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.
Six weeks ago, Prime Minister Justin Trudeau said the country was at a “crossroads” in the COVID-19 pandemic.
Now, with cases spiking in regions that were practically untouched by the virus in the first wave, it appears we’ve taken a wrong turn.
There have been more than 100,000 new cases of COVID-19 and over 1,000 more deaths in this country since Trudeau made those comments.
The percentage of COVID-19 tests across the country that have come back positive has also grown by more than 235 per cent — from 1.4 per cent in mid-September to 4.7 per cent in the past week.
So where did Canada go wrong?
Experts say a mix of insufficient public health measures and complacency brought us to where we are today and we need to act quickly to turn things around — or at the very least prevent them from getting worse.
Canada ‘failed’ to follow lessons
South Korea taught us that by building up a robust test, trace and isolate system, it’s possible to control the spread of the coronavirus without subjecting your population to a lockdowns at all.
New Zealand locked down quickly, then shifted to a South Korean model focused on building up testing, tracing and isolating cases.
But Australia learned the hard way in the second wave that, if you let the coronavirus spread unchecked for too long, tough action is needed to keep it under control through further lockdowns and strict public health measures.
“The lesson across all of the world is that the places that do the best are the ones that act hard and early,” said Raywat Deonandan, a global health epidemiologist and an associate professor at the University of Ottawa.
“That’s where we failed.”
Experts say Canada, comparatively, has seemingly not yet learned these lessons.
“In Canada, we never set clear goals and so we opened up without having built a solid test, trace isolate strategy,” said Dr. Irfan Dhalla, vice-president of physician quality at Unity Health in Toronto.
“We didn’t follow the indicators closely enough and now we’re paying the price. The good news is we’re not paying nearly as bad a price as people in some other countries are paying, but it would be a big mistake to compare ourselves to the worst countries in the world.”
“The situation we find ourselves in right now is highly unstable,” said Dhalla, who is also an associate professor at the University of Toronto who sits on provincial and federal committees related to the COVID-19 response.
“It wouldn’t take much to put us on a path towards the kinds of outcomes we’re seeing in Belgium, Switzerland, the United Kingdom, many American states.”
But with over half of Ontario’s cases with no known link to previous cases and community transmission running rampant, experts say the province doesn’t have a clear enough view of the situation.
“We don’t understand how many people are infected. We know that it’s a lot, but we really don’t know the magnitude,” said Dr. Andrew Morris, a professor of infectious diseases at the University of Toronto and the medical director of the Antimicrobial Stewardship Program at Sinai-University Health Network.
“If this were an iceberg, we don’t know how much is above or below water.”
“We know in Ontario that 1,000 cases per day is not a sustainable situation. We have too many outbreaks in hospitals, we have too many outbreaks in long-term care homes,” he said.
“We have to bring the number of cases down from 1,000 a day back down to something like 50 or 100 per day. And when we get back down there, we need to have a test, trace, isolate strategy that works.”
WATCH | Ontario’s restrictions system under fire:
Ontario has announced a new tiered system for triggering COVID-19 restriction, but critics say the sky-high thresholds won’t stop the virus from spreading across the province. 1:59
Manitoba suffered from ‘complacency’
Manitoba went from one of Canada’s shining examples of how to successfully manage the spread of the coronavirus, to facing its single worst outbreak.
“Some of us lost our way, and now COVID is beating us,” Premier Brian Pallister said Monday. “Perhaps we were cursed by our early success.”
It was that early success that caused the province to let its guard down, leaving it vulnerable to a surge in cases when the virus re-entered the community.
“We had a very good proactive response in early spring. We shut things down very quickly, everybody seemed to be quite on board and cases receded,” said Jason Kindrachuk, an assistant professor of viral pathogenesis at the University of Manitoba in Winnipeg and Canada Research Chair of emerging viruses.
“And that, probably, in some ways, fed a complacency across all levels.”
Kindrachuk said that because Manitoba didn’t bear the brunt of COVID-19 that other regions of the country had, it lost focus on the need to prepare for the future.
“Then everything hit at the perfect time — we had exponential growth, we had community transmission, we likely had superspreading events, we had outbreaks that occurred in long-term care facilities,” he said.
“The worst of the worst that could have happened, did happen.”
Alberta faces ‘tipping point’
Alberta shattered COVID-19 records on Thursday, recording what health officials described as “about 800” new cases after specific numbers were unavailable due to technical problems with the province’s reporting system.
It’s another province that saw low case numbers slowly rise after a lull in the summer, but waited to act on imposing stricter restrictions and now faces the prospect of a worsening second wave.
Dr. Lynora Saxinger, an infectious diseases specialist and an associate professor at the University of Alberta’s faculty of medicine, called the situation “profoundly disturbing.”
“You can have things simmering along, and then it just starts to boil over — there’s a tipping point, and it starts to change,” she said.
“And when that happens, what we’ve seen across the world, is the actions in that early phase make a really big difference.”
Alberta Premier Jason Kenney rejected the call for stricter public health restrictions this week, the same time a record 171 people were hospitalized with COVID-19, 33 of them in ICU, and nine more people died.
“We’ve seen other jurisdictions implement sweeping lockdowns, indiscriminately violating people’s rights and destroying livelihoods,” Kenney said Friday, rejecting the call for further measures to curb the spread of the virus.
“Nobody wants that to happen here in Alberta.”
Saxinger said Alberta should look at emulating a “circuit breaker” model of controlling the virus from the U.K., focused on brief lockdowns that can interrupt transmission and reverse rising case numbers quickly if rolled out successfully.
WATCH | Stop gatherings in homes, Kenney urges Albertans:
Premier Jason Kenney is calling on Albertans to not host parties or large family dinners and is expanding the 15-person limit on social gatherings to all communities on the province’s COVID-19 watch list. 2:42
“There’s a certain part of the population that’s just not really paying attention as much anymore,” she said. “So you might need to have that short, sharp, lockdown that’s visible to actually really get the whole population re-engaged.”
Saxinger said she’s worried Alberta is past the point of “targeted” restrictions due to rising community transmission and inadequate contact tracing and is being “surged under” by new cases and hospitalizations.
“I’m really afraid that it could take off in a really bad way,” she said. “A lot of us are very anxious right now and the hospitals are already stressed.”
Record numbers in B.C.
British Columbia was praised for its vigorous test, trace and isolate approach and became a global model for how to effectively control the spread of the virus, but could risk jeopardizing the progress it’s made if it doesn’t regain control of a surge in cases.
The province hit a record high COVID-19 case numbers two days in a row this week, with 425 on Thursday and 589 on Friday adding to the 3,741 active cases in the province currently.
Unlike Quebec, which saw its cases surge a month after school started and has been struggling to regain control, B.C. has largely seen outbreaks in community settings.
“Most of the transmissions are through gatherings … superspreader-type events that happen with lots of people in a room,” said Dr. Srinivas Murthy, an infectious disease specialist and clinical associate professor in pediatrics at the University of British Columbia.
“I think our lack of attention to that, and how we can target where we know those large-scale transmission events happen, was probably not as rigorous as it could have been.”
“So far we’ve been able to, with pretty rigorous data collection, follow up and trace and isolate most of the cases in the superspreading events that have happened,” he said.
“But if there is an increased, unlinked case number in the community that’s unable to be traced and isolated — then obviously large-scale social distancing would be probably the next step.”
Atlantic bubble needs vigilance
The Atlantic bubble, a success story for curbing COVID-19 spread, is another model that other parts of the country can learn from.
The four Atlantic provinces imposed tight restrictions on points of entry, moved quickly to clamp down on new outbreaks of COVID-19 and focused on aggressive contact tracing and isolating.
But epidemiologist Susan Kirkland said the recent surge in cases in parts of Canada that weren’t hit as hard in the first wave is a stark reminder of the need for the region to avoid letting its guard down.
“We have to be constantly vigilant,” said Kirkland, head of public health and epidemiology at Dalhousie University in Halifax. “As long as COVID isn’t introduced, we’re OK. But the minute it is, the environment is rife for it to spread very, very quickly.”
The Atlantic provinces have so far avoided rampant community spread of the virus with unknown origins, but Kirkland says rising numbers across the country show it could happen anywhere — even the North.
Nunavut confirmed its first case of COVID-19 on Friday and while health officials say contact tracing is currently underway in the community, the territory’s rapid response team is “on standby to help manage the situation should it become necessary.”
WATCH | No sign of bubble bursting:
Like an extended family, the four Atlantic provinces have walled themselves in, creating measures to restrict outsiders and COVID-19 cases. So far, it’s worked and there doesn’t seem to be much of a rush to burst the Atlantic bubble. 5:09
Kirkland said Atlantic Canada has much more in common with the North than it does with more populous provinces like Ontario and both regions face an uncertain future.
“Part of the reason that we’ve done so well is because we are isolated,” she said, adding that they have also benefited from strong public health messaging and a compliant public.
“But the minute we have community spread, we’re again in that situation where we’re putting ourselves at big risk. So it’s hard to be complacent.”
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A B.C. teen has a suspected case of H5N1 avian flu — the first known human to acquire the virusin Canada.
The provincial government said on the weekend that B.C.’s chief veterinarian and public health teamsare still investigating the source of exposure, but that it’s “very likely” an animal or bird.
Human-to-human transmission is very rare, but as cases among animals rise, many experts are worried the virus could develop that ability.
The teen was being treated at BC Children’s Hospital on Saturday. The provincial health officer said there were no updates on the patient Monday.
“I’m very concerned, obviously, for the young person who was infected,” said Dr. Matthew Miller, director of the Michael G. DeGroote Institute for Infectious Disease Research at McMaster University in Hamilton, Ont.
Miller, who is also the co-director of the Canadian Pandemic Preparedness Hub, said there have been several people infected with H5N1 in the U.S.,and almost all were livestock workers.
In an email to The Canadian Press on Monday afternoon, the Public Health Agency of Canada said “based on current evidence in Canada, the risk to the general public remains low at this time.”
WHAT IS H5N1?
H5N1 is a subtype of influenza A virus that has mainly affected birds, so it’s also called “bird flu” or “avian flu.” The H5N1 flu that has been circulating widely among birds and cattle this year is one of the avian flu strains known as Highly Pathogenic Avian Influenza (HPAI) because it causes severe illness in birds, including poultry.
According to the World Health Organization, H5N1 has been circulating widely among wild birds and poultry for more than two decades. The WHO became increasingly concerned and called for more disease surveillance in Feb. 2023 after worldwide reports of the virus spilling over into mammals.
HOW COMMON IS INFECTION IN HUMANS?
H5N1 infections in humans are rare and “primarily acquired through direct contact with infected poultry or contaminated environments,” the WHO’s website says.
Prior to the teen in B.C., Canada had one human case of H5N1 in 2014 and it was “travel-related,” according to the Public Health Agency of Canada.
As of Nov. 8, there have been 46 confirmed human cases of H5N1 in the U.S. this year, the Centers for Disease Control and Prevention says. There is an ongoing outbreak among dairy cattle, “sporadic” outbreaks in poultry farms and “widespread” cases in wild birds, the CDC website says.
There has been no sign of human-to-human transmission in any of the U.S. cases.
But infectious disease and public health experts are worried that the more H5N1 spreads between different types of animals, the bigger the chance it can mutateand spread more easily between humans.
WHAT ARE THE SYMPTOMS OF H5N1?
Although H5N1 causes symptoms similar to seasonal flu, such as cough, fever, shortness of breath, headache, muscle pain, sore throat, runny nose and fatigue, the strain also has key features that can cause other symptoms.
Unlike seasonal flu, most of the people infected in the U.S. have had conjunctivitis, or “pink-eye,” said Miller.
One reason for that is likely that many have been dairy cattle workers.
“At these milking operations, it’s easy to get contamination on your hands and rub your eyes. We touch our face like all the time without even knowing it,” he said.
“Also, those operations can produce droplets or aerosols, both during milking and during cleaning that can get into the eye relatively easily.”
But the other reason for the conjunctivitis seen in H5N1 cases is that the strain binds to receptors in the eye, Miller said.
While seasonal flu binds to receptors in the upper respiratory tract, H5N1 also binds to receptors in the lower respiratory tract, he said.
“That’s a concern … because if the virus makes its way down there, those lower respiratory infections tend to be a lot more severe. They tend to lead to more severe outcomes, like pneumonias for example, that can cause respiratory distress,” Miller said.
WILL THE FLU VACCINE PROTECT AGAINST H5N1?
We don’t know “with any degree of certainty,” whether the seasonal flu vaccine could help prevent infection with H5N1, said Miller.
Although there’s no data yet, it’s quite possible that it could help prevent more severe disease once a person is infected, he said.
That’s because the seasonal flu vaccine contains a component of H1N1 virus, which “is relatively closely related to H5N1.”
“So the immunity that might help protect people against H5N1 is almost certainly conferred by either prior infection with or prior vaccination against H1N1 viruses that circulate in people,” Miller said.
HOW ELSE CAN I PROTECT MYSELF?
The Public Health Agency of Canada said as a general precaution, people shouldn’t handle live or dead wild birds or other wild animals, and keep pets away from sick or dead animals.
Those who work with animals or in animal-contaminated places should take personal protective measures, the agency said.
This report by The Canadian Press was first published Nov. 11, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
MADISON, Wis. (AP) — A conservative prosecutor’s attorney struggled Monday to persuade the Wisconsin Supreme Court to reactivate the state’s 175-year-old abortion ban, drawing a tongue-lashing from two of the court’s liberal justices during oral arguments.
Sheboygan County’s Republican district attorney, Joel Urmanski, has asked the high court to overturn a Dane County judge’s ruling last year that invalidated the ban. A ruling isn’t expected for weeks but abortion advocates almost certainly will win the case given that liberal justices control the court. One of them, Janet Protasiewicz, remarked on the campaign trail that she supports abortion rights.
Monday’s two-hour session amounted to little more than political theater. Liberal Justice Rebecca Dallet told Urmanski’s attorney, Matthew Thome, that the ban was passed in 1849 by white men who held all the power and that he was ignoring everything that has happened since. Jill Karofsky, another liberal justice, pointed out that the ban provides no exceptions for rape or incest and that reactivation could result in doctors withholding medical care. She told Thome that he was essentially asking the court to sign a “death warrant” for women and children in Wisconsin.
“This is the world gone mad,” Karofsky said.
The ban stood until 1973, when the U.S. Supreme Court’s landmark Roe v. Wade decision legalizing abortion nationwide nullified it. Legislators never repealed the ban, however, and conservatives have argued the Supreme Court’s decision to overturn Roe two years ago reactivated it.
Democratic Attorney General Josh Kaul filed a lawsuit challenging the law in 2022. He argued that a 1985 Wisconsin law that prohibits abortion after a fetus reaches the point where it can survive outside the womb supersedes the ban. Some babies can survive with medical help after 21 weeks of gestation.
Urmanski contends that the ban was never repealed and that it can co-exist with the 1985 law because that law didn’t legalize abortion at any point. Other modern-day abortion restrictions also don’t legalize the practice, he argues.
Dane County Circuit Judge Diane Schlipper ruled last year that the ban outlaws feticide — which she defined as the killing of a fetus without the mother’s consent — but not consensual abortions. The ruling emboldened Planned Parenthood to resume offering abortions in Wisconsin after halting procedures after Roe was overturned.
Urmanski asked the state Supreme Court in February to overturn Schlipper’s ruling without waiting for a lower appellate decision.
Thome told the justices on Monday that he wasn’t arguing about the implications of reactivating the ban. He maintained that the legal theory that new laws implicitly repeal old ones is shaky. He also contended that the ban and the newer abortion restrictions can overlap just like laws establishing different penalties for the same crime. A ruling that the 1985 law effectively repealed the ban would be “anti-democratic,” Thome added.
“It’s a statute this Legislature has not repealed and you’re saying, no, you actually repealed it,” he said.
Dallet shot back that disregarding laws passed over the last 40 years to go back to 1849 would be undemocratic.
Planned Parenthood of Wisconsin filed a separate lawsuit in February asking the state Supreme Court to rule directly on whether a constitutional right to abortion exists in the state. The justices have agreed to take the case but haven’t scheduled oral arguments yet.
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This story has been updated to correct the Sheboygan County district attorney’s first name to Joel.
CAPE CANAVERAL, Fla. (AP) — Better catch this week’s supermoon. It will be a while until the next one.
This will be the year’s fourth and final supermoon, looking bigger and brighter than usual as it comes within about 225,000 miles (361,867 kilometers) of Earth on Thursday. It won’t reach its full lunar phase until Friday.
The supermoon rises after the peak of the Taurid meteor shower and before the Leonids are most active.
In 2025, expect three supermoons beginning in October.
What makes a moon so super?
More a popular term than a scientific one, a supermoon occurs when a full lunar phase syncs up with an especially close swing around Earth. This usually happens only three or four times a year and consecutively, given the moon’s constantly shifting, oval-shaped orbit.
A supermoon obviously isn’t bigger, but it can appear that way, although scientists say the difference can be barely perceptible.
How do supermoons compare?
This year features a quartet of supermoons.
The one in August was 224,917 miles (361,970 kilometers) away. September’s was 222,131 miles (357,486 kilometers) away. A partial lunar eclipse also unfolded that night, visible in much of the Americas, Africa and Europe as Earth’s shadow fell on the moon, resembling a small bite.
October’s supermoon was the year’s closest at 222,055 miles (357,364 kilometers) from Earth. This month’s supermoon will make its closest approach on Thursday with the full lunar phase the next day.
What’s in it for me?
Scientists point out that only the keenest observers can discern the subtle differences. It’s easier to detect the change in brightness — a supermoon can be 30% brighter than average.
With the U.S. and other countries ramping up lunar exploration with landers and eventually astronauts, the moon beckons brighter than ever.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
