Simcoe Muskoka’s top public health official warned Tuesday that travel within Ontario should be restricted and school reopenings could falter if community transmission of extra-contagious COVID-19 viral variants takes hold — a reality that may be already be underway after a rash of new positive results.
Samples collected from 99 more people in the region screened positive for a “variant of concern,” the health unit said Tuesday. Two of those cases have no known links to the devastating outbreak at Barrie’s Roberta Place nursing home, where the presence of the U.K. variant was confirmed Saturday in six swabs.
Since then, a total of three cases in Simcoe Muskoka with no links to Roberta Place have tested positive for variants — two of which are involved in separate outbreaks, one at a different nursing home and one at a psychiatric hospital. Full genome sequencing will confirm the variant involved, but the health unit said it expects all to be more instances of the U.K. variant, known scientifically as B.1.1.7, which researchers have calculated is about 50 per cent more transmissible than pre-existing viral strains.
“If it isn’t spreading readily in our community now, it may very well do so in the near future,” Dr. Charles Gardner, Simcoe Muskoka’s medical officer of health, said in a Tuesday press briefing.
Infectious disease specialist Dr. Isaac Bogoch was more blunt: “The horse is out of the barn. We already have community transmission.
“It just means we have to double down on our efforts to keep this virus under control, and vaccinate as swiftly as possible,” said Bogoch, a member of the province’s vaccine task force.
The 99 new cases were identified through a point-prevalence study being conducted by Public Health Ontario, which is analyzing all positive COVID-19 test results from last Wednesday, Jan. 20, for the three known variants of concern, a single-day snapshot that will help establish a baseline for how the variants have spread.
As of Tuesday, 47 cases of B.1.1.7 have been confirmed in Ontario through full genome sequencing, according to data from Public Health Ontario — a count that doesn’t include preliminary screening results, including the 99 from Simcoe Muskoka, for which full sequences are not yet available. Variants of concern from Brazil and South Africa have not yet been reported in the province.
Gardner also said Tuesday that 42 household contacts of people linked to Roberta Place have tested positive for COVID-19, in addition to 127 residents, 82 staff, and six essential caregivers and “external partners.” Forty-six deaths have been reported at the home. Recent evidence from the U.K. suggests that besides being more transmissible, the B.1.1.7 variant may be somewhat more lethal, although that finding is debated by experts.
While the outbreak at the home itself may be receding, “the bigger picture … is transmission in the households of staff, and out into the community,” Gardner said. “And to me, we’re at the beginning of that. We’ve got to do all we can to slow that down.”
Another case of B.1.1.7 was identified in the Kingston region in a person who had travelled to Simcoe Muskoka but had not travelled outside the country, according to a health unit spokesperson. The person tested positive for COVID-19 “several weeks ago” but was only identified as a B.1.1.7 case on Monday.
Gardner and Bogoch both said provincial policies focused on international travellers — whether in the form of which cases get prioritized for variant screening, or in the form of stronger border controls — were likely to now be insufficient measures on their own.
“Additional measures at the border might provide some further incremental protection, and it might slow down the introduction of more of this (variant), or other variants,” Bogoch said. “But this is already here, and it’s circulating.”
Any additional measures at the borders shouldn’t distract the province from keeping transmission under control within its borders, Bogoch said, including focusing on the “huge” equity-related issues of infection risk.
“There’s no magic, right? We know how to control this,” adding that evidence shows COVID-19 vaccines are still effective against the U.K. variant.
Gardner said that in addition to strict adherence to the province’s current stay-at-home order, he believes Ontario needs more stringent controls on travel between jurisdictions — measures he acknowledges would be unpopular, but were used successfully in Australia.
“I think that movement in the population is a problem … I’ve long advocated that there needs to be some form of restrictions. You’ve got a lot of transmission happening between jurisdictions,” said Gardner, a member of the province’s public health measures table, which provides advice to government.
While cases are currently dropping in Ontario, Gardner warned that B.1.1.7 could quickly overwhelm those gains — and if the variant causes case counts to spike, “it would make it difficult to open schools again. There would be a lot of concern about the wisdom of that.”
He also expressed frustration over vaccine supply. While the health unit has visited every long-term-care facility to provide first doses, plans to vaccinate all retirement homes in the region had to be scuttled because of low supply, with only high-priority retirement homes receiving doses.
“It’s a worrying situation. It’s far better if you can to slow and contain this from spreading widely, if possible.”
Source: – Toronto Star
Unexplained hepatitis cases rise to 429 across 22 countries, WHO says – The Irish Times
Cases of unexplained hepatitis have risen to at least 429 in 22 countries, according to the World Health Organisation (WHO).
The number of countries reporting at least five cases has doubled since the last WHO briefing in April, from six to 12. Nine of these countries are in Europe.
A further 40 possible cases of acute liver disease are awaiting classification, officials told a press conference in Geneva on Tuesday.
Six children have died and 26 have required transplants, according to Prof Philippa Easterbrook of the WHO’s global hepatitis programme. About 75 per cent of cases are in children aged under five years.
Although the cause remains unclear, scientists are still investigating whether the cases were caused by an adenovirus activating an inflammatory response, possibly after a previous Covid-19 infection.
In Ireland, one child has died after being treated for the disease, and a second has received a liver transplant, the Health Service Executive reported last week.
Six probable cases of children with hepatitis of unknown cause have been detected in Ireland since the UK issued an alert in April.
The six children were aged between one and 12 years of age. All were hospitalised.
Meanwhile, Covid-19 cases rose in four out of six regions of the world last week, according to WHO secretary general Dr Tedros Ghebreyesus. With testing and sequencing programmes being reduced in many countries, he said it was increasingly difficult to know “where the virus is and how it’s mutating”.
Officials expressed concern about virus outbreaks in North Korea, where state media has said there are about 1.4 million suspected cases, and Eritrea, which has yet to start vaccinating its population.
High levels of transmission of the coronavirus among unvaccinated people, such as in North Korea, creates a higher risk of new variant, a WHO official said.
“Certainly it’s worrying if countries . . . are not using the tools that are now available,” said WHO emergencies director Mike Ryan in response to a question about the outbreak in North Korea.
“WHO has repeatedly said that where you have unchecked transmission there is always a higher risk of new variants emerging,” he said.
Maria Van Kerkhove, WHO technical lead on Covid-19, said the notion that the Omicron variant of Covid-19 is mild was false and this narrative needed to be corrected. Omicron, in all its sublineages, can cause anything from asymptomatic infection to death, she pointed out, though vaccination provides protection. – Additional reporting: Reuters
The Characteristics of Patients Who Develop Long-COVID Symptoms – Neurology Advisor
Nearly one-third of patients with symptomatic COVID-19 developed symptoms of postacute sequelae of SARS-CoV-2 (PASC), according to a study published in the Journal of General Internal Medicine.
Patients who have recovered from COVID-19 frequently report PASC symptoms such as fatigue, dyspnea, and anosmia. Prior studies describing PASC have focused on hospitalized adult patients or patients with mild COVID-19 treated in outpatient settings up to 9 months following infection. Cohorts of patients with PASC have included small proportions of individuals of minority groups. This is the first study to examine the association of ethnicity, social vulnerability, and insurance status with developing PASC, according to the researchers.
They analyzed data of 1038 participants (aged 60 years; interquartile range [IQR], 37 to 83 years; 42% Latino, 30% White) in the University of California Los Angeles (UCLA) Health COVID Ambulatory Monitory Program. The patients completed follow-up surveys at 30, 60, or 90 days after hospital discharge or outpatient diagnosis. Eighty percent of patients followed up after their illness.
PASC were reported by 29.8% of patients at least 60 days after acute illness (30.8% of patients treated in hospitals, 26.5% of high-risk outpatients).
At 30 days, the most commonly reported symptoms were fatigue (73.2%), shortness of breath (63.6%), fevers and chills (51.5%), and muscle aches (50.6%). At 60 days, fatigue (31.4%), shortness of breath (13.9%), and loss of taste or smell (9.8%).
Fatigue was the most common symptom among both hospitalized and outpatient patients. About 15% of hospitalized patients experienced shortness of breath, and about 16% of outpatients experienced loss of taste or smell.
PASC patients in outpatient care were more likely to be younger, White, women, and commercially insured. Hospitalized patients were more likely to report PASC symptoms if they were women. Patients with history of organ transplant were less likely to develop PASC.
Hospitalization for COVID-19 (OR, 1.49 95% CI 1.04-2.14), having diabetes (odds ratio [OR], 1.39; 95% CI, 1.02-1.88), and higher body mass index (OR, 1.02; 95% CI, 1.0002–1.04), were linked with developing PASC. Patients with Medicaid (OR, 0.49; 95% CI, 0.31-0.77) or history of organ transplant (OR, 0.44; 95% CI, 0.26-9.76) were less likely to develop PASC.
The researchers said the lack of association between age or race with developing PASC may be influenced by access to the same health system with standardized follow-up, importance of risk factors for contracting COVID-19 compared with recovering from COVID-19, or variance in symptoms and expectations across demographic groups and ability of tools detecting PASC to realize those differences. Variation in symptoms between hospitalized patients and outpatient treated patients is likely due to differences in clinical phenotypes, according to the researchers.
Study limitations included potential self-report bias, referral bias, survivorship bias, evaluation of a limited number of PASC symptoms, no control group of patients with persistent symptoms following hospital admissions unrelated to COVID, and limited knowledge of pre-existing conditions.
“Understanding the effects of long COVID will allow for more effective education among patients and providers, and allow for appropriate healthcare resource utilization in the evaluation and treatment of PASC,” the researchers concluded.
Yoo SM, Liu TC, Motwani Y, et al. Factors associated with post-acute sequelaeof SARS-CoV-2 (PASC) after diagnosis of symptomatic COVID-19 in the inpatient and outpatient setting in a diverse cohort. J Gen Intern Med. Published online April 7, 2022. doi: 10.1007/s11606-022-07523-3
Monkeypox outbreak spreads in Europe as U.K., Portugal confirm cases – CBC News
Portuguese authorities said on Wednesday they had identified five cases of rare monkeypox infection and Spain’s health services are testing eight potential cases after Britain put Europe on alert for the virus.
The five Portuguese patients, out of 20 suspected cases, are all stable. They are all men and they all live in the region of Lisbon and the Tagus Valley, the Portuguese health authorities said.
European Health authorities are monitoring any outbreak of the disease since Britain has reported its first case of monkeypox on May 7 and found six more in the country since then.
None of the eight suspected cases in Spain has been confirmed yet, the Spanish Health Ministry said in a statement on Wednesday.
Monkeypox is a rare viral infection similar to human smallpox, though milder, first recorded in the Democratic Republic of Congo in the 1970s. The number of cases in West Africa has increased in the last decade.
Symptoms include fever, headaches and skin rashes starting on the face and spreading to the rest of the body.
It is not particularly infectious between people, Spanish health authorities said, and most people infected recover within a few weeks, though severe cases have been reported.
Disease may spread via sexual contact: officials
Four of the cases detected in Britain self-identified as gay, bi-sexual or other men who have sex with men, the U.K. Health Security Agency said, adding evidence suggested there may be a transmission in the community.
The agency in Britain urged men who are gay and bisexual to be aware of any unusual rashes or lesions and to contact a sexual health service without delay.
The Spanish Health Ministry and Portugal’s DGS health authority Spanish did not release any information on the sexual orientation of the monkeypox patients or suspected patients.
The two countries sent out alerts to health professionals in order to identify more possible cases.
Dr. Ibrahim Soce Fall, the World Health Organization’s assistant director-general for emergency response, said the spread of monkeypox in the U.K. needed to be investigated to understand how the disease was being transmitted among men who have sex with other men.
Fall said that health officials still need a better understanding of how monkeypox spreads in general, even in the countries where it is endemic.
He noted that while there were more than 6,000 reported cases in Congo and about 3,000 cases in Nigeria last year, there are still “so many unknowns in terms of the dynamics of transmission.”
Britain previously reported three earlier cases of monkeypox, two involving people who lived in the same household and the third someone who had traveled to Nigeria, where the disease occurs frequently in animals.
The virus has typically spread to people from infected animals like rodents, although human-to-human transmission has been known to occur.
Among people, the disease is spread when there is very close contact with lesions, body fluids, respiratory droplets or contaminated materials, like bedsheets.
Some British experts said it was too soon to conclude that monkeypox had spread through sexual contact, although the outbreak there suggested that possibility.
Vaccine approved, anti-virals appear effective
“The recent cases suggest a potentially novel means of spread,” Neil Mabbott, a disease expert at the University of Edinburgh, said, adding that related viruses were known to spread via sex.
Keith Neal, an infectious diseases expert at the University of Nottingham, said the transmission might not have occurred through sexual activity but just “the close contact associated with sexual intercourse.”
Monkeypox typically causes fever, chills, a rash and lesions on the face or genitals resembling those caused by smallpox.
A vaccine developed against smallpox has been approved for monkeypox, and several anti-virals also appear to be effective.
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