Health
Nova Scotia’s premier encourages residents to support local as businesses reopen
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HALIFAX —
As Nova Scotians count down the days until the province reopens, Premier Stephen McNeil is thanking them for working hard to follow protocols and flatten the curve.
“We haven’t had a lot of good news in this province in the last few months, but when I wake up and see the low numbers and feel the level of relief and gratitude, knowing what all of you have been doing to keep Nova Scotians safe,” says MaNeil.
“We have said all along that we are in this together and you have proven that every day.”
The premier is reassuring Nova Scotians that testing will continue and immediate action will be taken if there is a spike in cases.
“I know many of you are nervous but we have to get our economy moving again. We are taking it slow, we are reducing capacity, protocols will be in place, and we need everyone to follow them. I believe we all understand the importance of self-distancing and wearing a mask,” says McNeil.
“What’s really important is for all of you to support your local businesses. They need you and they want to welcome you back. So think local, buy local, support local. That makes us Nova Scotia strong and Nova Scotia proud.”
Dr. Robert Strang, Nova Scotia’s chief medical officer of health, says every sector that was closed down under the public health order has submitted their reopen plans, however not all of them have had final approval.
“There are a few that are in the final stages. I have a number of emails and plans that I have to approve later today, but we are in a place that everybody has a plan at least somewhere in the process. The majority have already been sent back and approved,” says Strang.
Customer experience will be different
When businesses reopen, Strang says the customer experience will be different and expectations should be adjusted accordingly.
“Whether you are going to a restaurant, whether you are going to a hair salon, whether you continue to go shopping, your experience will look different,” says Strang.
“Certainly in restaurants we know you can expect tables to be further apart, so that they can maintain that six-foot social distancing. There are other public health measures that support better handwashing, controlling how people move around in a restaurant or a bar space, and limitations on the type of activities that can happen in terms of entertainment and dancing.”
Bubble rules still apply
Strang also clarified that, at this time, they are not ready to have people from multiple households come together at a single table at a restaurant.
“The physical distancing requirements and the rules around household bubbles and family household bubbles haven’t changed and they pertain to restaurants and bars, like everywhere else,” says Strang.
“While people may be at tables in up to groups of 10, unless they can be separated by six feet while they are at that single table, which is not likely, they have to be people from the same household or household bubble.”
Public health is working with business and community partners to create environments that support public health requirements.
“At the end of the day, there is an obligation and a need for all Nova Scotians to participate and follow those public health requirements that are being put in place in all our public spaces and retail and business places,” says Strang.
“One of the critical things is that, people need to understand that if you are not feeling well, then it is not the time to go out. You may have COVID-19. If you meet any of the symptoms, if you are not sure do the 811 online assessment, but if you are not feeling well it is critically important that you not go out and potentially expose others to COVID-19.”
CERB
When the pandemic hit, the federal government introduced the Canada Emergency Response Benefit (CERB), designed to help people who lost income due to COVID-19. The program is available until Oct. 3 and provides successful applicants with $2,000 a month for up to four months.
As businesses prepare to reopen in Nova Scotia, one of the challenges presented is the reality that some employees who receive CERB are making more to stay home than go to work.
“I strongly encourage all Nova Scotians to take the opportunity to go back to work. While it may have a short-term impact, your hard work and effort in the business you are working with will determine the long-term future of that business and, quite frankly, your long-term employment,” says McNeil.
“Let’s not look at this in the short term, let’s look at this in the long term. Every business needs its employees to go back to work to help with the viability and that means that that business will be there for years to come, not just for a few months when we know that CERB program is going to run out.”
Public schools
With businesses opening on June 5 and daycares not far behind, many Nova Scotians are wondering about the status of public schools.
“We haven’t started a conversation yet about public schools, it’s coming very soon,” says Strang.
“I know we’ve got some meetings coming up in the next couple of weeks. Understanding that we are very busy focusing on getting to Friday and then we are focusing on working on our daycares who are coming soon, so we haven’t had a detailed conversation yet about schools but we need to get there.”
New case in eastern zone
For the first time in over three weeks, a new case of COVID-19 has been identified in Nova Scotia’s eastern zone.
The province last reported a new case of the virus in the eastern zone on May 10. The eastern zone now has 52 cases of COVID-19.
Strang said Wednesday that the person who tested positive had travelled outside of Nova Scotia.
“Fortunately, this individual followed public health protocol and was in self-isolation from the time they returned to the province, and had minimal exposure at the time they may have been infectious,” said Strang during a news conference in Halifax.
The province isn’t reporting any additional cases, or deaths, at this time.
The QEII Health Sciences Centre’s microbiology lab completed 639 Nova Scotia tests on Tuesday.
To date, Nova Scotia has 43,340 negative test results, 1,058 positive COVID-19 test results and 60 deaths.
Fifty-three of the deaths have been at Halifax’s Northwood long-term care home, which has seen the most significant outbreak in the province.
A Halifax law firm is proposing a class-action lawsuit against the facility, claiming normal standards of care weren’t met to protect against infection from COVID-19.
993 people recovered
The province says one more person has recovered from COVID-19, for a total of 993 recoveries.
This would leave five active cases in all of Nova Scotia. However, Northwood is still reporting five active cases involving three residents and two staff members.
During the pandemic, there has been confusion over the number of recovered and active cases reported by the province, which don’t always match up with the numbers reported at Northwood.
Strang has explained that the data from long-term care homes comes from a different data source than the one used by public health and is on a different timeline. As a result, the data doesn’t always reconcile.
Two more people released from hospital
The province says two more people have been released from hospital. There are now three people in hospital, with one patient in the intensive care unit.
The province’s confirmed cases range in age from under 10 to over 90.
Sixty-two per cent of cases are female and 38 per cent are male.
The Nova Scotia Health Authority’s central zone, which contains the Halifax Regional Municipality, has seen the largest number of cases.
The western, central and northern zones are reporting no additional cases at this time.
- western zone: 54 cases
- central zone: 907 cases
- northern zone: 45 cases
- eastern zone: 52 cases
Anyone who tests positive for COVID-19 is required to self-isolate at home, away from the public for 14 days.
Anyone who travels outside of Nova Scotia must also self-isolate for two weeks.
The provincial state of emergency, which was first declared on March 22, has been extended to June 14.
COVID-19 symptoms
Last month, the province expanded the list of symptoms for which it is screening.
Anyone who experiences one of the following symptoms is encouraged to take an online test to determine if they should call 811 for further assessment:
- fever (i.e. chills, sweats)
- cough or worsening of a previous cough
- sore throat
- headache
- shortness of breath
- muscle aches
- sneezing
- nasal congestion/runny nose
- hoarse voice
- diarrhea
- unusual fatigue
- loss of sense of smell or taste
Source- CTV News
A business plan for a new BC Cancer Centre at Nanaimo Regional General Hospital has been approved by the province.
Health Minister Adrian Dix says the state-of-the-art cancer facility will benefit patients in Nanaimo and the surrounding region through the latest medical technology.
The facility will have 12 exam rooms, four consultation rooms and space for medical physicists and radiation therapists, medical imaging and radiation treatment of cancer patients.
The procurement process is underway, and construction is expected to begin in 2025 and be complete in 2028.
Upgrades to NRGH have also been approved, such as a new single-storey addition to the ambulatory care building and expanded pharmacy.
Dix says Nanaimo’s population is growing rapidly and aging, and stronger health services in the region, so people get the health care they need closer to home.
Health
Outdated cancer screening guidelines jeopardizing early detection, doctors say – Powell River Peak
A group of doctors say Canadian cancer screening guidelines set by a national task force are out-of-date and putting people at risk because their cancers aren’t detected early enough.
“I’m faced with treating too many patients dying of prostate cancer on a daily basis due to delayed diagnosis,” Dr. Fred Saad, a urological oncologist and director of prostate cancer research at the Montreal Cancer Institute, said at a news conference in Ottawa on Monday.
The Canadian Task Force on Preventive Health Care, established by the Public Health Agency of Canada, sets clinical guidelines to help family doctors and nurse practitioners decide whether and when to recommend screening and other prevention and early detection health-care measures to their patients.
Its members include primary-care physicians and nurse practitioners, as well as specialists, a spokesperson for the task force said in an email Monday.
But Saad and other doctors associated with the Coalition for Responsible Healthcare Guidelines, which organized the news conference, said the task force’s screening guidelines for breast, prostate, lung and cervical cancer are largely based on older research and conflict with the opinions of specialists in those areas.
For example, the task force recommends against wide use of the prostate specific antigen test, commonly known as a PSA test, for men who haven’t already had prostate cancer. Saad called that advice, which dates back to 2014, “outdated” and “overly simplistic.”
The task force’s recommendation is based on the harms of getting false positive results that lead to unnecessary biopsies and treatment, he said.
But that reasoning falsely assumes that everyone who gets a positive PSA test will automatically get a biopsy, Saad said.
“We are way beyond the era of every abnormal screening test leading to a biopsy and every biopsy leading to treatment,” he said, noting that MRIs can be used to avoid some biopsies.
“Canadian men deserve (to) have the right to decide what is important to them, and family physicians need to stop being confused by recommendations that go against logic and evidence.”
Dr. Martin Yaffe, co-director of the Imaging Research Program at the Ontario Institute for Cancer Research, raised similar concerns about the task force’s breast cancer screening guideline, which doesn’t endorse mammograms for women younger than 50.
That’s despite the fact that the U.S. task force says women 40 and older may decide to get one after discussing the risks and benefits with their primary-care provider.
The Canadian task force is due to update its guidance on breast cancer screening in the coming months, but Yaffe said he’s still concerned.
“The task force leadership demonstrates a strong bias against earlier detection of disease,” he said.
Like Saad, Yaffe believes it puts too much emphasis on the potential harm of false positive results.
“It’s very hard for us and for patients to balance this idea of being called back and being anxious transiently for a few days while things are sorted out, compared to the chance of having cancer go undetected and you end up either dying from it or being treated for very advanced disease.”
But Dr. Eddy Lang, a member of the task force, said the harms of false positives should not be underestimated.
“We’ve certainly recommended in favour of screening when the benefits clearly outweigh the harms,” said Lang, who is an emergency physician and a professor at the University of Calgary’s medical school.
“But we’re cautious and balanced and want to make sure that we consider all perspectives.”
For example, some men get prostate cancer that doesn’t progress, Lang said, but if they undergo treatments they face risks including possible urinary incontinence and erectile dysfunction.
Lang also said the task force monitors research “all the time for important studies that will change our recommendations.”
“And if one of them comes along, we prioritize the updating of that particular guideline,” he said.
The Canadian Cancer Society pulled its endorsement from the task force’s website in December 2022, saying it hadn’t acted quickly enough to review and update its breast cancer screening guidelines to consider including women between 40 and 50.
“(The Canadian Cancer Society) believes there is an obligation to ensure guidelines are keeping pace with the changing environment and new research findings to ensure people in Canada are supported with preventative health care,” it said in an emailed statement Monday evening.
Some provinces have implemented more proactive early detection programs, including screening for breast cancer at younger ages, using human papillomavirus (HPV) testing to screen for cervical cancer and implementing CT scanning to screen for lung cancer, doctors with the Coalition for Responsible Healthcare Guidelines said.
But that leads to “piecemeal” screening systems and unequal access across the country, said Dr. Shushiela Appavoo, a radiologist with the University of Alberta.
Plus, many primary-care providers rely on the national task force guidelines in their discussions with patients, she said.
“The strongest association … with a woman actually going for her breast cancer screen is whether or not her doctor recommends it to her. So if her doctor is not recommending it to her, it doesn’t matter what the provincial guideline allows,” Appavoo said.
In addition to updating its guideline for breast cancer screening this spring, the task force is due to review its guidelines for cervical cancer screening in 2025 and for lung cancer and prostate cancer screening in 2026, according to its website.
This report by The Canadian Press was first published April 16, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
Nicole Ireland, The Canadian Press
Premature opioid-related deaths doubled in Canada after the onset of COVID-19 pandemic, and more than one in four deaths occurred in young adults, a new study suggested.
“The intersection of the COVID-19 pandemic with the drug toxicity crisis in Canada has created an urgent need to better understand the patterns of opioid-related deaths across the country to inform targeted public health responses,” the study authors wrote.
Some Canadian provinces were disproportionately affected by the crisis, they noted. For example, in Alberta, close to half of all deaths among people aged 20-39 years were opioid-related.
“Although the finding that the early loss of life was increasing over time was expected, the magnitude of this burden across Canada surprised me,” lead author Shaleesa Ledlie, MPH, a PhD candidate at the Leslie Dan Faculty of Pharmacy of the University of Toronto, Toronto, Ontario, Canada, told Medscape Medical News.
In addition to the increase in Alberta, she said, “in Manitoba, opioid-related death rates and the associated years of life lost increased almost fivefold between 2019 and 2021. This really reinforces the urgency of this issue across Canada and identifies regions where focused attention might be warranted.”
The study was published online on April 15 in Canadian Medical Association Journal.
Significant Increases
Researchers conducted a repeated cross-sectional analysis of accidental opioid-related deaths from 2019 through 2021 in nine Canadian provinces and territories. All provinces and territories for which age- and sex-stratified data were available at the time of the study were included: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia, and the Northwest Territories. These areas represent 98% of Canada’s population.
Deaths were determined to be accidental or intentional by the coroner or medical examiner in each province or territory who investigated the death, according to Ledlie.
The primary outcome was the burden of premature opioid-related death, measured by potential years of life lost (YLL). The secondary outcome was the proportion of deaths attributable to opioids.
Overall, the annual YLL from opioid-related deaths doubled during the study period, from 3.5 YLL per 1000 population in 2019 to 7.0 YLL per 1000 in 2021.
In 2021, the highest burdens of death were observed among men (9.9 YLL per 1000) and young adults aged 20-29 years (12.8 YLL per 1000) and 30-39 years (16.5 YLL per 1000).
More than 70% of all opioid-related deaths occurred among men each year (73.9% in 2021), and about 25% of deaths occurred among people between the ages of 30 and 39 years (29.5% in 2021).
Geographic Variation
The annual increases by age and sex in each province and territory were generally consistent with the overall analysis. The observed changes in YLL over time varied geographically, however. They ranged from a 0.8-fold decrease in Nova Scotia (1581 YLL in 2019 to 1324 YLL in 2021) to a 4.7-fold increase in Manitoba (2434 YLL in 2019 to 11,543 YLL in 2021).
In 2021, the rate of YLL ranged from a low of 1.4 per 1000 in Nova Scotia to a high of 15.6 per 1000 in Alberta, whereas the absolute number of YLL ranged from 93 in the Northwest Territories to 111,633 in Ontario.
Between 2019 and 2021, the average percentage of all deaths attributed to opioids increased in all age groups. In 2019, 1.7% of deaths among people younger than 85 years were related to opioids. This proportion increased to 3.2% of deaths in 2021.
The largest relative increase between 2019 and 2021 (50.3%) was among young people. Opioid-attributable deaths increased from 19.3% to 29.0% among those aged 30-39 years. This change was followed by a 48.0% increase among those aged 20-29 years from 19.8% to 29.3%.
The authors noted that the study was limited by their inability to examine four provinces and territories for which the numbers of opioid-related deaths were suppressed because of small counts (ie, < 5). However, sensitivity analyses suggested that the demographic distribution of these deaths followed a pattern like that of the overall results.
More Information Needed
Commenting on the study for Medscape Medical News, S. Monty Ghosh, MD, MPH, an assistant professor at the University of Alberta, clinical assistant professor at the University of Calgary, and co-medical lead of Alberta Health Services’ Rapid Access Addiction Medicine program in Calgary, said, “The study was fairly robust in its evaluation. Their approach statistically is sound and makes sense, given the quality of data they received.” Ghosh did not participate in the analysis.
It would be important to know whether the premature deaths were polysubstance related, he noted. “More nuanced data in Alberta demonstrated that most of the deaths are related to polysubstance use on top of fentanyl. This includes alcohol, meth, as well as substance contaminants such as benzodiazepines, and more lately (outside of the research period), xylazine.”
Furthermore, Ghosh added, “It would be good to see more demographic information around the youth in Alberta. For instance, were they housed or unhoused? Are they Indigenous? Anecdotally, we know that blue-collar workers, especially those in Alberta who work in construction and oil rigs, have a disproportionate rate of substance use and at times substance death. This was seen in British Columbia and Ontario.”
What’s Being Done
The government of Alberta is responding to these data, said Ghosh. For example, in 2022, specialized funding was provided to enable young adults to access gold-standard opioid agonist treatment. The treatment was rolled out through Alberta’s Virtual Opioid Dependency Program (VODP) and other community-based addiction programs. “This [program] still needs to be more focused on homeless youth, however, who may not have access to technology or other resources.”
Furthermore, the government recently announced a $1.55-billion plan to continue building the Alberta Recovery model, he said. “This is the largest investment seen in our province. Safer supply or prescribed alternatives is very controversial in Alberta and thus is not an option available to this population.”
In addition, he said, the Ministry of Seniors and Community Social Services recently began “coordinated work with other ministries to support vulnerable and equity-deserving populations around this issue, including creating navigation centers for housing, income support, and access to treatment through the VODP.”
Ledlie noted that various policies and programs have been developed in response to the ongoing drug toxicity crisis. Some were included in a recent review that her team conducted to summarize the evidence from Canadian safer opioid supply programs. “We found that in general, these programs had positive impacts on clients, including reduced rates of opioid toxicities and improvements in quality of life.”
“Because most healthcare is coordinated at the provincial or territorial level, the investments into, and accessibility of, treatment and harm-reduction services tend to vary across Canada,” she said. “Even in regions where these programs exist, we know that they are not always accessible for various reasons, such as a lack of resources preventing widespread expansion and geographic barriers in more remote and rural regions.”
“One example of a simple yet life-saving harm reduction measure that has been effectively implemented by most provincial and territorial governments is the availability of publicly funded naloxone kits,” she added. “Given the widespread societal impacts of opioid toxicities described in our study, we believe it is pivotal for all levels of government to coordinate to ensure equitable access to evidence-based services across the country, while still providing the opportunity to tailor and adapt those responses to the unique needs of local communities.”
The study was supported by grants from the Ontario Ministry of Health and the Canadian Institutes of Health Research. Ledlie is supported by an Ontario Graduate Scholarship and the Network for Improving Health Systems Trainee Award. Ledlie and Ghosh declared no relevant financial relationships.
Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.
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