GUEST POST BY DR. SCOTT LEAR

The pandemic has led to a surge in supplements as people hope to ward off COVID-19. Of these, vitamins C and D, along with zinc and melatonin, have gained particular attention.

Should we use supplements to help prevent or treat COVID-19 ? What is the evidence?

Vitamin C

Vitamin C is a water-soluble antioxidant needed to increase the production and function of immune cells. Long touted as a ‘cure’ for the common cold, this has never been realized. At most, regular vitamin C may shorten the duration of a cold, but only by about 8% (about 10 hours over a five-day cold).

The recommended intake is between 75 mg to 90 mg per day (a large orange, one cup of broccoli, a small red pepper). While excess amounts are excreted in the urine, mega-doses can result in intestinal discomfort.

Pre-pandemic studies have suggested vitamin C may benefit people suffering from sepsis (an extreme reaction to infection that can lead to organ damage and death). In these studies, vitamin C is delivered intravenously at doses around fifty times that of dietary recommendations. However, a study on hospitalized COVID-19 patients in China one year ago found no difference in need for ventilation and mortality while it did demonstrate a potential benefit for critically ill patients. Although a number of studies are underway, vitamin C isn’t recommended for treatment.

Vitamin D

Vitamin D is a building block for bones and many steroids in the body. The main source is from the sun. However, with concerns of skin cancer, food sources (oily fish and fortified milk) have taken over. One cup of fortified milk provides approximately 20% of the daily recommended 600 IU intake. Having too much vitamin D is unlikely through natural sources, but taking mega-doses through supplements can result in toxic effects.

People with darker skin and higher amounts of body fat tend to have lower levels of vitamin D, and hospitalizations and deaths from COVID-19 have been greater in these two populations. Subsequent cross-sectional studies have reported a higher risk for COVID-19 in people with vitamin D deficiency. Small randomized trials in hospitals have reported vitamin D supplementation associated with faster clearing of infection and severity, but a larger study in preprint found no difference. Dozens of trials are currently underway to investigate its role in the prevention and treatment of COVID-19.

As a result of the lack of robust evidence thus far, vitamin D is not recommended. However, many health agencies recommend vitamin D supplementation during the winter months and in people with darker skin living away from the equator.

Zinc

Zinc helps fight off infections and keeps the immune response from getting out of control. Zinc may also reduce the severity and duration of the common cold. People who took zinc lozenges (twice daily recommended amount) reduced the duration of their colds by 40%.

The daily recommended zinc intake is between 8 to 11 mg. Most people get sufficient amounts from meat, dairy products, beans, and peas. While overt zinc deficiency is rare in Canada, as many as one-third of adults over 60 years may not be meeting these recommendations.

It’s unknown whether zinc has any effect on the COVID-19 virus. Lab-based studies have suggested mechanisms by which zinc may reduce the risk for infection (reviewed here). A retrospective study in preprint found people with low zinc levels had worse outcomes from COVID-19.

However, a non-randomized study found no effect of zinc supplementation on mortality in people hospitalized for COVID-19 and a number of studies are in process. A just-published, much-anticipated study by the Cleveland Clinic investigating supplementation with ascorbic acid (vitamin C) and zinc found no benefit when it came to reducing the duration of COVID-19 symptoms.

Melatonin

Melatonin is commonly known as the sleep hormone. Its release is suppressed by exposure to light resulting in lower levels during the day. Besides promoting the onset of sleep, melatonin is involved in immune function and has anti-inflammatory and antioxidant properties.

Melatonin levels decline with age. As a hormone that your body naturally produces, there is no recommend dietary amount of melatonin. However, most foods contain trace amounts while cherries, nuts, eggs, milk and fish contain higher amounts.

Early on in the pandemic, melatonin was identified as a potential treatment to blunt the effects of COVID-19. A study in 26,779 tested for COVID-19 infection found people taking melatonin had a 52% lower chance of being positive and an observational study currently in preprint suggests treatment with melatonin is associated with positive outcomes in COVID-19 patients requiring intubation. However, given these studies are observational, more evidence is warranted and randomized trials are currently investigating its potential.

The bottom line

The limited studies to date have investigated the use of mega doses of these supplements in the treatment of COVID-19 and shouldn’t be translated to prevention with over the counter doses. In societies where healthy food is readily available, overt nutrient deficiencies are rare. A balanced diet, regular activity, and sufficient sleep are recommended to keep your immune system functioning. Wearing a mask, frequent handwashing and physical distancing remain the best strategies for reducing your chances of getting COVID-19.

Scott Lear is a professor in the Faculty of Health Sciences at Simon Fraser University. He holds the Pfizer/Heart & Stroke Chair in Cardiovascular Prevention Research at St. Paul’s Hospital.

He has been an outspoken advocate for mandatory masks during the pandemic. He writes the weekly blog Feeling Health with Dr. Scott Lear.

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BY PAMELA FAYERMAN

Blood samples from residents and staff of long term care (LTC) facilities will provide precious clues into how the immune system reacts to both COVID-19 infections and vaccinations.

Vancouver researchers at Providence Health Care, Simon Fraser University, UBC and the BC Centre for Excellence in HIV/AIDS have been granted over $1 million from the federal government to conduct and analyze blood draws from residents and staff of LTC facilities before and after vaccinations. That will allow experts to learn how to understand more about immunity so they can learn how to protect individuals who live and work in the facilities from future outbreaks. Healthcare workers in acute care facilities will also be included in the blood analysis research.

No one knows for sure yet how long immunity to COVID-19 will endure after vaccinations and/or infections. Will we require shots on an annual basis as is the case for protection from influenza? Perhaps, especially the elderly with less robust immune systems.

Principal investigator Dr. Marc Romney said in an interview that hundreds of blood samples have already been collected – including from individuals who died at Holy Family Hospital during an outbreak last year. Their blood has been banked as will all other samples drawn from study participants who will be asked for at least four specimens over a one-year period, including before vaccination, a month after and then again after their second vaccine doses. (Blood samples from deceased individuals will obviously not be useful for post-vaccination research).

The durability of the immune system response will be evidenced by various components including antibodies, T-cells, B-cells and cytokines.

Dr. Romney, the clinical associate professor at UBC and medical leader for medical microbiology and virology at St. Paul’s Hospital, said the hypothesis is that immunosenescence is a defining factor in immune durability. Immunosenescence is the gradual deterioration of immune systems as individuals age which affects the capacity to respond to infections and to maintain long-term immune memory acquired by infection or vaccination.

“The elderly have fragile white blood cells. They’re relatively immune compromised so it’s important to know how durable their vaccine protection is for them,” he said.

Since everyone will want the results “yesterday,” Romney said researchers will release interim results in stages to help with vaccination planning in 2022 and beyond. Romney has also been active in the development of pre-flight rapid testing protocols at the Vancouver International Airport.

The study will utilize state of the art technology that helps analyze vaccine-induced immunity.  The research is part of the federal government’s COVID-19 Immunity Task Force (CITF). Scientists across Canada have been asked to conduct research that helps answer what proportion of the general population has antibodies to COVID-19; how long immunity lasts after infections; what antibody tests are the best; and how long individuals are protected against COVID after being vaccinated.

In Alberta, teams will look at vaccine-induced immunity as well as whether sewage wastewater can be used as an early warning system to detect outbreaks in LTC facilities. Wastewater samples from selected LTC facilities in Edmonton will be analyzed to determine whether the virus is circulating even before residents and staff develop symptoms. If levels of COVID biomarkers are detected, then it would trigger rapid testing to identify those who are infected to help prevent the spread of the disease.

EMAIL: [email protected]

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COVID-19 vaccinations are expected to resume again in the next few weeks after a lull due to vaccine scarcity from suppliers. Selfie photos posted on social media of individuals getting vaccinated can trigger negative emotions on the part of those waiting for vaccinations. A commentary on this is by Ben Huang, an emergency medicine resident at the University of B.C. who is also a Global Journalism Fellow at the Dalla Lana School of Public Health at the University of Toronto.

BY BEN HUANG

As doctors across Canada receive COVID-19 vaccines, many are sharing photographs on social media to inspire hope and to encourage others to get vaccinated too.

This has sparked controversy around “vaccine selfies,” as other doctors say the pictures provoke anxiety, anger and envy.

The debate among doctors over how to use social media is merely the tip of the iceberg, with inequalities in Canada’s slow and irregular vaccine rollout at the root of the frustrations.

Studies over the past decade have demonstrated links between browsing social media and depressive symptoms, especially when online content triggers envy. And during the COVID-19 pandemic, vaccine envy is inevitable, with vaccines being limited and the pandemic continuing to rapidly grow.

By all means celebrate, but celebrate privately….We get it—we’re happy for you. Just don’t rub salt in our wounds.

Social media triggers
For some health-care workers, social media selfies are an unwelcome trigger.

“Social media is complicated,” says Dr. Amelia Yip, a cardiologist in Waterloo, Ont., who recently received her first dose vaccine. “Even within the healthcare profession, there are people who should be getting it before others. But the way it’s being rolled out doesn’t always work that way.”

“The way the distribution is happening, it feels like there isn’t a coordinated effort. It feels under-appreciative for healthcare workers, or even those at risk, not just doctors,” says Dr. Yip.

Canada’s vaccine rollout has been highly variable between provinces. In Ontario, for example, almost 19% of vaccinated people have completed both doses, compared to only 1.5% in British Columbia.

And in Québec, where second doses are being postponed significantly until mid-March, no one has yet received two doses.

Dr. Yip says there are pockets of people who have been missed in her local rollout, and that at her hospital, cardiologists had to remind authorities that they, too, are involved in critical care.

Meanwhile, says Dr. Yip, it’s been doubly frustrating to see vaccine selfies posted by people who don’t work on the frontlines.

“Yesterday, a completely non-medical person who’s an accountant and happens to work at a Toronto hospital got it. When you see someone not even working [with COVID-19 patients] getting it, it feels like the person is jumping the queue.”

Anger and resignation
The vaccine rollout in B.C. has featured similar criticisms and controversies around queue-jumping by doctors and administrators.

Dr. Alan Drummond, an emergency physician in Perth, Ont., where frontline workers are still waiting for word of vaccines, says: “You have to take the broader context to understand where some of the disappointment and anger is coming from. For at least 10 months, ER physicians and nurses were dealing with a novel virus that has the potential to be quite deadly. I don’t know anybody in my sphere who shied away from the responsibilities of looking after patients—nobody.”

Dr. Drummond says the initial arrival of vaccines in Canada was met with hope and enthusiasm, and that it was “entirely appropriate” that doctors celebrated on social media as a sign of the beginning of change.

But as selfies continue to get posted online, Dr. Drummond says he and his colleagues are beginning to feel resigned and angry.

“The inequities are starting to show…. We need an appropriate queue—we certainly aren’t in it. And [the selfies are] the icing on the cake.”

Impacts of stress
Stress due to providing care to coronavirus patients has significant consequences. Frontline doctors, nurses and therapists are burned out. Tragically, 35-year-old Dr. Karine Dion recently died by suicide. Emergency and intensive care doctors have also reported feeling overwhelmed.

Dr. Sarah Giles, a rural family and emergency doctor in Kenora, Ont., says her community will not be receiving vaccines until April.

“When we look at inequalities, we know that there is a lifespan discrepancy between living in northwest Ontario and in southern Ontario. As my friend said, we’re at the end of the supply for fruits and vegetables and you can tell: We’re at the end for vaccines as well.”

And especially in rural communities, says Dr. Giles, every healthcare worker is paramount.

“We have human resources issues. If we lose a couple of doctors or nurses, it’s going to be a big problem.”

For Dr. Giles, who lives alone, vaccine selfies have been personally anxiety-provoking; she says when she gets vaccinated, she will not post a selfie.

As for Dr. Drummond, he has this message for doctors: “By all means celebrate, but celebrate privately. Just don’t do it so publicly when a lot of your colleagues who are dealing with their own anxieties and fears. We get it—we’re happy for you. Just don’t rub salt in our wounds.”

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The post As vaccinations resume, health pros cautioned about selfies on social media appeared first on Medicine Matters.

COVID-19 infections continue to rise amongst B.C. healthcare workers as data just released shows the cumulative number of infections rose 34% in the past month, to 4,850.

The count provided by the B.C. Centre for Disease Control only goes up to January 15 when there were a total of about 60,000 COVID cases in the province. As of today, there are over 68,000 cases so it is likely there have now been somewhere around 5,400 infections among healthcare workers since the pandemic began. In mid-December, there were 3,624 cumulative cases among healthcare workers.

The good news, if you can call it that, is that COVID-19 infections among healthcare workers continue to account for just over eight percent of all cases in B.C. That proportion has not risen for a few months. As well, first vaccinations have been completed among all staff and residents of long-term care facilities so infections in LTC sector staff should start to fall.

Care aides who most commonly work in LTC facilities and nurses in various categories  – RN, nurse practitioner and licensed practical – continue to head the list. As you will see from the table below, care aides account for about 25% of all infections in the healthcare sector while nurses are a close second, accounting for another 24%.

Cases among dental professionals (156) slightly outnumber those in physicians (151). The only professionals who’ve been vaccinated so far in B.C. are those who work in intensive care units, emergency departments and COVID units. That means healthcare workers like nurses, dentists and physicians not providing direct care to COVID-19 patients have not yet been inoculated.

The government and Dr. Bonnie Henry continually emphasize that not all COVID infections are contracted on the job. But it is clear that wherever healthcare workers acquire COVID-19, they are vulnerable and carry a heavy burden when it comes to the virus. A category called unknown/unspecified has 577 cases. That means individuals answered yes when they were asked during testing if they worked in healthcare but they declined to provide more information about their occupation.

In an ideal world, every healthcare worker would be getting vaccinated now. But the supply for most of February has dried up because of modifications to vaccine production facilities in Belgium.

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151% rise in COVID-19 cases in healthcare workers

Steep rise in COVID cases in healthcare sector

25% of COVID cases have been in healthcare workers

Growing number of cases among healthcare workers

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Dr. Bonnie Henry and the provincial government have been served with a lawsuit filed in the Supreme Court of B.C. that alleges pandemic emergency public health orders are unjustified.

The lawsuit spearheaded by Kip Warner and a non-profit group calling itself the Canadian Society for the Advancement of Science and Public Policy makes numerous allegations like COVID is no worse than seasonal influenza. They allege that Henry and the government have misrepresented the severity of COVID-19.

The plaintiffs are seeking to have the court certify the lawsuit as a class action proceeding. They allege public health orders have led to more drug overdose deaths, suicides, depression, unemployment, and bankruptcies.

Warner says on his website he is a software developer specializing in artificial intelligence. He has formerly been labelled a conspiracy theorist for allegations about 911. According to the referenced National Post article, in 2011 he wrote a long public letter to the government suggesting the true blame for the coordinated jet plane attacks lies with a usurious “cabal of Rothschild banksters.”

In an interview, Warner said the society is not made up of a bunch of conspiracy theorists.  Members backing the legal action “don’t deny that COVID exists” but do contend the government exceeded its powers by making orders based on “controversial claims” about the severity of COVID.

A Go Fund Me campaign to finance the litigation has to date raised has raised under $20,000 from 120 donors. The target for fundraising is $100,000.

Citadel Law Corporation is the Vancouver firm representing the plaintiffs. The law firm says on its website that it specializes in strata property law, estate litigation and tenancy matters.

Staff in the ministry of health said the government would not be commenting on the lawsuit because it is “currently before the courts.”

[email protected]

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Converted shipping containers have been turned into tiny homes, man-caves, backyard offices, and even swimming pools. Now inventive individuals have created another novel use for them – a place for families to visit their loved ones in long-term care.

In the Fraser Health region, the Queen’s Park Healthcare Foundation got a government grant to help purchase a shipping container now on site at the Queen’s Park Care Centre. The New Westminster healthcare facility serves 148 long term- care residents and 77 rehab patients. It has had multiple COVID outbreaks in the past year – two outbreaks in long-term care involving 10 residents, five staff and four deaths. And three outbreaks in acute care involving 20 patients, four staff and one death.

The repurposed container has been insulated, heated, furnished and equipped with an intercom system. Families enter the Britco modular container from one entrance while residents enter from another. They are separated by a plexiglass partition. While it sounds a little like jail visits, it certainly beats outdoor window visits. Indeed, it’s a private, safe way to have visits while the pandemic is still claiming lies in the long-term care sector.

The Manitoba government is believed to be the first in Canada to make a big ($17.9 million) purchase of shipping containers from a construction company last fall. Modifying the units can cost up to $200,000.

Karl Segnoe, whose 92-year-old grandmother lives there said in a press release: “I have every confidence in the staff to keep my grandmother safe, but I fear social isolation is taking a toll on her well-being. Being able to visit as a family will be huge because my grandmother is such an important person in our lives.”

Families must reserve visits and still wear masks. They are also pre-screened with temperature checks and other measures to help detect COVID symptoms. Long term care residents are accompanied by a staff worker who remains for the duration of the visit. Every surface is disinfected in-between visits.

Elizabeth Kelly, the executive director of the Queen’s Park Healthcare Foundation, said:

“We had the space, so I applied for a $25,000 federal grant. All of us at Queen’s Park Care Centre are looking forward to the day when COVID-19 is behind us and we can remove the partition in the visitor centre so families can celebrate together and hug each other. The pandemic has taught us that the small things in life are really the most important.”

Fraser Health has not yet responded to questions about how much the shopping container cost in total.

The post Another clever use for shipping containers in the pandemic era: safe visits with loved ones in long term care appeared first on Medicine Matters.

Vancouver health authorities have completed their investigations into hospital-based physicians who jumped COVID-19 vaccination queues by not waiting for their second dose “invitations.”

“While we are unable to disclose the details of specific personnel cases, we can confirm that the medical staff who have had received their second dose before they were invited to do so was limited and each case has been formally investigated and appropriate action has been or will be taken,” said Vancouver Coastal Health spokeswoman Rachel Galligan.

I first reported on the controversy here after obtaining the internal memo circulated to the medical staff at hospitals like Vancouver General and St. Paul’s. The identity of the physicians is a closely guarded secret, but since the only doctors who’ve been able to access COVID vaccinations thus far are those providing care to COVID patients, they are likely critical care specialists, emergency department physicians or other specialists working on COVID units.

“The vast majority of our health-care workers and medical staff are adhering to public health guidance and are patiently awaiting their turn for vaccination,” Galligan continued. “VCH and Providence Health Care are committed to fully investigating and addressing any substantiated breaches of Public Health direction regarding vaccine sequencing and administration.”

Meanwhile, the vanishing and indeed near-extinct supply of COVID-19 vaccine means that many first priority physicians, nurses and other healthcare workers – those providing direct patient care to COVID-19 patients – will likely miss recommended timelines for their second shots. The two vaccines approved in Canada so far — PfizerBioNTech and Moderna’s — both require two separate doses in order to achieve 94-95% protection for the patient. Pfizer’s second dose is intended to be delivered 21 days after the first, while Moderna recommends 28 days after the first. But the World Health Organization and the National Advisory Committee on Immunization (NACI) have each given support for up to 42 days between doses because of extraordinary supply issues.

Provincial health officer Dr. Bonnie Henry was among the first doctors to get vaccinated last month when the first shipments arrived. It’s now been 38 days since Dr. Henry’s first dose, so I dared to ask the ministry of health whether she has had her second shot or when she intends to get it. Her office staff declined to divulge anything yesterday. Today, at the end of an hour-long press briefing, Henry said she has not received her second dose:

“I absolutely believe in the data that we have that shows extending the interval between dose one and dose two is not only safe but there’s a real probability it will provide more durable and longer-lasting protection. So I will be waiting until there’s sufficient vaccine available later on in the Spring.” The first day of Spring is March 20.

Undoubtedly, vaccinations are a sensitive and politically charged matter purely because of vaccine supply issues. Henry had a photographer take photos of her getting her first dose at an Island Health clinic in Victoria late last year. Although she doesn’t treat patients and wouldn’t be considered a frontline healthcare worker, it made sense for her to make this public display in order to show her confidence in the safety and effectiveness of the brand new vaccine. Indeed, the confidence in vaccines demonstrated by experts like Dr. Henry – coupled with public desperation – are factors contributing to public opinion polls that show vaccine hesitancy is rare in Canada.

But now that the fridges are essentially empty for second doses, it makes little sense, from a public relations standpoint, for Henry to be seen rolling up her sleeve for her second dose. Indeed, doing so might provoke or irritate front line healthcare workers who may not get second doses until March, given supply interruptions.

A current BCCDC graph showing the huge gap between 1st and 2nd doses. BC supplies have seriously dwindled because of manufacturing delays caused by vaccine factory expansions currently taking place in Europe.

Returning to the matter of discipline against the physicians who jumped the queue, many readers are likely intrigued by their possible excuses, explanations or even legal defences. Typically, doctors who get into medical-legal trouble immediately seek advice from the Canadian Medical Protective Association, their legal defence organization. I asked the CMPA if the Vancouver physicians had sought advice on this matter. Said Dr. Todd Watkins, Associate Executive Director of the CMPA:

“CMPA’s assistance to physician members is discretion-based. This means that we carefully review the facts and circumstances of each particular case and determine if the circumstances are within our scope of assistance and the nature of the assistance we can provide. Discretion gives us the flexibility to assist members rather than deny assistance based on a set of policies.

We cannot comment on individual cases, but we will generally assist members with College matters relating to the professional practice of medicine, such as developing medical directives to support the COVID-19 vaccine rollout.”

Information about the CMPA’s assistance concerning the COVID-19 vaccination program states:

“The CMPA will not generally extend assistance with respect to administrative or logistical issues associated with the vaccination process, such as decisions about prioritization of individuals eligible to receive vaccines. Physicians involved in these issues should ensure that the organization that they are being asked to serve will provide them with full defence and full indemnification in the event of medical-legal difficulties that arise from this role.”

[email protected]

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The post Investigations over into hospital doctors who jumped queues for 2nd COVID-19 shots appeared first on Medicine Matters.

A new and significant COVID-19 outbreak on a surgical ward at Royal Inland Hospital in Kamloops is a wake-up call to not only wear masks and PPE but to conduct COVID-19 tests on all pre-surgery patients.

One patient has died out of 19 patients infected so far. Another 29 cases are among staff for a total of 48 cases.

There are 38 outbreaks in healthcare facilities across B.C. right now – 29 in long term care and nine in acute care hospitals.  I have long questioned why COVID testing isn’t done on all pre-surgery patients. I’ve written about this often (see links below). Inexplicably,  Provincial Health Officer Dr. Bonnie Henry has been opposed to widespread rapid and other testing among those without symptoms. She thinks pre-screening questions about symptoms or possible exposures are sufficient.

“We aren’t going to test for no purpose. That is wasteful,” she has said on various occasions. Today she acknowledged this: “It’s challenging to know when people are incubating the disease.”

We now know, however, that as many as a third of those who have COVID are asymptomatic. That, compounded with the fact that B.C. is a laggard when it comes to testing, is a recipe for outbreaks. B.C. has the lowest rate of testing among all provinces with a population of over one million, as shown by this CBC graph:

The good thing is that one health region has taken matters into its own hands. When COVID-19 cases started surging in the sprawling Fraser Health region last year, surgeons and other hospital leaders determined it was time to start testing patients requiring urgent and non-urgent operations.

They realized that pre-surgery testing, even in the absence of symptoms is absolutely necessary and not a waste of resources.

Some readers may have seen a recent Canadian Press story about pre-surgery testing in Fraser Health. It was confusing and conflated figures so I will attempt to clear this up although Fraser Health has been slow to respond to all my questions.

What we know is that two pilot studies have been initiated – one in emergency departments and one for elective surgery patients. All patients who go to Fraser Health hospitals for any reason are screened for signs and symptoms of COVID-19. They are also asked if they’ve had any exposure to COVID.

The rote screening process is far from perfect and misses those who may be asymptomatic.

In the pilots, all patients admitted to hospitals through emergency departments and deemed to need surgery were tested for COVID. Over a four-week period, 65 individuals needing urgent surgery, or 1.7% of all those who didn’t meet screening criteria, tested positive. That means that 65 seriously ill people could have caused outbreaks, risking the health and lives of health professionals and other patients. Fraser Health has not released the proportion of patients who still tested positive even after raising no flags on the pre-screening questionnaire.

During a three week period of the pilot study for elective surgery patients, 11 – or 0.4% – were positive for COVID. Fraser Health has not divulged what proportion of patients who passed the pre-screens tested positive however “identifying these individuals as being infected with COVID-19 ensured they were managed appropriately, with infection control measures to protect other patients and staff in place.” One presumes such patients were sent home to recover before getting their surgery but Fraser Health has not responded to that question.

“Given the high prevalence of COVID-19 in our communities and outbreaks occurring in both acute and long term care, these enhanced testing programs will remain in place at the present time,” added the statement from Fraser Health.

There are currently 19 outbreaks in longterm care facilities and hospitals in Fraser Health. That’s half of all the outbreaks in healthcare facilities in the province today.

To reinforce the importance of what Fraser Health is doing, in its small pilot study, there were dozens of patients identified through testing who might otherwise have infected healthcare professionals and other patients. And since research has shown that COVID raises the mortality risk of patients undergoing surgery, patients are better off having their operations delayed until they’ve recovered.

All other health authorities should follow the Fraser Health lead without delay.

RELATED LINKS:

NO PRE-OPERATIVE TESTING. IT’S CONTROVERSIAL.

PRIVATE SURGERY CENTRE WANTS PATIENTS TO GET TESTED

NO TESTING BEFORE SURGERY. IS IT LIKE ROLLING THE DICE?

151% RISE IN COVID AMONG HEALTHCARE WORKERS

[email protected]

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Influenza has been M.I.A. across the northern hemisphere this winter, presumably because of the protective (physical distancing, masks and hygiene) measures being taken to prevent the spread of COVID-19.

That, and the fact that sizeable proportions of populations were vaccinated. In B.C. alone, health minister Adrian Dix said the province has distributed 2.2 million doses since last fall.

The BC Centre for Disease Control (BCCDC) monitors flu activity every year and in its latest report, it shows about 30,000 tests have been conducted to determine the prevalence of flu. Many of those tests are done at the same time as COVID-19 tests to determine the true culprit behind symptoms. Seven individuals have tested positive with various influenza strains. But each one of those individuals had been given a flu vaccine.

So does this mean that this year’s iteration of the flu vaccine has been a poor match? I delved into this.

Dr. Danuta Skowronski is a leading expert in influenza at BCCDC. She told me this:

“The live attenuated influenza vaccine (LAIV) which is given intra-nasally includes live virus that replicates but is attenuated (weakened) so as not to cause actual influenza infection,” she said, referring to the nasal spray product by AstraZeneca that is recommended for individuals aged two to 49. It’s a popular option for children since it’s a no-needles approach. Indeed, that suggests that a good proportion of the positive tests for flu were among children.

She went on to say:

“The nose swab that is collected to test for influenza viruses (is sensitive enough that it) would pick up these vaccine viruses in someone who recently received (the nasal spray).

The importance of all seven of the individuals in whom we found influenza viruses (including some with dual influenza virus detections) having recently received LAIV is that their viruses were likely LAIV viruses, NOT wild type circulating virus.

It is not that they were vaccinated and still got influenza virus infection. It is that they were recently vaccinated and their nose swabs picked up the vaccine strain.

The PCR test we do is very sensitive and can still pick up the LAIV strain. This is not unexpected.”

This is what the BCCDC says:

“As 2021 begins, influenza virus circulation remains remarkably absent in BC. Approximately 30,000 tests for influenza virus have been conducted in BC since the start of the 2020-21 season in week 40 (September 27, 2020) through to the end of the first week of 2021 (January 3-9, 2021).

So far, just 12 influenza viruses (7 influenza A and 5 influenza B) have been identified from among 7 individuals. However, each had recently received the live attenuated influenza vaccine (LAIV), suggesting vaccine-type rather than wild-type virus. Overall, there remains no indication of influenza virus circulation in BC. Elsewhere in the northern hemisphere, influenza virus detection also remains exceptionally low.

By contrast, for the same week 40 to week 1 period of the past 5 (2015-2019) seasons, there were on average 7,059 tests conducted and 1,005 influenza detections per season (range 285-1820). Average week 1 influenza positivity for the past 5 seasons was 32% (compared to zero percent positivity in week 1 of 2020-21).

No long-term care facility influenza outbreaks have been reported in 2020-21. Conversely, during the 2019-20 season, 19 long-term care facility outbreaks were reported between week 40 and week 1.”

[email protected]

The post People who got influenza immunizations still tested positive for flu. Here’s why. appeared first on Medicine Matters.

When the COVID-19 pandemic struck, there was generalized panic about whether Canada would have enough mechanical ventilators, ICU beds and healthcare professionals for critically ill COVID patients.

As the world watched the situation unfold in China, Italy and Spain last winter, political leaders responded with bold plans to boost the domestic production of ventilators. In the U.S., President Donald Trump signed an order under the Defence Production Act compelling General Motors to produce ventilators for hard-hit hospitals. In Canada, Prime Minister Justin Trudeau announced a deal with four Canadian companies – Victoria’s StarFish Medical (StarFish Product Engineering Inc.), CAE Inc., Thornhill Medical Research Inc., and Ventilators for Canadians to produce 30,000 ventilators. 

“We need a sustainable, stable supply of these products and that means making them at home,”  Trudeau said in April.

A Vancouver startup company saw an opening and quickly assembled a team of engineers to design and manufacture a locally-made ventilator containing fewer than 60 components. Ocalink Technologies Inc., gained emergency Health Canada certification for its trademarked Pantheon Emergency Ventilator (PEV) and announced it was taking orders for its lifesaving technology. In Saskatchewan, university researchers collaborated with clinicians at a Saskatoon-based company that also designed and built an emergency use ventilator. The Saskatchewan Health Authority placed orders for 100 but so far, none have been used in hospitals.

In B.C., Corbin Lowe, co-founder and CEO of Ocalink told me last spring: “This is a very exciting time for Ocalink as our first manufactured units can now ship, and we can bring our made-in-Canada solution to the world…we are in the position to manufacture in large quantities and scale up to 1,000 devices a day despite a currently constrained global supply chain.”

Recently, I re-connected with Lowe to ask how many units were sold to hospitals. The answer? Zero.

While it seemed like the situation elsewhere dictated demand for more ventilators, Lowe said across North America, critical care physicians realized fairly early that only certain COVID cases required mechanical ventilator support and by May, the demand for mass production of new units waned.

“Ventilators are quite an invasive, traumatic experience for patients and, over time, physicians realized that COVID doesn’t mimic acute respiratory distress syndrome which often does require ventilators,” he said.

At Royal Columbian Hospital (RCH) where there are 30 ICU beds – 16 of them equipped with ventilators – there has never been a time during the pandemic when there weren’t enough ventilators. But questions about which COVID patients have required ventilators has always been given delicate consideration. RCH medical director Dr. Steve Reynolds said this in an interview today: “I know we had many discussions about getting more ventilators and there were lots of orders that went in across Canada. I even looked at different types as I joined the panic but to be honest, we leaned into it and we’ve been managing with what we have.”

Reynolds is leading a case series study to help answer which patients require highly invasive mechanical ventilation and other best practices for COVID patients. He agrees that as the pandemic progressed, doctors have learned from each other. And experiences in big metropolitan areas like New York influenced care decisions here, especially when it came to determining which patients needed mechanical breathing support.

Reynolds, a specialist in internal medicine, infectious diseases and critical care, has been working on inventions to improve diaphragm conditioning in patients on ventilators so they can be weaned off mechanical breathing perhaps a little faster, thus reducing the risk of ventilator-induced lung injuries and other life-threatening complications like pneumonia and infection.

While inflamed and infected COVID lungs may appear to look the same as those in patients with pneumonia or serious lung infections, too much ventilation pressure can be risky, not only to the lungs but to other organs as well. Up to 30% of patients on ventilators experience face permanent difficulties after they are weaned off ventilators, according to medical literature.

Medical device technology that Reynolds is involved in is called Lung Pacer. It features a nerve-stimulating catheter inserted intravenously to activate the phrenic nerve and strengthen the diaphragm muscle. Doctors in Germany have been the first to trial it in COVID patients. The device is being developed by Lungpacer Medical Inc., a Simon Fraser University spinoff company.

“Ventilators can hurt the lungs but we’ve shown that if you activate the diaphragm, it can help,” said Reynolds. Ventilators can also cause brain cell death because of interruptions in signals from the lungs to the brain. “It’s very much a use it or lose it scenario,” he added, referring to the fact that relying on mechanical ventilation can cause weakness or even atrophy in various organs. The lungs, for example, can become stiff and scarred (fibrotic) from the oxygen blowing into the lungs as opposed to inhaling and exhaling in normal (non-assisted) breathing.

One measure that has worked pretty well to improve respiratory function in COVID patients has been placing them face down, in what is called the prone position. There are no magic bullets with COVID treatments, but Reynolds said prone positioning has become “a neat thing.

“We sometimes call it tummy time. It’s pretty remarkable how it changes oxygen needs for some people.”

Another aspect of his research involves imaging of internal organs to show what happens in real-time when patients – ventilated or not – are flipped over into the prone position by teams of healthcare professionals. A whole bundle of this kind of research is being funded by the RCH Hospital Foundation and the TB Vets Charitable Foundation Professorship in Critical Care at Simon Fraser University.

While shortages of ventilators have so far not been a problem, Reynolds said there’s always a worry about enough staff to tend to hospitalized patients. Health Minister Adrian Dix regularly updates the number of vacant beds there are in the province, to reassure citizens that the hospitals aren’t overflowing. But as Reynolds said:

“A bed is not a bed is not a bed. Ventilating patients or caring for all those in the ICU, or in COVID units, requires huge health care teams. Nurses are bearing the brunt of this and they are exhausted.”

RCH is one of a few hospitals in the Fraser Health region providing critical care for COVID patients. More than 2,000 COVID patients have been admitted to Fraser Health hospitals since the pandemic began. That is nearly two-thirds of all the patients across B.C. who’ve been hospitalized with COVID.

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