H5N1

High and rising working-age mortality in the US: A report from the National Academies of Sciences, Engineering, and Medicine

Via JAMA Network: High and Rising Working-Age Mortality in the US: A Report From the National Academies of Sciences, Engineering, and Medicine. Excerpt:

Life expectancy has increased in the US and in the world for the past century. In 2010, life expectancy plateaued in the US while continuing to increase in other high-income nations. In the US, life expectancy declined for 3 consecutive years (2015-2017) due primarily to an increase in mortality among working-age adults (those aged 25-64 years). Although the increase in mortality was first described among White middle-aged adults, mortality is now increasing among young and middle-aged adults and in all racial groups. 

This increase in premature death, claiming lives during the prime working ages, has important implications for individuals, families, communities, employers, and the nation. 

A new report from a National Academies of Sciences, Engineering, and Medicine committee studied mortality data from 1990 to 2017 by cause of death, age, sex, race/ethnicity, socioeconomic status, and geography. It found that average working-age mortality rates decreased after 2010 in 16 high-income countries but increased in the US. 

Three causes of death were identified as chiefly responsible: (1) drug poisoning and alcohol-induced causes, (2) suicide, and (3) cardiometabolic diseases. The first category includes mortality from mental and behavioral disorders, which often involve drugs or alcohol. Cardiometabolic diseases include endocrine, nutritional, and metabolic diseases (eg, diabetes, obesity); hypertensive heart disease; and ischemic heart disease and other diseases of the circulatory system (eg, arrhythmia, cardiomyopathy, heart failure). 

Mortality among working-age adults increased from other causes (eg, liver cancer, neurological diseases, homicides, transportation injuries), but none individually made large contributions to the overall trend.

Canada’s COVID-19 death toll from first months of pandemic higher than thought, data show

Via The Globe and Mail: Canada’s COVID-19 death toll from first months of pandemic higher than thought, data show. Excerpt:

The loss of life in the pandemic’s first nine months was more widespread than official numbers indicated, with mortality spiking sharply even in provinces that reported relatively low death tolls from the virus, according to newly available national data. 

 A revised geography of the pandemic in Canada emerges from an analysis of the figures by Tara Moriarty, a professor of laboratory medicine and pathobiology at the University of Toronto. 

Official COVID-19 deaths in the spring and summer of 2020 were mostly limited to Ontario and Quebec. However, the rate of “excess deaths” – those over and above what would have been expected given the trend in recent years – was much more pronounced in Western Canada than virus fatalities alone can account for. 

The statistics suggest some provinces may have inadvertently undercounted COVID-19 deaths by a wide margin, Dr. Moriarty said. Provincial governments themselves have argued the disparity could be caused by hundreds of ailing people dying at home while avoiding hospitals for fear of the virus. 

Whatever their exact cause, the number of excess deaths shows a country that suffered much more equally than previously believed. (The analysis found there was virtually no gap between COVID-19 deaths and excess deaths in Atlantic Canada and the North.) 

Between March and November last year, British Columbia saw about six times as many “excess deaths” as reported COVID-19 fatalities, Dr. Moriarty found. Saskatchewan saw 10 times as many. The figures suggest hundreds if not thousands more people may have died in Western Canada as a result of the pandemic than official estimates recorded. 

“I think we’ve had a much bigger epidemic than we know,” she said. 

To gain a clearer picture of the virus’s real toll, Dr. Moriarty parsed data compiled by Statistics Canada dating from the beginning of the pandemic to mid-November, the most recent point for which fairly complete numbers are available for all provinces. 

Dr. Moriarty also subtracted the growth in toxic drug deaths from her analysis, to make sure she wasn’t simply capturing the human cost of Canada’s parallel opioid-poisoning epidemic. The numbers that remained were stark and surprising. 

Even controlling for overdoses in this way, B.C. still had 1,650 excess deaths in those nine months, compared with 290 official COVID-19 deaths. Among adults over 64 – those most vulnerable to COVID-19 – there were 1,099 excess deaths.  

In Saskatchewan, the disparity was even more dramatic: 293 excess deaths against just 29 COVID-19 fatalities. Alberta (1049 vs. 401) and Ontario (4,037 vs. 3,372) also had considerably higher excess death tallies than their official pandemic death toll. All told, Dr. Moriarty’s calculations show more than 3,000 excess deaths, over and above those attributed to COVID-19, outside of the Quebec epicentre. 

“We’re missing something,” she said.

Deaths of despair and the incidence of excess mortality in 2020

Via the National Bureau for Economic Research: Deaths of Despair and the Incidence of Excess Mortality in 2020. The abstract, with my bolding:

Weekly mortality through October 3 is partitioned into normal deaths, COVID, and nonCOVID excess deaths (NCEDs). Before March, the excess is negative for the elderly, likely due to the mild flu season. From March onward, excess deaths are approximately 250,000 of which about 17,000 appear to be a COVID undercount and 30,000 non-COVID. 

Deaths of despair (drug overdose, suicide, alcohol) in 2017 and 2018 are good predictors of the demographic groups with NCEDs in 2020. The NCEDs are disproportionately experienced by men aged 15-55, including men aged 15-25. 

Local data on opioid overdoses further support the hypothesis that the pandemic and recession were associated with a 10 to 60 percent increase in deaths of despair above already high pre-pandemic levels.

'Diseases of despair' skyrocket in America

Via HealthDay.com: 'Diseases of Despair' Skyrocket in America. Excerpt:

TUESDAY, Nov. 10, 2020 (HealthDay News) -- Even before the coronavirus pandemic began, Americans were already suffering: A new study reports that alcohol and drug misuse were up dramatically, and suicidal thoughts and behaviors were up 170% between 2009 and 2018. 

Researchers call these conditions "diseases of despair."  

"The origin of these conditions isn't strictly medical. Rather, they seem to follow conditions of despair in people's lives and communities," explained study author Emily Brignone. She's a senior research scientist with Highmark Health in Pittsburgh, Penn. 

Economic decline, stagnant wages, fewer community ties and unemployment are some of the factors she said can be linked to diseases of despair.  

"Over the past 10 years, diagnoses related to drug and alcohol misuse and suicidal thoughts and behaviors have increased across the board for men and women in all age groups," Brignone noted. 

The information in this study was collected long before COVID-19 began spreading across the United States. But Brignone said the pandemic may worsen conditions related to diseases of despair, like unemployment, social isolation, barriers to health care and uncertainty.  

"There is some evidence of COVID-19-related changes in diseases of despair, including increases in opioid overdoses and high numbers of people reporting suicidal thoughts. However, we won't know the full extent of the impact of COVID-19 on diseases and deaths of despair for many years to come," Brignone said.  

The new study included 12 million Americans insured by Highmark, a large U.S.-based health insurance company. The people covered by the company are concentrated in Pennsylvania, West Virginia and Delaware. These are states that have been disproportionately affected by deaths of despair, according to the researchers. 

Almost one in 20 people in the study were diagnosed with a disease of despair during the study period. 

The biggest increases were seen in suicidal thoughts and behaviors, particularly in young people. Suicidal thinking and behaviors rose by 287% between 2009 and 2018 in people under 18 years of age. For those between 18 and 34, the rate increased by 210%. For all other age groups, there was a rise of at least 70% in suicidal thoughts and behaviors, the findings showed.  

"We don't fully understand why this is happening. Some researchers have pointed to changing social structures and the rise of smartphones and social media. There are also questions about the role of bullying and less sleep. But it is a complex issue without easy answers," Brignone said.  

Alcohol problems increased in all age groups, except for those under 18. The biggest jump (59%) in alcohol misuse was seen in people between the ages of 55 and 74.  

Brignone said a number of things might trigger greater alcohol misuse later in life, including increases in health conditions, pain, mental health concerns, and increased disconnection from family, friends and neighbors. She also noted that alcoholism and the other diseases of despair often occur together.  

Older Americans (aged 55 to 74) also had the largest increase in substance misuse, with an increase of 172% during the study. The overall prevalence of substance-related diagnosis increased by 94%. 

Men had nearly 50% higher odds of being diagnosed with a disease of despair than women were, the researchers reported.

Overdose crisis affecting more British Columbians than COVID-19: Survey

Via CBC News: Overdose crisis affecting more British Columbians than COVID-19: survey. Excerpt:

A lot has changed in the four years since Michelle Jansen tragically lost her son, Brandon, to a fentanyl overdose.  

There have been government awareness campaigns, increased funding for treatment centres and a swath of new overdose prevention sites across the province.  

Those are changes that might have given her hope in the past. But with overdose deaths reaching record highs in B.C., she fears the crisis is spiralling out of control.  

"Even though people are having the conversation, they're not in my opinion dealing with the overdose crisis with the urgency that's required," Jansen told CBC News outside her Coquitlam home.  

"We're losing five or six people a day."  

An Insights West survey suggests the overdose crisis has a greater impact on British Columbians than the COVID-19 pandemic when it comes to the health of loved ones. Nearly one-third of people polled have friends or loved ones that grapple with addictions or have died from overdose. Just 10 per cent of respondents know someone who has had COVID-19 or died from it. 

The researchers behind the poll say they aren't trying to downplay the coronavirus pandemic, but rather to show that the opioid crisis should be addressed with the same level of urgency as the coronavirus. 

"The goal of the poll is to really put it into perspective, that we have two major crises and let's not forget about either of them," said Steve Mossop, president of Insights West. 

Parallel health crises 

B.C. recorded 911 overdose deaths between January and July of 2020. Over that same period of time, 195 people died of COVID-19. 

While more British Columbians who were surveyed are concerned about COVID-19 than the overdose crisis (91 per cent compared to 81 per cent), the poll found more people felt the opioid crisis has an "extremely negative" impact on their community.  

"[The overdose crisis] affects every aspect of society. It's not just Metro Vancouver, it's throughout the province, it's through every age range, old and young, male and female," said Mossop.

Did COVID-19 skip Vancouver's poorest neighbourhood? Antibody testing might have the answer

Via CBC News: Did COVID-19 skip Vancouver's poorest neighbourhood? Antibody testing might have the answer. Excerpt:

When the COVID-19 pandemic hit Canada mid-March, health experts feared Vancouver's impoverished Downtown Eastside would be decimated — the coronavirus expected to tear through its vulnerable population. 

That didn't happen, and now a B.C. medical sleuth is trying to find out why only a handful of residents have tested positive for the virus in one of Canada's poorest neighbourhoods.  

It's a medical mystery given there are an estimated 15,000 people crammed into 30 square blocks around Vancouver's infamous Main and Hastings intersection. 

Many residents have mental health issues, are infected with HIV or hepatitis C, and have compromised immune systems. 

The answer to the apparent low infection count could benefit all Canadians in the fight against the spread of the coronavirus, says Dr. Brian Conway, medical director of the Vancouver Infectious Diseases Centre. 

"The thrill of the chase is exciting," says Conway. "The more we learn, the more we will be able to help." 

'Pop-up clinics' test for antibodies 

Conway has launched a series of free community "pop-up clinics" to test blood for telltale coronavirus antibodies among Downtown Eastside (DTES) residents.   

Antibodies are formed when a person's body attempts to fight off infection. 

They are an indication that the individual was, at some point, infected with the virus, even if there were no symptoms of illness or only mild symptoms.  

Conway says if antibodies are found in a large percentage of volunteer test subjects, that would mean the virus has been more common in the Downtown Eastside than previously thought. 

Symptoms of COVID-19, the illness caused by the virus, could have been masked by underlying health and addiction issues. 

"It is possible that certain cases were missed since opioid withdrawal might look a little bit like an acute [coronavirus] infection," Conway said. "So we want to just make sure that we understand exactly what happened in that community since the middle of March."  

'Is there something here ... protecting them?' 

If antibodies aren't found, Conway says, that could mean the coronavirus has skipped over an easy target, perhaps due to the community's social isolation from the rest of the Vancouver area. 

There's another intriguing possibility: that Downtown Eastside residents have some form of resistance to the potentially deadly virus.

BC goes 6 days without a single death from COVID-19

Via CBC, bittersweet news: B.C. goes 6 days without a single death from COVID-19. Excerpt:

B.C. has marked a sixth straight day without a death from COVID-19, but Dr. Bonnie Henry is drawing attention to the province's other health emergency with a tearful statement about the overdose crisis. 

On Thursday, the provincial health officer said B.C. has confirmed another 14 cases of the novel coronavirus, to bring the province's total to 2,694 to date, including 183 that are still active. Thirteen people are in hospital, including five in intensive care.  

A total of 167 people have now died of COVID-19 in B.C., but as Henry pointed out, 170 died of suspected overdoses in the month of May alone. 

"I cannot express how difficult this news was to hear," Henry said, her voice breaking.  "I share your grief. These are our brothers and sisters, our coworkers … our friends and our community." 

She acknowledged that the COVID-19 pandemic has only worsened the overdose crisis. More people are using drugs alone because of physical distancing measures and drug toxicity is increasing. 

Henry said fear of the criminal justice system is a major contributor to the problem, and she repeated her call for decriminalization of drug possession. 

She urged people who use drugs to call 811 for help, to use overdose prevention sites and to seek out the legal prescription alternatives that are now available. 

Outbreaks continue in long-term care 

Thursday's COVID-19 update included no new outbreaks in health-care settings or in the community, but public health officials continue to deal with five active outbreaks in long-term care. 

To date, 560 people have become infected in connection with outbreaks in long-term care, including 341 residents and 219 staff members. 

At least two new clusters of cases announced in recent days have been linked to large family gatherings. 

Youyang Gu''s COVID-19 Projection site estimates British Columbia's pandemic deaths through October 1:

Our opioid deaths just in the past 3 months: 401. Since overdoses were declared a provincial public health emergency in 2016: 5,565.

COVID-19: A letter from Vancouver's Mayor Kennedy Stewart

Via email, with Mayor Kennedy Stewart's bolding:

Two days ago, we took the extraordinary action of becoming the first jurisdiction in BC to restrict all food and beverage service to take out or delivery only.

At the same time, we urged everyone in Vancouver to step up and take physical distancing seriously.

I reiterated a message that our senior staff, BC’s Minister of Health and Public Health Officer, and the Prime Minister have all been saying: stay two metres away from others in public and stop all unnecessary trips.

I told residents that if they failed to listen we would enforce and prosecute where necessary.

It’s OK to spend time on our beaches and parks, but you must be 2 meters away from anyone else, and only gather with your immediate household.

The vast majority of residents and businesses have been outstanding members of our community, abiding by these rules.

But too many did not.

This weekend I saw reports of people hosting house parties, having group picnics on the beach, playing soccer, playing beer pong.

This is not a game. People are dying.

So today we are announcing even more steps the City is taking, and I am also stressing that the time of asking nicely is coming to an end.

We still want people to get outside alone or with members of their immediate household.

However, even when outside, you need to stay at least 2 meters away from other people.

To address the volumes we have seen over the weekend at some locations, the Park Board is prohibiting parking at our most high-traffic parks and beaches across the city.

Earlier today they also closed all outdoor public fitness facilities including bike parks, tennis courts, basketball courts, field sports, and more.

And tomorrow, City Council will also be meeting virtually once again to pass new bylaws that authorize enforcement and penalties to anyone violating these orders.

Like I said, the time for asking is over.

Those found in violation of these critical orders will be subject to significant fines.

And what we’re ordering is necessary to protect front line workers, essential services, and the lives of our most vulnerable neighbours.

We have also been in contact with Provincial emergency management and health officials about going even further and ordering a general order for non-essential workers to stay put.

I am asking Council to approve this power tomorrow just in case we need to use it.

Many residents have asked me why the City hasn’t already moved to shut down all non-essential services and places.

I have been in regular contact with provincial and local health officials.

Right now, they are telling me that we do not need to do this — yet.

But if—and only if—health officials deem it necessary, I want us to be able to immediately order non-essential services shut down.

Make no mistake, we will act to save lives if we need to.

The message right now, to everyone, is clear:

Shut down. Stay put. Save lives.

You might think that you’ll be fine. That getting sick would be no big deal.

But as I’ve said many times before, there are more than 10,000 highly vulnerable neighbours who live in our City.

Many, many more are seniors and those with compromised immune systems that are rightfully worried right now.

Reckless behaviour, like playing beer pong in the middle of a pandemic, could lead to people dying.

While I am extremely concerned about the health of everyone in our City at time, we are particularly conscious of the fact that many of our vulnerable neighbours in the Downtown Eastside do not have the opportunity to isolate and protect themselves from this virus.

So while we are stepping up our efforts to get everyone to limit their time away from home, we are calling for urgent action to protect those in and around the Downtown Eastside.

Yesterday, I announced a serious of important measures the Federal and Provincial governments need to take now, in coordination with the City of Vancouver, to keep people safe in the Downtown Eastside.

This eight part plan includes:

Goods delivery

Access to safe supply

Support for overdose prevention sites

Cleaning and community hygiene

Building security

Protection and testing for frontline workers

Increased Income assistance

Housing stock and protection for renters

Vancouver is unique in all of Canada with a high-risk and high-need population.

We cannot fail them. We must act now.

Friends, I don’t know how else to say this. The actions we take today and over the next few days could mean the difference between life or death for many of our neighbours.

When this is all over, will you be able to look at yourself in the mirror and honestly tell yourself that you did everything you could to help?

Right now, for too many people, the answer is no.

Yesterday the Minister of Health, Adrian Dix, said that we need 100% compliance.

Now is the time to meet this challenge together.

Thank you.

-Kennedy

Public health advice from Rush Limbaugh

Via the Rush Limbaugh show, a transcript: Overhyped Coronavirus Weaponized Against Trump. Excerpt, and no comment at all:

RUSH: Folks, this coronavirus thing, I want to try to put this in perspective for you. It looks like the coronavirus is being weaponized as yet another element to bring down Donald Trump. Now, I want to tell you the truth about the coronavirus. (interruption) You think I’m wrong about this? You think I’m missing it by saying that’s… (interruption) Yeah, I’m dead right on this. The coronavirus is the common cold, folks. 

The Drive-By Media hype of this thing as a pandemic, as the Andromeda strain, as, “Oh, my God, if you get it, you’re dead.” Do you know what the — I think the survival rate is 98%. Ninety-eight percent of people get the coronavirus survive. It’s a respiratory system virus. It probably is a ChiCom laboratory experiment that is in the process of being weaponized. All superpower nations weaponize bioweapons. They experiment with them. The Russians, for example, have weaponized fentanyl. Now, fentanyl is also not what it is represented to be.

Canada: How the opioid crisis is hammering BC’s north

Via The Tyee: How the Opioid Crisis Is Hammering BC’s North. Excerpt:

Quesnel seems like the kind of small town you’d pick to raise a family or retire.

The community of about 10,000 people on the Fraser River is surrounded by forests and mountains — a place to escape big city problems.  

But Maclean’s magazine says Quesnel’s crime stats make it the third most dangerous place to live in Canada.  

Two years ago, the community about 120 kilometres south of Prince George didn’t even make the magazine’s list of the most dangerous 229 communities. 

People told The Tyee they hardly recognize the town, which — like many communities across the north — has been grappling with a spike in crime and drug use.

“People are living in fear and are reluctant to come downtown or leave their homes,” said Debra McKelvie, who owns a floral shop in the city’s downtown. “We are faced with aggressive panhandling, being followed into our banks and having our windows smashed out of our vehicles by addicts looking for anything of value to fuel their drug habits.  

“We have a lovely downtown, and we’re trying desperately to hang onto it.”  

In Quesnel, crimes like drug trafficking, robbery and breaking and entering have risen to three to four times the national average. Three other northern B.C. communities placed high on the Maclean’s list of most dangerous communities — Terrace at 11, Prince George at 14, and Prince Rupert at 20.  

Northern and Interior communities are struggling with the opioid crisis and resulting crime and homelessness. 

The public and media focus has been on Vancouver. But Northern Health and the Vancouver Coastal Health Authority had almost the same rate of illicit drug deaths in the first 10 months of 2019, according to the BC Coroners Service. 

In Quesnel, McKelvie and other residents have formed Quesnel in Action, a citizens’ group calling for increased services for addiction and mental health. The group has held two recent rallies and collected more than 900 letters from concerned residents, which have been forwarded to federal and provincial governments.  

“My place of business has been broken into,” she says. “The business community is getting hit the worst. I can’t think of any business that hasn’t been broken into or that somebody hasn’t attempted to break into.”  

Melanie MacDonald is the executive director for Quesnel Shelter and Support Society and works directly with Quesnel’s homeless population through the Seasons House emergency shelter. She cautions against linking the entire homeless population with drugs and crime. But the impacts of the opioid crisis can’t be ignored, she says.