'So real:' COVID-19 driving up hospitalizations; Saskatchewan's ICUs nearly full
REGINA — The Saskatchewan Health Authority says a fivefold increase of COVID-19 patients in ICUs in the last 30 days means nearly 100 per cent of intensive care beds provincewide are full.
It says Saskatoon is under particular pressure. There were 35 COVID-19 patients in regular hospital beds in the city Thursday, but only a handful of intensive care spots available if their conditions worsened.
Saskatoon has around 23 ICU beds and as of that afternoon, health officials reported 10 COVID-19 patients in the city receiving intensive care.
The health authority had already been diverting intensive care patients from outside the city to other ICUs in the province, as there are more than 90 of these beds across Saskatchewan.
"What it looks like, what it feels like is something I've never seen before," said Dr. Susan Shaw, whose worked as a critical care physician for two decades and is chief medical officer with the health authority.
"This is a sustained increase in very sick people for the longest period of time that I think we've ever seen and we know it's going to continue for the weeks to come."
In a briefing Thursday, officials outlined what plans were in place to add more hospital beds and the ways resources could be diverted from providing everyday health-care services to care for those most in need.
"But that comes with a cost," said health authority CEO Scott Livingstone.
"If it comes to that point where we're talking about completely being overwhelmed those are wartime conditions … that's what the risk is with not containing the virus."
Livingstone repeated the request for people to stop socializing to slow the spread of the virus, saying contact tracing is becomingly increasingly strained because those testing positive have too many close contacts.
Officials say every positive case means hours of work for contact tracers and some investigations found a single person had around 150 contacts. In some cases those with large contact lists had gone to multiple social events while symptomatic.
"I can tell you it's so frustrating when I get emails, I get letters, I get phone calls, I get texts, I get tweets by people saying, 'this isn't real, you're exaggerating, it's not really happening, why (are) you doing this to us," Shaw said.
"I just have to say it is so real."
The province reported 299 new cases of COVID-19 on Thursday. There were 108 people in hospital, 18 of them in intensive care.
Three more people, who were 70 or older, died from the infection, bringing the provincial death toll to 40.
One of the outbreaks in Saskatoon is at a provincial jail, where 68 offenders and four staff were reported on Thursday to be infected with the novel coronavirus for a total of 85 active cases.
The province said incoming inmates who are on remand or those in sentenced custody will be sent to correctional centres in Regina and Prince Albert. It said anyone sent to a jail in the province will now be tested for COVID-10 on top having to be quarantined for 14 days.
The province recently made it mandatory for offenders to wear masks, which has been the case for staff since the summer.
Stephanie Taylor, The Canadian Press
TORONTO — Pediatric and mental health experts say pandemic stress is driving a spike in eating disorders among adolescents and teens, pointing to school disruptions, social isolation and infection fears as destabilizing factors that could have long-term physical and mental health effects. Doctors at Toronto's Hospital for Sick Children, Ottawa's pediatric hospital and research centre CHEO and the Alberta Children's Hospital in Calgary are among those noting a significant jump in admissions and demand for outpatient treatment. Dr. Ellie Vyver of the Alberta Children's Hospital says admissions more than doubled at her hospital between July and September last year and continue to rise. Colleagues across the country are reporting similar signs of despair. "What we have been seeing in Alberta and at SickKids is not unique. It's happening in B.C., it's happening in other centres in Ontario outside of SickKids, it's happening in Montreal. It's something that's happening across across the country," says Vyver, who said the illness tends to have the highest prevalence around ages 15 to 19. At the same time, children who struggle are displaying more severe mental and physical problems, adds the director of CHEO's mental health program, who says his eastern Ontario hospital can only treat the "tip of the iceberg." "The supply and demand is so off-kilter right now that it is overwhelming the system," says David Murphy. The cutoff for admission to CHEO is a heart rate below 45 beats per minute. CHEO says there were 67 admissions between April 1 and Oct. 31 last year – a 63 per cent jump from the same period in 2019. Christina Bartha of the SickKids Centre for Community Mental Health points to increased isolation, school disruption, social media exposure and stress as fuelling unhealthy eating and exercise habits. Compared to last year, Bartha says yearly admissions at her Toronto hospital are expected to jump as much as 30 per cent to 170 (from 128), while the number of referred outpatients is heading towards a 50 to 60 per cent increase with 245 cases (versus last year's 154). The cases primarily involve restrictive eating, including anorexia nervosa and avoidant/restrictive food intake disorder, which is similar to anorexia but does not involve stress over body shape or size. Dr. Debra Katzman, senior associate scientist at SickKids and co-founder of its eating disorders program, also says children are in more acute physical and mental distress than past cases. That could be because of delayed assessments if some families feared contracting COVID-19 by visiting a hospital early in the pandemic, she says. Meanwhile, virtual care has made it more difficult for some recovering patients to maintain health goals. "We're seeing kids who are at significantly low weights, are extremely malnourished and have all kinds of medical and psychiatric comorbid complications," says Katzman. Although SickKids is still collecting and analyzing its data, she and Bartha expressed little doubt that pandemic-fuelled turmoil has played a key role in driving up youth anxiety. "These young people are so used to having a routine that they engage in every day – waking up, going to school, coming home, et cetera – and now they have no routine. And they're quite disconnected from their peers. That's a huge thing, especially during adolescence," says Katzman. "(And) they're not with their teachers or their coaches who are able to identify these very life-threatening disorders quite early." Sterling Renzoni of Orangeville, Ont., believes social media, isolation and disrupted care were key factors in a "mini-relapse" he says he experienced during the lockdown last spring. The 18-year-old says he was discharged early from a southern Ontario residential treatment program for anorexia in the early days of the pandemic. No longer forced to follow a strict daily routine, under less supervision and unable to see his friends, Renzoni says he began fixating on exercise. "It was challenging to figure out how I was going to keep myself busy," admits Renzoni, who says he stopped obsessing with the help of virtual care and by redirecting focus to his long-term goal of attending university in the fall. "I had more time to just be on social media (and) it was still filled with a lot of unhelpful accounts, unhelpful information and unhelpful people that I was following... but I realized that after already having a mini-relapse." Now a Trent University freshman, Renzoni says if it hadn't been for the pandemic, he likely would have stayed in residential care for three months instead of one, and would have been more physically and mentally able to withstand pandemic restrictions when discharged. Aryel Maharaj, outreach and education co-ordinator with the National Eating Disorder Information Centre, says social media has played a large role in driving fat-phobic messages around the so-called "Quarantine 19" in recent months, while repeated lockdowns ignited grocery sprees and encouraged food hoarding. These all make it difficult for anyone struggling with food issues, he said. "It just makes it a lot harder if food is your primary means of coping and now you're surrounded by it and you're stressed out," says Maharaj. Maharaj says NEDIC's anonymous helpline has seen a 43 per cent overall increase in calls, and more than double the number of calls from those aged 11 to 19. The head of the Adolescent Medicine Program at the Janeway Children's Health and Rehabilitation Centre in St. John's, N.L., says admissions are up there, too. Dr. Anna Dominic says the wait-list for assessments of medically stable patients is now seven months, when it's typically two to three months. Over at CHEO, Murphy says the hospital would not turn away anyone approaching its 45 bpm threshold, but he says the very fact they require such a stark cutoff – introduced before the pandemic – speaks to how dire the situation is. Demand is so high, CHEO also denies 73 per cent of referrals — up from 49 per cent from the year before. Murphy admits that means many very sick and starving youngsters are forced to look elsewhere for help, and risk deteriorating further while seeking care. He knows of at least two community-based services with 18-month wait-lists. Maharaj says eating disorders thrive in isolation and so it's important for struggling youngsters to know they are not alone and can turn to a growing number of remote resources. He says hospitals, community groups, therapists, dietitians and others have embraced online options to reach more people. "It's so easy to fall into this pit of despair, of hopelessness, if you think that it's never going to change and there's nothing out there for you," says Maharaj. "There are virtual ways that we can try to connect and provide some kind of support so you're not just sitting there spiralling on your own." Murphy says the issue has always been under-resourced, and the pandemic has highlighted that problem. "When we talk about mental health, we think of depression, suicide, schizophrenia. It's all of those acute mental illnesses, but then there's this thing called eating disorders," he says. "And the eating disorder population requires a specific level of training and expertise to be able to deal with, and we just simply do not have the capacity, the resources and the training to be able to deal with it as a community at large." This report by The Canadian Press was first published Jan. 20, 2021. Cassandra Szklarski, The Canadian Press
JAKARTA, Indonesia — Indonesia's leader on Wednesday assured relatives of 62 people killed in a Sriwijaya Air plane crash that they will be compensated. President Joko Widodo visited the command centre at Jakarta's international container terminal where tons of plane debris hauled by divers from seafloor were collected for an investigation into what caused the Boeing 737-500 to nosedive into the Java Sea shortly after takeoff from Jakarta on Jan. 9. He also witnessed the first three relatives of the victims receiving money from the compensation fund. Sriwijaya Air offered relatives an insurance payout of 1.25 billion rupiah ($89,100), in line with the Indonesian law that stipulates compensation must be offered within 60 days of a crash. In addition, state-owned insurance company Jasa Raharja has provided 50 million rupiah ($3,560) to each family of the victims. "I assure you that all compensation will be completed immediately for all victims," Widodo said. A search is still ongoing for the crucial memory unit of the cockpit voice recorder. The device apparently broke loose from its exterior and officials have said the underwater locator beacons attached to both crash-proof black boxes became dislodged due to the impact. The flight data recorded was recovered three days after the crash. The 26-year-old Boeing had been out of service for almost nine months last year because of flight cutbacks caused by the pandemic. Indonesia's aviation industry grew quickly after the nation's economy was opened following the fall of dictator Suharto in the late 1990s. Safety concerns led the United States and the European Union to ban Indonesian carriers for years, but the bans have since been lifted due to better compliance with international aviation standards. ____ Associated Press writer Niniek Karmini in Jakarta, Indonesia, contributed to this report. Fadlan Syam, The Associated Press
2,000 Holland College students return to in-class learning
As of the third week of January, Holland College has brought most of its students back on campus, with some seeing it for the first time. The college got approval from P.E.I.'s Chief Public Health Office to bring students back after having to move many students to online learning because of COVID-19. "We're extremely excited, and it feels good to have the students back. They're learning in the method that we want them to learn in," said Michael Dimitroff, manager of recruitment and first-year advising at Holland College. "Our education is very hands-on and we couldn't go much longer with the online format, so we had to make the move," he said. "Online can only go so far." 'The class looks awesome' Logan MacKenzie, a culinary arts student, said it feels great to be on campus for the first time. "It's amazing to be here in person. The class looks awesome," said MacKenzie. MacKenzie is from Halifax and had to isolate before beginning in-person classes. He said the online learning "wasn't bad" but he prefers the in-class experience. "Been waiting a very long time for this," he said. "I'm like a kid on Christmas." He said most of his classes will be in a kitchen setting, and his group of eight must wear masks at all times. He said when he thinks about what's happening in many parts of Canada, he's grateful. "We're very fortunate that we're able to get out," he said. More productive in person Shumbusho Armel Gispain came from Rwanda to attend the business administration program. He also isolated before attending classes. "I think it will be pretty productive, now that we get to see people in person," he said. "We're really glad to be here." He said it's nice to be able to ask questions to instructors in person. "You can ask them questions, more than in an online setting. It's really hard — you're really kind of reserved," he said. "I'm getting to make new friends, a lot of great experiences so far." He said P.E.I. is handling COVID-19 really well. Gym and performance hall in use Holland College says it's following public health guidelines for social distancing and classes of 30 are using the gym or a large performance hall so students can be well spaced out. But many groups are much smaller. Dimitroff said the number of students on campus will also be much lower than a normal year, with certain programs only coming certain days. "They're likely not here every single day of the week," he said. Although some students have been following a blended format all along, he said almost half of the college programs started online last semester. "So far, so good," said Dimitroff. Holland College hopes to keep students on campus until the school year ends this spring. "Ideally we can get back to a closer normal in September," he said. More from CBC P.E.I.
Flu season has been stopped in its tracks this winter
This time of year would normally be the height of flu season in Nova Scotia, but so far there have been no reported cases in the province. Health Department spokesperson Marla MacInnis confirmed the absence of influenza cases to CBC News and said there were 442 cases last season. Nova Scotia's experience is reflected in national influenza figures. A Jan. 15 report from Public Health Agency of Canada said there haven't been enough influenza cases to even declare the start of the 2020-2021 season in Canada. MacInnis said in an email that public health protocols to minimize the spread of COVID-19 have had a similar effect on influenza in the province. "Masking, physical distancing and good hand hygiene are all measures that can not only reduce the risk of transmission of COVID-19, but other viruses such as influenza," she said. Statistics for the past six years show that by this time of year there would normally be an average of 14,811 influenza detections reported in Canada. So far this season there have been just 51 influenza cases reported. Twenty-seven of the 51 influenza detections reported to date this season are connected to people who received an attenuated influenza vaccine and do not represent community circulation of the flu virus. The agency's Flu Watch report for Jan. 3-9 said the percentage of positive tests for influenza in Week 1 of 2021 was 0 per cent, compared to 23.4 per cent during the past six seasons. There have been no laboratory confirmed outbreaks in Canada this season. The low circulation of the seasonal flu has meant that the National Microbiology Laboratory has been unable to test for influenza strain characterizations or antiviral resistance. MacInnis said the province ordered more doses of the flu vaccine this year than we ever before, but said many providers ran low because of demand. She said the province secured more influenza vaccine in December and has distributed these additional doses to providers. MacInnis said if someone still wants the vaccine and it is not available at their usual provider they may need to call around. Some experts predicted flu cases would tumble in the Northern Hemisphere based on Australia's experience with plummeting flu figures after it introduced COVID-19 measures. Australia's flu season coincides with Canada's summer. In October, Dr. Robert Strang, Nova Scotia's chief medical officer of health, said it's possible to avoid a flu season. "We would expect and hope that as long as we all stick with the COVID protocols it'll have a significant positive impact on influenza as well," he said. "But that doesn't diminish the importance at all of having as many Nova Scotians as possible add another layer and the best way to protect influenza and that is getting a flu vaccine." In a normal year, the Public Health Agency of Canada said influenza causes 12,200 hospitalizations and 3,500 deaths in the country. MORE TOP STORIES
Irving Oil criticizes N.B.'s stale petroleum margins, despite role in causing them
Irving Oil Ltd. is blaming petroleum price regulation in New Brunswick for failing to keep up with industry costs and pushing it to request "urgent" price increases, even though it twice refused requests from the Energy and Utilities Board to help improve wholesale margins. In written evidence submitted to the board earlier this month, Irving Oil marketing president Darren Gillis said that regulated markets "have become disconnected from non-regulated markets over time and do not provide for adequate recovery of costs." That has "eroded industry's ability to continue to supply regulated markets and remain competitive across our regions," Gillis said. Irving Oil applied on Jan. 5 to increase the margins wholesalers can earn on gasoline, diesel and furnace oil sales by 4.13 cents per litre, including an "immediate" increase of 3.5 cents. This week, it revised that request downward to 4.09 cents for gasoline and diesel and 3.02 cents for furnace oil. If that request is granted, that will increase the cost to consumers by a total of $60 million more per year. Irving Oil, others declined to help EUB update margins In evidence submitted with the application, Gillis said the last increase in wholesale margins was awarded by the Energy and Utilities Board (EUB) in 2013, based on 2011 cost data. Since then, he said, industry expenses have escalated significantly without matching increases in revenue. Irving Oil's claim that petroleum regulation has caused wholesaling margins in New Brunswick to grow stale comes after two major Energy and Utility Board attempts to keep them current were thwarted by a number of companies, including Irving Oil. In 2016, three years after the last margin adjustment, the board wrote to every New Brunswick petroleum wholesaler asking for help to update margins to cover changing costs. "It is important to remember that the Board can only change the margins if it has sufficient evidence to support such adjustments," it noted in asking for the companies' cooperation, and the review had to be abandoned. But four months later, the consultant the board hired to conduct the analysis, Gardner Pinfold of Halifax, reported back that no companies would cooperate with it. Review abandoned in 2019 after second attempt "Gardner Pinfold sent a letter to each petroleum wholesaler on December 15, 2016 to invite companies to participate in the review," it told the Energy and Utilities Board at the time. "No wholesaler expressed an interest in participating in the review and none provided data. Due to a lack of data, Gardner Pinfold is unable to provide a recommendation to change the current wholesale margin." The board tried again in 2019. Petroleum wholesalers again declined to provide any information to Gardner Pinfold about the adequacy of margins, prompting comment from then Energy and Utilities Board chair Raymond Gorman. "I would point out that this technically is a review of the wholesale margin, but Mr. Gardner didn't get any evidence," Gorman said during hearings in September 2019. "Nobody filed any evidence, so again we are in that situation where we have no data in order -- you know, to be able to deal with it." Following the hearing in November 2019, the board announced it could not increase margins for New Brunswick petroleum wholesalers because none of them would provide information, even in confidence. The board noted that a consultant "made initial and follow-up requests to wholesalers" to provide data on certain specified costs, including maritime freight, working capital, receivables, and terminal costs. "No data was submitted by the wholesalers. In the absence of sufficient evidence of changes to those factors, or other factors, an adjustment to the maximum wholesale margin for motor fuels cannot be justified," the board wrote, concluding the matter and taking no action. Irving Oil did not respond to a request for an interview about why it did not ask for margin increases in 2017 or 2019, when the board was asking for its help to reset them. But the company is pointing to margins not increasing in those years, combined with sudden demand reductions caused by the COVID-19 pandemic, as evidence regulation is not working. "Petroleum pricing regulations in New Brunswick were created 15 years ago. They did not contemplate the challenges of the last several years and were not designed to react to a global pandemic," said Gillis. "Unregulated markets, however, respond as required to ensure supply at reasonable cost recovery levels. This is not the case in regulated markets."