H5N1

Joint statement on BC’s COVID-19 response, latest updates

Via BC Government News: Joint statement on B.C.’s COVID-19 response, latest updates. Excerpt:

Dr. Bonnie Henry, B.C.’s provincial health officer, and Adrian Dix, Minister of Health, have issued the following joint statement regarding updates on the novel coronavirus (COVID-19) response in British Columbia:  

“Today, we are reporting 941 new cases of COVID-19 in the last 24 hours, for a total of 28,348 cases in British Columbia.  

“There are 7,732 active cases of COVID-19 in the province. There are 284 individuals currently hospitalized with COVID-19, 61 of whom are in intensive care. The remaining people are recovering at home in self-isolation. 

“Currently, 10,283 people are under active public health monitoring as a result of identified exposure to known cases and 19,605 people who tested positive have recovered. 

“Since we last reported, we have had 174 new cases of COVID-19 in the Vancouver Coastal Health region, 678 in the Fraser Health region, 11 in the Island Health region, 49 in the Interior Health region, 29 in the Northern Health region and no new cases of people who reside outside of Canada.  

“There have been 10 new COVID-19 related deaths, for a total of 358 deaths in British Columbia. We offer our condolences to everyone who has lost their loved ones during the COVID-19 pandemic.  

“We have two new health-care facility outbreaks at Valley Haven Care Home and Little Mountain Place. The outbreak at Fraserview Intermediate Care Lodge has been declared over. There have been no new community outbreaks. 

“B.C.’s health-care workers are in our labs and hospitals, at our testing sites and in our communities. These people are our health-care system. They are there to support all of us without question and without pause, and we need to show that same support to them by all of us doing our part. 

“We need to slow the spread of COVID-19 in our province and that needs to happen now. That is why we have paused all gatherings, events and indoor group fitness activities. 

“That is also why everyone, young and old, needs to pause their social interactions and increase their layers of protection and stay within their local communities as much as possible.  

“We need to ease the pressure to allow us to get over this next hurdle, and importantly, give us the ability to once again enjoy those things that are important to all of us. 

“Let’s remember that every case of COVID-19 is a person who requires support and care, who may become severely ill and need to be in hospital, and whose family will experience the stress, emotional burden and for some, the tragedy, that has come with this virus. 

“Let’s step up our efforts to protect our families, friends and neighbours. The time to do that is now.”

COVID-19 deaths among US clinicians

Via JAMA Network: COVID-19 Deaths Among US Clinicians.

More than 100 000 US health care personnel have contracted coronavirus disease 2019 (COVID-19) since February and at least 641 have died, according to a report by health officials from the CDC and several states. 

Based on data reported to the CDC between February 12 and July 16, the report reflects a 10-fold increase in cases among personnel at health care facilities since the last CDC analysis in April. At that time, nearly 10 000 COVID-19 cases and 27 deaths had been reported. The authors note that the current total likely underestimates the true number of cases among health care personnel because occupational status was available for fewer than one-quarter who had COVID-19. 

Among nearly 7000 health care personnel with COVID-19 for whom workplace data were available, two-thirds worked in nursing homes or residential care facilities. About one-third of almost 6000 cases with their occupation reported occurred among health care support workers—nursing assistants, medical assistants, and other providers or aides. Nurses accounted for 29% and physicians for about 3% of cases. Among nonclinical staff, 581 administrative staff and 330 environmental health workers contracted the disease. 

Health worker deaths from COVID-19 were most common among men, those aged 65 years or older, and Asian or Black adults. Ninety-two percent of those who died had an underlying health condition compared with 41% of workers who survived. More than half of those who died had cardiovascular disease or diabetes; one-third had both.  

The authors recommended ensuring universal mask use in health care settings, screening for illness before entering the workplace, granting nonpunitive sick leave policies, and recognizing the social inequities that put some workers at higher risk in the workplace and at home. 

“Ensuring adequate allocation of PPE [personal protective equipment] to all [health care personnel] in the workplace is one important approach to mitigating systemic inequalities in COVID-19 risk,” the authors wrote.

North Dakota Nurses Association against governor’s decision to allow COVID-positive nurses to keep working

Via KFGO: North Dakota Nurses Association against governor’s decision to allow COVID-positive nurses to keep working. 

BISMARCK, N.D. (KFGO) – The North Dakota Nurses Association says it does not support the decision by Governor Burgum to allow nurses who are asymptomatic, COVID-19 positive to continue to work in COVID-19 units at hospitals and nursing homes. Burgum says the decision was made to mitigate staffing shortages as the pandemic outbreak continues to spike and hospitals are reaching their limits.  

The Nurses Association says guidance outlined by the CDC about providing care under these circumstances is the decision of the COVID-19 positive nurse and their willingness to work. If a nurse believes they are not well enough to provide safe patient care and chooses not to work under these circumstances, employers should not retaliate against the nurse for making this decision.  

NDNA says all other measures to reduce the demand on the health care system and address staffing shortages should be used before implementing this particular strategy. This should include effective and scientifically proven preventative measures such as mandating mask-wearing in public places, maintaining physical distancing, and exercising good hand hygiene.  

Burgum said hospital administrators asked for the extraordinary action to be taken and interim State Health Officer Dirk Wilke amended an order to allow the new measure to take effect.

Nursing homes still see dangerously long waits for Covid-19 test results

Via CNN.com, a report by Rachana Pradhan, Jordan Rau, and Lauren Weber of Kaiser Health News: Nursing homes still see dangerously long waits for Covid-19 test results. Excerpt:

(KHN)Nursing homes are still taking days to get back Covid-19 test results as many shun the Trump administration's central strategy to limit the spread of the virus among old and sick Americans. 

In late summer, federal officials began distributing to nursing homes millions of point-of-care antigen tests, which can be given on-site and report the presence or absence of the virus within minutes. By January, the Department of Health and Human Services is slated to send roughly 23 million rapid tests. 

But as of Oct. 25, 38% of the nation's roughly 15,000 nursing homes have yet to use a point-of-care test, a KHN analysis of nursing home records shows. 

The numbers suggest a basic disagreement among the Trump administration, state health officials and nursing home administrators over the best way to test this population and how to strike the right balance between speed and accuracy. Many nursing homes still primarily send samples out to laboratories, using a type of test that's considered more reliable but can take days to deliver results. 

As a result, in 29% of the approximately 13,000 facilities that provided their testing speed to the government, results for residents took an average of three days or more, the analysis found. Just 17% of nursing homes reported their average turnaround time was less than a day, and the remainder tended to get results in one or two days. Wait times for test results of staff members were similar. 

Those lags could have devastating consequences, because even one undetected infection can quietly but rapidly trigger a broad outbreak. It's especially concerning as winter sets in and the pandemic notches daily records of infections. 

In the meantime, the coronavirus continues its march through institutions. Nursing homes have reported more than 262,000 infections and 59,000 deaths since the government began collecting the information in May. Even without estimating how many residents died from Covid-19 before then, reported nursing home deaths amount to more than a quarter of all Covid-19 fatalities in the U.S. so far. 

During the week ending Oct. 25, the most recent period for which data is available, a third of skilled nursing facilities reported a new suspected or confirmed coronavirus infection of a resident or staff member.

Osterholm: 200,000 cases a day? 'It's going to happen'

Via The Washington Post: With coronavirus cases spiking nationwide, all signs point to a harrowing autumn. Excerpt:

This is the dismal reality America faces as the coronavirus continues its unchecked surge around the country: In North Dakota, health-care workers with asymptomatic cases of the coronavirus will be allowed to keep working as the number of infected patients outstrips the staff members needed to care for them, the governor said this week.

In multiple states, hospital leaders warned that the current spike is straining resources and sidelining the very staffers needed to face growing numbers of sick people. From Maryland to Iowa, local officials have pleaded for tighter restrictions that might help slow the virus’s accelerating spread.  

As a worrisome summer gives way to a harrowing fall, the nation’s surge of coronavirus cases shows no signs of easing. With little help and scant guidance from a Washington stuck in political limbo, some states and localities rushed to put in place new restrictions aimed at slowing the virus’s spread. Still, almost every metric appeared headed in an ominous direction. 

On Tuesday, the country hit another one-day record, logging more than 135,000 new coronavirus cases, along with 1,403 additional deaths. At least five states, including Missouri and Wisconsin, set single-day highs for fatalities. At least five more, including Illinois and Pennsylvania, set single-day highs for new cases. Almost nowhere in the country are caseloads actually subsiding. 

“We’re now seeing widespread community transmission,” said Maryland Gov. Larry Hogan (R). “More people are getting infected with the virus, more people are being hospitalized and going into intensive care, and more people are dying.”  

He announced plans to return the state to restrictions that haven’t been in place for months, including a 50 percent capacity limit on restaurants and a new health advisory urging a 25-person cap on indoor gatherings. Hogan also issued an updated travel advisory, asking residents to avoid nonessential travel to 35 states with high infection rates. 

Nearly 62,000 infected Americans currently lie in hospital beds — a number the nation has not experienced since April. More than a dozen states have hit new highs for hospitalizations this month, with many setting records again on Tuesday, according to figures compiled by The Washington Post. 

“I’m not sure it disappoints me as much as it scares the hell out of me,” said Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “This is like one huge coronavirus forest fire, and I don’t think it’s going to spare much human wood out there unless we change our behavior.” 

More likely, he said, the grim present will grow only darker as the fall wears on. Despite positive news this week, no vaccine will arrive in time to quickly alter the current trajectory. In many places, bars, gyms and restaurants remain open. Weddings and funerals continue. People fighting pandemic fatigue or who are dismissive of the risks are gathering with friends and family, and doing so more often indoors as cold weather arrives.  

Osterholm believes the United States will soon see new confirmed cases climb above 200,000 a day — a figure that would have seemed unfathomable when daily infections peaked at roughly 30,000 new cases a day last spring. 

“I don’t see anything changing this right now. The behaviors are not changing,” he said. “The deaths will go up precipitously over the course of the next month. It’s going to happen.”

With North Dakota hospitals at 100% capacity, Burgum announces COVID-positive nurses can stay at work

Via the Grand Forks Herald: With North Dakota hospitals at 100% capacity, Burgum announces COVID-positive nurses can stay at work. Excerpt:

BISMARCK — North Dakota's hospitals have reached their limit, and the coming weeks could push them past their capabilities, Gov. Doug Burgum said at a news conference on Monday, Nov. 9. 

Due to a major shortage of health care staffing, the state's hospitals have a severe lack of available beds. Rising COVID-19 hospitalizations and high noncoronavirus admissions, some resulting from residents who deferred health care earlier in the pandemic, have caused the crunch on medical centers.  

Burgum said hospitals are implementing their "surge" plans, and some will be voluntarily stopping elective surgeries to free up staff. He added that the state will coordinate with hospitals to move nurses to medical centers in most dire need of staff. 

In an attempt to alleviate some of the staffing concerns, Burgum announced that interim State Health Officer Dirk Wilke has amended an order that will allow health care workers with asymptomatic cases of COVID-19 to continue working in COVID-19 units at hospitals and nursing homes. 

The move aligns with "crisis" guidelines from the Centers for Disease Control and Prevention. Since only patients with COVID-19 could receive care from doctors and nurses with the virus, Burgum said he believes there will be little risk of more spread. He added that health care workers in COVID-19 units already wear protective gear to prevent them from contracting the virus.  

The Republican governor said health care providers asked the state to take the extraordinary step, adding that "apparently some (providers) had the ability to do this in other states." 

Burgum spokesman Mike Nowatzki said he didn't have information on other states that have allowed nurses with COVID-19 to return to work and referred Forum News Service to the state Health Department and hospitals who asked for the measure.  

Department of Health spokeswoman Nicole Peske and Sanford Bismarck spokesman Jon Berg both said they were unaware of any other states that have taken the extreme step. 

Scattered news reports from around the country suggest that some nursing homes have allowed workers with asymptomatic cases of COVID-19 to stay on the job, but Forum News Service could find no evidence of a defined policy exception put in place by a state government.   

Burgum also announced that the state would be sending out new-age rapid tests to hospitals, nursing homes, schools and colleges. He said the tests that can produce results in as little as 15 minutes could free up health care workers who might have been relegated to the sidelines while waiting for test results. 

The governor added that the state is looking to hire emergency medical technicians and paramedics to run COVID-19 testing operations, which would allow nurses who are currently administering tests to begin working in hospitals.

COVID-19 in BC: 589 new cases, 2 new deaths

Via BC Government News: Joint statement on B.C.’s COVID-19 response, latest updates. Except:

Dr. Bonnie Henry, B.C.’s provincial health officer, and Adrian Dix, Minister of Health, have issued the following joint statement regarding updates on the novel coronavirus (COVID-19) response in British Columbia:  

“Today, we are reporting 589 new cases, including five epi-linked cases, for a total of 17,149 cases in British Columbia.  

“There are 3,741 active cases of COVID-19 in the province, 7,887 people who are under active public health monitoring as a result of identified exposure to known cases and 13,035 people who tested positive have recovered.  

“Currently, 104 individuals are hospitalized with COVID-19, 28 of whom are in intensive care. The remaining people with COVID-19 are recovering at home in self-isolation.  

“There have been 146 new cases of COVID-19 in the Vancouver Coastal Health region, 402 in the Fraser Health region, five in the Island Health region, 24 in the Interior Health region, 12 in the Northern Health region and no new cases of people who reside outside of Canada.  

“There have been two new COVID-19 related deaths, for a total of 275 deaths in British Columbia. We offer our condolences to everyone who has lost their loved ones during the COVID-19 pandemic.  

“There have been six new health-care facility outbreaks at Suncreek Village, Fort Langley Seniors Community, Northcrest Care Centre, Fellburn Care Center – PATH unit, Ridge Meadows Hospital and Langley Memorial Hospital. The outbreak at Fair Haven Homes Burnaby Lodge has been declared over. In total, 31 long-term care or assisted-living facilities and four acute-care facilities have active outbreaks. 

“There has been one new community outbreak at the Royal Inland Hospital construction site. There continue to be exposure events around the province. Public alerts and notifications are posted on the BC Centre for Disease Control’s (BCCDC) website and on all health authorities’ websites."

The Brazilian government's mistakes in responding to the COVID-19 pandemic

Via The Lancet, correspondence: The Brazilian Government's mistakes in responding to the COVID-19 pandemic.

It is unfortunate to read the unsubstantiated and misguided opinion of a few physicians about the role of the current administration during the COVID-19 crisis in Brazil. For those of the international scientific community who base their understanding on reliable data, the conclusion that Brazil has shown one of the worst responses to the pandemic is unequivocal. 

The gravity of the pandemic in Brazil is evidenced by the current epidemiological facts: Brazil is among the three countries with the largest number of confirmed cases (more than 5 million as of Oct 15, 2020, according to WHO), with high mortality, evidence of underreporting, and a high number of deaths among health professionals, pregnant women, and the indigenous population. 

The federal government's denial of science and, consequently, of the seriousness of the pandemic to the health and wellbeing of Brazilians has led to a failure to coordinate, promote, and finance internationally sanctioned public health measures. The ministry of health has not developed a national plan to combat the pandemic, nor has any other federal government agency. States and municipalities continue to be neglected and receive insufficient assistance. Influenced by political interests, the federal government has disrupted the flow of financial transfers and slowed the deliveries of essential supplies to certain regions. 

Furthermore, Brazil's public health system, Sistema Único de Saude (SUS), is the largest in the world and provides universal coverage without any cost to patients. It is accessible nationwide and provides community-based primary health care to more than 70% of the population. Yet, primary health care has been overlooked by the federal government as a key element in this public health crisis response. 

Financial emergency aid to the most vulnerable populations was gravely delayed, insufficient, and cumbersome to obtain. Moreover, the federal administration denies international recommendations for non-pharmacological interventions, refusing to establish a national mandate for social isolation and mask use.

It is necessary to analyse the Brazilian Government's response to the COVID-19 pandemic based on trustworthy knowledge built upon scientific facts. The negative effects of governmental decisions represent important risks to the health of Brazilians and for the pandemic's global situation. A coordinated political response guided by social justice and evidence-based knowledge is essential to managing any public health emergency, especially one with as broad economic and health impacts as COVID-19. Regrettably, this is not what is happening in Brazil.

The key lesson from SARS that Canada failed to heed when COVID-19 hit

Via CBC News Second Opinion: The key lesson from SARS that Canada failed to heed when COVID-19 hit. Excerpt:

In the years that followed the 2003 SARS outbreak that infected over 400 Canadians and killed 44, an independent inquiry was launched in Ontario to investigate the response to the outbreak and learn from the mistakes made. 

Some of the experts involved in that inquiry say there was one key lesson learned at the time — which Canada failed to apply when the coronavirus pandemic hit.  

At the helm of the 2007 SARS Commission was Justice Archie Campbell, a superior court judge with an "insatiable curiosity," who colleagues say was determined to ensure the lessons from the outbreak were never forgotten.    

As Campbell met with advisers in the library of a federal building in downtown Toronto, he noted how decades of previous royal commission reports were there just collecting dust on the shelves. 

"We would look around the room and he'd point out a royal commission and he'd say, 'As far as I know, that is as far as the recommendations of that royal commission got. They're sitting on the library shelf,'" remembers lawyer Doug Hunt, chief counsel for the commission. "And he said, 'I do not want ours to end up that way.'"  

That was the driving force behind the inquiry, which aimed to thoroughly investigate the outbreak and make clear recommendations that governments would want to follow in the face of future infectious disease outbreaks.  

"We had great hope at the time," said Hunt. "But I think in the end, from a government standpoint, it did end up just on the shelves of that library."    

Canada didn't 'err on the side of caution' early in pandemic  

Canada has faced a much more dire situation in the coronavirus pandemic, with more than 190,000 COVID-19 cases and 9,700 deaths in the eight months since it began.  

But experts who worked on the SARS Commission say if the lessons from SARS had been better applied early on, the country could have fared much better.    

"Canada, China, Hong Kong and Taiwan had more than 90 per cent of all SARS cases and deaths, so they're the ones who we should be comparing ourselves to," said Mario Possamai, a senior adviser to Campbell on the SARS Commission. "Canada now has more COVID-19 deaths and cases than China, Taiwan and Hong Kong combined." 

He said the most important lesson from the SARS Commission was a concept called the "precautionary principle," a strategy that future governments could apply to ensure the situation didn't get out of control.  

The basic tenet of that principle is to always take the safest approach in an outbreak and not wait for all of the scientific evidence before acting.   

"What Justice Campbell said was that when there is scientific uncertainty, err on the side of caution and protect health care workers and protect Canadians," said Possamai. "And we didn't do that."  

Possamai said early hesitation on closing borders to international travellers, the resistance to recommending the use of masks for the general public and the impact of a depleted national stockpile of PPE had devastating consequences on Canada's ability to control COVID-19.  

"In case after case, a precautionary approach would have made a difference," said Possamai. "We were not only late in moving in that direction, but there was a real lack of transparency."   

Time and time again the Public Health Agency of Canada assured Canadians it was using the best guidance available, but declined to cite the specific scientific evidence behind its decisions, like its reluctance to acknowledge asymptomatic transmission and the possibility of airborne spread of the virus — something Possamai said caused confusion. 

"What were the studies? What was the science?" he asked. "It's completely opaque."   

Hunt said the lack of personal protective equipment available to frontline health-care workers at the beginning of the pandemic was "inexcusable," and called the decision to destroy millions of expired N95 masks last year "mind-boggling." 

The federal government was widely criticized early in the pandemic for failing to maintain an adequate supply of personal protective equipment in the National Emergency Strategic Stockpile (NESS), and for sending 16 tons of PPE to China, leading to a scramble to procure supplies. Canada has since become almost entirely self-sufficient in producing its own PPE, and China has repaid the donation. 

Canada's Chief Public Health Officer Dr. Theresa Tam finally conceded this week that the science is "evolving" on whether COVID-19 can be transmitted via aerosols — or microscopic airborne particles — yet PHAC's guidelines still make no mention of it. 

"In key areas, we just didn't take a precautionary approach," Possamai said. "The kinds of arguments that the federal government made at the time didn't make sense then, and make even less sense now."

Canada 'must do a lot better' at protecting elderly in 2nd wave

Prime Minister Justin Trudeau responded to questions last week about whether Canada's lessons from SARS had been followed, after the release of a report Possamai authored that alleged Canada put health-care workers at undue risk of COVID-19.

"As we look back on those first months, there are a lot of things we could have done differently, we should have done differently, and things we're learning from," Trudeau said during a news conference on Oct. 5.

"At the same time, many of the things that we were able to do successfully in those first months of the COVID-19 pandemic were based on lessons learned from SARS."

 

Czechs plan first field hospital as COVID-19 infections soar

Via Reuters: Czechs plan first field hospital as COVID-19 infections soar. Excerpt:

PRAGUE (Reuters) - The Czech Republic will start building capacity for COVID-19 patients outside of hospitals, officials said on Thursday, as the country grapples with the fastest rate of infections in Europe, putting healthcare under severe strain.

Coronavirus cases have nearly doubled in October alone to a total so far of 139,290 since the pandemic erupted in March. The Health Ministry reported 9,544 new COVID-19 cases on Wednesday, its highest one-day tally so far.  

The central European country, with a population of 10.7 million, is recording the continent’s fastest per capita rise in infections and deaths from the respiratory disease, forcing hospitals to scramble to free up space.  

The number of patients needing care has more than doubled since Oct. 4 to a current count of 2,678, of which a fifth need intensive care. COVID-related deaths have climbed to 1,172, up 75% this month. 

The head of the Czech Medical Chamber pleaded on Thursday with doctors who have left to work abroad to return home to help as the number of infections among healthcare workers rises. 

The government was also drawing up plans for makeshift hospitals. Interior Minister Jan Hamacek told CTK news agency the army would start building an area for 500 hospital beds at the Letnany fairground in Prague from Saturday.