The Saskatchewan ministry of health is advising the public to take precautions against West Nile virus.
The virus was first detected 20 years ago and the risk has decreased in recent years.
But Health minister Paul Merriman wants the public to use best practices to protect against mosquito bites.
While the number of culex tarsalis mosquitoes, the type that carries West Nile virus has declined in recent years, he says it’s important to take precautions against mosquito bites.
In 2021, there was only one human neuroinvasive disease case and no one has died of West Nile Virus in Saskatchewan since 2018.
Provincial monitoring will continue in Saskatoon, Regina and Estevan to approximate the threat of West Nile in the province this summer.
Reducing exposure to mosquito bites includes insect repellant, loose fitting, long sleeve tops and long pants, avoiding outdoors at dawn and dusk, proper door and window screens and reducing standing water around the yard.
Most people infected with West Nile have no or mild symptoms while a few can develop fever, confusion and severe headache.
People still would have died across Canada, and the number of deaths would have been somewhat predictable based on data from previous years.
Dr. Kimberlyn McGrail
Dr. Kimberlyn McGrail, a professor in UBC’s school of population of public health, examined all “excess deaths” across Canadian provinces during the first 19 months of the pandemic, and how many of those were attributed specifically to COVID-19.
Excess deaths are deaths above and beyond what would have been expected under normal circumstances.
Why look at “excess deaths” rather than just COVID-19 deaths when trying to understand the pandemic?
The pandemic had a direct effect on deaths, in that people got the virus and unfortunately some died from it, but the pandemic also had other effects. People delayed care, or had surgeries, diagnostics and appointments cancelled, which can lead to poorer outcomes. We also had other public health events going on—particularly in B.C. with the ongoing tainted drug supply and the heat dome in the summer of 2021. Those things were potentially affected by the pandemic. So overall mortality is a better indication of what’s actually happening at the population level.
How do we know how many deaths were expected?
I used data provided by Statistics Canada. They look at trends in the population’s size and age in the five years preceding the pandemic to model what would have been expected in 2020-21, absent the pandemic.
What did you learn about excess deaths across Canada during the pandemic?
Excess mortality is just an estimate, but the experience across the provinces, according to what Statistics Canada is telling us, is very different. We saw very little to no excess death in the Atlantic provinces, and quite high excess deaths in western provinces.
What are some possible explanations for this wide variation?
One of the challenges is that a number of different things could contribute to this variation, and it’s probably not one or another, but a combination.
For COVID-19 deaths, differences in COVID-19 reporting practices could be contributing. Each province defines and counts COVID-19 deaths in different ways, and reports them at different speeds.
For overall excess deaths, it could be because provinces differed in their responses to COVID-19. It could be because of the additional public health events going on. Or it could be the broader implications of COVID-19, like cancelled surgeries and delayed diagnostics. There may also be some inaccuracy in the modelling of expected deaths by Statistics Canada.
Your study shows that excess deaths far exceeded COVID-19 deaths in some provinces. How is that possible?
I'll use the heat dome in the summer of 2021 as a particular example. The B.C. Coroners Service has now attributed almost 600 deaths to that event. You might say that's not related to COVID-19. However, so much policy attention was being placed on COVID-19 at the time. Some of the precautions, with people being locked down, limited activity and so on, might have contributed to how we responded to the heat dome, which in turn could have contributed to deaths. For example, lots of older people living alone didn’t have the usual level of social support and people checking on them.
What does this study reveal about the way data is collected and reported across provinces?
Probably the most important thing to underline is that good, timely data are essential for health care system planning. There has to be clear understanding of what the trends are and the most likely reasons for those trends so appropriate decisions can be made.
Given the variation in excess mortality across provinces, it's really important that we have a pan-Canadian conversation about trying to understand which potential causes are related to that, and come to some agreement about common data, timeliness and definitions. Clearly we're going to have health events and pandemic-type things happen again. This is the opportunity to have those conversations. That's how we’re going to make sure we're prepared for the next event.
Wildlife pathologist Trent Bollinger says the cases are primarily in skunks and the occasional red fox. (Submitted by Brittany Crossman - image credit)
Presumptive cases of avian flu are showing up in some species of mammals in Saskatchewan.
Trent Bollinger is a wildlife pathologist at the Western College of Veterinary Medicine in Saskatoon.
He told CBC News the first presumptive case of avian flu in a "major carnivore" came into the lab about three weeks ago.
As of the last week, six to ten more have been tested.
"These are primarily skunks, with the occasional red fox, that have neurological signs which could be attributed to (high pathogenic) avian influenza virus," he said.
Bollinger noted there are other viral diseases — such as distemper and rabies — that cause similar symptoms in these species.
However, recent molecular diagnostic tests point to avian flu as the most likely cause in at least three of the cases.
"We have several others that that we've done autopsies on and are investigating further. And that could cause the numbers to go up," Bollinger said.
The transmission to mammals is not a surprise to Bollinger, who said cases have been showing up in the United States.
"But we're seeing a fair number, which is maybe a bit unusual. So we'll see as time goes on," he said.
Mortality to continue through summer
The pathologist says he expects more waterfowl, which are at high risk of viral transmission, will succumb to the avian flu through the summer.
He noted a "peak of activity", referring to the number of birds dying from the virus, during the spring migration through the prairies.
While he expects those numbers to decline through the next few months, there's another vulnerable group: baby birds.
"We're going to have new cohorts of ducklings and young juveniles that that could be exposed as well," he said.
"So we may see, again, an uptick in mortalities that the public is observing."
Bollinger said bird species most affected by the virus appear to be "relatively abundant", and that mortality rates are not significantly impacting those populations at this time.
He noted the bigger concern is spread into poultry flocks, which have to be depopulated en masse and have economic implications.
Bollinger said transmission to people and domestic pets, such as dogs and cats, doesn't seem to be happening.
What to watch for
Bollinger said people who spot an animal "acting abnormally", should avoid touching the animal, and contact a conservation officer.
However, if the animal subsequently dies and there's concern it could be avian flu, people can pick up the animal with latex gloves or a plastic bag to get it to a diagnostic lab.
"Bring it into the vet college here. We will do an autopsy on it, determine cause of death and then report back those findings," he said.
He added that the lab has not seen the disease in domestic pets, such as dogs and cats, and there's no concern about transmission there at the moment.
Presumptive cases of avian flu are showing up in some species of mammals in Saskatchewan.
Trent Bollinger is a wildlife pathologist at the Western College of Veterinary Medicine in Saskatoon.
He told CBC News the first presumptive case of avian flu in a "major carnivore" came into the lab about three weeks ago.
As of the last week, six to ten more have been tested.
"These are primarily skunks, with the occasional red fox, that have neurological signs which could be attributed to (high pathogenic) avian influenza virus," he said.
Bollinger noted there are other viral diseases — such as distemper and rabies — that cause similar symptoms in these species.
However, recent molecular diagnostic tests point to avian flu as the most likely cause in at least three of the cases.
"We have several others that that we've done autopsies on and are investigating further. And that could cause the numbers to go up," Bollinger said.
The transmission to mammals is not a surprise to Bollinger, who said cases have been showing up in the United States.
"But we're seeing a fair number, which is maybe a bit unusual. So we'll see as time goes on," he said.
Mortality to continue through summer
The pathologist says he expects more waterfowl, which are at high risk of viral transmission, will succumb to the avian flu through the summer.
He noted a "peak of activity", referring to the number of birds dying from the virus, during the spring migration through the prairies.
While he expects those numbers to decline through the next few months, there's another vulnerable group: baby birds.
"We're going to have new cohorts of ducklings and young juveniles that that could be exposed as well," he said.
"So we may see, again, an uptick in mortalities that the public is observing."
Bollinger said bird species most affected by the virus appear to be "relatively abundant", and that mortality rates are not significantly impacting those populations at this time.
He noted the bigger concern is spread into poultry flocks, which have to be depopulated en masse and have economic implications.
Bollinger said transmission to people and domestic pets, such as dogs and cats, doesn't seem to be happening.
What to watch for
Bollinger said people who spot an animal "acting abnormally", should avoid touching the animal, and contact a conservation officer.
However, if the animal subsequently dies and there's concern it could be avian flu, people can pick up the animal with latex gloves or a plastic bag to get it to a diagnostic lab.
"Bring it into the vet college here. We will do an autopsy on it, determine cause of death and then report back those findings," he said.
He added that the lab has not seen the disease in domestic pets, such as dogs and cats, and there's no concern about transmission there at the moment.
VANCOUVER – BC Cancer has launched a provincewide lung cancer screening program, providing access to eligible high-risk people at 36 sites throughout the province.
The Lung Screening Program expects to start screening close to 10,000 patients in the first year of the program, with this number expected to increase by approximately 15% per year. It is estimated the program will diagnose approximately 150 lung cancer cases annually, with more than 75% of these diagnosed at an earlier stage than without screening.
Lung screening is available provincewide through 36 sites across all health authorities using the existing computed tomography (CT) scanning capacity.
Lung screening is best suited for those who are at high risk for lung cancer and who are not experiencing symptoms. Eligible participants may include those who are:
* between 55 and 74;
* currently smoking or have previously smoked; and
* have a smoking history of 20 years or more.
Patients who meet the above criteria are encouraged to call the Lung Screening Program at 1 877-717-5864 to complete a consultation and risk assessment to determine eligibility.
Key benefits of a provincewide screening program:
* equitable access for eligible British Columbians;
* early detection resulting in improved survival rates; and
* consistent, high-level screening and prevention delivered via a centralized program.
BC Cancer clinicians and researchers led by Dr. Stephen Lam, medical director of the BC Cancer Lung Screening Program, are leading the program’s implementation.
The centralized program will determine who is eligible, communicate results to patients, provide a pathway to cancer care if required and provide information on smoking-cessation programs.
With 26 confirmed cases of monkeypox in Canada, health officials warn there will likely be more cases reported in the coming days and weeks. However, one expert says the outbreak can be stopped if the country works quickly to get it under control.
Infectious disease expert Dr. Isaac Bogoch says that Canada will "definitely" see more cases of the virus in the "few days and weeks ahead."
"This outbreak is going to crumble along unfortunately for a bit of time," Bogoch told CTV's Your Morning on Friday.
However, if health officials act quickly, Bogoch said the outbreak in Canada can be stopped.
"Currently, there's only 26 people in a country of 38 million people and the risk of the general population today is extremely, extremely small. But let's play our cards right. Let's deal with this quickly and effectively so that no one else needs to get this infection and that we just get this under control," he said.
The Public Health Agency of Canada announced on Thursday there are now 25 confirmed cases of monkeypox in Quebec, and one confirmed case in Ontario. However, the health agency says several suspected and probable cases are still being investigated.
Prior to this month, monkeypox had never been detected in Canada.
Despite the unexplained rise in cases in Canada, and a growing number in other countries such as the U.S., Spain, Portugal, and the U.K., Bogoch says Canada has the tools to "quell this quickly," if federal and provincial health officials take a co-ordinated approach to vaccinating those at high risk.
"We have an outbreak of this right now, but there's no reason to let this run amok and there's no reason to have this infect many people," he said.
PHAC said they are focusing on a "targeted approach to vaccination and treatment" amid the current outbreak, and do not believe a mass vaccination campaign is necessary.
There is no proven treatment for the virus infection, but the smallpox vaccine is known to also protect against monkeypox, with a greater than 85 per cent efficacy. Because the smallpox vaccine eradicated the disease, however, routine smallpox immunization for the general population ended in Canada in 1972.
PHAC has already supplied Quebec with 1,000 doses of the smallpox vaccine Imvamune from Canada’s National Emergency Strategic Stockpile. Because of the limited supply, it is not yet clear who will be eligible for the vaccines, but Bogoch said they will likely be reserved for close contacts and health-care workers.
Bogoch said if vaccines are issued to high-risk groups quickly, officials "can certainly prevent the spread of this and fewer Canadians need to be impacted."
WHAT TO KNOW ABOUT MONKEYPOX
First discovered in 1958, monkeypox is a rare disease caused by a virus that belongs to the same family as the one that causes smallpox. The disease was first found in colonies of monkeys used for research.
The disease has primarily been reported in central and western African countries, with the first case outside the continent reported in 2003 in the United States.
The virus is transmitted through contact with an infected animal, human or contaminated material. Transmission between people is thought to primarily occur through large respiratory droplets, which generally do not travel far and would require extended close contact. Transmission from an animal can happen through bites or scratches, contact with an animal’s blood or body fluids.
Monkeypox symptoms are similar to those for the smallpox, but generally milder. The first signs are fever, headache, muscle aches, backaches, chills, and exhaustion.
The incubation period — the span of time between initial infection and seeing symptoms — for monkeypox is generally 6-13 days, but can range to as many as 21 days, according to PHAC.
The "pox" develops after the onset of a fever and usually occurs between one to three days later, sometimes longer. A rash usually begins on the face and spreads to other parts of the body, developing into distinct, raised bumps that then become filled with fluid or pus.
Dr. Howard Njoo, Deputy Chief Public Health Officer, said Canadians should be aware of these symptoms, and seek medical attention particularly if they have an unexplained rash.
He added that people can avoid infection by "maintaining physical distance from people outside their homes."
"As well, wearing masks, covering coughs and sneezes, and practicing frequent handwashing continues to be important, especially in public spaces," Njoo said.
While the overall risk of monkeypox to the general public is low, Njoo said it is important to remember that everyone is susceptible, despite most cases in the country and others appearing to be spread through sexual contact between men.
He added that more guidance on case identification and contact tracing, along with infection prevention, will be released shortly.
Monkeypox is endemic in animals in regions in Western Africa, and while cases have popped up in countries where it is not endemic before, the cases typically involved people who recently travelled from a country in Africa.
What is unusual right now is that officials in numerous countries that don’t usually deal with monkeypox are seeing cases where the patient has no travel history, Njoo said.
Due to the unexpected nature of the current outbreak, Njoo said health officials in Canada and abroad are looking at whether there are any changes from what was previously known about the rare illness, including incubation period and method of transmission.
He said global cases are "not all similar in how they're presenting," and said milder cases may even go undetected.
"Our understanding of the virus is still evolving, but I want to emphasize this is a global response," Njoo said.
With files from CTVNews.ca's Alexandra Mae Jones and Solarina Ho
A new map released by the B.C. Centre for Disease Control lists the Castlegar and Trail areas as Lyme disease risk areas.
Lyme disease is caused by a bacterium spread by ticks, tiny bugs that feed on the blood of animals and humans.
Although the map identifies many of the populated areas of the province as having a risk of Lyme disease, the overall risk in the province remains low with less than 0.5 cases per 100,000 people and a less than one-per-cent tick infection rate.
Lyme disease is carried by Ixodes pacificus and Ixodes angustus, also known as western black-legged ticks. But most of the ticks in the region are wood ticks (Dermacentor andersoni) which do not carry the Lyme disease bacteria. However, wood ticks can carry other diseases such as Rocky Mountain spotted fever, although it is rare.
The BCCDC has launched a campaign asking for the public’s assistance in identifying ticks with the goal of limiting Lyme disease. They have partnered with eTick, a free app that allows users to upload tick photos so researchers can track where western black-legged ticks are found.
Lyme disease is preventable by avoiding tick bites.
“There are easy things you can do to protect yourself from ticks such as covering up before you head outdoors and checking for ticks when returning from a walk, hike or bike ride,” said Dr. Fatemeh Sabet, Interior Health medical health officer. “Most tick bites do not result in illness; however, any bite from a tick should be cleaned because the infection can occur whenever there is a break in the skin.”
Anyone who has a bull’s-eye target skin rash after a tick bite or any other symptoms compatible with Lyme disease should see their physician.
More information on identifying ticks and what to do it you are bitten by one can be found at bccdc.ca.
B.C. is leading the way in lung cancer screening, launching the country's first screening program for individuals who are at high risk of getting the disease. BC Cancer Lung Screening Program Medical Director Dr. Stephen Lam explains how it works, and who is eligible.
That's what Cheryl-Anne Labrador-Summers thought, anyway. It was October 2020, not long after she'd moved to the tranquil lakeside Ontario community of Georgina, and instead of relaxing with her family like she'd planned, the mother of three was struggling to figure out why she kept experiencing strange, unexplained stomach cramps.
Labrador-Summers tried to visit her family physician, but the office was shuttered because of the COVID-19 pandemic. So she searched for another clinic — only to be offered a phone appointment rather than an in-person assessment. She wound up being told that her grumbling digestive system was likely caused by a mild gastrointestinal illness.
By January, the 58-year-old had a distended stomach, looking — in her own words — "about nine months pregnant." Again, she reached out to a physician, went for some tests, then headed to the nearest emergency department.
After finally seeing a doctor face to face for the first time in months, she learned the real cause of her discomfort: an intestinal blockage caused by cancer.
"It ended up being a nine-centimetre tumour, and it had completely blocked off my lower bowel," she said.
An emergency surgery left Labrador-Summers with 55 staples along her torso and a months-long recovery before she could begin oral chemotherapy. Her question now is unanswerable but painful to consider: Could that ordeal have been prevented, or at least minimized, by an earlier diagnosis?
"Had I maybe been able to see the doctors earlier, I would not be in Stage 3," she said. "I might have been a Stage 2."
Photos show Labrador-Summers with a distended stomach before her emergency surgery, left, and the 55 staples along her torso following the procedure. (Supplied by Cheryl-Anne Labrador-Summers)
951,000 fewer cancer screenings in Ontario
More Canadians could experience late-stage cancer diagnoses in the years ahead, medical experts warn, forecasting a looming crisis tied to the ongoing COVID-19 pandemic.
"We expect to see more advanced stages of presentation over the next couple of years, as well as impacts on cancer treatments," said oncologist Dr. Timothy Hanna, a clinician scientist at the Cancer Research Institute at Queen's University in Kingston, Ont.
"We know that time is of the essence for people with cancer. And when people are waiting for a diagnosis or for treatment, this has been associated with increased risks of advanced stage and worse survival."
One review of Ontario's breast, lung, colon, and cervical cancer screening programs showed that in 2020 there were 41 per cent — or more than 951,000 — fewer screening tests conducted compared with the year before.
Screening volumes rebounded after May 2020, but were still 20 per cent lower compared to pre-pandemic levels.
WATCH | Late-stage cancer being diagnosed in Canadian ERs:
ERs faced with late-stage cancer diagnoses amid pandemic
3 days ago
Duration 2:11
Hospital emergency rooms are seeing a wave of patients being diagnosed with late-stage cancer after the COVID-19 pandemic forced many doctors’ offices to close or pivot to virtual appointments, leading to fewer cancer screenings.
That drop in screenings translates into fewer invasive cancer diagnoses, including roughly 1,400 to 1,500 fewer breast cancers, wrote Dr. Anna N. Wilkinson, an assistant professor in the department of family medicine at the University of Ottawa, in a May commentary piece for the journal Canadian Family Physician.
"The impact of COVID-19 on cancer is far-reaching: screening backlogs, delayed workup of symptomatic patients and abnormal screening results, and delays in cancer treatment and research, all exacerbated by patient apprehension to be seen in person," she wrote.
"It is clear that there is not only a lost cohort of screened patients but also a subset of missed cancer diagnoses due to delays in patient presentation and assessment," leading to those cancers being diagnosed at a more advanced stage.
Tough accessing care in a 'timely way'
The slowdown in colonoscopies may already be leading to more serious cases of colorectal cancer in Ontario, for instance, suggests a paper published in the Journal of the Canadian Association of Gastroenterology.
"Patients who were treated after the COVID-19 pandemic began were significantly more likely to present emergently to hospital. This means that they were more likely to present with bowel perforation, or severe bowel obstruction, requiring immediate life-saving surgery," said the study's lead author, Dr. Catherine Forse, in a call with CBC News.
"In addition, we found that patients were more likely to have large tumours."
Dr. Lisa Salamon, an emergency room physician with the Scarborough Health Network, is pictured outside Birchmount Hospital, in Scarborough, Ont. (Evan Mitsui/CBC)
In some cases — like Labrador-Summers's situation — Canadians learned alarming news about their health in hospital emergency departments after struggling to receive in-patient care through other avenues.
Shuttered family physician offices, a shift to telemedicine, and some patients' fears surrounding COVID-19 may all have played a role.
"It became harder for patients to access care and to access it in a timely way," Hanna said.
"At the same time, there were real risks — and there are real risks for leaving home to go anywhere, particularly to go to an outpatient clinic or a hospital in order to get checked out."
Dr. Lisa Salamon, an emergency physician with the Scarborough Health Network in Toronto, said she's now diagnosing more patients with serious cancers, including several just in the last few months.
"So previously, it may have been localized or something small, but now we're actually seeing metastatic cancer that we're diagnosing," she explained.
Lessons for future pandemics
Health policy expert Laura Greer is dealing with Stage four, metastatic breast cancer herself after waiting more than five months for a routine mammogram she was initially due for in the spring of 2021 — a precautionary measure given that her mother had breast cancer as well.
Unlike an early-stage diagnosis, Greer's cancer is only treatable, not curable.
"It was an example of what happens when you don't have the regular screening, or those wellness visits," said the Toronto resident and mother of two.
"I most likely would have had earlier-stage cancer if it had been sooner."
Health policy expert Laura Greer is dealing with Stage 4, metastatic breast cancer after waiting more than five months for a routine mammogram she was due for in the spring of 2021. (Esteban Cuevas/CBC News)
Pausing access to care and screenings for other health conditions can have dire impacts on patients, according to Greer, offering lessons for how policy-makers tackle future pandemics.
"We need to make sure that we've got enough capacity in our health system to be able to flex, and that's what we really didn't have going into this," she said.
For Labrador-Summers, it's hard to forget the moment her life changed while she was alone in an emergency department, learning a terrifying diagnosis from a physician she'd just met. Her mind raced with questions about the future and concerns for her family.
Labrador-Summers's husband and one of her sons kiss her on the dock near their lakeside home in Georgina, Ont. (Ousama Farag/CBC News)
"My older son had just told us they were expecting a child, and I just wanted to be there for them. And I didn't know what next steps were. And we had lost my mom to cancer a few years back — to us, cancer was always terminal," she recalled.
"So again, I'm alone, trying to process all of this."
A screening following Labrador-Summers' surgery and chemotherapy treatment wound up finding more cancer.
Saskatchewan's HIV numbers remain the highest in the country.
Latest provincial health data reveals a record-breaking 237 diagnoses in 2021 — a nearly 30 per cent jump from the 184 cases recorded in 2020, which puts transmission rates at more than double the national average.
"It's unfortunate, and — even though we talk percentages — those are real individuals," said Dr. Johnmark Opondo, a medical health officer on Saskatchewan's HIV provincial leadership team.
According to the Ministry of Health, sexual contact contributed to 68 per cent of HIV cases (which is higher than usual for the province) and injection drug use made up 50 per cent. These risk factors are not mutually exclusive.
Still, Opondo maintains needle sharing is a primary driver.
"Sexual encounters are very risky if you're not using protection and you're not with your steady, regular partner — but injection drug use, if you're not practicing safe needle use, even a single episode can be enough to transmit HIV," he explained.
Safe consumption sites key in containing HIV: doctor
Opondo says harm reduction services, like safe drug consumption sites, are among the key preventative elements that can help contain the province's HIV numbers.
Kayla DeMong, executive director of Prairie Harm Reduction (PHR) in Saskatoon, agrees.
She calls last year's HIV numbers "heartbreaking," noting they speak to the need for more facilities like PHR in Saskatchewan and why provincial funding is needed to run them.
"With each HIV transmission that we can prevent at our site, we know that we are saving the health-care system huge dollars," DeMong said.
Saskatoon's Prairie Harm Reduction, a safe consumption site, is pictured. Executive Director Kayla DeMong says more facilities like this are needed. (Kendall Latimer/CBC)
"The individuals that we are serving here are people who are affected by homelessness, they have complicated health issues, complicated mental health problems and they're not engaged in a lot of services in our community," DeMong explained.
"The more investment that we can have toward this population, the better impact we'll see in lowering [HIV] transmission rates."
PHR doesn't offer people drugs but provides a space where they can use them under medical supervision. The site can also check drugs for laced substances, and help people get access to sterile equipment and supports.
"It's a life-saving service," Opondo said.
Education, testing among best preventatives
While intravenous drug use is considered a primary driver in Saskatchewan's HIV numbers, Dr. Larissa Kiesman — a family physician and the medical director at Westside Community Clinic in Saskatoon, a hub for HIV care — says people shouldn't lose sight of other risk factors.
She says last year's high rate of sexual transmission shows the virus is spreading widely in non-drug users as well.
"To isolate this as a problem amongst people who inject drugs is not appropriate," Kiesman said.
"We're seeing a lot of transmission in people who have never used intravenous drugs — and they're very, very shocked by this diagnosis."
LISTEN | Sask. infectious diseases doctor weighs in on record-breaking HIV spike:
The Afternoon Edition - Sask8:00Sask. infectious diseases doctor weighs in on record-breaking HIV spike
There were 237 HIV cases reported in 2021 — a 30 per cent increase from 2020 that puts the provincial rate at more than twice the national average. Dr. Alexander Wong, an infectious diseases physician with the Saskatchewan Health Authority, joins host Garth Materie to tell us more.
Robin Hilton, the sexual health outreach co-ordinator with the University of Regina Students' Union, says the spike in sexual transmission of HIV can be linked to a lack of updated sex education in schools.
"If we have that ability right from that foundation to have conversations about sexual health and to feel comfortable going for [HIV] screenings, then we're getting off on a right foot," Hilton said.
"We know that with HIV, knowing your status is the best possible way to prevent spreading the infection."
That's where testing comes in.
Throughout the pandemic, Saskatchewan has seen a dramatic decrease in HIV testing. There were 78,858 tests performed in 2021 — up slightly from the 71,681 in 2020, but still down from the 93,832 in 2019.
Free HIV self-test kits are now available to the general Saskatchewan public at 23 locations across the province. (Kirk Fraser/CBC)
In January, the Saskatchewan government made HIV self-test kits available at pharmacies and community-based organizations across the province, aiming to aid with early diagnosis.
Kiesman says she hopes that helps the province bounce back to pre-pandemic testing levels.
However, she added, that comes with an inevitable influx of cases, and the provincial government would need to put its nearly $6-million HIV strategy in action and allocate the appropriate amount of resources to deal with it.
Through testing, early diagnosis and treatment, Kiesman believes there's a chance the province can one day come close to eradicating HIV.
"We know because of COVID that we can do this kind of work; we can identify issues and we can be responsive," she said.
"We just have to be very proactive. This is a public health urgency — it's a public health crisis."
Advocates warn that stigma could pose a public health threat as a cluster of monkeypox cases stokes concern in the queer community.
Health authorities are investigating more than two dozen confirmed monkeypox cases in Canada as part of an unprecedented outbreak of the rare disease that seldom spreads outside Africa.
Twenty-five infections have been confirmed in Quebec, in addition to one in Ontario, the Public Health Agency of Canada said Thursday, predicting the tally will rise in coming days.
While everyone is susceptible to the virus, clusters of cases have been reported among men who have sex with men, officials say.
For some LGBTQ advocates, this raises the spectre of sexual stigmatization that saw gay and bisexual men scapegoated for the rise of the HIV-AIDS epidemic.
Others say the early detection of the monkeypox cases by sexual health clinics shows how the queer community has mobilized to dismantle shame and promote safe practices.
Quebec confirms 25 cases of monkeypox, plans to administer vaccine
Quebec confirms 25 cases of monkeypox, plans to administer vaccine
Canada’s deputy chief public health officer said he’s mindful of the potential for stigma and discrimination, reiterating that the virus’s spread isn’t limited to any specific group or sexual orientation.
But as early signs suggest that the virus is circulating in certain communities, authorities are working to raise awareness among those at elevated risk of exposure, Dr. Howard Njoo told a news conference Thursday.
The disease can be contracted through close contact with a sick person, including but not limited to sexual activity, said Njoo. Scientists are still working to determine what’s driving cross-border transmission of the virus.
Aaron Purdie, executive director of the Health Initiative for Men in B.C., said he worries that the spread of fear and stigma could present a greater threat than the disease itself.
“Stigma spreads like a virus,” Purdie said. “Yes, it’s treatable. Yes, it’s containable. But it spreads nonetheless.”
Stigma can be a major hurdle to effective disease prevention and treatment, particularly for gay men who have suffered systemic discrimination by the health-care system, said Purdie.
Dane Griffiths, director of the Gay Men’s Sexual Health Alliance of Ontario, said silence tends to perpetuate stigma, so one of the best strategies to combat it is to provide timely and accurate information without “shame or blame.”
The identification of monkeypox cases in men who have sex with men speaks to the success of community-led efforts to improve access to sexual health testing and care, said Griffiths.
“There are gay and bisexual men who have been showing up around the world at clinics and doctor’s offices and are being seen and therefore counted,” said Griffiths. “That’s a good thing, and it’s actually to be encouraged within our community.”
St. Luke’s Mission Hospital, in Pangnirtung. The Nunavut Department of Health said on May 26 that 139 cases of TB have been identified in Pangnirtung in the past 18 months.Pat Kane/The Globe and Mail
Pangnirtung, a small hamlet on Baffin Island, is grappling with the largest tuberculosis outbreak in Nunavut since 2017, according to data the territorial government released on Thursday after refusing for months to reveal the extent of the disease’s spread.
The Nunavut Department of Health said on Thursday that 139 cases of TB have been identified in Pangnirtung in the past 18 months, 31 of which were active, meaning the patients were sick and infectious. The rest were cases of latent or “sleeping” TB, an asymptomatic version of the bacterial infection that isn’t contagious, but that puts patients at risk of developing active TB in the future.
The Globe and Mail travelled to Pangnirtung earlier this month as part of a continuing investigation into health care in Canada’s youngest territory. In interviews, community leaders have expressed frustration at the lack of official information about the TB outbreak, which Michael Patterson, the territory’s chief public-health officer, first declared on Nov. 25 without providing a tally of cases.
The size of the outbreak came as a surprise to Pangnirtung Mayor Eric Lawlor who, along with the rest of the hamlet’s elected council, wasn’t privy to official statistics on the ballooning health problem in his own community.
“The information should have been provided to us regularly to begin with,” Mr. Lawlor said on Thursday. “This is more concerning than COVID, actually. With the numbers being so high, it’s kind of worrisome and bothersome that we haven’t been addressing it more seriously from the government side.”
The Nunavut Department of Health published the figures in a news release a week after receiving a list of questions from The Globe about the ongoing tuberculosis outbreak in Pangnirtung, a community of about 1,600 people an hour’s flight north of Iqaluit, the territorial capital.
“I don’t know why they’re so secretive,” said Madeleine Qumuatuq, Pangnirtung’s community wellness co-ordinator. “You can’t be secretive and then do prevention. I mean, they’ve got to be truthful to us.”
Ms. Qumuatuq was one of several Pangnirtung residents who raised concerns about the pace of the government’s response to the TB outbreak. She pointed out that the health department rented the community hall – one of Pangnirtung’s few public spaces – beginning March 1 for a satellite TB clinic that still isn’t up and running.
“We’re missing out on a lot of age groups that would normally be coming here to play checkers, pool, whatever it might be. And the teenagers hang out here,” she said. “All that is taken away because they’ve rented the space. But they’re not even here yet.”
Danarae Sommerville, a spokesperson for the Nunavut Department of Health, said by e-mail that the delay has been caused by a shortage of skilled workers “required to ensure the Hamlet building has the appropriate wiring and network to set up workstations for staff.” Those workers were waylaid responding to the aftermath of a fire that consumed a government building in another hamlet, she added.
In responses to earlier questions about the outbreak, she pointed out that the Department of Health sent extra nurses and other front-line staff to Pangnirtung to help manage the outbreak – no easy feat during a national nursing shortage exacerbated by the pandemic.
Active tuberculosis infections, which are caused by bacteria that spread through the air and usually lodge in the lungs, can cause fever, weight loss, night sweats, fatigue and a chronic, sometimes bloody cough. Antibiotics can cure active TB and prevent latent cases from turning into serious disease. The infection can be fatal if left untreated.
Tuberculosis is a disease that most Canadians think of as a scourge of the past. But it remains a scourge of the present in Indigenous communities, particularly Inuit communities, where deep-seated poverty, overcrowded housing and limited access to medical care make residents particularly vulnerable.
The federal Liberal government, along with Inuit Tapiriit Kanatami, a national Inuit organization, promised in 2018 to eliminate TB in Inuit communities by 2030.
The most recent data from the Public Health Agency of Canada show there were 72.2 active cases of TB per 100,000 population among Inuit people in 2020, compared with a national case rate of 4.7 per 100,000.
Despite being 15 times higher than the national average, the TB rate among Inuit in 2020 was down significantly, from 188.7 cases per 100,000 in 2019 and from a 10-year annual average of 184.14 per 100,000 from 2010 to 2019. The decline likely reflects cases of TB going undiagnosed in the first year of the pandemic, experts on the disease have said.
Nunavut, which is home to the majority of Inuit in Canada, recorded 34 active cases across the territory in 2020, or 86.40 per 100,000, down from an average of 66 active cases per year territory-wide over the previous four years.
In February, Nunavut’s privacy commissioner ruled in The Globe’s favour after the newspaper appealed the territorial government’s refusal to release TB case counts by community, age and gender.
But privacy commissioner decisions aren’t binding in Nunavut. Health Minister John Main rejected the call to release community-level data, saying at the time that doing so could risk identifying patients and stigmatizing entire communities.
Neither Mr. Main nor Dr. Patterson were available for interviews Thursday.
Chris Puglia, another spokesperson for the Nunavut Department of Health, said in an e-mail that the department doesn’t plan to release TB data by hamlet, except during outbreaks. “Community level data outside an outbreak does not offer additional protection to public health and could further stigmatize the disease and create hesitancy in people seeking testing,” he wrote.
He added that Dr. Patterson’s office decided to compromise in the case of Pangnirtung and release updates every three months that “might assist in outbreak management.” The Department of Health released community-level data during Nunavut’s last major TB outbreak, in Qikiqtarjuaq in 2017-2018. A 15-year-old girl died in that outbreak.
Nunavut Privacy Commissioner Graham Steele said the government should go further and follow his ruling on TB data.
“I continue to believe that the law requires that community-level numbers be released, and not only at a time and place selected by the government,” he said Thursday. “It’s hard to hold the government to account for tuberculosis policy when it holds all the numbers in secret.”
Our Morning Update and Evening Update newsletters are written by Globe editors, giving you a concise summary of the day’s most important headlines.Sign up today.
Advocates warn that stigma could pose a public health threat as a cluster of monkeypox cases stokes concern in the LGBTQ2S+ community.
Health authorities are investigating more than two dozen confirmed monkeypox cases in Canada as part of an unprecedented outbreak of the rare disease that seldom spreads outside Africa.
Twenty-five infections have been confirmed in Quebec, in addition to one in Ontario, the Public Health Agency of Canada said Thursday, predicting the tally will rise in coming days.
While everyone is susceptible to the virus, clusters of cases have been reported among men who have sex with men, officials say.
For some LGBTQ2S+ advocates, this raises the spectre of sexual stigmatization that saw gay and bisexual men scapegoated for the rise of the HIV-AIDS epidemic. Others say the early detection of the monkeypox cases by sexual health clinics shows how the queer community has mobilized to dismantle shame and promote safe practices.
Canada's deputy chief public health officer said he's mindful of the potential for stigma and discrimination, reiterating that the virus's spread isn't limited to any specific group or sexual orientation.
But as early signs suggest that the virus is circulating in certain communities, authorities are working to raise awareness among those at elevated risk of exposure, Dr. Howard Njoo told a news conference Thursday.
The disease can be contracted through close contact with a sick person, including but not limited to sexual activity, said Njoo. Scientists are still working to determine what's driving cross-border transmission of the virus.
Aaron Purdie, executive director of the Health Initiative for Men in B.C., said he worries that the spread of fear and stigma could present a greater threat than the disease itself.
"Stigma spreads like a virus," Purdie said. "Yes, it's treatable. Yes, it's containable. But it spreads nonetheless."
Stigma can be a major hurdle to effective disease prevention and treatment, particularly for gay men who have suffered systemic discrimination by the health-care system, said Purdie.
Dane Griffiths, director of the Gay Men's Sexual Health Alliance of Ontario, said silence tends to perpetuate stigma, so one of the best strategies to combat it is to provide timely and accurate information without "shame or blame."
The identification of monkeypox cases in men who have sex with men speaks to the success of community-led efforts to improve access to sexual health testing and care, said Griffiths.
"There are gay and bisexual men who have been showing up around the world at clinics and doctor's offices and are being seen and therefore counted," said Griffiths. "That's a good thing, and it's actually to be encouraged within our community."
This report by The Canadian Press was first published May 28, 2022.
Toronto Public Health continues to offer COVID-19 vaccination opportunities and youth vaccinations at Thorncliffe Park Community Hub - Toronto Read More
Medicines are not normally needed to treat monkeypox. The illness is usually mild and most people infected will recover within a few weeks without needing treatment. But there are vaccines that can be used to control monkeypox outbreaks, which some countries are already using. And treatments do exist for those who become quite ill from the virus.
Monkeypox belongs to the Orthopoxvirus genus of viruses, which includes smallpox. Luckily, due to something called cross-protection, smallpox vaccines also work for monkeypox.
Although the world was declared free of smallpox in 1980, many countries keep stocks of smallpox vaccines for emergencies. For example, the smallpox vaccine is used to protect laboratory workers who accidentally come into contact with pox viruses (such as monkeypox or vaccinia – a pox virus that is similar to smallpox but less harmful). They are also kept in case of a terrorist attacks that might use smallpox as a biological weapon.
Smallpox vaccine can be up to 85% effective in stopping infection with the monkeypox virus if it is given before people are exposed to the virus.
There are two types of smallpox vaccine. Both types are based on the vaccinia virus. An older type of smallpox vaccine contains the “live” vaccinia virus. The main one in this group is ACAM2000, which is approved in the US for protecting people against smallpox.
Although ACAM2000 cannot cause smallpox, the vaccinia virus it contains can replicate after the vaccine is given, transmitting from the vaccinated person to an unvaccinated person who comes into close contact with the injection site or any leaking fluid for up to 21 days afterwards.
This also means that ACAM2000 can cause many side effects and shouldn’t be given to at-risk groups, such as pregnant or breastfeeding women, and those with weakened immune systems. People with weakened immune systems, including those with HIV, can get very ill from the vaccine.
The smallpox virus belongs to the same genus as monkeypox.Phanie / Alamy Stock Photo
The other “live” vaccinia virus is the Aventis Pasteur Smallpox Vaccine. It is not formally approved, but can be made available if other supplies run out.
A newer type of smallpox vaccine, called Imvanex, contains a live but modified form of the vaccinia virus called vaccinia Ankara. Imvanex, made by Danish biotechnology firm Bavarian Nordic, has been licensed in the European Union for preventing smallpox.
In the US, the vaccine goes by the brand name Jynneos and is licensed for preventing both smallpox and monkeypox in adults at risk of these diseases. Jynneos has been used in the UK in previous monkeypox cases.
Because Bavarian Nordic vaccines are made of a modified form of the vaccinia virus, they are considered safe for people in at-risk groups.
It would usually take between five and 21 days for someone who comes into close contact with an infected person to show symptoms of monkeypox (and most likely seven to 14 days) so it is hard to tell if giving the vaccine after someone has been exposed to monkeypox will fully protect them. However, the recommendation in the US and the UK is that, after a risk assessment, people exposed to the monkeypox virus are offered a modified vaccinia Ankara vaccine dose as soon as possible, ideally within four days, but up to 14 days afterwards.
Antivirals
Apart from vaccines, there are some medicines that could be used for treating monkeypox.
One such drug is tecovirimat which stops the spread of infection by interfering with a protein found on the surface of Orthopoxviruses.
Tecovirimat is approved in the US for treating smallpox only. It has been tested in healthy humans and shown to stop the smallpox virus in the lab. However, it has not been tested in people with smallpox or other Orthopoxviruses. Still, in Europe tecovitimat has been authorised for treating smallpox, monkeypox and cowpox under exceptional circumstances.
Another antiviral that might be used is cidofovir – an injectable drug licensed in the UK to treat a serious viral eye infection in people with Aids.
In the body, cidofovir is converted into the antiviral ingredient cidofovir diphosphate. Because cidofovir stops smallpox in the laboratory, it could be authorised for emergency use in smallpox or monkeypox outbreaks.
However, cidofovir is quite a potent medicine and can damage the kidneys, so a better alternative might be the closely related drug brincidofovir, which has been approved in the US for treating smallpox.
Brincidofovir (brand name Tembexa) is given by mouth and can be prescribed to people of any age. Its special design helps get the right amount of the drug into cells to release the cidofovir component and also makes it less damaging to the kidneys.
Brincidofovir has been tested in humans for other viral conditions. Its approval for use in smallpox in the US comes from laboratory studies showing that it works against Orthopoxviruses. For this reason, brincidofovir is also listed as a potential drug for treating monkeypox.
What we still lack, though, is data on how effective cidofovir, brincidofovir and tecovitimat will be in treating monkeypox infections in humans. A recent paper, published in The Lancet Infectious Diseases investigated the effectiveness of brincidofovir (three patients) and tecovirimat (one patient) in monkeypox cases between 2018 to 2021 in the UK. The researchers reported poor efficacy for brincidofovir and called for more studies of tecovirimat in human monkeypox infection.
Warren Clarmont, provincial director, Indigenous Cancer Control, BC Cancer –
"Indigenous people are experiencing higher incidences of lung cancer when compared to other B.C. residents. The introduction of a provincewide lung-screening program will help reduce barriers to access for Indigenous people across B.C. We hope that with this new program, more lives will be saved through culturally safe and accessible screening for eligible First Nations, Métis and Inuit people."
Sarah Roth, president and CEO, BC Cancer Foundation –
“This first-in-Canada provincewide lung cancer screening program would not be possible without our incredible community of donors. We are so proud to funnel their support, in partnership with the Province and BC Cancer, to help bring this life-saving prevention and early-detection tool to high-risk people across B.C., regardless of where they live. It is our deepest hope that it will change the game for the deadliest cancer in the province.”
Dr. Kim Nguyen Chi, chief medical officer, BC Cancer –
“BC Cancer’s new Lung Screening Program will help diagnose lung cancer at an early stage before people develop symptoms. Cancer screening for early detection is a key tool in the fight against cancer. Earlier detection of cancer means treatment that can be less invasive and have faster recovery and higher rates of cure.”
Dr. Craig Earle, CEO, Canadian Partnership Against Cancer (CPAC) –
“CPAC congratulates British Columbia and the BC Cancer team for acting quickly to implement a provincewide lung cancer screening program and supporting early diagnosis for people at high risk for this disease. Because of the solid evidence showing that lung cancer screening saves lives, implementing screening programs is a priority initiative in the Canadian strategy for cancer control. Co-creating these programs across the country with First Nations, Inuit, Métis and equity-deserving communities will help achieve the strategy’s vision of equitable access to high-quality, culturally safe cancer prevention and care for all people in Canada.”
Shannon McCrae, B.C. lung-screening trial participant and lung cancer survivor –
“My best friend passed away from lung cancer, so I knew first-hand that lung cancer can be a silent killer. I was a smoker for over 20 years, so when I saw an ad about the BC Cancer lung-screening trial, I registered on the spot. I was shocked when the screening results came back positive even though I displayed no symptoms. The cancer was removed immediately after I was notified about my results. I can say with confidence and gratitude that early detection and the B.C. Lung Screening Pogram saved my life. I’d like to encourage all who qualify for the screening to enrol.”
The B.C. government is expanding its lung cancer screening program to 36 locations around the province, using existing CT scanners to check people aged from 55 to 74 who have smoked for at least 20 years.
Patients who meet those criteria can call the health ministry’s lung screening program at 1-877-717-5864 to complete a consultation and risk assessment to determine if they are eligible for the screening, which will be available in all five regional health authorities. The aim is to get earlier diagnosis of at-risk people before they have symptoms.
“Lung cancer is the leading cause of cancer death in Canada and worldwide,” Dr. Stephen Lam of B.C. Cancer said May 25. “In B.C., seven people die of lung cancer every day. With 70 per cent of all cases diagnosed at an advanced stage, the lung screening program aims to change this trend by detecting the majority of lung cancers at an early stage when treatment is more effective.”
The lung screening program expects to start screening close to 10,000 patients in the first year of full operation, expected to increase by approximately 15 per cenrt per year. It is estimated the program will diagnose approximately 150 lung cancer cases annually, with more than 75 per cent of these diagnosed at an earlier stage than without screening.
Health Minister Adrian Dix said Wednesday that B.C. is the first province in Canada to have cancer screening available province-wide. More information on the program is available here.
:format(webp)/cloudfront-us-east-1.images.arcpublishing.com/tgam/5G7WZ55LJ5BB3FIWJVE7VGMCZQ.jpg)
