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Could remdesivir be a game changer for COVID patients?

MELISSA COUTO, THE CANADIAN PRESS | posted Friday, May 1st, 2020

A major study from the United States suggesting an experimental drug could shorten COVID-19 recovery time is stirring up optimism, but Canadian infectious disease experts caution it’s too early to know how effective it is.

The U.S. National Institutes of Health revealed results Wednesday of a study on antiviral medication remdesivir, developed by the California-based company Gilead Sciences, which was tested on 1,063 COVID-19 patients sick enough to be hospitalized.

Officials said recovery in patients using the drug was shortened by 31 per cent – 11 days on average versus 15 days for those just given usual care.

But the data from the U.S. study still needs to be peer reviewed and published in a medical journal, says Dr. Gerald Evans, chair of Queen’s University’s infectious diseases division in Kingston, Ont.

“We really need to see the data on this particular study because the devil is in the details with these things,” Evans said.

“They’ve tantalized everybody with the idea that they’re reporting, and they’ve only analyzed half the patients that were in the trial. … So when we look at that (data), we’ll be able to see a lot more of what’s going on.

“But I’m like everybody else, I’m really hopeful and enthusiastic that there appears to be something that this drug might do.”

Remdesivir was being evaluated in at least seven major studies, said Dr. Anthony Fauci of the National Institutes of Health, with the one led by the NIH described as the strictest.

Results of the test are based on the first 460 patients from the 1,063 studied.

Dr. Ameeta Singh, an infection disease expert at the University of Alberta in Edmonton, says a nationwide clinical trial in Canada that hopes to test three antiviral drugs – including remdesivir – is awaiting approval.

She described the U.S. randomized-control trial as the “gold standard” for medical studies.

And while it’s only one test on a relatively small sample size, it does offer some optimism at a time when it’s perhaps most needed.

“I think everyone is excited that there’s even a signal that (the drug) could be helpful and potentially prevent severe illness in those most at risk for developing complications,” Singh said.

“It definitely looks like it can shorten the duration of the illness. What is unclear from the information is did it reduce the severity of the illness? I suspect it did but that wasn’t specifically stated.”

Ontario’s chief medical officer of health Dr. David Williams said his team is waiting to be advised by Canada’s clinicians and specialists about the drug’s potential.

“I understand the data is fairly new and of some limitations,” Williams said at a press conference Thursday.

B.C. health officer Dr. Bonnie Henry said the results of the U.S. study looked promising.

“We are in B.C. and in Canada participating in a number of trials that include remdesivir. We need to continue the randomized control trials to have a better understanding of exactly how it works, how much and who it’s going to work best for,” Henry said at a news conference.

It’s also not certain from the partial results revealed if the drug is reducing deaths, both Evans and Singh pointed out, and no information was released about potential side effects.

Evans, who also chaired the Committee to Evaluate Drugs in Ontario for several years, said “safety signals” of new medications are more easily seen after they have been used to treat “thousands and thousands of people versus a few hundred within a clinical trial.”

“As a doctor who treats patients, I want to make sure I also don’t harm people,” Evans added. “What’s happened with some of the people in trials – have some of them had very bad side effects?”

Evans expects data from the study to be published within two weeks, a timeline he called “incredibly fast.”

An effective treatment for COVID-19 could have a drastic impact on society, especially if a vaccine is still a year or more away, by potentially allowing businesses to reopen and physical distancing measures to relax.

“If (remdesivir) works really well, then what it means is that the public and people who are infected can be less fearful of a bad outcome,” Evans said.

“But at least until we see more details, I don’t know if this drug is telling us that it could do that.”

Remdesivir is an antiviral drug aimed against RNA viruses like SARS-CoV-2, which causes COVID-19. It was originally created to treat Ebola, another RNA virus.

Evans said antiviral drugs work by interfering with the virus’s ability to replicate itself, meaning the amount of virus being produced by an infected cell would be “markedly reduced.”

“By impairing viral replication, it dampens down the inflammation that the virus causes, and it’s the inflammation that makes you sick,” Evans said. “So that means we’re buying time for your immune system to kick in and get rid of the virus by itself.”

The U.S. study only tested remdesivir in patients sick enough to be hospitalized, so Singh said its effectiveness on less severe cases remains unknown.

There are currently no drugs approved for treating the novel coronavirus, which has killed about 226,000 people worldwide since it emerged late last year in China.

U.S. government officials said Wednesday they would work to make remdesivir available to appropriate patients as quickly as possible.

But what does that mean for Canada?

First, Evans said, remdesivir would need to be approved by the national drug-governing body. Canada would also need to secure supply, something Evans believes could be difficult.

“What we see the Americans doing unfortunately is tending to hold onto everything themselves. So that’s where things get tricky,” Evans said. “I would suspect that Gilead would have to work on an industrial level of production of the drug, and how much they produce will also tell us how much we could get up here in Canada.”

Gilead said it was ramping up production and aims to have more than 140,000 treatment courses by the end of May, more than 500,000 by October and more than 1 million by December.

Singh expects the validation process for a drug like remdesivir to move more swiftly than usual, given the pandemic circumstances, but she said approval for the Canada-wide clinical trial could still be weeks away.

There’s also concern of a global shortage of remdesivir, but Singh is hopeful Canada would be able to secure some.

“Eventually we’ll need to have a lot more data from clinical trials like this, and those trials are ongoing,” Singh said, noting a recent smaller study in China that showed no benefit to remdesivir.

Evans agrees there’s much to be seen about how effective the drug can be.

“I would say we don’t know if it’s a game-changer, and we’re not going to know more until we see the data in print,” he said. “Until that time, I think it’s reasonable to be optimistic, but people have to recognize this is not a cure all.”

With files from The Associated Press

Coronavirus threat to First Nations, Inuit communities grows as it eases elsewhere

THE CANADIAN PRESS | posted Friday, May 1st, 2020

The federal government will be under pressure today to explain what it’s doing to prevent coronavirus from spreading like wildfire through First Nations reserves and remote Inuit communities in the North.

Crown-Indigenous Relations Minister Carolyn Bennett, Indigenous Services Minister Marc Miller and Northern Affairs Minister Dan Vandal are scheduled to be grilled by MPs at a virtual meeting of the House of Commons Indigenous and Northern Affairs committee.

Their appearance comes one day after Nunavut identified its first positive case of COVID-19 in the 1,600-strong, largely Inuit community of Pond Inlet on Baffin Island.

First Nations reserves and remote communities are considered among the most vulnerable areas in the country, due to often over-crowded living conditions that make physical distancing next to impossible and the lack of ready access to health-care services.

Even as the infection rate appears to be slowing down in most of the country and provinces are taking the first cautious steps toward reopening their economies, chief public health officer Dr. Theresa Tam warned Thursday about the growing risk to Indigenous communities.

“I am also concerned about increasing numbers of COVID-19 in First Nations communities in several provinces,” she said.

“We must get ahead of things to protect and support these communities, ramping up testing and contact tracing to find where chains of transmission are occurring.”

As of April 29, Miller said there have been 129 COVID-19 cases in First Nations reserves and 16 confirmed cases in Nunavik’s Inuit communities.

As for Nunavut’s first case, Miller promised that the federal government “will be giving this our full attention to ensure appropriate contact tracing and maximum containment efforts are undertaken.”

The federal government has so far committed more than $690 million to pandemic preparedness and procurement of supplies and nursing services for Indigenous communities.

It has been heavily criticized, however, for largely ignoring the needs of Indigenous people living off reserve.

As the situation grows more worrisome for Indigenous communities, Prince Edward Island is poised today to become the second province to cautiously begin a gradual return to normal.

It will restart priority, non-urgent health-care services, including some elective surgeries and certain health providers, including physiotherapists, optometrists and chiropractors. And it will begin allowing outdoor gatherings and non-contact outdoor recreational activities of no more than five individuals from different households.

P.E.I. follows New Brunswick’s move last week to allow limited golfing, fishing and hunting;    interactions between two families; and a return to school for post-secondary students.

Saskatchewan, Alberta and Manitoba are planning to ease some restrictions starting on Monday.

Quebec, which has seen the largest number of COVID-19 cases and deaths, is also set to re-open retail stores outside Montreal on Monday, with those in Montreal to follow on May 11. Schools and daycares outside Montreal are set to re-open May 11 as well.

The federal government, in collaboration with the provinces and territories, unveiled earlier this week national guidelines for re-opening shuttered businesses and allowing Canadians to resume more normal activities.

During a conference call late Thursday, premiers “reaffirmed their commitment to the joint statement on the shared public health approach to support restarting the economy,” Prime Minister Justin Trudeau’s office said a statement summarizing the call.

“They spoke about the plans they are putting forward in each of their respective jurisdictions to restart the economy. First ministers acknowledged the importance of doing this through a gradual and phased approach, based on the advice of public health experts.”

A look at how provinces plan to emerge from coronavirus shutdown

THE CANADIAN PRESS | posted Friday, May 1st, 2020

Provinces have begun to release plans for easing restrictions that were put in place to limit the spread of the coronavirus.

Here is what some of the provinces have announced so far:

Newfoundland and Labrador

Newfoundland and Labrador plans to loosen some public health restrictions in a series of five “alert levels.” The move to level four on May 11 will allow some medical procedures to resume as well as low-risk activities, such as golf, hunting and fishing. Low-risk businesses including garden centres and professional services, such as law firms, will be able to reopen under level four. Alert level four is to remain in place for at least 28 days. At level three, private health clinics, such as optometrists and dentists, will be permitted to open, as well as medium-risk businesses, such as clothing stores and hair salons. At level two, some small gatherings will be permitted, and businesses like performance spaces and gyms will be allowed to open. Level one will represent “the new normal.”

Prince Edward Island

The Renew P.E.I. Together plan calls for the restart of priority non-urgent health-care services on May 1, including certain elective surgeries and select health-service providers, including physiotherapists, optometrists and chiropractors. Also to begin May 1 are outdoor gatherings and non-contact outdoor recreational activities of no more than five individuals from different households. Screening is to continue at points of entry and all people coming into P.E.I. will be required to isolate for 14 days.

New Brunswick

Premier Blaine Higgs put the first phase of his four-phase reopening plan into action April 24. It allows limited play on golf courses as well as fishing and hunting. Two families are allowed to interact as part of a so-called “two-family bubble.” Post-secondary students can return if it’s deemed safe by the school, and outdoor church services can be held, if people remain in their vehicles and are two metres apart. The second phase, which could begin within two to four weeks would see resumption of elective surgeries, and reopening of daycares, offices, restaurants, ATV trails and seasonal campgrounds. The third phase would allow regular church services, dentistry work and reopened fitness centres. The final phase, which would probably come only after a vaccine is available, would include large gatherings.

Quebec

Premier Francois Legault has set May 11 as reopening day for schools and daycares outside greater Montreal. The city is to follow suit on May 19. Legault says attendance won’t be mandatory. High schools, junior colleges and universities are to remain closed until September. Quebec aims to open retail stores outside Montreal by May 4 while those in the greater Montreal region are to reopen May 11. The construction industry is to completely start up May 11, while manufacturing companies are to resume operations the same day with initial limits on the total number of employees who can work per shift.

Ontario

Premier Doug Ford released a three-step plan on April 27, but did not include a timeline. Stage 1 could include opening select workplaces that could modify operations such as providing curbside pickup or delivery, opening parks, allowing for more people at certain events such as funerals, and having hospitals resume some non-urgent surgeries. Stage 2 could include opening more businesses, opening more outdoor spaces, and allowing some larger public gatherings. Stage 3 would include having all workplaces open and further relaxing rules on public gatherings — though large ones such as sporting events and concerts would still be restricted.

Saskatchewan

The Saskatchewan government released on April 23 a five-phase plan to reopen parts of its economy. Lifting of some measures could start May 4, with dentists, optometrists and other health professionals allowed to resume services. Phase 1 also includes reopened golf courses and campgrounds. Phase 2 would give the green light to retail businesses and salons. Restaurants and gyms could open in Phase 3 but with limited capacity. Phase 4 could see arenas, swimming pools and playgrounds opening. In Phase 5, the province would consider lifting restrictions on the size of public gatherings.

Manitoba

May 4 is the day Manitoba plans to allow reopening of health offices, including dentists, chiropractors and physiotherapists. Retail businesses to reopen at half occupancy as long as they can ensure physical spacing. Restaurants to reopen patios and walk-up service. Museums and libraries to open doors, but occupancy to be limited to 50 per cent. Playgrounds, golf courses and tennis courts can reopen along with parks and campgrounds. A second phase of the plan is to begin no earlier than June 1. That’s when restaurants to be allowed to open indoor dining areas and non-contact children’s sports to resume. Mass gatherings such as concerts and major sporting events will not be considered before September.

Alberta

Alberta plans to allow some scheduled, non-urgent surgeries to start May 4. Dentists, physiotherapists and other medical professionals will be allow to open. On May 2, in golf courses can reopen as long as their pro shops and clubhouses remain shuttered. On May 14, retail businesses, such as clothing, furniture and bookstores, will be allowed to reopen gradually. Cafes and restaurants with no bar service will also be allowed to reopen at half capacity. The second phase of Alberta’s plan includes potential kindergarten to Grade 12 classes, with restrictions, and movie theatres and theatres, again, with restrictions. The third phase includes nightclubs, gyms, pools, recreation centres and arenas all with restrictions. There is no timeline for the final two phases.

British Columbia:

The province hasn’t released its reopening plan, but Premier John Horgan is promising details next week.

Man seriously injured in East York shooting, 1 in custody

BT Toronto | posted Thursday, Apr 30th, 2020

One person is in custody after a man suffered serious injuries following a reported drive by shooting in East York.

Police say they responded to reports of gunfire in the area of Wakunda Place and O’Connor Drive just before 8 p.m.

Upon arrival police discovered a male victim suffering from gunshot wounds. He was taken to a trauma centre in non-life threatening condition.

Police say one man is in custody and a firearm has been recovered. They are searching for two other suspects, both described as black males, approximately 6-feet tall, wearing dark hoodies. They were last seen fleeing the area northbound on Victoria Park Avenue in a white SUV.

‘What do we do with the kids?’ Experts say child care needed in reopening plans

STEPHANIE TAYLOR, THE CANADIAN PRESS | posted Thursday, Apr 30th, 2020

Kelly Knowles has many questions about returning to work, including where her son would go.

The Regina hairstylist contacted his daycare after the Saskatchewan government announced last week that some businesses such as salons, shut down because of COVID-19, could reopen in mid-May.

She was told there is space for her 2-1/2-year old, but the centre is only caring for kids of essential workers. And with her partner still working, there isn’t anyone else at home to help, she said.

“If I did go back to work, we do need that extra care,” Knowles told The Canadian Press.

“I can’t open up my schedule and start accepting my guests to come in if I don’t have a daycare for my son.”

Questions about child care and schools are being raised as various provinces outline their plans to relax public health restrictions so that some services and businesses can reopen and residents can go back to work.

“For families with kids, they can’t participate in that if they don’t have child care,” says Jennifer Robson, associate professor in political management at Carleton University in Ottawa.

Each province is dealing with the issue differently. In Saskatchewan, there is no timeline for expanding the current capacity in child-care facilities. Premier Scott Moe has said students are unlikely to return to classes this school year.

Manitoba plans to keep schools closed, but intends to allow day camps with a maximum of 16 kids per site.

Schools and daycares in Quebec are to reopen May 11 outside greater Montreal, but high schools are to stay closed until September. In Ontario, publicly funded schools are to stay closed until at least the end of May.

The inability to provide hard timelines is understandable, Robson says, since those decisions are driven by medical evidence.

She says households with parents who can resume work will be figuring out what makes economic sense. And without child care or schools, someone has to stay home with the kids.

“Gender roles being what they are and gender-related pay gaps being what they are, odds are good that most families are going to elect to have Mom end up staying home with the kids.”

Lindsay Tedds, professor of economics at the University of Calgary, says women have already borne the brunt of the pandemic and, without child-care options, that could be exacerbated.

Citing a Statistics Canada labour force survey from March, Tedds says women were the hardest hit by job losses and a lot of the impact was felt in female-dominated sectors such as hospitality and tourism.

“Women had to leave their jobs even before the big shutdown started simply because the schools shut down.”

In a statement, the president and CEO of the Business Council of Canada, acknowledges that restarting the economy will be tough for working parents if schools and daycares stay closed during the initial phases. Goldy Hyder encourages employers to be flexible.

Dan Kelly, head of the Canadian Federation of Independent Business, says some employers may not be able to find workers who can pull away from their families. But he feels it’s better to move ahead with an imperfect plan than to keep the economy frozen.

While some parents can work from home, those who work in bars, restaurants and sectors such as the airline industry cannot, Tedds notes.

She and Robson say household incomes will continue to take a hit if both parents can’t get back to work. Gains made over the last few decades have been in large part thanks to women entering the labour force.

They also say time away from work may mean not getting promotions or building up work hours associated with career advancement. As well, staying home means not paying into a pension plan or employment insurance, including maternity and paternity leave.

“If we’re … expected to go back to work and nobody has thought about what we do with the kids, we have a huge problem,” said Tedds.

The CEO of the Canadian Women’s Foundation says it’s time governments examine how child-care centres are funded. Right now, without receiving fees from parents, they could close.

Paulette Senior says Ottawa has a critical role to play.

“This government is committed to gender equality and gender equality is an essential rung to the economy.”

Maryam Monsef, federal minister for women and gender equality, says in a statement that the pandemic has shown long-term solutions are needed in child care — and provinces need to collaborate.

“It is clear that the steps that all orders of government take in the next days and weeks as we contemplate slowly reopening our economy will require a vision for child care.

“We can’t resume without it.”

Parliamentary budget officer weighs costliest federal emergency aid programs

THE CANADIAN PRESS | posted Thursday, Apr 30th, 2020

Canadians will get an update Thursday on two of the costliest emergency aid programs the federal government has initiated to help them weather the coronavirus crisis.

The parliamentary budget officer is scheduled to post a costing note on the 75 per cent wage subsidy — a program the government expects to cost $73 billion and which it has called the largest economic policy in Canada since the Second World War.

Yves Giroux is also expected to post a costing note on the Canada Emergency Response Benefit, which is providing $2,000 a month for four months to Canadians forced out of work due to the pandemic.

The government has estimated the cost of that program at $35 billion, but has expanded the eligibility criteria several times to add those initially left out, including workers earning up to $1,000 per month, seasonal workers and those who have exhausted their regular employment insurance benefits.

In total, the federal government has so far poured $145 billion into emergency aid and Prime Minister Justin Trudeau has promised more to come, including for seniors.

He is not expected to announce any new funding Thursday, however. His daily briefing on the pandemic is likely to be overtaken by questions about another tragedy — the crash of a Royal Canadian Air Force’s Cyclone helicopter into the Mediterranean Sea late Wednesday.

The Cyclone was participating in a NATO exercise off the coast of Greece when the crash occurred, the Canadian Armed Forces has said.

The military said a search and rescue operation was under way and declined all other comment.

However, Greek state broadcaster ERT said one body had been found and five others on board were missing.

While Trudeau will likely be preoccupied with that bad news, MPs on six House of Commons committees will be delving into various aspects of the federal response to the pandemic.

Industry Minister Navdeep Bains — who is spearheading the drive to mobilize Canadian researchers and scientists in the campaign to develop tests, treatments and ultimately a vaccine to protect against the novel coronavirus — is to testify at the industry committee.

And Social Development Minister Ahmed Hussen, who is responsible for measures aimed at helping children, seniors and the homeless through the pandemic, is to testify at the human resources committee.

That committee is also scheduled to hear from the head of the Canada Mortgage and Housing Corp. The CMHC is administering the federal government’s new program to relieve eligible small businesses of 75 per cent of their rent payments due in April, May and June.

Meanwhile, the procedure and House affairs committee is scheduled to hear how legislatures in Wales, Scotland and the United Kingdom are handling the move to virtual sittings as politicians, like everyone else, try to keep physical distance from one another to prevent the spread of COVID-19.

Canada’s MPs held their first virtual gathering on Tuesday, which was deemed generally successful despite numerous glitches in using unaccustomed video-conferencing technology.

Toronto City Council to meet online Thursday due to coronavirus restrictions

THE CANADIAN PRESS | posted Thursday, Apr 30th, 2020

Toronto City Council will hold a special meeting online Thursday due to restrictions on public gatherings during the coronavirus pandemic.

City councillors will use an online video conferencing platform while the public can watch a livestream of the meeting.

It’s the first time councillors of Canada’s most populous city will meet virtually.

Mayor John Tory’s report on the COVID-19 emergency response is on the agenda, which has already been posted online.

 

3 staff test positive for coronavirus at city daycare centre

BT Toronto | posted Wednesday, Apr 29th, 2020

Three staff members at a city-run child care centre have tested positive for the coronavirus.

The city said Tuesday night the three people work at the Jesse Ketchum Early Learning and Child Care Centre at 7 Berryman Road in the Davenport Road and Bay Street area.

Two other staff members and two children are also awaiting test results, the city said in a news release.

“The city continues to reach out to notify the families who have children attending the child care centre. Staff and the 58 children who attended the child care centre from April 21 to April 28 will be asked to remain at home for two weeks from their last day at the child care centre and will be excluded from all Toronto emergency child care centres as a precautionary measure for this same period,” the city said.

The facility has suspended child-care services for 14 days to allow crews to clean and disinfect the building.

The Jesse Ketchum site is one of seven emergency child care centres that were kept open to care for the children of essential services workers.

The city’s other remaining emergency child-care centres will remain open. A list is available here.

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