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The unintended consequences of surgery delays during 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.


The sacrifice Canadians have collectively made to flatten the coronavirus curve also includes immeasurable suffering from postponed surgeries, says a B.C. man who lost his mother not to the virus but to cancer.

Min Hua (Jasmine) Yang, 60, started having abdominal pain, fever and then breathing difficulties in January. She went to an emergency department in Surrey, B.C., and was diagnosed with a rare form of ovarian cancer in March.

Her son, Jonathan Hu, 31, said oncologists recommended surgery in early April as the best treatment for Yang’s three, late-stage tumours. But the COVID-19 pandemic lockdown included postponing or cancelling non-emergency surgeries like Yang’s — and an estimated 394,575 others across Canada.

“There is a lot more people who are suffering or dying other than just a number of deaths that you see from the coronavirus,” Hu said.

Canada’s health-care systems made a choice to cancel surgeries and to devote hospital staff and resources to COVID-19.

“We were really frustrated,” Hu said.

Jonathan Hu and his mother Jasmine Yang. He says the family felt powerless watching her deteriorate every day waiting for surgery. (Submitted by Jonathan Hu)

The family “felt powerless” as they watched Yang deteriorate daily during chemotherapy that was not part of the original treatment plan for her sex cord stromal cancer. The surgery was postponed weeks to May 4.

Yang died two days earlier.

“The choice that we made has consequences and we’re living with those consequences right now,” Hu said.

Tough choices

Dr. Iris Gorfinkel, a family physician in Toronto, worries about unintended consequences from those choices for her patients, too.

For example, virtual care excludes the physical exams she performs to quantify the degree of pain a patient has.

WATCH | The complications of resuming surgeries during pandemic: 

Many provinces are starting to resume non-emergency surgeries delayed because of the COVID-19 pandemic, but it’s a complicated balance of trying to clear the backlogs and keeping patients safe. 2:03

“You put your hand on that person’s belly you see immediately they’re not doing well because you can feel how they’re reacting,” Gorfinkel said. “I know from my own practice I’m more likely to order tests because of that uncertainty, which is another cost to the system because I don’t want to be wrong.”

Patients are also left wondering whether delays in tests and procedures made a difference in their care, Gorfinkel said.

It’s one reason why health-care professionals across the country are preparing to do more procedures and surgeries.

Surgery backlog mounts

In May, B.C. Health Minister Adrian Dix estimated it could take up to two years to clear the backlog of 30,000 patients whose surgeries were postponed or not scheduled since mid-March in that province alone due to COVID-19.

In Quebec, Dr. Gilbert Boucher, head of the province’s association of emergency medicine specialists, said the flow of patients sick with medical conditions besides COVID-19 has resumed in much of the province.

The last three weeks, however, have included struggles with finding space, including for patients discharged from hospital who are unable to return home or to long-term care.

At Montreal’s older hospitals with four-bed rooms, many cannot be used while COVID-19 cases continue in the community. One tertiary care centre lost 30 per cent of its beds during confinement, Boucher said.

Hospitals with wards for people testing positive for COVID-19 had doctors and nurses working overtime for the last three months.

An empty operating room is seen in a Maryland hospital in March as hospitals worldwide cancelled elective surgeries to make space for COVID-19 patients. (Rosem Morton/Reuters)

“Those people are getting tired so we just don’t have the staff to staff the operating room and to do the gastroscopy and the colonoscopy and all those follow-up” procedures, said Boucher. “It’s summer for everybody so people do need a little break.”

Safety prioritized

Medical experts say to ramp up surgeries, a “four-sided Rubik’s cube” of prerequisites, known as the 4S’s, first need to align:

  • Screening for COVID-19 safely.
  • Increased staffing capacity.
  • Supplies such as personal protective equipment and medications like anesthetics.
  • Space and systems in place to keep patients clear of COVID-19 before and during hospitalization and for patients and their family members to understand the importance of quarantine in the first 30 days after surgery.

In addition to surgery delays, the COVID-19 pandemic has led to global shortages of some drugs.  

Christina Adams, chief pharmacy officer for the Canadian Society of Hospital Pharmacists, said drug makers have increased production of medications for critical care, such as the injectable anesthetic propofol that’s reportedly chronically short in the U.S.

Patients with COVID-19 who require continuous ventilation need two to three times the usual amount of propofol compared with patients requiring surgery under general anesthesia, Adams said.

She added that Health Canada anticipated global shortages and expedited imports of non-Canadian labelled products, such as from the European Union, to ensure supplies weren’t interrupted.

“Right now, the situation is not bad,” Adams said.

COVID-19 greatly compounds surgery risks

Janet Martin an associate professor of anesthesia and perioperative medicine at Western University and an international team of surgery researchers, estimated that 28.4 million elective surgeries worldwide could be cancelled or postponed this year based on the 12-week peak of disruptions to services in hospitals.

For Canada, the cancelled surgeries include hip and knee replacements and procedures to confirm whether or not someone has cancer.

“That’s exactly for whom we are doing this type of research,” Martin said.

Researchers said they looked at surgery delays during COVID-19 to help people like those living with a knee that is constantly painful waiting for a replacement. (Vincent Bonnay/Radio-Canada)

If hospitals successfully increase capacity by 10 per cent by running operating rooms longer and partly on weekends, Martin figures it will take nearly 90 weeks to clear Canada’s backlog.

In a study published last month in The Lancet, Martin and co-authors followed 1,128 patients in 24 countries who had emergency and elective surgery this year before March 31.

Nearly one in four patients died within a month, the researchers found. For those undergoing elective surgery, the mortality risk rose from below the one per cent to 18 per cent.

One in two (51 per cent) developed serious pulmonary complications, including needing ventilation.

“We were absolutely surprised,” Martin said. “That is far and above what we had ever expected.”

As the increased risks from surgeries due to COVID-19 become apparent from the new data, Martin hopes hospitals will find ways to better protect patients.

Janet Martin said she’s thankful to no longer be in the dark about how risky surgery can be during COVID-19. (Western University)

For his part, Hu emailed CBC News looking for information on how many others in Canada like his mother who weren’t infected with COVID-19 but missed treatment and died.

It’s impossible to know exactly how delays affect an individual patient.

Gorfinkel said while such societal fallout can only be measured in retrospect, there are definitely consequences from postponing routine screenings during the pandemic, such as mammograms or tests to look for blood in feces, which can be a sign of a colorectal cancer or a growth that can easily be treated.

“Would an earlier diagnosis have made a difference?” Gorfinkel said of the questions she’s anticipating from her patients. “Much of the time it may not but the fact is we can’t be certain.” 


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30 workers at Vaughan, Ont., mushroom farm test positive for COVID-19 – Canada.com

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VAUGHAN, Ont. — Health officials say they are looking into an outbreak of COVID-19 at a mushroom farm in Vaughan, Ont.

York Region Public Health says the “workplace cluster” involves 30 workers at Ravine Mushroom Farm.

The agency says it has determined the risk of transmitting the virus to the general public is low.

It is also following up with those who have come in close contact with the infected workers.

The public health agency says it has inspected the facility to review and reinforce infection prevention and control measures.

It says it has also reaffirmed the importance of not having employees work when they are sick.

This report by The Canadian Press was first published on July 7, 2020.

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30 workers at Vaughan mushroom farm test positive for COVID-19 – Toronto Sun

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Health officials say they are looking into an outbreak of COVID-19 at a mushroom farm in Vaughan.

York Region Public Health says the “workplace cluster” involves 30 workers at Ravine Mushroom Farm.

The agency says it has determined the risk of transmitting the virus to the general public is low.

It is also following up with those who have come in close contact with the infected workers.

The public health agency says it has inspected the facility to review and reinforce infection prevention and control measures.

It says it has also reaffirmed the importance of not having employees work when they are sick.

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8 new coronavirus cases identified in Ottawa on Monday – Globalnews.ca

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Ottawa Public Health’s (OPH) novel coronavirus case tally rose by eight on Monday as the city’s streak of days without a death related to the virus hit double digits.

The local public health unit says it’s identified 2,118 lab-confirmed cases of the novel coronavirus in Ottawa since the pandemic was first declared in mid-March.

There are currently 54 active cases of COVID-19, the disease caused by the virus, in Ottawa, but 85 per cent of previously identified cases are now marked resolved.

Read more:
Ottawa, surrounding regions make indoor masks mandatory as of Tuesday

Three people are currently in hospital with the disease.

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Some 263 people in the city have died as a result of COVID-19 — that figure has remained unchanged for the past 10 days.

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OPH also said Monday the outbreak at the Peter D. Clark long-term care facility ended on July 4, which marked at least 14 days since a resident or staff member last tested positive for the virus.

The outbreak at the city-run long-term care home was first declared on April 28. There were 45 coronavirus cases linked to the Peter D. Clark outbreak, with eight residents dying as a result of complications from COVID-19.

Staff at the home are now starting to schedule outdoor visits between residents and family members.

There is now only one Ottawa institution currently facing an outbreak: the Rideau building at the Perley & Rideau Veterans’ Health Centre.

Eleven people have tested positive for the virus at the long-term care home’s Rideau facility, with one resident dying in connection to COVID-19.






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Coronavirus: Ontario health minister says there’s ‘hope’ for move to stage 3 soon


Coronavirus: Ontario health minister says there’s ‘hope’ for move to stage 3 soon

© 2020 Global News, a division of Corus Entertainment Inc.

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