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‘We’re holding up a floodgate’: B.C. fights off superbugs brought home by medical tourists

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The risks involved in medical tourism aren’t just personal. Having surgery abroad could also mean bringing back a drug-resistant superbug and putting people in this country at risk, B.C. officials warn.

That alert comes after the recent discovery that two patients at New Westminster’s Royal Columbian Hospital had been colonized with the multidrug-resistant yeast Candida auris. Though neither patient is infected with the bug, the two join just a handful of cases that have been identified in B.C. since 2017.

Dr. Linda Hoang, medical co-director for the Provincial Infection Control Network (PICNet), said most of these cases have come from travellers who have had treatment overseas, including medical tourists.

It means patients need to do serious research on the facilities they’re considering for surgeries or other treatments abroad, including looking for objective information about the presence of any drug-resistant microorganisms.

“It’s not only a problem in India or Southeast Asia. It is endemic in parts of the U.S. and parts of Europe,” Hoang told CBC News.

“It [antibiotic-resistant superbugs] is a global problem, and the only way to to be aware of them is to make sure that health-care professionals are informed and our residents are informed when they’re seeking health care outside of British Columbia.”

It’s a sobering reminder for those who travel abroad for medical treatments, whether it’s to skip the surgery wait list in B.C., access therapies that aren’t approved in Canada or save money on cosmetic therapy. Some of the top destinations for medical tourists from around the world include India, Mexico, Southeast Asia, Brazil and Turkey, according to the Medical Tourism Association.

But facilities in other countries can sometimes take a more haphazard approach to prescribing antibiotics, and overuse can trigger the evolution of resistance to these crucial drugs.

India a major source of bug

The two colonized patients at Royal Columbian were isolated after the bug was discovered, and the hospital has been aggressively cleaning all areas they had visited, using UV light for disinfection, according to Fraser Health.

C. auris was first identified in Japan in 2009, but it has popped up since then in countries around the world.

It acts much like any other yeast species, causing infections in wounds, the bloodstream and the ears, but the real problem is how to treat it.

“The only real reason why we’re concerned or interested in monitoring Candida auris is because of that potential resistance profile, making it difficult to treat with the anti-fungal agent that we have,” Hoang said.

The biggest risk of infection right now seems to come from Indian facilities, Hoang said.

A microscopic image, at left, shows Candida auris cells. At right is a culture of the yeast in a petri dish. (The Journal of Infection in Developing Countries)

The bug was confirmed for the first time in B.C. in July 2017 in a patient who’d been treated in India. As it turned out, that traveller also came back with infections from multiple other drug-resistant organisms.

B.C. doesn’t track whether infected people travelled abroad as medical tourists or simply required medical treatment because of an emergency during their voyages.

But patients who have had medical treatment outside B.C. for any reason are a major source of these superbugs, she said.

They include so-called CPOs — carbapenemase-producing organisms like Klebsiella, E. coli and Pseudomonas that have become resistant to broad-spectrum antibiotics, which Hoang describes as the “last resort” for treatment.

In 2017-2018, PICNet recorded more CPO cases than ever before, and more than half of them were from people who had accessed health care overseas, Hoang said.

‘There’s only so much we can do’

The key for anyone who chooses to have surgery abroad —​ and anyone who needs medical attention while travelling —​ is to let your B.C. doctor know when you return. That way, the doctor can check you for any drug-resistant bugs you may have picked up and give you the appropriate medication if you get sick.

Being open with that information protects everyone around you.

“If you require health care in British Columbia, you are running the risk of spreading that into our facilities. And that’s not a good thing for your neighbouring patients, who might be very sick and vulnerable,” Hoang said.

She said B.C. is aggressively monitoring returning travellers for drug-resistant superbugs, but the real key to stopping their spread will be eliminating the excessive use of antibiotics that allows these micro-organisms to evolve resistance.

“We’re basically holding up a floodgate, and unless the problems are addressed in these countries where antibiotics are used with minimal regulation and control, there’s only so much we can do,” Hoang said.

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Ottawa sets monthly record for total COVID-19 cases with 99 new cases on Friday

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Sixteen days into October, Ottawa has already set the record for most cases of COVID-19 in a single month.

Ottawa Public Health reported 99 new cases of COVID-19 in Ottawa today, and three more deaths linked to novel coronavirus.

Ontario’s Ministry of Health had reported 108 new cases of COVID-19, but there is sometimes a lag in COVID-19 case reporting between Ontario and Ottawa Public Health. On Wednesday, Ontario reported 39 new cases in Ottawa, while Ottawa Public Health reported 45 new cases.

There have been 1,511 laboratory-confirmed cases of COVID-19 in Ottawa in October, surpassing the September record of 1,413 new cases.

Since the first case of COVID-19 on March 11, there have been 5,908 laboratory-confirmed cases of COVID-19 in Ottawa, including 301 deaths.

Across Ontario, there are 712 new cases of COVID-19 on Friday. Health Minister Christine Elliott reported 213 new cases in Toronto, 135 in Peel Region and 62 in York Region.

HOSPITALIZATIONS IN OTTAWA

One more person was admitted to an Ottawa hospital with COVID-19 related illnesses on Friday.

Ottawa Public Health reports 47 people are currently in hospital with COVID-19, including eight in the intensive care unit.

ACTIVE CASES OF COVID-19 IN OTTAWA

The number of active cases of COVID-19 increased on Friday.

There are 792 active cases of COVID-19 in Ottawa, up from 777 active cases on Thursday.

A total of 4,806 people have recovered after testing positive for COVID-19.

The number of active cases is the number of total laboratory-confirmed cases minus the numbers of resolved cases and deaths. A case is considered resolved 14 days after known symptom onset or positive test result.

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Ottawa mayor rejects possible return of Ottawa-Gatineau border checkpoints, ‘I really don’t think they work’

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Mayor Jim Watson does not want to see police checkpoints return to the five interprovincial crossings between Ottawa and Gatineau, saying “I really don’t think they work.”

Earlier this week, Gatineau Mayor Maxime Pedneaud-Jobin told the Ottawa Citizen that police checkpoints could return to the Ottawa-Gatineau border at “any time,” with the final decision in the hands of the Quebec Government. Earlier this month, Dr. Brigitte Pinard of the Centre Integre de sante et de services sociaux de l’Outaouais said border checkpoints were “possible,” adding “right now, our message is to limit large gatherings.”

When asked by CTV Morning Live host Leslie Roberts about the possibility of police checkpoints returning to the Ontario-Quebec border, Watson said he did not think they worked back in the spring.

“There were so many gaps when the police were not there, and people just figured out I’ll go at an earlier time or a later time. We saw police officers sticking their heads in the car with no masks, so that was not healthy for those individuals,” said Watson Friday morning.

“It’s a costly expense when our police are stretched already to the limit trying to do the work, to have them set up at five different bridge points potentially 24 hours a day would cost hundreds of thousands of dollars every month and I think the money is better spent.”

On April 1, Gatineau Police and the Surete du Quebec set up checkpoints along the Ottawa-Gatineau border to limit non-essential trips into Gatineau. Gatineau Police estimated the random police checkpoints between April 1 and May 17 cost the service more than $400,000.

Mayor Watson tells CTV Morning Live that the Quebec Government’s decision to move Gatineau into the “red zone” two days after Ontario moved Ottawa to a modified Stage 2 should help.

“We are a close relationship and when things happen in Gatineau there’s often a trickle effect over here and I think the fact that we’re both in the red zone, and Quebec of course is the worst hit province, at least levels the playing field for our restaurants and bars,” said Watson.

“I think in the past what had happened was our restaurants and bars would close and then the ones in Gatineau would stay open, and then people from Ottawa would go over there irresponsibly, in my opinion, and then come back potentially with the virus and spread it here.”

While border checkpoints would limit the non-essential travel across the Ottawa-Gatineau border, Watson says that’s not the way to beat COVID-19.

“The message is very clear, stick to your household. This is not the time to have an AirBNB party or a keg party in your backyard, or have 20 people or 30 people in for an engagement party. I know a lot of these get-togethers are important socially for people and emotionally, but we have to ask people to be reasonable and responsible, and this is not the year to do those kinds of things.”

Roberts asked the mayor if he would have a conversation about border checkpoints with Gatineau’s mayor.

“I had it the first go-around, but at the end of the day I also respect their jurisdiction and their autonomy. It is the province that would have to impose that, not the municipality,” said Watson.

“From our perspective, we don’t think it’s an effective use of resources. We want to continue to get the message across that we can win this battle against COVID-19 if we socially distance, we wear a mask, we actually follow the simple rules that are put forward.”

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Ottawa woman breaks 14-day quarantine rule to work at long-term care home: police

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OTTAWA — A 53-year-old Ottawa woman is facing charges under the federal Quarantine Act after Ottawa police say she failed to self-isolate for 14 days after travelling abroad and returned to work at a long-term care home.

Ottawa Police say information was received indicating that an Ottawa woman had travelled abroad. She returned to Canada on Sept. 26, so she was required under federal law to quarantine for 14 days, until Oct. 9

“The woman decided not to respect this order and went to work on Sept. 30 at a long-term health facility in Ottawa,” police said in a news release. “When management was apprised of the situation, she was immediately sent home. The facility immediately activated mitigating self-isolation and cleaning protocols and informed all persons that had been in contact with the subject.”

Police say none of the residents of the long-term care facility have tested positive for COVID-19 as a result of the woman attending work.

Ottawa police say this is the first person they have charged under the Quarantine Act during the pandemic.

The woman is charged with failing to comply with entry condition under section 58 of the Quarantine Act and cause risk of imminent death or serious bodily harm under section 67 of the Quarantine Act.

The maximum penalty for causing risk of imminent death or serious bodily harm is a $1 million fine and three years in prison. For failing to self-isolate for 14 days, she faces a $750,000 fine and up to six months in jail.

Police did not release the name of the woman, nor where she worked. The woman is due in court on Nov. 24.

Ottawa Mayor Jim Watson’s office issued a statement following the announcement of the charges.

“Mayor Watson was disturbed to learn about the alleged carelessness of the individual in question. This type of reckless behaviour could have harmed their colleagues, and more importantly, the residents of the long term care home. We must all do our part to limit the spread of COVID-19 in our community.”

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