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Vitalité accused of silencing doctors, controlling public message amid COVID-19 – CBC.ca

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The Vitalité Health Network is being accused of silencing doctors and controlling the public message under the reign of outgoing president and CEO Gilles Lanteigne.

The criticisms by a former health manager and former board member come after the regional health authority issued a retraction statement last week on behalf of a doctor who had voiced concerns about the prevention and control protocols on the COVID-19 unit at the Campbellton Regional Hospital.

“We must admit that for appearances, it is as if we had forced her to retract,” said retired Dr. Louis-Marie Simard, the former president and chief executive officer of the former Beauséjour Health Authority, which pre-dated Vitalité.

“If that’s what has been done, twisting your arm is certainly not a good management practice,” he said.

“As far as I can remember, what I preach is what I did … I don’t think anyone in the organization had fears that the administration was going to slap them on the wrist if he spoke.”

Last Thursday, Dr. Vona MacMillan, a family physician based in Charlo, 30 kilometres east of Campbellton, told Radio-Canada she was a “little nervous” starting on the COVID-19 unit at the Campbellton hospital after 10 staff had tested positive for the respiratory disease.

She had called on Vitalité to allow staff to wear N95 masks while treating COVID-positive patients, regardless of the procedure being performed. 

By 4:20 p.m. on Friday, Vitalité released a statement saying MacMillan “wishes” to retract her comments and apologize.

Dr. Vona MacMillan called for the wider use of N95 masks for Campbellton hospital staff treating COVID-19 patients. (Serge Bouchard/Radio-Canada)

In Simard’s view, such control of the public message is dangerous for democracy and for patient confidence in the health-care system.

“Suppose people know that a doctor can be threatened and [forced] to retract. When I go to the doctor in his office, I have a condition that could have a public impact, and I see that my doctor is telling me a story and does not seem comfortable, can I trust him?” he said.

“Health is a personal system. When I speak to a health-care professional, I have to feel 100 per cent confident that he is trying to do the best he can for my case.”

Public health must be transparent

Simard acknowledges certain laws must frame the right to speak. “I have the right to speak, but I don’t have the right to lie and I don’t have the right to reveal intimate or private information, there is a framework.”

But he also noted Vitalité is dependent on the Department of Health, financed with public funds.

“When we talk about a health service, it is a public service, paid for by the public and managed by the public, so it must be transparent.”

Lanteigne defended himself, saying there was no muzzling in MacMillan’s case. She is the one who decided to retract her statement, he said.

Can anybody speak to the media? Of course they can speak.– Gilles Lanteigne, Vitalité president and CEO

“She decided that after consideration to recognize that the standards and the procedures as established by Canadian Public Health and the New Brunswick Public Health are appropriate, that the patients are secure and that there is enough equipment in the Restigouche, and that she would follow the guidelines and the policies and procedures of Vitalité Health Network,” he told reporters during the question period of Vitalité’s annual general meeting Tuesday afternoon.

MacMillan “has decided to do that on her own. She’s an adult. She had decided to speak.”

Lanteigne said Vitalité — like most organizations — does have a policy on who can speak on behalf of the organization.

But it considers its roughly 7,400 physicians and medical staff as “ambassadors.”

“Can anybody speak to the media? Of course they can speak. They’re doing it … as [a] private citizen,” he said.

“When we have someone who works for us, there is an obligation on both sides … that we respect and that we expect everybody to conform to their code of policy and their ethical framework that guides their professions,” he added.

‘We weren’t allowed to speak to the media’

Norma McGraw, who resigned in February as vice-chair of the Vitalité Health Network’s board of directors in protest over health reform plans, said she’s not surprised to hear about MacMillan’s case.

“We weren’t allowed to speak to the media, that’s for sure … We weren’t allowed to go and ask employees questions to find out how they were, how the services were. These are things we were not supposed to do,” she said, adding she believes information control was exercised within senior management to ensure the delivery of a consistent message.

Norma McGraw resigned as vice-chair of the board last February, publicly denying Vitalité’s assertion that a vote had been held behind closed doors on the planned overnight closure of the emergency rooms of six small hospitals. (Radio-Canada)

McGraw said she regrets, however, that a doctor who expressed legitimate fears appears to have been silenced.

“This doctor, if she transgressed the communication channels, it is because she felt preoccupied … It is a cry of alarm. Has it been listened to? I imagine not, otherwise there would not have been the” retraction.”

Three front-line care-givers who have worked on the COVID-19 unit told CBC News last week that they didn’t feel safe under current personal protective equipment protocols, especially one that allows the use of N95 masks only for procedures that produce airborne droplets.

Masks, but not N95 masks, are to be worn at all times at the hospital.

The employees said staff have been refused extra protection when treating COVID-19 patients, and lax protocols create a risk of spread throughout the hospital.

The employees said they’re fearful of bringing the virus home to vulnerable family members and called on Vitalité for change.

As of last Wednesday, 10 employees of the Campbellton Regional Hospital had tested positive for COVID-19 and 31 others were self-isolating.

One of the positive cases was determined to be a false positive over the weekend, Lanteigne said.

About half of the 40 affected employees are expected to return to work by Friday, he said.

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3 Reasons You Shouldn't Get Your Hopes Too High About COVID-19 Vaccines – Motley Fool

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A safe and effective vaccine would be a shot in the arm for a world that’s grown weary of the COVID-19 pandemic. The good news is that there’s a lot of work going on to produce just such a vaccine. At least 19 novel-coronavirus vaccine candidates are now in clinical testing, according to the World Health Organization (WHO). Another 130 candidates are currently in preclinical trials.

But you shouldn’t get your hopes too high for COVID-19 vaccines. Here are three reasons why.

Image source: Getty Images.

1. The probability of success isn’t as great as you might think

Many Americans assume that regulatory approval of a vaccine is right around the corner. President Donald Trump even publicly suggested that a “vaccine solution” for COVID-19 will be available “long before the end of the year.” But these assumptions could be off-base.

WHO’s list of COVID-19 vaccines includes only one U.S.-made candidate in phase 2 testing. Moderna (NASDAQ:MRNA) recently announced that its late-stage study of COVID-19 vaccine candidate mRNA-1273 would be delayed. The biotech still hopes to begin the trial in July, however. Meanwhile, AstraZeneca (NYSE:AZN) and its partner, the University of Oxford, are already recruiting for participants in a phase 3 study for their COVID-19 vaccine candidate.

The probability of these or other vaccines being successful isn’t as great as you might think. Only around 24% of vaccines in phase 2 clinical testing go on to win approval from the Food and Drug Administration, according to a historical analysis conducted by biopharmaceutical trade group BIO. That percentage jumps to 74% for vaccines in phase 3 testing. But that’s still a 1-in-4 chance of failure.

2. COVID-19 vaccines might not be as effective as you expect

Even if one or more COVID-19 vaccines win FDA approval, they might not be as effective as you’d expect. Why? The bar isn’t all that high when it comes to efficacy.

Last week, the FDA issued guidelines for its review and approval process for COVID-19 vaccine candidates. To be considered effective, a vaccine only has to “prevent disease or decrease its severity in at least 50% of people who are vaccinated.”

This threshold isn’t unusual for the first vaccines against a virus for which no vaccines currently exist. However, it also means that there’s a real possibility that among those who receive a COVID-19 vaccine, nearly half won’t be effectively immunized against the novel coronavirus.

3. Many Americans will refuse to get a COVID-19 vaccine

Michael Jordan once said, “You miss 100% of the shots you don’t take.” He was, of course, referring to basketball. However, the idea is also relevant to COVID-19 vaccines.

A survey conducted by the Associated Press-NORC Center for Public Affairs Research in May found that only 49% of Americans said that they planned to get vaccinated if a vaccine against the novel coronavirus becomes available. That number isn’t too surprising, considering that it’s roughly in line with the percentage of American adults who get the flu vaccine.

It’s possible that more Americans would want to be vaccinated against the novel coronavirus, though. Another 31% of the survey respondents stated that they weren’t sure about getting a COVID-19 vaccine. However, if the percentage of Americans who refuse to be immunized isn’t high enough, even an effective vaccine won’t be enough to prevent COVID-19 from spreading.

Still a big opportunity

The probabilities for approval, efficacy, and potential immunization rates don’t paint an encouraging picture. However, there’s still a chance that one or more COVID-19 vaccines that are highly effective will win regulatory approval and gain widespread public acceptance.

And there’s still a big opportunity for investors hoping that coronavirus-focused biotech stocks pay off in a huge way. For example, even though its shares have tripled so far this year, Moderna would almost certainly soar even higher if mRNA-1273 is successful in late-stage testing.

Any vaccine that’s safe and effective enough to secure approval will help in the fight against COVID-19. COVID-19 vaccines might not be the magic bullet that many hope for. But combined with new treatments and better testing, they could be part of an overall arsenal that enables the world to move past the pandemic and return to normal.

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Airborne coronavirus spread: Five things to know – Al Jazeera English

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More than seven months after the new coronavirus was first detected, scientists and health experts are still trying to get a better understanding of how it spreads and how to curb the COVID-19 respiratory disease it causes.

The coronavirus is transmitted from person to person through “droplet transmission”, including direct contact with someone who has been infected, indirect contact with contaminated surfaces, droplets of saliva from coughing or discharge from the nose when sneezing, according to the World Health Organization (WHO).

Airborne transmission is also possible, but its effects and risks have recently sparked a scientific debate.

What is airborne transmission?

The WHO has long said the new coronavirus spreads mainly through small droplets released from the mouth and nose that fall from the air in a short period.

But some scientists and researchers are increasingly pointing out to evidence that the virus can also be transmitted by even smaller droplets called aerosols. Usually generated when people are shouting and singing, these remain suspended in the air for longer and can travel farther.

How is it different from droplet transmission?

The respiratory droplets sneezed or coughed out are larger in size – a diameter of five to 10 micrometres – and the range of exposure is one to two metres (three to six feet).

Aerosols, however, are less than five micrometres in diameter and travel beyond two metres from the infected individual.

“The new coronavirus can survive in both droplets and aerosol for up to three hours under experimental conditions, although this depends on temperature and humidity, ultraviolet light and even the presence of other types of particles in the air,” Stephanie Dancer, a consultant medical microbiologist in the UK, told Al Jazeera.

“Microscopic aerosols can project at least six metres in indoor environments, and possibly even further if dynamic air currents are operating. The distance depends upon how large the aerosol is.”

Animation: How does coronavirus behave?

How is COVID-19 spreading through the air?

As in droplet transmission, aerosols can be released in several ways including, breathing, talking, laughing, sneezing, coughing, singing and shouting.

“Breathing would not offer much projectile force, but shouting, singing, coughing and sneezing project aerosol through the air with a range of different velocities,” said Dancer.

“Even if one individual particle does not contain enough virus to cause infection, if you carry on breathing in these particles over time, you will acquire enough in your mouth, nose and respiratory tract to initiate infection.”

Airborne transmission can also occur in certain medical procedures that involve the patient generating aerosols, putting healthcare workers particularly at risk.

“Coronavirus can be spread by aerosol under special circumstances if using nebulisers, bronchoscopy, intubation, dental and other oral procedures using suction and lavage,” said Naheed Usmani, president of the Association of Physicians of Pakistani Descent of North America (APPNA).

“This is particularly dangerous for healthcare workers who should only attempt these procedures wearing proper personal protective equipment (PPE), including N95 masks,” she told Al Jazeera. 

Is airborne COVID-19 less contagious?

The extent to which the coronavirus can be spread by the aerosol route – as opposed to by larger droplets – remains disputed.

While the WHO has long maintained that the primary source of infection is through droplet transmission, it has acknowledged there was “emerging evidence” of airborne transmission.

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“The possibility of airborne transmission in public settings – especially in very specific conditions, crowded, closed, poorly ventilated settings that have been described, cannot be ruled out,” Benedetta Allegranzi, the WHO’s technical lead for infection prevention and control, said in a news briefing this week.

This came after a group of 239 scientists from 32 countries and a variety of fields made the case in an open letter that there was a “real risk” of airborne transmission, especially in indoor, enclosed and crowded environments without proper ventilation.

Dancer, who was one of the signatories of the letter, said there is a lower risk of catching the virus the further you are from the source.

Jose-Luis Jimenez, a chemist at the University of Colorado, also told Al Jazeera the “virus loses infectivity over a period of an hour or so indoors”.

How can you protect yourself?

Wearing face masks properly and maintaining physical distancing are recommended at all times.

Experts also recommend avoiding crowded places, especially public transport and public buildings.

In closed spaces at schools, offices and hospitals, increasing proper ventilation with outdoor air by opening windows can also mitigate the risk of infection, Jimenez said.

“For spaces where ventilation cannot be increased, we recommend portable high-efficiency particulate air (HEPA) filter air cleaners or possibly ultraviolet (UV) germicidal lights at the high end of need. We do not recommend other types of air cleaners.”

Follow Saba Aziz on Twitter: @saba_aziz

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Essential workers during COVID-19 susceptible to 'moral injury' and PTSD, hospital says – CBC.ca

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Health-care workers on the front lines of the COVID-19 pandemic are at risk of severe stress that could cause long-term psychological damage, the Centre of Excellence on Post-Traumatic Stress Disorder says.

The centre at the Royal Ottawa Hospital has teamed up with the Phoenix Australia Centre for Posttraumatic Mental Health to develop a guide for facilities including hospitals and peer-support organizations in an effort to reduce the impact on those susceptible to so-called moral injury, a type of PTSD.

It can result from dilemma on the job from witnessing or performing an action that goes against someone’s beliefs, similar to what has been documented in war veterans, the centre says.

Dr. Patrick Smith, CEO of the Canadian centre, said the guide applies to anyone doing essential work, including in long-term care homes and grocery stores.

“We will be working with hospitals, clinics, provinces, municipalities,” he said Tuesday. “Everyone who’s already finding themselves trying to support their health-care workers, their essential workers, will be supported to use this guide.”

Many medical associations across the country have for decades implemented wellness programs focusing on doctors practising self-care to prevent burnout from working long hours, for example.

However, Smith said the guide calls on organizations to put widespread preventative measures in place to support staff grappling to make the right decisions during an unprecedented work experience while fearing their jobs may put themselves and their families at risk of becoming infected with COVID-19.

“They need to have the licence to put up their hands and say they are struggling,” he said.

“The obligation to protect essential workers falls on those in charge — the supervisors and administrators who may also be suffering moral stresses and dilemmas of their own as a result of sending workers into dangerous situations.”

Practise self-care

The guide, which is available online, calls on employers to take measure such as rotating staff between high- and low-stress roles, establishing policies to guide them through ethically tough decisions and promoting a supportive culture.

It also urges workers, including doctors, nurses, lab technicians and social workers, to practise self-care through proper nutrition, exercise and social connection and to seek professional help when needed.

Fardous Hosseiny, the Canadian centre’s vice-president of research and policy, said first responders could develop a “moral injury” leading them to question whether their actions were justified, for instance if they led to poor outcomes from having to cancel someone’s surgery.

“One doctor we talked to said he and his team turned a COVID-19 patient on his back who then quickly started breathing. But when they tried the same technique the next day on another patient, that person flatlined,” he said, suggesting physicians may have felt guilty about their abilities with a decision that contributed to someone’s death.

‘Space suits’ create barrier to human contact

Hosseiny noted that while doctors and nurses in Canada have not had to decide which patients get access to ventilators, for example, they have faced risks from a lack of personal protective equipment in some parts of the country early in the pandemic.

Moral injury is not yet clinically diagnosable but is generally considered to include an experience that caused people moral conflict, guilt, shame and loss of trust in themselves as well as depression, anger or moral conflict, he said.

Health-care workers of colour have faced additional issues amid systemic inequities in health care and growing national attention to racism, Hosseiny said, adding Ontario residents living in ethnically diverse areas have twice the risk of dying from COVID-19.

“Health-care workers of colour have reported stress because of identification with patients and the need to keep their frustration with health inequities to themselves.”

Sarah Beanlands, a nurse at a supervised consumption site in Ottawa, said many of the usual clients are no longer accessing the service because they don’t recognize staff behind head-to-toe personal protective gear and staff is concerned about the well-being of those at risk of overdose.

The Canadian health care system has changed forever because of COVID-19, especially its attempts to keep both patients and staff safe. CBC News recently got a first-hand look at those changes and heard from doctors and nurses about their new normal. 5:11 

WATCH  | Hospital’s new normal

“Space suits” of face shields, gowns, masks and gloves create barriers between workers and clients, who are required to wear a mask, as part of a service that relies on human contact and trust, Beanlands said.

Staff can’t offer some services that are no longer available in the community and many clients have refused to stay in shelters, she said, adding multiple changes during the pandemic have led to connections with vulnerable people being fractured.

“All of this causes moral anguish for my co-workers and me. It weighs on us heavily as we try to provide the best service under these new circumstances.”

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