H5N1

Welcome to the Canadian Covid Society

Via its home page, the Canadian Covid Society introduces itself. Excerpt:

Our Mission  

At the Canadian Covid Society, we strive to protect the health and safety of people in Canada against the harms of COVID-19 and long Covid, through education, engaging and empowering the public and organizations with scientific knowledge.  

The Stakes  

Covid is the 3rd leading cause of death, behind heart disease and cancer.  There have been nearly 30 million excess deaths worldwide since the start of the pandemic.  While the acute phase of the pandemic has ended, the virus continues to cause significant chronic illness.

Global pandemic agreement at risk of falling apart, WHO warns

Via The Guardian: Global pandemic agreement at risk of falling apart, WHO warns. Excerpt:

Plans for a global pandemic preparedness agreement risk falling apart amid wrangling and disinformation, according to the chief of the World Health Organization, who has warned that future generations “may not forgive us”.  

Shaken by the Covid-19 pandemic, the WHO’s 194 member states decided more than two years ago to start negotiating an international accord aimed at ensuring countries are better equipped to deal with the next health catastrophe, or to prevent it altogether.  

The plan was to seal the agreement at the 2024 World Health Assembly, the WHO’s decision-making body, which convenes on 27 May.  

However, Tedros Adhanom Ghebreyesus, the WHO’s director-general, said the momentum had been slowed down by entrenched positions and “a torrent of fake news, lies, and conspiracy theories”.  

He warned that if nobody was prepared to seize the initiative or give ground, the whole project risked going nowhere.  

Tedros told the WHO’s executive board in Geneva on Monday: “Time is very short. And there are several outstanding issues that remain to be resolved.”  

Failure to strike an agreement would be “a missed opportunity for which future generations may not forgive us”, he said.  

Tedros said all countries needed the capacity to detect and share pathogens presenting a risk, and timely access to tests, treatments and vaccines.  

He called for a “strong agreement that will help to protect our children and grandchildren from future pandemics”.  

Tedros said claims that the accord would cede sovereignty to the WHO or give it the power to impose lockdowns and vaccine mandates were “completely false”.  

“We cannot allow this historic agreement, this milestone in global health, to be sabotaged.”  

WHO member states decided in December 2021 to create a new international instrument on pandemic prevention, preparedness and response, aimed at ensuring the flaws that turned Covid-19 into a global crisis could never happen again.  

The WHO emergencies director, Michael Ryan, reminded countries how the pandemic “ripped apart our social, economic and political systems and became a multi-trillion dollar problem”.  

In the midst of major geopolitical conflicts, “this is one thing the world agrees on”, he said.  

Roland Driece, who is co-chairing the negotiations, said the project had condensed a seven-year process into two years.  

He said the accord should be ambitious, innovative and with clear commitments

Canada’s lack of public data about pediatric flu numbers leaves pediatricians ‘flying blind’

Via The Globe and Mail, health reporter Carly Weeks writes: Canada’s lack of public data about pediatric flu numbers leaves pediatricians ‘flying blind’. Excerpt:

At least two children have died in Canada after contracting influenza in recent weeks, but Ottawa has so far not released any data on how flu season is affecting pediatric patients across the country – a situation clinicians say is leaving them in the dark and may be compromising the response to emerging problems.  

“It’s really concerning that we don’t know what’s going on,” said Manish Sadarangani, a pediatric infectious diseases specialist. “I sort of feel like we’re flying blind.”  

“It really helps to know what infections are currently circulating and which infections are causing more severe illness and hospitalization in children,” said Ashley Roberts, a clinical assistant professor of pediatric infectious diseases at the University of British Columbia.  

“To not have that active data present for our clinical care is certainly a loss right now,” Dr. Roberts added.  

Each week, the Public Health Agency of Canada publishes a FluWatch report that details influenza trends across the country. Last season, for instance, the report helped pediatricians understand and respond to soaring rates of hospital admission for the flu at a time when COVID-19 and respiratory syncytial virus (RSV) were also sickening many kids across Canada.  

But as of Oct. 1, FluWatch reports have not included any information on the number of children who have fallen severely ill as a result of the flu. The reports simply state the data were “not available.” 

The lack of information appears to be the result of a decision by PHAC to put a new group in charge of collecting pediatric data on severe outcomes for respiratory viruses.  

On Nov. 1, the agency awarded a new contract to the University of Calgary, PHAC spokesperson Tammy Jarbeau wrote in an e-mail. She said the government is working with the group “on the implementation of the contract and the transition” to ensure the new data will be comparable to information collected in previous years.  

According to another PHAC spokesperson, Marie-Pier Burelle, the government received the first cache of data on Nov. 24, and the information is being used internally. It should be made public sometime this month, she wrote in an e-mail.  

For more than 25 years, Ottawa had been using the same surveillance network, IMPACT, to collect this data. IMPACT, which stands for Canada’s Immunization Monitoring Program ACTive, is run by the Canadian Paediatric Society and has experts based in 12 pediatric sites, representing 90 per cent of tertiary care pediatric beds in the country.  

Dr. Sadarangani, a co-principal investigator of IMPACT, said it’s critical to have data on pediatric respiratory virus outcomes for this season, given that last season hospitals saw an unusually high influx of flu, RSV and COVID-19 cases. And it’s expected that a new vaccine to prevent severe illness in infants with RSV will become available next season, so experts will need detailed information on RSV cases this season to help them determine who should get that vaccine and when, he said.  

“We really need that data this year, almost more than ever,” Dr. Sadarangani said.

Theresa Tam reveals the toll handling COVID-19 took on her

Via The Star, a long interview with Canada's Chief Medical Officer of Health: Theresa Tam reveals the toll handling COVID-19 took on her. Excerpt:

In a wide-ranging interview with the Star, Tam reflected on that experience, opened up about the so-called “Freedom Convoy” movement, and shared what she thinks must be done to rein in an eruption of misinformation — an issue she says is the top threat facing public health today.   

It’s also a threat that targets health professionals themselves: especially the person with the unenviable task of guiding a nation through a crisis that was both catastrophic and poorly understood. 

For Tam, the experience was just as personal as it was punishing. Her words were broadcast across the country every day. People were stuck at home with little to do. And, Tam notes, it was the first pandemic in the social media age.  

“That throws yourself out there as an individual a lot more,” she said. “You're exposed to anyone who can comment in the comment sections. So that was tough.”  

Despite being born in Hong Kong and raised in the United Kingdom, she was accused by conspiracy theorists of working for Beijing and covering up the origins of the disease. Transphobic internet trolls claimed she was not a woman. Commenters seized on racist and misogynistic tropes to raise doubts about her expertise and credibility. None of it was true.  

“That was unacceptable,” Tam said.  

“You kind of had to call out people on that. Not even from a personal perspective — I just think it's unacceptable in our society.”  

She tried not to read the comments, which her communications team monitored closely. The posts disturbed her staff and colleagues. Tam was grateful her parents didn’t use social media, because they would have found the onslaught “very upsetting.”  

Still, she found ways to cope with the barrage of attacks and a relentless schedule that left little time for rest.  

A colleague’s husband helped her put her 1992 mountain bike on a set of rollers so she could cycle from the safety of her home. Before bed, she took up learning Korean: she likes the food, and was interested in the K-pop and K-dramas that have swept the pop culture landscape in recent years.  

She got her piano tuned — she also plays the cello, violin and trumpet — and listened to different kinds of music depending on her mood. If she needed structure, she turned to Bach. Other times, Taylor Swift did the trick.   

Sometimes, during the pandemic’s longest nights, a staff member would read out letters that kids wrote to her. The former pediatric disease specialist is particularly tickled by the LEGO displays she received, including one from colleagues that depicts her at one of her infamous pandemic news conferences, dressed as Wonder Woman. (Tam, a LEGO aficionado, keeps that one in her office.)  

Those were the kinds of handholds Tam hung on to when the “Freedom Convoy” — a demonstration that saw hundreds of vehicles gridlock downtown Ottawa in protest of COVID-19 vaccination mandates and other pandemic restrictions — rolled into town.   

“There were very, very targeted challenges to public health, and people like myself,” Tam recalled. “So that was hard. It meant maybe no movement, really, during that time. You're stuck at home. Friends bring you meals. It was a very restrictive time.”

Communication of COVID-19 misinformation on social media by physicians in the US

Via JAMA Network: Communication of COVID-19 Misinformation on Social Media by Physicians in the US. The key points and abstract:

Key Points  

Question  What types of COVID-19 misinformation have been propagated online by US physicians and through what channels?  

Findings  In this mixed-methods study of high-use social media platforms, physicians from across the US and representing a range of medical specialties were found to propagate COVID-19 misinformation about vaccines, treatments, and masks on large social media and other online platforms and that many had a wide reach based on number of followers.  

Meaning  This study’s findings suggest a need for rigorous evaluation of harm that may be caused by physicians, who hold a uniquely trusted position in society, propagating misinformation; ethical and legal guidelines for propagation of misinformation are needed.  

Abstract  

Importance  Approximately one-third of the more than 1 100 000 confirmed COVID-19–related deaths as of January 18, 2023, were considered preventable if public health recommendations had been followed. Physicians’ propagation of misinformation about COVID-19 on social media and other internet-based platforms has raised professional, public health, and ethical concerns.  

Objective  To characterize (1) the types of COVID-19 misinformation propagated by US physicians after vaccines became available, (2) the online platforms used, and (3) the characteristics of the physicians spreading misinformation.  

Design, Setting, and Participants  Using US Centers for Disease Control and Prevention guidelines for the prevention and treatment of COVID-19 infection during the study window to define misinformation, structured searches of high-use social media platforms (Twitter, Facebook, Instagram, Parler, and YouTube) and news sources (The New York Times, National Public Radio) were conducted to identify COVID-19 misinformation communicated by US-based physicians between January 2021 and December 2022. Physicians’ state of licensure and medical specialty were identified. The number of followers for each physician on 4 major platforms was extracted to estimate reach and qualitative content analysis of the messages was performed.  

Main Outcomes and Measures  Outcome measures included categories of COVID-19 misinformation propagated, the number and traits of physicians engaged in misinformation propagation, and the type of online media channels used to propagate misinformation and potential reach.  

Results  The propagation of COVID-19 misinformation was attributed to 52 physicians in 28 different specialties across all regions of the country. General misinformation categories included vaccines, medication, masks, and other (ie, conspiracy theories). Forty-two physicians (80.8%) posted vaccine misinformation, 40 (76.9%) propagated information in more than 1 category, and 20 (38.5%) posted misinformation on 5 or more platforms. Major themes identified included (1) disputing vaccine safety and effectiveness, (2) promoting medical treatments lacking scientific evidence and/or US Food and Drug Administration approval, (3) disputing mask-wearing effectiveness, and (4) other (unsubstantiated claims, eg, virus origin, government lies, and other conspiracy theories).  

Conclusions and Relevance  In this mixed-methods study of US physician propagation of COVID-19 misinformation on social media, results suggest widespread, inaccurate, and potentially harmful assertions made by physicians across the country who represented a range of subspecialties. Further research is needed to assess the extent of the potential harms associated with physician propagation of misinformation, the motivations for these behaviors, and potential legal and professional recourse to improve accountability for misinformation propagation.

CIHI releases inaugural report exploring priority health care topics in Canada

A news release from the Canadian Institute for Health Information: CIHI releases inaugural report exploring priority health care topics in Canada. Excerpt:

August 2, 2023 —  The Canadian Institute for Health Information (CIHI) has released its inaugural report on priority health care topics, Taking the pulse: A snapshot of Canadian health care, 2023. This report is the first of what will be an annual series — the result of a formal commitment made in early 2023 by the Government of Canada and the provincial and territorial governments to improve health care in Canada in shared priority areas.   

As part of that commitment, governments agreed to work with CIHI to collect, share and learn from health information, with CIHI reporting to Canadians on the priority areas each year. Quebec is not participating in the joint reporting exercise.     

Taking the pulse: A snapshot of Canadian health care, 2023 offers Canadians an initial overview of where we are today in the 4 priority areas:  

• Expanding family health services and improving access to primary health care  

• Increasing the supply of health workers and decreasing backlogs in care to support resilient health systems  Improving access to mental health and substance use services   

• Modernizing health care’s information systems and digital tools for the secure sharing of electronic health information  

The indicator results (none of which include data from Quebec) are based on publicly available data stemming from a partnership between Canada Health Infoway, integrated youth services networks, Statistics Canada and CIHI.  

Selected indicator highlights include the following:  

• 88% of Canadians age 12 and older reported having a regular health care provider.  

• There were about 743,000 fewer surgeries performed in Canada during the first 2.5 years of the pandemic, a drop of about 13% compared with before the pandemic.  

• Half of Canadians who required community mental health counselling received a first appointment in less than a month, while 1 in 10 waited about 4 months (data is not available for Prince Edward Island, Quebec, Ontario and Nunavut).  

• Fewer than 40% of Canadians have accessed their personal health information online.

How Canada’s decentralised covid-19 response affected public health data and decision making

This is a major report that deserves close attention. Via The BMJ: How Canada’s decentralised covid-19 response affected public health data and decision making. Excerpts:

Highs and lows of covid-19 response in Canada  

Highs 

• Public health leadership included women at each level of decision making. 

• Canada became one of the most vaccinated countries with >83% of the population receiving at least one vaccine dose in February 2023. After Health Canada approved Pfizer-BioNTech and the Moderna covid-19 vaccine in December 2020, rollout was prioritised for indigenous populations and those living and working in long term care homes  

• Research collaborations from basic science through to clinical and health services research emerged rapidly to address urgent questions of seroprevalence (eg, covid-19 Immunity Task Force), correlates of infection and immunity, and outbreak mitigation factors and engagement of patients in research conduct such as knowledge synthesis  

Lows  

• Failure to learn from previous reports led to failure to protect older adults and staff in long term care homes and among the highest proportions of deaths in this sector globally  

• Challenges to access and delivery of effective covid-19 medications such as tocilizumab, remdesivir, and ritonavir-nirmatrelvir resulted in provinces and hospitals rationing use  

• An exodus of exhausted and distressed healthcare workers, coupled with inadequate training paths for replacements, produced a critical workforce shortage that is ongoing  

• Canada lacked a coordinated system for evidence generation and use across government jurisdictions  

• Lack of research infrastructure embedded within the healthcare system limited Canada’s ability to participate in or lead clinical trials or other international studies 

• Lack of a clear and standardised approach to case definitions and testing contributed to inability to share use of data and make decisions           

• Absence of data sharing agreements across federal and provincial or territorial jurisdictions slowed or limited data sharing

Key messages

• Canada’s public health system was insufficiently prepared for the covid-19 pandemic

• Public health decisions and outcomes varied across jurisdictions and were hampered by outdated health information systems and lack of integration 

• Decentralisation of public health decision making has benefits such as tailoring interventions to local constituencies, but during a crisis, governance structures need to pivot to enable coordination and systematisation of data collection and analyses 

• Gaps in data and decision structures created a vacuum, filled by science advisory committees with disparate roles, responsibilities, and accountabilities within different jurisdictions 

• A shift to a culture of data access and shared analysis is needed to enhance health system learning and population health benefit, and for future crisis and pandemic preparedness

Goodbye, Johns Hopkins covid tracker

Via The Washington Post: Goodbye, Johns Hopkins covid tracker. Excerpt:

When the pandemic hit, the federal government struggled to publish snapshots of the virus’ spread.  

So, academics and journalists quickly filled the void, creating new tools with near real-time estimates of the unfolding pandemic. Since January 2020, Johns Hopkins University has operated one of the most prominent resources for tracking covid-19 case counts and deaths across the world.   

After more than three years, the university will stop updating its tracker on March 10 as the country has moved into a different stage of the pandemic with a different data flow. But the story of the online dashboard — a $13 million project that’s been viewed over 2.5 billion times — is more than just about a tool to track the pandemic. It underscores the country’s fragmented public health systems and its decentralized and underfunded reporting system, which hobbled the U.S. pandemic response.    

“The thing that became the biggest surprise was the importance and reliance on it by everyone: by the general public and decision-makers and everyone in between,” said Lauren Gardner, the director of the Johns Hopkins Center for Systems Science and Engineering who started the global tracker with one of her PhD students.  

“Hopkins filled a gap that nobody else was able to do,” Ali Mokdad, a professor of health metrics sciences at University of Washington’s IHME. “So all of us, reporters, us in academia, we went to Hopkins to get the data.”  

Why now?  

The Johns Hopkins researchers point out that they don’t believe the pandemic has ended — and the move to stop updating the tracker shouldn’t be conflated as such. Instead, the decision comes amid a different phase of the pandemic and was made for two main reasons.   

The first: The Centers for Disease Control and Prevention and the World Health Organization have built up their capacity to share covid data with the general public, which Gardner called the “appropriate” entities to be providing this information long term.   

The second: The quality of the tracker depends on the quality of publicly available data. At the beginning of the pandemic, states, counties and even cities were providing daily covid updates, which scrapers for the tracker could collect data from. But that’s not the case anymore, and that has a direct impact on what the dashboard can do.   

Looking forward  

The country has made some improvements on its data collection efforts, but there’s still a ways to go, according to several experts.   

Beth Blauer, an associate vice provost at Johns Hopkins University who helped run the Coronavirus Resource Center, said that many states closed up their covid reporting with little information on any next steps.  

“Our big question is whether or not they’re making long-term investments in critical public health data infrastructure to navigate lots of challenges that they face,” Blauer said, citing the opioid epidemic and economic mobility. 

WHO meets with Chinese officials on current COVID-19 situation

A statement by WHO: WHO meets with Chinese officials on current COVID-19 situation. Evidently WHO has run out of praise for China's response:

A high-level meeting took place on 30 December between WHO and China about the current surge in COVID-19 cases, to seek further information on the situation, and to offer WHO's expertise and further support.  

High-level officials from China's National Health Commission and the National Disease Control and Prevention Administration briefed WHO on China's evolving strategy and actions in the areas of epidemiology, monitoring of variants, vaccination, clinical care, communication and R&D.   

WHO again asked for regular sharing of specific and real-time data on the epidemiological situation — including more genetic sequencing data, data on disease impact including hospitalisations, intensive care unit (ICU) admissions and deaths — and data on vaccinations delivered and vaccination status, especially in vulnerable people and those over 60 years old.  WHO reiterated the importance of vaccination and boosters to protect against severe disease and death for people at higher risk.    

WHO called on China to strengthen viral sequencing, clinical management and impact assessment, and expressed willingness to provide support on these areas, as well as on risk communications on vaccination to counter hesitancy. Chinese scientists are invited to engage more closely in WHO-led COVID-19 expert networks including the COVID-19 clinical management network. WHO has invited Chinese scientists to present detailed data on viral sequencing at a meeting of the Technical Advisory Group on SARS-CoV-2 Virus Evolution on 3 January.  

WHO stressed the importance of monitoring and the timely publication of data to help China and the global community to formulate accurate risk assessments and to inform effective responses.

US CDC begins agency-wide changes after pandemic failures

Via The Lancet: US CDC begins agency-wide changes after pandemic failures. Excerpt:

The US Centers for Disease Control and Prevention (CDC) is on a mission to reorganise and modernise itself, so that its mistakes during the pandemic will not happen again. The aim is to make the nation's leading disease detective more nimble and accountable, and fortify its role as public health protector. But although some changes have been made, progress will be limited without support from the US Congress. 

The CDC's Director, Rochelle Walensky, an infectious disease physician and research scientist appointed by President Joe Biden in January, 2021, commissioned an independent review of the CDC's pandemic record in April, conducted by James McCrae, Associate Administrator for Primary Health Care in the Department of Health and Human Services’ Health Resources and Services Administration. “To be frank, we are responsible for some pretty dramatic, pretty public mistakes, from testing to data to communications”, Walensky told her roughly 11 000 staff when she unveiled a summary of the review's findings in August (panel).  

Panel  

Key findings and recommendations from the CDC review  

It takes too long for the CDC to publish its data and science for decision making  

• Create an online mechanism for pre-publication delivery of science  

• Expedite the review or approval process for scientific publications and data (including laboratory data) to match the needs of the emergency  

The agency's turnover of staff during the COVID-19 response created gaps and other challenges for partners   

• Increase the number of CDC leaders trained and ready to deploy to a response  

• Require a minimum of 6-month rotation for leadership positions on the response; build a redundancy model of emergency staffing (ie, backup or co-lead staff in all key positions) to prevent response burnout and assure continuity in operations  

The agency's guidance documents are confusing and overwhelming, and the website is not easy to navigate  

• Produce plain-language, easy-to-understand implementation guidance documents that apply over multiple settings; reduce the number and length of guidance documents; include a brief scientific rationale or background in the implementation guidance with a referenced or accompanying Morbidity and Mortality Weekly Report, Science Brief, as necessary  

• Restructure the agency web site and digital communication platforms to eliminate unnecessary content and focus on key target audiences with a primary emphasis on the public  

COVID-19 uncovered the need for flexibilities that do not exist today at the CDC  

• Establish new authorities that will allow the CDC to be more nimble and work faster, such as public health and regulatory authorities mandating data collection from local jurisdictions, and human resource authorities with authority to hire faster, and ensure competitive salaries to recruit and retain for hard-to-fill positions like data scientists