CBC: How the head of critical care in London sees this ‘brutal virus’

CBC: How the head of critical care in London sees this ‘brutal virus’

Dr. Wael Haddara is a Chair Chief of Critical Care Medicine at the London Health Science Centre. (Wael Haddara)

There are more people than ever before being treated for COVID-19 in intensive care units across Ontario.

No one knows what that looks like or its implications better than London Health Sciences Centre’s Chair Chief of Critical Care Medicine, Dr. Wael Haddara. He spoke with London Morning guest host Allison Devereaux.

Q: What is the situation at Victoria Hospital and at University Hospital? 

We’re seeing an increase in numbers, along with the rest of the region and the province. We’re not as hard hit as some other hospitals, but the pattern has certainly been very alarming with the increase in admissions over the last two weeks or so.

Q: What have your days been like since the second wave hit?

They’ve been long and challenging. You know, we deal with the sickest of patients in the ICU. And so the entire team in the ICU, nurses, physicians or therapists, pharmacists, social workers. You know, we have to continue to coordinate for the care of the patients, often in full PPE garb. And so that makes for very long and difficult days.

Q: Can you elaborate on that a little bit more? How are the challenges related to a COVID-19 illness different from what you would normally see in the ICU? 

Sure. So, you know, this is a brutal virus. Some people, as you know, are entirely asymptomatic with the virus, and that’s how they pass it on to other people. But a subset of people, it hits them very, very hard. And for many of us in intensive care, it’s unlike anything that we’ve seen before in terms of how sick people get and how quickly they deteriorate. So it feels like you’re almost always playing catch up to the disease. Some of the traditional things that we do in ICU don’t quite work for these patients. Some of the ways that we traditionally, say ventilate patients, don’t seem to do much good for patients who are severely hit. And so we cycle through a lot of different ways of managing and treating patients until we find the one thing that works for a particular person.

Q: How do you deal with the anxiety that you or someone in your family could contract it? 

This is a challenge that I think all of us deal with. We try to deal with it in in the professional way that we’re trained to. You focus on what you can do. You focus on good infection control habits. People are obsessive about washing their hands, changing their clothes when they get home. If they’ve had an exposure, they report early and make sure that they’re monitoring themselves for symptoms. But it weighs on you for sure.

Q: Should the lockdown have started sooner? 

It’s certain that the numbers have been going up for a number of days, and I think many people have been calling for a lockdown earlier. But I don’t want to make light of how difficult a decision this is. There’s obviously disease transmission, but there’s people’s mental health, particularly over Christmas, and the sense of social isolation that can be very real for some people. And then, of course, there’s the economic side of things. So I would have liked to see a lockdown earlier but I think we have to understand that for the government, this is an exceedingly difficult decision.

Q: What message do you have for Londoners who question the seriousness of COVID-19? 

My message is to say, we have done so well for so long, you know, nine long and agonizing months. We need to barrel through this, you know, for the next eight weeks before the weather gets better and we can get outside and socially distance. Let’s try and reach within ourselves to find the resilience. It’s only a short period of time.

This interview has been edited for length and clarity.

Original Link: https://www.cbc.ca/news/canada/london/how-the-head-of-critical-care-in-london-sees-this-brutal-virus-1.5852884

CTV News: Case counts not the only measure of COVID-19 severity, say London doctors

CTV News: Case counts not the only measure of COVID-19 severity, say London doctors

Left Dr. Robert Arntfield, right Dr. Wael Haddara.

LONDON, ONT — While it may be human nature to grow increasingly concerned over the rising positive COVID-19 case counts in Ontario, a pair of London’s top intensive care unit physicians say it’s not the only measure we should be looking at. Far from it, in fact.

Thursday saw yet another day north of 400 as far as positive cases in Ontario, but such numbers are not unexpected, says Dr. Robert Arntfield.

“If we increase socialization, if we engage with one another, we put people back in schools the cases going up is not a mystery or surprise. In many respects it’s not even news in my opinion, it’s expected.”

Dr. Arntfield is the medical director of the intensive care unit at Victoria Hospital, London Health Sciences Centre.

He says rather than just case counts, a more complete measure of covid-19 severity is hospitalization rates and deaths.

“Other countries that have seen really big second wave numbers, a lot in Europe, have seen a really different response in terms of hospitalizations and deaths. They have not seen the same magnitude. There certainly is a magnitude and there is an importance to that, but it is not anywhere near the same level that we saw back in the early wave.”

As of Thursday there were fewer than 100 COVID-19 hospitalizations in all of Ontario, and in London there have been none in the past week according to Dr. Wael Haddara, the Chair of Critical Care at LHSC.

He says if that changes, intensive care units are far better prepared than in spring.

“We have a very robust plan in place in terms of IC beds, creating capacity to accommodate patients if we need to. So we’re hoping for the best but preparing for the worst.”

And while it’s a message that’s heard time and again, both doctors continue to stress that how well we follow social distancing rules will go a long way to determining how we fare during this second wave of infections.

According to the Ministry of Health and Long Term Care, people under the age of 40 account for roughly two-thirds of the most recent cases. While their hospitalization rates are much lower than older demographics, it’s still a major concern says Dr. Haddara.

“The challenge is that younger people don’t and should not to exist in a bubble from the rest of society. And so as younger people encounter older people the rates of hospitalization will be very similar to what we saw in the spring. No man is an island.”

Original Link: https://london.ctvnews.ca/case-counts-not-the-only-measure-of-covid-19-severity-say-london-doctors-1.5118646

Global News: Returning students could cause COVID-19 infections to double in University towns: New study finds

Global News: Returning students could cause COVID-19 infections to double in University towns: New study finds

A new research study from Western University researchers says that returning students in university towns could double the number of COVID-19 infections.

The study by researcher and lead author Lauren Cipriano, associate professor of management science at Ivey Business School, who is also cross-appointed to the department of epidemiology and biostatistics at Schulich School of Medicine & Dentistry, projects that the return of university students can lead to a doubling of infections over a single semester in mid-sized communities with previously low levels of COVID-19 activity.

The new research paper, “Impact of university re-opening on total community COVID-19 burden”, said more than two-thirds of infections attributable to the return of university students occur in the general population, leading to increased COVID-19 hospitalizations and death.

Cipriano said the findings are important for making public health decisions and suggests that mass screening and high-frequency testing of students can make a significant difference.

While screening the student population frequently may be challenging, the study argues a one-time mass screening event at the end of September would help identify and isolate a large fraction of asymptotic infections in the student population to reduce community infection.

“We know a third of cases are asymptomatic and as we move into a younger demographic more people are asymptomatic, and it’s important to identify those people not necessarily for their own health information but testing for prevention,” Cipriano said.

“The choices communities make around what types of businesses to open, diligent masking, and the amount of physical, social interaction will determine the feasibility of maintaining essential activities like in-person primary and secondary education and continued access to elective surgeries.”

The research, funded by the Western University Catalyst Research Grant and a grant through Johns Hopkins University, uses a model of COVID-19 transmission and hospital resource utilization in London.

“Fortunately, university students are an identifiable high-transmission group, and our research shows that even a one-time mass screening event early in the term can identify asymptomatic infections and influence the transmission trajectory,” Cipriano said.

As of Tuesday, at least half the 49 cases reported over the last week involved Western University students. At least two outbreaks declared by the health unit last week were associated with Western students.

One outbreak, declared in the wake of a large house party last weekend, has been linked to at least 17 cases, while another, “Western Student Outbreak Alpha,” has also left at least 17 people infected.

At least two COVID-19 cases reported in the area are Fanshawe College student.

Cipriano said they modelled the study off of what is happening in London but said the work represents a lot of midsized cities with large college and university populations across North America.

The model looks at the number of infections expected in the university student population, the general population, and long-term care residents, with and without the return of the student population. It also incorporated people’s responses as numbers increase and hospitals gain more patients also taking into account the COVID-19 mortality in the community.

“We have a limited opportunity to make a significant difference in the course that this virus will take in our community, and the time for a coordinated mitigation event is now,” says Dr. Wael Haddara, study co-author and chair and chief of critical care medicine at London Health Sciences Centre.

Haddara said they hope they can build on the strong partnerships that are already in place between the city, university, public health, primary care, long-term care, and the hospitals to bring evidence-informed mass screening solutions to practise.

Original Link: https://globalnews.ca/news/7352758/covid-19-infection-rates-university-college-students/

The National Post: ‘Optimism tinged with anxiety’: What to expect from the next 100 days of COVID-19, according to experts

The National Post: ‘Optimism tinged with anxiety’: What to expect from the next 100 days of COVID-19, according to experts

‘What’s keeping you awake at night?’ That’s the question we put to doctors, scientists, philosophers, psychologists, futurists, microbiologists and bioethicists

On a dreaded second wave:

“I look at the next 100 days with optimism tinged with anxiety. What keeps me up at night is that, as the memory of the catastrophic events in Spain, Italy and N.Y.C. fades, people will take this disease lightly. We are seeing resurgences of the virus in places like Beijing and some U.S. states, and Canada is not immune from that. But until we have a vaccine we have to be vigilant as a population.” — Dr. Wael Haddara, chair/chief of critical care medicine at London Health Sciences Centre

Original Link: https://nationalpost.com/health/optimism-tinged-with-anxiety-what-to-expect-from-the-next-100-days-of-covid-19-according-to-experts

Aljazeera: Is Another Revolution Brewing In Egypt?

Aljazeera: Is Another Revolution Brewing In Egypt?

In a speech marking the Prophet Muhammad’s birthday last month, Egyptian President Abdel Fattah el-Sisi warned critics not to hold protests on January 25, the fifth anniversary on the 2011 popular uprising, saying a new revolt could destroy the country.

“Why am I hearing calls for another revolution? Why do you want to ruin [Egypt]? I came by your will and your choice, and not despite it,” Sisi told the hand-picked audience of politicians, media pundits and members of Egypt’s newly elected parliament.

Sisi’s words, greeted by a roar of applause, revealed the regime’s fears that another popular uprising may be brewing.

As Egypt nears the fifth anniversary of the uprising that ended three decades of Hosni Mubarak’s rule, analysts and activists say the regime is imposing a “reign of terror” to deter people from marking the day. Security forces have stepped up their crackdown on activists: On January 7, police arrested three administrators of Facebook pages allegedly promoting anti-government protests on January 25. Four journalists, along with members of the April 6 Youth Movement, have also been arrested.

In addition, earlier this week, security forces conducted mass searches of flats, primarily in downtown Cairo near Tahrir Square, the heart of the 2011 protests. Hundreds of Egyptian revolutionaries and regime opponents are already behind bars, and the religious establishment has described those calling for a new round of January 25 protests as “weak believers who carry extremist ideas”.

“The spirit of the January uprising continues to pose a threat to the regime, despite the fact that none of the known revolutionary forces actually called for protests, to my knowledge,” Khalil al-Anani, a political science professor at the Doha Institute, told Al Jazeera.

While it is difficult to predict when uprisings will take place and in what form, the regime’s concerns do not seem entirely imaginary, analysts say.

“There is likely just as much support today for an uprising as there was on January 25, 2011,” Wael Haddara, a former adviser to Egypt’s deposed President Mohamed Morsi, told Al Jazeera. The social and economic grievances that led to the 2011 uprising are present in ways quite similar to 2010, Haddara added.

Other analysts concurred, citing a raft or problems in Egypt today: a worse dictatorship than before the 2011 uprising, brutal police practices, the targeting of activists and journalists by security forces, a deteriorating economic situation, and a newly elected parliament that is dominated by pro-government figures.

The very fact that there is widespread speculation about the likelihood of a popular uprising tell us how unstable Egypt is.

Wael Haddara, former adviser to Egypt’s deposed President Mohamed Morsi

“While the Egyptian state of 2010 was brutal in some ways, that of 2015 is far more so,” said Michele Dunn, the director and a senior associate with the Middle East programme at the Carnegie Endowment. The government has succeeded to some extent in rebuilding “the wall of fear between citizens and the state”, Dunn told Al Jazeera.

But with a spate of industrial actions picking up steam in recent weeks, coupled with an increase in “the mass of unemployed”and simmering popular discontent over the widening gap between what Egyptians were promised and what has been delivered to them, analysts say the regime has reason to worry.

“The conditions are certainly in place for another wave of popular uprising,” Haddara said. “The very fact that there is widespread speculation about the likelihood of a popular uprising tells us how unstable Egypt is.”

Although street protests have all but dried up in Egypt since an anti-protest law was passed in November 2013, popular unrest has not completely burned out.

Last August, thousands of public sector workers took to the streets in one of the biggest street actions since July 2013, when a military coup led by Sisi deposed Morsi. The workers were protesting against the civil service law issued last March, which they say negatively affects up to seven million civil servants by decreasing their income, increasing the managerial powers of administrators and introducing regulations that threaten basic workers’ rights.

Gilbert Achqar, author of the book The People Want, noted that Egypt’s 2011 uprising came after five years of significant developments in the struggle of Egyptian workers. “The wave of labour strikes was instrumental in precipitating Mubarak’s downfall. Whether Sisi will face the same fate is a big question,” Achqar told Al Jazeera.

On January 9, Democracy Meter, an NGO that monitors the Egyptian labour movement, issued its annual report on Egyptian industrial actions, citing 1,117 labour protests throughout 2015 – an average of around three each day.

Another cause of concern for the regime is the wave of public anger that has followed a number of recent deaths in police stations. Over the past two months, thousands of citizens have taken to the streets in Luxor and Ismailia governorates to protest against the killings of Talaat Shabib and Afify Hosny, reportedly tortured to death by police.Incidents of police brutality and the ensuing lack of accountability were among the driving forces behind the 2011 uprising.

The simmering unrest in Egypt today indicates that the public sphere has yet to be brought completely under military and police control, analysts say.

“Securing popular support, or at least ending widespread discontent, is necessary for the construction of a military-backed regime under Sisi,” said Amr Adly, a senior researcher at the Beirut-based Carnegie Middle East Center.

Some observers, however, prescribe caution, suggesting that fears of a repeat of 2011 are overblown. While the anniversary of the uprising remains an open wound in the view of many Egyptians, the fissures and schisms that divide the disparate factions, whose unity once made history in Tahrir Square, appear beyond mending, as they still suffer from a lack of leadership and vision.

“It is unlikely that the generals’ dominance will be met with the kind of unified challenge that toppled Mubarak,” one analyst told Al Jazeera on condition of anonymity.

Still, there are continuing calls for another revolution.

Late last year, an unknown group of activists issued a call for demonstrations on the revolution’s anniversary through a Facebook event, to which at least 50,000 people registered their attendance. Another group advocating an uprising against the Sisi regime initiated the hashtag #WeAreBackToTheSquare, while others have used the hashtag #IParticipatedInTheJanuary25Revolution.

If public opinion turns against Sisi after two years of his rule without economic improvements, more turmoil in the form of another popular uprising and another military coup could well be in the cards.

Michele Dunn, director and senior associate with the Middle East programme at the Carnegie Endowment

An organiser of the Facebook event told a local news website that “reclaiming the revolution” was among the group’s goals. But other activists were sceptical, saying they did not expect this anniversary to be any different from the last one, and predicting that it would be mainly characterised by demonstrations of small numbers of people and random arrests.

The problem with calls for another revolution is that they are abstract and not based on any political organisation, Khaled Abdel Hamid, a leftist activist who participated in January 25 uprising, told the local website Mada Masr.

“Revolutionary groups need to organise themselves, learn lessons from previous years, and reach a consensus on the form, methods and the slogans necessary to face the counter-revolution, which is a difficult matter and needs time,” he said.

Egypt’s shift from a full revolution to the nearly complete restitution of the pre-revolutionary regime is “Mubarakism without Mubarak”, Adly noted.

“The old state-dominated system with the same socioeconomic biases and autocratic leaning has been reborn under the guise of a new military-supported dictatorship,” Adly said in a study of the economics of Egypt’s rising authoritarian order. “How successful that is will depend in large part on the economic policies that Sisi’s government enacts.”

While the economic situation in Egypt today is crucial, there are other factors at play. The reconstitution of Mubarak-style rule is unlikely to be durable for many years, considering Egypt’s restive youthful population and the dim economic outlook, Dunn said.

“If public opinion turns against Sisi after two years of his rule without economic improvements, more turmoil in the form of another popular uprising and another military coup could well be in the cards,” Dunn said.

According to Haddara, the two barriers that fell during the 2011 uprising were fear and expectations of violent repression.

“In 2015, those same elements [fear and violent repression] will determine whether an uprising happens,” he said. “Will a critical mass of Egyptians overcome the psychological fear of brutalisation, and if so, will the army respond with mass violence?”

Original Link: https://www.aljazeera.com/news/2016/01/160122114637805.html

UofT Faculty of Law: Egypt and The Struggle for Democracy: An Interview with Dr. Wael Haddara

UofT Faculty of Law: Egypt and The Struggle for Democracy: An Interview with Dr. Wael Haddara

By Zacharia al Khatib, 

Dr. Wael Haddara is the Medical Director of the Medical-Surgical Intensive Care Unit at the University Hospital in London, Ontario. In 2012-2013, he served as a senior advisor to President Mohammed Morsi, Egypt’s first democratically elected president. After the military coup of 2013, Dr. Haddara returned to Canada.

Major news networks, including the New York Times, have sought Dr. Haddara’s commentary and insight into the political and social circumstances of the Middle East. He generously agreed to be inter- viewed about his experiences for Rights Review.

How did you find yourself working as an aide to President Morsi?

It was quite accidental and came about mainly because I knew two individuals – Dr. Esam Haddad and Khaled Al-Qazzaz, a University of Toronto alumnus. Khaled had recently completed graduate training at U of T. During his time he had become involved in public outreach and bridge building between the Muslim community and wider society. Post-9/11, a number of us had the same desire to reach out, and so we took media training and became point people for media contacts in our respective communities. Khaled and I both played that role.

Khaled’s time in Canada was transformative. He was always a passionate person, but he brought a newly discovered passion for education and societal development back with him to Egypt. Returning to Egypt, he changed careers from engineering to education and opened a school with his wife.

When the revolution broke in January 2011, Khaled was in Tahrir Square from day one. When the Muslim Brotherhood formed a new political party open to all Egyptians, the Freedom and Justice Party (FJP), Khaled was recommended as a media liaison. He eventually was chosen as the No. 2 man in the Foreign Relations Committee. Mohammad Morsi was the Chair of the FJP at the time, and when he became the FJP’s nominee for President, Khaled moved to his presidential campaign. I had gone back to Egypt at the time of the elections, and through Khaled was asked if I would advise the President on communication and media. We met, hit it off, and when he won the election he asked me to join him as part of the presidential team.

It was not something I had ever planned for. I’m politically aware and keep up with local, national and international politics, but I had never envisioned myself in that realm. It was, however, an incredible chance to do outreach and narrow the understanding gap between the East and West.

Which accomplishment of the elected Egyptian government are you most proud?

Hands down, it is that we were able to sustain an atmosphere of openness and freedom during our year in office. The first act President Morsi took was to abolish pre-trial detention for journalists. In Egypt, prior to President Morsi, a journalist could (and often would) be jailed while awaiting investigation and trial whereas non-journalists could not be jailed until convicted. President Morsi abolished this intimidation mechanism and I was one of the people who helped convince him this was a key move for Egypt early on.

The President’s response to Israel’s attack on Gaza in the fall of 2012 was also something of which we were all proud. I was not involved in those negotiations, but it was a hectic period with then-US Secretary of State Hillary Clinton shuttling back and forth between the Egyptian, Palestinian and Israeli sides. The President demonstrated, for possibly the first time in recent memory, principled but pragmatic Egyptian foreign policy.

Many Canadians are unfamiliar with the current state of affairs in Egypt, and why it might be important here. What would you say in response?

There is an old saying that “if you have not seen Egypt, you have not seen the world.” For various historic, social, geopolitical and cultural reasons, Egypt has the capacity to inspire millions of people around the world. Egypt is the seat of the Coptic Church, the oldest Church in Christendom. It is also the seat of Al-Azhar, the oldest Islamic institution of learning.

Historically, as Egypt goes, so does the Middle East and also the broader Islamic world. Because of the decline in Egypt’s standing over the past 50 years, her regional and global influence diminished. But all it took was the revolution of 2011 to see hope alive again in so many people within, and well beyond, Egypt’s borders. During my travels in 2011-2013, it became normal for people in airports from Kuala Lumpur to Istanbul to Paris to tell me that their hopes are pinned on Egypt for a new renaissance in the Middle East.

With its vast population (close to 100 million people) and natural resources, Egypt is also an important economic player. It is set to become one of the key economies in the upcoming years. It can be a true link and bridge between East and West.

We repeat the mantra ceaselessly that we now live in a global village. It is more than a mantra: it is a reality. Egypt is central to our village. If Egyptians can develop a model of democratic, inclusive governance that is true to their culture and faith, Egypt can be an important stabilizer in a world that needs stability and peace. Alternately, if the Egyptian experiment in “government by the people” perishes, then Egypt will become a huge source of instability. And in a global village, instability spreads quickly. So there is a lot more at stake here than just what’s happening in one country in the Middle East.

What kind of trajectory do you foresee for this situation (or the Middle East more broadly), in light of what is happening in Egypt?

Unfortunately, I think that the most likely trajectory for the Middle East is more conflict. We have two large groupings – one represented by old power structures and their beneficiaries (oligarchs, regional and international businesses) and the other represented by ordinary citizens in groups like the FJP, labour unions, and student groups.

For the past 70+ years, most people in the Middle East were content to allow the older power structures to dominate life – social, political, economic and cultural – in the hope that things would improve eventually. These authorities promised change through nationalism, pan-Arabism, socialism and various ideologies.

Here in 2015, people have realized the total failure of those regimes to bring about a better life for their citizens and people are fed up. They want freedom and dignity, as well as better living conditions and economic opportunities.

What happened in Egypt was not only the overthrow of a democratically elected president but a full counter-revolution that brought back an even more repressive statist system. This time around, the people are not taking it lying down. We see this struggle in different forms across almost all countries of the Middle East, and so we will either have a South Africa moment – the emergence of a Frederik Willem de Klerk who can negotiate the end of repression and convince the old guard to share power, or we will see more violent confrontation erupt.

If you could give Canadian law students some advice, what would it be?

Pay close attention to the Middle East. Lots will happen there in the next few years and the Middle East will continue to have an important effect on the rest of the world.

The other piece of advice is to develop a near-sacred respect for the rule of law. This principle should be cherished and guarded because it is the only true guarantee of a free society. Not all laws are correct, or even moral. But the rule of law is the only way through which a just society can be organized. 

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