MONTREAL — Researchers are having a hard time explaining why Quebec had the country’s highest official COVID-19 death toll despite a relatively low number of excess deaths between March 2020 and October 2021.
A new study released Monday by the Canadian Medical Association Journal tried to answer that question but came up short.
“I would say at this point it’s something we need to understand,” Kimberlyn McGrail, professor at University of British Columbia’s school of population and public health, said in an interview.
The study, “Excess mortality, COVID-19 and health-care systems in Canada,” says Quebec had 4,033 excess deaths between March 2020 and October 2021 but reported 11,470 COVID-19 fatalities — almost three times more. It’s the biggest gap recorded in Canada during the pandemic. Excess deaths refer to the degree to which observed deaths exceed expected deaths based on modelling from previous years.
McGrail said she observed too many factors to offer a definitive answer.
“Quebec was an interesting case,” she said. “What we see is that in Quebec, you have these periods where there are high excess mortalities, but you also have periods where the excess mortality rates are below zero, meaning that there were less mortalities in those weeks than were predicted.”
Between February 2021 and July 2021, for example, Quebec’s mortality rate was lower than in pre-pandemic years, yet officials in the province were reporting up to 10 COVID-19 deaths per 100,000 people every day.
“I don’t have a definitive answer,” McGrail said. “That’s part of the reason I was interested in writing the paper, because of the number of things that could play into this.”
One reason that could explain the gap, she said, is that Quebec officials were testing many people who — for reasons unrelated to COVID-19 — were already close to death.
“Quebec was doing more testing, particularly with people who were clearly near the end of their life,” McGrail said. “They were maybe picking up people who had COVID-19 who were truly going to die in the next days or weeks regardless.”
Earlier in May, Quebec’s statistical institute released a report indicating there had been 6,400 excess deaths between the start of the COVID-19 pandemic and March 12, 2022. The province had officially reported more than 15,000 COVID-19 deaths during that period.
In response to the report, Premier François Legault said the data from the Institut de la statistique du Québec indicated the health orders his government had imposed had worked to reduce death in the province. “What this says is that the measures that we put in place over the past two years have had results,” he said at the time.
McGrail’s study indicated that Nova Scotia had the lowest proportion of COVID-19 deaths to excess deaths. The province reported 98 COVID-19 deaths during March 2020 and October 2021, yet there were 217 fewer people who died during that period compared with what was expected based on prior years.
While McGrail was cautious to give definitive answers to explain the gap between Quebec’s excess death rate and its COVID-19 mortality rate, Frédéric Fleury-Payeur, with the province’s statistical institute, offered several theories.
One explanation, he said Monday in an interview, is that older people stayed inside more than usual between March 2020 and October 2021, leading to less opportunities to hurt themselves.
“Falls among older people are still quite an important cause of death,” Fleury-Payeur said. “It leads to a hip fracture or other bones, and since the elderly have been less mobile during periods of isolation and the curfew, it could have played a role.”
Another explanation, he said, is that Quebec doctors included COVID-19 as a cause of death in medical reports more liberally than doctors in other provinces did. He said it’s known in Canada’s medical community that medical reports in Quebec are more detailed than in other provinces.
“We have known for quite a long time that there are more details in the cause-of-death section in Quebec (medical reports) than in other provinces,” Fleury-Payeur said. “When the pandemic began, were Quebec doctors, by habit or tradition, more sensitive to identifying every suspicious COVID-19 death and reporting it?”
Fleury-Payeur said a full portrait of the situation would be available when all the coroners’ reports involving deaths during the pandemic are made public and studied.
This report by The Canadian Press was first published on May 30, 2022.
This story was produced with the financial assistance of the Meta and Canadian Press News Fellowship.
Virginie Ann, The Canadian Press
Kingston, Ont., area health officials examining future of local vaccination efforts – Global News
More than 455,000 people in the Kingston region have been vaccinated against COVID-19.
Now health officials say they’re using the summer months, with low infection rates, to look ahead to what fall might bring, urging those who are still eligible to get vaccinated do so.
“Large, mass immunization clinics, mobile clinics, drive-thru clinics and small primary care clinics doing their own vaccine,” said Brian Larkin with KFL&A Public Health.
Infectious disease expert Dr. Gerald Evans says those who are still eligible for a third and fourth dose should take advantage and roll up their sleeves during the low-infection summer months.
“Now in 2022, although you still might get COVID, you’re probably not going to be very sick. You are less likely to transmit and ultimately that’s one of the ways we’re going to control the pandemic,” added Evans.
He expects another wave of COVID-19 to hit in late October to early November and that a booster may be made available for those younger than 60 who still aren’t eligible for a fourth dose.
“The best case scenario is a few more years of watching rises in cases, getting boosters to control things and ultimately getting out of it with this being just another coronavirus that just tends to cause a respiratory infection and worst-case scenario is a new variant where all the potential possibilities exist to have a big surge in cases and hopefully not a lot more serious illness,” said Evans.
Public Health says they’re still waiting for direction from the province on what’s to come this fall.
“We’re expecting that we would see more age groups and younger age groups be eligible for more doses or boosters but about when those ages start, we have yet to have that confirmed,” said Larkin.
The last 18 months of vaccines paving the way for the new normal could mean a yearly COVID booster alongside the annual flu shot.
© 2022 Global News, a division of Corus Entertainment Inc.
Monkeypox detected in Norfolk County | TheSpec.com – Hamilton Spectator
The monkeypox virus has found its way to Norfolk County.
The health unit announced on Friday that a Norfolk resident has tested positive and is currently isolating at home.
Contacts of the infected resident have been notified, according to a media release from the health unit.
“There is no increased risk of monkeypox to the general public stemming from this case,” acting medical officer of health Dr. Matt Strauss said in the release.
“Outside of an emergency situation, if you have symptoms of monkeypox, it is important to stay home and call your doctor to be assessed. When seeking medical care, you should wear a high-quality medical mask and cover up all lesions and open sores.”
Monkeypox is spread by direct physical contact, most often by touching a rash on an infected person’s skin but sometimes through “respiratory secretions” if in close proximity for a prolonged period, the health unit said.
“Most people infected with monkeypox will have mild symptoms and recover on their own without treatment,” said the release.
Symptoms lasting between two and four weeks can include fever, headache, swollen lymph nodes, low energy, muscle aches, skin rash or lesions, sometimes starting on the face or genitals and spreading elsewhere.
The health unit says symptoms usually start between six and 13 days of exposure to the virus.
The Halton region recorded its first confirmed case of monkeypox earlier this month.
Close contacts of monkeypox patients are eligible to receive the smallpox vaccine, which also provides protection against monkeypox.
Mass vaccination campaign against Monkeypox needed, experts say – Global News
As the World Health Organization calculates whether to declare monkeypox a global health emergency, infectious disease experts are urging health officials to be more proactive and start ramping up vaccinations and surveillance — especially in African nations where the virus is most prevalent.
The WHO convened its emergency committee Thursday to consider whether the spiralling outbreak of monkeypox should be declared a “public health emergency of international concern,” the WHO’s highest level of alert.
But the United Nations agency is facing criticism over its treatment of monkeypox — jumping into action only after the disease started to spread in rich western nations.
The viral disease that causes flu-like symptoms and skin lesions is endemic in parts of Africa, which means it is consistently present in certain regions. The continent has registered just over 1,500 suspected cases since the start of 2022, of which 70 have been fatal, according to the WHO.
By comparison, Canada has confirmed over 200 cases, the majority of which are in Quebec, and has had no deaths.
“There are more cases that occur in Africa on a yearly basis than have already been reported outside of Africa right now. And there are more deaths that have occurred in Africa from monkeypox than have occurred in the rest of the world,” said Dr. Sameer Elsayed, an infectious disease physician and professor of epidemiology and biostatistics at Western University.
That’s why he believes Africa should be getting the lion’s share of resources to deal with monkeypox — and that should include mass vaccinations, he says.
“I think Africa needs to be looked at with high, high priority,” he said.
“It needs to be a mass vaccination campaign for monkeypox with the newer vaccines for people in the African continent, especially in the high endemic areas.”
He’s not alone.
Dr. Monica Gandhi, a physician and infectious disease expert at the University of California, San Francisco, says she also believes more people living in regions where monkeypox is more prevalent should be vaccinated.
“That will actually stop it in endemic regions in this non-endemic outbreak.”
That the WHO is only now taking monkeypox seriously is “profoundly problematic,” Gandhi says, given that the disease has been spreading and killing people in Central and West Africa for years.
Monkeypox has about half of Canadians worried, but most confident with health response: poll
“It’s been circulating since 1958. There are increasing outbreaks — a severe one in Nigeria, for example in 2017 — and it’s only really essentially when this has affected high-income countries that the WHO is jumping on it.”
Experts who have worked on monkeypox in places like the Democratic Republic of Congo have long taken note of rising cases while population immunity to pox viruses has been decreasing, due to lack of vaccination. This is why the world shouldn’t be surprised at the current outbreaks, said Anne Rimoin, an epidemiology professor at UCLA in California, who has studied monkeypox for two decades.
The COVID-19 pandemic has demonstrated how quickly a deadly virus can spread across the globe when the right conditions are present, so health officials ought to learn from this and start being more proactive, she said.
“When it comes to infectious diseases, in particular those viruses that have the potential for global spread, it’s much easier to stay out of trouble than it is to have to get out of trouble.”
In addition to providing vaccines, health officials should also be ramping up resources to study this disease and do more surveillance to get a better understanding of monkeypox and learn why it is spreading in new and unusual ways, Rimoin said.
“We’ve given this virus a lot of runway to be able to spread. We have not been looking for it as vigilantly as we should be,” she said.
“I think we have to learn the lessons that we’ve learned with COVID-19 and that it is much better to invest ahead of time to get in front of these viruses, to do the kind of surveillance it’s necessary to be regularly updating our knowledge about viruses.”
Good disease surveillance is just as important in poorer countries as it is in “high-resource settings,” she added.
Like many countries around the world, Canada and the United States stopped vaccinating the general population against smallpox by around 1972, which means many on this continent are highly susceptible to pox viruses like monkeypox.
Given that scientists expect to see more emerging infectious diseases due to factors such as climate change, deforestation and globalization, the world should start getting better prepared for new outbreaks, Elsayed said.
This is why, in addition to calling for vaccinations and more resources to fight monkeypox in Africa, Elsayed believes governments in developed nations should also consider more options to protect citizens from pox viruses, including possibly re-introducing mass smallpox vaccinations.
“I believe that these vaccines should come on board again for the general population … but not (just) for monkeypox, but also to protect the world against perhaps a smallpox pandemic that can happen in the future, or even another virus that’s closely related to monkeypox but hasn’t reached humans,” Elsayed said.
He stressed this should only be considered after addressing the more pressing needs in Africa first.
WHO looks into reports of traces of monkeypox found in semen
Rimoin noted that when the world stopped vaccinating against smallpox, it opened a “gap of immunity” for populations to once again be vulnerable to it. And with the emergence of a number of new pox viruses in different parts of the globe, including mousepox, cowpox and camelpox, the world is not immune to new outbreaks, she said.
“We now have to really think about, How important is it for us to be able to keep pox viruses out of the population?” she said. “What are the stakes of allowing this virus to spread? And then acting accordingly.”
-With files from Global News reporter Reggie Checcini and Reuters.
© 2022 Global News, a division of Corus Entertainment Inc.
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