COPD World News

COPD World News - Week of May 24, 2020

In the Anti-Vaxxer Era, Will Countries Make a Coronavirus Vaccine Mandatory?

Calgary, AB - In 2019, the World Health Organization listed vaccine hesitancy as one of the ten gravest threats to global health. Now, public health agencies are trying to figure out what to do next. After months of isolating from friends and family, it seems like most people are desperately hoping for a COVID-19 vaccine that’ll put an end to the pandemic. But in an era of misinformation and lockdown protests, often touted by anti-vaxxers, there’s an open question on how much uptake there will be for the vaccine, should one arrive. And that leads to a second question: should governments consider making a COVID-19 vaccine mandatory? “Making vaccines mandatory is the last tool in the toolkit of public health,” said Lynora Saxinger, a professor with the University of Alberta department of medical microbiology and immunology. Vaccination rates for most diseases are quite high, which suggests public health agencies won’t have to force people to take a COVID-19 vaccine, Saxinger said. For example, according to the World Health Organization (WHO), as of 2018, an estimated 84 percent of the global population was immunized for Hepatitis B; about 86 percent of children received a measles vaccine before their second birthday; and 84 percent of infants were immunized for polio. (Rates tend to be higher in North America and Europe than elsewhere largely due to unequal access.) But there's been a lot of misinformation spreading about the coronavirus, Saxinger said, so she’s worried it could sway Canadians away from vaccines. Both Saxinger and another expert told VICE they’re particularly worried about people who don’t identify as anti-vaxxers, but express hesitancy when considering vaccinations, because they’re likely more susceptible to misinformation. Last week, Alberta Premier Jason Kenney said he has no intention of making a COVID-19 vaccine mandatory. However, if a safe and effective vaccine is found, the government will “strongly encourage people to use it as we do in flu season" Kenney said. Laval University medical anthropologist, Ève Dubé, said she’s noticed a lot of people express “a perception that the government will force people to get vaccinated.” “These are’s really unlikely,” she said. According to Dubé, it might not be feasible to mandate inoculation. When a vaccine is finally found, mass production will take a while, which means there won’t be enough doses at the start to make it mandatory, Dubé said. Past government practice across the country also makes it difficult to enforce inoculation, she said. Alberta’s public health act allows the province to make vaccines mandatory, but that’s never been pursued. Provinces like Ontario, New Brunswick, and Manitoba have implemented some mandatory vaccines, but Quebec, for example, hasn’t, Dubé said. That would make it a lot easier for Ontario than Quebec to impose a mandatory COVID-19 vaccine. Yet studies have shown that just as many people in Quebec get immunized as in Ontario, Dubé said, so making vaccines mandatory likely isn’t necessary. Plus, less than one percent of Canadians identify as anti-vaxxers. The anti-vaxxer movement is stronger in the U.S. where groups are well-funded, heavily organized, and enjoy more influence, she said. “Trust is key with governments and public health,” Dubé added. According to most estimates, the world is still at least a year away from a COVID-19 vaccine.

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COPD World News - Week of May 17, 2020

Demands grow for national, universal long-term care in response to pandemic

Ottawa, ON – According to a news story carried by the CBC the COVID-19 crisis has exposed critical vulnerabilities in Canada's network of long-term care facilities. Now, momentum is building in support of major reforms to improve care for the country's elderly by making long-term care a publicly funded, universal system. Painting a grim picture of the situation in seniors' homes across the country, Amanda Vyce, representing CUPE members who work as care aides, said residents are often left unbathed in soiled diapers or clothing by overworked and underpaid staff. "COVID-19 didn't create the deadly crisis we're facing in long term care. The systemic issues that facilitated this heartbreaking situation existed long before this moment. What the pandemic is doing is shining a spotlight on those problems and making them worse," she told the House of Commons health committee today. Vyce urged the federal government to work with provinces and territories to bring long-term care under the Canada Health Act, making it a publicly insured core health care service that is accessible and universal. She also called on the federal government to provide adequate, targeted funding for long-term care through the Canada Health Transfer. Canada's COVID-19 death toll passes 4,000 as provinces ease restrictions. Vyce said the federal government should work to enforce a national standard of 4.1 hours of hands-on care per resident every day — and eventually eliminate private, for-profit ownership of nursing homes. The COVID-19 crisis and its disproportionate impact on long-term care facilities has ignited a debate over long-term care in Canada. Nearly 80 per cent of COVID-19-related deaths in this country have happened in seniors' homes — a statistic Vyce called "horrifying." A Conference Board of Canada study in 2017 projected that another 199,000 long-term care beds would be needed by 2035 — a vast increase over the 255,000 beds available in 2016. Vyce said the largely profit-driven private care system is characterized by low wages, precarious employment and high levels of workplace violence and injury that make it difficult to recruit and retain workers. That, she added, has left long-term care homes dangerously short-staffed for more than a decade. When a staff member calls in sick, she said, often they're not replaced — adding to an already heavy workload. "When this occurs, staff rush from resident to resident to perform care. For residents, it means they may not receive their bath, their call bell may go unanswered, or they may sit or lay in a soiled diaper for hours," she said. "When workers don't have adequate time to perform necessary tasks, the quality of resident care suffers." Situation is 'appalling and unacceptable': NDP MP Tamara Jansen, the Conservative MP representing the B.C. riding of Cloverdale–Langley City, told CBC News in an email that the crisis in Canada's long-term care facilities was made worse by a lack of access to personal protective equipment (PPE).  "We have discovered that lack of access to personal protective gear for health care workers has contributed to the spread of infection in senior care facilities," said Jansen. "From previous pandemics we already know the importance of having a well-maintained stockpile of PPE. The Liberal government has no excuse for the situation we find ourselves in." NDP health critic Don Davies called the current situation in Canada "appalling and unacceptable." He said the country must move to bring long-term care under the Canada Health Act. "When seniors are in hospital, they are cared for in our public system. When they are transferred to long-term care, there is no reason this should change," he told CBC. "I think bringing long-term care under our public health system is key to addressing the deplorable conditions our seniors in care face. It would also result in more effective and efficient care." Erin Strumpf, a health economics expert at McGill University, said the arguments in favour of publicly funded long-term care would be similar to those in support of a national pharmacare program. "It would not necessarily be more expensive overall, but it would be more expensive for provincial and territorial governments. The extent of this shift toward the public sector would depend on current programs and mix of financing," Strumpf told CBC. With increased public coverage likely would come a greater demand for long-term care (LTC) services, Stumpf said — and without an increase in the supply, that could mean longer wait times and increased in-hospital costs. Greater government involvement also could improve the quality of care in long-term settings through regulation and workplace incentives, she said. In a media statement, Canadian Nurses Association CEO Mike Villeneuve said that Canadians should have access to long-term care based on their needs, not on their ability to pay. "We will be advocating for a dramatic overhaul of the LTC system from the ground up. Whether that means LTC falling under medicare or some parallel agreement remains to be determined and we do not want to presume those policy decisions," he said. During today's health committee meeting, Liberal MP Marcus Powlowski, a medical doctor from Thunder Bay, Ont., said he sees widespread agreement that long-term care in this country needs significant improvements. But he wondered aloud how society would pay for it. "Can we as a society afford to put that much more money into looking after elderly people? How are we going to find the money?" he asked. Vyce said questions of funding social policy programs are usually complex and difficult. "Where there is a political will, there is a way to find the money and to provide it to the services where it is most needed to support Canadians," she replied. The Canadian Institute for Health Information (CIHI) projected in 2017 that Canada's population of people aged 65 and older would jump by 68 per cent in 20 years. It predicted the number of people aged 75 and older would double over the same time period.

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COPD World News - Week of May 10, 2020

No evidence to date to suggest COVID-19 antibodies protect against re-infection

Geneva - There is currently no evidence to suggest that people who recover from COVID-19 and have antibodies are protected against reinfection with the illness, according to a scientific brief from WHO. As a result, although some governments have suggested that the presence of antibodies to SARS-CoV-2 may be an “immunity passport” that allows individuals to travel or return to work under the belief that they are protected from reinfection, there is no evidence to support that. The development of immunity to a pathogen through natural infection is “a multistep process” that generally occurs over the period of 1 to 2 weeks, according to the brief. The combined adaptive response may clear the virus from the body and could prevent progression to severe illness or reinfection by the same virus, if the response is strong enough. The presence of antibodies in the blood is commonly used to track this process, the brief notes. WHO officials say that as of April 24, no study has assessed whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans and that tests that detect antibodies to SARS-CoV-2 in people need further study to establish accuracy and reliability. These tests also need to differentiate between past infections from SARS-CoV-2 and those caused by the known set of six human coronaviruses two of which cause Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome and four of which cause the common cold. According to WHO, at this point in the pandemic, there is not enough evidence regarding the effectiveness of antibody-mediated immunity to ensure the reliability of an “immunity passport” or “risk-free certificate” yet. WHO officials also noted that people who believe that they are immune to a second infection because they have received a positive test result may ignore public health advice, which could increase the risk for ongoing transmission of COVID-19. Experts from the Infectious Diseases Society of American echoed these concerns during a press briefing last week.  “The hope for antibodies has been that the detection of them in the blood represents protection for reinfection,” Mary K. Hayden, MD, FIDSA, IDSA spokesperson and professor of internal medicine and pathology at Rush University Medical Center, said during the briefing. “That's really the million-dollar question.” Hayden explained that even if antibody immunity is proven, the degree of protection is unknown and could wane over time. Because of this, it should generally be assumed that people with antibodies could be at risk for reinfection and should not change their behavior in any way regarding social distancing and other actions.

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COPD World News - Week of May 3, 2020

Controlled trial reports positive results for remdesivir

Maryland - National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, MD, said that data from a multinational randomized control trial showed that Gilead’s investigational antiviral remdesivir “has a clear-cut significant positive effect in diminishing time to recovery” for patients with COVID-19. “This will be the standard of care,” Fauci, a White House advisor on the pandemic, said during comments from the Oval Office. Fauci said the results, which have not yet been peer-reviewed, prove “that a drug can block this virus. We think it’s opening the door to the fact that we now have the capability of treating” COVID-19, he said. The trial, which began Feb. 21 this year, compared remdesivir with placebo in more than 1,000 patients. Remdesivir improved recovery from 15 days to 11 days, with a P value of 0.001, Fauci said. He said the mortality rate trended toward being better in the remdesivir arm, 8% vs. 11%, but the result had not reached statistical significance. “The reason why we’re making the announcement now is something that I think people don’t fully appreciate. Whenever you have clear cut evidence that you have a drug that works, you have an ethical obligation to immediately let the people in the placebo group know so that they can have access,” Fauci said. “We would have normally waited several more days. The data may change, but the conclusion won’t.” He said researchers would now start testing other investigational therapies in combination with remdesivir. Elsewhere, a study published in The Lancet showed no statistically significant benefit from remdesivir in 237 adult patients admitted to 10 hospitals in China for severe COVID-19. However, the study did show “a numerically faster time to clinical improvement” among participants who received remdesivir compared with those who received placebo among patients who experienced symptoms for 10 days or less. That finding “requires confirmation in larger studies,” the researchers wrote. Also, Gilead announced in a news release that patients with severe COVID-19 infection who received a 10-day treatment course of remdesivir experienced similar improvement in clinical status as those who were treated with a 5-day course. “The study demonstrates the potential for some patients to be treated with a 5-day regimen, which could significantly expand the number of patients who could be treated with our current supply of remdesivir,” Merdad Parsey, MD, PhD, chief medical officer of Gilead Sciences, said in the release. “This is particularly important in the setting of a pandemic, to help hospitals and health care workers treat more patients in urgent need of care.”

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COPD World News - Week of April 26, 2020

Blood-pressure drugs are in the crosshairs of COVID-19 research

Baltimore, Mayland - Scientists are baffled by how the coronavirus attacks the body - killing many patients while barely affecting others. But some are tantalized by a clue: A disproportionate number of patients hospitalized by COVID-19, the disease caused by the virus, have high blood pressure. Theories about why the condition makes them more vulnerable – and what patients should do about it – have sparked a fierce debate among scientists over the impact of widely prescribed blood-pressure drugs. Researchers agree that the life-saving drugs affect the same pathways that the novel coronavirus takes to enter the lungs and heart. They differ on whether those drugs open the door to the virus or protect against it. Resolving that question has taken on new urgency after an April 8 report by the U.S. Centers for Disease Control and Prevention showed that 72% of hospitalized COVID-19 patients 65 or older had hypertension. The drugs are known as ACE inhibitors and ARBs, broad categories that include Vasotec, Valsartan, Irbesartan, as well as their generic versions. In a recent interview with a medical journal, Anthony Fauci - the U.S. government’s top infectious disease expert - cited a report showing similarly high rates of hypertension among COVID-19 patients who died in Italy and suggested the medicines, rather than the underlying condition, may act as an accelerant for the virus. Efforts to understand how the virus uses the pathway to the heart and lungs, and the role of the medicines, are complicated by a lack of rigorous studies. “There are millions of Americans that take an ACE inhibitor or AR daily,” said Dr Caleb Alexander, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness in Baltimore. “This is one of the most important clinical questions.” An estimated 100 million U.S. residents suffer from high blood pressure, which increases the risk of heart disease, stroke and kidney failure. About four-fifths of them need to take prescription drugs to control it, according to the CDC. ACE inhibitors and ARBs are widely prescribed to patients with congestive heart failure, diabetes or kidney disease. The drugs account for billions of dollars in prescription sales worldwide. The absence of clear answers on how the drugs impact COVID-19 patients has sparked rampant speculation in correspondence and editorials posted on medical journal websites and those where scientists share unreviewed, pre-publication study drafts. Many patients are agonizing over whether their medicines will help or hurt them.

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COPD World News - Week of April 19, 2020

New data on Gilead’s remdesivir show no benefit for coronavirus patients.

Geneva, Switzerland - The antiviral medicine remdesivir from Gilead Sciences failed to speed the improvement of patients with Covid-19 or prevent them from dying, according to results from a long-awaited clinical trial conducted in China. Gilead, however, said the data suggest a “potential benefit.” A summary of the study results was inadvertently posted to the website of the World Health Organization and seen by STAT on Thursday, but then removed. “A draft document was provided by the authors to WHO and inadvertently posted on the website and taken down as soon as the mistake was noticed. The manuscript is undergoing peer review and we are waiting for a final version before WHO comments,” said WHO spokesperson Tarik Jasarevic. The data (for details, see screenshot below) will be closely scrutinized but are also likely imperfect. The study was terminated prematurely, which could have affected the results. The context that would be provided by a full manuscript is missing, and the data have not been reviewed as normally occurs before publication. Many studies are being run to test remdesivir, and this one will not be the final word. Results are expected soon from a Gilead-run study in severe Covid-19 patients, although that study may be difficult to interpret because the drug is not compared to patients receiving only standard treatment. Encouraging data from patients in that study at the University of Chicago were described by researchers at a virtual town hall and obtained by STAT last week. However, unlike those data, these new results are from a randomized controlled trial, the medical gold standard. Gilead is also running a study with a control group in more moderate Covid-19 patients, and the National Institute of Allergy and Infectious Diseases is running a study that compares remdesivir to placebo. There are even more studies of the drug ongoing. According to the summary of the China study, remdesivir was “not associated with a difference in time to clinical improvement” compared to a standard of care control. After one month, it appeared 13.9% of the remdesivir patients had died compared to 12.8% of patients in the control arm. The difference was not statistically significant. “In this study of hospitalized adult patients with severe COVID-19 that was terminated prematurely, remdesivir was not associated with clinical or virological benefits,” the summary states. The study was terminated prematurely because it was difficult to enroll patients in China, where the number of Covid-19 cases was decreasing. An outside researcher said that the results mean that any benefit from remdesivir is likely to be small.

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COPD World News - Week of April 12, 2020

With ventilators running out, doctors say the machines are overused for Covid-19

Boston, MA - Even as hospitals and governors raise the alarm about a shortage of ventilators, some critical care physicians are questioning the widespread use of the breathing machines for Covid-19 patients, saying that large numbers of patients could instead be treated with less intensive respiratory support. If the iconoclasts are right, putting coronavirus patients on ventilators could be of little benefit to many and even harmful to some. What’s driving this reassessment is a baffling observation about Covid-19: Many patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen. That is making critical care physicians suspect that blood levels of oxygen, which for decades have driven decisions about breathing support for patients with pneumonia and acute respiratory distress, might be misleading them about how to care for those with Covid-19. In particular, more and more are concerned about the use of intubation and mechanical ventilators. They argue that more patients could receive simpler, noninvasive respiratory support, such as the breathing masks used in sleep apnea, at least to start with and maybe for the duration of the illness. “I think we may indeed be able to support a subset of these patients” with less invasive breathing support, said Sohan Japa, an internal medicine physician at Boston’s Brigham and Women’s Hospital. “I think we have to be more nuanced about who we intubate.” That would help relieve a shortage of ventilators so critical that states are scrambling to procure them and some hospitals are taking the unprecedented (and largely untested) step of using a single ventilator for more than one patient. And it would mean fewer Covid-19 patients, particularly elderly ones, would be at risk of suffering the long-term cognitive and physical effects of sedation and intubation while being on a ventilator. None of this means that ventilators are not necessary in the Covid-19 crisis, or that hospitals are wrong to fear running out. But as doctors learn more about treating Covid-19, and question old dogma about blood oxygen and the need for ventilators, they might be able to substitute simpler and more widely available devices.

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COPD World News - Week of April 5, 2020

Chiropractors told to remove Covid-19 immune system boost claims 

Toronto, ON - There's no scientific evidence that chiropractic care can boost your immune system, but that hasn't stopped some chiropractors from touting the practice as a tool to prevent infection from the novel coronavirus that has caused the COVID-19 pandemic. The CBC recently reported that the problem is so widespread that one Ontario man has filed at least 34 complaints against chiropractic clinics in the province alone in the past few weeks. "As soon as there is public fear to exploit, these practitioners are really quick to get on message and promote this type of misinformation for their own profit," said Ryan Armstrong, who runs an independent non-profit called Bad Science Watch. He provided CBC News with copies of 34 complaints he recently filed with the College of Chiropractors of Ontario, along with the posts that triggered his complaints. In one video Armstrong had captured, three practitioners stand in front of a whiteboard with the word "Coronavirus" on top and the words "Boost your immune system" underneath. During the video, they talk about coronavirus and the need to boost your immune system through chiropractic care.  The College of Chiropractors of Ontario (CCO) said it has sent 54 cease and desist letters to practitioners since March 2nd. According to a statement from Dr. Dennis Mizel, the president of the college, the college had sent the letters "within hours of receiving information about potential inappropriate claims for the benefits of chiropractic." A different Facebook post that Armstrong shared with CBC News reads, "Covid-19? Now is the best time to see your Chiropractor! Spinal adjustments have been shown to boost your immune function."  Across the country, provincial governing bodies have issued warnings to their members not to spread misinformation about chiropractic care and COVID-19. The College of Chiropractors of B.C., the Alberta College and Association of Chiropractors, the Manitoba Chiropractors Association and L'Ordre des chiropraticiens du Quebec have all put out statements in the last week or so. Nationally, the Canadian Chiropractic Association has also warned members about making unsubstantiated claims. "We would be remiss to ignore the rise of misinformation at this difficult time. While we firmly believe in the efficacy and benefits of chiropractic care in supporting the health of Canadians, there is no scientific evidence that supports claims of a meaningful boost in immune function from chiropractic adjustments," the association wrote in a post from March 16.

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COPD World News - Week of March 29, 2020

Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection

London, UK - Doctor groups are recommending testing and isolation for people who lose their ability to smell and taste, even if they have no other symptoms. Anosmia, the loss of sense of smell, and ageusia, an accompanying diminished sense of taste, have emerged as peculiar telltale signs of Covid-19, the disease caused by the coronavirus, and possible markers of infection. British ear, nose and throat doctors, citing reports from colleagues around the world, called on adults who lose their senses of smell to isolate themselves for seven days, even if they have no other symptoms, to slow the disease’s spread. The published data is limited, but doctors are concerned enough to raise warnings. “We really want to raise awareness that this is a sign of infection and that anyone who develops loss of sense of smell should self-isolate,” Prof. Claire Hopkins, president of the British Rhinological Society, wrote in an email. “It could contribute to slowing transmission and save lives.” She and Nirmal Kumar, president of ENT UK, a group representing ear, nose and throat doctors in Britain, issued a joint statement urging health care workers to use personal protective equipment when treating any patients who have lost their senses of smell, and advised against performing nonessential sinus endoscopy procedures on anyone, because the virus replicates in the nose and the throat and an exam can prompt coughs or sneezes that expose the doctor to a high level of virus. Two ear, nose and throat specialists in Britain who have been infected with the coronavirus are in critical condition, Dr. Hopkins said. Earlier reports from Wuhan, China, where the coronavirus first emerged, had warned that ear, nose and throat specialists as well as eye doctors were infected and dying in large numbers, Dr. Hopkins said. The British physicians cited reports from other countries indicating that significant numbers of coronavirus patients experienced anosmia, saying that in South Korea, where testing has been widespread, 30 percent of 2,000 patients who tested positive experienced anosmia as their major presenting symptom (these were mild cases). The American Academy of Otolaryngology on Sunday posted information on its website saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of taste are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms. The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self-isolation and testing of these individuals,” the academy said. The organization has reminded its members that the Centers for Disease Control and Prevention.

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COPD World News - Week of March 22, 2020

AstraZeneca to donate 9 million face masks in fight against COVID-19

Cambridge, UK - AstraZeneca is donating nine million face masks to support healthcare workers around the world as they respond to the COVID-19 (novel coronavirus) global pandemic. AstraZeneca has partnered with the World Economic Forum’s COVID Action Platform, created with the support of the World Health Organization, to identify countries in greatest need. Italy will receive the first shipments this week with other countries to follow. In addition to these donations, AstraZeneca is accelerating the development of its diagnostic testing capabilities to scale-up screening and is also working in partnership with governments on existing screening programs to supplement testing. To help ensure the continued supply of its medicines to patients, AstraZeneca is screening employees across its manufacturing and supply network. AstraZeneca’s Research and Development (R&D) teams have also been working expeditiously to identify monoclonal antibodies to progress towards clinical trial evaluation as a treatment to prevent COVID-19. More than 50 virology, immunology, respiratory, and protein engineering experts across research, clinical, regulatory, and manufacturing are placing the highest priority on developing a treatment to minimize the global impact of the disease. Pascal Soriot, Chief Executive Officer, said: “Our first thoughts are with those suffering from this global pandemic and with the brave healthcare workers who are caring for them. As a company, we have prioritized our response by partnering with international health authorities and others to share our scientific knowledge and expertise, and we have taken this step to donate these masks as we continue to accelerate our efforts on diagnostic testing and a treatment against COVID-19.” The nine million masks will be manufactured and distributed from China, where the large-scale and accelerated effort has been aided by AstraZeneca’s leading position and strong relationships with the country’s healthcare system and manufacturing sector.  Since the start of the COVID-19 outbreak, AstraZeneca has also made financial donations and given millions of units of personal protective equipment to health organizations in China and several other countries around the world.

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What happens if COVID-19 overwhelms ICUs

Toronto, ON - Within four to five weeks, doctors in Canada could be grappling with the kind of grim moral choices facing doctors in Italy, where it is being proposed that only COVID-19 patients who have the greatest chance of survival and those with the most years of potential life left get access to precious ICU beds and ventilators. Some of the nation’s leading infectious diseases and critical care doctors say that Canada needs to prepare now for a possible total saturation of intensive care resources, and begin discussing the once unthinkable: Which patients should get routed to the ICU and, of those who could hypothetically benefit, who should be left behind? “I think we should be having these conversations calmly and rationally now as opposed to waiting until it happens, and I want to emphasize if it happens,” said Dr. Anand Kumar, a critical-care doctor at Winnipeg Health Sciences Centre who is also trained in infectious diseases. Modelling suggests that ICUs may collapse under the strain of a dramatic spike in COVID-19 cases if the measures being implemented now — Ontario Premier Doug Ford’s declaration Tuesday of a state of emergency that has forced the shutdown of bars, restaurants, theatres, cinemas, schools and daycares until at least March 31, the sweeping travel restrictions announced by Prime Minister Justin Trudeau Monday, the urging of Ottawa’s medical officer of health to “stay home” — don’t buy the time needed to slow the virus’ spread. The country isn’t overrun with known infections but no one has a firm grasp on just how much community spread is occurring because we aren’t testing every person in the country with a fever or cough. As the country braces for a potential crush of the virus-infected, hospitals are restricting visitors, ramping down non-urgent procedures and surgeries to free up hospital beds, especially ventilated ones, ordering more ventilators, clearing operating rooms for virus patients and refitting mothballed ICU’s. In Toronto, lung and living kidney donor transplants have been put on hold for 14 days to free up ICU beds. Even then, “the system is likely to be overwhelmed and that’s why I think we need to get more aggressive with this now while we have time,” Kumar said, adding that the kind of aggressive social distancing measures announced by Ontario and Quebec should be implemented nationwide. In China and Italy, five per cent or more of those known infected with COVID-19 require intensive care. Among all infected people, the death rate is hovering at around one to three per cent, but among the critically ill, it climbs as high as 62 per cent. Most deaths are due to hypoxia, an insufficient supply of oxygen to the body’s tissues, or multi-organ collapse. There are currently about 3,200 ICU beds in the country. “So maybe you double that by throwing everything you’ve got at it,” Kumar said. “You increase your bed capacity by an additional 3,000 beds or maybe 4,000 beds.” In the U.S., 20 per cent of the population was infected with H1N1 in the first year of the outbreak. One-third of the world’s population became infected with the 1918 pandemic virus. If one-quarter of the Canadian population is infected with COVID-19 in the first year, “that’s roughly 10 million people,” he said. If five per cent require ICU support that could mean 500,000 people requiring intensive care.

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COPD World News - Week of March 15, 2020

Feds issue global travel advisory

Ottawa, ON - Avoid non-essential travel outside of Canada until further notice. To limit the spread of COVID-19, many countries have put in place travel or border restrictions and other measures such as movement restrictions and quarantines. Airlines have cancelled flights. New restrictions may be imposed with little warning. Your travel plans may be severely disrupted and you may be forced to remain outside of Canada longer than expected. Contact your airline or tour operator to determine options for cancelling or postponing your trip. If you are still considering travelling or are already outside of Canada: Check your destination’s Safety and security, Entry/exit requirements and Health sections. Get the Government of Canada’s latest updates on COVID-19. Also, check the Pandemic COVID-19 travel health notice. Find out what commercial options are still available to return to Canada. Consider returning to Canada earlier than planned if these options are becoming more limited. Ensure that you have sufficient finances and necessities, including medication, in case your travels are disrupted. Check with your travel insurance provider to know more about their policies related to COVID-19. Find out if you are covered for medical treatment if you become infected with COVID-19 as well as for extended stays outside of Canada. This advisory overrides all other risk levels, with the exception of areas for which we advise to avoid all travel (including regional advisories). The avoid all travel advisories remain valid. Canada has announced the creation of the COVID-19 Emergency Loan Program for Canadians Abroad to help Canadians return home. For more information on this program, visit COVID-19: Financial help for Canadians outside Canada. The federal government has also adviced that people avoid all cruise ship travel due to COVID-19.

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COPD World News - Week of March 8, 2020

We have a youth vaping crisis

Ottawa, ON - More than one third of teenagers 15 to 19 have tried vaping at some point in their lives, according to a new report from Statistics Canada, the first of its kind to provide detailed information about vaping. The Canadian Tobacco and Nicotine Survey, based on data collected from 8,600 people in November and December 2019, found that 36 per cent of teens in that age bracket had tried vaping, and 15 per cent reported doing so in the past 30 days. "The new data reinforces the trend that we've been seeing over the last short while, which is that we have a youth vaping crisis," said Sarah Butson, public policy analyst for The Lung Association. "It demonstrates to us that vaping is in the hands of exactly the folks we are trying to protect and really emphasizes that we need to do more." She said The Lung Association has been calling for stricter regulation of vaping products, including a wholesale ban on flavours, "which are an incredibly powerful marketing tool for young people." Likewise, 15 per cent of young adults ages 20 to 24 had vaped in the 30 days prior to the survey, while nearly half (48 per cent) had done so in the their lifetimes. In comparison, just three per cent of adults ages 25 and older reported that they had used a vaping product in the previous month, while 12 per cent had tried it at least once in the past. Among the people surveyed who had vaped in the past 30 days, about 80 per cent had vaped nicotine. Reasons for vaping vary across age groups. Those who responded to the survey were asked to identify their main reason for vaping in the 30 days prior to the survey. Among users ages 15 to 19, 29 per cent chose "because they wanted to try" and another 29 per cent picked "because they enjoyed it." Only nine per cent of teens surveyed cited a desire to quit or cut down on smoking cigarettes as their main motivation for vaping. But among the 20- to 24-year-old cohort, 28 per cent said smoking cessation was their main reason, along with more than half of those 25 and older. Sarah Butson, public policy analyst for The Lung Association, said the organization is calling for stricter regulation of vaping products, including a wholesale ban on flavours, which she says are very powerful for enticing young people to take up the habit. When vaping products first came to market, they were billed as harm-reduction and smoking cessation tools for tobacco users. But Butson said it's unclear they're effective that way. "What we've seen to date is that the evidence is really inconclusive to suggest that e-cigarettes can be a cessation aid," she said. Instead, the association urges Canadians to talk to their health care providers about evidenced-based tools that can help them quit smoking. 'We need to do more' Butson said there's been good strides made at the provincial level, with some moving to restrict flavours and increase the age to purchase vaping products. "We would like to see that happen at the federal level, to really set the benchmark and make sure that we don't have disparity across provinces so that we're really protecting all Canadians, in particular all young Canadians." Butson said youth have a number of misconceptions around vaping. "One of the most common myths is that it's harmless," she said. In fact, vaping-related illness is on the rise in both Canada and the U.S.

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COPD World News - Week of March 1, 2020

Feds propose changes to medical assistance in dying legislation

Ottawa, ON - Medical assistance in dying (MAID) is a complex and deeply personal issue. Last week the Honourable David Lametti, Minister of Justice and Attorney General of Canada, the Honourable Patty Hajdu, Minister of Health, and the Honourable Carla Qualtrough, Minister of Employment, Workforce Development and Disability Inclusion, announced the introduction of a bill, which proposes changes to Canada’s Criminal Code provisions on MAID. The Bill would remove the requirement for a person’s natural death to be reasonably foreseeable in order to be eligible for MAID. Introduce a two-track approach to procedural safeguards based on whether or not a person’s natural death is reasonably foreseeable. Existing safeguards will be maintained and certain ones will be eased for eligible persons whose death is reasonably foreseeable. New and modified safeguards will be introduced for eligible persons whose death is not reasonably foreseeable. The bill will also exclude eligibility for individuals suffering solely from mental illness; allow waiver of final consent for eligible persons whose natural death is reasonably foreseeable and who may lose capacity to consent before MAID can be provided. The government plans to expand data collection through the federal monitoring regime to provide a more complete picture of MAID in Canada. The introduction of this Bill would respond to the Superior Court of Québec’s September 2019 Truchon decision by allowing individuals who are not nearing the end of their lives to be eligible to receive MAID. The amended procedural safeguards would require practitioners to take appropriate steps to ensure that, in non-end-of-life cases, the request for MAID is fully informed and considered, and that individuals making the request have given serious consideration to reasonable and available treatment options. The Bill also reflects emerging societal consensus and was informed by views and concerns raised by Canadians, experts, practitioners, stakeholders, Indigenous groups, as well as provinces and territories during the January and February 2020 consultations. It is also informed by the past four years of experience with MAID in Canada. The Government of Canada would continue to work closely with provinces and territories, health system partners, and health practice regulatory bodies to support the implementation of the proposed changes to the legislation, if passed by Parliament. This includes the development of monitoring, reporting, best practices, and guidance for the MAID regime. In addition, the federal government will work with provincial and territorial partners to enhance disability support. Other important questions relating to MAID in Canada—such as advance requests for persons newly diagnosed with a condition that could affect their decision-making capacity in the future, eligibility for persons suffering solely from mental illness and eligibility for mature minors—could be considered during a broader parliamentary review of MAID legislation expected to begin by June 2020.

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COPD World News - Week of February 23, 2020

Hospitals across the US prepare for coronavirus global pandemic

Atlanta, GA - “This is the time to open up your pandemic plans and see that things are in order,” Dr. Anne Schuchat, a top official of the Centers for Disease Control and Prevention, urged hospitals last week as an outbreak of a deadly new coronavirus ravaged much of China. “For instance,” she continued, health-care providers need to plan for a “surge at a hospital, the ability to provide personal protective equipment for your workforce, the administrative controls and so forth that you might put place in a health care setting.” Schuchat’s warning came as U.S. and world health officials increasingly sound the alarm of a possible pandemic outbreak of the deadly new coronavirus that has killed more than 2,100 people in China in the last seven weeks. The COVID-19 epidemic in China has not yet met world health officials’ designation of a global pandemic that spreads far and wide throughout the world. While it has spread to more than two dozen countries, international health officials say there’s very little transmission on local levels outside of China right now. But they’ve warned that could quickly change. The virus is proving to be far more contagious than the flu, having spread from 300 people in mid-January to more than 75,700 as of Thursday morning. While a majority of those cases are in China — with just 15 confirmed in the U.S. — the CDC has been working with the health-care sector to prepare for the virus to “take a foothold in the U.S,” Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, told reporters Feb. 12. “At some point, we are likely to see community spread in the U.S. or in other countries,” she warned. U.S. hospitals from San Diego to New York are taking heed. The threat of the new virus comes at an already busy time for most U.S. hospitals. Another serious respiratory illness, the seasonal flu, is at its peak in the United States, with more than 26 million cases and many hospitals stretched thin. A larger spread of the new virus across the U.S. could overwhelm emergency rooms and quickly cause supply shortages of some crucial medical supplies, according to half a dozen interviews with doctors, U.S. hospitals and health systems.

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COPD World News - Week of February 16, 2020

Impact of comorbidities and commonly used drugs on mortality in COPD

Uppsala, Sweden - Life expectancy is significantly shorter for patients with chronic obstructive pulmonary disease (COPD) than the general population. Concurrent diseases are known to infer an increased mortality risk in those with COPD, but the effects of pharmacological treatments on survival are less established. Researchers here aimed to examine any associations between commonly used drugs, comorbidities and mortality in Swedish real-world primary care COPD patients. Patients with physician-diagnosed COPD from a large primary care population were observed retrospectively, utilizing primary care records and mandatory Swedish national registers. The time to all-cause death was assessed in a stepwise multiple Cox proportional hazards regression model including demography, socioeconomic factors, exacerbations, comorbidities and medication. During the observation period (1999– 2009) 5776 (32.5%) of 17,745 included COPD patients died. Heart failure (hazard ratio [HR]: 1.88, 95% confidence interval [CI]: 1.74– 2.04), stroke (HR: 1.52, 95% CI: 1.40– 1.64) and myocardial infarction (HR: 1.40, 95% CI: 1.24– 1.58) were associated with an increased risk of death. Use of inhaled corticosteroids (ICS; HR: 0.79, 95% CI: 0.66– 0.94), beta-blockers (HR: 0.86, 95% CI: 0.76– 0.97) and acetylsalicylic acid (ASA; HR: 0.87, 95% CI: 0.77– 0.98) was dose-dependently associated with a decreased risk of death, whereas use of long-acting muscarinic antagonists (LAMA; HR: 1.33, 95% CI: 1.14– 1.55) and N-acetylcysteine (NAC; HR: 1.26, 95% CI: 1.08– 1.48) were dose-dependently associated with an increased risk of death in COPD patients. This large, retrospective, observational study of Swedish real-world primary care COPD patients indicates that coexisting heart failure, stroke and myocardial infarction were the strongest predictors of death, underscoring the importance of timely recognition and treatment of comorbidities. A decreased risk of death associated with the use of ICS, beta-blockers and ASA, and an increased risk associated with the use of LAMA and NAC, was also found. Lead author of the study is J. Ellingsen of the Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden

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COPD World News - Week of February 9, 2020

Model suggests coronavirus outbreak began earlier than reported

Toronto, ON - The coronavirus epidemic started one month earlier than is commonly reported and has yet to be brought under control, a new disease-transmission model created by University of Toronto researchers suggests. Using open access data that are updated daily, the model replicates epidemiological scenarios and allows researchers to test narratives about the outbreak that originated in Wuhan, China – including the notion that it started in December. The work is detailed in the Annals of Internal Medicine. “You can’t get up to that level of cases if the epidemic started in December even if you pushed the reproduction really high,” says David Fisman, a professor in the Dalla Lana School of Public Health and one of the model’s creators. “If you have a reproduction number of three, the epidemic could not have stated in mid-December because, according to the graph, it is undershooting the cases that were found in December.” In epidemiology, reproduction refers to the number of secondary cases a single case can infect in a susceptible population. “It had to be earlier, which raises some interesting questions about how this emerged,” Fisman says. “The plausible start date seems to be mid-November.”  The tool also shed insights into the international effort to contain the spread of the virus. The Chinese government implemented containment measures by mid-January, but, according to the model’s graph, the disease’s reproduction number has not yet been reduced below one – the level needed for control. “Even with the reproduction being less than one ... when looking at Jan. 14, that level control is not happening because the observed cases are exceeding that level,” Fisman says. Reproduction numbers have not been less than one since the World Health Organization formally declared the epidemic a public health emergency of international concern on Jan. 30, according to the model. Fisman says it takes about a week to infect someone and for the person to exhibit the virus’ symptoms. “What you’re seeing today [in the graph] is what happened last week.” The model also allows users to create plausible epidemic curves or scenarios to observe the outbreak’s trajectory. Fisman says it is a simplified version of reality that can rule out ongoing narratives. “You can play with this to see how the response is doing,” he says. “It’s a qualitative tool, but there’s also a lot we can’t say with certainty. If the cases take a sharp right turn and stop going up, there are two possibilities: control has been achieved or they are running out of resources.  We can’t distinguish those with the graph alone.” Fisman and Tuite will be working on the virus’s lethality for an upcoming paper.

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COPD World News - Week of February 2, 2020

Tech to support aging in place

Ottawa, ON - More than 90 per cent of Canadians aged 65 and older are currently living in private residences. And most, if not all, of them want to remain there as long as possible. To support this desire to “age in place,” there are many new health technologies being developed that aim to help older adults remain healthier, more productive, and living in their own communities. In a recent issue of Health Technology Update, CADTH looked at a few emerging technologies that could potentially help support aging in place. CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures to find out what the evidence says. Its Health Technology Update newsletter describes new and emerging health technologies that are likely to have a significant impact on health care in Canada. The technologies described in this recent issue aren’t yet available in Canada, with the exception of the virtual-reality bike, described next. A virtual reality-inspired exercise bike that rides you through places that hold fond memories could be the ticket to improved physical, memory-related, and cognitive abilities. But how can this be made possible? BikeAround combines a stationary bike with Google Street View to create a virtual bike riding experience. It has been developed for use by older adults experiencing physical disabilities, memory problems, or cognitive disabilities such as dementia or Alzheimer disease. The technology allows users to tour their childhood communities, favourite vacation spots, or any other place they wish to revisit simply by typing the desired address into Google on the BikeAround laptop. This activity is intended to improve memory skills as well as provide social engagement for participants, who are encouraged to discuss their ride with an attendant or volunteer assisting with the session. Even users with mobility limitations can experience the cognitive and reminiscent therapy by having a trained assistant navigate the streets for them. BikeAround bikes are typically set up at locations within communities and have been commercially available and distributed in Canada since 2018. Older adults experiencing physical and mental decline may eventually need someone to keep an eye on them, either through an in-home care arrangement or by moving to an assisted living or nursing home facility. But smart home technology could someday offer health monitoring that could allow older adults to live independently at home for longer. The concept of wireless smart home monitoring technology isn’t new, but a system that claims to take the concept further is in the works. Called Emerald, it uses radiofrequency signals to track, and differentiate between, multiple individuals; measure breathing, heart rate, and sleep; and learn about patterns of human activity in a house. This could allow the system to detect falls and measure cognitive decline, mental health, and chronic conditions remotely and unobtrusively, allowing older adults to live independently and alleviating the need for trips to the hospital. As is typically the case with new and emerging technologies, there’s currently only limited evidence on their effectiveness or how they compare with existing treatments. But early awareness of interventions that might come into broad use can help us plan for their possible introduction into the Canadian health care system.

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COPD World News - Week of January 26, 2020

Study looks at using virtual reality training as rehab tool for patients with COPD

Opole, Poland – This study compared the effects of inpatient-based rehabilitation program of patients with chronic obstructive pulmonary disease (COPD) using non-immersive virtual reality (VR) training with a traditional pulmonary rehabilitation program. The aim of this study was to determine whether rehabilitation featuring both VR as well as exercise training provides benefits over exercise training (ET) alone or whether rehabilitation featuring VR training instead of exercise training provides equivalent benefits. The study recruited 106 patients with COPD to a 2-week high-intensity, five times a week intervention. Randomized into three groups, 34 patients participated in a traditional pulmonary rehabilitation program including endurance exercise training (ET), 38 patients participated in traditional pulmonary rehabilitation, including both endurance exercise training and virtual reality training (ET+VR) and 34 patients participated in pulmonary rehabilitation program including virtual reality training but no endurance exercise training (VR). The traditional pulmonary rehabilitation program consisted of fitness exercises, resistance respiratory muscle and relaxation training. Xbox 360® and Kinect® Adventures software was used for the VR training of lower and upper body strength, endurance, trunk control and dynamic balance. Comparison of the changes in the Senior Fitness Test was the primary outcome. Analysis was performed using linear mixed-effects models. The comparison between ET and ET+VR groups showed that ET+VR group was superior to ET group in Arm Curl (p< 0.003), Chair stand (p< 0.008), Back scratch (p< 0.002), Chair sit and reach (p< 0.001), Up and go (p< 0.000), 6-min walk test (p< 0.011). Whereas, the comparison between ET and VR groups showed that VR group was superior to ET group in Arm Curl (p< 0.000), Chair stand (p< 0.001), 6-min walk test (p< 0.031). Results suggest that pulmonary rehabilitation program supplemented with VR training is beneficial intervention to improve physical fitness in patients with COPD. Lead author of the study was Sebastian Rutkowski of the Institute of Physiotherapy, Department of Physical Education and Physiotherapy, Opole University of Technology.

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COPD World News - Week of  January 19, 2020

"Skyping' your GP could be in your future

St. John, NB - Take two aspirin and Skype me in the morning." That could be a phrase in your future if the New Brunswick Medical Society succeeds with its call for more virtual care in the province. Virtual care could include anything from doctors emailing test results to patients, to holding a consultation over Skype. Chris Goodyear, the society's president, said the idea of virtual care isn't to replace the standard doctor visit but to augment it. "It is a tool that a physician can use to see a patient when a physical exam is not necessary," said Goodyear. He said a lot of care is now done outside hospitals or doctors' offices, so this is a logical step. "Years ago, the only time you would get your blood pressure checked would be when you went to your family doctor's office," said Goodyear.  "Nowadays blood pressure machines are in pharmacies, they're in gyms, you can do it at home, you can constantly monitor your blood pressure … that part of the physical exam that a doctor would perform is no longer necessary in the office." Goodyear said virtual care would not solve the doctor shortage problem, but it would help. As of July 2018, more than 44,000 New Brunswickers without a family doctor. And an aging population, which would include many doctors reaching retirement age, will exacerbate the shortage that already exists. Dr. Chris Goodyear is a surgeon and president of the New Brunswick Medical Society, and he's hoping to roll out virtual care in the province. "Virtual care is being tested in other parts of North America," said Goodyear. "The feedback we're getting from physicians is that by incorporating that model as part of what they provide patients, it allows them to be more efficient, which does free up some time to get patients seen quicker and to expand their practice." Goodyear said some privacy concerns would need to be addressed before any regime was implemented. "There are platforms where the technology does exist to have this done on a secure platform," said Goodyear.  "People do their banking online nowadays. So they are comfortable with the notion of, you know, their personal information being ... out there in the Internet."

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COPD World News - Week of January 12, 2020

Smoking increases risk for invasive fungal disease

Paris, France - The risk for invasive fungal disease is higher among smokers, according to data from a recent study, leading researchers to suggest that strategies to end smoking be implemented, particularly among those already at increased risk for invasive fungal disease. “Invasive fungal disease (IFD) is a major cause of morbidity and mortality in immunocompromised hosts,” Annabelle Pourbaix, of the Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Paris, and colleagues wrote. “The general population may be at risk for IFD as well, as a result of specific environmental exposures, such as climate and agricultural profession, and lifestyle habits, such as smoking. Several studies have assessed the association between smoking and infection. Smoking increases the risk for bacterial pneumonia and meningitis and second-hand smoke exposure is associated with increased risk for childhood invasive meningococcal disease.” Pourbaix and colleagues performed a systematic review and meta-analysis that included 25 studies collected from MEDLINE and Web of Science published through September 2018 to investigate the correlation between smoking and risk for IFD. Results of the analysis showed that there was a greater risk for IFD among smokers (RR = 1.41; 95% CI, 1.09-1.81). The risk for IFD was higher among participants in the retrospective studies compared with those in the prospective studies (RR = 1.93 [95% CI, 1.28-2.92] vs. RR = 1.02 [95% CI, 0.78-1.34]), as well as studies that included multivariate adjustments compared to studies with univariate analysis (RR = 2.15 [95% CI, 1.27-3.64] vs. RR = 1.15 [95% CI, 0.88-1.51]) and in studies published after 2002 (RR = 2.08 [95% CI, 1.37-3.15] vs. RR = 0.95 [95% CI, 0.75-1.22]).  “This review and meta-analysis showed an increased risk for IFD among smokers, with a stable association across a variety of clinical subgroups,” the authors concluded. “This provides new evidence supporting the implementation of smoking cessation strategies, including tobacco, marijuana, opium and crack cocaine, especially in patients with HIV and patients with hematological malignancies who are already at higher risk for IFD.”

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COPD World News - Week of January 5, 2020

Canadian officials closely monitoring mysterious virus based in China

Ottawa, ON - Seventeen years after SARS killed 44 Canadians and sickened hundreds of others, Canadian officials are closely monitoring a new potential threat — a mysterious virus based in China that has caused atypical pneumonia in at least 59 people. So far, Chinese officials have ruled out SARS (Severe Acute Respiratory Syndrome), which also began in China in 2002. They have also ruled out bird flu, influenza and Middle East Respiratory Syndrome, among other potential causes. Officials say there is no evidence yet that it has spread from human to human. But the world is watching closely. Not just because there are so many unanswered questions about the cluster of undiagnosed viral pneumonia cases in Wuhan, China, but because global infectious disease officials have long warned that another pandemic is coming. Canada’s Chief Public Health Officer Dr. Theresa Tam has been in touch with provincial and territorial public health officials, the World Health Organization and other international partners to discuss the mysterious virus, said Eric Morrissette, spokesman for the Public Health Agency of Canada. The Ontario Ministry of Health is also monitoring the situation, said spokesman David Jensen. “As the situation develops, the ministry will continue to assess and determine whether any further action is needed,” said Jensen. Could this become a global public health threat? For now, public health officials are watching and trying to get more information. But the virus in Wuhan should serve as a wakeup call about the implications of overcrowding in Ontario hospitals for outbreaks or a pandemic, said Dr. Alan Drummond, a Perth emergency physician who is co-chair of public affairs for the Canadian Association of Emergency Physicians. A Public Health Agency of Canada spokesman notes that numerous system improvements have been put in place since the SARS outbreak, which killed 774 people worldwide, 44 of them in Toronto. Those changes include new and improved systems in Canadian provinces and territories to “identify, prevent and control the spread of serious infectious diseases into and within Canada.” Post-SARS protections also include a global public health intelligence monitoring system, which scans the world’s open source media, in addition to international collaboration and information sharing across Canada, said Morrissette. “The Canadian public health laboratory system is well-equipped to detect serious infectious diseases,” he added.

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