Why is British Columbia gatekeeping injectable HIV medication? - Xtra Magazine

In the mid-’90s, one person in British Columbia died of AIDS every day. Two more were diagnosed with HIV daily. The epidemic was more severe in B.C. than anywhere else in Canada. 

That history is why, in the 30 years since, the province has revolutionized care—opening the nation’s largest largest HIV/AIDS research and treatment centre, pioneering the treatment as prevention strategy and becoming the first province to completely cover the costs of treatments and the highly effective HIV prevention medication PrEP for those at risk of contracting the virus.

Yet this robust infrastructure is now preventing people with HIV in the province—many of them LGBTQ2S+—from receiving the care they want. 

A new advocacy campaign by AIDS Vancouer is pointing out that this is the case with the long-acting, injectable HIV medication Cabenuva. Cabenuva is a combination of two HIV medications, typically taken orally, that help keep the amount of HIV in someone’s body low—preventing that person from developing AIDS or transmitting the virus to another person. Approved for use in Canada three years ago, B.C. remains the only province that has not made Cabenuva widely accessible to its residents. 

“I’ve worked with people who have been looking forward to injectables being a possibility for many, many years,” says Sarah Chown, executive director for AIDS Vancouver. “We really want to make sure this option is available for people to choose.”

What is injectable HIV treatment?

Treatment for HIV involves taking a combination of medicines, most of which aim to slow the rate at which HIV makes copies of itself in the body. While there’s no cure, a lower viral load allows a person’s immune system to remain strong (preventing them from developing AIDS), and limits the virus’s ability to move from one person to another during sex. Sex is still the most common form of transmission, which contributes to the fact that half of all HIV cases in Canada are among gay, bisexual and other men who have sex with men. 

In the earliest years of treatment, people with HIV had to take multiple (and costly) pills a day, many of which caused intense side effects like liver problems and low blood-cell counts. Over decades, these treatments have become simpler, more effective and better tolerated. Today, someone living with HIV can get their entire regimen of medications in one daily pill.

Then came Cabenuva. A combination of two HIV drugs, Cabenuva is injected once a month for two months, and then every two months following. Though not the only HIV treatment option that involves injectables, Cabenuva is currently the only available one that can completely replace daily pills—and Canada was the first to adopt the treatment in 2020, with the EU and U.S. following shortly after.

Why do many people prefer injectable HIV treatments over pills?

“Taking a daily pill is a huge burden for lots of different reasons,” says Chown, citing a major demand for injectable medication among young people—especially those who have had HIV since birth. “I’m talking to teens and tweens who want to go on a school trip or sleepover and, because of HIV stigma, don’t want to tell their friends or be caught taking medication.” Another priority group for AIDS Vancouver and their partners is women, both cis and trans, who may face violence from a partner if their HIV pills are discovered. 

Because pills need to be taken at specific times of day or with food, it’s harder for people to keep this personal medical information discreet, Chown explains. This is backed by a 2021 global survey of nearly 2,400 people living with HIV which found that about 40 percent are worried that their pills will expose their HIV status, and a third are stressed about the need to take pills every day.

“People who work long or irregular days … people who can’t get home on time … people who experience a psychological toll or difficulty based on trauma around their status. All of this makes it harder for thousands of people to take their medication every day.”

Why is British Columbia the outlier in Canada when it comes to injectable HIV treatments?

Since being approved by Health Canada in March 2020, most people can access Cabenuva through their doctors—sometimes at no cost, depending on coverage. This includes Canada’s other most-populous provinces of Ontario, Quebec and Alberta.

People in B.C., however, need secondary approval through the B.C. Centre for Excellence in HIV/AIDS. Spokespeople from both the Centre and the province’s Ministry of Health tell Xtra that this means Cabenuva is, in fact, available in B.C., and that their oversight is because of the “specific clinic and implementation considerations” of the treatment, as well as their desire to “maximize patient and population health outcomes.” This secondary approval also applies to communities who would have had access through federal drug programs, like Indigenous people and inmates.

Chown, however, is quick to point out that the Centre’s guidelines for approving Cabenuva are incredibly limiting. “We’ve had a really hard time figuring out who the guidelines actually apply to, and we don’t know of anyone who has been able to successfully access the injectable treatment option through those guidelines.”

This is largely due to seemingly conflicting rules, Chown says. For instance, the Centre says they’d approve Cabenuva for people who have both a low viral load (meaning they’ve been taking HIV medications consistently) and an inability to take oral medication (like being diagnosed with a swallowing disorder). 

“You can’t really get to a controlled viral load without being able to swallow the daily pills, so it’s really hard to see how those two things could both happen at the same time.” 

The Centre’s spokesperson confirmed that people in B.C. have been successfully approved for Cabenuva, but stopped short of saying how many people that applies to or addressing Chown’s specific concerns.

Why should British Columbia expand access to injectable treatments?

At the height of the HIV epidemic, the Centre’s centralized powers were a good thing. People were dying, so decisions and resources needed to be allocated quickly, and the Centre was established to step around broader homophobia and racism in the province—providing care through their own channels.

But their withholding of Cabenuva has been prescriptive and paternalistic, says longtime HIV advocate Wayne Campbell. “It’s shameful, especially considering B.C. was a leader for so many years.”

As for why the Centre won’t release Cabenuva more widely, Campbell—who works with AIDS Vancouver and is part of the campaign—is unsure, but suspects it may, like most things, have to do with control and money. “With the Centre’s monopoly on everything, they are watching their budget numbers. That’s been one of their longest-standing arguments, that their budget is stretched thin as it is.” 

The Centre’s spokesperson, however, emphasized that their control over access is to manage the “safety and efficacy profile of the drug.” But Campbell also highlights how injectable treatments would save costs elsewhere in the healthcare system, specifically when it comes to clearing up capacity.

“You’d go into a doctor’s office for 15 minutes, get a shot and you’re done for a month or two. We won’t need to sit in pharmacy offices for so long getting pill refills.”

What happens now?

The Centre’s spokesperson tells Xtra that as evidence and experience around Cabenuva accumulates, they’ll adjust the approval criteria as necessary.

Chown is hoping to speed up that process, launching a letter-writing campaign directed to B.C.’s minister of Health, ​Adrian Dix, and other members of his government. Her hope is that the government can put some pressure on the Centre to, if not change the approval process, then to communicate more openly with representatives of people living with HIV.

“We’ve asked repeatedly for the decision-makers to tell us why they’re saying no,” she says. “We’re not asking for everyone taking pills to be given injectables. We’re asking for people who want injectable medications to have that option in the way they do in most of the rest of the country.”

Adblock test (Why?)

Why is British Columbia gatekeeping injectable HIV medication? - Xtra Magazine
Read More

COVID-19 associated with significant increases in postpartum opioid prescription fills - Healio

Hypertrophic herpes simplex virus 2 infection resistant to acyclovir in an immunosuppressed patient - CMAJ

KEY POINTS

• Herpes simplex virus (HSV) 1 and 2 infections primarily cause oral or genital disease that is usually self-limited or resolves with antiviral therapy.

• Hypertrophic HSV infection is an uncommon manifestation that most frequently affects anogenital structures and is typically seen in immunocompromised patients.

• Acyclovir and its related compounds, valacyclovir and famciclovir, are the primary antiviral agents used to treat HSV infections.

• Resistance should be suspected in patients who do not clinically respond to first-line treatment, especially in those who are immunocompromised and those with repeated exposures to these medications.

• Antiviral options for patients with resistance include foscarnet and cidofovir.

An 80-year-old man on ruxolitinib for myelofibrosis was referred to the infectious diseases clinic with a subacute, progressive mass over his left forehead. He also had type 2 diabetes mellitus and dyslipidemia, and was taking rabeprazole, simvastatin and metformin.

Three years before presentation, he developed an erythematous, crusting rash over the outer side of his left ear. He was previously given a diagnosis of otitis externa, but the rash did not improve despite 14 empiric courses of oral antibacterial therapy. A swab from the lesion was sent for herpes simplex virus (HSV) testing by polymerase chain reaction (PCR), which was positive for HSV-2. The patient had no history of oral or genital HSV infection. The rash resolved with a 5-day course of oral valacyclovir (1 g, 3 times daily). Over the following 3 years, the patient had 8 recurrences involving the left side of his face. These were presumed to be episodes of HSV-2 reactivation and each resolved with empiric oral valacyclovir for 7–10 days.

Six months before presentation, the patient developed a small, sessile, sesame seed–shaped lesion over his left forehead. Despite 18 courses of oral valacyclovir and 3 courses of oral famciclovir (500 mg, twice daily), each for 7–14 days, the mass continued to increase in size. A biopsy was performed, and viral culture was positive for HSV-2. Histopathology showed acantholytic keratinocytic cells with viral changes, suggestive of an ulcerative lesion of viral etiology.

When we saw the patient in clinic, he had a fungating, verrucous mass on his left forehead measuring about 12 × 8 cm and extending superiorly to the scalp (Figure 1). The mass was raised and pink, with a well-demarcated border. It had regions of slough and crusting, but was not tender. The mass and associated edema resulted in slight left-sided ptosis. The patient had no other cutaneous lesions on the head and neck. Cranial nerve examination was normal. Laboratory investigations showed leukocytosis and anemia that were caused by his myelofibrosis (leukocyte count 17.1 [normal 4–11] × 10⁹/L and hemoglobin 95 [normal 120–160] g/L). His creatinine was 92 (normal 42–102) μmol/L.

Figure 1:

A large fungating and verrucous lesion on the left forehead of an 80-year-old man, caused by herpes simplex virus 2 infection; the lesion was progressive over a 6-month period.

Based on the patient’s history, including multiple previous courses of antiviral treatment, our presumptive diagnosis was hypertrophic HSV infection, with concern for resistance to acyclovir and related compounds (valacyclovir and famciclovir), as evidenced by the lack of clinical response. We obtained a swab of the mass for HSV PCR, which was positive for HSV-2. Genotyping was performed at the National Microbiology Laboratory in Winnipeg. Sequence variations in the UL23 thymidine kinase gene were identified, confirming resistance. Testing for HIV was negative.

We treated the patient with intravenous foscarnet (90 mg/kg, daily) in our hospital’s infusion clinic. He received 20 doses in total, with substantial improvement (Figure 2). By the end of therapy, the lesion had flattened and regressed in diameter, with a residual irregularly shaped region of hypopigmented skin. The patient had 2 further recurrences on his left ear 3 and 11 months after his initial treatment. Each responded to foscarnet. Given the resistance to acyclovir and related compounds, no oral antiviral options were available for suppressive therapy. If the patient has additional recurrences, further management strategies will include immune modulation therapy with topical imiquimod.

Figure 2:

Left forehead of an 80-year-old man with herpes simplex virus 2 infection after treatment with intravenous foscarnet, showing flattening and regression of the mass, with areas of postinflammatory hypopigmentation.

Discussion

Herpes simplex virus 1 and 2 belong to the Herpesviridae family of DNA viruses. Infection with HSV is common; estimated seroprevalences among adults in Ontario are 51.1% for HSV-1 and 9.1% for HSV-2.1 The 2 primary clinical manifestations are oral and genital infection. Classically, HSV-1 is associated with oral infection and HSV-2 with genital infection, but the reverse trend is occurring with greater frequency.2 As with all Herpesviridae, HSV-1 and HSV-2 have the capacity for latency and can reactivate intermittently after primary infection. Primary oral infection can be severe, characterized by painful gingivostomatitis and pharyngitis, with exudative, ulcerative lesions of the oropharynx. Recurrences tend to be mild and are characterized by painful vesicular lesions, classically located at the vermillion border. Similarly, primary genital infection is typically more severe, with bilateral, painful, ulcerative lesions, regional lymphadenopathy and systemic symptoms (such as fever, headache and malaise). Recurrent genital infection is usually less severe, with painful, unilateral, vesicular and ulcerative lesions. Other cutaneous manifestations include herpetic whitlow and herpes gladiatorum, the latter of which occurs in the setting of contact sports.3 Herpes simplex virus 1 and 2 can also cause infection at other sites, such as the anus and perianal skin, particularly among men who have sex with men (MSM).

Mucocutaneous HSV infections are typically diagnosed by HSV PCR of swabs obtained from herpetic lesions. Acyclovir and related compounds are first-line therapies (Table 1).4 Treatment is associated with reduced symptom duration and decreased risk of transmission, and should be started as soon as possible after symptom onset.4 Recurrent episodes are usually self-limited and antiviral therapy may not be required for patients with minimal or mild symptoms. For patients with frequent (i.e., episodes at least every 2 mo or at least 6 times/yr) or severe recurrences, daily suppressive antiviral therapy can be considered and should be re-evaluated annually.4

View this table:

Table 1:

First-line treatment of genital herpes simplex virus infection^*

Hypertrophic HSV infection is an atypical and uncommon manifestation of HSV. Described cases have most commonly involved the anogenital structures. In a review of 110 cases, 76.4% were anogenital; lesions of the oropharynx, nose, ears and ocular structures have also been reported.5 The clinical course is chronic and can be disfiguring, and the appearance is often mistaken for cutaneous malignant disease. Hypertrophic HSV infection has predominantly been described among people living with HIV infection. An association with immune reconstitution inflammatory syndrome has been hypothesized, although many cases have been described in patients on stable antiretroviral therapy with long-term virologic suppression.6 Anogenital involvement is most commonly seen among people living with HIV infection and may be related to sexual practices in MSM. Cases have also been seen with other forms of cellular immunodeficiency, such as hematologic malignancy, solid organ transplantation and congenital immune deficiencies (including common variable immunodeficiency secondary to T-cell lymphopenia, congenital T-cell deficiency syndrome and hyperimmunoglobulin E syndrome related to STAT3 sequence variations).5^,6

The pathogenesis of hypertrophic HSV infection is poorly understood, although it may reflect chronic viral lytic replication in a host with underlying immune dysfunction.6 Our patient was taking ruxolitinib, a Janus kinase inhibitor, which is used for the treatment of myeloproliferative disorders including myelofibrosis. Increased frequency of Herpesviridae infections have been attributed to ruxolitinib, although these are most commonly varicella zoster virus infections rather than HSV.7 Diagnosis is generally made with biopsy of the lesion for histopathologic examination, HSV PCR or viral culture.5 Previous case reports have suggested that hypertrophic HSV infection is poorly responsive to conventional treatment with antiviral therapy.6 Alternate nonantiviral treatment modalities include surgical resection, topical imiquimod and thalidomide.5

Our patient’s management was complicated by resistance to acyclovir and related compounds via sequence variations in the UL23 thymidine kinase gene. Acyclovir and related compounds are the mainstay of treatment for HSV infections. They exert their effects through termination of viral DNA transcription.8 Upon entry into host cells, these antiviral agents undergo 3 consecutive phosphorylation reactions with conversion to acyclovir triphosphate, the active form.8 The first phosphorylation reaction is by viral thymidine kinase, while the second and third phosphorylation reactions are by host cell enzymes.8 Resistance to these compounds is primarily seen in immunocompromised hosts, such as people living with HIV infection and recipients of solid organ transplants.9 It is most often related to previous substantial exposure to acyclovir and related compounds.9 Our patient was immunocompromised owing to myelofibrosis and treatment with ruxolitinib, and had exposure to multiple courses of antiviral therapy over the previous 3 years, increasing his risk of resistance. Resistance mediated by sequence variations in the UL23 thymidine kinase gene results in absent, low production or altered activity of viral thymidine kinase, thereby preventing the first phosphorylation reaction. Less commonly, variations in the UL30 DNA polymerase gene result in target site alteration.8 In Canada, resistance genotyping is performed by Sanger sequencing at the National Microbiology Laboratory in Winnipeg.10 Alternate antiviral agents that can be used for resistant HSV include foscarnet and cidofovir; we prescribed the former for our patient. Foscarnet and cidofovir are inhibitors of viral DNA polymerase, but unlike acyclovir and related compounds, do not require phosphorylation by viral thymidine kinase. Both agents are administered intravenously and are associated with substantial risk of nephrotoxicity. Patients should be closely monitored for renal impairment and electrolyte disturbances; aggressive hydration and electrolyte replacement may be required.

We report a case of hypertrophic HSV infection in a man with myelofibrosis and substantial previous exposure to antiviral treatment, which was resistant to treatment with acyclovir and related compounds. Hypertrophic HSV infection is uncommon but can be seen in patients who are immunocompromised, most commonly people living with HIV infection. Resistance to antiviral agents should be suspected in patients who do not respond to conventional treatment, especially in patients who are immunocompromised or those with repeated antiviral exposure.

The section Cases presents brief case reports that convey clear, practical lessons. Preference is given to common presentations of important rare conditions, and important unusual presentations of common problems. Articles start with a case presentation (500 words maximum), and a discussion of the underlying condition follows (1000 words maximum). Visual elements (e.g., tables of the differential diagnosis, clinical features or diagnostic approach) are encouraged. Consent from patients for publication of their story is a necessity. See information for authors at www.cmaj.ca.

Footnotes

• Competing interests: None declared.

• This article has been peer reviewed.

• The authors have obtained patient consent.

• Contributors: Charlie Tan and Wayne Gold led the conception and design of the work. Charlie Tan wrote the first draft of the manuscript. All authors revised the manuscript critically for important intellectual content, approved the final version to be published and agree to be accountable for all aspects of the work.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

Adblock test (Why?)

Hypertrophic herpes simplex virus 2 infection resistant to acyclovir in an immunosuppressed patient - CMAJ
Read More

Should you get another COVID booster? Guidelines are changing - Global News

The World Health Organization (WHO) on Tuesday said it no longer “routinely recommends” additional COVID-19 vaccine boosters for medium or low-risk people, but one Canadian doctor is warning the “advice isn’t probably the best.”

The updated roadmap from WHO outlines three priority-use groups for COVID-19 vaccination: high, medium and low, and is designed to prioritize vaccines for those at greater risk of the disease.

Read more: WHO now recommends high-risk people get COVID booster 12 months after last dose

The WHO recommended additional booster doses for high-priority groups such as older people, immunocompromised people of all ages, front-line health workers and pregnant people. But for those who fall under the low and medium-risk group, WHO did not recommend additional COVID-19 boosters, citing “low public health returns.”

The WHO’s updated guidance comes just weeks after Canada’s National Advisory Committee on Immunization (NACI) last updated its guidelines on boosters.

“Society is caught between wanting this whole thing to be over and still reconciling that it’s still a threatening problem out there,” Dr. Kashif Pirzada, a Toronto emergency room doctor, told Global News.

“We see plenty of people with just two vaccines who get a fairly brutal illness…the most severe your illness, the more chances you’ll have long-term lingering symptoms. So I think they didn’t really factor that in is that it’s still out there,” he said.

Despite the persistent presence of the highly contagious Omicron variant in Canada, COVID-19 is not expected to surge in the coming months as hospitalizations and deaths remain stable, federal health officials said earlier this month.

2:36 COVID-19 apathy: vaccination rates slowing three years into pandemic

On March 10, Canada’s chief public health officer, Dr. Theresa Tam, said that COVID-19 activity has reached a “relatively steady state,” in the country and “we may not see any major waves in the coming months as we prepare for a potential fall and winter surge.”

Because the country is seeing a decrease in deaths relating to COVID-19 infection, Dr. Susy Hota, medical director of infection prevention and control at the University Health Network, said she agrees with WHO’s recommendations.

“I think from a global perspective it makes a lot of sense and probably also makes sense from a Canadian perspective,” she said.

Read more: After 3 years of COVID-19, here’s how Canada’s ‘endemic’ future may look

“We know that especially in Canada, younger people have a higher level of hybrid immunity. So having had vaccine doses, but then also prior infections…may offer better protection overall,” she said.

Canada — and the rest of the world — seems to be shifting into a new way of dealing with the disease, she added, which is transitioning into something “more sustainable” for the long term, such as focusing on high-risk individuals.

In terms of where Canada stands on vaccine boosters, Pirzada said there has been little messaging out there, other than a spring shot for high-risk individuals.

Canada's current COVID vaccine recommendations

NACI’s latest guidance on COVID-19 vaccines on March 3 recommended that people facing a high risk of serious illness should get another COVID-19 booster in the spring.

The committee advises all Canadians five years old and up should get immunized against COVID-19 with a full primary series of vaccines. For most people, a primary series is two doses of a COVID-19 vaccine, at a recommended interval of eight weeks apart.

NACI states that “children 6 months to under 5 years of age may be immunized with a primary series of an authorized mRNA vaccine.”

NACI further recommends a booster dose six months after the last dose of a primary course for everyone aged five years old and up.

Trending Now

• Canadian Navy offers ‘no strings attached’ program amid recruitment woes 

• How a short trip to Canada turned into a nightmare for an Argentinian family

'Make a case' to get booster

Because the most recent NACI guideline is only for high-risk individuals, Pirzada worries, like the WHO, NACI is not taking into account long-term COVID-19 symptoms, which can happen in healthy young people too.

“And the farther out you are from your boosters or from your vaccines, the more chances of having a much more severe course of illness,” he said.

His advice for Canadians is to get a booster if you are six to 12 months out of your vaccine, especially if you’re going to travel or be around large crowds.

Read more: COVID-19 bivalent boosters recommended for at-risk Canadians this spring: NACI

If you don’t fall under the high-risk category and want to get boosted, Pirzada said “to make a case” to a physician or pharmacist saying, you’re worried about COVID-19 infection and want a booster.

“Boosters will protect you for three months from infection. That’s pretty good…protection for three months. If you are at high-risk settings in that time where you want to really have fun, that’s not a bad idea,” he added.

Hota believes that low-risk individuals, mainly those who feel nervous about travelling without a booster, should modify their behaviour “if they are concerned.”

The goal of vaccines, she said, is to reduce the risk of severe illness, and if an individual has a very low risk of getting severely sick from COVID-19 (because of hybrid immunity), “it’s probably not going to be offering you that much more protection.”

4:41 Health Matters: Bivalent vaccines and pregnancy

She stressed that vaccines will have the greatest impact on those at the highest risk.

According to Health Canada, a booster dose of a BA.4/5 bivalent mRNA COVID-19 vaccine “provides increased protection against both symptomatic disease and hospitalization, compared to those who did not receive a bivalent booster dose but received at least two previous doses of original monovalent vaccines in the past.”

— with files from Reuters

More on Health

&copy 2023 Global News, a division of Corus Entertainment Inc.

Adblock test (Why?)

Should you get another COVID booster? Guidelines are changing - Global News
Read More

Ageism and the pandemic: How Canada continues to let older adults suffer and die from COVID-19 - The Conversation

Three years into this pandemic, most Canadians have taken off their masks and many have stopped getting booster shots. However, COVID-19 is rising among the leading causes of death in Canada, reaching the No. 3 spot.

This is the first time an infectious disease has pushed its way into the top five causes of death during the last 80 years or so of the antibiotic era.

Older adults account for most of those deaths, and we are letting it happen.

COVID-19, aging and ageism

COVID is a vaccine-preventable disease, but we are not using vaccines as well as we could. Most Canadians don’t understand the importance of booster shots in protecting them from long-term health issues that may follow infection, such as long COVID. Even fewer recognize that getting vaccinated helps protect their entire community, including older adults.

Healthy seniors are assets to their communities. They are caregivers, volunteers and keepers of cultural knowledge. (Shutterstock)

Most COVID deaths are in older people. That’s not just a problem for them. It’s a problem for everyone. When older adults are healthy they are an incredible asset to our communities — they are caregivers, volunteers and repositories of knowledge and culture. When they are unwell it is a tremendous strain on them, their caregivers and our health-care system.

COVID has become the second-leading cause of hospitalization in Canada, after childbirth. Among those over 50, it is the single leading cause of hospitalization.

We had more outbreaks in long-term care facilities in 2022 than we had in 2020 and 2021 combined, and more deaths and more hospitalizations than the first two years of the pandemic combined.

COVID is not over, but we are acting like it is. Many COVID research programs are winding down. Can you imagine winding down research into any other condition on the top five mortality list?

The reason for not doing more to prevent COVID-19 appears to be ageism, plain and simple. There is no logical explanation for accepting an unnatural degree of hospitalization and premature deaths in elders except that we value the lives of younger people more.

The toll of COVID-19 in older people

Unfortunately, dying isn’t even necessarily the worst of it.

It’s just the part that’s easier to count and that makes the most headlines. There is still a sea of suffering out there, as older people — who are more likely to have other health issues — get sick with COVID and take a long time to recover, if they do recover.

Canada had the highest proportion of COVID deaths in long-term care of any country in the Organisation for Economic Co-operation. and Development. Crosses outside a Mississauga, Ont. long-term care centre during the first wave of the pandemic. THE CANADIAN PRESS/Nathan Denette

For older adults, respiratory illness is often a catalyst for other health problems, triggering a spiral that ends in premature death. Illness also causes many people to retire early because they or the people they care for are chronically ill.

Canada had the highest proportion of COVID deaths in long-term care of any country in the Organisation for Economic Co-operation and Development, because we did not prioritize preventing infectious disease. Now, because of the demographic bulge of the Baby Boom, the demand for long-term care for older adults is rising, even as COVID outbreaks continue in such facilities.

It’s hard to believe that after the horror show in so many Canadian long-term care homes during early months of COVID that we have slipped back into complacency, allowing Canadians’ parents, grandparents, neighbours and friends to become infected because the rest of us won’t take simple actions.

It doesn’t have to be this way, and it shouldn’t.

Excess COVID-19 deaths in older adults are not inevitable

Typically, people under 50 are likely to have much more social contact through school, social events and work, making them the most likely to be exposed to the virus. However, they are also the least likely to protect themselves — and others — by keeping up with their booster shots and wearing masks.

If more Canadians kept up with their vaccines, there could be less COVID-19 in the community and vulnerable populations would be better protected. (Shutterstock)

It may be easier for them to believe and behave as if the threat of COVID has passed, because they are far more likely to make a quick and complete recovery from COVID. But they are also the ones most likely to spread it to those who have far less immune protection and far less choice.

We shouldn’t treat COVID-19 in older adults as inevitable. With better testing, policy makers could have better information to make decisions about how to reduce the number of infections. If more Canadians kept up with their vaccines, there could be less COVID-19 in the community and vulnerable populations would be better protected.

Older adults have inherent value and dignity, and are an asset to their communities. They are people who have already contributed to society in family, professional and social capacities, and who continue to do so. They deserve to live as long and as well as possible.

Adblock test (Why?)

Ageism and the pandemic: How Canada continues to let older adults suffer and die from COVID-19 - The Conversation
Read More

Heads up - wood ticks are out and about in the Thompson-Okanagan - Vernon News - Castanet.net

Photo: Colin Kennedy

Tick season is back in the Okanagan.

Colin Kennedy came across one of the blood-suckers while taking a walk with his dog.

Kennedy was on the Test of Humanity Trail in Summerland last week and came home with an unwanted passenger – a wood tick.

“I just thought it would be good to report it so people start checking their dogs for ticks now that the weather is getting better,” Kennedy says.

Kennedy also reported the tick to eTick.

Anyone who has lived in the B.C. Interior for any length of time has likely had an encounter with a tick or knows someone who has.

They can be found year round, but are most likely to bite from March to June.

Ticks will lie in wait on a branch or tall grass, waiting for an unsuspecting person or animal to brush by. They then latch onto their victim and bury their heads under the skin.

Staying out of the woods is no guarantee you won't encounter ticks.

Rob Higgins, an entomologist with the department of biological sciences at Thompson Rivers University in Kamloops, says the most common area to find ticks is on grasslands, but they can be found in urban environments as well.

“You can definitely pick them up in town, even when you think you're walking in urban areas, because you’re brushing up against grasses on the side of the sidewalks,” he said.

If a tick has bitten you, Higgins says the best way to remove it is to take a pair of forceps or tweezers, slide them under the tick and pull backwards firmly – but not abruptly.

It will often take about 30 seconds of firm pressure to pull the tick out.

The variety most often found in B.C. is the Rocky Mountain wood tick.

Western black legged ticks, a species which Higgins said exists in low numbers in B.C., can carry Lyme disease. Each year, there are around a dozen Lyme cases discovered in the province, but about half those originate from outside the region.

Ticks can also carry other diseases, such as tick paralysis. According to Higgins, this disease mostly affects animals and he said vets and ranchers see cases each year.

Overall, it’s important to be careful, but most ticks in B.C. aren’t harmful.

“People don’t like ticks, fortunately here we don’t need to worry about them a great deal," he said.

"You definitely want to remove them, you want to keep your eyes on your pets for symptoms of paralysis, but otherwise, we can consider the vast majority of them to be harmless.”

Have you had a close encounter of the insect kind? Email us a picture and we may feature it as Castanet's Bug of the Week.

Adblock test (Why?)

Heads up - wood ticks are out and about in the Thompson-Okanagan - Vernon News - Castanet.net
Read More

Mycologist becomes first person in the world to contract a plant fungal disease - Ottawa Citizen

Article content

A 61-year-old plant mycologist from India is the first person in the world to contract a plant fungal disease.

Article content

“This case highlights the potential of environmental plant fungi to cause disease in humans and stresses the importance of molecular techniques to identify the causative fungal species,” the study notes. 

The man worked with decaying plant and fungi material as part of his research activities and has since recovered after receiving two antifungal medications for two months. The unnamed man is said to have no complications as a result of the disease.

Of the millions of fungi that exist, only a few hundred are capable of infecting humans. The fungal species that can grow at 35—37 °C can become a human pathogen or commensal flora, notes the report, adding that the pathogen enters the human body through damaged skin and the respiratory tract.

Article content

“That animal and human diseases can be caused by plant pathogens is a new concept that raises serious questions regarding the propensity of such infection to occur in healthy as well as immunocompromised individuals. If the fungi can escape the phagocytosis pathway and is able to evade the host immune system, then they can establish themselves as human pathogens.”

The report points to climate change as causing a rise in new pathogenic fungi, stating that “the worsening of global warming and other civilization activities opens Pandora’s Box for newer fungal diseases.”

Some fungi that are sensitive to high temperatures and have the potential to cause illness can develop the ability to survive in the human body at elevated temperatures. This is a significant concern as certain fungi can utilize “a natural selection-adaptation strategy” and adjust to higher temperatures through thermal selection.

Adblock test (Why?)

Mycologist becomes first person in the world to contract a plant fungal disease - Ottawa Citizen
Read More