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Winnipeg lupus patients on edge amid shortage of drug at centre of COVID-19 trials – CBC.ca

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An unproven claim a drug used to treat lupus can combat COVID-19 is causing an increase in prescriptions of the drug, creating shortages and putting Winnipeggers who rely on it on edge. 

Elena Anciro was diagnosed with lupus eighteen years ago and relies on taking hydroxychloroquine daily in order to function without being in intense pain, and to reduce the flare-ups that make it hard to get out of bed.

“People have called this medication ‘lupus life insurance,'” Anciro said. “It is vital.”

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While the drug was created in the 1950’s to treat malaria, it is commonly prescribed to control inflammation and pain for those with lupus and rheumatoid arthritis. 

However, it came to the forefront in the fight against COVID-19 thanks to a famous tweet by U.S President Donald Trump.

The tweet sent earlier this month heralded it as a possible way to treat COVID-19.

It sent people scrambling to get their hands on the drug, causing a spike in prescriptions in Manitoba and a dire warning from the province’s health regulators — it was being over-prescribed and now they are facing “serious shortages.” 

“Due to the recent yet-to-be-proven claims of effectiveness of hydroxychloroquine sulfate against COVID-19 and the growth in prescribing for it, we are now faced with a very serious shortage (and some brands, outages) of the product,” read a March 26 notice co-authored by the College of Physicians and Surgeons, Nurses and Pharmacists.

“This presents very serious challenges for long-term continuity of care for patients suffering from rheumatoid arthritis and lupus.”

Manitoba reports spike in prescriptions of hydroxychloroquine

According to the notice there has been a “significant increase” in Manitoba over the past two weeks in the number of prescriptions written and dispensed for hydroxychloroquine and Kaletra — an antiretroviral used to treat HIV.

As part of mandatory reporting requirements, a drug shortage report was given to Health Canada on March 19 by the drugs’ manufacturer, Apotex Inc. It cited the shortage was due to “demand increase” for the drug.

Anciro is just one of the 15,000 Canadians who have lupus, an autoimmune disease that cause severe inflammation of the joints among other symptoms. A further 300,000 Canadians have rheumatoid arthritis, many of whom also rely on the drug to function in their lives. 

“When Trump announced that and this all happened, to have to not only worry about getting this sick from this highly contagious virus, [but also] having to worry about the pills that allow me to be well, is very stressful,” said Anciro.

Stephanie Corbett has lupus and says if she wasn’t able to take the drug, she would have to be hospitalized and would be in immense pain. (Supplied)

Stephanie Corbett is another Winnipegger who takes hydroxychloroquine daily to treat lupus. The mother of five was diagnosed with lupus nine years ago and says without the drug, she’d likely end up in the hospital.

So far, both have been able to fill their prescription without any issues. Both say it would take weeks for the drug to leave their system, but when it does, it’ll be devastating.

“It will be life-threatening for people like me,” said Corbett. 

“I’ll end up in the hospital. The rashes will start. The pain will get worse. You know, every symptom will start rearing.”

Clinical trial at U of M

While a clinical trial is currently underway at the University of Manitoba to see if hydroxychloroquine can be repurposed to reduce the severity of COVID-19, there are currently no approved treatments or vaccines for the virus.

Virologist Jason Kindrachuk says the key message for Manitobans is they need to wait and see the outcomes of these trials before jumping to conclusions.

“The data is simply not there. I’m not arguing for or against it. I’m just saying that right now we don’t have data to support that it is actually truly beneficial for patients,” said Kindrachuk, an associate professor at the University of Manitoba and Canada research chair in emerging viruses.

Jason Kindrachuk of the University of Manitoba says the scientific community needs to explain that they are still studying these drugs and don’t know all their benefits or possible negative affects. (Jaison Empson/CBC)

He says the scientific community needs to do a better job of communicating to the public the proven benefits of a drug.

“Our biggest concern is that we don’t want to give people false hope if we truly don’t know whether or not there’s a benefit, because, again, we can have a position where people are demanding hydroxychloroquine,” Kindrachuk said 

CBC reported last week that medical regulators across the country were seeing overprescription of drugs such as hydroxychloroquine and azithromycin, another drug being studied as part of the fight against COVID-19.

Regulators reported an increase in orders for the drugs from doctors who list it as “for office use.” These requests are typically from doctors who want to keep a supply on hand for future use, raising concerns that stockpiling was occurring. 

The Manitoba College of Physicians and Surgeons cautioned its members against stockpiling, warning that it may be reviewing prescriptions of these drugs and “prescribers must be able to demonstrate good medical care.”  

“These drugs have an intended use and prescribing these drugs as a precautionary measure leads to drug shortages and is compromising care for other patients,” the College wrote on Thursday.

Chief provincial public health officer Dr. Brent Roussin talks about a new Manitoba clinical trial looking at the effectiveness of using hydroxychloroquine, which has been used for malaria and other conditions, to treat COVID-19. 1:16

A warning was only given to nurses from their regulator, warning them not to prescribe Hydroxychloroquine or azithromycin to treat COVID-19.

“Nurses have an obligation to ensure that their practice and any treatment they prescribe is evidence-informed,” wrote the College of Nurses. 

Both Corbett and Anciro say they understand Manitobans are gravitating to the drug because they are scared. 

“But as of right now, there is nothing saying that the public should to be taking it,” said Corbett.

“So leave the drug for the people with the diseases that are taking it and that need it to survive.”

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Measles case reported locally turns out to be negative: health unit

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
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On March 26, the Simcoe Muskoka District Health Unit (SMDHU) was notified by Public Health Ontario’s (PHO) laboratory that due to laboratory error, the case of measles that had been lab-confirmed positive on March 12, based on symptoms and a positive urine measles laboratory result by PHO’s laboratory, is in fact negative for the measles virus.

“With this new information of the negative lab result, we believe that that individual was not infected with measles and that there has not been any public exposure to measles resulting from this individual’s illness,” said Dr. Charles Gardner, medical officer of health. “We recognize that notifying the public of what we believed to be a positive measles case in our area created worry, anxiety and disruption for some, and we regret this.

“We do know that, despite best efforts, on rare occasions laboratory errors can occur. We are working closely with the PHO’s laboratory to do all that we can to ensure that such an incident does not occur again.”

Measles is a highly contagious viral infection that spreads very easily through airborne transmission. The measles virus can live in the air or on surfaces for up to two hours.

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Symptoms of measles begin seven to 21 days after exposure and include fever, runny nose, cough, drowsiness, and red eyes. Small white spots appear on the inside of the mouth and throat but are not always present. Three to seven days after symptoms begin, a red, blotchy rash appears on the face and then progresses down the body.

The risk of transmission to those vaccinated with two doses is low, and when it does occur tends to show a reduction in the severity of these symptoms.

“Although we are relieved for the individual involved, and for all Simcoe-Muskoka residents, that this case has now been confirmed as negative, we know that measles is still active in Ontario at this time and the potential remains for new cases to arise, especially given the increase in Ontarians travelling to areas in the world that have higher numbers of measles cases,” said Dr. Gardner. “This is why we continue to advise individuals to keep up to date with their routine immunizations, including measles, mumps and rubella (MMR) vaccination.”

The risk of measles is low for people who have been fully immunized with two doses of measles vaccine or those born before 1970; however, many children have been delayed in receiving their routine childhood immunizations and people who have not had two doses of measles vaccine are at higher risk of contracting the disease.

People who do get sick usually recover without treatment, but measles can be more severe for infants, pregnant women, and those with compromised immune systems. Possible complications include middle-ear infections, pneumonia, diarrhea, or encephalitis (swelling of the brain) and occasionally death in the very young. Even individuals who are up to date with the measles vaccine should watch for symptoms of measles for 21 days after exposure.

For more information about measles, please visit smdhu.org or call Health Connection at 705-721-7520 or 1-877-721-7520, Monday to Friday between 8:30 a.m. and 4:30 p.m. to speak with a public health professional.

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Kate Middleton Not Alone. Cancer On Rise For People Under 50, Say Experts

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Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery

London:

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When Catherine, Princess of Wales, revealed she was being treated for cancer last week, part of the shock was that an otherwise healthy 42-year-old has a disease that mostly plagues older people.

However, researchers have been increasingly sounding the alarm that more and more people under 50 are getting cancer — and no one knows why.

Across the world, the rate of under-50s diagnosed with 29 common cancers surged by nearly 80 percent between 1990 and 2019, a large study in BMJ Oncology found last year.

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The researchers predicted the number of new cancer cases among younger adults will rise another 30 percent by the end of this decade, with wealthy countries particularly affected.

The increase in cases — and soaring global population — means that the number of deaths among under 50s from cancer has risen by nearly 28 percent over the last 30 years.

This occurred even as the odds of people of all ages surviving cancer have roughly doubled over the last half century.

Shivan Sivakumar, a cancer researcher at the UK’s University of Birmingham, called it an “epidemic” of young adult cancer.

Since Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery earlier this year, Sivakumar and other doctors have spoken out about the uptick in younger cancer patients they have been seeing at their clinics.

While breast cancer remains the most common for people under 50, the researchers expressed particular concern about the rise of gastrointestinal cancers — such as of the colon, pancreas, liver and oesophagus — in younger adults.

Colon cancer is now the leading cause of cancer deaths in men under 50 in the United States, according to the American Cancer Society. For women, it is number two — behind only breast cancer.

One high profile case of colorectal cancer was “Black Panther” actor Chadwick Boseman, who died at the age of 43 in 2020.

Why is this happening?

“We just don’t have the evidence yet” to say exactly what is causing this rise, Sivakumar told AFP, adding it was likely a combination of factors.

Helen Coleman, a cancer epidemiology professor at Queen’s University Belfast who has studied early onset cancer in Northern Ireland, told AFP there were two potential explanations.

One is that people in their 40s were exposed to factors known to cause cancer — such tobacco smoke, alcohol or being obese — at an earlier age than previous generations.

She pointed out that the “obesity epidemic” did not start until the 1980s.

Sivakumar felt that at least part of the puzzle could be explained by obesity.

However, there is “another wave” of under-50 patients who are neither obese nor genetically predisposed still getting cancer, he emphasised, adding that this could not be put down to “statistical chance”.

The other theory, Coleman said, is that “something different” has been going on with her generation.

Fingers have been pointed out a range of possible culprits — including chemicals, new drugs and microplastics — but none have been proven.

Some have suggested that so-called ultra-processed foods could be to blame. “But there’s very little data to back any of that up,” Coleman said.

Another theory is that the food we eat could be changing our gut microbiome.

While there is nothing conclusive yet, Coleman said her own research suggested that cancer causes changes to the microbiome, not the other way around.

Anti-vaxx conspiracy theorists have even tried to blame Covid-19 vaccines.

This is easily disproven, because the rise in young adult cancer has taken place over decades, but the vaccines have only been around for a few years.

What can be done?

To address the rise in younger colorectal cancer, in 2021 the US lowered the recommended age for screening to 45. Other countries have yet to follow suit.

But the researchers hoped that Catherine’s experience would remind people at home that they should consult their doctor if they sense anything is wrong.

“People know their bodies really well,” Sivakumar said.

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“If you really feel that something isn’t right, don’t delay — just get yourself checked out.”

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Almost 3,000 students suspended in Waterloo Region over immunization issues

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Close to 3,000 children attending elementary school across Waterloo Region were suspended from school on Wednesday morning for not having up-to-date immunization records.

The region says Waterloo Public Health suspended 2,969 students under the Immunization of School Pupils Act (ISPA).

For several months, the region has been campaigning for people to get their children’s vaccinations up to date, including sending letters home to parents on a couple of occasions, warning that students’ records needed to be up to date or they would be suspended.

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It announced in January that 32,000 students did not have up-to-date records: 22,000 elementary students and 10,000 high school students.


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“We have made remarkable progress from the original 27,567 immunization notices we sent to parents in November and December 2023,” Dr. Hsiu-Li Wang, medical officer of health, stated.

“Since that time, we have resolved more than 24,500 outdated vaccination records, providing students with valuable protection against these serious and preventable diseases.”

The high school students still have a few weeks to get their records up to date or else face suspension.

The ISPA requires students to have proof-of-vaccination records for diphtheria, polio, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox) and meningitis, which must be on file with public health.

Public health says caregivers whose children are suspended will need to book an appointment at regionofwaterloo.ca/vaccines for clinics, which will be held in Cambridge and Waterloo on weekdays.

“Given the high number of suspensions, it may take several days before you can be seen at an appointment and return your child to school,” a release from the region warns.

“Record submission and questions must be done in person to ensure immediate resolution.”

The last time suspensions over immunizations were issued was in 2019, when 1,032 students were suspended.

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