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What you need to know as Alberta prepares to launch an online health portal

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So, you’re sitting in a tiny room at a medical clinic as your doctor stares intently at a computer screen — at your medical records.

She clicks the mouse a few times, and then starts to type.

What, you wonder, is in there? What does it say? After all, it’s your personal health information — right there in black and white. Shouldn’t you be able to see it?

Actually, you can.

Canadians have a right to see what’s inside their medical records. It’s well established in Canadian law. But it isn’t always easy.

In most provinces patients have to ask their doctors for copies of their personal health information, which can take time and there can be fees attached. That means doctors can act as a kind of gatekeeper to our personal health information — whether they want to or not. Patients need their cooperation to see it.

But that is changing.

Albertans are on the verge of having instant access to at least some of their medical records.

An online portal, called MyHealth Record, is set to roll out in the coming weeks. Alberta Health is not talking about how it might all work ahead of the official launch. It will only say it is in the final consultation process.

But we know based on information already sent to doctors that patients who sign up will be able to see the results of 59 lab tests, medication history and immunization records on their computer, tablet or smartphone.

Alberta isn’t the first province to make this kind of information electronically available to all patients. But it’s on the leading edge.

So imagine, being able to log in and check out your own test results whenever you want. From your phone. A whole new way of keeping an eye on your own health.

In another five years we may look back and we won’t believe this wasn’t the standard of care.– Dr. Iris Gorfinkel

But this also raises some questions.

What happens if you find out you have a health problem before you have a chance to see your doctor? What happens if you misunderstand the context of your results?

What should you know and when should you know it?

Quebec’s experience

Quebec launched a province-wide online patient portal last year.

So far more than 337,000 people have signed up for the Quebec Health Booklet. It contains a list of medications, lab test results and medical imaging reports such as MRIs, CT scans and x-rays.

And the portal has fans in the medical community.

“I think it’s a great thing because it makes the patients more involved in their healthcare,” said Dr. Vincent Demers, vice president of the Quebec Medical Association.

“Patients are more informed these days, and they want to be informed.”

Demers says his patients like it and the portal could potentially help prevent oversights.

“If for whatever reason a doctor misses an abnormal result, the patient can see it and go to the doctor and ask about the abnormal result,” he said.

Quebec Medical Association vice president Dr. Vincent Demers. (Quebec Medical Association)

But in Quebec test results are not released immediately. According to Demers, they’re held for 30 days, which gives doctors time to set up appointments for people with abnormal results. The delay applies to everything from bloodwork to CT scans.

The Alberta system appears set to handle timelines differently.

While results for scans such as MRIs and CTs are not expected to be made available in the MyHealth Record portal, or at least not right away, patients will have “immediate access” to lab test results.

A joint letter to doctors from the College of Physicians and Surgeons of Alberta and The Alberta Medical Association stated: “MyHealth Records is designed to be easily understood by Albertans; patient lab results will include abstract information to help explain tests, and a call-in line will help Albertans with troubleshooting or any health-related questions concerning information found on MyHealth Records.”

But seeing abnormal blood results right away could cause some real anxiety, according to Demers.

“You can discover something in your blood that is really serious — like a leukemia. So if the patient is the first to discover that he has a leukemia and he goes on Google and checks that, and he doesn’t have his physician in front of him to discuss it … it can make the patient very anxious,” said Demers.

He says the Quebec system, which delays results, may not be perfect but it helps avoid that outcome. Physicians can offer context and answer questions and concerns.

“So I think a delay is a good thing — even for the lab results,” he said.

Dr. Google

“What’s natural in the face of uncertainty … is human beings tend to do things to increase certainty,” said Kim Lavoie, a clinical health psychologist and researcher at the University of Quebec in Montreal.

We’ve all been there. Or, at least know someone who has. Something is off. You’re not well. So you whip out your phone and start searching for answers.

“They’re going to turn to the internet and the internet is full of great information and it’s full of terrible information,” said Lavoie.

While Alberta’s patient portal is expected to come with links to information about the tests and the results, Lavoie wonders if that’s enough.

Kim Lavoie is a clinical health psychologist and researcher at the University of Quebec in Montreal. (Submitted by Kim Lavoie)

What happens if someone discovers that their blood sugars are too high and they can’t get in to see their doctor right away?

“You don’t want patients with … pre-diabetes to go and do homeopathy, for example, because some random website says this is going to … decrease your blood sugar levels, which is nonsense,” she said.

Alberta, she says, should consider a delay — similar to Quebec — and have a plan to manage patients who are getting results without medical support.

According to Lavoie those people could become deeply concerned and, as an unintended consequence, jam up emergency rooms and walk-in clinics.

Kim Lavoie, a clinical health psychologist, worries people will turn to Google for answers about their medical information. (Cultura RF/Getty Images)

“In general I think [the portal] is a great idea. But you can’t just give people information and leave them powerless or helpless to do something about it,” she said.

In Nova Scotia, doctors have more control over when and how patients see their records.

‘Its time has come’

Nova Scotia launched a scaled down version of its own in 2016.

Family doctors can sign up and invite interested patients to join too. When test rests are in, physicians can control when the information is released to patients.

“Most routine lab stuff can be released immediately. Other tests such as CT scans, MRIs, pathology reports, the physicians have about five days to release that and it gives them a chance to … look at the result so they can get in touch with the patients,” said Dr. Gerard MacDonald, chair of the information technology steering committee with Doctors Nova Scotia.

Patients have a right to access this.– Dr. Gerard MacDonald

So far about 300 physicians — or roughly one quarter of the family doctors in Nova Scotia — have signed up.

“I think initially there were fears and a lot of those were fears of the unknown,” said MacDonald.

In that province’s system, people can get information, but also chat with their doctor’s through an e-messaging tool. MacDonald says doctors were concerned at the outset that they would be bombarded by messages from patients. But it hasn’t turned out that way.

Dr. Gerard MacDonald says family doctors can sign up and invite interested patients to join too. When test rests are in, physicians can control when the information is released to patients. (Gerard MacDonald)

“We have done some follow-up surveys with physicians,” said MacDonald. “The concern about the workload really has been overblown.”

There were also early worries patients would become anxious if they were confused about test results. According to MacDonald that hasn’t been a big problem yet either.

“Just a small percentage of patients are going to be worried and concerned. But whether you have a portal or not, that’s still going to be the case,” he said.

MacDonald welcomes online access and says patients will eventually want to see their data more quickly than they can in Quebec. 

“Its time has come,” said MacDonald. “Canadians demand to have access to their records. Just like they can access … their bank records. Patients have a right to access this.”

Several other provinces are at various stages of developing province-wide online patient portals. Some regional health authorities and hospitals already have their own versions in place. And patients in some provinces can also access results electronically from private laboratories.

Providing direct access to personal health information is a move many experts argue will push Canadians to be more active participants in decisions about their own health.

‘They don’t have to be afraid of the doctor’

Dr. Iris Gorfinkel, a Toronto-based family physician, would like all Canadians to have full access to their records within a decade.  

Gorfinkel wrote a commentary for the Canadian Medical Association Journal last year, calling on all provincial governments to mandate patient portals.

She believes patients should be able to log on and see their entire medical record with no delays. Having some understanding of their results ahead of time, she says, allows for a better conversation.

“They don’t have to be afraid of the doctor because the doctor isn’t the sole keeper of the records. They’re empowered with that knowledge and now that allows them to ask questions and fill in the gaps in that knowledge to address their worst fears,” said Gorfinkel.

Dr. Iris Gorfinkel is a Toronto-based family physician who says all Canadians should have full access to their medical records. (Craig Chivers/CBC)

The power dynamic, she says, is shifting.

“We need to do everything we can … to equalize the playing field.”

Gorfinkel believes the benefit of immediate access to medical records outweighs the potential harm of seeing an abnormal test result before you can talk to your doctor.

“I don’t call that anxiety. I call that patient engagement,” she said.

“This gives the potential for patients themselves to challenge doctors and say, ‘well wait a second, what about this aspect?’ … It’s a different level of conversation.”

“Hopefully … in another five years we may look back and we won’t believe this wasn’t the standard of care.”

And, Gorfinkel points out, no one is forcing you to look at your chart.

You only click on it if you want to.

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Health Ranger posts new microscopy photos of covid swabs, covid masks and mysterious red and blue fibers

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(Natural News) What follows is a series of microscopy photos of covid swabs (a synthetic swab, then a cotton swab), a covid mask and some zoomed-in photos of mysterious red and blue fibers found in the masks.

The magnification range for these photos is 50X to 200X. Most were taken with white light, but several (as indicated) were taken with UV light.

The images shown here are 600 pixels wide. We have higher resolution images available to researchers and indy media journalists; contact us for those hi-res images.

More microscopy investigations are under way, and new images will be posted as they are finalized.

First, this series shows the carbon fiber layer of a covid mask, illuminated with UV light:

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5,800 test positive, 74 die of coronavirus at least 14 days after getting fully vaccinated

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(Natural News) The Centers for Disease Control and Prevention (CDC) on Thursday, April 15, confirmed some 5,800 breakthrough coronavirus (COVID-19) cases in the U.S.

A breakthrough COVID-19 case is defined as someone who has detectable levels of SARS-CoV-2 – the virus that causes COVID-19 – at least 14 days after getting fully vaccinated against the disease.

Nearly 400 breakthrough cases required treatment at hospitals and 74 died. A little over 40 percent of the infections were in people 60 years and above and 65 percent were female. About 29 percent of the vaccine breakthrough infections were reportedly asymptomatic. The figures were for cases through April 13.

CDC Director Rochelle Walensky told a congressional hearing on Thursday that the causes of the breakthrough cases are being probed. “Some of these breakthroughs are, of course, failure of an immune response in the host. And then some of them we worry might be related to a variant that is circulating. So we’re looking at both,” she said.

The CDC is monitoring reported cases “for clustering by patient demographics, geographic location, time since vaccination, vaccine type or lot number, and SARS-CoV-2 lineage.” It has created a national COVID-19 vaccine breakthrough database, where state health departments can enter, store and manage data for cases in their region.

Where available, respiratory specimens that tested positive for COVID-19 will be collected for genomic sequencing “to identify the virus lineage that caused the infection.”

Positive test less than two weeks after getting fully vaccinated is not a breakthrough case

The number of cases the CDC has identified does not include people who contracted COVID-19 less than two weeks after their final dose. The two-week marker is important, said infectious disease expert Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.

A human body should have enough time to develop antibodies to SARS-CoV-2 after that timeframe. Before then, a person won’t necessarily have the built-up immunity needed to fight off an infection. According to Dr. Adalja, cases that occur before the two-week mark are not considered breakthrough cases.

Dr. Adalja also noted that more research is needed to determine if highly infectious variants of the virus are behind the breakthrough cases. “It is crucial to study breakthrough cases to understand their severity, their contagiousness and what role variants may be playing,” Dr. Adalja said.

More than 78 million people have been fully vaccinated against COVID-19 in the U.S. as of April 15.

“To date, no unexpected patterns have been identified in case demographics or vaccine characteristics,” the CDC said in a statement. “COVID-19 vaccines are effective and are a critical tool to bring the pandemic under control.”

But the CDC conceded that “thousands of vaccine breakthrough cases will occur even though the vaccine is working as expected.”

Dr. William Schaffner, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, agreed with the CDC. “These vaccines that we’re using are fabulous but they’re not perfect,” he said. “At best, they’re 95 percent effective in preventing serious illness, but minor illnesses can occur.”

According to U.S. drug regulators, Pfizer’s COVID-19 vaccine is 95 percent effective in preventing infection. Moderna’s was shown in a clinical trial to be 94.1 percent effective while Johnson & Johnson’s was 66.9 percent effective. Only Johnson & Johnson vaccine, which received its emergency use authorization from the Food and Drug Administration (FDA) on Feb. 27, was tested when variants were circulating.

The percentages are based on results from vaccine recipients two weeks after the final vaccination.

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, stated in a briefing last week that the breakthrough cases are not a cause for concern.

“I think the important thing is to look at what the denominator of vaccinated people is. Because it is very likely that the number of breakthrough cases is not at all incompatible with the 90-plus percent vaccine efficacy,” he said. “So I don’t think that there needs to be concern about any shift or change in the efficacy of the vaccine.”

More info needed before drawing conclusions from breakthrough cases

The percentage of vaccine breakthroughs in a population depends on multiple factors, including vaccine efficacy, the amount of virus circulating and the length of time since vaccination, according to Natalie Dean, an assistant professor of biostatistics at the University of Florida.

“I love to see small numbers as much as anyone, but know that numbers like this cannot be directly interpreted as a measure of vaccine efficacy (although I have a feeling they will be). We can only interpret them against a background rate in unvaccinated people,” Dean wrote on Twitter.

“Similarly, ‘most breakthroughs have been in elderly adults’ should not be read as the vaccine is less effective in elderly adults. The majority of vaccinations (and the longest amount of follow-up time) have been in elderly adults. Again, we need more info to interpret.”

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More people died from fentanyl overdose than coronavirus in San Francisco last year

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(Natural News) More people died from fentanyl overdose than coronavirus (COVID-19) in San Francisco last year, a microcosm of a larger nationwide problem coinciding with the pandemic.

Data from San Francisco’s Office of the Chief Medical Examiner shows that 708 people were killed by fentanyl in 2020, an astonishing 118 times more since the introduction of the drug in the city just five years earlier.

That figure nearly tripled the 254 COVID-19 deaths recorded in the city for the whole of last year. More than 8 in 10 deaths were male, and just under half were white. People aged 55 to 64 made up nearly a quarter of the fatalities. Nearly 40 percent of the deaths occurred in open-air drug markets such as the Tenderloin and South of Market.

The number of overdose deaths in the city could have been far worse as more than 3,000 addicts suffering from an overdose were administered with naloxone, the lifesaving medication that reverses overdoses.

San Francisco’s death rate from fentanyl overdose continues to rise this year as 135 died by overdose in January and February, putting the city on pace for more than 800 deaths by the end of the year.

The city has become a significant part of a larger trend. The Centers for Disease Control and Prevention (CDC) released data on Wednesday, April 14, showing that more than 87,000 Americans died from drug overdose over the 12-month period that ended in September last year – the highest since the opioid epidemic began in the 1990s.

Lockdowns lead to more cases of drug overdose

The surge represents an increasingly urgent public health crisis that may be correlated to the government’s monotonous battle plan against the COVID-19 pandemic.

On March 19 last year, California became the first state in the U.S. to implement a stay-at-home order. It subsequently endured the longest lockdown of any state in the country.

The pandemic and accompanying lockdowns are believed to be partly responsible for the soaring number of drug deaths for obvious reasons. Lockdowns have badly disrupted the social services in the city, including drug addiction treatment. Drug experts say the isolation of the past 12 months is causing vulnerable residents to turn to opioids.

“We see the death and devastation getting worse right in front of us,” said Matt Haney, San Francisco Board of Supervisors member. “It’s an unprecedented spiraling, directly connected to the introduction of fentanyl in our city.”

Fentanyl first appeared on the streets of San Francisco in 2015. There were just six deaths from the synthetic opioid that year, 12 deaths in 2016 and 37 deaths in 2017. The figure skyrocketed when the drugs became widely available in the city in 2018.

Kristen Marshall, manager of the national drug harm reduction DOPE Project, noted the grim irony that while social isolation could save lives from COVID-19, it had undoubtedly contributed to the number of overdose deaths.

“Isolation is also the thing that puts people at the absolute highest risk of overdose death,” she said.

Pandemic exacerbates rise in deaths from drug overdose

The number of deaths from drug overdose started rising in the months leading up to the coronavirus pandemic, making it hard to gauge how closely the two phenomena are linked. But the pandemic unquestionably exacerbated the trend. The biggest jump in overdose deaths took place in April and May when fear and stress were rampant, job losses were multiplying and the strictest lockdown measures were in effect.

Many treatment programs closed during that time while drop-in centers, which provide support, clean syringes and naloxone, cut back services.

The data released by the CDC shows a 29 percent rise in overdose deaths from October 2019 through September 2020 compared with the previous 12-month period. Illicitly manufactured fentanyl and other synthetic opioids were the primary drivers, although many fatal overdoses have also involved stimulant drugs like methamphetamine.

Unlike in the early years of the opioid epidemic, when deaths were largely among white Americans in rural and suburban areas, the current crisis is affecting Black Americans disproportionately.

“The highest increase in mortality from opioids, predominantly driven by fentanyl, is now among Black Americans,” Dr. Nora Volkow, the director of the National Institute on Drug Abuse, said at a national addiction conference last week.

“And when you look at mortality from methamphetamine, it’s chilling to realize that the risk of dying from methamphetamine overdose is 12-fold higher among American Indians and Alaskan Natives than other groups.”

Dr. Volkow added that more deaths than ever involved drug combinations, typically of fentanyl or heroin with stimulants.

“Dealers are lacing these non-opioid drugs with cheaper, yet potent, opioids to make a larger profit,” she said. “Someone who’s addicted to a stimulant drug like cocaine or methamphetamine is not tolerant to opioids, which means they are going to be at high risk of overdose if they get a stimulant drug that’s laced with an opioid like fentanyl.”

The Drug Enforcement Administration (DEA) supported Dr. Volkow’s claim, saying that transnational criminal organizations cause a spike in overdoses by mixing fentanyl into illicit narcotics.

According to the DEA, Mexican cartels often purchase the drug components in China and use human mules to smuggle the narcotics to lucrative drug markets north of the border.

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