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Why lockdowns alone won't save us from the pandemic – CBC.ca

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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.


The prospect of locking society down again the way we did in the first wave of COVID-19 — and the collateral damage that comes with it — is daunting.

The financial devastation on businesses forced to close and lay off employees, the increase in mental health issues, the halting of elective medical procedures and the continuing risks to essential workers on the front lines all factor in.

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Keeping society functioning and supporting devastated sectors of the economy while limiting the spread of the coronavirus is key to navigating the pandemic until a safe and effective vaccine is here.

But experts acknowledge there is growing resistance to some of the restrictions that highlights a need to manage the public mood as the pandemic rages on.

You arguably could not find a more politically charged term right now than “lockdown,” since everyone has a different, personal idea of what it is.

“This term has become equated with so many bad things that no one really understands what it means,” said Michael Osterholm, director of the Centre for Infectious Disease Research and Policy at the University of Minnesota.

“It’s everyone’s worst fear about what somebody else is doing to them regarding the pandemic.”

Osterholm, a veteran of SARS and MERS who warned the world for 15 years that a pandemic was coming, thinks the term lockdown should be abolished altogether.

Instead, Osterholm said we need to look at it as targeted public health measures necessary to reducing the spread of COVID-19 and getting back to normal as quickly as possible, while at the same time supporting those who have suffered financially. 

The key to successfully riding out the pandemic lies in finding balance between working with the population to help keep the number of cases low without substantially changing life as we know it.

“The challenge is, the end isn’t coming soon,” he said. “But it’s coming, and what we need to do is try to have as few cases as possible between now and the time a vaccine arrives.”

‘Pandemic fatigue’ can turn to ‘pandemic anger’

Managing the public’s frustration presents a challenge for public health officials in the second wave.

During a journalism conference at Carleton University in Ottawa on Thursday, Canada’s Chief Public Health Officer Dr. Theresa Tam said that public health messaging can seem inconsistent because of the evolving science in the pandemic. 

“We are living in a more challenging period right now,” she said, in which authorities have “to convince people who are fatigued to stick to sustainable habits or public health practices.” 

Ontario and Quebec have already moved to close bars, restaurants and gyms in their hardest-hit regions amid rising cases, while Alberta and British Columbia weigh the need to tighten restrictions amid record-high rises in cases. 

Osterholm said resistance to public health restrictions not only stems from the concept of “pandemic fatigue,” but also from something he calls “pandemic anger.” 

“It’s people who don’t believe that the pandemic is real,” he said. “They think it’s a hoax.”

Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa, said the resistance also stems from “raw selfishness.” 

Protesters clash with police officers during an anti-lockdown protest in London, England, on Sept. 26. (Hollie Adams/Getty Images)

“There’s an inability to think about community responsibility,” he said, explaining that people think they won’t personally be seriously affected by the virus because it has a comparatively higher survivability rate in younger age groups.

“But if you scale this up to a population, then that’s tens of thousands of deaths – and they don’t care.”

Perception of risk has a cost

The latest World Economic Outlook from the International Monetary Fund found that while lockdowns controlled the spread of the coronavirus, they also contributed to a global economic recession that disproportionately affected vulnerable populations. 

But the IMF report also found the damage to the economy was largely driven by people “voluntarily refraining” from social interactions out of a fear of contracting the virus.

Osterholm said the perception of risk — and not strict public health restrictions — is what holds people back from doing things like travelling by plane or entering a retail store.

“Nobody is telling you you can’t go to the grocery store rather than ordering online — it’s just people don’t feel safe and secure,” he said.

“Well, how do you make that happen? You make it happen by making cases occur at a much, much lower rate than they’re occurring now. It’s not going to be just by telling the virus we’re done.”

Lockdowns should be last resort

Dr. Amesh Adalja, an infectious disease physician and a senior scholar at the Johns Hopkins Center for Health Security in Baltimore, Md., isn’t in favour of lockdowns as a first line of defence in the pandemic. 

“If you’re going to take public health interventions, they have to be very targeted towards specific activities that are actually leading to spread,” he said. “You only use a lockdown when you have fouled up your response so bad that that’s all you have left to do.” 

WATCH | Push to pursue COVID-19 herd immunity is ‘dangerous’:

A group of international experts push back against the Great Barrington Declaration and its pursuit of COVID-19 herd immunity, calling it “a dangerous fallacy unsupported by scientific evidence.” 2:05

But ignoring lockdowns isn’t an effective strategy, either.

The Great Barrington Declaration, a controversial proposal from a group of scientists (backed by a U.S. think-tank) to lift restrictions, made headlines last week for its calls to protect “the vulnerable” from COVID-19 with strict measures while allowing those “at minimal risk of death” to return to normal life and build up herd immunity to the virus.

But it failed to present a logical counterargument for controlling the virus or concrete ways to protect the vulnerable (including the elderly and the poor), not to mention those who care for them.

Referring to the declaration, Deonandan said, “If there wasn’t a vaccine coming, if nothing changes and this has to be how we live in perpetuity, then OK, maybe we have to discuss some other options. But none of that is true.”

Canada has had more than 200,000 cases and is approaching 10,000 deaths, but modelling predicts the situation would be much worse if public health guidelines like physical distancing, mask-wearing and proper hand hygiene weren’t followed. 

Osterholm said those pushing the the Barrington Declaration completely misunderstood the concept behind public health restrictions and the reasons behind enacting them in the first place. 

“If you’re going to keep thinking about this as a lockdown, then we’re going to find a lot of resistance to this,” he said. “But on the other hand, if you don’t suppress transmission, we’re also going to see a lot of deaths.” 

A question of public tolerance

Lockdowns are one of many tools a country can use in the face of an infectious disease outbreak, but their effectiveness is dependent on the public’s willingness to tolerate them.

China imposed some of the most severe public health restrictions in modern history upon the discovery of the coronavirus at the beginning of this year, something democratic nations would be unlikely to imitate.

But China is already seeing the rewards of its draconian efforts to control the spread. It’s the only major economy expected to grow this year, with retail spending surpassing pre-pandemic levels for the first time and factory output rising on the backs of demand for exports of masks and other medical supplies to countries like Canada.

Other regions like New Zealand, Singapore, Taiwan and Hong Kong acted swiftly by closing borders, imposing strict public health measures and opting for shorter, more strategic lockdowns, which have allowed them to carefully reopen society. 

South Korea, meanwhile, didn’t lock down at all and instead focused on testing, tracing and isolating cases to control the spread of the virus successfully. 

“The lesson here is you choose one path and you stick with it,” Deonandan said. “What is not acceptable is vacillating between different strategies.”

Lockdowns are one of many tools a country can use in the face of an infectious disease, but their effectiveness is dependent on the public’s willingness to tolerate them. (Tolga Akmen/AFP via Getty Images)

Australia imposed targeted lockdown measures in the face of outbreaks, which University of Western Australia epidemiologist Dr. Zoë Hyde said has been “enormously successful” in eliminating the virus in much of the country. 

“While lockdowns absolutely have harms associated with them, the harms are much less than those of an unmitigated epidemic,” she said. “Governments can also minimize the harms of lockdowns by making them short and sharp, and by financially supporting workers and businesses.” 

Lockdowns ‘a sign of failure’

Hyde said the eastern Australian state of Victoria was a precautionary tale for the debate over lockdowns, because of mistakes made in a hotel quarantine system that allowed the virus to spread again. 

“If governments have not tried hard enough to suppress the virus, then a lockdown is inevitable, whether people want one or not,” Hyde said.

“Lockdowns are a sign of failure. They’re a sign that governments have not been doing enough.” 

Victoria was recording around 700 new cases per day in July, but a second lockdown coupled with a mask mandate have brought case numbers down to only a handful a day at most.

“Measures to combat the virus have to be tailored. They can’t be more than the economy can bear,” Hyde said, “but equally we must remember that the best way to protect the economy is to suppress the virus.” 

“Ultimately it’s the virus doing the damage to the economy, not the measures designed to suppress it. No matter what we wish, the economy won’t go back to normal if a dangerous virus is circulating.” 


To read the entire Second Opinion newsletter every Saturday morning, subscribe by clicking here.

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Toronto reports 2 more measles cases. Use our tool to check the spread in Canada – Toronto Star

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Canada has seen a concerning rise in measles cases in the first months of 2024.

By the third week of March, the country had already recorded more than three times the number of cases as all of last year. Canada had just 12 cases of measles in 2023, up from three in 2022.

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Cancer Awareness Month – Métis Nation of Alberta

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Cancer Awareness Month

Posted on: Apr 18, 2024

April is Cancer Awareness Month

As we recognize Cancer Awareness Month, we stand together to raise awareness, support those affected, advocate for prevention, early detection, and continued research towards a cure. Cancer is the leading cause of death for Métis women and the second leading cause of death for Métis men. The Otipemisiwak Métis Government of the Métis Nation Within Alberta is working hard to ensure that available supports for Métis Citizens battling cancer are culturally appropriate, comprehensive, and accessible by Métis Albertans at all stages of their cancer journey.

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Receiving a cancer diagnosis, whether for yourself or a loved one, can feel overwhelming, leaving you unsure of where to turn for support. In June, our government will be launching the Cancer Supports and Navigation Program which will further support Métis Albertans and their families experiencing cancer by connecting them to OMG-specific cancer resources, external resources, and providing navigation support through the health care system. This program will also include Métis-specific peer support groups for those affected by cancer.

With funding from the Canadian Partnership Against Cancer (CPAC) we have also developed the Métis Cancer Care Course to ensure that Métis Albertans have access to culturally safe and appropriate cancer services. This course is available to cancer care professionals across the country and provides an overview of who Métis people are, our culture, our approaches to health and wellbeing, our experiences with cancer care, and our cancer journey.

Together, we can make a difference in the fight against cancer and ensure equitable access to culturally safe and appropriate care for all Métis Albertans. Please click on the links below to learn more about the supports available for Métis Albertans, including our Compassionate Care: Cancer Transportation program.

I wish you all good health and happiness!

Bobbi Paul-Alook
Secretary of Health & Seniors

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Type 2 diabetes is not one-size-fits-all: Subtypes affect complications and treatment options – The Conversation

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You may have heard of Ozempic, the “miracle drug” for weight loss, but did you know that it was actually designed as a new treatment to manage diabetes? In Canada, diabetes affects approximately 10 per cent of the general population. Of those cases, 90 per cent have Type 2 diabetes.

This metabolic disorder is characterized by persistent high blood sugar levels, which can be accompanied by secondary health challenges, including a higher risk of stroke and kidney disease.

Locks and keys

In Type 2 diabetes, the body struggles to maintain blood sugar levels in an acceptable range. Every cell in the body needs sugar as an energy source, but too much sugar can be toxic to cells. This equilibrium needs to be tightly controlled and is regulated by a lock and key system.

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In the body’s attempt to manage blood sugar levels and ensure that cells receive the right amount of energy, the pancreatic hormone, insulin, functions like a key. Cells cover themselves with locks that respond perfectly to insulin keys to facilitate the entry of sugar into cells.

Unfortunately, this lock and key system doesn’t always perform as expected. The body can encounter difficulties producing an adequate number of insulin keys, and/or the locks can become stubborn and unresponsive to insulin.

All forms of diabetes share the challenge of high blood sugar levels; however, diabetes is not a singular condition; it exists as a spectrum. Although diabetes is broadly categorized into two main types, Type 1 and Type 2, each presents a diversity of subtypes, especially Type 2 diabetes.

These subtypes carry their own characteristics and risks, and do not respond uniformly to the same treatments.

To better serve people living with Type 2 diabetes, and to move away from a “one size fits all” approach, it is beneficial to understand which subtype of Type 2 diabetes a person lives with. When someone needs a blood transfusion, the medical team needs to know the patient’s blood type. It should be the same for diabetes so a tailored and effective game plan can be implemented.

This article explores four unique subtypes of Type 2 diabetes, shedding light on their causes, complications and some of their specific treatment avenues.

Severe insulin-deficient diabetes: We’re missing keys!

In severe insulin-deficient diabetes, beta cells limit production of the keys that unlock cells to allow entry of sugar from the blood.
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)

Insulin is produced by beta cells, which are found in the pancreas. In the severe insulin-deficient diabetes (SIDD) subtype, the key factories — the beta cells — are on strike. Ultimately, there are fewer keys in the body to unlock the cells and allow entry of sugar from the blood.

SIDD primarily affects younger, leaner individuals, and unfortunately, increases the risk of eye disease and blindness, among other complications. Why the beta cells go on strike remains largely unknown, but since there is an insulin deficiency, treatment often involves insulin injections.

Severe insulin-resistant diabetes: But it’s always locked!

A diagram of three closed locks and lots of keys

In severe insulin-resistant diabetes, the locks start ignoring the keys, triggering the beta cells to produce even more keys to compensate.
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)

In the severe insulin-resistant diabetes (SIRD) subtype, the locks are overstimulated and start ignoring the keys. As a result, the beta cells produce even more keys to compensate. This can be measured as high levels of insulin in the blood, also known as hyperinsulinemia.

This resistance to insulin is particularly prominent in individuals with higher body weight. Patients with SIRD have an increased risk of complications such as fatty liver disease. There are many treatment avenues for these patients but no consensus about the optimal approach; patients often require high doses of insulin.

Mild obesity-related diabetes: The locks are sticky!

Illustration of a lock and key

In mild obesity-related diabetes, the locks are ‘sticky,’ making it difficult for the keys to open the locks.
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)

Mild obesity-related (MOD) diabetes represents a nuanced aspect of Type 2 diabetes, often observed in individuals with higher body weight. Unlike more severe subtypes, MOD is characterized by a more measured response to insulin. The locks are “sticky,” so it is challenging for the key to click in place and open the lock. While MOD is connected to body weight, the comparatively less severe nature of MOD distinguishes it from other diabetes subtypes.

To minimize complications, treatment should include maintaining a healthy diet, managing body weight, and incorporating as much aerobic exercise as possible. This is where drugs like Ozempic can be prescribed to control the evolution of the disease, in part by managing body weight.

Mild age-related diabetes: I’m tired of controlling blood sugar!

Illustration of a lock and a beta cell

In people with mild age-related diabetes, both the locks and the beta cells that produce keys are tired, resulting in fewer keys and stubborn locks.
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)

Mild age-related diabetes (MARD) happens more often in older people and typically starts later in life. With time, the key factory is not as productive, and the locks become stubborn. People with MARD find it tricky to manage their blood sugar, but it usually doesn’t lead to severe complications.

Among the different subtypes of diabetes, MARD is the most common.

Unique locks, varied keys

While efforts have been made to classify diabetes subtypes, new subtypes are still being identified, making proper clinical assessment and treatment plans challenging.

In Canada, unique cases of Type 2 diabetes were identified in Indigenous children from Northern Manitoba and Northwestern Ontario by Dr. Heather Dean and colleagues in the 1980s and 90s. Despite initial skepticism from the scientific community, which typically associated Type 2 diabetes with adults rather than children, clinical teams persisted in identifying this as a distinct subtype of Type 2 diabetes, called childhood-onset Type 2 diabetes.




Read more:
Indigenous community research partnerships can help address health inequities


Childhood-onset Type 2 diabetes is on the rise across Canada, but disproportionately affects Indigenous youth. It is undoubtedly linked to the intergenerational trauma associated with colonization in these communities. While many factors are likely involved, recent studies have discovered that exposure of a fetus to Type 2 diabetes during pregnancy increases the risk that the baby will develop diabetes later in life.

Acknowledging this distinct subtype of Type 2 diabetes in First Nations communities has led to the implementation of a community-based health action plan aimed at addressing the unique challenges faced by Indigenous Peoples. It is hoped that partnered research between communities and researchers will continue to help us understand childhood-onset Type 2 diabetes and how to effectively prevent and treat it.

A mosaic of conditions

Illustration of different subtypes of Type 2 diabetes

Type 2 diabetes is a mosaic of conditions, each with its own characteristics.
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)

Type 2 diabetes is not uniform; it’s a mosaic of conditions, each with its own characteristics. Since diabetes presents so uniquely in every patient, even categorizing into subtypes does not guarantee how the disease will evolve. However, understanding these subtypes is a good starting point to help doctors create personalized plans for people living with the condition.

While Indigenous communities, lower-income households and individuals living with obesity already face a higher risk of developing Type 2 diabetes than the general population, tailored solutions may offer hope for better management. This emphasizes the urgent need for more precise assessments of diabetes subtypes to help customize therapeutic strategies and management strategies. This will improve care for all patients, including those from vulnerable and understudied populations.

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