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HIV spike among B.C. drug users associated with COVID-19 lockdown, research says

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By Brieanna Charlebois in Vancouver

A new study says reduced access to HIV services during early COVID-19 lockdowns in British Columbia was associated with a “sharp increase” in HIV transmission among some drug users.

The study by University of British Columbia researchers says that while reduced social interaction during the March-May 2020 lockdown worked to reduce HIV transmission, that may not have “outweighed” the increase caused by reduced access to services.

The study, published in Lancet Regional Health, found that fewer people started HIV antiretroviral therapy or undertook viral load testing under lockdown, while visits to overdose prevention services and safe consumption sites also decreased.

The overall number of new HIV diagnoses in B.C. continues a decades-long decline.

But Dr. Jeffrey Joy, lead author of the report published on Friday, said he found a “surprising” spike in transmission among some drug users during lockdown.

Joy said transmission rates for such people had previously been fairly stable for about a decade.

“That’s because there’s been really good penetration of treatment and prevention services into those populations,” he said in an interview.

B.C. was a global leader in epidemic monitoring, which means the results are likely applicable elsewhere, Joy said.

“We are uniquely positioned to find these things,” he said. “The reason that I thought it was important to do this study and get it out there is (because) it’s probably happening everywhere, but other places don’t monitor their HIV epidemic in the same way that we do.”

Rachel Miller, a co-author of the report, said health authorities need to consider innovative solutions so the measures “put in place to address one health crisis don’t inadvertently exacerbate another.”

“These services are the front-line defence in the fight against HIV/AIDS. Many of them faced disruptions, closures, capacity limits and other challenges,” Miller said in a news release.

“Maintaining access and engagement with HIV services is absolutely essential to preventing regression in epidemic control and unnecessary harm.”

The Health Ministry did not immediately respond to requests for comment.

Researchers said the spike among “select groups” could be attributed to a combination of factors, including housing instability and diminished trust, increasing barriers for many people who normally receive HIV services.

British Columbia is set to become the first province in Canada to decriminalize the possession of small amounts of hard drugs in January, after receiving a temporary federal exemption in May.

Joy said this decision, alongside measures like safe supply and safe needle exchanges, will make a difference preventing similar issues in the future.

“The take-home message here is, in times of crisis and public health emergency or other crises, we need to support those really vulnerable populations more, not less,” he said.

“Minimally, we need to give them continuity and the access to their services that they depend on. Otherwise, it just leads to problems that can have long, long-term consequences.”

This report by The Canadian Press was first published Sept. 24, 2022.

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Alberta

Two deputy chief medical officers resign from their positions with Alberta Health

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Edmonton – Alberta’s two deputy chief medical officers of health are leaving their roles — less than a month after Dr. Deena Hinshaw was removed as the province’s top doctor.

Health Minister Jason Copping confirmed during question period Wednesday that both of the doctors have submitted letters of resignation.

“They are still continuing to work at this point in time,” he said in the legislature. “We are in the process of actually looking to fill those roles.”

A statement from Alberta Health said Dr. Rosana Salvaterra and Dr. Jing Hu, who are listed as public health physicians on the department’s website, have given notice.

When reached by her department email, Salvaterra responded: “Unfortunately, we are not able to comment.”

She later added that she respects and admires both Dr. Hinshaw and Dr. Hu.

“They are brilliant, hard-working, and compassionate public health physicians and I consider myself fortunate to have had the opportunity to work alongside them for these past 14 months.”

Salvaterra, who has extensive public health experience including as the medical officer of health for Peterborough, Ont., joined the office in October 2021.

Her career in public health includes work in “the COVID-19 response, mental health, the opioid response, women’s health, poverty reduction, health equity, community food security and building stronger relationships with First Nations.”

Hu’s out-of-office message said her “last day at work with Alberta Health was Nov. 18, 2022,” and noted she wouldn’t have access to the department email after that date.

She got extensive training in China and at the University of Calgary before joining the health department in January 2020.

Their resignations came within a month of Hinshaw, who became the face of Alberta’s public health response to the COVID-19 pandemic, being removed from her position.

Hinshaw was replaced by Dr. Mark Joffe, a senior executive member of Alberta Health Services, on an interim basis.

“Dr. Joffe will be supported by medical officers of health within AHS, by other staff in the Office of the Chief Medical Officer of Health, and by the Public Health Division,” said the statement from Alberta Health late Wednesday.

“We expect these changes to have no impact on the department’s and Dr. Joffe’s ability to meet the requirements of the Public Health Act.”

Hinshaw’s dismissal didn’t come as a surprise.

Premier Danielle Smith announced on her first day in office in October that she would be replaced.

Smith has made it clear that she blames both Hinshaw and Alberta Health Services for failing to deliver the best advice and care for Albertans as the hospital system came close to buckling in successive waves of the COVID-19 pandemic.

“A lot of the bad decisions were made by Alberta Health Services on the basis of bad advice from the chief medical officer of health,” Smith told reporters on Oct. 22.

Smith has not placed the blame on front-line doctors and nurses but broadly on AHS senior management. Joffe, while serving as chief medical officer of health, retains his role in AHS senior management as a vice-president responsible for areas in cancer and clinical care.

Hinshaw, an Alberta-trained public health specialist, became a celebrity of sorts in the first wave of the pandemic in the spring of 2020, as she delivered regular, sometimes daily, updates to Albertans on the virus, its spread and methods to contain it.

This report by The Canadian Press was first published Dec. 7, 2022.

— By Colette Derworiz in Calgary.

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COVID-19

China eases anti-COVID measures following protests

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By Joe Mcdonald in Beijing

BEIJING (AP) — China rolled back rules on isolating people with COVID-19 and dropped virus test requirements for some public places Wednesday in a dramatic change to a strategy that confined millions of people to their homes and sparked protests and demands for President Xi Jinping to resign.

The move adds to earlier easing that fueled hopes Beijing was scrapping its “zero COVID” strategy, which is disrupting manufacturing and global trade. Experts warn, however, that restrictions can’t be lifted completely until at least mid-2023 because millions of elderly people still must be vaccinated and the health care system strengthened.

China is the last major country still trying to stamp out transmission of the virus while many nations switch to trying to live with it. As they lift restrictions, Chinese officials have also shifted to talking about the virus as less threatening — a possible effort to prepare people for a similar switch.

People with mild cases will be allowed for the first time to isolate at home, the National Health Commission announced, instead of going to sometimes overcrowded or unsanitary quarantine centers. That addresses a major irritation that helped to drive protests that erupted Nov. 25 in Shanghai and other cities.

Public facilities except for “special places,” such as schools, hospitals and nursing homes, will no longer require visitors to produce a “health code” on a smartphone app that tracks their virus tests and whether they have been to areas deemed at high risk of infection.

Local officials must “take strict and detailed measures to protect people’s life, safety and health” but at the same time “minimize the impact of the epidemic on economic and social development,” the statement said.

China’s restrictions have helped to keep case numbers low, but that means few people have developed natural immunity, a factor that might set back reopening plans if cases surge and authorities feel compelled to reimpose restrictions.

Still, after three years spent warning the public about COVID-19’s dangers, Chinese officials have begun to paint it as less threatening.

People with mild cases “can recover by themselves without special medical care,” said Wu Zunyou, chief epidemiologist of the China Centers for Disease Control, on his social media account.

“The good news is that the data show the proportion of severe cases is low,” said Wu.

The latest changes are “small steps” in a gradual process aimed at ending restrictions, said Liang Wannian, a member of an expert group advising the National Health Commission, at a news conference.

The government’s goal is “to return to the state before the epidemic, but the realization of the goal must have conditions,” said Liang, one of China’s most prominent anti-epidemic experts.

Dr. Yanzhong Huang, an expert on public health in China, also emphasized the gradual nature of the announcement.

The new measures are a shift away from “zero COVID” — but “not a roadmap to reopening,” said Huang, director of the Center for Global Health Studies at Seton Hall University.

“When implemented, these measures may generate dynamics that fuel the rapid spread of the virus even though China is not ready for such a dramatic shift,” he said.

The government announced a campaign last week to vaccinate the elderly that health experts say must be done before China can end restrictions on visitors coming from abroad. They say the ruling Communist Party also needs to build up China’s hospital system to cope with a possible rise in cases.

But public frustration is rising now, as millions of people are repeatedly confined at home for uncertain periods, schools close abruptly and economic growth falls.

The changes have been rolled out despite a renewed spike in infections started in October. On Wednesday, the government reported 25,231 new cases, including 20,912 without symptoms.

Xi’s government has held up “zero COVID” as proof of the superiority of China’s system compared with the United States and Western countries. China’s official death toll is 5,235 since the start of the pandemic versus a U.S. count of 1.1 million.

Rules were left in place that warn apartment and office buildings might be sealed if infections are found. Complaints that families are confined for weeks at a time with uncertain access to food and medicine were a key driver of the protests.

The ruling party switched early this year to suspending access to neighborhoods or districts where infections were discovered instead of isolating whole cities.

On Wednesday, the government said the scope of closures will be narrowed still further to single apartment floors or buildings instead of neighborhoods.

It said schools in communities with no outbreaks must return to in-person teaching.

That appeared to be a response to complaints that local leaders, threatened with the loss of their jobs in the event of outbreaks, impose closures that are destructive, might be unnecessary and exceed what the central government allows.

The demonstrations in at least eight major cities and on dozens of university campuses were the most widespread display of public dissent in decades. In Shanghai, some protesters shouted the politically explosive demand for Xi, China’s most influential figure in decades, to resign.

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