A committee of world health officials said Thursday that “now is not the time” to call a global health emergency related to a new coronavirus that has left 17 dead and more than 500 others infected in China.
The World Health Organization made the announcement in Geneva at a press conference after the second meeting this week of a WHO emergency advisory committee on the new virus.
It was “a bit too early to consider that this event is a public health emergency of international concern,” said Didier Houssin, the chair of the emergency advisory committee, noting that there remained strong divisions during discussions.
“The emergency committee members were very divided, almost 50-50,” he said. Some felt the severity of the disease and increase in cases warranted a global health emergency, he added.
“Several others say that it is too early because of limited number of cases abroad and also considering the efforts which are presently made by Chinese authorities in order to try to contain the disease,” he continued. “Declaring a public health emergency of international concern is an important step in the history of an epidemic.”
A “public health emergency of international concern” (PHEIC) must be an “extraordinary event” that poses a global risk and requires co-ordinated international action, according to WHO. Global emergencies have been declared before, including for the Zika virus outbreak in the Americas, the swine flu and polio.
PRECAUTIONS IN CHINA
Key to the announcement were recent extraordinary precautions already in place around China. Beijing announced it would cancel public celebrations of Lunar New Year, which is typically one of the busiest travel seasons of the year. Wuhan, the city at the centre of the outbreak, has been placed on a lockdown.
“They’re making a very concerted effort in China to try and contain things. We’re making efforts worldwide. That’s the most important thing,” said Susy Hota, the medical director of Infection Prevention and Control at the University Health Network in Toronto, on CTV News Channel. The committee was likely attempting to strike a “balance” to avoid negative consequences, Hota added.
Global health emergencies often prompt foreign governments to restrict travel and trade to affected countries. In 2003, WHO issued travel warnings for Toronto during the outbreak of severe acute respiratory syndrome (SARS), which impacted the Greater Toronto Area economy at the time. Hotels in the area lost $39 million in revenue in one month, according to the Canadian Tourism Commission.
“It would be very similar for China,” said infectious disease physician Michael Gardam on CTV’s Your Morning. “People would definitely avoid the country.”
There are still a number of “unknowns” to be probed, WHO said at the Thursday press conference, including the possible animal source of the virus, its mode of transmission and the quality of containment measures.
The WHO announcement was encouraging for Neil Rau, an infectious disease specialist and assistant professor at the University of Toronto.
“If they had said it was an emergency, it would mean they were more concerned,” he told CTV News Channel, adding that the announcement underscored the fact that the committee still needs more information on two key things:
First, how deadly is the virus? “What percentage of people who get this infection actually die from it? Based on my calculations it looks like it’s only about two per cent.”
Second, how contagious is the virus? “It’s looking right now that there are no chains of transmission beyond what we call a secondary chain,” he said. “In other words, a person has it, then a person in close contact with them gets it, but it doesn’t keep transmitting person-to-person after that.”
The committee added Thursday that they would be prepared to convene again “as soon as necessary” as more information emerges.
PREPARATION IN CANADA
A global health emergency likely would not have changed much in Canada, according to Gardam, much in thanks to 17 years of preparation for another outbreak after SARS.
“We learned a lot from SARS. We also went through the H1N1 pandemic in 2009. So there’s been a lot of preparation done quietly in the background,” he said.
In Canada, travellers from Wuhan are screened, others are put in isolation who have symptoms, and hospitals have stockpiled necessary equipment for an outbreak. Those procedures would continue, said Gardam. It’s possible that a broader screening process to include travellers from Beijing or China in general may be implemented, he added. But that is less about the declaration from WHO, and more about where the virus is linked to in China.
“We may start to broaden our screening criteria. As we do that, we’re going to start screening a lot more people,” he said.
On the ground, that process would have a major impact for health care workers. “That’s going to be quite disruptive for the running of our hospitals,” he said. “We’re already pretty full dealing with all the other respiratory viruses.”
With files from The Associated Press
B.C. ramps up appeal to vaccinate as influenza surges in children – Times Colonist
The province is ramping up its flu-shot campaign, especially for young children, as hospital emergency departments deal with a flu-driven spike in visits.
Provincial health officer Dr. Bonnie Henry said the province is seeing a “dramatic increase” in cases of Influenza A, particularly H3N2, which can cause severe illness, especially in children.
The surge began about two weeks ago and while it’s leveling off in older teens, it continues to spike in younger children who — along with seniors — are most susceptible to serious illness and complications.
Henry, speaking at a news conference in Vancouver Monday with Health Minister Adrian Dix, said it’s not too late for vaccination to make a difference. “We can blunt that and we can prevent that ongoing transmission to older adults as we come together over the holiday season, which is often when we see our influenza peaking.”
Prior to the COVID-19 pandemic, the flu season usually lasted six weeks to two months, peaking after the winter holidays when people gather indoors. Typically in Canada every year, 15,000 to 20,000 people would be hospitalized with the flu and 2,500 to 3,000 would die.
Now, however, it’s surging earlier and the number of cases of Influenza A is way up, said Henry.
Children’s hospitals across the country have seen a surge in patients, including those affected by COVID-19, flu and respiratory syncytial virus, or RSV, for which there is no vaccine.
On Monday, children’s critical care beds in the province were at 63 per cent capacity, with high acuity/pediatric ICU beds at 85 per cent. (On the Island, the numbers were slightly lower: Children’s critical care bed capacity at Nanaimo Regional General Hospital was at 44 per cent capacity and Victoria General Hospital was at 50 per cent. High acuity/pediatric ICU beds at Victoria General Hospital were at 60 per cent capacity.)
At B.C. Children’s Hospital, where ER wait times were reported as 10 hours on Friday and nine on Saturday, a “code orange” that’s generally used for disasters and mass-casualty incidents was called at 6:35 a.m. Saturday and cancelled 28 minutes later.
Dix said the alert was based on information “available at the time” and promptly cancelled with new information.
Henry said while other respiratory viruses, including RSV, are levelling off in B.C., pediatricians and children’s hospitals are reporting more severe influenza and in some cases complications from influenza. Many children haven’t been exposed to the flu virus during the restrictions of the pandemic and thus haven’t built immunity.
Prime Minster Justin Trudeau said Monday he is “extremely worried” about a rise in respiratory illnesses among children as hospitals across the country report they are struggling to keep up with high volumes of patients.
Trudeau said it’s everyone’s responsibility to get vaccinated against both COVID-19 and influenza. He said health officials will consider measures such as mandatory masks.
Influenza A H3N2, which causes more severe illness, particularly in children age five and younger, is the main strain in circulation. Influenza is more concerning in young children than COVID because it can lead to secondary bacterial infections such as streptococcus or pneumococcus that can cause serious bacterial pneumonia, said Henry.
The vaccine offered this year includes H1N1 and H3N2 and two B strains, and appears to be a “very good” match to the virus circulating, offering 50 to 70 per cent protection against infection and illness, said Henry.
In B.C., influenza vaccine is free to anyone six months and older through health clinics, doctors’ offices, and pharmacies — with enhanced vaccines for seniors and FluMist for children who can’t tolerate needles.
So far, about 1.5 million British Columbians — including more than 50 per cent of those age 65 and older — have been vaccinated, using about 70 per cent of the current vaccine stock, with more expected.
However, only 20 per cent of children ages six months to 11 are vaccinated against the flu, and just 15 per cent of those age 12 to 17, said Dix, who urged parents to vaccinate their children. “What we’re seeing amongst children is a more significant influenza season by a very significant margin than last year and that reflects on the presentation at emergency departments.”
Emergency room visits in September and October of about 6,700 have increased to 6,800 to 6,900, he said.
Dr. Penny Ballem, executive lead of Immunized B.C. vaccine operations, said the province will host a vaccination blitz Dec. 9, 10, and 11 to get more people vaccinated through pharmacists, family doctors or health authority clinics designed for children, with thousands of appointments available on the GetVaccinated system.
The province will also send out emails and texts to the families of about 150,000 children age 5 and younger inviting them to make appointments.
B.C. Green Leader Sonia Furstenau, MLA for Cowichan Valley, called on the province to take steps beyond vaccination, including focusing on ventilation, masks and physical distancing.
A high number of children and teachers are missing school because they are sick, children’s wards and ERs are overwhelmed, and operations for children and infants are being cancelled, said Furstenau at a news conference Monday at the Pan Pacific Hotel in Vancouver. “I am deeply concerned for children and families in this province right now,” she said.
Dr. Sanjiv Gandhi, a pediatric cardiovascular and thoracic surgeon at B.C. Children’s Hospital who joined Furstenau at the news conference, said mandating masks is a reasonable and effective tool that should be used in addition to vaccination.
As a heart surgeon, Gandhi said, he’s seeing kids with viral infections who are sicker than he’s seen in decades. “We have all the tools to change the trajectory of this horrible situation — and it’s horrible. The only missing ingredient is courage, the courage for our leaders to be transparent to the public about what’s happening in our hospitals.”
Henry said masking in schools now is “very unlikely” to have any effect on the trajectory of the several viruses that are circulating.
Masks continue to be required in health-care settings, she said, but a general mask mandate is a “heavy handed” measure used as a “last resort when it’s something that is absolutely needed, everywhere, all the time.”
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Most B.C. residents under 60 have been infected with COVID-19 or vaccinated: study – Prince Rupert Northern View – The Northern View
A large study that chronicles the trajectory of COVID-19 over the first 2-1/2 years of the pandemic suggests most British Columbia children and adults younger than age 60 developed antibodies to slash their risk of severe illness — either through vaccination, infection or both.
Lead author Dr. Danuta Skowronski, an epidemiologist at the BC Centre for Disease Control, said the findings can be generalized to the rest of Canada due in part to a push to deliver first doses of vaccine and the “beast” of Omicron, which drove wave after wave of infections.
Antibodies to SARS-CoV-2, the virus that causes COVID-19, can be detected in the blood of people who have recovered from the disease and among those who have been vaccinated.
Researchers looked for antibodies in the leftover blood of a total of 14,000 people who had lab tests in British Columbia between March 2020, before the World Health Organization declared a pandemic, and August 2022, as the fast-spreading Omicron variant was evading vaccine protection.
They did eight analyses, amounting to snapshots of the virus’s presence in the population over the research period.
The study, published Monday in the Canadian Medical Association Journal, found that by January 2021, less than five per cent of people had been exposed to the virus.
But the proportion of those with COVID-19 antibodies rose to 56 per cent in June 2021 as vaccines were rolled out. It shot to 95 per cent in August of this year through a combination of vaccination and infection as Omicron became the dominant variant.
“The highest infection rates were in children and in parental-age adults. That likely reflects their greater interconnectedness, socially,” Skowronski said, adding that while data from other provinces is limited, similar findings have been reported in the United States.
The lowest infection rates were in the very old, as seen elsewhere in the world. She said that was possibly due to social isolation, and a high rate of vaccination and boosters among this age group, which is also at greatest risk of severe illness.
That points to the need for older adults to be prioritized for vaccination, Skowronski said.
The BC Centre for Disease Control launched similar seroprevalence surveys, which measure the attack rates of a particular illness in a population over time, during the 2009 swine flu pandemic caused by the H1N1 influenza virus.
It has completed several surveys during the COVID-19 pandemic, including one published in September that suggested at least 70 to 80 per cent of children and youth in Greater Vancouver and the Fraser Valley of B.C. had been infected. Another seroprevalence study is set to begin later this month to continue monitoring the virus’s tracks, Skowronski said.
The data can inform real-time policy decisions because without antibodies, a vast proportion of the population is susceptible to infection in a pandemic and that would crush the capacity of the health-care system, she said.
“As (the research) was unfolding, there were several points that I thought were really quite remarkable and in some ways a testament to the decisions that had been made in B.C., but not only in B.C., in Canada, because I think our findings are generalizable to other areas.”
Quick vaccine rollouts helped prevent further spread, she said.
“Canada went from being in a precarious position in January of 2021 in terms of vaccine supply to by June of 2021 being the world leader in vaccine coverage — outstripping the United Kingdom, even Israel, in terms of the proportion that had been vaccinated. And we show that in our seroprevalence survey, that swift uptake in vaccine coverage.”
Caroline Quach-Thanh, a professor in microbiology, infectious diseases and pediatrics at the University of Montreal, will co-lead a study surveying antibodies in children up to age 17 to detect the presence of past COVID-19 infection and/or vaccination.
The research team wants to obtain 36,000 samples of leftover blood from emergency departments in 14 children’s hospitals over five testing periods starting in January 2023.
The yearlong study will involve all provinces except Manitoba. New Brunswick and Newfoundland and Labrador will be excluded because they do not have children’s hospitals.
The hope is to gain more data on how COVID-19 has impacted youth across various provinces, and to be on the front lines of whatever the pandemic may bring next, Quach-Thanh said.
“The question is: Are we able to pick up something new that might be coming?”
—Camille Bains, The Canadian Press
'Intense' flu season hits Canadian kids hard, landing more in hospital – CBC News
Flu infections are raging among children and hospitalizing them across Canada, say pediatricians who are calling for urgent and longer-term solutions.
On the weekend, hospitals across the country were forced to scale back regular service to deal with a surge in influenza illnesses:
- CHEO in Ottawa said the Red Cross will be deployed to help out with its surge of cases.
- A respite care facility in Calgary closed to redeploy staff to a children’s hospital.
- BC Children’s Hospital declared an emergency for 30 minutes on Saturday to quickly boost capacity and resources.
- Newfoundland and Labrador’s children’s hospital cancelled some scheduled surgeries and appointments.
Doctors say the moves reflect a surge in influenza on top of long-standing pressures on both pediatric hospitals and care providers in the community. Cases of respiratory syncytial virus (RSV) have, in the meantime, stabilized after spiking earlier this season.
For the week ending Nov. 26, the Public Health Agency of Canada’s FluWatch reported 223 influenza-associated hospitalizations among children 16 and under.
That’s up from an average of 11, with a maximum of 35, at pediatric hospitals from 2014-15 to 2019-20, says Dr. Jesse Papenburg, a pediatric infectious-disease specialist at Montreal Children’s Hospital.
“This shows that we have had an early and intense influenza season so far this year, hitting the pediatric population particularly hard,” he said in an email.
Similarly in the U.S., Rochelle Walensky, director of the Centers for Disease Control and Prevention, said Monday that flu is at its highest level the U.S. has seen for a decade. So far this season, 14 youth in the U.S. have died.
Federal health officials haven’t released the exact number of influenza deaths among those aged 16 and under so far this season but say it’s fewer than five. The number of deaths for that age group were in the single digits annually before the COVID-19 pandemic.
Bend the curve with flu shots
Influenza is “overwhelmingly … causing a lot of problems,” particularly for children under five, said Dr. Fatima Kakkar, a pediatric infectious diseases specialist at Ste. Justine’s Hospital in Montreal.
But it’s not necessarily the flu, alone, that’s the problem, she says.
Rather, kids catch the flu, which leaves them prone to “really significant bacterial infections,” like pneumonia — and that’s when they land in hospital.
Kakkar says she’d like to see an emphasis on influenza vaccination for children, including publicity campaigns.
“I say this because I think it’s not too late and especially in parts of the country where influenza hasn’t taken hold, I would really like to see people encouraging and making it easier for parents and their children to be vaccinated.”
Whitehorse-based pediatrician Dr. Katharine Smart called it “immensely concerning” that children who are acutely ill and need attention quickly are having trouble receiving it.
But there are other, bigger-picture problems throughout the pediatric health-care system that deserve attention, she says.
Smart, past president of the Canadian Medical Association, cites wait-times for surgery for young people with scoliosis, or curvature of the spine, as an example.
“I’ve had patients that had to put off their post-secondary school planning because they don’t know when they’re going to get the operation and the recovery,” Smart said. “They say, ‘Well, how do I go off to college if I don’t know that I’m going to now have to have a massive spine surgery and be out of commission for weeks or months?'” she said. “Some of these [teens] have been waiting three to four years for this operation.”
Other health-care needs for children are provided outside of the hospital, which is especially important in the first years of life, such as autism services. Some kids aren’t able to access services to improve their speech, social skills and cognition. Once a child is in kindergarten, they may no longer be eligible for certain help because the developmental window to intervene has closed.
“These are problems that we’re seeing across the country,” Smart said. She suggests bolstering nurse staffing and retention.
She also wants to see more uptake of the flu vaccine among children and adults, to “bend the curve” for overwhelmed health-care systems.
The good news, Papenburg says, is that the influenza A H3N2 strain that is mainly circulating in Canada now is genetically the same as the strain in this year’s influenza vaccine. “That bodes well for good vaccine effectiveness, although that needs to be assessed in field studies now underway.”
In the long term, researchers are evaluating newer vaccine technologies for better, longer-lasting flu immunization, he said.
Like Smart, Papenburg suggested governments “invest in our child health care systems capacity, so that we can better handle these types of unpredictable surges of infections in our pediatric population.”
“When you look at Canada, we rank 30th out of 38 countries for childhood well-being,” Smart said. “It’s really shocking to think a country, as wealthy as ours, is doing that poorly for our kids, but it’s because we do not have a strategy for children.”
Health officials also recommend that people mask in indoor public places, screen daily for respiratory symptoms, stay home when sick, practice hand hygiene and keep surfaces clean to reduce the spread of respiratory illnesses such as RSV and flu.
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