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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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
