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 considering gathering with loved ones over the holidays this year need to come to terms with some harsh realities.
The country faces a perfect storm: record rates of COVID-19 amid a growing sense of pandemic fatigue at a time when we typically travel to see loved ones and spend time together indoors.
But COVID-19 is insidious, an unwanted guest that can slip in unnoticed and wreak havoc despite our best efforts to control it.
“We have to ask ourselves honestly, must we socialize? And the answer is probably no,” said Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa.
“There is no way to eliminate risk except not to do it in the first place.”
But we’ve learned a lot more about how COVID-19 spreads since it first emerged at the beginning of this year, which can help inform us on where we’re most at risk.
Confusion over holiday guidelines
There’s understandably a lot of confusion about what sorts of holiday gathering might be reasonable to consider this year, especially since depending on where you live in this country the rules and recommendations differ.
Certain provinces, like Ontario, recommend skipping extended family gatherings altogether and taking precautions like self-isolating for 10 to 14 days for those travelling home from away, including colleges and universities.
While others, like Quebec, have put a lot of faith in their population by allowing gatherings of up to 10 people for four days over the holidays after a seven day period of self-imposed quarantine.
But Deonandan says we can’t necessarily rely on people to completely self-isolate on their own — that requires not leaving home for groceries, essential items or even to walk the dog.
WATCH | Dr. Theresa Tam advises no large gatherings or non-essential travel
Canada’s chief public health officer, Dr. Theresa Tam, says it’s clear that Christmas this year is not going to be like other years. She recommends against any gatherings but has some advice if people choose to forgo the public health guidelines. 0:48
“You’re also going to have outliers who have infectious periods longer than two weeks,” he said.
“If enough people do this, you’re going to get a sufficient number of people who do not fall under that umbrella who are indeed infectious and who start outbreaks.”
Silent spread a ‘key driver’ of outbreaks
While we weigh whether it’s even possible to gather safely with friends and family in a pandemic, it’s important to keep in mind the unseen dangers we could be inviting in — even in parts of the country that have low rates of COVID-19.
“The problem with this virus is that it’s like many other viruses,” said Dr. Allison McGeer, a medical microbiologist and infectious disease specialist at Toronto’s Mount Sinai hospital who worked on the front lines of the SARS epidemic in 2003. “You shed virus before you get sick and some people who get infected don’t develop symptoms.”
“That’s why what has worked is everybody wearing masks and everybody maintaining social distance, because you can’t tell who the next infected person is going to be.”
McGeer says viruses like influenza, chickenpox and measles typically present symptoms in the body before people are infectious — but the virus behind COVID-19 is different.
The U.S. Centers for Disease Control and Prevention released updated scientific guidance this week that acknowledged asymptomatic or presymptomatic individuals account for more than half of all COVID-19 transmissions.
“Silent transmission is one of the key drivers of outbreaks,” said Seyed Moghadas, a professor of applied mathematics and computational epidemiology at Toronto’s York University.
“There is an incorrect notion in the general population that if someone feels fine then they are not infected. A person can certainly be infected, infectious, and feel completely fine.”
Seyed Moghadas at York University says because of high rates of asymptomatic COVID-19 infections, silent transmission is one of the ‘key drivers’ of outbreaks. (Evan Mitsui/CBC)
Moghadas, the lead author of a study published in the journal PNAS on the silent spread of COVID-19 that was cited in the CDC guidelines, says this underscores how difficult the virus is to control, a challenge “magnified” in close quarters.
In Nova Scotia, which has successfully contained the spread of COVID-19 throughout the pandemic despite the bursting of the Atlantic bubble this week, catching those silent spreaders before they unknowingly infect others is key.
Dr. Lisa Barrett, an infectious disease specialist at Dalhousie University, has partnered with public health authorities in a pilot project to use rapid COVID-19 tests on people without symptoms in high-traffic areas of Halifax.
It’s only been a few days, but what they’ve found was surprising.
On the first day they tested 147 people and found one asymptomatic case, the second day they tested 604 more and found another one, and on the third day they did 804 tests and found five more.
“We recognized that there are a lot of people out there, even if they’re doing the right thing, that don’t know they’re infected, don’t know they’re infectious and could be spreading to other people,” said Barrett.
“When there’s community spread of a virus that has a long period of time when you can be infectious without symptoms, you have to test broadly in the community or you have no idea what’s going on.”
‘A negative test is not a license to socialize’
One novel approach to avoid meeting with loved ones while unknowingly infectious that has emerged is to get a COVID-19 test beforehand to pre-emptively detect it.
But the timing of that test is incredibly important and there’s a lot of room for error, so it may be a less effective strategy than it first appears.
A new study in the journal Science looked at 1,178 people infected with COVID-19 and more than 15,000 of their close contacts to determine when people were most infectious.
It found most of the transition — 87 per cent — happened in a fairly wide window of time, up to five days before or after symptoms appeared, while 53 per cent was in the pre-symptomatic phase.
“It’s possible to be early in the disease cycle such that you won’t detect any viral presence. But in two days suddenly you’re infectious and now we’re screwed,” said Deonandan, at the University of Ottawa.
“So a negative test is not a license to socialize.”
Still, Deonandan says there will be people who are going to socialize anyway, so it’s better they do so with precautions in place like testing and self-isolating than nothing — even if those precautions aren’t perfect.
Whether you celebrate Christmas, Hanukkah, Kwanzaa or the winter solstice, Canadians are being told to consider meeting virtually, avoid risky indoor gatherings without masks and instead find ways to connect while still physical distancing.
“I think the pitch to people is that yes, we’re used to having time off school and we’re used to seeing everybody,” said McGeer. “But this is the year to delay.”
WATCH | Tam on the holiday season and how the pandemic won’t go on forever
Canada’s Chief Public Health Officer Dr. Theresa Tam talks to The National’s Andrew Chang about the holiday season and getting to the end of the COVID-19 pandemic. 6:31
“The best advice this year is maybe not to go too far from home,” said Barrett. “Is it worth it to lose control of the virus?”
“We’re hanging on by a thread here. Please don’t let that thread break.”
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Some Ontario doctors have started offering a free shot that can protect babies from respiratory syncytial virus while Quebec will begin its immunization program next month.
The new shot called Nirsevimab gives babies antibodies that provide passive immunity to RSV, a major cause of serious lower respiratory tract infections for infants and seniors, which can cause bronchiolitis or pneumonia.
Ontario’s ministry of health says the shot is already available at some doctor’s offices in Ontario with the province’s remaining supply set to arrive by the end of the month.
Quebec will begin administering the shots on Nov. 4 to babies born in hospitals and delivery centers.
Parents in Quebec with babies under six months or those who are older but more vulnerable to infection can also book immunization appointments online.
The injection will be available in Nunavut and Yukon this fall and winter, though administration start dates have not yet been announced.
This report by The Canadian Press was first published Oct. 21, 2024.
-With files from Nicole Ireland
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
ISLAMABAD (AP) — Polio cases are rising ahead of a new vaccination campaign in Pakistan, where violence targeting health workers and the police protecting them has hampered years of efforts toward making the country polio-free.
Since January, health officials have confirmed 39 new polio cases in Pakistan, compared to only six last year, said Anwarul Haq of the National Emergency Operation Center for Polio Eradication.
The new nationwide drive starts Oct. 28 with the aim to vaccinate at least 32 million children. “The whole purpose of these campaigns is to achieve the target of making Pakistan a polio-free state,” he said.
Pakistan regularly launches campaigns against polio despite attacks on the workers and police assigned to the inoculation drives. Militants falsely claim the vaccination campaigns are a Western conspiracy to sterilize children.
Most of the new polio cases were reported in the southwestern Balochistan and southern Sindh province, following by Khyber Pakhtunkhwa province and eastern Punjab province.
The locations are worrying authorities since previous cases were from the restive northwest bordering Afghanistan, where the Taliban government in September suddenly stopped a door-to-door vaccination campaign.
Afghanistan and Pakistan are the two countries in which the spread of the potentially fatal, paralyzing disease has never been stopped. Authorities in Pakistan have said that the Taliban’s decision will have major repercussions beyond the Afghan border, as people from both sides frequently travel to each other’s country.
The World Health Organization has confirmed 18 polio cases in Afghanistan this year, all but two in the south of the country. That’s up from six cases in 2023. Afghanistan used a house-to-house vaccination strategy this June for the first time in five years, a tactic that helped to reach the majority of children targeted, according to WHO.
Health officials in Pakistan say they want the both sides to conduct anti-polio drives simultaneously.
WASHINGTON (AP) — Millions of people with private health insurance would be able to pick up over-the-counter methods like condoms, the “morning after” pill and birth control pills for free under a new rule the White House proposed on Monday.
Right now, health insurers must cover the cost of prescribed contraception, including prescription birth control or even condoms that doctors have issued a prescription for. But the new rule would expand that coverage, allowing millions of people on private health insurance to pick up free condoms, birth control pills, or “morning after” pills from local storefronts without a prescription.
The proposal comes days before Election Day, as Vice President Kamala Harris affixes her presidential campaign to a promise of expanding women’s health care access in the wake of the U.S. Supreme Court’s decision to undo nationwide abortion rights two years ago. Harris has sought to craft a distinct contrast from her Republican challenger, Donald Trump, who appointed some of the judges who issued that ruling.
“The proposed rule we announce today would expand access to birth control at no additional cost for millions of consumers,” Health and Human Services Secretary Xavier Becerra said in a statement. “Bottom line: women should have control over their personal health care decisions. And issuers and providers have an obligation to comply with the law.”
The emergency contraceptives that people on private insurance would be able to access without costs include levonorgestrel, a pill that needs to be taken immediately after sex to prevent pregnancy and is more commonly known by the brand name “Plan B.”
Without a doctor’s prescription, women may pay as much as $50 for a pack of the pills. And women who delay buying the medication in order to get a doctor’s prescription could jeopardize the pill’s effectiveness, since it is most likely to prevent a pregnancy within 72 hours after sex.
If implemented, the new rule would also require insurers to fully bear the cost of the once-a-day Opill, a new over-the-counter birth control pill that the U.S. Food and Drug Administration approved last year. A one-month supply of the pills costs $20.
Federal mandates for private health insurance to cover contraceptive care were first introduced with the Affordable Care Act, which required plans to pick up the cost of FDA-approved birth control that had been prescribed by a doctor as a preventative service.
The proposed rule would not impact those on Medicaid, the insurance program for the poorest Americans. States are largely left to design their own rules around Medicaid coverage for contraception, and few cover over-the-counter methods like Plan B or condoms.
