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Why saliva testing for COVID-19 in Canada won't be a panacea for long lineups any time soon – CBC.ca

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Canadians in several provinces face long lines for a swab to help diagnose COVID-19 as school and workplaces open. While new testing technologies could help, doctors say they won’t be a silver bullet. 

The gold standard swab of the nose or throat can be uncomfortable. In contrast, a key promise of saliva tests is that people could collect saliva themselves so that fewer nurses and other health professionals would be needed at assessment centres, as staffing is one of the factors that can drive up wait times.

But that ideal won’t happen immediately. Currently in Canada, both saliva collection and testing remain a research project that regulators are closely evaluating. 

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There are three main barriers to overcome before saliva tests roll out widely. 

Gobs of saliva vary in how fluid they can be, so collecting a high-quality sample can be a challenge even for something as non-invasive as spitting into a cup. The next hurdle for scientists is to get accurate and consistent results on the presence of the virus. Finally, clinicians need to determine how well the test results help them to correctly identify those with the disease. 

Dr. Mel Krajden, medical director of the public health laboratory at the BC Centre for Disease Control, said health professionals face a quandary in finding the best ways to support a return to school, with all of its formative benefits for students, while protecting the oldest people at highest risk for severe consequences from COVID-19, such as grandparents or parents who are vulnerable because they have other health conditions.

Dr. Mel Krajden, medical director of the public health laboratory at the BC Centre for Disease Control. The Vancouver lab is exploring whether a saline gargle might work better than saliva testing itself. (Ben Nelms/CBC)

Krajden said in his experience, saliva testing works better with COVID-19 patients in hospital than on people living in the community who’ve tried it as part of a research project. His Vancouver lab is working on a simpler approach to collection than the traditional nasal swab using a saline gargle that seems to work in older children. 

On Thursday, British Columbia announced it’s introducing a new mouth rinse, gargle and spit test for students from kindergarten to Grade 12 to make it easier for children and teenagers to check whether they have COVID-19.  But this new test is only offered to school age kids, and only in B.C.

“What we need to be thinking through is what is the best mixture of tests and how are they best supplied?” Krajden said. “You want to have the right balance between convenience and sensitivity.”

Unresolved questions about saliva tests

Health Minister Patty Hajdu said on Wednesday that Health Canada will not approve a test that endangers Canadians’ health because they are inaccurate or offer a false sense of security.

In Canada, the mobile Spartan Cube was recalled because of reliability problems with its swab for the lab-in-a-box PCR test (also known as a polymerase chain reaction test) that was billed as providing results in less than an hour. In the United States, wide-scale problems early on with another PCR test developed by the Centers for Disease Control and Prevention hampered containment efforts.

A different technology, a molecular test launched by Illinois-based Abbott that the company says can deliver positive results in as little as five minutes, was also subject to a recall. It aims to detect the virus during active infection.

The outstanding questions about saliva tests include: How good an alternative could they be to a nasal or throat swab, who would benefit — such as different age groups or those who show symptoms — and when would they be available? 

For governments and clinicians globally and across Canada, the challenge now is to organize all kinds of testing to allow society to function while preventing transmission to those at highest risk of severe consequences.

For the majority of young people, COVID-19 is like a common cold, Krajden said. It’s older adults and those who are vulnerable because of other health conditions that can face serious infection or death.

Policy-makers urged to shift gears

Dr. Larissa Matukas, head of the microbiology division at St. Michael’s Hospital, Unity Health Toronto, said experts and policy-makers need to shift gears to understand where cases are multiplying and shut them down quickly by moving resources, including testing, to where there are signs of concern.

“I’m not sure that’s actually happening right now,” Matukas said.

Dr. Larissa Matukas, head of the microbiology division at St. Michael’s Hospital, Unity Health Toronto, says experts need to understand where cases are multiplying and shut them down quickly by moving resources, including testing, to where there are signs of concern. (Yuri Markarov/Unity Health Toronto)

“We should be shifting to a very aggressive finding of individuals, testing those who are symptomatic or testing those who’ve been in close contact with those who’ve been diagnosed with COVID and then isolating those individuals to really stop all the chains of transmission,” she and her co-authors wrote in an editorial last week in CMAJ

Matukas said the first step is finding cases by improving access to diagnostic nasal or throat swabs or having a health-care professional evaluate symptoms. 

“Unfortunately, there’s been this drive, particularly in Ontario, to reach a particular number of tests per day indiscriminately of who is actually being tested,” she said.

Other, equally important parts of containment have been neglected, Matukas said, such as governments communicating a clear need for all people with symptoms compatible with COVID-19 to get tested immediately and to self-isolate while they wait for the test result.

Dr. David Williams, Ontario’s chief medical officer of health, said Thursday that people who haven’t been in contact with a case, aren’t connected to an outbreak, haven’t received a notification from the COVID Alert app and don’t have symptoms “might want to defer your visit” until the demand for tests falls.

Dr. David Williams, Ontario’s chief medical officer of health, said Thursday that people who haven’t been in contact with a case, aren’t connected to an outbreak, haven’t received a notification from the COVID Alert app and don’t have symptoms might want to delay testing until the demand falls. (Government of Ontario)

‘New technologies are always welcomed’

The level of disease in a particular community also makes a difference in misdiagnosing COVID-19 — another accuracy wrinkle to overcome in adopting quick, at-home saliva-based antigen tests for use in Canada.

“All new technologies are always welcomed,” Matukas said. “They always need to be evaluated in an objective, independent evaluation, and that’s the purpose of not just Health Canada, but that’s my job.”

As a medical microbiologist, Matukas carefully evaluates every diagnostic test introduced to ensure it meets the performance characteristics patients need in hospital. As part of her evaluation, new technologies are compared with  a standard way of testing as a reference. 

Lab workers need to do the same quality-assurance steps to check tests and equipment from all manufacturers. The goal is to ensure they perform well under real-life conditions, not just optimal ones.

Antigen tests that are used to identify mid-infection as the microbe multiplies, such as rapid tests for strep throat, is another technology under evaluation to help detect people likely infected with COVID-19 in schools, long-term care homes or other high-risk environments.

A laboratory worker shows a prototype of a self-test that will use saliva in a rapid COVID-19 test, which could replace more commonly used swabs, at the University of Liege, Belgium, in August. In Canada, saliva tools are also still being researched. (Yves Herman/Reuters)

Krajden, of the BCCDC, said more data is needed to determine when it makes sense to deploy antigen tests to quickly inform decisions.

Matukas said people living in long-term care will continue to be a priority for diagnostic testing.

Living in an area with a high prevalence of the disease, taking part in certain activities — such as waiting tables, driving a cab or attending a large gathering —  and not using personal protective equipment also contribute to the risk.

On the other hand, scolding people for breakdowns that can’t be controlled could drive some people underground and make it harder to detect cases, Matukas said.

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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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