.
That represents an increase of 20 more residents and three staff compared to the previous figures, which is the same number of new cases reported by Northwood.
At the news conference, Premier Stephen McNeil extended his condolences to the families and loved ones of the Northwood residents who have died from COVID-19.
“This doesn’t get any easier, and to the families, I’m sorry, ” he said. “And to everyone with family members in Northwood, I want you to know that we are doing our best to get this virus under control.”
A total of 12 people have died from COVID-19 in Nova Scotia, again with most of those deaths – eight – at Northwood.
There were 35 new cases reported Wednesday for a total of 772 and 44 more people have recovered for a total of 330.
The QEII Health Sciences Centre’s microbiology lab completed 849 Nova Scotia tests on Tuesday.
Also Wednesday, the premier announced that the province will be paying for extra prescriptions resulting from a 30-day limit for Pharmacare clients. The limit was put in place by the College of Nova Scotia Pharmacists to reduce the risk of drug supply shortages amid the pandemic.
Starting Thursday, the province will cover the second and third refill dispensing fees for prescriptions typically dispensed for 90 days. The $5 prescription co-pay for clients of the Income Assistance program and the Low Income Pharmacare for Children program will also be waived.
Unmasking the stealth virus behind COVID-19 – CBC.ca
Scientists have discovered the pandemic-causing coronavirus is unique in short-circuiting the safest way our immune system kills off a virus, which could have implications for treating COVID-19 with interferon.
Interferon describes a family of proteins produced by the body’s immune system in response to an invading viral infection. As the name implies, interferon interferes with the virus’s ability to copy itself.
Interferon drugs are made in the lab and were used for years to treat hepatitis, a liver infection, as well as other diseases that involve the immune system, such as multiple sclerosis and some cancers.
In May, researchers in Hong Kong published the results of their Phase 2 trial on fewer than 150 people who were admitted to hospital with mild or moderate COVID-19. Participants were randomly assigned to a combination of potential antivirals, including interferon, or placebo injections for two weeks.
The findings lent support to the idea of continuing research efforts, including in Canada, to investigate interferon in larger, blinded trials designed to find more definitive answers.
Dr. Jordan Feld, a liver specialist at Toronto General Hospital and senior scientist at U of T, previously used interferon to treat people infected with hepatitis. He’s now leading a Phase 2 clinical trial to test a targeted form of the drug, called peginterferon lambda, in injections compared with saline placebo injections.
“It’s kind of like a stealth virus,” Feld said of SARS-CoV-2, the virus that causes COVID-19.
Normally, when interferon in the body’s white blood cells responds to a viral invader, the interferon sends out a flare signal so nearby cells will work to stop the virus from copying itself or replicating if they, too, should be invaded.
In ferrets infected in the lab (a common animal model for studying respiratory viruses), healthy human lung cells, and in people with COVID-19, doctors and scientists say it seems like the natural interferon “flies under the radar” of the immune system and isn’t activated the way it should be.
Feld said the idea behind giving interferon medications is to provide the body with what it should be making to fend off the infection.
The potential therapeutic approach gained scientific backing last month when a study published in the journal Cell showed a “striking” feature of SARS-CoV-2 infection.
Ben tenOever is a Canadian-born professor of microbiology at the Icahn School of Medicine at Mount Sinai in New York who led the Cell study and has been flooded with e-mail requests from researchers the world over to test experimental drug compounds against the virus.
TenOever said every cell that gets infected has two major jobs:
- Fortify its defences and those around it with a “call to arms” mediated by interferon, like sending out an emergency flare for the immune system’s first responders.
- Send a “call for reinforcements” for a longer-term response by releasing proteins called chemokines.
Most viruses block both of those roles.
What makes SARS-Cov-2 unique is it blocks the call-to-arms function from interferon only.
Reinforce call to arms with drug?
“Treatment with interferon or drugs that induce interferon, the main character in the call to arms, is probably beneficial,” tenOever said.
“The secret is to do it early,” he said, when people have a mild cough and test positive for the virus and haven’t developed respiratory distress.
But there could also be mild side-effects.
When we’re fighting off a flu virus, blame interferon for feeling so crummy, feverish and achy as your immune system kicks into high gear.
Likewise, interferon drugs, could also lead to flu-like symptoms for a day or two.
Individuals enrolling in COVID-19 clinical trials of interferon based in Toronto, Hamilton, Ont., Harvard in Cambridge, Mass., Stanford in California, Johns Hopkins in Baltimore and elsewhere will need to weigh whether that (potential) shortfall is worth the (potential) payoff of protection from the deadly damage and delivers key answers that only their participation can offer.
TenOever said what the enormous scientific interest in the publication shows is an incredible demand for biosafety Level 3 labs like his during the pandemic. Without that lab capacity, the fear is that medical researchers won’t be able to run all the experiments they need to do to guide vaccine efforts.
Matthew Miller is an associate professor of infectious disease and immunology at McMaster University who isn’t involved in the clinical trials or studies.
Miller said interferon is what cells use to try to kill off the virus by themselves.
“Its sort of the preferred route,” Miller said, adding interferon is also the safest way for the body to get rid of a virus.
Miller called tenOever’s paper “an important first step in understanding how our body is responding to this particular new virus.”
Speed up recovery
Dr. Sarah Shalhoub, a transplant infectious disease physician at Western University’s medical school, studied the use of interferon to treat another coronavirus infection called Middle East Respiratory Syndrome or MERS.
While interferon hasn’t yet panned out to fight MERS, Shalhoub is optimistic for COVID-19.
“Patients that received interferon beta clear their viruses faster and the duration for hospital admission was also significantly lower,” Shalhoub said of the Hong Kong findings last month.
“It was encouraging in that sense that there might be an effective therapy that’s available on the market that can be repurposed.”
Shalhoub was quick to add a caution. Since no one in either the drug or placebo group died, the mild infections and response to them are difficult to interpret without more research.
The Lancet retracts hydroxychloroquine study following data concerns – Global News
One of the world’s most prestigious medical journals, The Lancet, has retracted an influential COVID-19 research paper after three of the paper’s authors said the patient data used for the study could not be independently verified.
The paper, published on May 22, sparked worldwide concern that using the anti-malarial drug hydroxychloroquine on COVID-19 patients may not be safe.
“After publication of our Lancet article, several concerns were raised with respect to the veracity of the data and analysis conducted by Surgisphere Corporation and its founder and our co-author, Sapan Desai, in our publication,” authors Mandeep Mehra, Frank Ruschitzka and Amit Patel said in a statement published by The Lancet, Thursday.
“Our independent peer reviewers informed us that Surgisphere would not transfer the full dataset, client contracts, and the full ISO audit report to their servers for analysis as such transfer would violate client agreements and confidentiality requirements.
“As such, our reviewers were not able to conduct an independent and private peer review and therefore notified us of their withdrawal from the peer-review process.
“We deeply apologise to you, the editors, and the journal readership for any embarrassment or inconvenience that this may have caused.”
The observational study had found that after reviewing 96,000 COVID-19 patients across six continents, those treated with hydroxychloroquine had a higher risk of heart arrhythmia and death.
“It caused people to stop what they’re doing (and) delay the high quality science in order to sort out whether this initial paper was accurate or inaccurate” said Derek Exner, Associate Dean of Clinical Trials at the University of Calgary Cummings School of Medicine.
The World Health Organization immediately suspended the hydroxycholoroquine arm of its international Solidarity trial pending a safety review.
On Wednesday, WHO Director-General Dr. Tedros Adhanom Ghebreyesus announced that review was complete and that trial would be able to resume.
“The Data Safety and Monitoring Committee of the solidarity trial has been reviewing the data. On the basis of the available mortality data, the members of the committee recommended that there are no reasons to modify the trial protocol,” he said.
“The executive group received this recommendation and endorsed the continuation of all arms of solidarity trial, including hydroxychloroquine.”
Enrollment for The Alberta HOPE COVID-19 trial at the University of Calgary was suspended following The Lancet study publication as well.
“Our safety committee has reviewed everything and said that look, the trial looks totally safe and there’s no major adverse affects with hydroxychloroquine,” said Dr. Michael Hill, the trial’s co-lead.
WHO halts hydroxychloroquine clinical trials
Still, the delay has been costly for the project.
In the nearly two weeks since the Alberta research was suspended, COVID-19 cases in that province have dropped. A spokesperson for Alberta Health says the trial might not resume at all.
“We understand the trial will remain on hold for the next 10 days while the researchers determine whether to suspend for the summer pending (a) fall recurrence of cases or close the trial formally with a plan for data pooling with international collaborators,” said Tom McMillan in an email to Global News.
The coronavirus pandemic has put pressure on scientists to work faster than ever before, but some researchers worry if the cost of speedy science may be too high.
“Of course this pandemic is unfolding at a very rapid pace and the rate of new knowledge is unprecedented and the rate of data sharing is also unprecedented,” said Dr. Isaac Bogoch, an infectious diseases physician at the University of Toronto.
“But it’s also important that you get it right and there’s clearly got to be a balance of speed with accuracy. You can’t compromise accuracy.
“(That would) erode public trust in science, in medicine and in public health and this is time more than ever before where we need public trust in science, medicine and in public health.”
© 2020 Global News, a division of Corus Entertainment Inc.
2,000 COVID-19 cases missing from Toronto's map of hot spots – CBC.ca
More than 2,000 confirmed COVID-19 cases are missing from the map the City of Toronto released last week that shows infections by neighbourhood, CBC News has found.
The detailed geographic information about the spread of the novel coronavirus was released last week by Toronto Public Health, marking the first time such data has been made available in Ontario during the pandemic. It shows infections based on where patients live.
But in a review of published data, CBC News found the count on the map comes up short.
On Thursday morning, the map showed 9,623 positive COVID-19 cases distributed over 140 neighbourhoods. That’s 2,029 cases short of the official 11,652 total count for that day.
That means roughly one out of every five cases is missing in the city’s own geographic analysis. Similar proportions of missing data were found in the map and case counts from previous days.
The data gap was not mentioned in any of the local health authority’s statistics or on its webpage until CBC pointed it out.
An extra row identified as “Missing addresses/postal code,” totalling 2,029 cases, has been added to the city’s downloadable spreadsheet showing the number of cases assigned to each neighbourhood.
Toronto Public Health blames the missing data on reports sent by testing labs. The public health authority says some forms only have a name and an address, while others don’t have a patient’s postal code or phone number, leaving health authorities scrambling to fill in gaps.
“Sometimes, they are not putting enough contact details, and in the legislation it doesn’t specify that you must include XYZ details of the individual,” said Dr. Vinita Dubey, Toronto’s associate medical officer of health, referring to the provincial law that requires medical labs to report positive results of certain tests to local health authorities.
“It just requires that it be reported, so that’s where some of the missing information and gaps occur.”
Dubey said it’s “very unlikely” that the missing data had an impact on contact tracing, but that there could have been delays as her staff had to retrieve missing contact information before they could connect with a patient who tested positive.
Toronto Public Health said that so far, it has been able to complete contact tracing for a patient within 24 hours in 88 per cent of cases.
The issue of information transfer between laboratories and public health units was raised last Friday in a report to city council and the Toronto Board of Health by Toronto Medical Officer of Health Dr. Eileen de Villa.
“Laboratories’ reports are received all together in one large fax, sometimes containing hundreds of individual lab results, which must be taken apart for further processing,” de Villa wrote.
She called for changes in laboratory procedures and the provincial law.
Missing hot spots
Beyond potential delays in contact tracing, the missing geographic data might have another impact.
Toronto’s current map distribution suggests that some of the city’s poorest and most diverse neighbourhoods — predominantly in the northwest and northeast areas — have had the highest number of cases so far and might be most vulnerable to the novel coronavirus.
As Ontario is ramping up testing, resources like mobile testing clinics, staff and personal protection equipment will be focused on those hardest-hit areas of the city.
But with 2,000 cases missing, one researcher familiar with Toronto’s map data said health authorities could be missing out on other vulnerable communities.
Kate H. Choi, an associate professor in the department of sociology at Western University in London, Ont., said Toronto has been ahead of the curve in terms of COVID-19 data collection, so she was “really, really surprised” when she was told how many of the city’s confirmed cases were missing from its map.
She said part of the issue might also be that some populations are less likely to be able to provide a precise address or a postal code, including homeless people, migrant workers or nursing home residents.
“We may be missing COVID-19 hot spots or certain vulnerable populations may be missing from the narrative about COVID-19 in Toronto.”
Alternatively, some Torontonians might feel a false sense of security after assuming their neighbourhood is low-risk based on the map, said Choi. It’s also possible that resources and staff could fail to be deployed to hospitals in unknown hot spots, which could lead to more transmission of the virus.
“Those 2,029 individuals are someone’s loved one,” said Choi. “They are also 2,029 people who could be your neighbours. They could be residents in an area where there are a lot of asymptomatic carriers and unfortunately, that may mean they could bring COVID-19 to your doorsteps.”
WATCH | Toronto releases a map showing the city’s COVID-19 cases:
Choi stressed that more research on the age, gender and other characteristics of the missing 2,029 cases is needed to fully understand the impact and risks of this data gap.
Toronto Public Health has also repeatedly said that the map shows where patients infected with COVID-19 live and not where they acquired the infection.
Gap won’t be fixed for weeks
Toronto Public Health said it does not have the resources to go looking for the 2,029 missing postal codes at the moment.
“Some of them were early on in our outbreak and so it would require going back to some of these cases in February and March. That work won’t be done until we either have less cases or have reached the end of the first wave,” said Dubey.
This is the second data gap uncovered by CBC in less than a week. On Monday, it was revealed that Ontario hospitals had failed to flag 700 positive COVID-19 tests to public health officials because of a mixup.
In a statement to CBC, Ontario Health has said the impact of the error “may not be fully understood for some time.”
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