Answer: You can rest assured that a COVID vaccine won’t give you the illness that it is designed to prevent.

Consider, for example, that two of the leading vaccine candidates are based on a new type of vaccine technology using messenger RNA – or mRNA. To create immunity, the vaccines contain some of the genetic instructions for SARS-CoV-2, the novel coronavirus that causes COVID-19.

“It’s only one strand of RNA for making a part of the virus – not the entire virus – and it’s not infectious,” says Dr. Rob Kozak, a scientist and clinical microbiologist at Sunnybrook Health Sciences Centre in Toronto. And the other promising vaccines don’t contain infectious agents either. “So, there is no risk of these vaccines making you sick with COVID.”

However, he adds that it’s harder to predict how well the vaccines will work in people with underlying medical conditions.

Preliminary data from trials of healthy adults indicate some of the experimental vaccines are effective in 90 to 95 per cent of those who receive two doses.

An encouraging sign is that some of the trials included volunteers over the age of 65 who tend to have less efficient immune systems than younger folks.

Dr. Kozak notes that a new vaccine from AstraZeneca has produced a comparatively strong immune reaction in older adults.  “This suggests the vaccines will probably work to some degree in people who are immune compromised.”

Nonetheless, we won’t know the true protective capacity of the vaccines until there are results from trials involving a broader segment of the population, including individuals with various medical conditions.

Indeed, many questions remain unanswered.

The main goal of a vaccine is to get your immune system ready to fight off a specific microbial invader.

Traditionally, vaccines have used weakened or dead viruses – or parts of viruses – to train the immune system. When exposed to a harmless de-activated virus in this way, the body will produce antibodies and other immune cells that are primed for a rapid attack if they encounter the real live pathogen.

In recent months, the threat posed by the global pandemic has helped accelerate the development of new and innovative vaccine technologies – including mRNA.

Several pharmaceutical companies – such as Pfizer and Moderna – are banking on this approach. Their mRNA vaccines contain the genetic code for producing “spike” proteins – the distinctive protrusions that dot the surface of the coronavirus.

When delivered in a vaccine, the mRNA enters the body’s cells and instructs them to churn out spike proteins.  Human cells immediately recognize these are “foreign” proteins and alert the immune system to start generating protective antibodies.

The key advantage of an mRNA vaccine is that the synthetic raw materials can be produced faster than some traditional vaccines, like flu shots, which rely on viral samples grown in eggs.

But, on the downside, mRNA is inherently unstable. The Pfizer vaccine, for instance, must be stored at minus 70 degrees Celsius – creating huge challenges for distributing the doses.

The other promising vaccine is being developed by the University of Oxford and its pharmaceutical partner AstraZeneca. They are using a genetically-altered cold virus to deliver spike protein genes to trigger an immune response.

And there are still more vaccines in the pipeline. “No one expects that just a few companies will be able to produce enough vaccine to inoculate the entire world before next fall,” says Dr. Kozak. “So, we absolutely need more.”

Another uncertainty is that we don’t how long the vaccinations will last. Immunity may wane over time, requiring booster shots down the road.

But the more immediate question is whether the vaccines will actually block infection or just reduce the severity of the illness.

Even if a vaccine only minimizes symptoms, that may be sufficient to prevent a surge in COVID-19 cases from overwhelming the health-care system, says Dr. Chris Labos, an epidemiologist and cardiologist in Montreal.

“If the symptoms are reduced, then fewer people will need to be admitted to hospital, and fewer of them will be taking up ICU (Intensive Care Unit) beds and ventilators.”

On the other hand, if you are inoculated and only have partial immunity, you might later contract a mild case of COVID and still be capable of spreading it to others.  As a result, we may need to take protective measures to guard against infections until enough people are vaccinated to create collective “herd” immunity.

“Just because a vaccine is rolled out, it doesn’t necessarily mean we stop wearing masks or keeping our distance,” says Dr. Labos.

Dr. Kozak agrees: “I think masks are going to be with us for a while.”

The post Will a COVID-19 vaccine work in people with underlying medical conditions? appeared first on Your Health Matters.

Answer: You are certainly not the only person pouring back more alcohol in these troubling times.

“Many of my patients are struggling with the realities of the pandemic, including uncertainties over finances and employment as well as challenges with childcare and schooling,” says Dr. David Gratzer, a psychiatrist at the Centre for Addiction and Mental Health (CAMH) in Toronto.

“Not surprisingly, some are turning to alcohol and other substances. While alcohol can provide short-term relief for mood and anxiety symptoms, it is also addictive.”

A recent CAMH-Delvinia poll revealed 28.5 per cent of men and 22.6 per cent of women report binge drinking.

Even if you consider yourself a casual drinker, there is a risk you may be slipping into a danger zone.  It’s worthwhile talking to your health-care provider, whether that’s a family physician or nurse practitioner. “They know you and your medical history so they’re a very good starting point,” says Dr. Mark Greenberg, an addiction-medicine physician at Sunnybrook Health Sciences Centre in Toronto.

Of course, not everyone has a primary-care provider. Fortunately, there are alternatives.

In Ontario, for instance, people seeking help for substance-use issues can go to a Rapid Access Addiction Medicine (RAAM) clinic. “No referral from a doctor or pre-arranged appointment is necessary. It’s a walk-in type of place,” explains Dr. Greenberg.

He notes that when people decide they are ready to make a significant change in their behaviour, any delay can divert them from that path. “What we have found is that if patients can get timely access to treatment, their chances of succeeding are higher,” says Dr. Greenberg

So, the main purpose of a RAAM clinic is to reduce barriers to care – people just show up and they are seen that day, on a first-come, first-served basis.

RAAM clinics, which deal with addictions to various substances including opioids, are still relatively new in Ontario. They first opened in 2015 as part of a seven-site pilot project funded by Health Quality Ontario, a provincial government agency with a mandate to improve health care. After the pilot showed positive results – including a reduction in emergency department visits and hospital admissions – the concept took off.

There are now 65 publicly funded clinics across Ontario, says Kate Hardy, network director of META:PHI, which provides oversight, expertise and support to the province’s RAAMs.

Clinic locations can be found online at metaphi.ca

In the early days of the pandemic, some clinics transitioned to providing care “virtually” through video conferencing and telephone calls. More recently, they have re-opened their doors – giving patients a choice between in-person and virtual visits.

At the first appointment, patients meet with a doctor or nurse practitioner who has special training in addiction medicine. Patients are usually offered a prescription to one or more medications – such as acamprosate and naltrexone – which can curb cravings and ease withdrawal symptoms.

“These medications are really effective in helping people reduce their drinking, whether their goal is abstinence or simply to control the quantity they consume,” says Dr. Jennifer Wyman, associate medical director of the substance-use service at Women’s College Hospital in Toronto.

Aside from using medications to treat the biological and physiological aspects of the addiction, RAAM clinics also provide other forms of assistance.

“Patients are linked with a social worker or case manager who will talk to them about their immediate needs,” says Ms. Hardy. “For some people, that might be access to housing or food.”

Ms. Hardy says the long-term objective of a RAAM clinic is to shift patients to supports in the community. The patient’s own family doctor may take over prescribing the addiction medication. But in places where certain services are not readily available, “they can stay with us as long as they need our support,” she adds.

The RAAM model of treatment has proven to be so successful in Ontario that it is currently being considered or tried in other provinces including Manitoba, Saskatchewan, Alberta and British Columbia.

Addiction is a complex condition and a medication alone may not be enough to overcome the disorder. “I think the best treatment plan includes psycho-social supports which might involve group or individual counselling,” says Dr. Wyman.

She notes there are various types of support groups ranging from traditional 12-step programs to SMART Recovery training, which is growing in popularity. “Different people respond to different things.”

Many of these support groups are now being conducted virtually because of the pandemic – and that’s a good thing. Going virtual increases the options available to those who might find themselves imbibing a bit too much alcohol during what is expected to be a challenging winter ahead.

The post The pandemic is driving me to drink. Where can I get help? appeared first on Your Health Matters.

Answer: Don’t discard your face mask just yet.  SARS-CoV-2, the novel coronavirus that causes COVID-19, is so new that medical experts are still trying to determine how long immunity might last following an infection.

In fact, troubling evidence suggests immunity might be very short lived in some people.

U.S. researchers recently published a case report of a Nevada man who was re-infected within six weeks of first testing positive for the virus.  And, for this 25-year-old patient, the second bout of the illness turned out to be worse than his original infection. This time, he had to be hospitalized and given extra oxygen because of difficulty breathing.

A few other re-infection cases have been reported from other places – including Canada.

Immunity lasting for only a few weeks is probably the exception rather than the rule, says Dr. Andrew Morris, medical director of the antimicrobial-stewardship program at Sinai Health and the University Health Network in Toronto.

After all, he notes that over 40 million people worldwide have contracted COVID-19 and, so far, only a handful of re-infections have been identified.

“I think we can comfortably say it is extremely unlikely that someone will be re-infected in the short term. What we don’t know is the long term,” says Dr. Morris.

Will immunity last several months or a few years? Researchers just don’t have enough information to make a reliable prediction.

What can be said with some certainty is that the body’s immune system usually produces specialized cells to guard against subsequent attacks from a microbial invader.

“Like an army, there are different types of immune cells that carry out specific jobs and they all work better together,” says Rob Kozak, a scientist and clinical microbiologist at Sunnybrook Health Sciences Centre in Toronto.

For instance, antibodies will bind to the surface of a virus, marking it for elimination by other immune cells.  And if the virus evades detection by the antibodies and actually enters a cell, so-called T-cells can destroy the infected cell to prevent the virus from replicating.

After an infection is over, the immune system usually retains a type of memory of the foe so that the body’s defences are primed and ready for future attacks.

Blood tests can reveal if a patient has developed antibodies to a pathogen. But, in the case of COVID-19, researchers don’t know how many antibodies are needed to successfully fight off subsequent infections, says Dr. Kozak.

As a general rule, these protective antibodies tend to decline over time. We can also expect that the ability to beat back the virus will vary from person to person – depending on an individual’s genetics and overall health. Furthermore, a virus can mutate, essentially presenting as a brand new threat.

So, immunity acquired through an infection isn’t a sure thing.

However, researchers are confident that they can create effective protection with a vaccine – several of which are currently under development.

“A vaccine can be formulated to enhance the immune response,” explains Dr. Kozak.  He notes that adjuvants – or immunological stimulants – can be added to a vaccine so the immune system produces more antibodies and long-lasting protection.

Even so, it will likely be some months before one of the vaccine candidates clears all the safety and effectiveness tests and is ready for the general public.

In the meantime, everybody – including those who have already recovered from a bout of COVID-19 – should do their best to protect themselves and others from infection, says Dr. Allison McGeer, an infectious diseases physician at Sinai Health.

That means wearing a face mask properly (covering the nose and mouth), frequent hand washing and keeping a safe physical distance away from others who might be contagious.

“I think there are a lot of people who are impatient with this advice,” says Dr. McGeer.

She readily acknowledges that some people who have already been infected may be tempted to forgo such precautions because they might assume they are immune.  And, unfortunately, the medical community can’t provide them with an accurate estimate of their potential risk of re-infection.

“Until we have more data, it is really hard to say anything other than you just need to be careful for now,” says Dr. McGeer.

The post If I’ve recovered from COVID-19, do I still need to wear a face mask? appeared first on Your Health Matters.

Answer:  In recent years, a growing number of patients have been choosing the direct anterior approach. And it’s certainly true that during the first few weeks and months after the operation these patients tend to get better faster compared to those who have other types of hip replacement surgery.

However, like all medical procedures, it involves both pros and cons. What you need to know is that a landmark Canadian study published in March in the Journal of the American Medical Association identified potential problems with this approach.

“We found that the direct anterior approach was associated with a significantly higher risk of major surgical complications,” says Dr. Bheeshma Ravi, the senior author of the study and an orthopaedic surgeon at Sunnybrook Health Sciences Centre in Toronto.

The complications included deep infections and painful dislocations where the artificial joint pops out of the socket.

Dr. Ravi is quick to point out that that vast majority of patients undergoing a total hip replacement – regardless of the surgical approach – do well and they’re normally happy with the results.

“The hip replacement is one of the most successful surgical procedures in terms of quality-of-life improvement,” he explains.

“But when there is a complication, it’s not pleasant.  It’s going to be the dominant focus of your life for months because you may need multiple surgeries.”

Before delving deeper into the risks, it’s worthwhile reviewing the two other types of hip replacement surgery commonly performed in Canada.

One is called the posterior approach, in which the surgeon makes an incision, or cut, through muscles on the back of the hip.

The other is the lateral approach. It involves an incision on the side of the hip.

In both these procedures, the surgeon has to cut through muscle to gain access to the joint. The worn-out section of the upper thighbone – the ball of the joint – is then removed and replaced with an artificial part.

This means the cut muscles must heal before patients can experience the full benefits of a hip replacement.

With the anterior approach, by contrast, the surgeon makes an incision at the front of the thigh and then moves aside the muscles and other tissues to reach and replace the joint. As a result, the muscles remain largely intact which can contribute to a speedier recovery.

To evaluate the three different surgical techniques, the researchers used Ontario health data from 30,000 patients who received total hip replacements between April 2015 and March 2018.

The findings revealed that two per cent of patients who chose the anterior (frontal) approach suffered a major surgical complication within one year of their operation, compared with only one per cent of those who had either the lateral (side) or posterior (back) approach.

The researchers noted that patients who had the anterior approach tended to be younger and in better overall health than those who had the other surgeries. These two factors are usually associated with a lower chance of complications.

So, why was there double the risk with the frontal approach in a comparatively younger, healthier population? It’s possible that the position of the leg during the operation makes it harder for the surgeon to get the artificial ball into the right spot.

(Some hospitals use a specialized operating-room table for this procedure, but the researchers didn’t notice it made a difference in terms of the complication rate.)

Despite the elevated risks, Dr. Ravi says some patients may still prefer the frontal approach if an earlier recovery is important to them. He adds, though, they should at least be made aware of the potential complications.

Patients should also consider the surgeon’s experience and not just the surgical approach, says Dr. Amir Khoshbin, an orthopaedic and trauma surgeon at St. Michael’s Hospital in Toronto.

He suggests patients may want to pick a surgeon who does a lot of these surgeries – over 100 a year. “Higher-volume surgeons usually have fewer complications and potentially better outcomes,” says Dr. Khoshbin.

On the other hand, by choosing a specific surgeon who might be in high demand, it could add to the length of time you have to wait for your hip replacement.

So, what’s a discriminating patient to do? One important thing to keep in mind is that most people reach the same level of recovery in six to 12 weeks after their operation, regardless of the type of surgery.

In other words, those who have the frontal surgery are off to a faster start, but within about three months all patients end up at roughly the same place – provided they haven’t run into surgical complications.

The post What’s the best type of hip replacement surgery?  appeared first on Your Health Matters.

Answer: In some ways, we are in a better position than we were back in February when the first Canadian case was identified.

Since then, the medical community has learned a great deal about the novel coronavirus that causes COVID-19.

We now know that wearing masks, keeping two metres apart and proper hand washing can substantially help prevent the spread of the illness. Furthermore, public health officials have had time to set up testing centres and create contact-tracing processes to keep on top of outbreaks.

However, many infectious diseases experts are concerned that our testing and tracing systems could be overwhelmed by a significant and prolonged surge in cases. Long lines are already snaking around COVID-19 assessment centres.

The arrival of cold and flu season will be an added challenge, says Dr. Jerome Leis, medical director of infection prevention and control at Sunnybrook Health Sciences Centre in Toronto.

“Seasonal respiratory viruses can produce the same symptoms as COVID-19 and while we normally don’t test for these viruses in the community, this year we are going to have to sort them out,” says Dr. Leis. “That will put added pressure on our testing capacity.”

To further complicate matters, winter is coming. That means people will be heading back indoors, where it’s easier for the illness to spread. The virus is transmitted through respiratory droplets from an infected person coughing, sneezing and talking.  At least during the summer, folks could gather outside and a simple breeze might be enough to prevent the droplets from reaching another person.

But possibly the most troubling trend is that many people are showing signs of pandemic fatigue.

“This has been going on for months and they are just tired of it,” says Dr. Janine McCready, an infectious-diseases specialist at Michael Garron Hospital in Toronto. If people let down their guard, they could increase their likelihood of catching the virus and spreading it to others.

During the first wave, many were willing to heed the advice of public health officials.

“In the beginning, there was a certain sense of terror in the population,” says Dr. Matthew Muller, medical director of infection prevention and control at Unity Health, a collection of medical centres in Toronto.

“When people were told to stay inside, don’t go out, they really listened. On the news, you would see pictures of highways with no cars during rush hour.”

Government measures to close schools in the spring and curtail certain business activities also slowed the advance of the pandemic.

Dr. McCready noted that a large proportion of those originally infected included front-line service workers and those who lived in multi-generational homes where it’s difficult to self-isolate. Older adults living in close quarters in long-term care homes were also vulnerable to infection.

“People who were able to stay at home didn’t have to risk exposure,” says Dr. McCready.

With students returning to school and many sectors of the economy reopening, “infections will become more widespread across communities,” she predicts.

And if a second wave emerges from these cases, governments will likely be limited in their ability to introduce sweeping control measures, says Dr. Leis.

He thinks there is neither the public support nor the political will for another major lockdown.  Schools, which are widely considered to be an essential service, need to keep operating. So, government interventions will probably be targeted at specific areas and limited in scope.

“These smaller-scale measures may not be as effective in rapidly reducing community cases as we saw with the lockdowns in April and May,” says Dr. Leis. “We could have more prolonged COVID activity in the months ahead.”

Problems could arise if COVID-19 testing can’t keep pace with increased demand.  A person is infectious two days before developing symptoms and for up to ten days after becoming ill. So, it is critically important to have a relatively fast turnaround between the testing and availability of the results.

Dr. Muller points out that the health-care sector still hasn’t recovered from the disruption caused by the first wave of the pandemic. There is a huge backlog of delayed surgeries and postponed screening tests.  A second wave would probably add more patients to existing wait lists.

Even so, a big second wave isn’t inevitable, says Dr. McCready, adding that, “it all depends on human behaviour.”

With continued vigilance, and adherence to proven prevention measures – such as proper mask wearing (over the nose and mouth) and physical distancing – the number of new cases can be curbed.

And getting an annual flu shot would help to minimize influenza cases, which can be confused with COVID-19, says Dr. Leis.

But, the question is, do we have the collective will to do what’s necessary?

The post The second wave of the COVID-19 pandemic: How bad could it get? appeared first on Your Health Matters.

Answer: You may have noticed that advice about masks has changed during the course of the pandemic as the medical community has gained a better understanding of SARS-CoV-2, the coronavirus that causes COVID-19.

Experts agree that the virus is primarily transmitted through physical contact and respiratory droplets from an infected person coughing, sneezing and talking within close range.

The big challenge is that some people can spread the virus for up to two days before they experience symptoms, says Dr. Jerome Leis, medical director of infection prevention and control at Sunnybrook Health Sciences Centre in Toronto.

And certain cases are so mild that infected individuals may never grasp that they caught the virus.

This is very different from other viral respiratory infections that tend to produce obvious signs of illness, indicating when a person poses a risk to others.

The realization that COVID-19 could be transmitted unwittingly has led many experts to call for the universal use of masks in certain public places – especially indoors and where it may not be possible for people to keep at least two-metres apart.

For the general public, any cloth or fabric mask can effectively trap the respiratory secretions at their source – the nose and mouth – so they don’t spread to others or contaminate nearby surfaces.

“If two people are wearing masks properly, with the nose and mouth covered, then both are protected from each other,” says Dr. Leis.

But in health-care institutions, medical-grade masks are necessary to safeguard staff, says Dr. Susy Hota, medical director of infection prevention and control at the University Health Network, a collection of medical centres in Toronto.

“We are caring for people who are often the sickest and most infectious with COVID-19. And a sick patient in a hospital room may not be wearing any mask,” she explains.

What’s more, patients may require invasive respiratory procedures that can fill the surrounding air with tiny aerosol particles containing the virus.

“It’s a pretty high-risk scenario,” says Dr. Hota.

In order for health-care workers to be in close contact with COVID-19 patients to perform these procedures, they need special masks called respirators that prevent them from inhaling the virus.

There are different types of medical-grade masks, designed for a variety of situations.  A key feature of some masks is that the outer layer is hydrophobic, which means it repels and won’t absorb any liquid droplets that might land on it.

Dr. Hota says it’s important to conserve supplies of medical masks for those who need them the most – front-line health-care workers.

Even so, some people may still try to acquire these special masks online or in stores.

However, they may not be getting the real thing, says Dr. Leis.  “You may buy a mask that looks identical to one that is used in health care, but it might not meet the basic requirements in terms of fluid resistance and fit.”

He notes that hospitals follow procedures to ensure masks conform to certain specifications. The products available to the public may not go through the same level of rigorous testing.

But if your own safety is your primary concern, you can take some comfort in the fact that even a homemade mask “when it is well-designed and uses the right materials” can provide some degree of protection to the wearer, says Dr. Hota.

Indeed, if the outer surface is a droplet-resistant fabric, then it can act as a shield that stops the virus from entering the nose or mouth. Of course, you also need to take off the mask properly and wash your hands so germs aren’t scattered around.

Ordinary face coverings – if used correctly – can certainly curb new infections.

The widely-reported case of two hairstylists in Springfield, Missouri, illustrates the effectiveness of universal masking. The two women cut the hair of 139 clients while they were highly infectious. Fortunately, local regulations required the hairstylists and clients to use face coverings. After tests revealed the women had COVID-19, public health officials tracked down all their clients.  The investigation revealed not even one of them caught the bug.

In some ways, donning a face covering is an altruistic act because the primary purpose is to prevent the person wearing the mask from transmitting germs to others.  But when everyone puts on a mask, we end up safeguarding each other.  It’s a bit like the old saying, “You scratch my back, and I’ll scratch yours.

The post COVID-19: Who benefits the most from wearing a mask? We all do appeared first on Your Health Matters.

Answer:  For those who are considering medical assistance in dying, also known as MAID, it is important and beneficial to connect with their health-care providers in order to learn more about the process so that they are not surprised or disappointed if their MAID application is found ineligible.

Canadian law doesn’t preclude people with mental illnesses – including manic depression or bipolar disorder – from seeking MAID, but they must meet specific criteria.  In particular, a patient must have an incurable illness, and natural death must be reasonably foreseeable. Furthermore, individuals must have the mental capacity to make an informed decision.

Among some health-care professionals, there is a growing awareness that patients can be psychologically vulnerable in the period immediately after their application has been denied.

In a recently published study, a Toronto team of MAID assessors and providers report that three patients attempted suicide soon after they were deemed ineligible for an assisted death. In two of the cases, the patients didn’t have a foreseeable death. The third patient lacked mental capacity.

“We were, frankly, a bit caught off guard when it happened the first time,” says Sally Bean, one of the co-authors of the study and an ethicist at Sunnybrook Health Sciences Centre. “It wasn’t something we had anticipated.”

The three individuals had several things in common, says Dr. Elie Isenberg-Grzeda, lead author of the study and a staff psychiatrist at Sunnybrook.

They all had a history of depression and also suffered from mild cognitive impairment. Two of them had previously attempted suicide.

“The core features of depression are hopelessness about the future, suicidal thoughts and sometimes inflexibility in thinking,” explains Dr. Isenberg-Grzeda. “Similarly, cognitive impairment can prevent people from processing information clearly.” Both these conditions may increase the likelihood of self-harm.

To prevent further suicide attempts, the Sunnybrook clinicians revised their MAID process to identify in advance individuals who might be at risk.

“We started doing pre-assessments, looking at patients’ (medical) charts, and then managing the patients’ expectations,” says Dr. Isenberg-Grzeda.

They also put together support plans for people whose MAID requests are turned down.

The efforts appear to have paid off. There hasn’t been another suicide attempt since the process was changed over a year ago.

The study, published in the Journal of Pain and Symptom Management, “sheds light on an important issue,” says Dr. Stefanie Green, president of the Canadian Association of MAID Assessors and Providers in Victoria, B.C.

She says she is aware of other patients who died by suicide after being denied MAID.

“Probably the hardest thing we have to do is tell some people they are ineligible for assisted death,” adds Dr. Green.

“These are people who obviously believe they are suffering intolerably, and who are asking for our help, yet we are unable to aid them.”

Ms. Bean says many of the patients who seek MAID are highly independent individuals with long-held beliefs in the right to die. “They feel they should be able to control the circumstances of their death.”

What’s more, some of them are under the false assumption that they become eligible for MAID by simply signing a request form, which is available online.

The reality is very different. The requests go through a formal assessment to determine whether they meet the qualifications set out in legislation passed by the federal government in 2016.

“It would be a pretty devastating blow to be found ineligible,” says Ms. Bean. “They had hoped MAID would end their suffering and then told it’s not an option.”

Based on the MAID assessment study done at Sunnybrook, Dr. Isenberg-Grzeda believes numerous patients who don’t qualify for an assisted death could be at risk of self-harm.

He notes that the three attempted-suicide cases make up only 2.8 per cent of the 107 patients assessed for MAID eligibility during the study period from June 2016 to April 2019.

However, he adds, they represent 30 per cent of the 10 deemed ineligible for MAID. “This is a substantial proportion (of the rejected cases) and I think that is what makes this so significant.”

He believes it’s critically important for MAID assessors and providers to ensure that patients have realistic expectations and are supported through the process.

If you think your uncle is in an emergency situation, urge him to call 911 or visit his local hospital emergency department.

You can also let him know that help is available through community resources:

• ​​Find a local crisis resource at sunnybrook.ca/gethelp  
• Crisis Services Canada:

          Phone: 24-hour, toll-free 1-833-456-4566 

          Text: 45645 (4:00 p.m. – midnight Eastern Time)

The post Patients who are ineligible for a medically-assisted death may be at risk of self-harm appeared first on Your Health Matters.

Answer:  Most people assume that being cooped up in a commercial airliner is an extremely risky place to be during a pandemic. After all, passengers are in close proximity to a bunch of strangers for many hours. And there’s no doubt that infected travellers have been largely responsible for rapidly spreading SARS-CoV-2 – the coronavirus that causes COVID-19 – around the planet.

But your odds of catching the virus while onboard a plane may be actually less than you think. Frequent air exchanges, combined with safety precautions such as wearing face masks, can significantly reduce the chances of the virus being transmitted from person to person, according to infectious-diseases specialists.

“I think the risk of getting COVID-19 in flight is quite negligible,” says Dr. Jerome Leis, medical director of infection prevention and control at Sunnybrook Health Sciences Centre in Toronto.

He says that despite the large number of cases and frequent travel worldwide, there is very little documented evidence that people have contracted the virus during a flight.

Dr. Leis points to the example of Canada’s first two confirmed cases of COVID-19.  The married couple travelled from Wuhan – the original epicentre of the outbreak – to Guangzhou, China, where they boarded a plane to Toronto and arrived back in Canada on January 22nd.

The husband was already experiencing mild symptoms, such as a dry cough, during the flight. His wife became symptomatic the following day so both were considered infectious while they were travelling.

After they sought medical care, and tests showed they had COVID-19, Toronto public health staff went to work contacting 25 individuals, including crewmembers and passengers seated within three rows of the couple.  These contact tracing efforts, plus 14 days of monitoring, revealed that no one had been infected by the couple who apparently wore masks.

So, what might explain the lack of viral transmission in an airplane packed with 350 passengers?  SARS-CoV-2 doesn’t really travel far from the host, say medical experts.

The virus is primarily spread through respiratory droplets from an infected person coughing, sneezing or talking. The droplets might be propelled up to a distance of one or two metres before landing on nearby surfaces.  Smaller aerosols, tiny particles that may stay aloft a while longer, are not believed to play a significant role in COVID-19 transmission.

On an airplane, such particles would be quickly swept up by the ventilation system, says Dr. Susy Hota, medical director of infection prevention and control at the University Health Network (UHN), a collection of medical centres in Toronto.

She notes that the air inside a plane is normally exchanged between 15 and 20 times an hour.  And, in particular, the air passes through HEPA (high-efficiency particulate air) filters capable of trapping potentially harmful substances including viruses.

“Aerosols are unlikely to be hanging around long enough to actually result in an infection,” says Dr. Hota.

Of course, the larger respiratory droplets are still a concern. Many airlines, which are struggling financially, have resumed their customary practice of booking middle seats. That means it’s possible to be seated directly beside an infected individual.

“If you are wearing a mask and the person next to you is wearing a mask, that will substantially help reduce the risk – but it won’t bring it down to zero,” says Dr. Andrew Morris, medical director of the antimicrobial stewardship program at Sinai Health and UHN.

Overall, though, experts believe that the time spent on the plane isn’t particularly risky – especially if your seatmates are members of your household and you wear a mask as well as sanitize nearby surfaces.

In fact, the flight itself might be the least of your worries. “It’s not just the plane ride you have to consider – it’s how you’re getting from point A to point B and everything in between,” says Dr. Janine McCready, an infectious-diseases specialist at Michael Garron Hospital in Toronto.

Travel, she explains, often involves taking ground transportation, eating in restaurants, using public toilets and staying in places where you may not have control over your surroundings.

You also have to think about whether you are going to a region where there is a lot of local transmission of COVID-19, says Dr. McCready.  Being in a high-transmission area could increase the likelihood of exposure to the virus.

And if you’re visiting older family members, or someone who is not in good health, there’s a chance you might bring the virus with you and potentially infect them.

“Is it worth it?” asks Dr. McCready. “People have to make their travel decisions based on their own tolerance for risk.”

The post What are the chances of catching COVID-19 on an airplane flight? appeared first on Your Health Matters.

Answer:  It’s true that many infectious diseases follow a seasonal pattern with infection rates going up and down as the weather changes. For instance, influenza cases tend to peak during fall and winter months in both the northern and southern hemispheres.

However, SARS-CoV-2 –  the coronavirus that causes COVID-19 – is so new that it’s difficult to predict how it will behave in the future.

But preliminary evidence suggests that the activity of this virus isn’t linked to local temperature variations or geographic latitude  – at least for now.

One intriguing study looked at COVID-19 cases in 144 separate jurisdictions (various provinces, states and countries) during March when the pandemic was galloping around the globe.

The researchers collected data about temperatures, humidity and latitude, as well as public health measures introduced to control the virus, for the period of March 7 to 13. Then, allowing for a two-week interval for new infections to develop, be diagnosed and reported, they looked at the growing case count for the period of March 21 to 27.

The results showed the virus “doesn’t depend on temperature,” says the study’s lead author Dr. Peter Jüni, director of the Applied Health Research Centre at St. Michael’s Hospital in Toronto.

But, he added, public health measures – such as restricting mass gatherings and school closures – did help curb the virus.

In other words, communities that quickly took steps to contain the virus did better than those that were slow to respond – regardless of seasonal factors like temperature.

Dr. Jüni stresses that his study represents “a snapshot” in time.  “COVID-19 might eventually become seasonal,” as the virus and the human population interact with each other, he adds.

Right now, though, people are extremely vulnerable to the novel coronavirus. SARS-CoV-2 has been around for only several months. So, most people still have no immunity to it. That means the virus can cut a swath through humanity without facing any natural barriers to slow its advance.

As more and more people become infected, they are expected to develop some immunity and the virus will have a harder time spreading within the community.

When that happens, there is a possibility the virus will change, says Dr. Samira Mubareka, an infectious diseases physician and virologist at Sunnybrook Health Sciences Centre in Toronto.

She points out that many viruses routinely mutate, which can produce new genetic variants that can make it easier for them to proliferate.

In the case of SARS-CoV-2, “it doesn’t currently have a huge amount of pressure on it to change because it transmits quite effectively,” she explains. But, as human resistance increases, natural selection will favour those traits that give it a competitive edge.

And if the virus morphs, it might begin to resemble other infectious diseases that follow seasonal patterns.
But even with long-established viruses – such as influenza – scientists don’t fully understand how seasonal factors drive viral activity.  Temperature, humidity and solar radiation vary with the seasons. Yet, at the same time, human behaviour also changes. Students attend school in fall and winter months. And people are more likely to congregate indoors with the return of inclement weather. Bringing people closer together makes it easier for a virus to spread.

So, it can be difficult for researchers to determine what has the biggest impact on transmission – variable seasonal factors or changes in human activity? Both may be equally important.

Despite such uncertainties, it is becoming increasingly clear that SARS-CoV-2 has a harder time spreading outdoors than indoors, says Dr. Jüni.

He notes that SARS-CoV-2 is transmitted through large respiratory droplets and possibly also their smaller counterparts called aerosols that may  stay airborne after an infected individual coughs, sneezes or simply talks.
Outdoors, a gentle wind can “literally blow away” the aerosols, he says. What’s more, the sun may kill any viral particles that land on nearby surfaces.

“The longer this pandemic goes on, I become more convinced that crowding inside is the major problem,” says Dr. Jüni.

It’s a point of view that is shared by many medical experts who say we need to keep doing the things that can thwart the virus – such as physical distancing, proper hand washing, wearing face masks, as well as targeted testing and contact tracing.

In the fall, when Canadians retreat inside again, “it’s going to be really important that we don’t let down our guard,” says Rob Kozak, a clinical microbiologist at Sunnybrook.

He says the medical community learned a lot about how to contain the virus during the first wave of the pandemic. “The optimist in me says we can do a better job of controlling a second wave,” he adds. “Hopefully, I am not wrong.”

The post Will COVID-19 become a seasonal illness like the flu? appeared first on Your Health Matters.

Answer: Unfortunately, it does matter. For a vaccine program to be effective against a common pathogen, a certain percentage of the population usually needs to be inoculated and able to resist infection.

A high level of participation helps create so-called “herd immunity” which is often necessary to safeguard those who don’t respond well to the vaccine, says Rob Kozak, a clinical microbiologist at Sunnybrook Health Sciences Centre in Toronto.

He notes that many older folks may not generate a robust response to a vaccine. As people age, their immune systems become less efficient at producing the antibodies and T-cells necessary to fight off an infection.  As a result, they may still become ill even if they get a shot.

People with compromised immune systems, such as certain cancer patients, may also fail to benefit fully from a vaccine.

To protect vulnerable populations, we need a sufficient number of people who are immune to the infection so that the virus has a hard time spreading from person to person.

Essentially, herd immunity reduces the chances that a susceptible individual will come into contact with SARS-CoV-2, the official name of the coronavirus that causes COVID-19.

However, because SARS-CoV-2 is so new, medical experts still don’t know what percentage of the population needs to be vaccinated to achieve herd immunity.

“Some of the estimates range anywhere from 60 per cent all the way up to 85 per cent,” says Dr. Kozak.

Right now, the push is on to get a product to market as fast as possible.  The U.S. program, called “Operation Warp Speed,” has set a target of having a vaccine ready by the end of year – 18 months at the outside. It typically takes many years to develop a vaccine against a new pathogen.

That rush could undermine public trust in anything that is developed, says Byram Bridle, an associate professor of viral immunology at the University of Guelph.

“As soon as you use terms like ‘warp speed’ it creates the impression that corners are being cut and a lot of people will question the safety of the vaccine,” says Dr. Bridle.

Dr. Kozak says vaccine development can be accelerated without jeopardizing science or safety.

He notes that researchers often spend a lot of time applying for grants.

In this case, though, money is readily available and the regulatory process is primed for a rapid response. “People are putting in place the resources that are really useful in speeding things up.”

What’s more, some scientists are working on new types of vaccines – using synthetic genetic material – that may be quicker to develop than traditional inoculations that often include part of a killed or attenuated (weakened) virus to trigger an immune response.

But Dr. Kozak acknowledges that research is still a very lengthy process. It takes a fixed amount of time for the immune system to respond to a vaccine, and then it takes more time to do the tests that can confirm safety and effectiveness.  “It’s all just an exercise in patience,” he adds.

And once a vaccine (or more than one) is approved, it still needs to be manufactured in large amounts and administered to the public – additional time-consuming steps on the road to herd immunity.

Dr. Bridle doubts that any vaccine can be developed within the year.  “I’m not going to say it is impossible, but it’s a low probability.”

Even without a vaccine, he expects natural herd immunity will be gradually created in the community as more and more people have become infected with the virus. That assumption is based on the fact that people normally develop some immunity after successfully fighting off an infection. But it’s uncertain how long that protection will last because it might wear off or the virus could morph over time.

So, the medical community is banking on vaccine development. “The uptake of a vaccine is going to be driven by people’s perceptions of how safe it is,” says Dr. Bridle.

That means public-health leaders can’t ignore vaccine critics whose activities could help sow seeds of doubts among those who aren’t usually opposed to inoculations. “We could be at risk of not getting enough people vaccinated,” he warns. “And, I do believe, that could be a problem.”

The post Why anti-vaxxers can’t be ignored as researchers race to develop a COVID-19 vaccine appeared first on Your Health Matters.