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Using plasma to treat COVID-19 still in question after clinical trial results – CBC.ca

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Using convalescent plasma from the blood of people who have recovered from COVID-19 to treat other patients failed to prevent deaths or worsening illness in one clinical trial. But Canadian researchers continue to study its potential.

Investigators in India randomly split 464 adults hospitalized with COVID-19 between April and July into two groups. About half received transfusions of plasma with virus-fighting antibodies, and the others received standard care only.

In this week’s issue of the BMJ, researchers said that after seven days, use of convalescent plasma seemed to improve some symptoms, such as shortness of breath and fatigue. But this did not translate into a reduction in deaths or progression to severe COVID-19 after 28 days, based on clinical exams, lab tests and check-ins by phone.

The investigators said future research could explore using plasma with high levels of “neutralizing antibodies” to see if this might work better.

Jeannie Callum, a transfusion medicine specialist and hematologist at Sunnybrook Health Sciences Centre in Toronto said it’s logical that convalescent plasma would help fight viral infections, but it remains an unproven therapy. (Craig Chivers/CBC)

Jeannie Callum, a transfusion medicine specialist and hematologist at Sunnybrook Health Sciences Centre in Toronto, commended the Indian researchers for completing the trial with nearly 40 centres under real-world conditions.

Plasma treatment aims to eliminate virus

Here’s how convalescent plasma is thought to work: The virus binds to cells in the body. People with COVID-19 who have recovered develop what are known as antibodies — proteins that white blood cells make to bind to the virus and help eliminate it. 

“We believe that these antibodies actually neutralize the virus so it can’t reinfect your cells,” said Callum.

By clearing the virus from the bloodstream and tissues, she said it’s hoped that patients will be pushed into a state of recovery. 

Callum said that while it is logical that convalescent plasma would help fight viral infections, it remains an unproven therapy.

High level of antibodies needed

Dana Devine, chief scientist at Canadian Blood Services, is part of a Canadian project called CONCOR that is also trying to determine if the straw-coloured liquid component of blood helps patients to fight off COVID-19.

Devine said not all plasma from recovered people can be used in the ” target=”_blank”>Canadian trials on adults, children and teens who are admitted to hospital or intensive care with COVID-19 at sites across the country.

“Their own antibody levels are falling because they’re recovered from the virus,” Devine said. “You retain your immunity, but you don’t have that really high level of antibodies that we need for therapeutic [purposes] for other people.”

Large, randomized clinical trials are needed to answer the question of whether convalescent plasma helps people who are infected — a question that dates back to the 1918 flu pandemic.

The U.S. has temporarily approved plasma as a treatment for COVID-19 and it has been used in some 100,000 patients in that country, despite the limited evidence on its efficacy.

WATCH | Plasma’s benefits unproven, doctor says:

The way FDA commissioner Stephen Hahn characterized the benefits of convalescent plasma for COVID-19 patients raises concerns about political interference, says Dr. Samir Gupta, an associate professor in the Department of Medicine at the University of Toronto. 5:01

Scientists also say larger trials are needed for COVID-19 patients who have milder cases of the disease and for those who are newly infected. 

“One could well imagine that the treatment might work particularly well in those earlier in the course of the disease or who have not been able to mount a good antibody response to the virus of their own,” said Martin Landray, a professor of medicine and epidemiology at Britain’s Oxford University. “But such speculation needs to be tested.”

As for other treatments, so far, only the steroid dexamethasone has been shown to cut the risk of death from COVID-19.

On July 27, Health Canada approved the use of the antiviral medication remdesivir, with conditions, to treat COVID-19 in adults and youth 12 years and older with pneumonia needing supplemental oxygen.

Remdesivir was also the first drug authorized to treat Canadian patients hospitalized with severe symptoms.

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COVID-19 case investigations continue to lag days behind case identification in Manitoba – CBC.ca

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COVID-19 case investigations in Winnipeg are lagging days behind positive test results, contrary to the premier’s claim Manitoba has no more contact-tracing delays.

On Friday, Premier Brian Pallister said tracing delays are a thing of the past in this province.

“There’s zero backlogs on tracking and tracing right now in our province,” Pallister said during an interview that aired on Rosemary Barton Live on Sunday.

Backlogs, however, remain. CBC News has learned public health nurses in the Winnipeg health region started investigating COVID-19 cases on Monday that were identified as positive on Nov. 19 — a delay of four days — and are still working overtime to catch up on caseloads.

This four-day delay represents a vast improvement from October, when COVID-19 patients reported contact-tracing investigations lagging behind positive test results by as much as a week.

It nonetheless remains well behind the 24-hour timeframe epidemiologists have recommended for starting contact-tracing investigations in order to limit the spread of COVID-19.

“A twenty-four hour delay in getting a hold of somebody in a shelter, that’s a disaster,” said a public health nurse who CBC News is not identifying due to fears of repercussions.

WATCH | Manitoba Premier Brian Pallister insists his province’s restrictions are the most stringent in the country:

Delays are particularly important to avoid in Winnipeg, where people living in homeless shelters are disproportionately affected by the pandemic, the nurse said.

“When you get somebody on the phone that’s living on the street and you’re telling them they have COVID, it’s a lot different than calling somebody who’s living at home and have three people in their house.”

Darlene Jackson, president of the Manitoba Nurses Union, said the four-day lag reported by the public health nurse is in line with what she’s hearing from her members. 

“We’re hearing that there is a lag — anywhere from a couple of days, to five days,” said Jackson, adding some public health nurses are required to work evenings and weekends in order to catch up on caseloads.

“We know that public health nurses are still working excessive amounts of overtime. They’re being mandated frequently. They’re working through weekends. They’re not allowed to go home until they finish contact tracing on cases. It’s been it’s been months like this, with no end in sight,” Jackson said.

“I just find it very frustrating. We’re already eight months into a pandemic and it just feels like we’re just trying to get caught up now.”

Dr. Brent Roussin, Manitoba’s chief provincial public health officer, made it clear on Monday the lag involves the time between the identification of a positive case in a laboratory and the handover of information about that case to public health.

“Almost all cases are reached within 24 hours of the report being reported to public health,” said Roussin, adding some case investigations do not begin until the next day after that.

Province adding contact tracers

Case investigations are one aspect of contact-tracing in Manitoba. The province employs an average of 170 people per day — public health nurses and contractors with the Canadian Red Cross — to conduct these investigations.

The province also pays for an average of 80 people a day to notify contacts of known COVID-19 cases. Statistics Canada has been enlisted for this task.

The third aspect of contact tracing involves follow-up calls to infected patients. These are conducted by 43 staff and volunteers at the COVID-19 Contact Centre, jointly run out of the Deer Lodge Centre by Shared Health and the Winnipeg Regional Health Authority.

Dr. Brent Roussin, Manitoba chief public health officer, said most case investigations begin within a day of public health learning about them. (John Woods/The Canadian Press)

On Monday, Health Minister Cameron Friesen promised to bolster these 203 positions with 143 more workers.

The public health nurse who spoke to CBC News said that won’t help unless the reinforcements have specialized training.

“We need people who have the knowledge and the education to do proper contact-case investigations. It’s more than just calling people and telling them they have COVID,” the nurse said.

“We’re doing health assessments and directing people where to go if their symptoms exacerbate. We’re dealing with people who are structurally disadvantaged, who don’t have home. I mean, those are things that public health nurses know, not somebody answering the phone at a call centre.”

Contact tracers not allowed to work from home

The Manitoba Nurses Union also chastised the Winnipeg Regional Health Authority for not allowing COVID-19 case investigators to work from home.

Public health nurses are being subjected to unnecessary risks at the office — while some are unable to work because they are sick, isolating or caring for children, the union said.

“I do not understand why public health nurses are not allowed to access their files that they need at home and to work from home,” Jackson said.

Roussin, who has urged all employers to allow employees to work remotely, encouraged the WRHA to consider doing the same.

“If you can make it feasible, if you can get the work done by being at home, then I would encourage all employers to to look at that,” he said.

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Confusion remains in B.C. on who can gather in restaurants under COVID-19 restrictions – Global News

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The B.C. Restaurant and Food Association says a new set of COVID-19 restrictions imposed by the provincial government has customers struggling to understand who they are allowed to dine with.

The association’s president Ian Tostenson says restaurants are trying to tell customers to use common sense and follow advice from provincial health officer Dr. Bonnie Henry, but he says that advice has been unclear.

“There is a lot of confusion as to who can dine out as a result of the last couple of weeks with Dr. Henry,” Tostenson said Monday.

“The spirit of what Dr. Henry is saying is eat with people you trust, eat with people in your bubble. But if you try to define that too much it gets too hard.”

Read more:
‘Kicked when we’re down’: New COVID-19 restrictions hit already struggling B.C. restaurants

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The provincial orders issued last week require diners to only eat with someone from their own household. If someone is single, they can eat with one or two other people who make up their pandemic bubble.

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For example, three friends who are also married cannot all eat together at a restaurant. Another common mistake is parents cannot take their adult child and spouse for a meal at a restaurant if they live in separate households.

“For these two weeks we’re saying stick with your household bubble, and for some people that may mean one or two people who they have close contact with their pandemic bubble,” Henry said Monday.

The biggest challenge to uphold the order is enforcement.

Restaurants are being told not to ask diners whether they are following the rules. Instead, Henry is asking diners to know the rules themselves.


Click to play video 'Christmas events put ‘on hold’ by pandemic'



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Christmas events put ‘on hold’ by pandemic


Christmas events put ‘on hold’ by pandemic

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“It is not the restaurant’s responsibility to ask people who they live with, or where they are from,” Tostenson said.

“The more that we increase confusion and uncertainty in the marketplace the harder it is.”

There is growing concern from the province that British Columbians are trying to exploit loopholes in the order. The priority for the government is to crack down of social gatherings if that is in someone’s home or in a restaurant.

Read more:
Your questions about B.C.’s new COVID-19 measures answered

One thing enforcement can do is crack down on organized events in a restaurant like live music.

“There is a tendency to … see these like a speed limit and it says 80 (km/h), and maybe I can go 86. That’s not what these are,” Health Minister Adrian Dix said Monday.

“These are provincial health orders to help us stop the spread of a virus that is harming our loved ones in long-term care and causing great disruption in our society, and these are the things we’re doing together to stop that.”

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

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'We are on the verge of significant bankruptcies': Restaurants and pubs struggle under B.C.'s new restrictions – CTV News Vancouver

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VANCOUVER —
New measures introduced last Thursday by Dr. Bonnie Henry meant to curb the spread of COVID-19 by limiting social interactions appear to be having the desired effect, to the detriment of businesses.

At a news conference on Nov. 19, Henry ordered B.C. residents to limit social gatherings to their immediate household, or a small pandemic bubble for those living alone.

“This applies in our homes, vacation rentals and in the community and in public venues, including those with less than 50 people in controlled settings,” Henry said.

She made no specific mention of restaurants or pubs, and Ian Tostenson with the BC Restaurant and Foodservices Association said there has been confusion about who can dine out.

“We haven’t seen the latest health order, it hasn’t been written from last week, so as far as we’re concerned, we’re telling people go to a restaurant but go to a restaurant in the spirit of hanging with people you trust in a small bubble,” Tostenson said.

Tostenson estimates over the last 10 days, restaurants have lost about 30-40 per cent of their pandemic sales as those who were confused by the orders chose to stay home.

Henry’s order was an expansion of a previous regional order that only applied in B.C.’s Lower Mainland. During prior news conferences, Henry made clear that while dining out was encouraged, people should only do it with their households.

On Monday, Henry clarified again that she wants British Columbians to spend the next two weeks only socializing in person with others from their household, or a bubble of one or two designated people for those who live alone. That applies to going to restaurants.

The restrictions are also hitting bars and pubs hard. Jeff Guignard with the Alliance of Beverage Licensees estimated business dropped by 50 per cent of pandemic levels.

“So you have people who are down to 25 per cent of where they were in 2019 and that’s just not sustainable. We’re on the verge of significant bankruptcies right now,” he said.

Restrictions are scheduled tin place until Dec. 7.

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