This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.
Canadians hoping to get vaccinated against COVID-19 are stuck in limbo across much of the country.
While vaccination programs are well underway for high-risk populations, shipment reductions and ongoing uncertainty mean there is a lull — potentially for weeks or even months — before Canada sees a steady flow of supplies.
The tide is set to turn eventually, with Prime Minister Justin Trudeau saying on Friday that he has assurance from Canada’s two key suppliers, Moderna and Pfizer, that a combined six million shots are still coming down the pipe before the end of March.
Multiple other vaccines could also gain a stamp of approval alongside the shots already being used. Paying into the World Health Organization co-led COVAX program is set to pay off and Canada recently inked a deal to produce millions of Novavax doses domestically.
That gets shots into the country. But what about getting shots in arms?
With a federal government goal in place to vaccinate all residents who want the shot before the end of 2021, and millions of Canadians longing for an end to the pandemic, this waiting period comes with an opportunity to scale up vaccination programs — before the bulk of shipments arrive on provinces’ doorsteps.
Dr. Naheed Dosani, a Toronto-based palliative care physician and advocate for health justice, said Canada is in a “race against time” to build up community outreach, decentralize vaccination sites and combat vaccine hesitancy.
“We can’t waste time. Every minute, every hour every day counts,” he said.
“Down the road, we don’t want to look back and think in early February, we were kind of just waiting for vaccines, we could have done more to address education and provide information for our communities.”
Decentralize vaccine sites
Other medical experts agree this lull period is critical, giving Canada a chance to learn from the successes of countries that are further ahead in their vaccination programs.
Earlier this month, Ontario’s COVID-19 science advisory table released a report outlining takeaways from Israel, where roughly 80 per cent of older adults in the country are vaccinated as scientists there are tracking a drop in COVID-19 cases, hospitalizations and critical illness.
“Israel worked around the clock to vaccinate as quickly as possible,” said Toronto-based geriatrician Dr. Nathan Stall, one of the table members.
And it goes beyond speed, he said.
Instead of just hospital or pharmacy-based vaccination sites, Israel created pop-up and drive-thru centres — leveraging teams of community-based nurses, physicians and other medical professions to vaccinate residents rapidly.
“We really, really want to try to decentralize vaccine sites away from hospital systems into the communities, and I think it’s very, very important to engage community leaders, especially in areas in remote places where accessibility is a huge issue,” said Dr. Sumon Chakrabarti, an infectious diseases physician at Trillium Health Partners in Mississauga, Ont.
“And you know, this is going to be absolutely key in getting as many Canadians vaccinated as possible.”
That’s the approach in the U.K. as well, where more than 10 million citizens have been vaccinated against COVID-19 to date.
The country is using a mix of community clinics and pharmacies, hospital sites and large-scale venues like sports stadiums, totalling around 1,500 sites, with mobile units planned for highly rural areas.
The goal, according to the U.K. government, was to have every resident living within roughly 16 kilometres of a vaccination centre.
Provinces look to decentralization
Unlike the U.K., Canada has to contend with a population spread out over a vast geographic area. Even so, provinces are exploring decentralization in a variety of ways, although some frameworks are more fleshed-out than others.
In Ontario, which began its vaccine rollout within the hospital system, regional public health units are preparing and presenting vaccination plans, which may include work with community physicians and pharmacists, provincial officials told CBC News on Tuesday.
Saskatchewan has vaccination sites spread across 10 different zones, with doses heading to more than 50 different communities, while Manitoba is primarily taking a “supersite” approach with large-scale vaccination clinics happening at several facilities like a gymnasium and convention centre, alongside the shots doled out by physicians, pharmacists and pop-up clinics.
Meanwhile, British Columbia’s provincewide immunization plan notes 172 community-based vaccine clinics are being organized and will be held at large facilities, including school gyms, arenas and convention centres.
“Mobile clinics in self-contained vehicles will be available for some rural communities and for people who are homebound due to mobility issues,” the plan said, adding more details will be released before April.
On the East Coast, Prince Edward Island officials announced vaccine clinics in several cities set to launch in late February — and recently made changes to a law that comes into effect this month and will eventually allow pharmacists to provide COVID-19 vaccinations alongside their usual roster of shots.
But ensuring that community clinics can offer vaccines widely and efficiently requires significant planning beyond finding buildings or hiring staff.
“This short amount of time, until the next series of vaccines are rolled out in large numbers, is the time to develop those prototype clinics — if you haven’t done them — to make sure you’ve got a vaccination recording system in place and have all your communications sorted out,” said Dr. Joanne Langley, a pediatric infectious disease specialist at the Halifax-based Canadian Center for Vaccinology.
Multiple experts who spoke to CBC News stressed that communication needs to include trusted community leaders, culturally sensitive messaging and information about vaccine programs provided in a variety of languages.
“You can have some person on TV just talking, telling you to get vaccinated, but it’s different if you have somebody who’s trusted in the community, whether it’s a community member, priest, doctor that you know,” said Chakrabarti.
In the Toronto area, Dosani said there’s a groundswell of innovation and support from local organizations, with community health centres already working to address vaccine hesitancy among communities where it is common — and rooted in long-standing trauma and distrust of the mainstream medical system.
But governments need to support those efforts as well, he said.
“If we are taking an equity-based approach, what that means is putting more resources and supports in place so that the people who are less likely to take the vaccine get the supports and education that they need to so that they do take the vaccine.”
Booking system hiccups
As vaccination campaigns scale up to include more members of the community, building large-scale booking systems has been a key priority in different countries to manage the massive number of appointments.
Earlier this year, Canada’s federal government awarded international accounting firm Deloitte a multimillion-dollar contract to build a national computer system to manage the COVID-19 vaccine rollout.
But there may be lessons to learn there, too. South of the border, the same system is being used in multiple states, with U.S. media outlets reporting that it’s proving buggy and unreliable.
Meanwhile, in some areas of Florida, other types of online-only booking systems have sparked frustration among seniors — the age group most at risk of dying from COVID-19 — and led to reports of people stuck refreshing web pages to snag one of the limited spots or flying in from abroad to get vaccinated.
Those approaches require computer literacy and cause unnecessary chaos, Stall said.
“My fear is you’re going to have a vaccine booking system that’s going to be like purchasing playoff tickets for a sports team where everyone’s going to line up, crash the system, try and book as fast as they can,” he said.
“And you’re going to leave behind the people who need the vaccine the most.”
Yet, even more traditional booking methods can come with hiccups.
Prince Edward Island set up a dedicated phone line so anyone aged 80 or older can start booking COVID-19 vaccine appointments, seven days a week. It’s already so popular that seniors are struggling to get through, prompting the province to boost the number of people taking the calls and, soon, to start offering online booking options as well.
Sustain public health measures
With so many facets to a vaccination rollout, at a scale and speed Canada hasn’t experienced before, the process is rife with challenges — but that’s where this lull might come in handy.
“I appreciate that we don’t have an adequate supply yet to be vaccinating the general public,” Dosani said. “But there is a lot of time that’s just passing right now that can be used for things like public education.”
Officials are also stressing the need to maintain now-engrained precautions to keep the coronavirus at bay while Canadians await widespread inoculations.
Outbreaks keep happening throughout the country in high-risk populations and communities, including long-term care homes, correctional facilities, Indigenous communities and in remote areas, said Dr. Theresa Tam, Canada’s chief public health officer, in a statement on Thursday.
“These factors underscore the importance of sustaining public health measures and individual practices and not easing restrictions too fast or too soon,” she said.
“This is particularly important in light of the emergence of new virus variants of concern that could rapidly accelerate transmission of COVID-19 in Canada.”
It’s a tense time, but light at the end of the tunnel may be closer than it seems.
“Our job is to keep ourselves and our families safe until we get that vaccine,” Langley said.
“And once it’s rolled out in the whole population, we’ll be in a different place.”
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Woman almost loses $580 after money order reported lost by Canada Post – CTV Toronto
They’re not used as commonly as they once were, but a money order is something you can buy at Canada Post that is supposed to be as good as cash.
The post office says it’s a safe and secure way to send funds in the mail, but a Brampton woman says that when her money order got lost she was initially denied a refund.
Elizabeth Diehl said she appreciates Indigenous art and tries to support Canada’s First Nations artists so she ordered six pairs of handmade moccasins as Christmas presents.
“I ordered them in November as they are always lovely to wear on a cold winter day,” Diehl said.
When they arrived, Diehl sent a money order for $580 to the woman who made them in Weagamow First Nation in northern Ontario.
A money order is the preferred method of payment in the fly-in community.
“She relies on Canada Post money orders because they don’t have active banks up there I believe,” Diehl said.
One month after sending the money order, the person contacted Diehl to say she had never received it.
Canada Post said it would take 45 days to investigate so Diehl sent another money order to make sure the woman would receive her funds for the moccasins.
Canada Post eventually told Diehl the money order was lost in the mail, but that she would only get back fees she paid for the money order, not the $580 dollars.
A customer service agent with Canada Post told her “unfortunately, because insurance coverage was not purchased at the time of mailing, we are unable to provide any additional compensation.”
Diehl said there was no mention of insurance coverage being needed when she purchased the money order.
When CTV News Toronto reached out to Canada Post, we were told insurance is not required for money orders and funds are guaranteed returned if a money order is lost and uncashed.
“We spoke to Ms. Diehl to let her know we are refunding her $580 money order as per our policies,” a spokesperson told CTV news Toronto.
Diehl felt if she hadn’t contacted CTV News Toronto she would not have received her refund.
Canada PM says U.S. very open to helping other nations with COVID-19 vaccines
By David Ljunggren
OTTAWA (Reuters) – The United States is “very open” to helping other countries procure COVID-19 vaccines and conversations about how to do so are continuing, Canadian Prime Minister Justin Trudeau said on Wednesday.
The United States will have enough COVID-19 vaccine for every adult by the end of May, President Joe Biden said on Tuesday. The initial goal had been end of July.
Canada‘s target is end-September and critics, who complain about the slow vaccine rollout so far, say Trudeau should ask the United States to permit shipments across the border.
Trudeau told reporters it was clear from his conversations with Biden that Washington understood the best way to combat COVID-19 was to do so worldwide.
“By stepping up on the COVAX facility internationally, by looking at how they can be helpful around the world, (they are) very open to helping out other countries and those conversations will continue,” he said.
The COVAX program co-led by the World Health Organization is designed to ensure equitable vaccine distribution worldwide.
Mexican President Andres Manuel Lopez Obrador said on Tuesday he was hopeful the United States will be able to share COVID-19 vaccines.
Later on Wednesday, Canada‘s advisory panel on immunization recommended that to make the most of limited supplies, the gap between the first and second doses of the Pfizer Inc and Moderna Inc vaccines should be extended to four months, up from six weeks.
“Canada will be able to provide access to first doses of highly efficacious vaccines to more individuals earlier,” the panel said on its website. The provinces of Alberta and British Columbia have already announced a four-month gap.
The six-week gap was already a deviation from the way the vaccines were tested. In clinical trials, two doses of the Pfizer vaccine were giving three weeks apart and the Moderna shots four weeks apart.
Canada has recorded a total of 22,045 COVID-19 deaths compared to some 513,000 in the United States.
A first batch of 500,000 vaccine doses from AstraZeneca Plc arrived on Wednesday. These had not been included in Ottawa’s initial plan, Trudeau said, noting regulators were also examining other vaccines.
“We are very optimistic that we are going to be able to accelerate some of these time lines,” he said.
(Reporting by David Ljunggren; Editing by Alistair Bell and Bill Berkrot)
Judge finds Toronto van attack killer guilty of murder – CBC.ca
A judge has declared that the man responsible for Toronto’s deadly van attack in 2018 is guilty of 10 counts of first-degree murder and 16 counts of attempted murder.
In rendering her decision, which was broadcast on YouTube Wednesday morning, Justice Anne Molloy said Alek Minassian’s rampage was “the act of a reasoning mind,” and noted that the 28 year old has “no remorse for it and no empathy for his victims.”
“He freely chose the option that was morally wrong, knowing what the consequences would be for himself, and for everybody else,” Molloy said in her decision. “It does not matter that he does not have remorse, nor empathize with the victims.
“Lack of empathy for the suffering of victims, even an incapacity to empathize for whatever reason, does not constitute a defence.”
The man had pleaded not guilty at the judge-alone trial, which was held virtually at the Ontario Superior Court of Justice because of the COVID-19 pandemic.
In Canada, a first-degree murder conviction carries an automatic life sentence without the possibility of parole for 25 years.
Justice rejected defence’s autism argument
Defence lawyer Boris Bytensky said in his closing arguments that his client’s autism disorder left him without the ability to develop empathy, arguing that his client had no idea how horrific his actions were to his victims, his family and the community.
Molloy outright rejected that notion in her decision, which you can read in full at the bottom of this story.
“He considered the impact it would have on his family, and deliberately set those thoughts aside, ignoring them, because he did not want them to deter him from achieving this important goal,” she said, noting that he had been fantasizing about a crime like this for over a decade. “He was capable of understanding the impact it would have on his victims.
“He knew death would be irreversible. He knew their families would grieve.”
WATCH | Remembering the victims of the Toronto van attack:
Elwood Delaney, who lost his 80-year-old grandmother Dorothy Sewell in the attack, told CBC News that watching the judge give her decision was extremely emotional for his family.
“I don’t want to say happy, but we were relieved,” he said.
“I’ve held a lot of anger towards him this whole entire time. Knowing that he’s going to be locked up for a very long time … is a relief.”
Delaney said his grandmother was one of Canada’s biggest sports fans, and was a fervent follower of the Toronto Maple Leafs and Blue Jays.
“Every time I watch sports … I constantly think of her,” he said. “I miss her a lot. We all do.”
WATCH | Man remembers grandmother who was killed in Toronto attack:
Crown lawyer praises everyday people at scene
Speaking outside the courthouse after the decision was read, Crown attorney Joe Callaghan lauded the actions of the first responders who attended the scene, and read off the names of everyone killed in the attack.
“In addition, a neighbourhood was attacked, leaving its residents fearful and traumatized,” he said.
Callaghan also commended the actions of everyday people who were on the street that day, who tried to help victims who had been struck and comforted the dying.
“They demonstrated a remarkable level of selflessness and empathy, reflecting the true community spirit of this city,” he said.
Cathy Riddell, who was badly injured in the attack, also told reporters outside the courthouse that she feels justice has been done.
“I probably will sleep tonight for the first time in a while,” she said.
“He can spend the rest of his life in jail, because he deserves it … he took lives, and he didn’t care.”
WATCH | Family members, victim and Crown attorney react to judge’s decision:
Police say on the afternoon of April 23, 2018, the killer drove a rented van down Yonge Street near Finch Avenue, veering onto the busy sidewalk and hitting one person after another.
After a brief standoff with a police officer, he was arrested. His victims included Sewell, who was killed, and another woman who survived but had both of her legs amputated as a result of injuries suffered in the attack.
Molloy made sure to say the name and age of each of the victims in her decision. She also listed the serious, and in some cases life-changing injuries suffered by those who survived, including broken bones, bleeding on the brain and a collapsed lung.
The judge also said she would not be naming the killer in her decision and referred to him instead as “John Doe,” noting that notoriety was a driving force in his crimes.
“I am acutely aware that all of this attention and media coverage is exactly what this man sought from the start,” she said.
CBC News will continue to use his name, in some instances, for clarity.
Autism group relieved at verdict
In a statement issued Wednesday morning, the Ontario Autism Coalition said it was relieved at Molloy’s decision, and said it was a “firm rejection” of the use of autism as a defence.
“Violent traits have no connection to autism; in fact, people on the autism spectrum are far more likely to be victims as opposed to perpetrators of violence,” the statement reads.
“The court’s decision makes it clear this was never a case of autism causing mass murder, but rather a case where someone who committed mass murder happened to have autism.
“An autism diagnosis does not predispose one to commit acts of violence.”
The killer told police his rampage was a mission for the incel movement, an online subculture of so-called “involuntarily celibate” men who direct their misogynistic rage at women. But Molloy noted in her decision that he also made mention in interviews of making that connection purely to upgrade the notoriety of his actions.
Molloy said the killer has never shown any pleasure or sense of satisfaction to have killed or injured women, apart from the notoriety his crimes have brought to him.
“Accordingly, I agree with the assessors that [the killer’s] story to the police about the attack being an ‘incel rebellion’ was a lie,” the judge wrote.
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