COVID-19 hospitalizations, deaths and confirmed case counts across Canada are relatively stable after an early summer wave, but they remain far higher than past years, data shows.

As of Wednesday, Canada is seeing an average of 3,475 lab-confirmed cases and 44 deaths per day, according to provincial and territorial data compiled by Global News. Currently, 5,158 people are in hospital with COVID-19, including 305 patients who are in intensive care.

While those numbers are down slightly from the brief wave of infections in June and July, they remain far higher than the rates seen during the summers of 2020 and 2021.

In past years, there was an average of roughly 350 patients in hospital per day during the summer months. Even as hospitalizations climbed in August 2021 and into September of that year, they peaked at half the current rate.

The current death rate has also vastly eclipsed past summers, when the average number of deaths per day was in the single digits.

Previous evidence pointed to the summer months as predictable lulls in the pandemic, as people spend more time in outdoor spaces where there is less transmission of the virus.

But the more infectious Omicron variant upended that thinking, and further mutations — including the current BA.5 subvariant and its predecessor, BA.2 — have led to more waves of infections this year than in the past.

The World Health Organization warned on Wednesday that BA.5’s dominance has led to a 35 per cent increase in reported COVID-10-related deaths globally over the past four weeks.

In the last week alone, 15,000 people died from COVID-19 worldwide, according to WHO Director-General Tedros Adhanom Ghebreyesus.

“There is a lot of talk about learning to live with this virus, but we cannot live with 15,000 deaths a week. We cannot live with mounting hospitalizations and deaths,” he said at a press conference.

“We cannot live with inequitable access to vaccines and other tools. Learning to live with COVID-19 does not mean we pretend it’s not there. It means we use the tools we have to protect ourselves and protect others.”

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COVID guidelines for fall: Expert urges Canadians to look out for flu as well

Canada’s chief public health officer Dr. Theresa Tam has said the country is in a period of pandemic transition that will likely lead to further waves this year, warning back in June that COVID-19 “has not left the stage.”

Public health officials have shifted their focus toward a potential serious wave in the fall and winter. Planning is underway to provide vaccine booster doses to all adults that request one, while ensuring vulnerable populations receive an extra dose.

Experts say the boosters are important, as current vaccines do not sufficiently protect against Omicron and its subvariants, allowing for “breakthrough cases” and even reinfections among vaccinated people.

“However, there is evidence that if you have the vaccine, more than likely you don’t end up in the hospital,” said Dr. Horacio Bach, an infectious disease researcher and assistant professor at the University of British Columbia.

“People (infected with COVID-19) will say, ‘It’s just kind of a flu, that’s okay, I’ll stay home.’ That is the result of the vaccines.”

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Expert says Canada can expect a spike in COVID-19 variants cases during fall and winter

The Public Health Agency of Canada notes that between June 6 and July 3 of this year, unvaccinated cases were three times more likely to be hospitalized and four times more likely to die from COVID-19 compared to vaccinated cases.

Tedros urged everyone who has access to a booster dose to get one, and to continue to wear masks when it is impossible to keep distance from others.

As of Monday, 86.1 per cent of the Canadian population has received at least one dose of an approved COVID-19 vaccine, while 82.4 per cent have received at least two doses. Yet just under half — 49.7 per cent — have gotten at least one more booster dose.

Despite hospitalizations nationally remaining relatively stable, signs are emerging that more patients are being admitted with symptoms.

Hospitalizations are on the rise in Alberta, Manitoba and Quebec, according to the most recent updates. Most provinces besides Quebec have shifted to reporting data weekly, while Saskatchewan is due to release its first monthly report on Thursday.

To date, provinces and territories have confirmed more than 4,125,000 cases of COVID-19 including 43,471 deaths.

— With files from Rachel Gilmore

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Advocates from around the world came together at the U=U Global Summit at the 24th International AIDS Conference (AIDS 2022) in Montreal last month to share successes and challenges that continue to hamper full-scale integration of the ‘Undetectable = Untransmittable’ (U=U) message in diverse global contexts.

A central theme was that structural barriers – especially poverty, limited access to treatment and viral load testing, stigma, and widespread inequalities – continue to shape health outcomes. HIV criminalisation is also a formidable barrier in many contexts, and advocates discussed the possible role of U=U in challenging HIV criminal laws.

The Caribbean

Judy-Ann Nugent, from the Jamaican Network of Seropositives (JN+), spoke about challenges in the Caribbean, where there has been limited U=U buy-in from healthcare providers and people living with HIV. She emphasised the role of stigma, poverty, weak health systems and low levels of literacy in limiting treatment uptake and adherence.

“Simply put, if people are not fed, paid – have enough money or food – if their basic needs are not met, taking HIV medication will not be a priority for them,” she said.

However, there has been progress, with 70% of all people living with HIV in the region accessing treatment in 2021 and incidence continuing to drop. According to the latest UNAIDS data, 84% of people living with HIV in the Caribbean know their status, 83% are on treatment and 87% are virally suppressed.

To promote more widespread awareness of U=U, Nugent recommended that U=U messaging is embedded in funding agreements with PEPFAR and the Global Fund so that countries are required to take proactive steps to integrate U=U into national programmes in order to receive funding. PEPFAR’s updated country guidance for 2022 does just this, making extensive mention of the need for countries to integrate U=U messaging along the HIV care continuum.

Latin America

Dr Franco Bova, from the Argentinian organisation Asociación Ciclo Positivo, shared that only 60% of those on treatment are virally suppressed in Latin America, falling far short of the previous 90 and the current 95 targets for viral suppression. It is also one of the regions where HIV incidence has increased since 2020. Bova said poverty and inequality perpetuate new infections and are barriers preventing people living with HIV from achieving viral suppression.

Various approaches have been successful at creating awareness of U=U in the region. In Argentina, activists have worked with community-based organisations, NGOs, universities, and local government to spread the U=U message at large public events, such as Pride, and through social media. Bova spoke about some successful strategies used in other Latin American countries, such as storytelling in Mexico, music videos and concerts in Venezuela and official government campaigns in Brazil. He also highlighted important gaps that make it challenging to speak about U=U at all. For instance, in Peru, the Ministry of Health does not collect any data on viral suppression.

Bova’s organisation is promoting a virtual platform, Indetectable LAC, to bring stakeholders in Latin America and the Caribbean together to share information and to enable better networking in the regions.

The Middle East and North Africa

HIV infections increased by 33% in this region from 2020 to 2021. It is one of only three global regions, along with Latin America, and eastern Europe and central Asia, where HIV is still on the rise. In 2021, only 67% of people living with HIV knew their status, 50% were on treatment and 44% were virally suppressed.

“The Middle East and North Africa is the region where the international HIV community has failed,” stated Arda Karapinar, founder of Red Ribbon Istanbul, Turkey’s leading HIV civil society organisation. He emphasised the distinct contextual challenges in the region. HIV-related stigma, combined with conservative religious attitudes towards sex and limited human rights, present formidable challenges in getting the U=U message out.

However, he also spoke of how passionate local activism can result in change and create awareness. “I know from my own experience in Turkey how sometimes, just one activist from a country or a region, dedicated to creating a change in society for the benefit of all, may be highly sufficient. There are great activists in the region who are defending U=U. They continue to work despite countless risks.”

Karapinar argued that Turkey is uniquely positioned between Europe and the Middle East, and can act as a meeting point and a safe harbour for those hoping to improve HIV outcomes and U=U awareness in the Middle East and North Africa region.

United Kingdom

Activist Fungai Murau spoke about the gaps that still exist in U=U awareness, even in the UK. She shared the story of a young woman who had acquired HIV vertically and had never heard about U=U. “Children who acquired HIV vertically in the UK are being transferred from adolescent clinics to adult clinics without being told about U=U,” she said. “Because we are assuming that paediatric doctors should not be talking to young girls about sex. This is not correct. We need to change that. We need to ensure that by the time they transfer to adult clinics, we have closed that gap.”

She advocated for integration across different healthcare services in the UK. “My HIV clinic is my champion, but my GP or my dentist may not know about U=U.”

Criminalisation in the United States

The US is one of the leading countries criminalising people with HIV under laws ranging from non-disclosure to alleged transmission. Convictions under these laws can result in lengthy prison terms and registration as a sex offender.

While some activists have argued that U=U should be used as a basis for decriminalisation, Catherine Hanssens, founder of the Center for HIV Law and Policy, spoke about the potential pitfalls of being overly reliant on U=U when advocating for HIV decriminalisation, particularly because of the structural barriers to achieving viral suppression in the US.

Hanssens emphasised that advocacy on behalf of an individual is very different from advocacy for equitable policy and law reform. While it may certainly be beneficial to show proof of undetectability (and subsequent lack of ability to transmit HIV) in individual cases, there might be unintended negative consequences if advocates call for undetectable status to be codified into laws – especially for the groups most likely to be targeted by HIV criminalisation.

If viral load is a factor in determining whether a person is guilty, it can lead to using a person’s failure to stay in health care or to achieve viral suppression as evidence of guilt. It can also lead policymakers and prosecutors to believe, and argue, that people living with HIV who are not undetectable pose a significant risk of transmission to sexual partners. “Current science makes it clear that HIV is not easy to transmit,” Hanssens said. “And even when transmitted, it is easily survivable with appropriate treatment.”

She argued that efforts to reform HIV criminal laws should be based on whether intent to harm was present or not, and the fact that HIV is a manageable chronic illness with appropriate treatment, not a death sentence.

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News

It is no revelation that the mental health and wellbeing of many people has been impacted by the COVID-19 pandemic.
 
However, new findings indicate that for women, particularly mothers, that impact has been ‘profound’.
 
‘The pandemic has highlighted gaps in the current service delivery frameworks, especially for women with limited financial resources,’ social epidemiologist Professor Stephanie Brown said.
 
‘These gaps have resulted in many women in need of mental health support being unable to access mental health services.’
 
Professor Brown is Head of Intergenerational Health at the Murdoch Children’s Research Institute (MCRI) and led the Mother’s and Young People’s Study used to inform a policy brief on the pandemic’s impact on maternal mental health and wellbeing.
 
The prospective cohort study was originally investigating women’s health after childbirth, but expanded to include children and young people’s health and wellbeing, and how it links with their mother’s.
 
It identified that gaps in current health service delivery had widened during the pandemic, resulting in many women being unable to access appropriate services for mental health support.
 
In response, the researchers are calling for further policy action, including an extension of mental health strategies across the whole family.
 
‘It is important to provide multi-service frameworks that enable mothers, fathers, children and young people under 18 to receive appropriately tailored support,’ Professor Brown said.
 
According to an online survey of 418 women conducted as part of the study during Victoria’s second lockdown, almost one in three women reported ‘clinically significant’ mental health issues.
 
Notably, less than half (45%) of these women received support from health professionals, with just one in four talking to a GP or a psychologist.
 
More than half (55%) did not receive any mental health support from primary care or mental health services, and only 4% of women experiencing ‘clinically significant’ depression or anxiety had called a telephone support line.
 
The reported reasons for not receiving support from health professionals included prioritising support for their children’s mental health over their own, psychologists closing their books to new clients/long waiting periods, and a lack of confidence using telehealth.
 
Additionally, women experiencing mental health issues were almost four times more likely to delay their own medical care due to the cost of services.
 
Chair of RACGP Specific Interests Psychological Medicine Dr Cathy Andronis is not surprised by the findings.
 
‘The sense of isolation and disconnection from normal life as a result of the pandemic leaves many vulnerable people feeling abandoned by others and exacerbates underlying negative emotions 
and thoughts, leading frequently to helplessness and hopelessness,’ Dr Andronis told newsGP.
 
‘People give up on asking for help, particularly when there are urgent tasks at hand such as caring for a new baby that is needy night and day, and more helpless than their mother.’
 
The RACGP has recently raised a number of concerns around current Medicare structures for providing mental health care, leading to fragmentation and poor patient outcomes.
 
Acknowledging GPs’ essential place in providing mental health care, the college is lobbying for this space to be properly funded, including by implementing higher Medicare rebates for longer
consultations.
 
And although telehealth has helped expand access to care, Dr Andronis believes it is not always appropriate when it comes to mental health care.
 
‘The lack of human physical connection of telehealth services exacerbates this isolation [experienced by women in the study],’ she said.
 
‘We need real human, face-to-face connection when we are most distressed. Empathy and compassion online or over the phone is usually not as effective or responsive as live consultations.  
 
‘Fear by mothers of bringing COVID into their household was one more major stress that needed to be avoided when they were just coping with the necessary adjustments of the postnatal period.’
 
The Mother’s and Young People’s Study survey cohort also revealed that many women experienced:
 

• fatigue (53%)
• anxiety (41%)
• irritability (33%)
• sadness (27%)
• loneliness (21).

 
In January and April 2021, when many restrictions were lifted, 391 women took part in a subsequent survey which revealed that despite reports of these issues being reduced, they remained ‘well above’ pre-pandemic levels.
 
Professor Brown said the findings are expected given the many family disruptions caused by the pandemic.
 
‘Much of the responsibility for remote schooling was shouldered by women,’ she said.
 
‘For some women, this meant giving up their paid job, taking leave without pay or reducing their hours of work significantly.
 
‘The challenges of remote learning were particularly acute for mothers of children experiencing neurodevelopmental conditions such as ADHD or autism, and for women whose children started at a new school just prior to the pandemic.’
 
While underlying mental health issues were exacerbated by the pandemic, one in five women with no prior history of depression also reported ‘clinically significant’ depressive symptoms during the pandemic.
 
One third of women from the study continue to experience significant mental health problems including ongoing fatigue and parenting stress.
 
Professor Brown says these ongoing impacts present further cause for policy action.
 
‘[The] continuing day-to-day effects of the pandemic are likely to have both short- and longer-term impacts on women’s workforce participation, their own mental health and wellbeing, and the mental health and wellbeing of other family members,’ she said.
 
The MCRI policy brief states that the ‘process of healing and recovery from the pandemic will take time’, suggesting GPs will continue to play a major role supporting mothers well beyond the perinatal period for years to come.
 
‘GPs have been the most accessible and available healthcare providers during this pandemic and are likely to continue to be so,’ Dr Andronis said.
 
‘We are able to meet these women in our clinics and offer timely support. We are highly appreciated by vulnerable people when we offer our support and hold hope for them.
 
‘Managing these life events and transitions, collaboratively with patients is something we do well.’
 
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