This story is part of CBC Health’s Second Opinion, a weekly analysis of health and medical science news emailed to subscribers on Saturday mornings. If you haven’t subscribed yet, you can do that by clicking here.
When Colin Hunter got a sore throat and a fever last spring, he didn’t think much of it.
A week later, after packing and unpacking cardboard boxes, the middle finger of his right hand started to feel a bit irritated. By mid-afternoon, it was swollen. And by early evening, just hours later, it was clear something was very, very wrong.
“It went from nothing to, by about 5 p.m., a big plump grape on the end of my finger, turning black, swollen around the fingernail on all sides, and throbbing with each heartbeat,” Hunter recalled. “That’s when I went to the emergency room.”
Physicians at his local hospital feared it was a case of necrotizing fasciitis, also known as flesh-eating disease. So they cut open his finger, ran some tests and came back with a surprising diagnosis: He had a strep A infection.
Hunter had never heard of such a thing in someone’s hand. Then he realized his prior throat pain and fever might have been an undiagnosed case of strep throat — and that the bacteria could have gotten inside his finger through something as small as a paper cut.
Colin Hunter was hospitalized for five days last spring after a little cut on his finger got infected with what turned out to be strep A bacteria. Doctors used black marker to track the infection’s route. (Submitted by Colin Hunter)
The 47-year-old Guelph, Ont., resident ended up spending five days on intravenous antibiotics. During his hospital stay, physicians said the infection was likely spreading through his bloodstream, marking the route along Hunter’s arm with a black marker.
He fully recovered after treatment in the hospital and another round of antibiotics at home. But what haunts Hunter now is what would have happened if he hadn’t sought medical help as soon as he did.
“I might not have kept my finger,” he told CBC News. “Or my life.”
Fast-spreading and potentially deadly strep infections — known as invasive group A strep, or iGAS — are on the rise in Canada, hitting a new high in 2023, as CBC News first reported last week.
Provinces have also reported dozens of deaths in just the last few months, including at least 10 children across Ontario and B.C. Other countries, such as the U.K. and Japan, have also reported notable surges.
The big question is: Why? Why are we seeing a spike in these serious infections, both in Canada and abroad?
Scientists say there’s no single smoking gun, but rather a complex set of factors, some of which surfaced even before the COVID-19 pandemic.
“We don’t fully understand that, at this point,” said Dr. Jennifer Guthrie, an assistant professor of microbiology and immunology at Western University in London, Ont. “And it’s probably become more pressing to understand that recently with the rise.”
Rates were quietly rising for years
Group A streptococcus is a family of bacteria that typically causes milder illnesses, such as painful strep throat, skin infections or scarlet fever. In those cases, antibiotics usually clear things up.
The invasive form occurs when strep bacteria enter the soft tissues or the bloodstream. “It’s the highway to every single point in your body,” said Michael Johnson, an associate professor in the University of Arizona’s department of immunobiology.
Though relatively rare, those iGAS infections often progress rapidly, leading to a range of serious illnesses ranging from toxic shock syndrome to sepsis to brain inflammation. Among the various types of bacteria that can make humans sick, this family probably causes more kinds of diseases than any other, Johnson noted.
“It does not play well with others.”
Most estimates suggest around one in 10 people die from iGAS, at times within 12 to 24 hours of being infected.
WATCH | Severe strep infections on the rise:
Severe strep A infections are on the rise
10 days ago
Duration 2:51
Doctors say they’re seeing significantly more invasive strep A infections, caused by a bacteria that usually leads to milder illnesses. But in some cases it can enter the bloodstream and quickly become deadly.
And rates of those infections were quietly rising for years, research suggests. One Canadian study, published in September 2022, used a national disease surveillance database to look at rates of iGAS between 2009 and 2019.
The team, including University of Toronto researcher and infectious diseases specialist Dr. Allison McGeer, found the incidence of those infections went from four cases per 100,000 people to a little more than eight — doubling in just a decade.
The latest tally of 4,600 iGAS samples processed for 2023, provided to CBC News by the Public Health Agency of Canada, suggests the rate could now be as high as 12 cases per 100,000 people.
McGeer told CBC News there are multiple theories about the increase.
The family of bacteria behind strep-related illnesses often thrives in congregate settings, including long-term care facilities and the shelter system, since it spreads through close contact, including open wounds and airborne droplets from someone coughing, talking or sneezing.
So there’s speculation that rising levels of homelessness and intravenous drug use in Canada could mean more people living in situations “where you have more breaks in the skin and issues with accessing good hygiene,” leaving those populations vulnerable to strep infections, McGeer said.
Dr. Ivan Ying, an infectious diseases physician with Mackenzie Health, a hospital network north of Toronto, said global travel may be an additional factor, given the massive spike in international tourism observed in the 20 years leading up to the pandemic.
Group A strep is also a diverse family of bacteria, with hundreds of subtypes. The most common ones circulating in any given season tend to ebb and flow, scientists say, and they’re linked to different types of disease.
“I think travel, and close settings, and different strains crossing the border might have something to do with [the rise],” Ying said.
The U.K., for instance, observed a new lineage of group A strep prior to the pandemic that “does appear to be associated with some increased severity,” McGeer said. (That lineage has also been reported in Canada.)
“It was on its way up,” McGeer said. “Then we got the pandemic.”
LISTEN | Senior health and medical reporter Lauren Pelley on the rise of invasive strep A:
Front Burner19:53Invasive strep A: what you need to know
‘Perfect storm’ of respiratory, bacterial infections
That’s when the strep situation got even more complex.
And group A strep “was down by 50 or 60 per cent for the next year-and-a-half,” McGeer said.
Then it started to re-emerge, along with a variety of other infectious diseases. At the same time, Guthrie noted, vaccination rates for both COVID and flu petered out.
Several scientists agreed it may be a sheer numbers game, where higher rates of other illnesses — including old staples like flu and respiratory syncytial virus (RSV), as well as COVID-19 — are providing strep bacteria with a massive pool of people already weakened by other infections.
“It’s a perfect storm of having a lot of these viruses also co-circulating that also leave people vulnerable to strep A,” said Guthrie.
WATCH: Warnings about invasive strep A infections across Canada:
Health authorities across Canada are warning about a sharp increase in cases of invasive streptococcus A
9 days ago
Duration 4:44
Last year, 4,600 cases of invasive group A strep (iGAS) infections were recorded in Canada — a record number. Alberta Health says rates of iGAS have been increasing since 2017, with 768 confirmed cases reported in 2023.
In B.C., for instance, the province’s four recent strep-related deaths among children involved two cases where group A strep was identified alongside influenza, and another two where it was identified alongside another viral respiratory illness, human metapneumovirus.
One piece of the puzzle may be the fact that run-of-the-mill strep infections can damage the cells of the upper respiratory tract, noted McGeer.
Another may lie in changes to the immune system during an acute viral infection.
“There is no question that having increases in viral infections are associated with increases in complicated bacterial infections, to some degree,” she added. “Any two infections tend to be worse than any one infection.”
No strep A vaccine yet
Underpinning all those factors? The lack of a strep A vaccine.
“Group A strep is something we should, God damn it, have a vaccine for,” said McGeer. “Because it’s on the list of severe diseases where you can get really sick, really quickly — even if you’re perfectly healthy — and you can’t do anything about it.”
Researchers around the world have been trying to make a successful vaccine against strep A for decades, but there are major challenges to getting one to market.
One Canadian-Australian team that includes researchers at the University of Alberta is in the midst of early clinical trials for its vaccine candidate, and clinical lead Dr. Vanessa Meier-Stephenson was upfront about the complexities at play.
A major issue, she explained, is that researchers need to identify and track all the strains that cause severe disease — which could number upwards of 230 — while also watching for fluctuations in the strains that are most common in the population.
WATCH: Spike in invasive strep A infections reported in 2023:
Concerning rise in cases of invasive form of strep A
9 months ago
Duration 2:22
Doctors are seeing an increase in the number of patients experiencing an invasive form of group A strep. The illness is common but can be serious when bacteria spreads to the blood or deep tissue, and needs to be treated quickly.
On top of that, the arrival of strep A bacteria can sometimes spark a faulty immune response,where the body produces antibodies that, instead of targeting the virus, attack the body’s own tissues. That inflammatory reaction leads to autoimmune conditions such as rheumatic fever, which can cause joint pain, swelling and damage to the heart valves.
Thanks to antibiotic use that cuts short most strep infections, those impacts are now much more rare in countries like Canada. But there’s concern strep vaccines could mimic that mechanism and lead to a similar autoimmune response in some recipients.
“There’s a huge safety component that gets associated with that,” Meier-Stephenson said.
Still, she and other scientists are hopeful that a strep A vaccine will eventually reach Canadians — if there’s enough public interest and pharmaceutical support.
In the meantime, multiple clinicians say they expect strep A infection rates will slow down eventually and that invasive forms of disease will remain relatively rare.
“It’ll probably rise a bit, but at a certain point stabilize,” said Guthrie. “But I’d love to know for sure.”
Skinstitut Holiday Gift Kits take the stress out of gifting
Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.
In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.
“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.
There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.
Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.
Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.
In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.
Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?
It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.
Here’s how you can prepare your digital life for your survivors:
Apple
The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.
For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.
You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.
Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.
Google
Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.
When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.
You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.
There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.
Facebook and Instagram
Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.
When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.
The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.
You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.
TikTok
The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.
Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.
X
It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.
Passwords
Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?
Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.
But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.
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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.
The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.
New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.
The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.
Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.
Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.
“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.
“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”
McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.
But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.
The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.
He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.
“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.
“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.
McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”
McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.
He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.
“Early identification of reading difficulty can truly change the trajectory of a child’s life.”
This report by The Canadian Press was first published Oct. 23, 2024.
