6 die of diarrhoea in Bandarban, at least 200 affected

Six people have died of diarrhoea and at least 200 were affected in last three days as the disease is spreading rapidly in Kurukpata union in Alikadom upazila of Bandarban, reports our correspondent quoting the chairman of the union.

The deceased are Mandom Mro (50), Rengsang Mro (43), Ramdon Mro (40), Kaiyan Mro (36), Tumlot Mro (35), and Janorung Tripura (35), said Kratpung Mro, chairman of Kurukpata union.

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Six people from remote Manrum Para, Menu Para and Sonabi Para of Kurukpata union died of diarrhoea in last three days, said the chairman, adding that at least 200 people of the union were affected.

Dr Aung Swi Prue Marma, civil surgeon of Bandarban said, they have sent a medical team in Kurukpata union to provide primary treatment to the affected people.

Further information of the union’s diarrhoea situation will be updated once their team return tonight, the civil surgeon added.


Vaccines dominate Trudeau’s final day of international trip

Prime Minister Justin Trudeau has wrapped up a mini-summit with leaders of the European Union that was part business, part thank-you for co-operation in securing Canada a share of European-manufactured coronavirus vaccines.

Canadian Prime Minister Justin Trudeau is given a tour of a vaccine facility by Pfizer Director Aseptic Manufacturing Koen Vastenavond Tuesday June 15, 2021 in Puurs, Belgium. (Adrian Wyld/The Canadian Press)

Prime Minister Justin Trudeau has wrapped up a mini-summit with leaders of the European Union that was part business, part thank-you for co-operation in securing Canada a share of European-manufactured coronavirus vaccines.

There has been a lot of discussion between Canada and the EU over vaccine supply, which in the early stages proceeded in fits and starts.

Charles Michel, president of the European Council, took pains on Tuesday to emphasize that the EU had shipped 16 million doses of vaccine to Canada, which is 60 per cent of Canada’s total so far.

He insisted the EU is ramping up production to meet global demand and sharing it through COVAX, the international vaccine organization that ensures doses are distributed equitably.

Increasing vaccine supply, vaccine sharing and getting the world immunized as quickly as possible were prominent features of last weekend’s G7 Summit in Cornwall, England.

Goal of 11 billion doses

The World Health Organization (WHO) has set a goal of immunizing 70 per cent of the world’s population by this time next year, an endeavour for which it needs 11 billion doses.

There’s been a lot of debate and criticism over the EU’s opposition to temporarily waiving vaccine intellectual property protections.

Up until this point, the EU has said there are other solutions that can be explored to increase access to affordable coronavirus vaccines.

South Africa and India recently proposed the waiver of intellectual property protections for a whole host of coronavirus-related products, including vaccines, at the World Trade Organization. A vaccine waiver is considered critical in order to ramp up production, especially in the developing world, WHO officials have said.

Last week, EU lawmakers voted in favour of a resolution that calls for a patent waiver, with several countries saying it’s necessary to help end the coronavirus pandemic.

In front of the Canadian media, Michel defended the handling of the issue, saying there’s a lot to consider beyond the waiver, including how additional manufacturing capacity can be created.

European Commission President Ursula von der Leyen, right, European Council President Charles Michel, left, and Trudeau pose after participating in a media conference at the end of an EU-Canada summit in Brussels, Belgium on Tuesday. (Francisco Seco/Associated Press)

“The liberalization of intellectual property will not be the magic bullet, the silver bullet,” he said. “We need a global approach. We have to take into consideration the transfer of technology.”

EU Commission President Ursula von der Leyen said the wider discussion must consider the potential economic impact, because intellectual property rights “are the reward for innovation.”

‘Complexities … to be worked through’

Trudeau said Canada has been active in the global discussions and is committed to seeing a resolution and the goal of getting as many people vaccinated as quickly as possible.

“There are complexities that need to be worked through,” Trudeau said.

On Tuesday, following the meeting, Trudeau also announced a new bilateral Dialogue on Health with the EU. The aim is to enhance engagement on priority health issues outside of direct pandemic policy, such as mental health.

The concept of vaccine passports also came up on Tuesday, highlighting differences between Europe and Canada. The EU has in the works a system of vaccine passports to help restart international travel, while Canada does not.

Trudeau ended his trip with a tour of the Pfizer plant in Puurs, Belgium, that has been manufacturing most of the vaccines being shipped to Canada. It was an opportunity to say thank-you to the workers producing the vaccine under extraordinary circumstances.

Luc van Steenwinkel, the general manager of the Puurs vaccine manufacturing facility, told CBC News that the plant turns out 100 million doses per month to countries all over the world. 

He said the company’s staff has doubled in size — to 3,300 — during the crisis, and that employees are very proud of their role in helping bring the pandemic to an eventual end. 

Trudeau is expected to be back home tonight and headed into quarantine.


Coronavirus: What’s happening in Canada and around the world on Tuesday

Is the Atlantic travel bubble coming back? Provinces take a first step in that direction.

A Metro bus in St. John’s on May 6. The four Atlantic provinces are lifting many travel restrictions as of June 23 within the bubble. (Paul Daly/The Canadian Press)

The latest:

The Atlantic provinces are outlining plans to partly resume their travel bubble — with some specific regional requirements — as of June 23. 

Newfoundland and Labrador Premier Andrew Furey announced on Tuesday that travellers from Nova Scotia, New Brunswick and Prince Edward Island will be allowed in without having to self-isolate or get tested for COVID-19.

He says the move is possible because COVID-19 case numbers have remained low in the province while vaccination rates are climbing steadily.

Likewise, Nova Scotia is crediting low hospitalizations and high vaccination rates for the province’s move to allow visitors from other Atlantic provinces with no 14-day isolation period required. 

“Our case numbers and hospitalizations are low and every day we are putting more and more vaccines into the arms of Nova Scotians,” Premier Iain Rankin said in a news release.

WATCH | P.E.I.’s premier describes what will change as of June 23:

Atlantic Canadians with at least one dose of a COVID-19 vaccine will be able to visit Prince Edward Island starting June 23, said Premier Dennis King on Tuesday. The ‘soft launch’ reopening plan will be expanded to include people from other parts of the country on July 28, provided they meet certain vaccination requirements. 1:56

Prince Edward Island will allow people from the other Atlantic provinces who have obtained a so-called P.E.I. Pass — which will provide proof of residency and of at least a single dose of vaccine — to enter the province without self-isolating as of June 23, while unvaccinated travellers will need to complete a shortened self-isolation period.

Islanders who want to travel around Atlantic Canada and return without self-isolation may also apply for the pass. 

New Brunswick will reopen to residents of Nova Scotia’s Cumberland County without self-isolation for now. Residents from the rest of Nova Scotia are not expected to be allowed to enter New Brunswick without self-isolating until at least July 1.

The province is also ready to move to Phase 1 of reopening, the premier announced Tuesday, having reached its target of 75 per cent of people over age 12 being at least partially vaccinated.

“We got ‘er done … So one thumb up,” said Dr. Jennifer Russell, chief medical officer of health, calling it an “incredible milestone.”

Across the region, Nova Scotia reported four new COVID-19 cases Tuesday, while Newfoundland and Labrador reported two. New Brunswick had three new cases, while there were no new cases in Prince Edward Island, which no longer has any active cases. 

-From CBC News and The Canadian Press, last updated at 1:30 p.m. ET

What’s happening across Canada

As of 8:45 p.m. ET on Tuesday, Canada had reported 1,404,106 confirmed cases of COVID-19, with 14,935 considered active. A CBC News tally of deaths stood at 25,972. More than 29.9 million COVID-19 vaccine doses had been administered so far across the country, according to CBC’s vaccine tracker.

In Ontario on Tuesday, health officials reported 296 new cases of COVID-19 and 13 new deaths. Nearly three quarters of adults in Ontario now have at least one dose of COVID-19 vaccine. 

Quebec, meanwhile, reported six additional deaths Tuesday and 105 new cases of COVID-19. The province is now allowing anyone over 50 to move up their second dose of vaccine, no matter which shot they received first. 

WATCH | The latest science around vaccines and variants in Canada: 

It’s not entirely clear yet how effective a mix of two kinds of vaccines will be against COVID-19, says Dr. Isaac Bogoch, an infectious diseases specialist in Toronto. 9:21

Across the North, there were no new cases of COVID-19 reported in Nunavut or the Northwest Territories on Tuesday. Health officials in Yukon reported 12 new cases. 

In the Prairie provinces, Manitoba reported two additional deaths and 115 new cases of COVID-19 on Tuesday. 

Saskatchewan had four additional deaths Tuesday and 47 new cases. The seven-day average of new COVID-19 cases in the province is 70, its lowest seven-day average since Nov. 1, 2020.

Health officials in Alberta reported four deaths and 127 new cases on Tuesday. Unlike Saskatchewan, the province has three $1-million lotteries to encourage more people to get a COVID-19 vaccine. At least one psychologist says, it’ll probably work

WATCH | Will Saskatchewan launch a vaccine-incentive lottery?

Saskatchewan Premier Scott Moe dismisses the idea of a vaccine lottery in his province, explaining why he believes people are “already winning.” 0:58

In British Columbia, there were reported 108 new cases reported Tuesday and no deaths. With summer around the corner, B.C. says it will require day passes for people to visit five of its provincial parks, which must be obtained in advance of a visit, a move aimed at limiting crowding. 

-From CBC News and The Canadian Press, last updated at 8 p.m. ET

What’s happening around the world

A woman waits outside a factory to get her oxygen cylinder refilled in Kabul, Afghanistan, on Tuesday. (Reuters)

As of Tuesday evening, more than 176.5 million cases of COVID-19 had been reported worldwide, according to a coronavirus tracking tool. The reported global death toll stood at more than 3.8 million, according to the Johns Hopkins University database.

The British government fended off calls Tuesday to provide more financial support to businesses and workers who will suffer financially from its decision to delay the relaxation of coronavirus restrictions in England by four weeks to July 19.

Although many coronavirus restrictions have been eased in recent weeks, allowing large parts of the U.K. economy to reopen, a number of businesses — particularly those in the hospitality and entertainment sectors — have not been able to do so because it was not financially viable. After months of planning, those businesses had been preparing to reopen on June 21, the date the government had earmarked for the possible lifting of restrictions on social contact.

However, the recent spike in new infections as a result of the more contagious delta variant that was first identified in India has upended that plan.

The #COVID19 Dashboard has been updated: https://t.co/XhspoyTG79

On Tues 15 June, 7,673 new cases and 10 deaths within 28 days of a positive test were reported across the UK.

41,831,056 people have now received the first dose of a #vaccine. 30,209,707 have received a 2nd dose. pic.twitter.com/EHtDYBNZWL


Following the announcement, unions joined with business leaders to urge the government to compensate those affected by the delay, particularly those in the arts and hospitality industries.

Elsewhere in Europe, Germany’s health minister says the country has issued nearly five million vaccination certificates that are designed to be part of a European Union-wide digital pass system. Germany launched the rollout of the certificates late last week. Users can download proof of their coronavirus vaccination status onto a smartphone app.

In the Asia-Pacific region, India on Tuesday reported 60,471 new COVID-19 infections over the past 24 hours, the lowest since March 31.

A medical worker guides an elderly man for his vaccination against COVID-19 at the Tzu Chi Hospital in New Taipei City, Taiwan, on Tuesday. (Sam Yeh/AFP/Getty Images)

Africa will get priority treatment for the Group of Seven’s pledged 870 million doses of COVID-19 vaccine, a senior World Health Organization adviser said on Monday.

In the Middle East, Israel is no longer requiring masks indoors, lifting one of its last coronavirus restrictions following a highly successful vaccination campaign. The restriction was lifted on Tuesday, though people will still be required to wear masks on airplanes and on their way to quarantine. Unvaccinated individuals must wear masks in nursing homes and other long-term health facilities.

Israel has vaccinated about 85 per cent of its adult population, allowing schools and businesses to fully reopen. There are only a few-dozen active patients in the country of more than nine million.

People visit Dizengoff shopping centre as Israel ends one of its last main restrictions of mask wearing in indoor spaces as new COVID-19 infections continue to wane, in Tel Aviv, June 15, 2021. (Nir Elias/Reuters)

In the Americas, the U.S. death toll from COVID-19 has topped 600,000, according to the tally by Johns Hopkins University, as the vaccination drive has decreased daily cases and deaths. The number is greater than the population of Baltimore or Milwaukee, and about equal to the number of Americans who died of cancer in 2019.

Brazil’s government says it has already documented 41 cases of COVID-19 related to the Copa America, which started Sunday. It says the cases include 31 football players or staffers with teams and 10 workers who were hired for the event. Brazil’s Health Ministry also says all workers who tested positive are in Brasilia.

Mexico received 1.35 million doses of Johnson & Johnson coronavirus vaccines donated by the United States on Tuesday.

Chilean health authorities said they would extend a COVID-19 emergency through September to allow the government to impose restrictions.

-From Reuters and The Associated Press, last updated at 3:30 p.m. ET


Novavax says COVID-19 vaccine highly effective in trials

Vaccine maker Novavax said Monday its shot was highly effective against COVID-19 and also protected against variants in a large, late-stage study in the U.S. and Mexico.

Vaccine maker Novavax said Monday its shot was about 90 per cent effective overall and preliminary data showed it was safe. The new vaccine will make a difference in getting the rest of the world vaccinated, says epidemiologist Dr. Christopher Labos. 1:22

Vaccine maker Novavax said Monday its shot is highly effective against COVID-19 and also protected against variants in a large, late-stage study in the U.S. and Mexico.

The vaccine was about 90 per cent effective overall and preliminary data showed it was safe, the company said.

Novavax also said vaccine efficacy appeared to be preserved in those receiving an approved influenza vaccine along with its COVID-19 vaccine candidate, compared to those vaccinated with the COVID-19 vaccine candidate alone. 

While demand for COVID-19 shots in the U.S. has dropped off dramatically, the need for more vaccines around the world remains critical. The Novavax vaccine, which is easy to store and transport, is expected to play an important role in boosting vaccine supplies in the developing world.

That help is still months away, however. The company says it plans to seek authorization for the shots in the U.S., Europe and elsewhere by the end of September and be able to produce up to 100 million doses a month by then.

“Many of our first doses will go to low- and middle-income countries, and that was the goal to begin with,” Novavax Chief Executive Stanley Erck told The Associated Press.

More than 64 per cent of people in Canada and more than half of the U.S. population, have had at least one COVID-19 vaccine dose. But less than one per cent of people in the developing world have had one shot, according to Our World In Data, a tracking group based at Oxford University.

Novavax’s study involved nearly 30,000 volunteers aged 18 and up in the U.S. and Mexico. Two-thirds received two doses of the vaccine, three weeks apart, and the rest got dummy shots.

There were 77 cases of COVID-19 — 14 in the group that got the vaccine and the rest were in volunteers who received dummy shots. None in the vaccine group had moderate or severe disease, compared to 14 in the placebo group.

The vaccine was similarly effective against several variants including the one first detected in the U.K. that’s dominant in the U.S., and in high-risk populations including the elderly and people with other health problems.

Mostly mild side effects

Side effects were mostly mild — tenderness and pain at the injection site. There were no reports of unusual blood clots or heart problems, Erck said.

Novavax reported the results in a press release and plans to publish in a medical journal, where it will be vetted by independent experts. The Maryland-based company previously released findings from smaller studies in Britain and South Africa.

COVID-19 vaccines train the body to recognize the coronavirus, especially the spike protein that coats it, and get ready to fight the virus off. The Novavax vaccine is made with lab-grown copies of that protein. That’s different from some of the other vaccines now widely used, which include genetic instructions for the body to make its own spike protein.

The Novavax vaccine can be stored in standard refrigerators, making it easier to distribute.

Novavax previously announced manufacturing delays due to supply shortages. The company now expects to reach production of 100 million doses a month by the end of September and 150 million doses a month by December.

The company has committed to supplying 110 million doses to the U.S. over the next year and a total of 1.1 billion dosesto developing countries.

In May, vaccines alliance Gavi announced it had signed an agreement to buy 350 million doses of Novavax’s vaccine, with deliveries estimated to begin in the third quarter. COVAX, the global initiative to provide vaccines to countries, is facing a critical shortage of vaccines after its biggest supplier in India suspended exports until the end of the year,

Novavax has been working on developing vaccines for more than three decades, but hasn’t brought one to market. The company’s coronavirus vaccine work is partly funded by the U.S. government.


How the COVID-19 pandemic lowered life expectancy in Canada last year

COVID-19 deaths led to a five-month decrease in life expectancy at birth last year, recent data released by Statistics Canada suggest, potentially putting the country at a level not seen in seven years.

COVID-19 deaths have shortened life expectancy at birth in Canada, a recent study by Statistics Canada suggest. (Shutterstock)

COVID-19 deaths led to a  five-month decrease in life expectancy at birth last year, recent data released by Statistics Canada suggest, potentially putting the country at a level not seen in seven years.

The findings varied widely across the country, with Quebec logging a drop in life expectancy of almost a year while the Atlantic provinces and the territories barely saw any change, confirming major differences in the pandemic’s toll by region. Some experts also suggest that life expectancy doesn’t capture the long-term toll of COVID-19.

The numbers released by Statistics Canada are not a reason to hit the panic button, said Marisa Creatore, the associate scientific director at the Canadian Institutes of Health Research and an assistant professor in public health at the University of Toronto.

“We’re in the middle of a pandemic, so we would expect that the mortality rates would be a little bit higher right now,” she said, adding it was very unlikely that these rates would continue for the entire lifespan of a baby born today.

The pandemic’s death toll was already clear — more than 25,700 people have died from the virus in Canada since the start of the pandemic, according to the Public Health Agency of Canada — but the hit to life expectancy helps put those losses in context, experts say. 

It’s happened before

It’s not the first time that a health crisis has impacted Canada’s life expectancy at birth.

In 2017, the opioid crisis reduced life expectancy at birth by 0.07 years, according to Statistics Canada. The Public Health Agency of Canada reported more than 19,300 opioid-related deaths from January 2016 to September 2020.

The country’s HIV epidemic, which led to the deaths of about 18,300 people between 1987 and 2011, also contributed to a small drop.

The main difference this time is that COVID-19 claimed a lot more lives in a much shorter period of time. However, those who died were a lot older on average than during the other two health crises.

To understand the impact of these deaths, Statistics Canada estimated what life expectancy would have been if the pandemic hadn’t happened, and calculated how much it changed when they took into account COVID-19 mortality rate in 2020. 

The agency used 2019’s life expectancy of 82.1 years as a baseline for their calculations, because the actual life expectancy for 2020 won’t be known until the number of non-COVID deaths for that year is available.

Life expectancy is used to measure the overall health of a population, and can help determine how well a country or region is doing compared to other places.

Quebec sees biggest drop

Paramedics transfer a person from an ambulance into Verdun hospital in Montreal, Tuesday, December 29, 2020. Quebec was one of the worst hit provinces in Canada. (Graham Hughes/The Canadian Press)

Quebec, which accounted for more than half of Canada’s COVID-19 deaths last year, had a decrease in life expectancy of about 10 months — twice as much as the rest of the country.

“This corresponds with the crisis we saw in the long term care facilities,” said Tim Evans, director of the School of Population and Global Health at McGill University and executive director of the COVID-19 Immunity Task Force. 

“They were understaffed, they were under-equipped to deal with this,” he said, qualifying the death toll in these homes as “very, very, very high.”

Manitoba’s life expectancy was the second worst-affected with a drop of 0.6 years, followed by Ontario and Alberta. 

In comparison, the estimated change to life expectancy in the Atlantic provinces and the territories was minimal, due to the relatively low number of COVID-19 deaths. These regions, which implemented stricter lockdowns at the start of the pandemic and more rigid travel restrictions at their borders, experienced lower cases of the virus than elsewhere in the country. 

Canada faring better than other countries

Canada is doing better than the United States and many other European countries, including France, Italy and Spain, when it comes to this indicator, Statistics Canada found. But it fared worse than Germany, Denmark, Finland, Norway, Australia and New Zealand.

While the agency did not compile estimates for other countries, they used data published by them to make this comparison, said Patrice Dion, the author of the study and a statistician at Statistics Canada.

Citing similar research done in the United States, Dion said the impact of COVID-19 deaths on life expectancy in that country was three times worse than in Canada. “They came up with an estimate of 1.26 years [reduction],” he said.

That’s because Canada’s southern neighbour has a much higher COVID death rate attributed to the virus and people there were dying from it at a younger age, he explained.

Capturing the whole picture

While Statistics Canada’s findings are a good indicator of how taxing the virus has been on the population, it’s important to keep in mind that they don’t reflect the whole picture, Dion said.

“If you have delayed medical care, that may have a negative impact on life expectancy, but maybe there were less traffic accidents for example, and that could have a positive impact,” he said. 

Simply looking at life expectancy also fails to show the damage done to our health care system, said Creatore. “Are people for years to come going to be suffering the impacts of delayed cancer screening, insufficient control of chronic diseases?”

And it doesn’t capture the ways in which the pandemic affected communities differently, she added. “The overall life expectancy can continue to stay lower for several years, because it’s being driven by widening inequities across groups.” 

Low-income and racially diverse neighbourhoods have had higher rates of infections and deaths than more wealthy residential areas. 

“There’s not one number that will give you the whole impact of a pandemic, and even less capture human loss,” said Dion.


Why the conviction of 2 Hamilton paramedics in Yosif Al-Hasnawi’s death may change health care

In a legal first in Canada, two Hamilton paramedics were found guilty for their part in the death of 19-year-old Yosif Al-Hasnawi. Now, emergency responders are questioning what it means for their field and patient care.

Now that a judge has found two Hamilton paramedics guilty for failing to provide the necessaries of life to 19-year-old Yosif Al-Hasnawi, first responders are wondering about the legal implications for the field. (BC Ambulance Service / Stock)

In a legal first in Canada, two paramedics were found guilty for their part in the death of a Hamilton 19-year-old. Now, emergency responders wonder how that precedent might change the way they do their jobs. 

An Ontario Superior Court judge on Tuesday found Steven Snively and Christopher Marchant guilty of failing to provide the necessaries of life to Al-Hasnawi, who had been shot and later died in hospital.

John Schuman, a paramedic and lawyer, says paramedics followed the trial and conviction with intense interest. 

“From the paramedics’ perspective, if we make any mistake now, are we going to get charged? And if we have a bad day, and our judgment’s off, are we going to get charged?” said Schuman, who specializes in family law, education law and children’s rights in Toronto. 

Judge calls death a ‘tragic case’

On Dec. 2, 2017, Al-Hasnawi was outside a mosque with one of his brothers and others. The shooting happened after he intervened when he saw two people accost an older man. Dale King, who shot Al-Hasnawi, was acquitted last year of second-degree murder in a decision now under appeal.

Snively, 55, and Marchant, 32, testified in their trial that they believed the 19-year-old was shot with a BB gun. But they were wrong — it was a .22-calibre handgun, and the teenager died from internal bleeding about one hour later. 

“To say this is a tragic case would be a gross understatement,” Justice Harrison Arrell said in delivering his decision.

The judge ruled there was a “marked departure” from how a properly trained paramedic would have responded. 

The paramedics didn’t identify the wound was a penetrating one and participated in dangerous lifts to move Al-Hasnawi from the sidewalk, Arrell said.

They also delayed leaving the scene down the street from the mosque in Hamilton’s lower city.

“I conclude these various failures by the accused were not simple inadvertence, thoughtlessness or simple errors in judgment, but instead were a conscious decision to ignore their training and standards,” said Arrell.

Al-Hasnawi recites the Qur’an during a religious ceremony moments before he got into an altercation outside the Al-Mustafa Islamic Centre, and was shot and killed. (Al-Mustafa Islamic Centre)

Ramifications throughout health-care field

Schuman said the charge usually relates to people responsible for those in custody, who are entirely dependent on others or children. He stressed the ramifications aren’t exclusive to paramedics, despite them being at the centre of the trial. 

“Because of the way the legal test applies, it should apply to all health-care professions,” he said. 

He wonders if families will insist health-care professionals should be charged if they deviate from protocols or choose a treatment with more “risk” to save someone’s life. 

Dr. Najma Ahmed, an expert in trauma and critical care, testified at the paramedics’ trial that Al-Hasnawi had about a 50 per cent chance of survival that night. 

Mario Posteraro, president of OPSEU Local 256, the union that represents Hamilton paramedics, attended the entire trial, which started in November 2020.

He said that when charges were laid in 2018, “it sent both a chill through the paramedic profession, [and] a bit of a shockwave to the broader health-care sector as to what the potential precedent might be.”

“I think the concern and the chill that occurred when the charges were filed have now deepened, and we don’t really have all of the answers,” he said.

The worry, Posteraro said, is paramedics’ treatment on scene, transport decisions, and the care rendered will be scrutinized through a different lens — one that puts workers “in the direct line of fire.”

John Schuman, a paramedic and lawyer, says health-care professionals will now wonder: ‘If we make any mistake now, are we going to get charged? And if we have a bad day, and our judgment’s off, are we going to get charged?’ (Zoom)

A change for the better, family friend says

Firas Al Najim, a friend of the Al-Hasnawi family and human rights activist, said Tuesday he believes it will change the field for the better. 

“Hopefully there’s not going to be any case in the future. The paramedics are going to know not to deal with a patient like this,” he said. 

“When he’s telling you he can’t breathe, if he’s hurt, just take him to the trauma centre. Do your job. You’re not there to see if he’s acting.”

A substantial section of the trial focused on whether the paramedics followed protocols laid out in the Basic Life Support Patient Care Standards used by Ontario’s Ministry of Health.

Failing to follow protocols, Arrell said, deprived Yosif of his only chance of survival.

Delay was unjustified, judge said

The paramedics spent 23 minutes on scene that night; 17 of those minutes were in the back of the ambulance.

Dr. Richard Verbeek, medical director for Toronto paramedics at the Sunnybrook Centre for Prehospital Medicine, testified for multiple days.

He said 23 minutes would be “within what we might expect given average circumstances at a trauma scene” in North America for blunt and penetrating wounds as a combined category. 

But Verbeek, who edited the standards, noted that a penetrating wound qualified Al-Hasnawi as a “load-and-go” situation to the lead trauma hospital.

Arrell said the wait was “unjustified” and it was foreseeable the paramedics were risking Al-Hasnawi’s life.

Schuman said paramedics are taught to “assume the worst.” But the tests they perform can also change hospital destination, treatment regimens, and how the hospital may react to an incoming patient, he said.

“You don’t want to rush that. You don’t want to have people doing the wrong thing because they’re in a pressure to get moving.”

For a while, he said, people may feel pressure to treat everyone, regardless of presentation, as “being on death’s door.”

“That’s going to consume a lot of resources.” 

Future of care

Posteraro also said it’s a possibility that care will be impacted following the judgment. 

“It may be an extreme on either side of the equation. Perhaps care may suffer as a result of health-care providers, paramedics, looking at a call or treating a patient through a different lens — looking at it more defensively versus in the best interest of the patient,” he said. 

The outcome, Schuman said, may raise questions for workers about remaining as a frontline paramedic or transitioning to a more distanced role, like a supervisor. 


Canada still lacks national guidance for fully vaccinated Canadians as travel restrictions ease

Canada still hasn’t provided clear guidance to fully vaccinated Canadians on what they can and can’t do safely as the number of second doses of COVID-19 vaccines ramps up across the country and travel restrictions are set to ease.

A lack of guidelines has fully vaccinated Canadians confused about what they can and can’t do, but there’s debate in the medical community about how soon that should change. 2:04

Canada still hasn’t provided clear guidance to fully vaccinated Canadians on what they can and can’t do safely as the number of second doses of COVID-19 vaccines ramps up across the country and travel restrictions are set to ease.

More than 60 per cent of the population has at least one dose and more than eight per cent have two, but as our vaccine rollout strategy shifts toward getting more Canadians fully vaccinated — national guidelines for what activities are safe to do still don’t exist.

“We seem to be paralyzed in Canada,” said Dr. Nathan Stall, a geriatrician at Mount Sinai Hospital in Toronto. “We don’t differentiate between who’s vaccinated and unvaccinated.”

The federal government announced Wednesday that fully vaccinated Canadians and permanent residents crossing the border into Canada will soon not have to self-isolate for 14 days if they have a negative COVID-19 test, but there’s no specific direction on what they can actually do safely once they arrive here.

Without guidelines for the fully vaccinated, some experts say Canada is missing an opportunity to give Canadians a roadmap toward something resembling a normal life, while others feel we need to proceed carefully to avoid risking the progress we’ve made.

A man walks by groups of people eating at a bar on Commercial Drive in Vancouver on July 10, 2020. Canada still hasn’t provided clear guidance to fully vaccinated Canadians on what they can and can’t do safely. (Ben Nelms/CBC)

Travel rules unclear

Manitoba Premier Brian Pallister announced Tuesday that fully vaccinated Manitobans will now be able to travel within Canada without having to self-isolate for two weeks after they return, with an immunization card used as proof. 

Nationally, however, vaccine passports have not yet been rolled out and federal officials were unable to provide an exact time as to when quarantine rules will be lifted for fully vaccinated Canadians aside from saying on Wednesday they were aiming for early July.

Unlike Canada, the U.S. Centers for Disease Control and Prevention released guidelines on March 8 for fully vaccinated Americans that said they could safely interact indoors without masks or physically distancing themselves from others who had received both shots.

If you don’t provide guidance, people are going to make it up on their own.– Dr. Isaac Bogoch

The CDC also said those who had two doses can travel both within the U.S. and internationally without testing, as well as skipping quarantine altogether upon return. 

But three months later, Ottawa still hasn’t provided similar guidelines for fully vaccinated Canadians — despite saying over a month ago the guidance was coming “very shortly” — and experts say that could be driving confusion across the country.

“I don’t think we are thinking scientifically here,” Stall said. “Are we going to wait for all Canadians to be fully vaccinated so that we can all move together?” 

Dr. Isaac Bogoch, an infectious diseases physician at Toronto General Hospital and member of Ontario’s COVID-19 vaccine task force, says guidelines are needed now because the number of fully vaccinated Canadians will rapidly accelerate throughout the summer.

“If you don’t provide guidance, people are going to make it up on their own. Some people might obviously throw caution to the wind and others might still be, quite frankly, unnecessarily cooped up,” he said.

“I think it’s fair to say that if you’re fully vaccinated and you’re hanging out with other fully vaccinated individuals you can let your guard down. But I think we need some acknowledgement and some guidance from senior public health leadership.” 

Canada’s Chief Public Health Officer Dr. Theresa Tam did provide some informal guidance for partially vaccinated Canadians on May 14, saying they could socialize with family and friends outdoors over the summer, but has not updated guidelines for the fully vaccinated.

LISTEN | Are you having a two-dose summer? What’s safe to do if you’re fully vaccinated

The Dose23:18Are you having a two-dose summer? What’s safe to do if you’re fully vaccinated

More and more Canadians are getting their second dose of COVID vaccine. So what’s safe for you to do if you’re heading into a two dose summer? Can you travel? Hug your grandkids? Go to restaurants? Infectious diseases specialist Lynora Saxinger has the answers for what life can look if you’re fully vaccinated. 23:18

‘Fragile’ time to relax restrictions in Canada

But some experts say national guidelines for fully vaccinated Canadians could end up encouraging unvaccinated or partially vaccinated Canadians to stop following public health guidelines at a critical time, potentially risking outbreaks of COVID-19 in the weeks and months ahead. 

“Giving advice to one group really is problematic because people are mixing,” said Prof. Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa.  “How can you tell in a crowd who’s been vaccinated?”

Deonandan says he would prefer to see Canada release guidelines on what fully vaccinated Canadians can do once a significant proportion of the population has two doses, rather than giving guidance on an individual level.

“It’s still a narrative of ‘me, me, me’ rather than what does it mean for the population or the community or the country,” he said. “Society doesn’t work that way.” 

Dr. Allison McGeer, a medical microbiologist and infectious diseases specialist at Toronto’s Mount Sinai Hospital, says now is not the right time to relax public health restrictions for fully vaccinated Canadians because hospitalizations and ICU admissions for COVID-19 remain high in parts of the country. 

“Our current control of the pandemic is too fragile,” she said. “In terms of both control of the pandemic and of trying to be equitable about how we’re all getting through this, people who’ve had two doses really need to just be in solidarity with the rest of us.” 

Kevin Allen, 23, gets his first dose of the Pfizer-BioNTech COVID-19 vaccine at an overnight clinic at the International Centre in Mississauga, Ont., on May 16. Prof. Raywat Deonandan says he would prefer to see Canada release guidelines once a significant proportion of the population has two doses. (Evan Mitsui/CBC)

McGeer says one factor that could jeopardize our ability to control COVID-19 levels in Canada is the delta variant first identified in India, also known as B.1.617.2. Early research shows one dose of the vaccines are only about 30 per cent effective against it. 

“The moment we’re talking about delta, one dose is just not worth much anymore,” she said. “Delta is writing its own rules.” 

New data from Public Health England is also discouraging and found that while two doses are more effective than one against delta, it also appears to be more transmissible and can cause more significant illness as well. 

Stall says while there may be uncertainty with delta and other variants in the future, there’s no better time than now to offer clear guidance to vaccinated Canadians. 

“We have six months of data from around the world that vaccines are highly effective at both protecting individuals and at stopping transmission,” he said. 

“It really defies logic. Fundamentally, it’s a Canadian problem. It’s like, we’re all going to move as one because it’s not fair that some people are going to get to go ahead of others.”

Canadians need ‘roadmap’ for ‘life back to normal’

Stall says national guidance could help combat vaccine hesitancy by further instilling trust in the shots and incentivize Canadians to get fully vaccinated by rewarding them with an opportunity to spend much needed quality time with loved ones.

“We need to show people what vaccinated life looks like. What is the carrot to getting vaccinated? Because currently there is not really a carrot — everyone is being asked to follow the same public health measures,” he said.  

“I don’t understand the hesitancy towards accepting the really amazing efficacy of the vaccines and we haven’t provided people on an individual level the roadmap for what life back to normal looks like.”

WATCH | Health minister says fully-vaccinated Canadians will soon be allowed to skip quarantine hotel stay:

Patty Hajdu, Canada’s health minister, said the government is hoping to ease some restrictions in stages, starting in early July. 1:09

Bogoch said Canada should release practical national guidelines similar to the U.S. allowing for small gatherings indoors with other fully vaccinated individuals where the risk of COVID-19 is “negligible,” and for grandparents to hug their unvaccinated grandchildren. 

“If you think about the people who are fully vaccinated, a lot of them are older adults and some of them may have limited life expectancies,” Stall said. 

“These are precious moments that are fleeting. We’ve seen this in long-term care homes, but it also exists within the community as well. How many more Father’s Days, Mother’s Days and birthdays do people have when they’re in their 90s or late 80s?”


Pandemic has left backlog of almost 16 million medical procedures in Ontario, doctors say

The COVID-19 pandemic has left an estimated backlog of 15.9 million surgeries in Ontario, including MRIs, cataract surgeries, joint replacements and coronary bypass surgeries, according to the Ontario Medical Association. Doctors say they’re also worried about a decline in preventative screenings.

MRIs, cataract surgeries, joint replacements and coronary bypass surgery are among the most backlogged procedures during the pandemic, according to the Ontario Medical Association, but there has also been a significant decrease in visits to family doctors. (Diane Grant/CBC)

The COVID-19 pandemic has left an estimated backlog of 15.9 million surgeries, diagnostic exams, screenings and other medical procedures that should otherwise have been performed in Ontario, the Ontario Medical Association (OMA) says. 

That averages out to more than one missed medical procedure per Ontario resident, said OMA president Dr. Adam Kassam in an online media briefing on Wednesday.  

“COVID-19 cases in Ontario are finally falling,” he said. “But three significant waves of infection have created a lengthy backlog of surgeries, diagnostic exams and other health-care procedures.”

In a statement, the OMA estimated that the top six missed or delayed procedures in the province are:

  • MRIs (477,301)
  • CT scans (269,683)
  • Cataract surgeries (90,136)
  • Knee replacements (38,263)
  • Hip replacements (16,506)
  • Coronary bypass surgery (3,163)

These estimates are in addition to the number of people who were already on waiting lists prior to the pandemic, the OMA said. 

The association calculated the numbers by comparing OHIP billings for procedures in 2020 to billings in 2021. That method should give a fairly accurate estimate, Kassam said, because there’s no reason that the number of people requiring medical attention for non-COVID medical conditions would have declined year-over-year.  

“Many conditions are going undiagnosed or underdiagnosed,” he said. “Many people have not yet seen their doctors during this pandemic and may have conditions we actually don’t yet know about.”

Cancer screening, bloodwork down

The backlog for screenings and procedures delivered in the community (for example, those handled at family physicians’ practices) is higher than the backlog in hospitals, the OMA said.

“We have seen less preventative tests done to screen for illnesses, such as mammograms for breast cancer, tests for colon cancer detection and PAP tests for cervical cancer,” said Dr. Sohal Goyal, a family physician and chair of the Mississauga Halton Primary Care Network, who spoke at the OMA briefing. 

“Less cardiac testing has been done to detect heart disease. Less bloodwork for disease detection like high cholesterol.” 

Dr. Sohal Goyal, a family physician in Mississauga, Ont., wants patients to know that primary care facilities are open and patients shouldn’t hesitate to book preventative screenings as well as check-ins for chronic conditions such as diabetes. (Submitted by Dr. Sohal Goyal )

That means the kind of early detection that leads to early treatment or prevention of illnesses, such as stroke, isn’t happening as much as it should, Goyal said.  

In addition, he said, many patients with chronic conditions such as diabetes aren’t being monitored. 

Dr. Sandra Landolt, a dermatologist in Thornhill, Ont., and chair of the OMA’s dermatology section, said she’s worried there’s a “backlog that we don’t even know about yet,” as patients miss early detection of melanoma and other serious skin cancers. 

Clearing backlog could take months

Delays in detection and treatment have meant that cardiac patients are sicker by the time they see a doctor and are put on a waitlist, said Dr. Harindra Wijeysundera, head of the cardiology division at Sunnybrook Health Sciences Centre.  

The OMA also emphasized that mental health issues have increased during the pandemic and will require ongoing care in the years ahead. 

Clearing the backlog would take between four and 22 months, depending on the procedure, if health-care staff worked at 120 per cent — something that’s not sustainable, the OMA said. 

As a result, the association is consulting with its members, other health-care partners (such as nursing associations) and the public to come up with recommendations to more efficiently tackle the backlog, Kassam said.

One of the problems that can be addressed now is the mistaken perception that doctors still aren’t available to see patients during the pandemic, said Goyal, the family physician. 

“We are open,” he said. “Reach out to your doctor.”

“Go for your screening test as the system is opening up. Go for that bloodwork that’s been pending. If you’re vaccine-hesitant, reach out to us and we can help answer your questions.”

Patients anxious as they wait

Both Goyal and Wijeysundera, the cardiologist, said doctors recognize the anxiety many patients are feeling as they continue to endure long waits for procedures or screenings.  

“I acknowledge how hard this is. But I also would encourage all the patients out there who are waiting to not to wait in isolation,” Wijeysundera said. “The wait time is not a static thing.”

“They’re not alone in this, they’re not isolated. Engage with us and we’ll work through a solution,” he said. 

“We understand that you’re feeling anxious or helpless,” Goyal said. “We will do what it takes to make sure that we go through that backlog and support you.

“We’re going to continue to explore more solutions.”


Treatments for post-vaccine blood clots show promise but no ‘slam dunk,’ Canadian doctors say

A Canadian research team has published new evidence highlighting a combination of two treatments that could help patients suffering from a rare, but potentially-deadly, post-vaccine blood clot condition.

A Canadian research team has published new evidence highlighting a combination of two treatments that could help patients suffering from rare, but potentially deadly, post-vaccine blood clots. (Maggie MacPherson/CBC)

Ever since health officials announced Canada’s first known case of rare, post-vaccination blood clots back in April, scientists have been racing to learn more about what causes the potentially deadly condition — and how to treat it.

Now, a team from McMaster University in Hamilton has published new research-backed recommendations calling on clinicians to use a combination of two treatments: anti-clotting drugs alongside high doses of an intravenous, antibody-based therapy.

The potential effectiveness was outlined in three case studies featuring some of the first Canadian patients who developed post-vaccine blood clots, which was published Wednesday in The New England Journal of Medicine.

The three patients between the ages of 63 and 72 were all given a dose of the AstraZeneca-Oxford COVID-19 vaccine, the paper states, and were later diagnosed with vaccine-induced immune thrombotic thrombocytopenia (VITT).

Two developed clotting in their legs, including one who later required amputation, and the third suffered from blocked arteries and veins inside their brain.

WATCH | Researcher explains IVIG treatment:

Ishac Nazy is one of the researchers behind a new paper focused on treatments for post-vaccine blood clots, and the scientific director of the McMaster Platelet Immunology Laboratory. Here, he explains how intravenous immunoglobulin, or IVIG, works to treat patients suffering from these rare, but potentially-deadly, clots. 0:43

“What we recognized early on is that all three patients were treated with anticoagulants [or anti-clotting medication] along with intravenous immunoglobulin, or IVIG,” said Ishac Nazy, one of the researchers behind the new report and the scientific director of the McMaster Platelet Immunology Laboratory.

IVIG is a treatment made up of antibodies that can be given intravenously, and it’s long been used to help treat autoimmune conditions.

The three patients who received the treatment all survived, the paper noted.

How does IVIG work?

So how — and why — does IVIG seem to work for patients with post-vaccine blood clots?

While there’s still more research needed into why the condition happens in the first place, the study team suspects that for certain people, getting vaccinated with a viral-vector shot like AstraZeneca leads to the development of antibodies that attack a particular blood protein, which activates platelets in the bloodstream and causes them to clump together. 

IVIG treatment seems to work by flooding the system with different antibodies, which “outcompete” the patient’s own supply to prevent the chain of events leading to blood clots, Nazy explained.

The McMaster Platelet Immunology Laboratory has over 30 years of research into immune mediated platelet disorders, and operates under the direction of Ishac Nazy, left, Dr. Donald Arnold, centre, and Dr. John Kelton, right. (Submitted by McMaster University)

The team believes the therapy slows down the blood-clotting process, giving anti-clotting drugs time to work.

“This is a multi-faceted approach to try to target the clotting event from different angles,” Nazy said.

Lab work by the team found blood samples from the three patients all showed a drop in platelet activation after the treatment.

Not a ‘perfect drug’

But outside experts on blood-clotting conditions who viewed an advance copy of the paper stressed it’s just a starting point.

While the three case studies are “encouraging,” they only provide anecdotal evidence in an area that warrants far more research, said Halifax-based hematologist Dr. Sudeep Shivakumar, the interim division head and service chief for hematology at Dalhousie University’s Faculty of Medicine.

“It’s not a slam dunk,” he added, “but it does give us ideas for future studies.”

So far, there have been at least five deaths and 28 cases of vaccine-induced immune thrombotic thrombocytopenia, or VITT, reported in Canada following the countrywide distribution of more than 2.8 million doses of the AstraZeneca-Oxford vaccine. (Jeff McIntosh/The Canadian Press)

Dr. Lana Castellucci, a thrombosis physician and researcher with the Ottawa Hospital Research Institute, agrees the findings are just a jumping-off point, but says the recommendations are in line with discussions among clinicians across Canada who are navigating how to treat VITT.

Ontario’s COVID-19 Science Advisory Table, for instance, suggested both anti-clotting drugs and IVIG in its list of VITT treatment options, which formed part of the group’s interim guidance for health-care professionals back in May.

“The potential to see this as ongoing diagnosis remains, and knowing we have treatment strategies that are effective is certainly helpful,” Castellucci said.

Nazy himself acknowledged IVIG is not a “perfect drug,” and doesn’t work for every patient — noting that one of his three wound up requiring a different treatment later on, though he too eventually improved.

There have also been concerns over access and supply levels of the plasma-based treatment in recent years.

National surveillance program set up

The McMaster lab team set up a national surveillance program for VITT earlier this year and physicians around the country began sharing their clinical data, patient samples and treatment plans and progress updates.

That helped the researchers confirm VITT cases before Canadian physicians had encountered the condition, and allowed them to gauge different treatment approaches.

Months later, there are still significant unanswered questions about the mechanism behind VITT, and why it strikes certain individuals in rare circumstances.

So far, there have been at least 28 cases reported in Canada and five deaths, following the countrywide distribution of more than 2.8 million doses of the AstraZeneca vaccine.

“Is there a particular group that’s at greater risk than others?” Castellucci questioned. “Is there an age group that’s at risk? A gender more at risk — females more than males, for example?”

Guidelines allowing Canadians the choice to switch between manufacturers for each shot, and several provinces halting the use of AstraZeneca for first doses, “takes away a lot of the uncertainty” faced by many Canadians, she added.

“We know the mRNA vaccines have not seen complications like this,” Castellucci said.