Industry groups call on Freeland to abandon $100B stimulus plan in light of improved jobs market

Finance Minister Chrystia Freeland speaks to reporters before unveiling a fiscal update in Ottawa, November 30, 2020.

OTTAWA — Industry representatives are urging Finance Minister Chrystia Freeland to back away from plans to spend $100 billion in additional stimulus, saying it would needlessly swell public debt levels and could risk overheating the economy.

In her fiscal update last November, Freeland said the $100 billion in new spending would be pegged to the jobs market, which now serves as a “fiscal guardrail” to guide future spending plans. But many economists and business executives are warning that faster-than-expected economic growth and a vastly improved labour market have deemed those plans obsolete, and could instead harm the longer-term growth prospects of the country.

“I’m concerned that the minister may not have remembered what her own words were in the fall economic statement,” Goldy Hyder, chief executive of the Business Council of Canada, said in an interview Wednesday. “We don’t need the stimulus if unemployment is not a problem.”

His comments come as observers including bank executives and the Parliamentary Budget Officer question the necessity of Liberal spending plans. Prime Minister Justin Trudeau has long framed the COVID-19 pandemic as an opportunity to expand Canada’s social safety net, while at the same time saying his government would not introduce permanent spending measures that might lock Canada into endless deficits.

Unemployment in Canada peaked in May 2020 at 13.7 per cent, but has since come down to just 7.5 per cent, or only slightly higher than the 5.8 per cent posted before the global pandemic took hold. Those numbers are expected to continue improving in coming months as Canadians are vaccinated and restrictions gradually lifted.

At the same time, Canada’s economic growth projections have also gained steam: the government estimated a 2021 growth rate of 4.8 per cent when Freeland tabled her fiscal update on Nov. 30, but economists now peg that figure closer to six per cent.

“We believe the economy is going to slingshot out of the gate come summer, once we’ve all got at least one vaccine [dose] in us,” Hyder said.

Adding to concerns over higher projected economic growth, Canadian households are also sitting on record high levels of cash following more than a year of lockdowns, and in part due to the generous relief programs dolled out by the Liberal government. Freeland herself has referred to the sizeable household savings levels as “pre-loaded stimulus” that would be automatically unleashed once pandemic restrictions are lifted.

But adding to the anticipated flood of household spending only threatens to push interest rates higher, Hyder said. U.S. President Joe Biden’s $1.9-trillion stimulus package, which is expected to spillover into the Canadian economy, is yet another reason to ease off Freeland’s plans.

“You’ve got all this liquidity in the hands of businesses and in the hands of Canadians, and you’re going to have government go out there and do more? That runs the risk of inflation,” he said.

The Business Council of Canada is also calling on Freeland to abandon any plans to re-introduce the debt-to-GDP ratio as the government’s main fiscal anchor, saying it would not enforce fiscal restraint in the near term. His group is instead calling for a measure that would ensure government set aside 10 per cent of revenues for the purpose of debt servicing costs, similar to a policy laid out by former Bank of Canada Governor David Dodge.

“We don’t even want that as the mechanism, we think that would be a free pass for them for a decade or two, not having to worry about deficits and debts,” Hyder said, adding that he was concerned the government might “get cute” with a fiscal anchor measure that gives them years of leeway.

David McKay, chief executive of Royal Bank of Canada, made headlines last week when he called for restraint in Freeland’s spending plans, cautioning that “we don’t want to overdo this.”

In December, Parliamentary Budget Officer Yves Giroux warned that “the size and timing of the planned fiscal stimulus may be miscalibrated,” saying that employment levels were likely to return to pre-pandemic levels well before the $100-billion in funds has run its course. The spending is expected over a three-year period.

“In other words, it could be too much and too late,” he told reporters at the time.

The C.D. Howe Institute, a Toronto-based think tank, also said in a report last week that the Trudeau government should abandon its stimulus plans, and even consider tax hikes in some areas to fill the fiscal gap.

Robert Asselin, vice-president of policy at the Business Council, said the Liberal government’s propensity for stimulus measures points to a deeper belief system that has taken hold in the economics community, in which public spending measures are viewed as healthy and necessary regardless of the broader context of that spending.

“I think there’s a lack of reason here,” he said, citing the willingness of various governments during the pandemic to pump more money into the economy than was ever lost to begin with.

For the Trudeau government in particular, Hyder said, there appears to be a strong preference for redistribution over expanding Canada’s economic productivity, which could hinder growth opportunities years down the line.

“It seems that there’s only emphasis on one side of the ledger,” he said. “It’s all spending. If you add the phrase ‘-acare” after any program, it’s a good idea. But who’s going to pay for it?

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Source: National Post Quebec Nordiques

Procurement minister says federal government has committed $8B on COVID vaccine deals

Public Services and Procurement Minister Anita Anand appears virtually before the House of Commons operations committee on April 14, 2021.

OTTAWA – Procurement Minister Anita Anand revealed the government has committed to spend up to $8 billion on vaccine contracts and defended the government’s overall performance getting shots delivered to Canadians at a House of Commons committee Wednesday.

Anand appeared before the House of Commons government operations committee and said the government has allocated about $8 billion on the vaccine deals with seven different companies for hundreds of millions of total doses.

She said she wants to provide more transparency about the details of the deals, but doesn’t want to break confidentiality clauses in the agreements with pharmaceutical companies that could threaten Canada’s supply

“We are working with the companies in terms of what they are comfortable disclosing, but at the current time those negotiations are ongoing,” she told MPs at committee.

Anand stressed the government was ahead of its targets having delivered 9.5 million doses by the end of March, when it had originally promised province six million doses. She also pointed out Canada is third in the G7 in providing first doses of vaccines.

Conservative MP Kelly McCauley said the government was only able to make those claims because Canada had delayed the interval between the first and second dose to four months.

“We’re not able to give the second dose because your government has failed Canadian so miserably,” he said. “Lives are being destroyed.”

Anand said it was ultimately the provinces who decided the dosing strategy after getting recommendations from the National Advisory Council on Immunization. She said the government would like to have more vaccines of course, but believes the government has delivered.

“We all want more vaccines coming into this country. That’s what lights my fire every single day. But suffice it to say that a diversified portfolio of vaccines has served Canada well.”

She said that as of Tuesday 12 million doses had arrived in Canada in total and provinces had a two-week supply at their current inoculation rates.

Canada’s Moderna shipments have been delayed in recent weeks. Anand said those delays have been three to four days at most and related to the quality assurance at the company’s facility.

“There is a backlog of vaccines that need to be tested before they can leave the factory.”

Anand said Canada recognizes the importance of the testing, but said she has pushed the company to speed things up and address the problem.

She said she expects every Canadian can receive a first doses by the end of June and be fully vaccinated by the end of September and that should remain the case even without doses of the AstraZeneca or Johnson and Johnson vaccines.

“Pfizer and Moderna, are the workhorses of our portfolio. We have 44 million doses of Moderna and we have 40 million doses of Pfizer.”

Earlier this week, the U.S. suspended use of the Johnson and Johnson vaccine for further review to investigate rare blood clots that have happened in six people after 6.8 million shots were administered.

Conservative MP Pierre Paul-Hus asked Anand if Canada could abandon that contract. Anand said Health Canada still viewed the vaccine as safe and effective and Canada would be going ahead with the contract.

Anand’s testimony came the same day Health Canada completed a preliminary review of the AstraZeneca vaccine and declared it safe for people in all age groups.

Health Canada did find that the vaccine comes with a rare risk of blood clots, but found that risk to be remote. So far only one case has been identified in Canada, and Dr. Supriya Sharma, the department’s chief medical adviser, said they believe the chance of a clot is one in 450,000.

The department will add a warning about the risk to the vaccine, but overall she said it is a safe choice and everyone should be vaccinated.

“We know that the risks of getting these side effects from the vaccine are very rare. And we know that the risk of getting infected with COVID-19 and potentially experiencing serious health consequences, hospitalization or even death from the disease are very real,” she said.

Studies from Europe have found a few dozen cases in millions of doses of AstraZeneca administered there. Denmark took the rare step of suspending use of the AstraZeneca vaccine on Wednesday and other nations lined up to buy the country’s shots.

Canada currently limits the vaccine to people over the age of 55 based on a recommendation from the National Advisory Committee on Immunization. Sharma said they have forwarded their data to the committee who will reassess the age restriction in the coming days.

Sharma said Health Canada’s review did not find any specific age or sex was more vulnerable to the clotting issue, in contrast to previous studies that have shown it mostly impacts young women. Citing privacy, the government has released few details about the one case of rare blood clots connected to a vaccine in Canada, but Sharma did reveal the person was a woman from Quebec and was over the age of 55. The woman did not suffer any serious harm and is recovering at home.

She said their message about the importance of vaccination remains the same, especially as case spike across the country.

“Get whichever vaccine is available to you. It’s that simple. The longer you wait to get vaccinated, the longer you’re not protected.”

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Source: National Post Quebec Nordiques

'Surging like absolute crazy': Ontario hospitals 'pray' they don't reach last-resort stage in third wave

A tent city has been erected in the parking lot of Toronto's Sunnybrook hospital to handle a surge in COVID-19 cases.

The idea of people being removed from intensive care, unhooked from ventilators that might have saved them to make room for someone else more likely to survive is almost unfathomable, says the president and CEO of Canada’s largest university hospital.

“I believe we’ll fight that one as long as humanly possible, and I pray we never get to the point of having to consider that,” said Dr. Kevin Smith, head of Toronto’s University Health Network and co-chair of Ontario’s COVID-19 critical care table.

Staged withdrawals of life-support from people with low chances of survival are not part of a 32-page emergency triage protocol that would be enacted should Ontario ICU’s become saturated.

“Only the provincial government can take the steps necessary to enable physicians to withdraw life-sustaining treatment without consent” in order to give that care to someone with better prospects, the College of Physicians and Surgeons of Ontario said in a notice to physicians last week.

The triage protocol would, however, mean choosing which new patients should be offered potentially life-prolonging care   — who to admit and who not to admit to the ICU, whether for COVID or a heart attack.

Hospitals are working flat out to avoid enacting the protocol — transferring hundreds of patients from hot spots to communities with extra space, cancelling non-urgent surgeries to free up 700 critical care beds, and redeploying nursing and other health-care staff.

“Is it optimal and what we’d love to be doing? No. It’s where we find ourselves at this point in this rapid growth of the pandemic,” Smith said.

Admissions to ICUs have not only been rising, people are arriving in emergency rooms needing intensive care — immediately. “The virus has attacked them, literally, so quickly, it over came them so fast” that some are arriving in emergency desperately ill, before even having been tested for COVID, said Vicki McKenna, a registered nurse and provincial president with the Ontario Nurses Association.

As of midnight Monday, 1,892 people were in intensive care in Ontario hospitals, roughly a third — 623 — with COVID.

Should the number of people — with or without COVID — needing critical care approach 3,000, “that’s when we’re going to be precariously close to having to consider other options, and much less attractive options,” Smith said.

Those options include treating ICU patients outside ICUs, staffing ratios “we wouldn’t be very pleased by or comfortable with,” more field hospitals, bringing in doctors who don’t normally practise in hospitals, air lifting patients to Sudbury or Thunder Bay, “and, of course, last resort, thinking about the triage tool,” Smith said.

Nationally, more than 3,000 people with COVID were being treated in hospital each day over the past seven days, a 29 per cent increase over the previous week. ICU admissions are up 24 per cent.

The number of deaths has averaged around 30 a day for several weeks, a dramatic drop from the peaks of wave one and two, when Canada saw the highest rates of nursing home deaths globally. Deaths are down because jurisdictions prioritized seniors in long-term care and retirement home for vaccines.

But if rapidly spreading variants make more people severely ill, that mortality trend could change, federal health officials warned Tuesday.

British Columbia saw a record 121 people with COVID in critical care on Monday, and hospitalizations are starting to stretch the capacities of some hospitals in Metro Vancouver,

the Vancouver Sun reported.

Provincial health officer Dr. Bonnie Henry is pleading with British Columbians to not leave their neighbourhoods as the fearsome Brazilian P.1 variant spreads. Quebec is also reporting a rise in hospitalizations and ICU admissions.

 Under an emergency protocol for a major surge developed for Ontario hospitals, those with the best chance of surviving 12 months would be given priority for an ICU bed.

In Ontario, “we’re moving patients like absolute crazy; we’re surging like absolute crazy,” one critical care specialist said. Ontario quietly issued emergency orders last week allowing hospitals to transfer patients to other hospitals, if needed, without their consent.

About 1,300 to 1,400 people have been shuttled around the province so far, mostly from the GTA to southern Ontario, and “it isn’t without the realization of how stressful that is for families,” Smith said.

Ontario reported 3,670 new COVID cases Tuesday, down from Sunday’s 4,456 record high. But infections are based on exposures a week or so ago. And hospital admissions and deaths lag infections by a week or two.

Today’s ICU admissions reflect when case numbers in Ontario were in the 2,000-range, said Ottawa critical care physician Dr. James Downar. “Very likely the stay-at-home order, coupled with the delayed March (school) break, will have the effect of blunting and flattening this a little bit. But that’s going to take a while.”

Among his concerns, “super-loading” nurses. Ontario already had the worst registered nurse-to-population ratio of all Canadian provinces before the pandemic. ICU nurses are highly specialized and after 14 months of the pandemic are burning out.

Normally in the ICU, it’s a one-to-one, nurse-patient ratio. Occasionally, they might have two patients. “But when they get added, and loaded up, that’s when the situation is unbearable for the nurse, and very high concern of course for the number of patients they’re trying to care for at any one time,” McKenna said.

Under an emergency protocol for a major surge developed for Ontario hospitals, those with the best chance of surviving 12 months would be given priority for an ICU bed. The protocol includes a “short-term mortality risk” calculator physicians could use to input information on the person’s condition — whether they have heart failure, cancer, chronic liver disease or severe COVID — that gives the person’s triage priority score.

While no one wants it, it’s a rational approach based on core principles and criteria, said Downar, one of the authors. “You apply the same rule to everybody.”

The group Accessibility for Ontarians with Disabilities Act Alliance has said the protocol is discriminatory, reduces life and death decisions “to a cold digitized computation” and, if consent legislation was changed, would allow doctors to “evict” someone from critical care.

Quebec hospitals haven’t yet been hit hard in the third wave, despite rising infections. However, Montreal ICUs are still dealing with people who survived COVID in the second wave, and need critical care for “respiratory compromise,” said Dr. Peter Goldberg, director of critical care at the McGill University Health Centre.

“About one-third of all our ICU beds are committed to either active or recovering COVID patients,” Goldberg said in an email.

“I can’t imagine that we’ll escape another ICU admission blip over the next couple of weeks,” he said. But he added, “thankfully,” there are no discussions about implementing Quebec’s triage protocol.

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Source: National Post Quebec Nordiques

Prince Philip kept fit with this 11-minute Canadian workout known as 5BX

Queen Elizabeth and The Duke of Edinburgh in an undated photo take before their marriage, and in 2007, recreating the photo at Broadlands in the Hampshire to commemorate their diamond wedding anniversary.

When Prince Philip died, he still had good posture and was able to walk without a cane. He was remarkably fit and mobile for a man just a few months shy of his 100th birthday.

According to Prince Philip’s tailors, the six-foot-tall man’s physique barely changed over the years, and he was still able to fit into his wedding day uniform seventy years later, The Telegraph reported.

“He was a 31-inch waist when I first measured him, and he’s now only a 34…. That’s incredible,” tailor John Kent said in 2017. The London tailor of Kent & Haste, which served the Duke for more than 50 years, added he has never had to let out any of Prince Philip’s clothes.

How did he do it? Besides quitting smoking before marrying Queen Elizabeth II, and avoiding over-indulging in food and alcohol, the late Duke of Edinburgh credited a short Canadian-made exercise regime with keeping him fit all his life.

 Prince Philip reportedly relied on a daily workout designed for the Royal Canadian Air Force to keep himself fit.

The Duke, who also enjoyed cricket, sailing, carriage driving and regular walks, reportedly followed the daily full-body strength and flexibility regime known as 5BX (Five Basic Exercises). It was developed by athlete and National Defence scientist William Orban in 1956 to help get members of the Royal Canadian Air Force (RCAF) into shape without the need for equipment or much space, but it soon caught on among the general public.

A Canadian government

website

boasts that the RCAF “started one of the first fitness crazes” with 5BX and XBX (a corresponding routine for women). The plans challenged conventional wisdom at the time that the only way to get fit was through long, gruelling workouts.

 Prince Philip could reportedly still fit into his wedding day uniform 70 years later.

“The beauty of the system was that you didn’t need expensive equipment or a health club membership; it was created to keep aircrew in the far north in shape by using standalone aerobic exercises,” the RCAF website says. “It proved so popular that 23 million copies of the RCAF pamphlets were sold to the Canadian public and it was translated into 13 languages.”

The routine received international coverage at the time and the RCAF still receives requests for copies of the fitness routine to this day.

The 5BX regime takes 11 minutes to complete and involves just five basic exercises that get the heart racing and put all the major muscles to work. It doesn’t even require a warm-up before you begin.

The plan has six levels that get progressively more difficult, but the five exercises remain essentially the same. It begins with two minutes of stretching, followed by one minute each of sit-ups, back extensions and push-ups, and concludes with six minutes of running on the spot interspersed every 75 steps with everything from scissor jumps to jack jumps as the intensity increases. The last stage requires “physical capacities … usually found only in champion athletes,” notes a

booklet published in 1965

.

The Duke reportedly passed this fitness routine down to his son Prince Charles, and grandsons Prince William and Prince Harry. Even British actress Dame Helen Mirren is a fan. The 75-year-old revealed in 2014 that she has used the RCAF exercise plan (presumably the 12-minute XBX version aimed at women) for years to keep her fit or prepare her for a more rigorous workout.

“It is 12 minutes and they have charts you follow. Each day, you have to do the exercises within the 12 minutes and until you can, you can’t move up,” she said at a press junket for her film The Hundred Foot Journey,

according to People

. “It is the exercise I have done off and on my whole life. It just very gently gets you fit. Two weeks of doing that and you think: ‘Yeah, I could go to the gym now.’”

 British actress Helen Mirren presents a creation for L’Oreal during the Women’s Spring-Summer 2020 Ready-to-Wear collection fashion show at the Monnaie de Paris, in Paris on Sept. 28, 2019.

Orban’s fitness regime was met with some skepticism and criticism when it was released in the 1950s, but his theory — that the intensity of exercise is more important than the amount of time spent on it — has become conventional wisdom. His 5BX program is considered a precursor to high-intensity interval training (HIIT) as well as ParticipACTION, the federal government’s 1970s fitness campaign.

While some experts suggest modifying some of the 5BX exercises — holding the stretches for longer, or bending the knees during sit-ups to protect the lower back, for example — the simple routine, which promotes daily activity, seems to have worked wonders for Prince Philip.

With additional reporting from Heather Sokoloff, National Post

Source: National Post Quebec Nordiques

What the numbers fail to tell us about how and where COVID-19 spreads

A recent study found that the neighbourhoods in Toronto and Peel region that had the most essential workers and lowest incomes had the great number of COVID-19 cases.

The title for one of the Ontario Health Ministry’s many web pages of COVID-19 data is promising: “Likely source of infection.”

If there is one issue that has never been crystal clear during the pandemic, it’s where and in what ways people are most likely to catch the coronavirus. Knowing the answer might even help Canadians lessen their risk of infection until they can get vaccinated.

But a closer look at that

provincial data

turns up relatively few clues as to how SARS-CoV-2 — the bug that causes COVID-19 — is spreading during this third wave.

One of the largest categories of infection falls under the heading of “close contact.” That

refers to someone

contracting the virus from a person they know is already infected and with whom “they were physically close.”

The site offers no elaboration, although “close contact” is often understood to refer to private, household encounters. Incidents of more than one case in a public setting like a school, workplace or nursing home fall under a different category, “outbreak settings.”

Outbreaks give rise to relatively detailed source information, but after close contact, the next most prevalent grouping is “community spread.” It has a similarly non-specific meaning.

It refers to someone who tests positive but did not travel, did not knowingly have contact with an infected person and was not part of an outbreak. Beyond that, it could be almost anywhere and anyhow.

Outbreak settings account for the next greatest number of cases, though only about 10 per cent of the total, according to the Ontario statistics.

By definition, however, the figure can at least be broken down according to the outbreak’s specific site.

As of April 11, the greatest number of active outbreaks — defined typically as one or more cases — were in educational institutions, 345 in all. Next most common were workplace outbreaks, with 204 different sites.

There were 126 group homes, jails, hotels and other types of “group living” with outbreaks, as well as 120 long-term care or retirement homes, and 61 “recreational” sites, which includes bars, restaurants, nightclubs and fitness centres.

Travel cases — people whose symptoms began within 14 days of their being outside the province — make up a small percentage of the total, less than one per cent of cases according to separate,

national data

from the Public Health Agency of Canada.

But they have a greater importance than the raw numbers suggest, as it is through travel that more transmissible variants of the coronavirus entered this country.

The source of a number of Ontario cases is classified as simply “other” since no information is currently available on where the person caught COVID-19. The “other” numbers spike at the end of the reporting period, presumably because of a lag in receiving the source information.

While the official provincial data leaves much unclear,

a recent study

in Ontario arguably did more to illuminate what’s driving the pandemic today.

It found

that the neighbourhoods in Toronto and neighbouring Peel region — Canada’s COVID-19 hotspots — that had the most essential workers and lowest incomes had the great number of cases.

Dr. Zain Chagla, a McMaster University infectious disease specialist and one of the study’s authors, said that suggests that people forced to work outside the home in factories, warehouses, supermarkets and the like are contracting the virus and likely spreading it to family and other close contacts.

In response, the province has instituted plans to target those neighbourhoods with vaccination blitzes that are open to all adults, not just older people as set out in Ontario’s original vaccine rollout plan.

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Source: National Post Quebec Nordiques

Pandemic-related cuts in cancer screening, surgery have doctors worried more people will die

A doctor exams mammograms, a special type of X-ray of the breasts, which is used to detect tumours, in this file photo.

Thousands of Canadians failed to undergo proactive cancer screening or diagnosis of possible cancers last year because of the pandemic, leading some doctors and advocates to fear a future surge in advanced tumors and deaths.

Data obtained by the National Post from two provinces and a report issued by a third show that proactive screening of patients without symptoms, and diagnosis of those suspected of having cancer plummeted in the first months of the coronavirus crisis.

Prostate cancer saw a particularly dramatic change, with 60 per cent fewer biopsies performed in Ontario between last March and August.

The Quebec Health Ministry estimates that over 4,000 people who normally would have been diagnosed with a malignancy during the first COVID-19 wave went undiagnosed.

Experts blame both restrictions imposed by the health-care system itself, and patients afraid to visit doctors or the hospital when problems arise.

The number of tests has climbed back to normal levels recently, but there were still hundreds of thousands fewer mammograms, pap smears and colorectal cancer screens conducted on Canadians in 2020 than the year before.

That happened on top of a delay in hundreds of thousands of elective operations, which one prominent surgeon says has almost certainly allowed some cancers to get worse.

“I do believe that patients with cancer in Canada … are being rendered fatal, terminal or incurable, as a result of what’s happened,” said Dr. Neil Fleshner, chair of urology at the University of Toronto. “It has absolutely had an impact. I’ve seen it with my own eyes. It’s extremely stressful.”

While the missed screening may have less short-term impact than delayed surgeries, he said he seems to be encountering more patients with advanced, harder-to-treat disease.

Amid talk of triaging COVID-19 patients to assess who gets priority for limited critical-care resources, Fleshner said triaging of a sort has already occurred in the health care system. Cancer and other non-coronavirus patients have borne the brunt of that prioritizing, the physician said, though he said he supports the efforts to tackle the pandemic.

Based on the Quebec report about the pandemic’s first wave, Eva Villalba worries that over the last year more than 8,000 Quebecers have gone undiagnosed with cancer.

“Where this gets us is another pandemic,” said the executive director of the Quebec Cancer Coalition. “When we do catch these people, when we do screen them and get them through diagnosis, it won’t be early any more, it will be more advanced cases of cancer.”

But not everyone is convinced the consequences of the interruptions will be dire. One prominent skeptic of mass cancer screening programs says they detect so few serious malignancies, the coronavirus is likely to have minimal if any impact.

Only about

.5 per cent of screening mammograms

finds a tumour of any size.

The pandemic “gives us a really interesting opportunity to evaluate (screening),” said Dr. Steven Narod, a University of Toronto breast-cancer expert. “I can pretty much promise you there will be no difference.”

Meanwhile, the system in parts of the country is seeing more disruption. Ontario just announced it was scaling back elective surgeries again, after huge numbers have already been delayed.

Since the pandemic began, the province has carried out 215,000 fewer cancer and other operations – not including heart or transplant surgeries – than during the same period a year ago, said Ontario Health Monday.

The pandemic has also affected both cancer screening and diagnosis. Screening programs like regular mammograms for women over a certain age are designed to catch malignancy at an early stage. Diagnosis through biopsy or other means occurs as a result of a patient’s screening results or suspicious symptoms.

Resections – removal of tissue – and biopsies to diagnose cancer dropped in Ontario by about 20 per cent between March and August, with prostate biopsies seeing the steepest decline at 60 per cent, according to figures Ontario Health provided to the Post.

Despite some catch-up later in the year, there were still 15 per cent fewer resections and five per cent fewer biopsies overall in 2020 than before the pandemic. But the testing numbers have increased above the 2019 level this year, the agency adds.

Ontario ordered routine cancer screening paused in March 2020, and the impact was striking.

By the end of the year, the system had done about 360,000 fewer pap smears for cervical cancer, conducted 220,000 fewer mammograms and processed 300,000 fewer colon-cancer tests.

British Columbia’s Provincial Health Services Authority provided less extensive data, but said the province saw a 20-per-cent decrease in new cancer diagnoses in the first part of the pandemic.

Diagnoses are now climbing back up to pre-COVID-19 levels, the agency says. The number of screening mammograms B.C. did this February was about the same as in February 2019.

Quebec’s Health Ministry issued a report in January detailing the pandemic’s impact on cancer care. Based on the reduced number of biopsy and other pathology reports, it estimated 4,119 new cancers went undiagnosed just between March and August of 2020 that would have been found earlier.

Some of the potential impact of the lost screening will be rectified through catching up, and many of the missed tumours would be slow-growing, said Dr. Joseph Ragaz, a University of British Columbia medical oncologist and breast-cancer expert.

But he said a study he and colleagues have just completed – yet to be published – underscores that mammogram screening does significantly reduce the death toll from breast cancer, especially in women 60 and older.

“Clearly, it’s something that may have consequences,” said Ragaz about the pandemic-related cutbacks. “What we really see is that the screening leads to earlier diagnosis, and it will also lead to earlier management of breast cancer.”

Source: National Post Quebec Nordiques

Canadian law may not apply to PornHub, justice minister tells Commons committee

It’s often hard to determine whether a company is actually Canadian, federal Justice Minister David Lametti told the House of Commons ethics committee on Monday, April 12, 2021.

Canadian law may not apply to PornHub, the federal justice minister said Monday at a parliamentary committee studying accusations the company, whose main office is in Montreal, has distributed exploitative and illegal material.

“The Criminal Code applies in Canada, and in the internet context there are a variety of different standards that might mean that a company is actually operating in another country,” David Lametti told MPs.

MindGeek has 1,000 employees and an office in Montreal, and its CEO and chief operating officer both live in that city, NDP MP Charlie Angus pointed out. “Mr. Lametti, in your opinion, would this qualify MindGeek, as a Canadian company, subject to Canadian law?” he asked.

“I’m not going to comment on the actual details,” Lametti responded. “There have been differing opinions. As [Public Safety Minister Bill Blair] and I have pointed out, it can depend on where servers are located.”

Lametti, Blair and RCMP commissioner Brenda Lucki testified at the House ethics committee as part of its study on the allegations against PornHub. Last year, the company was accused of hosting videos involving child sexual abuse material and non-consensual content. Following a New York Times column that said the company was “infested with rape videos,” big credit card companies stopped their cards from being used on the site, and the company removed all unverified uploads, which was the majority of its content.

Lawsuits have been launched against the company in both Canada and the U.S.

MindGeek has denied the allegations, telling the Canadian Press in March it has “zero-tolerance for non-consensual content, child sexual abuse material (CSAM), and any other content that lacks the consent of all parties depicted.”

It’s often hard to determine whether a company is actually Canadian, Lametti said in the hearing.

The application of Canada’s Criminal Code and any investigations or prosecutions “are independent functions and their application in an international context is not always as clear as you would have it be, even if that’s what we would both like,” he told Angus.

MindGeek previously maintained that it doesn’t fall under Canadian law at a 2018 meeting with the RCMP, the committee heard.

Canada’s mandatory reporting act stipulates that any individual providing an internet service to the public must report child pornography, and preserve computer data related to that notification. The ministers and officials were asked why MindGeek has never made such a report in Canada.

“It’s very difficult for the RCMP to monitor and ascertain compliance with the mandatory reporting act, particularly in the cases where the companies have a complex international structure, and the data is stored in multiple jurisdictions. Those services flow through the internet and they transcend international borders,” Lucki said.

The RCMP met with MindGeek in 2018 to help them with software that automatically identifies exploitative material, and the RCMP raised the mandatory reporting act, she explained.

“And at the time, they had said that it doesn’t apply to them,” Lucki said, adding MindGeek was reporting the child abuse content, but to authorities in the U.S., who would then provide them to Canada. The RCMP now gets monthly reports about what MindGeek has reported in the U.S.

“It’s kind of a non-traditional way that it should be done, but the bottom line is we are getting reports,” Lucki added.

“This whole piece of jurisdiction still baffles me. Like why, why would they not report it to Canada?” Conservative MP Arnold Viersen asked. Lucki responded that it was due to the company’s servers.

During the meeting, Blair indicated the new regulator that will be created in upcoming legislation to deal with online harms will help in the effort to combat illegal material.

“We recognize that also there’s much more work to do. And that’s why we will introduce legislation to create a new regulator that will ensure that online platforms remove harmful content,” he said.

A month ago, more than 70 MPs and senators sent a letter to the RCMP asking for a full criminal investigation into MindGeek. That followed a similar request in early March from more than 100 victims of sexual exploitation.

Lucki said the RCMP’s policy is not to comment about whether investigations are underway, in order not to compromise any potential investigation.

“What I can say is that specifically in regards to PornHub or MindGeek, the call for criminal investigation is under review,” she said. “We’ve been working with police of jurisdiction in that case, and if there is the necessary information that leads us to launch the investigation, the investigation will be launched unequivocally.”

If that investigation leads to evidence, charges will be laid, Lucki said.

Source: National Post Quebec Nordiques

Ambassadors, opposition denounce 'shameful' Liberal posture toward China following Taiwan report

Taiwan's President Tsai Ing-wen.

OTTAWA — Former ambassadors and opposition members of Parliament called the Liberal government’s posture toward China a “disgrace” and “shameful” following a media report that said government officials had sought to block the president of Taiwan from receiving an award in Canada.

According to a report by Politico, federal government officials had threatened to pull funding to the Halifax International Security Forum if it awarded its John McCain Prize for Leadership in Public Service to Tsai Ing-wen, the president of Taiwan. The report attributed the Liberal decision to a fear of offending the Communist Party of China, which has for decades sought to reclaim Taiwanese territory as its own.

Guy Saint-Jacques, a former Canadian ambassador to China, said the report suggests the Liberal government had not just stayed silent on the issue of Taiwan, but had gone out of its way to avoid upsetting Chinese leadership.

“It would have been easy for the government just to keep quiet on this and let the award process go forward,” Saint-Jacques said, adding that Ottawa could have rightly claimed that the prize was awarded by an organization that is purportedly beyond government control.

He said Prime Minister Justin Trudeau needs to align himself more clearly with U.S. President Joe Biden, who has been much more explicit and direct in his comments toward China, and particularly on Taiwan.

“The government has to take action so it can be seen as being a lot more supportive of Taiwan,” he said. “I’ve been saying for a long time we have to drop the white gloves and be a lot more forceful and firm in our actions with China.”

Defence Minister Harjit Sajjan rejected the “absolutely false” claims that the Liberal government had threatened to pull funding if Tsai was given the award, saying the body determines recipients on its own.

“The Halifax International Security Forums is an independent organization and they make their own choices with regards to the award,” he said.

The Forum is an annual event attended by highly influential military officials and politicians.

It had awarded the John McCain prize just twice before, and was planning to award it to Tsai the third time for her courage in guarding against the COVID-19 pandemic and in standing up to repeated Chinese aggressions, according to the Politico report. Tsai was re-elected as president last year by a sizeable margin, in large part based on a promise to defend Taiwan’s independence from China.

David Mulroney, another former Canadian ambassador to China, called the report a “national disgrace” on Twitter Monday.

“Canada’s Feminist Foreign Policy has no room for one of the most courageous, principled, and seriously threatened women on the planet,” he said.

Beijing has long tried to gain political control over the self-governing democracy of Taiwan, and Chinese president Xi Jinping has made the reunification of the state a central part of his “China Dream” of national revival.

China in recent weeks has stepped up symbolic efforts over its sovereignty claim of Taiwan, regularly flying military jets through Taiwanese airspace on several occasions. Many observers view the aggressions as a test for Biden, who has denounced the moves. China has framed what it considers to be its sovereignty over Taiwan as non-negotiable, driving fears that the situation could escalate into deeper conflict.

Adding to criticism levelled by former ambassadors on Monday, opposition members and other observers also called out the Trudeau government, saying his weak foreign policy tactics run counter to his government’s feminist and pro-democracy talking points.

“Absolutely pathetic — Canadian government is a bunch of cowards condoning Chinese genocide,” Meghan McCain, daughter of the late U.S. senator after whom the award is named, said on Twitter.

“Instead of supporting the people of Taiwan, the Trudeau Liberals have threatened to pull support from the forum if the organizers went ahead with the award,” said Conservative foreign affairs critic Michael Chong. “This attempt to silence those critical of China is shameful. Canada should support those who stand up and speak out against the Chinese Communist Party’s violations of human rights and international law.”

Government officials, as well as organizers of the Halifax forum, did not verify the Politico report.

Robin Shepherd, vice-president of the Halifax forum, would only say that the forum has not yet announced a winner of the 2020 John McCain award. A recipient would be announced “at an appropriate time” in the future, Shepherd said in a written statement.

“President Tsai of Taiwan is a well respected international leader, the first female president of Taiwan and a strong global advocate for democracy,” the statement said. “She would certainly be an ideal fit for this award.”

A spokesperson for Sajjan said the government already provided its annual funding to the forum late last year, which it supplies through the federal Atlantic Canada Opportunities Agency. Several officials who spoke with the National Post would not confirm whether the Liberals had threatened to pull funding.

“The Government of Canada has provided financial support through a contribution agreement with the Halifax International Security Forum for the 2020 conference,” spokesperson Todd Lane said in a statement. “That money was given to the Halifax International Security Forum last year prior to the conference.”

• Email: jsnyder@postmedia.com | Twitter:

Source: National Post Quebec Nordiques

COVID-19 variants are spreading quickly. Will vaccines save us in time?

The Rogers Arena in Vancouver sits empty after a game between the Calgary Flames and Vancouver Canucks was cancelled March 31 due to an outbreak of a COVID-19 variant among Canucks. Canada is currently battling surging infections caused by three daunting variants.

In extreme cases of COVID-19, the lungs can become rigid, heavy, shrinking to half their size. Instead of salmon-pink and spongy, they look more like livers.

It’s not yet known whether the new variants pose a more perilous threat to lung tissue. A variant has swept through the Vancouver Canucks, benching healthy, young athletes with usually remarkable lung stamina. Doctors are reporting younger people arriving in ICUs needing ventilation or artificial lung support. “It’s hard to tell if the variants will cause more permanent lung damage,” said Dr. Marcelo Cypel, Canada Research Chair in lung transplantation at Toronto’s University Health Network.

Like so much of this moment — the “old” COVID-19 fading, a “new pandemic” surging in parts of the country — “I don’t think we can say that yet,” Cypel said.

Canada is in the supremely unenviable position of battling surging infections caused by three daunting variants  — the B.1.1.7 variant first found in England, the P.1 or Brazilian variant first identified in Japan in travellers returning from the Amazon, and the B.1.351 variant that emerged in South Africa. P.1 is gathering steam in British Columbia, while Ontario, now in its third stay-at-home state of emergency, has ordered hospitals to halt all non-urgent surgery and could soon enact a critical triage protocol that, should the variants push hospitals to crisis levels, could have random selection determining who ultimately gets the empty ICU bed.

Where will this virus go? How much of a threat are the variants? What mutations might arise in the future? And will the vaccines save us in time?

Across Canada, experts are monitoring the evolutionary trajectories of the variants, giving advice to governments.

The SARS-Cov-2 virus is still adapting to humans. Viruses may not have a brain, “but they’re governed by the same evolutionary drive that all organisms are — their first order of business is to perpetuate themselves,”

University of Connecticut virologist and vaccinologist Paulo Verardi wrote in The Conversation.

The more people infected, allowing the virus to propagate, the greater the probability of new variants of concern emerging.

Rattling nerves is evidence that, not only are they more transmissible, spreading more easily, and quickly, the Brazilian and South African variants can potentially evade antibodies produced through natural infections or vaccines.

The vaccines being deployed across Canada still offer immunity against the variants. They all prevent hospitalization, and death. “They work, and we have to get them out,” said University of Ottawa virologist Marc-André Langlois. Reduce the pool of people that are infected, and the virus has fewer opportunities to create new progeny and generate new variants.

“If variants continue to evolve, that’s when we’re going to run into problems,” particularly with the South African and Brazilian variants, said Langlois, lead of Canada’s Coronavirus Variants Rapid Response Network.

“If those variants continue to evolve, they could evolve into something that is vaccine-resistant.”

Almost 25,000 variant cases have been reported across Canada. On Jan. 12, there were officially 22. Even as vaccines bring us closer to the end of the crisis, “We cannot afford to give the virus an inch,” Canada’s chief public health officer Dr. Theresa Tam said Friday.

Among the worrying trends, the number of people experiencing severe and critical sickness is rising, including younger and previously healthy adults.

It’s not clear whether the variants have a higher biological affinity for younger people, but a

new preprint is

linking the P.1 variant for a sudden and dramatic spike in COVID-19 deaths among younger adults in the south of Brazil. “All groups above 20 years of age showed statistically significant increases in CFR (case fatality ratio, the proportion of deaths among confirmed cases) when diagnosed in February 2021 as opposed to January 2021,” the researchers reported. Those aged 20 to 29 saw a tripling of their CFR, from 0.04 per cent to 0.13 per cent; for those 30 to 59, the CFR roughly doubled.

P.1 could become the predominant variant in many jurisdictions in Canada, depending on policy decisions. “The science has been saying for some time that the VOCs (variants of concern) are more dangerous — but health policies are tending to follow rather than lead,” said Dr. Terrance Snutch, chair of the Canadian COVID-19 Viral Genomics Network.

All three of the main variants have mutations in their spike protein gene — some unique to each one, others shared between all three. The spike protein studs SARS-CoV-2’s surface. It’s what the virus uses to bind to the human ACE2 receptor and enter our cells.

“That shared mutations have arisen independently from across the world suggests that the virus is showing convergent evolution — in other words, there are only so many moves that the virus is capable of making regarding altering its spike protein and still be infectious, replicate and then go on to infect additional people,” Snutch said.

But evolution has its limits. “Sooner or later the virus is predicted to run out of options regarding mutating its spike protein — the route of infection into human cells,” Snutch wrote in an email.

Many thousand mutations distinct from the original Wuhan virus have been identified from samples from people who have tested positive across the country. While a portion could be considered “variants of interest,” Snutch said, none have so far reached the status of a “variant of concern.” What makes a VOC? It spreads more easily, makes people sicker and has the ability to dodge neutralizing antibodies induced by vaccines.

The vaccines available can elicit a broad immune response that includes not just antibodies but memory cells. Mutations in the virus shouldn’t make vaccines completely ineffective, and manufacturers have said they can tweak the composition of their vaccines to protect against the variants.

But most of the country remains unvaccinated. Ontario Premier Doug Ford has promised to have 40 per cent of adult Ontarians vaccinated by May 6. Quebec Premier Francois Legault’s goal is for all adult Quebecers who want one to get a COVID-19 shot by June 24.

One challenge could be vaccine hesitancy. How many Canadians will decline the vaccine? The larger that proportion, the greater the probability of the virus continuing to spread and evolve. “We need to reach out to the hesitant, showing them safety data. If you get infected with the virus you have a much higher probability of being critically ill than any probability of a vaccine side effect,” Langlois said.

 University of Ottawa virologist Marc-André Langlois: “If those variants continue to evolve, they could evolve into something that is vaccine-resistant.”

The variant currently reigning supreme in Canada — B.1.1.7 from the UK, which now accounts for 90 per cent of the variants — is already slightly more deadly, and “there’s a reasonable possibility it could even get worse,” University of Oxford professor of evolution and genomics Aris Katzourakis

told New Scientist.

Variants have emerged in New York City, California, Paris, London. What we’re seeing is still evolution, Langlois said, but nothing so far is as problematic as the Brazilian and South African strains.

“For virologists, the worst case scenario is that the current variants jump back in their animal reservoirs, recombine with other coronaviruses and come out with a new strain of something that the vaccines won’t work on,” he said.

There are hundreds of coronavirus strains in bats, believed the origin of SARS-CoV-2. “With deforestation and climate change, humans and wild animals are coming in closer contact, and these zoonotic exchanges are being seen more and more frequently,” Langlois said.

It’s not known how long vaccine-induced immunity will last. “One shot you don’t fall sick, with two shots you don’t make anyone else sick,” Langlois said. People infected with SARS-1 still show immunity. “Once a large proportion gets both vaccines, we will see the numbers drop,” Langlois said. Reinfection will happen. People will fall sick, but they won’t end up in the ICU.

Snutch doesn’t believe herd immunity will be easily achieved. The long-term effectiveness of the first generation of vaccines isn’t known. The virus will continue to circulate in the non-vaccinated, here and throughout the world, he said.

“At some point in time, one of those infected people is going to generate a new (variant of concern) that sufficiently avoids the current vaccine-driven immune responses, and when that person gets on a cruise ship or plane” the new variant could spark its own pandemic.

Finally, the virus will likely keep mutating enough that we’ll need a booster shot every year or two, an outcome Snutch said is “likely OK.” The vaccines could be tweaked again to be protective against death.

“One could predict that future infections of vaccinated people to be more along the lines of bad colds/flus,” he wrote.

• Email: skirkey@postmedia.com | Twitter:

Source: National Post Quebec Nordiques

‘Long COVID’ is real, but not the risk you might think

Long COVID sufferer Teresa Dominguez, 55, a social worker specialising in disabilities, poses for a photograph taken through blue plastic, in Collado Villalba, Spain, March 4, 2021. The photograph was taken through blue plastic to visualise the effects of long COVID.

Even as Canada is thrashed with a third wave of COVID-19, there are plenty of reasons for optimism: Deaths are staying remarkably static in the face of skyrocketing cases and after months of delays, Canada’s mass-vaccination campaign

has finally started to immunize Canadians in significant numbers

.

Yet even as we enter the last days of this pandemic, there remains ample fear of “long COVID”; symptoms of the disease that linger long after the usual two-week recovery period has ended. As one typical Tweet from a former COVID-19 patient put it, “I’m scared I’m never going to be able to taste or smell again.”

Long-term effects from COVID-19 are definitely real and have been experienced firsthand by many in the medical profession. British medical professor Paul Garner, for instance,

has described

a seven week “roller coaster of ill health, extreme emotions, and utter exhaustion.” But the reality of the condition is often far different from its usual depiction in the zeitgeist.

A

January paper in the journal Social Science & Medicine

wrote that, “Long Covid has a strong claim to be the first illness created through patients finding one another on Twitter.”

Social media is a perfectly legitimate way to discover chronic conditions (and the above paper praises it as a way to marshall “epistemic authority”), but it also highlights the fact that, as of now, most of what we know as “long COVID” is anecdotal and not subject to the usual safeguards on medical data — there is no “control group” in most long COVID research.

Nevertheless, some of the most reliable data on “long COVID” comes from the “COVID Symptom Study,” a U.K. program that recruited thousands of COVID-19 patients to log their long-term symptoms using a smartphone app. Of study participants,

only one in 20 reported any symptoms after eight weeks

, and only one in 50 were still ill after 12 weeks.

These proportions become even smaller when considering the vast numbers of COVID-19 infections that have gone undetected. According to the U.S. Centres for Disease Control, for every one confirmed case of COVID-19, more than three cases have gone

unnoticed

— and this ratio has

soared as high as 1 to 24 in some regions

.

The most conservative interpretation of these numbers show that for every 200 COVID-19 patients, only one of them can expect so much as a cough three months after their infection.

More recent studies focused exclusively on “long haulers” have found that symptoms were usually gone within a few months. A study led by University College London followed

3,800 COVID-19 patients

from 56 countries who were still reporting symptoms after 28 days. After six months, serious symptoms had usually subsided, with the most frequent lingering effects being milder conditions such as fatigue, “post-exertional malaise” and “cognitive dysfunction.”

Similar results can be found among the hardest COVID-19 cases: Those who have undergone hospitalization. A

University of Glasgow study

caught up with hospitalized COVID-19 patients 90 days after being discharged, and found that while 45 per cent reported feeling fully recovered, among the rest the most common symptoms were “fatigue” and “breathlessness.”

Months-long recoveries aren’t all that different from plenty of other respiratory diseases, as anyone who’s suffered a “never-ending cold” can attest. The average pneumonia sufferer, for one, can

expect to still have shortness of breath more than 90 days after infection

. The common flu regularly imposes health consequences on its sufferers that can last for months after infection, including a

higher risk of heart attack

.

“The experience of an acute respiratory illness will be different from person to person, and there is no ‘rule’ on when exactly a patient’s respiratory symptoms, fatigue, and general ‘sick feeling’ should resolve by,” wrote Harvard Medical School professor Adam Gaffney in an

extended critique

of contemporary reporting on “long COVID.”

In October, a

review by the UK’s National Institute for Health Research

determined that “long COVID” likely refers to a basket of conditions, most of which are not unique to the disease. Among those were “post-viral fatigue syndrome” and “

post intensive care syndrome

,” both of which are characterized by lengthy periods of general fatigue and mental cloudiness.

Reports of long COVID are also at risk of drawing in any number of chronic conditions unrelated to COVID-19. A plurality of respondents to the University College London study of “long haulers,” for instance, tested negative on serological studies probing the bloodstream for evidence of a prior COVID-19 infection. While serological studies are not ironclad, it highlights the risk that COVID-19 might be getting the blame for any number of headaches and fatigue with which it had no direct involvement.

As Gaffney noted, the “elephant in the room” with long COVID is that many of the condition’s distinguishing characteristics — mental distress, anguish and fatigue — are very similar to the wider social effects of COVID-19 lockdowns and resulting economic recession.

Again, this does not discount the experiences of those COVID patients who have been utterly laid flat by lingering symptoms, but it’s useful to note that they are members of a small and extremely unlucky minority.

Media accounts during the pandemic have frequently given outsized attention to relatively anomalous cases. Pediatric deaths from COVID-19 have garnered a disproportionate share of press coverage, even though COVID-19 is

dramatically less dangerous to children than the conventional flu

. Most recently, the alleged blood clot risks of the Astra Zeneca vaccine dominated headlines for days, even those the shot’s risk of imparting a rare blood clot

was only 1/250th that of the birth control pill

.

Ultimately, the best check against fears of “long COVID” is the simple fact that, with no data from the future, it is almost always premature to ascribe any “lifelong” effects to the virus.

So far as we know, the virus that causes COVID-19 has been in human bloodstreams for no more than 20 months at this point, severely limiting any reliable forecasts of what it will do to patients 5, 10 or 20 years after infections.

And the good news is that even “long-haulers” are seeing their symptoms dissipate over time. Just this week, new data from the U.K. found that

as many as 25 per cent

of COVID-19 patients suffering long-term symptoms are starting to feel better after vaccination.

• Email: thopper@postmedia.com | Twitter:

Source: National Post Quebec Nordiques