Virtual ERs are controversial, but in rural Newfoundland, one has saved a life

 The Canadian Press

ST. JOHN'S, N.L. — The 12-bed hospital in New-Wes-Valley, N.L. — population 2,000 — found itself at the centre of a heated debate about staff shortages in rural health care when the province signed a contract to staff its emergency department virtually.

Mayor Mike Tiller, a paramedic, is not completely sold on the idea of having doctors hundreds of kilometres away responsible for urgent care of his town's residents, but a recent experience has convinced him the virtual ER can save lives.

Tiller says a patient who came to the Dr. Y.K. Jeon Kittiwake Health Centre in cardiac distress was able to get a life-saving injection thanks to a virtual emergency doctor, who teamed with on-site health professionals such as nurses or paramedics to provide treatment. The injection broke up blood clots and kept the patient alive so he could be transferred to a larger hospital in Gander, about an hour and a half away, and then airlifted to St. John's, Tiller said in a recent interview.

Without the virtual emergency room, the hospital would have been closed, Tiller said.

"It will save lives," Tiller said about the town's virtual emergency room. "It's not ideal. It's not what we hope is a permanent solution … but it's saving lives, which is what it's there for."

Like many rural hospitals across Canada, the New-Wes-Valley health centre has been plagued by closures because there were no doctors or nurses to keep it open. It currently has one doctor on staff who does not cover the emergency room, Tiller said. Normally, the facility would have six doctors, all sharing emergency duties.

Tiller said the hospital was closed so much at the beginning of last year, he was worried it would be shut down for good.

In an effort to keep these centres open, the Newfoundland and Labrador government has offered more money to doctors working in rural hospitals, flown in temporary doctors, and introduced virtual services where patients in smaller, unstaffed hospitals could speak to physicians in larger facilities.

In November, the province signed a two-year, $22-million contract with Teladoc Health, which is headquartered in New York state, to build a more robust "virtual care solution" for rural emergency rooms and for patients who need primary care but don't have a family doctor. 

The move signalled that virtual care would play a more prominent role in the government's efforts to keep rural hospitals open. The contract, obtained by The Canadian Press, says Teladoc would offer its services in up to five rural emergency rooms beginning in November, and up to 20 rural emergency departments beginning in March. It began operating in the New-Wes-Valley hospital in late November.

In its proposal to Newfoundland and Labrador health officials, the company says it has a pool of 350 physicians licensed to practise in Canada. Doctors working virtual emergency rooms will reside outside the province but be licensed to work there, the company said. They will keep rural emergency departments open seven days a week, 24 hours a day.

"Teladoc Health’s vision is to make virtual care the first step on any health-care journey," the document said.

The company has since expanded its virtual emergency services into two more rural hospitals, said a statement Thursday from Newfoundland and Labrador Health Services. As of Dec. 31, 172 patients had sought urgent or emergency care across the three facilities, and ten were transferred to larger hospitals.

Staff shortages are driving a record number of rural emergency room closures across Canada, and more provinces are turning to virtual care to keep them open, said Dr. Trevor Jain, an emergency physician in Prince Edward Island and a spokesperson for the Canadian Association of Emergency Physicians. The approach is not without its risks, he said.

"I've heard this argument before, that some care is better than no care. But some care can cause harm if not done properly," Jain said in an interview. Virtual care is "extremely expensive," he added, and officials often turn to it as a "quick fix" without addressing the larger problems.

Ultimately, virtual care would work best in a hybrid situation, alongside on-site emergency physicians in well-staffed hospitals, Jain said. He added that provinces must keep working to train and recruit physicians and nurses who will work in rural emergency rooms and to shore up health-care systems outside of emergency rooms.

Dr. Jan Sommers agrees. In an ideal system, she said, virtual care would be primarily used to help during surge times in emergency departments that are already well staffed. Sommers is the head of emergency at Nova Scotia's Colchester East Hants Health Centre, which piloted the VirtualEmergencyNS system. Like the Teladoc system, it uses virtual physicians with on-site health professionals who act as the doctor's hands.

However, the physicians with VirtualEmergencyNS either work in Nova Scotia or have experience there, she said.

Virtual care as it's used today in Canada is relatively new — it emerged during the COVID-19 pandemic — and there are still questions about its use, Sommers said.

"Virtual care will never replace face-to-face care, and nor should it," she said. "But I do think that it definitely is going to be a piece of the solution for health care going forward."

In New-Wes-Valley, Tiller said he's grateful the hospital is open and saving lives, but virtual care still has its drawbacks. For example, patients who arrive at the town's virtual emergency room and need extended care still have to be transferred to Gander, and patients using virtual care for regular checkups see a different doctor for each visit.

"We want to have our doctors here," he said.

This report by The Canadian Press was first published Jan. 11, 2024.

Sarah Smellie, The Canadian Press

'Cutting the heck' out of Canada's boreal forest has put caribou at risk

Story by Benjamin Shingler • CBC

Canada is home to the largest boreal forest in the world, a vast expanse of wilderness rich in biodiversity that stretches from coast to coast.

But a major new study examining nearly a half century of logging in Ontario and Quebec warns that clear-cutting has left forests in the provinces severely depleted — and puts woodland caribou at risk.

The peer-reviewed research, published in the academic journal Land, found that logging practices between 1976 and 2020 have resulted in the loss of more than 14 million hectares of forest, an area roughly twice the size of New Brunswick.

There are only 21 million hectares of older forest (defined as forests 100 years or older) remaining in the region.

"We have been cutting the heck out of the boreal forest," said Jay Malcolm, a professor emeritus of forestry at the University of Toronto, and one of the authors of the study, conducted by researchers in Canada and Australia.

The researchers calculated that older forests make up only 42 per cent of the forest area, and most of the remaining older forest is in the remote north.

"It's very frightening. It was startling to see how little is left and how badly fragmented it is," said Malcolm.

Caribou herds under threat

Using satellite imagery and government data, the study found that only eight patches of older forest greater than 500 square kilometres are still intact in Ontario and Quebec.

The patchwork of remaining older forests threatens the survival of woodland caribou, which require large areas of undisturbed habitat for their survival.


Nearly all remaining caribou herds in Ontario and Quebec — 19 of 21 — are considered at "high risk" or "very high risk" because of disturbances to their habitat.

Environmental groups have been calling for more stringent measures to protect the dwindling caribou population.

"This paper shows that our logging practices are not, in fact, sustainable," said Rachel Plotkin, boreal project manager with the David Suzuki Foundation.

"What caribou need is to have the habitat that they depend upon protected and where it's already been degraded, to have it restored."



An aerial view shows an area of the boreal forest in Quebec where trees were felled during salvage logging efforts following an insect outbreak near Baie-Comeau, Que., in August 2022. A recent study, published in the academic journal Land, found that logging practices since 1976 have resulted in the loss of more than 14 million hectares of boreal forest, an area roughly twice the size of New Brunswick. 

(Ed Jones/AFP/Getty Images)© Provided by cbc.ca

Caribou feed on lichen, which grow on the floor of older forests. Plotkin said the disappearance of those feeding grounds and an expanding network of logging roads that make it easier for predators like wolves to track caribou have contributed to their decline.

According to Plotkin, the federal government hasn't done enough to manage the problem.

"Even if only one per cent of a forest is cut annually, Canada will say, 'Don't worry, we're unlocking one per cent of our forest every year.' But in 100 years the entire forest is going to be logged," she said.

Forests planted after logging are more limited in the variety of species they contain and don't have the attributes that favour caribou, like a floor rich in lichen, she said.

"We're not managing our forests so that they have old growth, and the roads that are used by forestry operations will be the lasting legacy that impact wildlife species like caribou."

In a statement, Natural Resources Canada said it is "committed to the protection" of at-risk species, including caribou.

"The government continues to work with provinces, territories, Indigenous peoples and stakeholders," the statement said.



A map prepared for the study features orange areas to indicates places that have been logged in Ontario and Quebec since 1976. The turquoise represents areas where the forest is at least 100 years old.

 (Griffith Climate Action Beacon/Griffith University)© Provided by cbc.ca

Quebec plan coming

Logging practices fall under provincial jurisdiction, but provinces must comply with federal environmental regulations.

Environment Minister Steven Guilbeault has been critical of Ontario and Quebec for not doing enough to protect caribou habitat. He has threatened to use the Species At Risk Act, which includes a seldom-used provision that allows Ottawa to impose stricter rules on provinces.


Amélie Moffet, a spokesperson for Quebec's environment minister, told CBC News a caribou protection plan is coming soon, with the goal of reducing human disturbance on herds.

In Ontario, forestry companies are required to demonstrate that their operations will not adversely affect the amount and arrangement of caribou habitat over a long period of time, said Marcela Mayo, a spokesperson for Ontario's Ministry of Natural Resources.

"Forest management activities are required to follow a comprehensive forest management plan."
'The most magical animal'

Valérie Courtois, executive director of the Indigenous Leadership Initiative, a national conservation and stewardship organization, questioned whether the current management practices are enough.

"We have a tendency as a Western culture to want to maximize our economic opportunities when we engage with natural resources," she said.



A caribou is seen in Gaspé, Que. The province has promised a stronger approach to protecting the animals, which require large areas of undisturbed habitat for their survival. 

(Denis Desjardins/SEPAQ)© Provided by cbc.ca

"What we're seeing with caribou is an early warning sign, and it behooves us to listen to that warning sign because the reality is that this will happen to other species."

Courtois is a member of the Innu community of Mashteuiatsh, located on the shore of Peikuakami, or Lac-St-Jean, Que., about 200 kilometres north of Quebec City. She has seen the George River caribou herd, which roams between eastern Quebec and Labrador, up close.

"They're beautiful," she said of caribou. "It's not an accident that it's featured on our quarter. I think caribou is the most majestic, the most magical animal I know."

MANITOBA

Trustees call on province to boost number of Indigenous teachers

 Winnipeg school trustees are calling on the newly-elected NDP government to set aside funding to help local universities graduate more Indigenous teachers.

Elected officials from two city school divisions, St. James-Assiniboia and Winnipeg, have co-written a letter to call attention to representation gaps in kindergarten-to-Grade 12 classrooms.

“It’s our way of saying to the government that this is still a priority for us and we hope that it can be a priority for them, too,” said Holly Hunter, chairwoman of the SJASD board of trustees.

The memo, sent Wednesday to Advanced Education Minister Renée Cable, requests the province make a “significant investment” into training to tackle the workforce shortage.

It also calls on the ministry to partner with community organizations to ensure First Nations, Métis and Inuit candidates have access to bursaries and wraparound services ranging from housing to child care.

Hunter said the letter, which was also shared with Education Minister Nello Altomare, Indigenous Economic Development Minister Ian Bushie and Premier Wab Kinew, is largely symbolic.

“We want to have more Indigenous teachers in our schools, but the universities aren’t graduating enough students for us to be able to have enough Indigenous teachers to be representative of the number of students that we have in our buildings,” said the trustee, who is also a certified teacher.

Indigenous teachers make up nine per cent of certified teachers in SJASD — a proportionate representation shortfall of 10 per cent, per June 2023 data from the division.

Hunter added: “This isn’t something that we can fix (alone).”

The Winnipeg Indigenous Executive Circle estimates an additional 570 teachers would need to be hired across city divisions to match the percentage of public school students who are First Nations, Métis and Inuit.

WIEC’s latest report on the state of equity in education indicates the University of Manitoba and University of Winnipeg have graduated an average of 35 Indigenous teachers annually over the last two decades.

“At this rate, it will take almost 20 years to address the under-representation of Indigenous teachers in Winnipeg,” states an excerpt from 2022 report.

Manitoba’s largest faculty of education is in talks with WIEC and, in a wider bid to attract teacher candidates, developing an introductory course to encourage students from different disciplines to consider the profession. The elective is anticipated to launch in the fall.

Given U of M’s program is an after-degree option, recruitment needs to happen internally within the campus community as much as it does externally with outreach to high schools, said Frank Deer, associate dean of Indigenous education.

“(Our recruitment) is not terribly robust, if I’m honest; we need to do more,” Deer said, noting the university has cut back on these efforts to find cost savings in recent years.

At the same time, the professor said the U of M — which graduated about 170 teachers overall last year — is also focused on up-skilling opportunities for working professionals.

The faculty is designing a post-baccalaureate diploma in Indigenous education to be rolled out as early as September.

“For us, it’s not just about Indigenous teachers in the field but it’s the sort of competencies they have to serve all students… on such things as Indigenous history, literature, science and other aspects of Indigenous life that are really quite important,” he added.

In their letter to government leaders, trustees acknowledged both concerted efforts to address the issue are ongoing and the reality that they have not made a significant dent.

For example, the Community-based Aboriginal Teacher Education Program — an initiative between divisions and the U of W that provides educational assistants a pathway to become teachers — only graduates a handful of teachers every year.

The letter also suggests there is an urgency to hiring more Indigenous teachers in order to improve academic outcomes among underrepresented children and youth.

“We will continue to support post-secondary institutions so that they are able to provide quality Indigenous teacher education programs,” Cable said in a statement that noted University College of the North is expanding its Kenanow bachelor of education.

The advanced education minister added there is “a long way to go” to address representation gaps owing to years of the Tories’ austerity agenda.

Last week, the province appointed its first assistant deputy minister of Indigenous excellence in education and tasked Jackie Connell, a Métis school division administrator, with providing advice to improve graduation rates, among other indicators.

maggie.macintosh@freepress.mb.ca

Maggie Macintosh, Local Journalism Initiative Reporter, Winnipeg Free Press

China's Zijin Mining to buy 15% stake in Canada's Solaris

Story by Reuters  • 

(Reuters) -Solaris Resources said on Thursday that Chinese mining firm Zijin Mining Group plans to acquire a 15% stake in the Canadian miner for about C$130 million ($96.99 million), in a deal that would test Canada's new foreign investment rules.

The deal is the first investment by a Chinese miner since November 2022, when Canada ordered three Chinese companies to divest their investments in Canadian critical minerals, citing national security.

Canada has in recent years tightened its Investment Canada Act (ICA), under which deals involving a foreign company are reviewed to safeguard national security.

The Canadian government did not immediately respond to a Reuters request for comment.

Under the terms of the agreement, Solaris will issue about 28.5 million shares at C$4.55 per share to a unit of Zijin, representing a 14% premium to the stock's close on Wednesday.

Shares of Solaris were up more than 5% on Thursday.

The deal would also permit Zijin to nominate a member to the Solaris board for as long as the Chinese firm held at least a 5% stake.

Solaris said it would use the proceeds of the transaction for the development of its Warintza copper-gold project in Ecuador.

Brokerage Eight Capital said in a note that it was a "good deal for Zijin Mining and a strong endorsement of the Warintza exploration strategy."

($1 = 1.3404 Canadian dollars)

(Reporting by Kabir Dweit; Editing by Shailesh Kuber)

VIDEO  Ottawa monitoring Chinese investment in domestic rare earths mine

The Canadian government says it's keeping an eye on a recent Chinese investment in a struggling Australian firm that owns Canada's only operating rare earths mine. The minerals are essential to the “green” economy. As Heidi Petracek explains, some industry insiders want Ottawa to take more assertive action to keep China away from domestic resources.

ALBERTA FREEZES  PRIVATIZED CHILD CARE FUNDING

Matthew Lau: The Alberta government's disastrous child-care takeover

Opinion by Special to National Post • 

Children's backpacks and shoes are seen at a daycare in Langley, B.C., 

on Tuesday May 29, 2018.© Provided by National Post

The government takeover of child care is a full-blown crisis in Alberta, with many of the province’s child-care entrepreneurs saying they are being pushed to the brink.

They have until the end of January to sign the provincial government’s new agreement, but its terms give child-care operators “serious concerns for financial viability moving forward,” says Krystal Churcher, chair of the Association of Alberta Childcare Entrepreneurs (AACE), in a letter co-signed by the Canadian Federation of Independent Business (CFIB) and addressed to Searle Turton, Alberta’s minister of children and family services.

Even as the government pours increasing sums of taxpayer money into the sector, child-care operators are suffering from a government-imposed revenue cap in the face of inflating expenses, a lengthy delay in receiving revenue and heavy administrative and audit expenses required to participate in the government program.

Opting out of the government program isn’t a great option either because it means competing without subsidies in a sector awash in government funding while also paying the same taxes that pay for everyone else’s subsidies.

One child-care entrepreneur, Christine Pasmore, who has managed her facility for 18 years and serves over 120 children, told me this week that “it is virtually impossible for my centre to remain financially viable under the new agreement.” She added that the situation is made worse by the heavy administrative burdens of the program.

“While the government emphasizes that child-care centres have the option to participate in the program or not, the reality for many operators is a stark choice between immediate bankruptcy by not signing in or a slower path to financial ruin by participating,” she said.

The new government agreement gives child-care operators a three per cent fee increase for 2024, but the baseline is artificially low because many child-care centres essentially froze fees coming out of the pandemic, and need 10 to 12 per cent revenue growth just to account for inflation.

On top of that, are the administrative burdens imposed by government. Child-care operators who participate in the government program must pay for mandatory financial audits, which for most centres will cost around $30,000 per year.

In her letter to the minister, Churcher noted that additional administrative expenses will come from paperwork, staffing and reporting. For her business specifically, she tells me the government-imposed administrative burden works out to $28 per child per month on top of the $30,000 audit fee.

 Another child-care operator, licensed for 100 spaces in Calgary, told me this week that he estimates the government is wiping out about one-third of his centre’s income by limiting the growth of fees to three per cent and by imposing significant new costs.

“Operators have little control and little ability to fix things as our revenues are contractually restricted,” he told me.

A one-third cut to income is a calamity; for many other child-care centres, the negative financial impacts could be even worse. When revenues cannot rise to match expenses, even modest expense growth causes a severe reduction to margins and earnings.

The government’s stated goal is to make child care more widely available, but wrestling control away from operators and severely impairing the value of their investments is not going to help grow or strengthen the sector.

In addition to constraining revenue, government is imposing a massive liquidity burden on child-care operators by delaying funding. Instead of receiving fees at the beginning of each month, government reimburses revenues on a delay of 40 to 45 days, which places “an unsustainable burden on child-care operators,” the AACE-CFIB letter states.

It will lead to “severe cash flow problems, making it challenging to cover essential expenses like rent and wages on time, depleting savings and requiring reliance upon business loans” which increases interest expenses. While 40 to 45 days of delayed revenue might not sound like much, for many centres this is equivalent to the government borrowing something like two-thirds or more of annual net income, interest-free and on a rolling basis.

Responses to a survey from the AACE to its members, who operate about 250 child-care centres accounting for 30,000 spaces across the province, was appended to their letter to the Alberta government. When asked how they would cope with the funding delay, many said they would need to obtain bank loans or lines of credit: “borrowing money to fund the government,” as one operator put it.

Some operators are panicking, and have asked landlords to delay rent and staff to delay payroll. Others say they will have to close their businesses unless a swift course correction is taken by government. Indeed, without serious policy improvement, the government is destroying a vitally important sector. It is a disaster for Alberta’s child-care businesses, their staff and the families they serve.

National Post

Matthew Lau is a Toronto writer. 

Ontario government's partnership with ServiceOntario and Staples Canada raises questions

Story by National Post Staff  • 

A ServiceOntario located photographed in Cornwall, Ont.

© Provided by National Post

The Ontario government is reportedly closing an undisclosed number of ServiceOntario locations as it moves forward with a plan to open new centres in select Staples Canada stores.

The government announced the change in December , stating it was “making it easier and more convenient for families and businesses to access vital government services.” It added that the new scheme would “reduce the overall cost to deliver government services to the public.”

The announcement did not mention any closures. Citing unnamed sources within the premier’s office, CityNews reported that an unspecified number of ServiceOntario centres are set to close and will have new locations open in Staples Canada stores.

There are 275 ServiceOntario locations currently operating in the province under a mix of private and provincial ownership. A 2013 Auditor General of Ontario report found that out of the then-289 ServiceOntario centres, 82 were provincially run and 207 were privately owned.

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CityNews reported that some of the locations set to close have been family businesses for decades and they were given just 70 days’ notice of the impending closures.

ServiceOntario says it completes 59 million transactions annually, and private operators are paid a commission for each transaction they process. It helps residents get vital documents, such as health cards, birth certificates and driver’s licences.

The government source told CityNews that Staples Canada was chosen after lengthy consultations with possible retail partners, including factoring in the number of locations, the size of the stores and parking availability, among other considerations.

The source said that Staples Canada was chosen as a partner because it met all its criteria and the shift will give customers “a 30 per cent improvement to current service accessibility hours.”

The reaction to the announcement on social media has been mixed, with some Ontarians, particularly in rural areas, expressing concerns about the impact the change could have on services in their communities, and the distances they would have to travel to access Staples Canada locations.

Staples Canada currently operates in 73 cities in Ontario. The privately held business was founded in 1991 and is headquartered in Richmond Hill, Ont.

Catherine Fife, the official opposition NDP critic for the finance and treasury board, said the move “raises serious concerns about Ontarians’ access to government services.

“Closing down ServiceOntario locations without details of how many or how service demands will be managed, especially in Northern and rural parts of the province, is worrisome,” she said . “This is not an expansion of service, but another attempt for Ford to quietly hand over more of our public services to private corporations.”

The financial details of the partnership, including what cost savings are expected, have not been disclosed.

Kootenay unemployment rate climbs to one of highest in Canada

Story by The Canadian Press  • 20h

 The Kootenay region’s economy is heading into unenviable territory.

Only three other economic regions in the country — outside of the Maritimes and the territories — had a higher unemployment rate than the Kootenay region in December, 2023, which now sports a 7.1 per cent rate (December, 2023, Statistics Canada).

One year ago the region was one of the lowest at 4.3 per cent, but 12 months later only Red Deer (7.9 per cent), Montreal (7.3 per cent) and Gaspésie–Îles-de-la-Madeleine (9.9 per cent) have a higher rate than the Kootenay region, which comprises both East and West Kootenay, and includes Nelson, Castlegar, Trail and Grand Forks.

The mark is over twice the figure from one year ago (3.5 per cent) when the Kootenay region was one of the lowest unemployment rates in B.C. and across the country.

Earlier this month Nelson and District Chamber of Commerce executive director Tom Thomson said staffing remained a big problem for regional businesses in 2023 and it was expected to continue in 2024, with the effects of the pandemic still being felt.

During the COVID pandemic the staffing issue was compounded by business uncertainty and government supports keeping people at home and out of the workforce. There were more people looking for work in 2023 and fewer jobs going unfilled, he explained.

“It can still be a problem recruiting mid- to senior-level staffing positions if applicants are coming from out of the area due to the tight housing market,” said Thomson. “Employers still tell us stories about quality candidates applying and wanting to relocate, but some are unable to find accommodation.”

The unemployment rate in British Columbia was 5.6 per cent in December 2023, up 0.3 percentage points from November and up 1.5 percentage points from 12 months ago. 

In December, both the labour force (up 29,000) and the number of people employed (up 17,700) increased on a month-over-month basis, while over the past 12 months it grew by 122,800 and 74,000, respectively. 

Compared to one-month prior, the number of full-time positions increased (by 23,100) while part-time positions decreased (by 5,300). Part-time positions increased for those in the core working aged population of 25 to 54 (up 2,500). 

Employment increased in both the private (14,300) and public (3,400) sectors. Meanwhile, there was a small increase in the number of self-employed individuals (100). 

 

Versus rest of Canada

At 5.6 per cent, B.C. had the fourth lowest unemployment rate in Canada during the month of December, with only Manitoba (4.2 per cent), Quebec (4.7 per cent), and Saskatchewan (five per cent) ahead of B.C. Alberta and Ontario were tied for the fifth lowest rate at 6.3 per cent. 

Across the country as a whole, employment remained nearly the same with an estimated 100 more jobs in December than in November. The unemployment rate (5.8 per cent) remained the same month-over-month but was up 0.8 percentage points when compared to 12 months ago. 

Gender 

Estimates on employment by gender are for people aged 25 years and over only. 

Compared to November, employment in B.C. for men increased by 5,600 while the labour force increased by 7,800. The unemployment rate for men was 4.8 per cent in December, 0.1 percentage points higher than in November. 

For women, there were 10,000 more jobs in December in B.C. and an estimated 19,200 women entered the labour force. As a result, the unemployment rate for women was 5.4 per cent, up 0.6 percentage points from November. 

Source: Statistics Canada

Timothy Schafer, Local Journalism Initiative Reporter, The Nelson Daily

Nearly 10K died from COVID-19 last month: WHO says

By Staff The Associated Press
Posted January 11, 2024 

COVID-19: Subvariant HV.1 now makes up 3rd of reported cases in Canada 

The head of the UN health agency said Wednesday holiday gatherings and the spread of the most prominent variant globally led to increased transmission of COVID-19 last month.

Tedros Adhanom Ghebreyesus said nearly 10,000 deaths were reported in December, while hospital admissions during the month jumped 42% in nearly 50 countries — mostly in Europe and the Americas — that shared such trend information.

“Although 10,000 deaths a month is far less than the peak of the pandemic, this level of preventable deaths is not acceptable,” the World Health Organization director-general told reporters from its headquarters in Geneva.

He said it was “certain” that cases were on the rise in other places that haven’t been reporting, calling on governments to keep up surveillance and provide continued access to treatments and vaccines.

Tedros said the JN.1 variant was now the most prominent in the world. It is an Omicron variant, so current vaccines should still provide some protection.

1:51Public Health Canada studying COVID-19 peaks

Maria Van Kerkhove, technical lead at WHO for COVID-19, cited an increase in respiratory diseases across the globe due to the coronavirus but also flu, rhinovirus and pneumonia.

“We expect those trends to continue into January through the winter months in the northern hemisphere,” she said, while noting increases in COVID-19 in the southern hemisphere — where it’s now summer.

Health Canada ignored warning signs before Ottawa spent billions on BTNX rapid tests

By Patti Sonntag Global News
Posted January 11, 2024 

Health Canada ignored critical warnings about a rapid-test supplier before approving its COVID-19 kits for distribution nationwide, Global News has found.

A year-long Global News investigation into federal procurement revealed that BTNX, a Toronto-area rapid-test supplier that buys the devices from China, deleted dozens of specimens, or samples, from a study it submitted to Health Canada in October 2020. Deleting the specimens increased the estimate of the rapid test’s ability to detect the virus.

In October 2020, BTNX submitted an application to Health Canada as it sought approval to sell its rapid test for COVID-19. One of the studies in the package was a study that suggested the test would detect 94.55 per cent of infections, among people who had symptoms for less than 14 days.

However, two months earlier, BTNX told authorities in Peru the same test detected 80.2 per cent of infections overall, according to records that government published online.

The lower detection rate of 80.2 per cent of infections is the estimate that the kit’s Chinese manufacturer, Assure Tech, gave to every business selling the test worldwide. It was based on a study of the test’s ability to detect the virus carried out at two health-care facilities near the company’s Hangzhou headquarters.

Though an assistant deputy minister at Health Canada had already flagged possible issues with another BTNX application, federal employees reviewing BTNX’s file did not challenge the company about this improvement or ask for an explanation, according to correspondence Global News obtained via freedom of information request.

BTNX admitted that it had deleted specimens. The company “worked with the data provided to us,” BTNX wrote to Global News in December 2023, making changes to “focus the data on the intended use of the product.”

In the wake of Global News’ reporting, BTNX added in a letter that the changes to the study were “based on the US FDA EUA template” and, in a press release, in “accordance with industry standards.”

The leap in the product’s accuracy was one of at least three red flags that Health Canada appears to have either missed or ignored as BTNX applied for a licence to sell the test kit in the fall of 2020. This included a warning from a senior Health Canada official about the veracity of the company’s public statements; data missing from a second study in BTNX’s application; and what researchers called elevated test results.

BTNX and Health Canada have stated that BTNX’s device works as promised, and regulators had all the information they required. Health Canada told Global News last month it will not re-examine BTNX’s licence to sell this test.

Dr. Stephen Ellis, member of Parliament for Cumberland-Colchester and the Conservative shadow minister for health, told Global News that his party will “hold the Liberals to account” and follow up on this “very serious concern regarding rapid test approvals.”

When Global News asked Mark Johnson, a Health Canada spokesman, what guidance applies to suppliers editing studies, he quoted the Food and Drugs Act.

“No person shall knowingly make a false or misleading statement,” he wrote.

Regardless, the federal government awarded BTNX a series of contracts in 2021 and 2022 that became Canada’s largest pandemic deal for medical supplies.

A wartime effort

When borders closed in the spring of 2020, with COVID-19 infections spreading, no vaccines, and entire nations in lockdown, workers at Health Canada and other federal offices faced a daunting task in finding the medical supplies Canada needed.

Government employees in Ottawa found themselves caught up in a global competition for rapid tests so fierce that a Health Canada official called it the “Hunger Games.”

Global News began looking into procurement while rapid test purchases were still underway. Federal ministries permitted some of the workers who evaluated rapid tests or procured them to participate in a rare group interview on the condition that Global News would not name employees or ask about contractors.

The interview took place in November 2022. Certain disparities in statements by BTNX executives a few weeks later led Global News to further investigate how and why BTNX received its contracts.

Six officials joined the interview, almost all of them at director level and above, in the interest of sharing their experiences during the public health emergency.

“The desperation can’t be captured in words,” recalled a senior official from the Public Health Agency of Canada.
Her voice broke as she shared the group’s fears that “we might not be able to get our hands on […] enough supply.”

All the world’s manufacturing plants were only able to meet a fraction of global needs. And Canadian officials could not match the purchasing power of their U.S. or European counterparts or the scale of their orders.

With few options, Canada turned inward. Prime Minister Justin Trudeau called on Canadian manufacturers to produce medical supplies, from face shields to ventilators.

Authorities preparing to launch mass screening pinned their hopes on a test manufactured by Spartan Bioscience, a company based in Ottawa. This DNA-based “lab-in-a-box” solution attempted to solve the problem of accuracy.

Health officials around the world had concerns about the reliability of the obvious alternative to lab tests, which were cheaply made rapid tests. In many markets these had never been regulated — and the World Health Organization would issue two warnings about them within the next six weeks.

Health Canada hired new employees, set up an emergency authorization process for health care equipment, and cut wait times on licences to sell medical supplies.

Over at Public Services and Procurement Canada, the invocation of the National Security Exemption empowered employees to skip most processes.

According to a CBC report published on April 12, 2020, exploring why Health Canada was lagging behind U.S. and European regulators, a BTNX executive said in an interview that the company was disappointed with the amount of time Health Canada was taking to approve its antibody test.

“We’ve seen the speed in which other, other health agencies around the world have been able to take these decisions,” BTNX’s CFO Mitch Pittaway said. “We think that Canada will hopefully be in a position to take a well-informed decision quite quickly.”

Pittaway was pitching an “antibody” test that detected the body’s reaction to the presence of COVID-19. Antigen tests, released soon afterward, detect the virus itself.

He noted that the company was selling the tests in the U.S. through an emergency program.

The next day, Pierre Sabourin, who was then an assistant deputy minister at Health Canada, flagged to Stephen Lucas, deputy minister, that he thought BTNX was misleading the public. Global News obtained correspondence between federal workers from a government website and freedom-of-information requests.

“Some manufacturers/importers claim falsely” that U.S. health authorities authorized their antibody tests for sale, Sabourin wrote. “For example, BTNX.”

At the time, the U.S. regulator was experimenting with pre-authorization sales, allowing rapid test suppliers to sell their products while they waited for officials to process their applications. BTNX was among that group.

BTNX’s application to Health Canada for authorization to sell the antibody test was “poor quality,” Sabourin added. The supplier had not submitted clinical data that backed up its claims, he wrote.

In response to Global News’ recent questions, BTNX wrote that it has always been transparent with regulators and the public.

 

Prime Minister Justin Trudeau addresses Canadians from Rideau Cottage in Ottawa on April 29, 2020, the same day that he spoke about rapid test suppliers in the House of Commons. 

THE CANADIAN PRESS/Sean Kilpatrick.

On April 29, 2020, in a House of Commons debate, Prime Minister Trudeau called BTNX an “innovative Canadian company that has moved forward with a world-class product.”

Health Canada did not respond to Global News’ questions about whether the ministry informed the Prime Minister’s Office about Sabourin’s concerns.

In a statement issued after this article was published on Jan. 11, 2024, the Prime Minister’s Office wrote that BTNX’s antigen “rapid tests work well and have been successfully used by millions of Canadians” to fight COVID-19. A spokeswoman described Health Canada’s decision-making as “independent.”

A priority application

Six months later, Spartan’s device had not proven reliable enough, according to Health Canada’s evaluation. And any obstacles to BTNX’s applications had seemingly vanished.

David Boudreau, director general of Health Canada, emailed Sabourin and Manon Bombardier, assistant deputy minister, on Oct. 14, 2020, to announce that, after discussions, BTNX had applied for authorization to sell an antigen test for COVID-19.

Given the emphasis on finding antigen tests, he wrote, Health Canada would review the file “in priority, as soon as possible.”

It is unclear why Health Canada prioritized BTNX’s application.

Assure Tech, BTNX’s supplier in China, had already applied separately to Health Canada for authorization to sell exactly the same product.

Sabourin did not reply to Boudreau in writing.

(Sabourin declined Global News’ request for comment. He retired in December 2021.)

Federal employees set to work.

In Winnipeg, workers at the National Microbiology Lab evaluated sample tests BTNX provided.

In Ottawa, an employee with a PhD in biochemistry supervised the examination of BTNX’s and Assure Tech’s nearly identical application packages, which workers paired together, according to federal records.

One of the evaluations in BTNX’s package, but not in Assure Tech’s, was the edited version of the study of the test’s ability to detect COVID-19.

It was not immediately apparent that the two documents described the same study. Global News’ analysis showed that in addition to omitting data, BTNX had renumbered the locations at which the evaluation took place and the specimens’ identifying numbers.

According to Health Canada, its employees did not notice that 132 out of the study’s original 348 specimens were missing and found no “reason to question [the studies’] scientific integrity.”

A quick scan of Canadian distributors’ websites would have shown that another business was marketing the same test to customers overseas with the overall 80.2 per cent sensitivity estimate. Yet in BTNX’s application to Health Canada, this figure jumped to nearly 95 per cent.

“There was no switching of sites,” the company’s spokesman wrote. BTNX provided a “reliable testing tool for Canadians.”

One of the changes involved removing “retrospective positives.” This refers to specimens that have been frozen.

BTNX said Canadian and U.S. health regulators recommended using fresh samples.

In fact, Health Canada advised the company that it could use frozen specimens in its correspondence with BTNX. The U.S. FDA said the same.

Global News’ examination of the data also revealed that BTNX did not delete all of the frozen specimens, only those that tested positive for COVID-19. Those deletions improved the outcome for the nasal test by nearly 10 percentage points.

Examining clinical studies posted to Health Canada’s website, Global News found that other rapid test suppliers used retrospective samples and described the results from unusable specimens.

In response to questions about whether editing data was common among Canadian rapid test companies, Cenk Ozkan, vice president of Artron Laboratories, based in Burnaby, B.C., told Global News that deleting data would risk “loss of credibility and legal actions.”

Health Canada, for its part, has defended its decision to approve BTNX’s application. The approval relied on the full package, a spokesman wrote in December, including a second study of the test’s sensitivity that was carried out in the United States and managed by Assure Tech, BTNX’s supplier.

Global News discovered BTNX’s version of this second study was different from Assure Tech’s as well.

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This table presents all known versions of studies in Assure Tech’s and BTNX’s Health Canada applications. Global News

The version of this second study Assure Tech submitted to Health Canada cited 230 specimens. BTNX’s version cited just 82, suggesting that an unknown person omitted the majority of the specimens.

Assure Tech did not respond to Global News’ requests for comment. BTNX told Global News that Assure Tech provided only 82 specimens to BTNX.

“AssureTech did not advise BTNX that it had additional specimens from another site or that it was submitting a broader study to Health Canada,” the company’s spokesman wrote on Jan. 5. Health Canada’s approval of the test for consumers relied on a third evaluation in the package, he stated.

The deletions have raised questions among Canadian researchers about why the regulator approved BTNX’s application.

Trudo Lemmens, a professor of health law and policy at the University of Toronto, said, “The fact that Health Canada didn’t see it or ignored it” suggests “regulatory failure.”

Lemmens called on the federal government to launch an investigation that also allows for “scrutiny by independent researchers outside of government, outside of industry, to be able to see whether the data supports the claims.”

New questions about the application

In the November 2022 interview, a Health Canada official recalled federal workers’ sense of unity as he looked back on those terrible days.
“We were all rolling up our sleeves,” he said, “trying [to protect] the health and safety of Canadians.”

He and his colleagues seemed confident that they had weeded out less reliable suppliers.

“We came to realize which companies were able to have quality applications” with “data that would support the claims,” he explained to Global News.

Since Global News’ report was published, Health Canada has argued that the National Microbiology Laboratory’s evaluation of BTNX’s kit supported BTNX’s stated sensitivity.

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A passer-by walked past a COVID-19 testing clinic in Montreal, Friday, Oct. 16, 2020. 

THE CANADIAN PRESS/Ryan Remiorz

Global News obtained the NML’s results and the lab report, which called the device a “less-sensitive” test. The technicians attributed its lower outcomes to storage issues.

Unknown to Health Canada, researchers for the German, Spanish and British governments were separately reaching the same conclusion in the fall of 2020 and winter of 2021. (To learn more, you can read our Dec. 21 story online.)

Researchers Global News asked to review the data said the contrast between the governments’ results and the outcomes BTNX reported to Health Canada were eye-catching.

Dr. Larissa Matukas, head of the microbiology division at Unity Health Toronto, St. Michael’s Hospital, explained, “You’re not going to score 100 per cent […] all the time for every single patient.”

The ministry approved BTNX’s and Assure Tech’s applications on Feb. 19, 2021.

Over the next year and a half, the federal government bought 404 million test kits from BTNX for an estimated $2 billion. Global News’ reporting indicates that this was the biggest order any government placed with any supplier of Assure Tech’s device worldwide.