Hospitals, long-term care homes and other workplaces in Canada need to err on the side of caution or risk being paralyzed in the face of uncertainty from COVID-19, some doctors say.
Six months after the country’s first presumed case, more than 8,900 devastating deaths have occurred mainly among elders and 98,000 others have recovered. Restrictions to everyday routines curbed transmission and avoided overwhelming health-care systems, but public health officials warn people still need to protect themselves to keep case numbers low.
COVID-19 is a tricky disease. Its symptoms can be absent or vague, its course remains unpredictable to physicians and its exact methods and timing of transmission haven’t been nailed down.
Those lingering uncertainties are on Dr. Lauren Crosby’s mind as Calgary ramps up day and elective surgeries.
“When you’re working in the context of scientific uncertainty, especially in the case of an impending and serious threat to health, it’s unreasonable to clarify, to wait for the answers to all your questions before you take action to avert the threat,” said Crosby, an anesthesia resident in Calgary.
Reassurance of higher-level precautions
That’s why Crosby and her father, Dr. Edward Crosby, an anesthesiologist at Ottawa Hospital, wrote an opinion piece last week in the Canadian Journal of Anesthesiology titled “Applying the precautionary principle to personal protective equipment (PPE) guidance during the COVID-19 pandemic: did we learn the lessons of SARS?”
“If we can’t be certain then we should be safe,” she said.
For the Crosbys, one of the lessons from the 44 deaths from SARS in Toronto in 2003 is that when health-care workers are asked to put themselves at risk of infection to care for others, PPE like masks, gowns and gloves should be provided. It’s an application of the precautionary principle — the idea of erring on the side of caution to protect public health.
Justice Horace Krever first recommended the precautionary principle during the Commission of Inquiry on the Blood System in Canada in 1997.
Justice Archie Campbell’s 2006 SARS Commission also called for the health concerns of health-care workers to be taken seriously so they feel safe, even if that requires higher levels of precautions, Crosby said.
Friends and family members of residents at Extendicare Guildwood Long-Term Care home, in Toronto, hold a rally on June 12. They say including long-term care in the Canada Health Act could better protect residents. (Evan Mitsui/CBC)
If health-care workers become sick with COVID-19, they pose a “triple threat” as vectors for more disease transmission, reduced capacity in the health-care system and by becoming patients.
“Scarcity is not a valid reason to limit protective equipment and to limit access to that equipment,” Crosby said.
Instead, she said, to prepare for a second wave, PPE should be used as efficiently as possible, including decontaminating and repurposing it and using other barriers during procedures that spray infectious aerosols.
Fostering public trust
People working in any industry need to feel involved in decision making and have their concerns addressed, Crosby said. Otherwise, there can be a loss of public trust, low morale, anxiety and confusion. In health-care settings, the stress can lead to burnout of workers who are particularly in demand during the pandemic.
WATCH | Lives remembered in Quebec:
Staff and family laid 101 flowers — one for each of the seniors who lost their lives at CHSLD Sainte-Dorothée in Laval, the Quebec long-term care home hit hardest by COVID-19. 1:17
Dr. Roger Wong, a clinical professor of geriatric medicine at the University of British Columbia, called the idea of applying the precautionary principle an important and timely conversation because COVID-19 has already hit long-term care homes and other shared living facilities hard.
“We have an opportunity, a very narrow window,” Wong said in an interview. “We should take action now.”
How? Wong told a ” target=”_blank”>Senate committee reviewing the government’s response to COVID-19 that he’d like to see systemic changes, such as including long-term care within the Canada Health Act.
The federal government is well positioned to set standards in areas like collecting physical and mental health outcome data, including social isolation and loneliness. Then, the data can drive policy change and better protect those who are most vulnerable, Wong said.
Wong was also involved in updating the federal government’s COVID-19 guidance for long-term care homes.
Be transparent as evidence evolves
Tim Caulfield, Canada research chair in health law and policy, supports applying the precautionary principle.
He said it has an intuitive appeal. During COVID-19, it’s been raised in the context of wearing masks and weighing the use of pharmaceutical treatments like hydroxychloroquine.
“If you’re going to do that, then you have to take extra care to ensure that you’re being transparent about the information that you’re using, the evidence you’re using to make the decision,” Caulfield said. “You want to make sure that you are open to change as the evidence evolves.”
He pointed to an association between jurisdictions around the world, such as Australia and regions of France, which have been the most successful in containing the disease so far, and public trust in key institutions and decision makers.
“In the face of uncertainty, we still have to march forward and we have to do it in a manner that benefits the most, and I think that we can’t allow uncertainty to paralyze us,” Caulfield said.
(CBC News)
Dr. Timothy Paul Hanna, a clinician and scientist at Queen’s University Cancer Research Institute, applied the precautionary principle to help guide Ontario’s prioritization plans for cancer care during COVID-19.
Potential risks to patients include:
Infection risk by leaving their homes to come for treatment.
Possible side-effects of treatment, such as radiation for lung cancer that further diminishes lung function after getting COVID-19.
Treatment and diagnostic delays associated with rationing care when hospitals scale back.
“We’re really fortunate across Canada,” Hanna said. ‘We weren’t left as single institutions or single physicians to proceed based on our own opinion when resources became limited. I think that that’s a real plus of our universal health-care system.”
Provincial prioritization frameworks weighed factors he wrote about such as the magnitude of benefit from treatment, if the treatment is meant to be curative or palliative, patient considerations such as age, comorbidity, and preferences as well as the availability of human resources and equipment to treat cancers.
Canada has a narrow window of opportunity to better protect its most vulnerable, says Dr. Roger Wong. (Submitted by UBC)
“Regardless of how we discover how well we might have done, I think the mental health effects and social stress, the impacts on patients and their families having to wait or having to experience care in maybe a different way, like through telemedicine or other virtual means, I’m sure we’ll find has been hard on patients.”
Canadians are touched not only as patients, but as employees and citizens, too.
Soma Ray-Ellis, chair of the employment group at Gardiner Roberts LLP in Toronto, said that as non-essential employees return to work and social gatherings occur, more direction is needed on applying precautionary principles together with human rights, occupational health and safety and privacy legislations.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
