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Don’t use rapid tests to rule out strep throat, many pharmacists directed

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As efforts to bring $15 rapid strep tests to Canada’s pharmacies continue, the Nova Scotia College of Pharmacists says using them in the absence of a consultation with a physician or nurse practitioner does not meet the “standard of care” for diagnosing strep throat, especially in children. 

The Neighbourhood Pharmacy Association of Canada, a national association representing pharmacy business owners, says the rapid tests can help save patients with sore throats a trip to the doctor’s office and reduce unnecessary antibiotic prescriptions. That’s because many sore throats are caused by viruses, not bacteria, rendering antibiotics useless. 

The association’s members include Shoppers Drug Mart, which started providing the tests about three years ago through pilot projects in the three provinces: Nova Scotia, Alberta and British Columbia.

For the rapid tests, pharmacists take a throat swab and test for Group A streptococcus bacteria (which cause strep throat) on site within minutes. If it comes back positive for strep, they advise the patient to go see a doctor or nurse practitioner for an antibiotic prescription.

If the test comes back negative, the association says, the patient may be able to just go home and rest instead of braving crowded waiting rooms. 

But many pediatric infectious disease specialists say the in-pharmacy tests aren’t accurate enough to rule out strep throat on their own — and it’s risky to miss strep diagnoses in children, because they can suffer from complications.

The Nova Scotia College of Pharmacists shares that concern. In May, it instructed pharmacists in that province to stop doing the rapid strep tests for diagnosis.  

‘It needed to stop’

Rapid strep tests seemed like a good idea when they first arrived, said Beverley Zwicker, registrar of the Nova Scotia College of Pharmacists.

Pharmacists “really saw this as providing a service to people,” she told CBC News. 

But as the tests became more widely available, the college began hearing concerns from children’s health-care providers. They included reports of pediatric patients showing up at a Halifax emergency department with positive strep tests from local pharmacies when they didn’t actually have strep throat, Zwicker said.

When the college looked into the issue further, it determined that having a pharmacist swab a child’s throat to test for strep without a complete medical examination was contrary to the clinical practice guidelines established by the Infectious Diseases Society of America, which are regularly used by health-care providers in Canada. 

Those guidelines say that for children, even a negative rapid strep test should be backed up by a throat “culture” test — which definitively confirms the presence of strep by seeing if it grows in a lab setting from the throat sample. That’s the test doctors routinely use when they suspect strep throat in kids.

So in May, the college “made it very clear to all pharmacists that conducting this test without the patient first having that physical assessment by a physician or nurse practitioner was inappropriate and that it needed to stop,” Zwicker said.  

The Nova Scotia College of Pharmacists issued this notice in May 2018. (Nova Scotia College of Pharmacists)

The point-of-care tests may still have a role to play if pharmacists work in conjunction with doctors and nurse practitioners, she said.

If a doctor examines a patient and believes they have strep throat, for example, they can send the patient to the pharmacy with an antibiotic prescription contingent on the result of the point-of-care test. If it’s positive, the patient can start antibiotics right away, instead of waiting for the results of a traditional “throat culture test,” which is sent to a lab and takes a couple of days.

It’s too early to tell whether doctors and nurse practitioners will use that option, Zwicker said, since the strep throat “season” has just begun.  

Pharmacists do ‘thorough assessment,’ association says

When asked to respond to the concerns expressed by the Nova Scotia College of Pharmacists, the Neighbourhood Pharmacy Association said it agreed “that an assessment of symptoms by a healthcare provider is required prior to determining the appropriateness of the point of care testing” and that pharmacists have “the training and the expertise” required. 

“Pharmacists are healthcare providers and we do perform a thorough assessment of the patient before determining whether to perform the test,” said Sandra Hanna, a practising Toronto-area pharmacist and the association’s vice-president of pharmacy affairs, in an email to CBC News.   

“Like any test there are always certain limitations and pharmacists use their professional judgment when determining whether the test is appropriate for a given patient,” Hanna said. 

“In some circumstances pharmacists would refer to a physician, and age is one of the criteria used in considering the appropriate care plan for a patient.”

But Zwicker told CBC News that the “assessment” Nova Scotia pharmacists were asked to use in conjunction with the rapid strep tests was a questionnaire about symptoms. The college concluded that was not an adequate replacement for the examinations conducted in a doctor’s or nurse practitioner’s office, she said. 

New guidelines for Alberta pharmacists

In Alberta and British Columbia, the colleges governing pharmacy practice have not issued similar directives to Nova Scotia’s. 

However, in an emailed statement to CBC News, Jeff Whissell, deputy registrar of the Alberta College of Pharmacy, said the college had completed new practice standards and guidelines on the use of point-of-care testing in pharmacies to take effect on Jan. 1.  

As consumer demand increases, pharmacists need to understand “the limitations” of rapid strep tests, “especially for children,” he said.  

“If a rapid strep test or any other point of care test produces a negative result, pharmacists should discuss the sensitivity limitations of the test with their patient, and provide appropriate information for the patient on the need for follow-up, including the possibility of consulting with their physician for further investigation.”

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Post-vaccine surge? Michigan’s spring coronavirus case spike close to previous year’s autumn high

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(Natural News) The spike in new Wuhan coronavirus infections recorded in Michigan over the spring is similar to a spike seen during the 2020 fall season. According to a Wall Street Journal analysis, the state’s daily coronavirus case count averaged more than 7,000 for almost two weeks – before taking a slight dip to 6,891 on April 20. This echoed similar figures back in November and December 2020, which saw sharp rises in infections for those two months before plunging.

Back in autumn of last year, Michigan averaged more than 7,000 cases per day for a span of 10 days. New infections dropped slightly, then briefly spiked as the December holidays approached. It then fell to the low 1,000s for the succeeding two months – until ascending again in March.

According to University of Michigan internal medicine professor Dr. Vikas Parekh, the sudden increase in new infections could be attributed to several factors. Among the factors he cited was re-openings, which increased people’s interactions and mobility. Parekh said the loosened restrictions contributed to the spread of the highly contagious U.K. B117 variant.

“As the B117 variant spreads nationally, we will likely see other stats [with] their own surges – although I hope none are as bad as Michigan,” the professor remarked. He continued: “The milestone just tells us we are not yet in the clear, especially as we still have large portions of our population who are not vaccinated yet.”

Parekh also expressed optimism over the lower daily caseloads the Great Lakes State reported. He said he believes both cases and hospitalizations have plateaued and will likely decline soon. The professor commented: “[COVID-19] positivity has been declining now for one week, which is usually a leading indicator of case decline.”

Meanwhile, the state cited younger populations and youth sports, such as basketball, wrestling and hockey, to increase new COVID-19 infections. Because of this, Gov. Gretchen Whitmer called to suspend youth sports and indoor dining in the state. She also exhorted high schools to conduct remote class sessions for two weeks to curb the spread of the pathogen.

Michigan still experienced the spike in cases despite having one of the highest vaccination rates in the country

During the opening stages of the U.S.’s immunization drive against COVID-19, Michigan boasted of having one of the highest vaccination rates nationwide. A report by Bridge Michigan even noted the initial “frenzy for vaccines” that “far exceeded the state’s limited supply.” But things have appeared to turn around for Michigan, as it now struggles to reach the 70 percent vaccination rate needed for herd immunity.

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Scottish mom’s legs turn into a pair of “giant blisters” after first dose of AstraZeneca’s coronavirus vaccine

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(Natural News) Sarah Beuckmann of Glasgow, Scotland, felt a tingling sensation in her legs and noticed a rash flaring up around her ankles a week after getting her first dose of AstraZeneca’s coronavirus (COVID-19) vaccine on March 18.

She also had flu-like symptoms right after the vaccination.

Beuckmann called her doctor to arrange an appointment the morning she noticed the rash, but by the afternoon her skin was already breaking out into blood-filled blisters. Blisters also appeared on her legs, hands, face, arms and bottom.

“I ended up asking my husband to take me to A&E,” said Beuckmann, referring to “accident and emergency,” the equivalent of an emergency room (ER). “When I got there, my heart rate was sitting at 160bpm, which they were very concerned about. I got put on an ECG machine.”

Doctors determine AstraZeneca’s COVID-19 vaccine triggers the rash

Medics carried out tests for HIV, herpes and other skin conditions to work out what triggered the rash, but all results came back negative. Doctors finally determined that the vaccine caused her rare reaction after carrying out two biopsies.

“Once they found that it was a reaction to the vaccine, they put me on steroids and that really seems to be helping my progress,” said Beuckmann. She had been advised by her doctor not to get the second dose of AstraZeneca’s COVID-19 vaccine because of her reaction.

Beuckmann spent 16 days at Queen Elizabeth University Hospital. She was discharged to recover at home. The 34-year-old mother of one is currently wheelchair-bound due to the bandages on her legs and blisters on the soles of her feet. She may need physiotherapy to help strengthen her leg muscles.

“They are starting to heal and they’re looking a lot better than they were but as the blisters started to get worse, they all sort of merged together,” she said. “I didn’t know what was going on.”

With the blisters merging, her legs have looked like a pair of “giant blisters.” Beuckmann admitted that at one point she feared her legs might have to be amputated.

Dermatologist agrees COVID-19 vaccine causes the blisters

Dr. Emma Wedgeworth, a consultant dermatologist and spokeswoman at the British Skin Foundation, agreed that Beuckmann had likely suffered a reaction to the vaccine.

“Vaccines are designed to activate the immune system. Occasionally people will have quite dramatic activation of their immune systems which, as happened in this case, can manifest in their skin” Wedgeworth told MailOnline. “This poor lady had a very severe reaction, which thankfully is extremely rare.”

It is not clear why Beuckmann, who works in retail, was invited for a vaccine. Scotland’s vaccine rollout was focused on people over the age of 50 when she got vaccinated, although vaccines are available to those who are considered at risk from the virus, or live with someone considered vulnerable.

At least 20 million Briton have had AstraZeneca’s COVID-19 vaccine, which drug regulators say causes a rash in one percent of cases. They say rashes caused by the jab tend to go away within a week.

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Trojan labs? Chinese biotech company offers to build COVID testing labs in six states

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In 2012, BGI acquired Complete Genomics, a DNA sequencing company and equipment maker. The funds for the $117.6 million purchase were raised from Chinese venture capitals. The company has expanded its footprint globally. According to its website, BGI conducts business in more than 100 countries and areas and has 11 offices and labs in the U.S.

People are concerned about China’s access to American DNA data

Some said that with Complete Genomics providing an American base, BGI would have access to more DNA samples from Americans, helping it compile a huge database of genetic information. Some also worried about the protection of the genetic information’s privacy.

According to a 2019 report from the U.S.–China Economic and Security Review Commission (USCC), BGI “has formed numerous partnerships with U.S. healthcare providers and research organizations to provide large-scale genetic sequencing to support medical research efforts,”

There are three main reasons why many people in the biotech community and government have expressed concerns about China’s access to American DNA data.

In the “60 Minutes” interview, Evanina discussed the very likely scenario in which Chinese companies would be able to micro-target American individuals and offer customized preventative solutions based on their DNA.

Evanina asked: “Do we want to have another nation systematically eliminate our healthcare services? Are we okay with that as a nation?”

The second concern is that China may use DNA to track and attack American individuals. As the USCC report states: “China could target vulnerabilities in specific individuals brought to light by genomic data or health records. Individuals targeted in such attacks would likely be strategically identified persons, such as diplomats, politicians, high-ranking federal officials or military leadership.”

The third concern is that China may devise bioweapons to target non-Asians. Steven Mosher, president of the Population Research Institute, discussed it in his article “What Will China Do With Your DNA?” published by The Epoch Times in March 2019.

He wrote: “We know that the Asian genome is genetically distinct from the Caucasian and African in many ways. … Would it be possible to bioengineer a very virulent version of, say, smallpox, that was easily transmitted, fatal to other races, but to which the Chinese enjoyed a natural immunity? … Given our present ability to manipulate genomes, if such a bio-weapon can be imagined, it can probably – given enough time and resources – be realized.”

An article from Technocracy said: “China’s aggressive collection of American DNA should be doubly alarming because it can only spell one ultimate outcome: biowarfare. That is, genetically engineering viruses or other diseases that will be selectively harmful to U.S. populations.”

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