When The Experts Get It Wrong

People wait in line to receive their COVID-19 vaccination at a clinic in the Fraser Health region of Surrey, B.C., on Wednesday. New early data suggests that Canada’s recommendation to delay the second dose of COVID-19 vaccines for up to four months may not be effective in some older, more vulnerable people. (Ben Nelms/CBC)

"People who want their second shot are now in limbo. Some don't know when their next shot is coming, some [are] told four months. They don't know if they have sufficient protection or if they have to wait, or whether the second shot will work."

"They signed a consent, which included a vaccine information sheet that says in several places, three weeks for the second Pfizer shot and 28 days for Moderna. [This could be a problem for governments resulting from the legal principle of] detrimental reliance [where one party can force another to abide by its obligations under a contract]."

Toronto lawyer Ian Cooper

"Pfizer could be held legally liable for a death caused by an extension of the time between vaccine doses. I doubt that would ever happen."

"I think it highly likely that Pfizer has been given some 'undertaking' by the Canadian federal government that will hold them harmless. Pfizer would have been legally wise to require that to be in place."

David McCarthy, founder, pharmaceutical industry consulting company

 

"The dosage of the Pfizer vaccine for the second dose is in three weeks, perhaps at the most in four weeks, in order to be effective -- 95 percent, based on clinical studies."

"The delay by our government to postpone the second dose by an extra three months, to July, is irresponsible and dangerous."

"The prime minister should advance the administration of the second dose, from July to April or May."

Leslie Dan, founder of Novopharm Pharmaceuticals

Canada became the sole country in the world earlier this month to mandate a gap of four months between doses of the Pfizer and Moderna vaccines. The country is in a position of severe vaccine shortage. Mostly resulting from the federal government's delay in ordering vaccines from trustworthy pharmaceutical sources. Prime Minister Justin Trudeau had directed his officials and federal health agencies to work in tandem with a Chinese pharmaceutical company, CanSino Pharmaceuticals which had a link to Canada since its founder was educated and worked for a Canadian pharmaceutical company before returning to China.

 

The National Research Council allowed CanSino unrestricted use of its biopharmaceutical platform on which to base its vaccine. The arranged contract, however, fell through when Beijing refused to permit the vaccine to be shipped to Canada where it was to undergo third trials and production. In the face of the reality of resulting late-order vaccine shortages from Western-oriented reliable sources, the National Advisory Committee on Immunization that had been appointed by the government, decided to stretch available resources by delaying second dosages in favour of vaccinating more people with a first dose.

This decision was undertaken on the theory that while the completed vaccine regimen of two doses reduces risk of infection by over 95 percent, data indicated the first shot on its own can reduce a patient's risk of contracting COVID-19 by a still-impressive 80 percent, ensuring a good level of protection from the virus despite failing to adhere to the 21-day recommended schedule. "Extending the interval between doses was shown to be a good strategy through modelling, even in scenarios considering a six-month interval and in theoretical scenarios where waning protection was considered", the Committee wrote.

Guido Armellin, 86, receives the COVID-19 vaccine during a clinic at a church in Toronto on March 17. A team was on-site administering the Pfizer-BioNTech vaccine to parishioners as part of a community outreach program to get seniors vaccinated at their place of worship. (Evan Mitsui/CBC)

 

Data exists, however, indicating that a delayed second dose can present a disproportionately risky threat to the elderly, most vulnerable to COVID-19. Britain's Public Health Agency shows COVID-19 vaccines not to be as efficaciously potent in elderly populations. First shots for the elderly shown to provide 57 percent protection over the age of 80 in Britain, where 85 percent protection was achieved only when the second dose was administered. 

Members appointed to Canada's National Advisory Committee on Immunization were found to be composed largely of pediatric specialists. "The overwhelming majority of deaths among COVID-19 victims have been elderly, and their interests and unique health and immunological considerations do not appear to be adequately represented on the NACI Working Group", wrote Toronto lawyer Ian Cooper, representing two retired elderly physicians threatening to take Canadian pandemic authorities to court over the decision to delay the second dose of Pfizer, the vaccine they also recommended for use in the elderly.

A notice of claim drafted by Ian Cooper representing the two retired elderly physicians, aged 79 and 83 who have expressed their opposition at having to wait a pharmaceutical-unauthorized protracted length of time for full vaccine coverage was forwarded to the Public Health Agency of Canada, the National Advisory Committee on Immunization and the federal and Ontario ministers of health. "The province broke the promise that was made both in writing and orally at the vaccination site", the draft notice of claim reads; conceivably prior to lodging a legal suit on behalf of the complainants insisting on being vaccinated in a "timely" fashion.

To further emphasize the inadequacy of the policy stretching out those unfortunately scarce vaccine resources, the head of the University of Ottawa Heart Institute has made an urgent appeal for all patients in treatment at the Institute and all patient-facing health workers to receive second doses of vaccine without further delay. Although those involved have received their first dose, in the interval between the first and the second both patients and health-care workers have contracted the novel coronavirus. "I am very worried for the staff" said Dr.Thierry Mesana, president and chief executive of the Heart Institute, at the very time that more transmissible variants are on the rise.

 

"Health Canada has the statutory mandate to authorize drugs for sale in Canada, and only it can authorize changes to the time interval between injections, and then only after the sponsor's submission of new data to support such a change."

"Direct questions need to be asked to Dr. Supriya Sharma, chief medical adviser to the deputy minister and senior medical adviser, health products and food branch -- and specific answers are required."

"Our politicians have played very loose with defined legal requirements, lied to Canadians and jeopardized our lives."

Conservative Member of Parliament Michelle Rempel-Garner

"I’m not aware of data showing that there is efficacy beyond two months of the first dose."

"In the past few weeks, we’ve seen different studies come out showing that the response to the first dose of the vaccine in the people who are elderly, in the people who are immuno-compromised is actually not that good and it wanes quite rapidly."

"[Both Health Canada and the NACI will also have access to the updated findings, meaning a new recommendation could be on the way]. I’m sure they’re following this and they may well be looking at perhaps modulating the recommendation as we go."

"As data emerges about what it takes to protect [seniors and immune-compromised people], we need to be reviewing what we’re doing."

"[As long as there aren’t issues with the vaccine supply, reverting to the original recommendations from the pharmaceutical companies] would be the ideal approach."

"The very people we want to protect the most require that we give them the second dose using the shorter interval, originally as done by the manufacturer in the clinical trials. The one-size-fits-all approach really needs to be modulated in terms of who we need to be protecting."

Canada’s chief science adviser Dr. Mona Nemer

AstraZeneca in Real Time

 "NACI [Canada's National Advisory Committee on Immunization] has determined that there is substantial uncertainty about the benefit of providing AstraZeneca COVID-19 vaccine to adults under 55 years of age, given the potential risks associated with it."

"As a precautionary measure, while Health Canada carries out an updated benefit-risk analysis based on emerging data, NACI recommends that the vaccine not be used in adults under the age of 55 years."

Dr.Shelley Deeks, vice-chair, National Advisory Committee on Immunization, Canada

"The [European Medicine Agency] still considers this product to be safe and effective, but the possibility of a link between the vaccine and clotting issues ... cannot be completely ruled out at this time."

Quebec Department of Health

An Iraqi nurse holds a vial of the AstraZeneca COVID-19 vaccine before starting the vaccination at a clinic in Baghdad, Iraq, Tuesday, March 2, 2021. (AP/Photo/Hadi Mizban)

 

Symptoms of potential serious side effects that may reveal the presence of blood clots are shortness of breath, chest pain, leg swelling, persistent abdominal pain, sudden onset of severe or persistent headache or blurred vision and skin bruising elsewhere than the site of vaccination, developing between four to 20 days following vaccination.

New data originating out of Europe suggesting the risk of blood clots now stands as potentially elevated as one in 100,000 representing a figure of risk substantially higher than the one in one million risk believed to exist in an earlier assessment of the AstraZeneca-Oxford vaccine has moved Canada's National Advisory Committee on Immunization to advise Canadian provinces to suspend their use of the COVID-19 vaccine produced by AstaZeneca.

AstraZeneca was asked by Health Canada on Monday to proceed with a detailed study on risks and benefits of its COVID-19 vaccine across multiple age groups even as the advisory committee recommended use of the shot be suspended until such time as an appropriate review has been achieved and its results studied. Most patients in Europe who developed a rare blood clot following vaccination with the AstroZeneca vaccine were women under age 55. They saw a fatality rate of 40 percent.

A change in advice has renewed apprehension around the AstraZeneca vaccine, which has been compounded by contradictory messages in Ontario. There’s also concern the confusion will add to vaccine hesitancy.

 

There have been no reports of blood clots occurring in Canada with the use of the AstraZeneca vaccine leading Health Canada's chief medical adviser, Dr.Supriya Sharma to declare she retains belief in the vaccine's benefits to outweigh any risks that may be inherent to its use. Health Canada changed the vaccine label to warn of the rare risk of blood clots developing with its use. 

 

Provincial governments take their own initiative on how a vaccine may be used. However, Dr.Howard Njoo, deputy chief medical officer of  health in Canada, revealed that all provinces and territories had reached agreement to suspend the vaccine's use for people under 55, while awaiting the results of further study.

Quebec, Manitoba, Newfoundland and Labrador and Prince Edward Island have announced their intention to limit the use of the vaccine. Taking a precautionary measure, Quebec's Health Department affirmed pausing the vaccine's use for its under-55 population, acknowledging the necessity of ruling out any possibility of a link to the development of blood clots with AstraZeneca.

Some adverse symptoms in younger people were noticed in the United Kingdom according to the medical lead of the province of Manitoba. "This is a pause while we wait for more information", explained Dr.Joss Reimer. Newfoundland and Labrador along with Prince Edward Island agreed they were pausing use of the vaccine for younger age groups as they wait for the new data expected to result from greater scrutiny in varied age groups being tested with the vaccine.

 

A medical worker receives a dose of the AstraZeneca vaccine in Taipei, Taiwan, on Monday. (Ann Wang/Reuters)

After AstraZemeca's vaccine was approved by Health Canada for all age groups, NACI observed enough seniors were not included in clinical trails to gain confidence on how the vaccine would perform on people over age 65. NACI then retracted that advice, claiming that new real-world evidence from the U.K. showed the vaccine was very effective in performance, used on seniors.  

"What we need to have is continued confidence in our expert review panel that it's looking at these vaccines and deciding what is going to be best, safest and most effective for Canadians."

"This is a new vaccine to a new virus, it's really important that we're following all the data as closely as possible and as the vaccines are rolling out, we're understanding them more and reviewing what the guidance should be."

Alyson Kelvin, virologist, Canadian Center for Vaccinology, Halifax.

The National Advisory Committee on Immunization (NACI) updated its guidelines against the use of the vaccine for younger Canadians on Monday. (Dado Ruvic/Reuters)

Russia's Taiga, Worth Its Weight In Carbon Offsets

"Russia has twenty percent of global forests, so the international community must be fair in that respect."

"We have the potential to turn them into a massive carbon capture hub."

Alexey Chekunkov, minister for the development of the Russian Far East and Arctic

 

"The lion’s share of Russia’s plan to cut emissions should be renewable energy, new technology and energy efficiency."

"Additionally, and with very strict criteria, would come forestry development."

Alexey Kokorin, director, climate and energy program, World Wide Fund for Nature (WWF) Russia

 

"We will need to demonstrate to the international community that calculation of CO₂ absorption in our offset projects is precise, reliable and not a single unit is miscalculated,."

"One mistake, let alone an intentional falsification, and the credibility of our projects may be lost."

Anna Romanovskaya, director, Moscow-based Yu A Izrael Institute of Global Climate and Ecology

Russian President Vladimir Putin and defence minister Sergei Shoigu on holiday in the Siberian taiga, Russia, March 21 2021. Picture: KREMLIN VIA REUTERS/SPUTNIK/ALEXEI DRUZHININ

The world's largest country gographically boasts a truly vast and remote Far East left to the stewardship of bears, wolves and a species of tiger that call it home. But there are plans afoot cooked up in the Kremlin to make practical anti-pollution use of the immense tract of northern forest in a bid to find respectability in the great global battle against climate change by a country that has not to the present distinguished itself particularly through involvement, pledging in good faith to reduce its carbon footprint.

 

Enter Russia's taiga, an area close to twice the size of India. As the world's biggest energy exporter, one of the globe's largest polluters, Russia is looking to create an entirely different reputation for itself as a global site where carbon offsets can be had for the greater benefit of those countries and their companies seeking to counter their own carbon footprints in a bid for welcome into the greater consortium of nations who take the campaign against global warming seriously. 

 

To that purpose, Russia is in the process of creating a digital platform for the collection of satellite and drone data relating to the C02 absorption capacity of the forests of its vast northern regions. The goal is to transform the forests into a marketplace where companies may offset their carbon footprint in the hope that the plan will reflect well on Moscow ahead of talks later this year at the United Nations where Russia has argued it should be given some respect in climate discussions to reflect the sequestration potential of forests known to hold some 640 billion trees.

 

Up to the present, the taiga has been inadequately managed. Forest fires in the past two years have been unusually fierce reflecting the capacity of global warming to produce hotter and dryer summers. The proposed system would see companies leasing sections of forest from the government of Russia to allow for the planting of new trees and in the process protecting those already in situ. Should data confirm that the investment made by companies tends to improve C02 absorption, companies could then proceed in the creation of a carbon credit, traded on a digital platform.

West Siberian Taiga, oneearth

Scientists warn that to avoid catastrophic global warming, greenhouse gas emissions must be cut in half globally by this decade's end, and go on to reach zero emissions by the year 2050. Scientists tend not to be too enamoured of carbon offsetting as adding to the solution, but rather distracting from one. An environmental campaign group, Fern, based in Brussels and the United Kingdom, speaks of offseting as being akin to "moving deckchairs while the Titanic sinks". 

 

Not a message that Moscow particularly values, as the country with the weakest climate target of any of its peers in major world economies, particularly since, looking ahead to 2030, it anticipates a slight increase in emissions.

 

BC-Russia-Wants-to-Use-a-Forest-Bigger-Than-India-to-Offset-Carbon, Dina Khrennikova, Laura Millan Lombrana and Ilya Arkhipov

In The Face of COVID: Mental Health Resilience

"That's the kind of data we're getting across the board; that at a population level we're not seeing changes."

"In many ways, things are OK."

"[Humans are dealing with COVID better than anticipated]; overall there's a lot of resilience."

"All the evidence seems to be showing that there is not a tsunami of a mental health crises."

"[But] I think we need to be concerned about vulnerable groups."

Brett Thombs, medical researcher, McGill University 

 

The World Health Organization stated, while on the cusp of declaring COVID-19 a pandemic, that the disease would carry along a tide of loneliness and self-harm through its penetration of every facet of peoples' lives. Canadians were forewarned by the Canadian Mental Health Association of an "echo pandemic" expressed in acute anxiety and depression. With all this in mind, governments around the world began to take note of what lay ahead, funding crisis hotlines and online counselling programs.

Timely proaction in the prevention of suicides which rates as one of the most reliable indicators of mental health in society. But as the situation matured it began to look as though the fears of mental health breakdowns leading to increases in suicide just wasn't going to happen. Not only was there no upward-slanting change in the suicide rate, it began instead to decline to the pleased consternation of record-keepers and health advocates.

Australia, England, Norway all saw that suicide rates appeared to remain the same as they were before the onset of the deadliest times of the first wave. Dr.Thombs and an international group of scientists headed up a massive project in cataloguing and reviewing all of the world's mental health research on COVID-19, calling it a "living systematic review" with an aim to produce a generalized snapshot of the mental health of the world's 7.6 billion people under COVID-19.

The team carefully riffled through over 50,000 studies published globally to gauge everything from anxiety to depression to loneliness under pandemic conditions, rejecting slighter research defined as studies with small sample sizes or flawed data collection like voluntary web surveys, to sift through the total, rejecting research identified for its poor quality and potential bias. The remainder whose conclusions were felt to be trustworthy presents a picture of a world managing to cope fairly well despite the s stressors of COVID.

In the United Kingdom, population-level data expressed the finding that depression and anxiety briefly spiked with the lockdowns, then returned to normal "possibly because individuals adapted to circumstances", the researchers wrote. The global entry of COVID-19 caused suicide rates to plunge 15 percent, a huge survey of Norwegians found, with mental illnesses subsiding noticeably in the first weeks of lockdowns.

Rates of loneliness remained roughly the same, a nationwide survey of Americans discovered, "Despite some detrimental impact on vulnerable individuals, in the present sample, there was no large increase in loneliness but remarkable resilience in response to COVID-19", Florida State University researchers concluded. A cohort of students with pre-existing mental health concerns saw slight improvements to overall wel0-being at McGill University, examining mental health before and after the pandemic struck, representing one of the only major Canadian studies.

Calls to crisis hotlines had soared across the board since the beginning of COVID-19 lockdowns. Dr.Thombs noted that the hotline calls could represent an indication of increased psychological distress, but just as easily reflect more awareness, given funding to these hotlines under lockdown. Young Swiss men presented clear majorities reporting having difficulties coping with "abstaining from cultural events", or "not spending time with people privately". Still, they ranked overall depression and stress as average; clearly the effect of the pandemic failed to bump them into worse mental health.

An Italian study credited the "misery loves company" effect or "come together effect", an unexpected surge of well-being and good feelings in the face of a common enemy, with increasing well-being under lockdown. In that the greater the time Italians spent on social media looking at the pandemic problems of neighbours, the better in comparison they felt of their own situation.

Problems with mental health tensions did occur in a number of smaller demographics, however. Health-care workers, residents in long-term care homes, racialized communities, those with pre-existing mental illness, and youth severed from schools, activities and support services.

Getty Images

The Race for COVID-19 Death Prevention

"The results are encouraging, they definitely support moving forward into a larger randomized trial."

"This is a population that has extremely poor outcomes, so anything that can reduce the severity of the disease and improve survival and recovery is really, really important."

Dr.Duncan Stewart, CEO, The Ottawa Hospital Research Institute

"This idea here is that you're using a cell that is capable ... of reversing the damage caused by a huge activation of the immune system."

"In a way, you are bringing some order and direction to the immune system."

"You really are trying to tackle more than one thing at once [in] modulating [the immune system]."

Dr.Ines Colmegna, McGill University

Shutterstock

 

Medical science continues to struggle in coping with the worst manifestation of the COVID-19 pandemic, against a virus that adamantly refuses to surrender any of its weak points of entry to researchers to enable humanity to meet the destructive challenge of a pathogen threatening the globe. As yet, research has found no solution to a virus whose effects in some of its victims causes an out-of=control response from the body's immune system which tends to attack lungs, sapping peoples' capacity to breathe.

Even as some improvement in treatment has eventuated over the past year, up to 40 percent of COVID patients who end up in the intensive-care unit are destined never to emerge again, alive. New on the horizon is a belief within the research community in Canada and elsewhere that an unlikely source exists to alleviate the conundrum, one that happens to be a byproduct of childbirth. Where discarded umbilical cords, a rich source of mesenchymal stromal cells (a type of stem cell scientists hope may be able to reset that berserk immune system and tamp down damaging inflammation) may provide some answers.

In Canada two clinical trials are underway, with dozens more embarked upon in other countries, with an aim to test the idea on the most ill of COVID patients. Still to come are results of randomized, controlled tests of the cells' efficacy, yet there are encouraging early signs. A small number of observational studies without a placebo group for comparison, have produced hopeful results, including one recently published by an Iranian team of researchers.

 

A phase one safety trial of the cells on eleven patients has been completed at the Ottawa Hospital Research Institute, indicating that the treatment was well tolerated. Another research team at McGill University plans to test yet another MSC product derived from umbilical cord blood, produced by a Swedish company. 

COVID-19 has been described by some experts as being similar to two different diseases; the first with the virus itself triggering various symptoms which eventually tend to clear in most patients -- while the second occurs when the immune system becomes hyperactive, inciting massive inflammation while impacting the cells of the lung, strangling their ability to shift oxygen to the bloodstream. Which can result in acute respiratory distress syndrome (ARDS), the most dangerous of COVID-19 symptoms, leading to many patients placed on ventilators to fight for their lives.

Potential treatments of various types for the condition have been attempted, but none has proven successful. However, mesenchymal stromal cells (MSCs) having the capacity to transform into other types of cells, invited investigation as a method by which damaged or diseased tissues could conceivably regenerate. While the results turned out less than completely encouraging, they did appear proficient at "modulating" the immune system, readjusting it to fight off disease while stopping the immune system from turning against the body.

Those elementary cells also -- unlike single-molecule treatments -- have a unique ability to multi-task, targeting a number of factors causing damage. Prior to the appearance of the global pandemic a phase one trial with the use of MSCs to treat acute respiratory distress syndrome -- caused by septic shock --  had been undertaken by the Ottawa team. In October, a team of Chinese researchers reported on a study of 61 patients suffering from ARDS due to H7N9 flu. Where fewer of the 17  receiving stem cells died than those who wee not given the treatment.

Dr.Stewart believes his team's MSC product has an advantage over others since it is derived from fresh living cultures, and as a result is likelier to be more potent than others that have been frozen, then thawed. "Off-the-shelf" products, on the other hand, tend to provide more flexibility in emergency cases when speed is of the essence.

Weeping Blood/ Haemolacria

"Drops of blood were seen to be coming out from both the eyes [but] there was no injury to the eye."

"It was not accompanied by headache or giddiness ... There was no family history of such a condition."

"She lived happily with her family, according to her husband."

Researchers

Haemolacria is a condition characterised by the presence of blood in tears. The condition is also known as dacryohemorrhea, haemato-dacryorrhea and sanguineous lacrimation.1 It is one of the most alarming and rare conditions, which has been attributed to several etiologies. Due to its low incidence and limited literature, the prevalence and predilection of haemolacria for a specific gender, race or age remain obscure. Haemolacria was first mentioned in the scientific medical book, Aëtius of Amida, in the sixth century. A millennium later, in the 16th century, there was a nun who had auricular and ocular haemorrhages every month instead of menstruating, cited by Brassavola. Later in 1581, a 16-year-old girl was cited by Dondonaeus who had drops of bloody tears instead of menstrual discharge.1 Haemolacria is a benign and self-limiting condition. However, it has an association with severe systemic diseases like hereditary haemorrhagic telangiectasia or Osler-Weber-Rendu disease, Henoch-Schönlein purpura, Gardner-Diamond syndrome and bleeding disorders like haemophilia, characterised by deficiency of clotting factors like VIII and IX. Vascular causes like high blood pressure is one of the common causes of epistaxis. Epistaxis with retrograde flow of blood through puncta lacrimalia has been reported as a cause of haemolacria.2 Ocular conditions like conjunctival varicose vessels, inflammatory conditions like blepharitis, conjunctivitis, dacryoadenitis, inflammatory papillomas of conjunctival sac and episcleritis with bloody tears have been reported. Neoplasms like conjunctival hemangioma, meningioma of lacrimal sac and lymphangioma in upper cul-de-sac are also important causes of haemolacria.1 In haemolacria, sources of blood can be tear glands, the walls of lacrimal basin or puncta lacrimalia. Thorough evaluation should be done in patients of haemolacria before labelling it as idiopathic. Idiopathic haemolacria is basically a diagnosis of exclusion.3 According to the literature, other causes of haemolacria are trauma, vicarious menstruation, stress, anxiety, physical exertion, including stooping, bending and coughing. Drugs like silver nitrate and acetylcholine have been reported to cause haemolacria. Close observation and regular follow-up of a patient is helpful in diagnosing a psychiatric condition known as Munchausen syndrome, a rare cause of haemolacria.

British Medical Journal

The British Medical Journal (BMJ) recently published documentation of a case study that resulted out of a young woman, alarmed  to see blood being emitted from her eyes, rushed to hospital. She had been bathing, was menstruating, and looked up to a mirror to see herself seeping blood from both her eyes. She hadn't been injured, wasn't ill, and was not experiencing any other symptoms. This was the second time it had occurred, she informed researchers, and both times the episodes occurred when she had her period.

The 25-year-old was diagnosed with the rare disorder called Haemolacria, known coloquially as blood tears, a condition causing an individual to produce tears mixed with blood. No clear explanation exists for the condition that is relatively benign, but disturbing in its presentation. Theories abound that haemolacria may be caused by factors such as hormonal changes, inflammation, conjunctival injuries, high blood pressure and certain blood disorders.

In this particular case the doctors involved in the woman's treatment felt the condition might have been caused by 'vicarious menstruation', "a rare and unusual" occurrence where a woman's menstrual cycle results in blood occurring outside the uterus. Where women in their 30s and 40s are the most likely to have the experience which can feature as well, bleeding from the eyelids, retinas, ears, lungs and nipples. It has been known to occur even more rarely, in males.

A screenshot taken from a video of an 11-year-old girl leaking bloody tears. (BMJ Case Reports)

Various types of eye tissue can be affected by hormonal alterations in the body, according to researchers producing previous studies. Where the thickness and curve of the cornea can fluctuate during a menstrual cycle; alternately throughout pregnancy and lactation, with the potential to open odd avenues for blood to escape from the body, unusual as that may be.

A possible instability in the nervous system may also play a part in the phenomenon, according to other research; however whatever the cause the condition is  treatable with medication. Surgery is rarely needed to correct the syndrome. In this young woman's case her attending physicians diagnosed the condition expeditiously since her symptoms coincided with her menstrual cycle.

Leaving them to diagnose her with ocular vicarious menstruation. For which they prescribed oral contraceptives that resulted in her highly unusual problem disappearing.

flushinghospital.org

The Humboldt Tragedy and the Immigrant Driver

"Contrary to almost all of the many people I have acted for, [Sidhu's] remorse and empathy for the victims was foremost, and his concern for his personal consequences was secondary."

"As a criminal barrister for 40 years, I can tell you that this type of selflessness is unusual."

"Throughout the proceedings, his instructions were to attempt to minimize the collateral grief to the families that necessarily flowed from the criminal proceedings."

Mark Brayford, Sidhu defence lawyer

Jaskirat Singh Sidhu is taken out of the Kerry Vickar Centre in Melfort following his sentencing on March, 22, 2019 for his role in the Humboldt Broncos bus crash Photo by Liam Richards /Saskatoon StarPhoenix

A young male immigrant from India, starting to make a new life for himself in Canada, hired by a cartage company to drive semi-trailers for which he received inadequate training. A week of instruction sufficed to earn him a legal license to drive a large rig on Canadian highways; in the instance at hand a tractor-trailer with an added pup trailer. He had two weeks' experience driving the rig solo. His attention fully turned to driving when he realized the tarp on the pup trailer was flapping. Distracted, he missed a stop sign at a poorly designed intersection.

That intersection was known locally as a dangerous  spot, to the extent that six people had died there in previous motor vehicle accidents. Jaskirat Sidhu had been on the job for a month when the assignment to drive a delivery with the rig came up. Because of that momentary distraction, the driver who was not using his cellphone, was not on drugs, hadn't used alcohol, was fully aware, drove past the flashing stop sign at the rural Saskatchewan intersection and collided with a bus carrying the junior hockey team from Humboldt, Saskatchewan. 

 

The young hockey players and the team's staff were being taken to a playoff game on April 6, 2018. 

Sixteen members of the junior hockey team and staff died in the collision and 13 were injured, some with life-changing injuries. 

 

At the scene, the shattered truck driver fully cooperated with police investigators. Throughout the investigation to follow, his arrest and trial, he abnegated any opportunity to help his case, even when evidence came to light that the intersection and the stop sign were inadequate to their purpose, the cause of previous deadly accidents; he was driving into the sun; and mature trees were growing beside the highway partially obscuring views, including that of the stop sign.

 

Aerial photographs of the scene showed the scale of the collision with heavy damage to the coach (right) Canadian Press, Rex/Shutterstock

His purpose was to take full responsibility for the outcome of a momentary distraction that had resulted in  a horrific ending. His purpose was to spare the families involved any additional suffering after their dreadful losses. Jaskirat Sidhu has the official status of a landed immigrant. He is not yet a citizen of Canada, although he aspired to citizenship. He was newly married to another immigrant and together they planned to make a life for themselves in Canada.

He was sentenced to eight years in prison, representing the stiffest such penalty for accidents of this kind. Vehicular homicides are not all that uncommon in Canada, mostly caused by people driving under the influence of alcohol, drugs, speeding, talking on their cellphones or instances of sheer carelessness. Jaskirat Sidhu had pleaded guilty to 29 charges of dangerous driving causing death and bodily harm. He made no effort to defend himself. Overwhelmed with remorse he instructed his lawyers to plead guilty on his behalf to all charges brought against him.

The case management team at Prince Albert Penitentiary where he was incarcerated citing his exemplary behaviour while in prison along with his "significant level of remorse and victim empathy", recommended his transfer to a minimum-security facility. That recommendation was turned down by the prison warden. Uppermost in the warden's mind would be the reaction from family members whose children were killed or maimed by the accident that shocked the entire country when news exploded nationally of the Humbold team's dreadful loss.

Under Canadian law, anyone who is not a citizen of Canada, someone with the status of a landed immigrant for example, who is found guilty of a major criminal act can be extradited to their country of origin. Despite the ghost of the tragedy following the young immigrant couple, their hope is to be allowed to remain in Canada, become Canadian citizens, make their lives here, raising a family. An official with the Canada Border Services agency is to decide whether to allow Jaskirat Sidhu to remain in Canada, or to deport him when he becomes eligible for parole this coming November.

"Deportation of Mr. Sidhu back to India only serves to cause more suffering to him, his wife and his family."

"We have exchanged several emails with Mr. Sidhu and his wife, Tanvir, and it is clear to us that Jaskirat is indeed a broken and suffering soul."

"There has been enough suffering for everyone involved in this tragedy. We do not need any more."

Scott and Laurie Thomas, parents of 18-year-old Evan Thomas who died in the crash.

Evan Thomas between his two parents   Photo: Scott Thomas

"I believe it would be extremely unfortunate to now not allow a man who made a mistake and owned up to it and accepted his consequences the opportunity to continue his life here in Canada."

"I spent every day of the trial watching a man cry and be utterly devastated by the results of a mistake he made ..."

"I believe in second chances. A man who took the harshest sentence for a crime of this nature without appealing or defending himself in an attempt to ease even a small amount of pain for those he hurt is someone I believe deserves a second chance."

Christina Haugan, widow, Broncos' head coach Darcy Haugan who died in the crash

"By contrast [to the Humboldt Broncos' case], a Saskatchewan driver who had previously dodged charges of drunk driving and fleeing the scene of a crash, drove through a stop sign in 1997, killing a 39-year-old woman and injuring her young son before fleeing the scene without rendering assistance."

"He was not charged with leaving the scene, but received a ticket for driving without due care and paid a small fine."

"That driver, Scott Moe, is now premier of Saskatchewan."

Parker Denham, retired Nova Scotia journalist

 

COVID Re-runs : One Vaccine Dose or Both?

"Somebody who has had COVID before seems to respond very quickly to a dose of vaccine. They respond as a naive person would with their second shot." 

"The question that remains is that a one-size-fits-all for every previous infection? If you were asymptomatic at first infection, is it still OK?"

"Will the response to a first dose of vaccine be the same for everybody who has had a COVID infection before, regardless of the severity of disease?"

Dr.Caroline Quach-Thanh, pediatric infectious disease specialist, co-chair, National Advisory Committee on Immunization, Canada

"There's certainly the suggestion that if you have previously been infected, it's kind of like having had your first dose [of vaccine]."

"[Reinfection can happen] It's not as rare as people think [and mutations are increasing the risk such that people who have contracted COVID before should be vaccinated]."

"[For younger people, a one-dose strategy may be a reasonable approach] but I think we need more data."

"For older people, I think it's really unknown, and I think assuming you could get away with it is probably not necessarily so wise."

Dr.Andrew Morris, infectious disease specialist, Toronto

Credit: iStock, Bill Oxford

 

In Canada, its premier national expert immunization advisory group is in the process of deliberating whether one dose of vaccine only may be sufficient protection for those people who have already experienced a bout of COVID-19. Recently, a few small studies appear to conclude that a single dose of the Pfizer/BioNTech and Moderna vaccine could be useful in creating a rapid immune response in people who have previously been infected with the coronavirus.

People with a known history of having had COVID report more vaccine side effects -- including fever, headache, chills and muscle and joint aches -- than the never-infected, following the first dose. The second dose generally tends to be more intensely prone to side effects. It remains unclear whether a single dose would gain sufficient protection for older people who were infected previously, or those people with compromised immune systems.

France's elite health authority recommends a one-dose-after-COVID strategy,  a recommendation that the province of Quebec has picked up for its effect in stretching vaccine supplies in this initial period of short supplies. The thought is there that while people appear to tolerate the vaccines, a single dose might also spare people unnecessary side effects by withholding a second dose, according to researchers.

It was found by one small study that following the first dose of a Pfizer or Moderna shot antibody titers -- meaning the amount of antibodies appearing in an individual's blood -- of those previously infected were seen to be ten to 46 times as high as those people being vaccinated who had no previous immunity after the first dose. They were 25 times as high 13 to 15 days following the first dose. Antibody concentrations of people never infected increased by a factor of 3 following the second shot "no increase in antibody titers was observed in the COVID-19 survivors who received the second vaccine dose" researchers from the Icahn School of Medicine in New York concluded, as they suggested a booster or second dose might offer little value.

Messenger RNA vaccines such as the Pfizer and Moderna models work by instructing the body's cells to produce a bit of the spike-shaped protein on the virus's surface, causing COVID. An immune response is then triggered to which the body responds by producing antibodies to protect against infection in the instance of the real virus entering someone's body. Once primed by a past infection to recognize the spike protein, the immune cells respond more vigorously following the first vaccine dose.

However, it is not yet understood how long those early differences in immune responses might last, much less whether older people would respond similarly. Nor how long a time the vaccine-based immune response would be effective. The advisory panel's controversial decision early in the month to recommend spacing shots out to up to 16 weeks in the interests of having more of the population vaccinated at least once places the new question into "less of an emergency situation to tackle."

Irrespective of which, according to most experts, booster shots are expected to represent the norm for the future which would see the regularization of annual vaccines to counter the coronavirus's anticipated season return and ongoing mutations. The Mount Sinai researchers suggested that people be screened for the presence of antibodies should infection history be unknown. Here too there are disagreements taking into account that people could have lower antibody levels following a COVID infection if they experienced mild or no symptoms at all.

Out of Denmark a larger study suggests that prior COVID infections endow people with up to an 80 percent protection rate against reinfection. There is, however, an age differential where people 65 and older were seen to have only a 47 percent protection against reinfection. 

A nurse supervisor prepared a dose of the Pfizer-BioNTech vaccine at a mass vaccination site in Hartford, Conn., this month.   Credit...Christopher Capozziello for The New York Times

COVID-19 Vaccination Critical Decision Making

"I’m not aware of data showing that there is efficacy beyond two months of the first dose. In the past few weeks, we’ve seen different studies come out showing that the response to the first dose of the vaccine in the people who are elderly, in the people who are immuno-compromised is actually not that good and it wanes quite rapidly."

"I’m sure they’re following this [updated findings] and they may well be looking at perhaps modulating the recommendation as we go."

"As data emerges about what it takes to protect [seniors and immune-compromised people], we need to be reviewing what we’re doing."

"[As long as there aren’t issues with the vaccine supply, reverting to the original recommendations from the pharmaceutical companies] would be the ideal approach."

"The very people we want to protect the most require that we give them the second dose using the shorter interval, originally as done by the manufacturer in the clinical trials."

"The one-size-fits-all approach really needs to be modulated in terms of who we need to be protecting."

Canada’s chief science adviser Dr. Mona Nemer

A health care worker prepares a first dose of the Moderna COVID-19 vaccine to administer to a Palestinian laborer who works in Israel at a coronavirus vaccination center set up at the Gilboa checkpoint crossing between Israel and the West Bank city of Jenin, Monday, March. 8, 2021. (AP Photo/Ariel Schalit)

"One size does not fit all."

"Cancer treatments have profound effects on the immune system and cancer patients' immune mechanisms are inferior."

"We need to be concerned about other vaccines [in addition to Pfizer's] for this population, too. They do need a second dose quickly."

Dr.Sheeba Irshad, lead researcher, study, King's College London/Francis Crick Institute

"The National Advisory Committee on Immunization (NACI) is an External Advisory Body that provides the Public Health Agency of Canada (PHAC) with independent, ongoing and timely medical, scientific, and public health advice in response to questions from PHAC relating to immunization."

"In addition to burden of disease and vaccine characteristics, PHAC has expanded the mandate of NACI to include the systematic consideration of programmatic factors in developing evidence-based recommendations to facilitate timely decision-making for publicly funded vaccine programs at provincial and territorial levels."

• NACI has considered evidence from recent scientific studies on efficacy and effectiveness of COVID-19 vaccines in preventing various health outcomes such as infection, symptomatic disease, hospitalizations and death from COVID-19.
• While studies have not yet collected four months of data on vaccine effectiveness after the first dose, the first two months of real world effectiveness are showing sustained high levels of protection.
• Short term sustained protection is consistent with immunological principles and vaccine science where it is not expected to see rapid waning of a highly effective vaccine in adults over a relatively short period of time. Extending the interval between doses was shown to be a good strategy through modelling, even in scenarios considering a six month interval and in theoretical scenarios where waning protection was considered.
• NACI recommends that in the context of limited COVID-19 vaccine supply, jurisdictions should maximize the number of individuals benefiting from the first dose of vaccine by extending the interval for the second dose of vaccine up to four months.
• Extending the dose interval to four months allows NACI to create opportunities for protection of the entire adult population within a short time frame. This will not only achieve protection of the adult population, but will also contribute to health equity.
• NACI will continue to monitor the evidence on effectiveness of extended dose intervals and will adjust recommendations as needed.

Government of Canada, National Advisory Committee on Immunization

 

The Government of Canada found itself -- through a series of decision misadventures -- in difficulties procuring sufficient vaccine doses to inoculate the most vulnerable among its population, which led to an issue of maximizing the doses available. The United Kingdom had decided to space out the time between the first and second dose of its vaccines to enable vaccinating a greater number of people, and Canada made the decision to go the same route. Both Pfizer and Moderna whose vaccines were the first Canada received, recommend on the basis of their research no more than 21 or 18 days respectively between doses.

 

Health Canada and the National Advisory Council on Immunization agreed that it would be feasible to stretch the time between doses to 105 days, the delay enabling the dosages to go further so that greater numbers of people could be vaccinated. This was seen as a critical intervention for several reason, the first being that more people would be protected against the virus; it would give a boost to Canada's economic recovery; and concerns over the emergence in Canada of three COVID-19 variants, from the UK, South Africa and Brazil were spurring a third wave which they hoped to be able to arrest.

Despite the decision to leave a greater space between inoculations for each individual in the belief that sufficient protection would arise from the protective effects of the first shot, many medical experts profess unease at the decision, warning that the vaccines' efficacy would be compromised, The manufacturers themselves feel the decision to be unwise, given the results of their own research; those very results which led to the vaccines' authorized use by Health Canada to begin with.

Now, a new study conducted by a team of researchers at King's College London and the Francis Crick Institute has discovered how inimical delays in administering the second dose turns out to be on the mortality rate among cancer patients. Lengthening the time between doses being administered to cancer patients renders them far more vulnerable to contracting COVID-19 and suffering morbid effects as a result of that delay and consequential vulnerabilities.

According to the study, those with cancer or who have had cancer are considerably less "protected" should they be placed in the position of waiting longer to receive their second dose of vaccine following the administration of the first. Dr.Sheena Irshad, lead scientist on the project, informs that a prolonged wait for the second dose leaves people unprotected, during which time opportunistic new variants have emerged that are more contagious. 

 

Canada sees about 225,800 new cancer cases annually, while two million Canadians currently suffer from cancer or have had cancer.Three weeks following one dose of the Pfizer vaccine, according to the study, an antibody response was found in only 39 percent of people with cancer, in comparison to 97 percent for those without cancer. Should a second dose be administered three weeks later, cancer patients' antibody responses rise sharply, matching those of non-cancer patients. Delayed, the response remained around 39 percent.

Britain's 12-week gap (Canada's is 15 weeks) should be immediately reviewed, urges Dr.Irshad. Breast Cancer Now has recommended the U.K.'s vaccine committee to "urgently review the evidence presented in this study and consider adapting its strategy", to ensure that people with cancer receive both doses within the recommended three-week period. A spokesperson noting: "Anyone undergoing cancer treatment should continue to follow the advice of their doctors and we encourage all who can to take up the vaccine".

Guerina Morra, 81, gets her first dose of the Pfizer-BioNTech COVID-19 vaccine at Caboto Terrace in Toronto on Thursday. Experts say the confusion around vaccine safety recommendations is unfortunate given the number of unvaccinated seniors in Canada at risk of severe COVID-19 complications. (Evan Mitsui/CBC)

It's All About Control : Harvesting Personal Data

"The unholy alliance between Canadian politicians and Big Tech features prominently in the political parties' own use of social media data to track, profile and target voters."

"With the help of social media companies, political parties scrape online information posted by Canadians and use it to send manipulated and micro-targeted content attuned to each individual's behavioural triggers, in order to persuade them to vote a certain way."

"The result is that even people in the same household will not see the same political content."

"As the January 6 insurrection at the U.S. Capitol showed, if voters are not seeing the same information, they are not living in the same world."

"Distorting communication between voters has serious moral and political implications, which is why the EU created free people. In modern, technologically advanced democracies, data protection laws should build trust in the digital environment by properly protecting citizens and safeguarding hard won human rights, such as the right to privacy."

Jim Balsillie, founder, Centre for Digital Rights

Governments in the 'free world', the democracies allied in their struggle to counter the Beijing Communist Party's all-consuming traction advancing its agenda to control the lives of all its citizens through facial recognition technology and web outreach to ensure complete resignation of individuality and adherence to the proscription of criticism of Xi Jinping, the CCP, and its actions against the Uyghurs, Tibetans and Christians, shudder with horror at the casual dismissal of human rights and interference in peoples' privacy.

There are, however, certain parallels between what Beijing is accomplishing in scooping up data holus-bolus and controlling its massive population through advanced AI technology, and what certain democracies are also engaging in. The Internet has intruded in every aspect of human life. The great global public has embraced the wide open accessibility of knowledge, entertainment, communication and commerce with an enthusiastic appreciation of how much of our lives have changed, how much time is spent online, how casual friendships are made, how commerce is conducted, how fascinated we are with the options for contact, gaming, expressing ourselves.

Surveillance technologies have forever altered our concept of privacy. On the other hand, most people are not as seized with the issue of their personal 'privacy' as are campaigners for the protection of the right to privacy. Many people won't hesitate a heartbeat before airing the most personal details of their lives, live on stream, and with no concern over divulging such intimacies to the worldwideweb. Everyone nurtures a sense of personal entitlement overriding the need for personal privacy.

There is a cure for all of this. It is simple enough. Walk away. But nothing is ever as simple as it seems since those willing to forego any further use of the technology we have all grown so dependent on -- is willing to leave it all behind as an expedient in honour of privacy protection -- are few and far between. Violation of privacy rights does not appear high on the public's list of necessities to live a self-respecting life. And since the public really doesn't much care, why should those who govern them when the situation confers benefits on government?

Jim Balsillie, with all his experience, expertise and deep-seated knowledge of fundamental human rights can point out, as he has that "Behavioural monitoring, analysis and targeting are no longer restricted to social media, but have spread across a wide range of products, services and sectors, including retail, insurance, finance, health care, entertainment, education and transportation. In the early 21st century, every industry became a technology industry and now just about every internet-enabled device, and online service is a supply-chain interface for the unobstructed flow of behavioural data that's used to power the surveillance economy. This has not only meant the death of privacy, but has served to undermine personal autonomy, free markets and democracy."

Yes, indeed. And the public's complacency with all of this is obvious enough. A lack of imagination works to fail to instruct people of how much they have and will continue to lose in the greater scheme of things simply because most people cannot identify the fact that they are being unscrupulously manipulated. There are such subtleties of silent interference they are not recognized, and if they are, shrugged off as being insignificant and irrelevant.

And, as Balsillie points out, "... Privacy is a fundamental human right. Privacy is a gateway right to other rights and freedoms, including free expression, personal autonomy and freedom from harassment. Privacy is treated as a human right in numerous international conventions, including the United Nations Universal Declaration of Human Rights and the International Covenant on Civil and Political Rights. This right should be codified in our data governance laws, as it is in the European Union's landmark General Data Protection Regulation."

Rethinking Privacy for the AI Era    Forbes