April 10, 2020


The recent COVID-19 epidemic has changed the world. Will these changes become a permanent part of our lives?

As we all know, COVID-19 is a virus. The usual “antibiotics” have proved to be useless against it, although the “antivirals” (such as Remdesivir) and the anti-inflammatory drug Chloroquine (Hydroxychloroquine) may have some effects.

Viruses and viral epidemics, such as the annual Influenza epidemic and COVID-19, cause deaths in two ways:

  1. Infection with the virus itself, usually from pneumonia.
  2. “Secondary bacterial infection”: Bacteria enter the body of a patient already weakened by the virus.

Viral epidemics, including the annual flu epidemic, tend to see upsweeps in antibiotic prescriptions, with as many as 1/3 of patients with clear influenza symptoms being prescribed antibiotics in some areas – inappropriately, as antibiotics are ineffective against the influenza virus.

Although statistics have yet to emerge from the present COVID-19 epidemic, there is little doubt that the present COVID-19 pandemic will see a similar increase in antibiotic use by physicians. This is based on clear historic precedence.

Antibiotics do carry risks, although many believe they are harmless, such as:

  1. Side effects in as many as 1/3 of patients
  2. Emergence of “resistant bacteria” that cause “Superinfections”
  3. Cost

There is definitely a place for antibiotics during viral pandemics. If antibiotics were prescribed properly and according to Evidence-Based Medicine – Best Practice Guidelines (EBM/BPG), these problems would be manageable. However, quality-control studies show poor adherence to such EBM/BPG:

  • Traditional “In Person” and “Physician Telemedicine” visits adhere to EBM/BPG inconsistently, 59-78% of the time at best, and tend to overprescribe antibiotics at a level of approximately twice the amount that EBM/BPG would recommend.

Artificial Intelligence (AI) Based Platforms offer your clients virtually 100% compliance with EBM/BPG. Benefits to your patients will be:

  1. Better evidence-based care with less side effects
  2. Lower costs for coverers
  3. Less emergence of antibiotics resistant bacteria for society

This is clearly a win-win for everybody!

April 7, 2020 11:00 am


  1. The total number of Cases in Canada to date is 17,063 (15,822 on April 6).
  2. The pandemic has not peaked yet, based on the number of “Daily New Cases”.
  3. Various reports of Computer “modeling” of the COVID pandemic have hit the media in the last few days, frequently presented as “best-case” and “worst-case” scenarios. Medextra believes that any “modeling” is only as accurate as the data fed into it, and currently, there remain too many unknowns about COVID.
  4. Strict preventive measures have now been in place for 2-3 weeks (the time an effect has been seen in other countries); data coming in the next week will be critical in helping to determine the course of the pandemic in Canada.


  1. Late last week, the Center for Disease Control (CDC) in the U.S. reversed its long-time policy of recommending against the wearing of masks in public by persons who do not feel sick. Its website states to “Cover your mouth and nose with a cloth face cover when around others”1:
    • You could spread COVID-19 to others even if you do not feel sick.
    • Everyone should wear a cloth face cover when they have to go out in public, for example to the grocery store or to pick up other necessities.
    • The cloth face cover is meant to protect other people in case you are infected.
    • Do NOT use a facemask meant for a healthcare worker.
    • Continue to keep about 6 feet between yourself and others. The cloth face cover is not a substitute for social distancing.
  2. As face masks are in short supply and frequently prioritized to hospitals, the CDC Website provides information on home-made masks2:
    • CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.
    • CDC also advises the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.
    • Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
    • The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders.
  3. As of the time of this writing, the Government of Canada Website states3:
    • Wearing a non-medical mask (for example a home-made cloth mask) in the community has not been proven to protect the person wearing it. Strict hygiene and public health measures, including frequent hand washing and physical (social) distancing, will reduce your chance of being exposed to the virus.
    • Wearing a non-medical mask is an additional measure you can take to protect others around you.
    • If wearing a non-medical mask makes you feel safer and stops you from touching your nose and mouth, that is also good. But remember not to touch or rub your eyes.
    • It is important to understand that non-medical masks have limitations and need to be used safely.
    • If you choose to use a non-medical face mask:
      • you must wash your hands immediately before putting it on and immediately after taking it off (in addition to practicing good hand hygiene while wearing it)
      • it should fit well (non-gaping)
      • you should not share it with others
  4. Cloth face coverings – Removing, cleaning and general care:
    • Do not touch your eyes, face or nose when removing your face covering.
    • Preferably, remove the cloth covering without touching it, using the string.
    • The cloth covering can be “sterilized” by washing it with the usual detergent in a washing machine on hot cycle. Other laundry can be cleaned at the same time.
    • Wash your hands afterwards.


The mainstays of Workplace Prevention, according to expert opinion, are as follows:

  1. Social distancing
  2. A vigorous hand-washing policy
  3. An active cleaning and disinfection program for public washrooms in the workplace, although the exact risk of bathroom transmission is still being debated but may be more significant than previously thought.

April 3, 2020 11:00 am


  1. The total number of Cases in Canada to date is 11,747 (9,017 on April 1).
  2. Quebec still has the largest number of cases in Canada.
  3. As more data is emerging, it appears that:
    • The disease seems to peak 2-4 weeks after a “substantial number” of cases occur.
    • This is followed by a “decline” over the next four weeks, not necessarily to “zero”, but more to a point where the virus is not considered a major health threat.
    • It’s important to note that different countries have used different strategies, and national comparisons are difficult to make.
  4. Disease activity in Canada is still rising and may not have reached its ‘peak’ yet. This means that it may be early May before we see a decline to levels that, although still worrying, are less of a major public health threat.
  5. It is becoming evident – despite at-times-dire headlines – that most patients infected with Coronavirus will have a relatively mild case of the disease that can be “treated” at home and will recover “uneventfully”:
    • 99% of the 9,064 cases where full data is available are said to be “mild” and only 1% “serious” or “critical”.
    • This data may not include a recent surge of cases in long-term-care units, where elderly patients tend to suffer more severe forms of the illness.


  1. There is speculation in the media that one of the major national infectious disease authorities may change their recommendation about the use of surgical masks by the general public. We have not seen official notice of this but will follow this development closely and keep our clients informed.
  2. Current recommendations relating to masks:
    • Outside of Healthcare Centers, masks are only recommended for infected patients and for their caregivers.
    • Regular handwashing, social distancing and not touching your face remain the mainstays of prevention in the workplace.
    • For those who are required to wear masks at home or elsewhere, proper mask technique is important:
      1. Before putting on a mask, clean hands with alcohol-based hand rub or soap and water for 20 seconds.
      2. Cover mouth and nose with mask and make sure there are no gaps between your face and the mask.
      3. Avoid touching the mask while using it; if you do, clean your hands with alcohol-based hand rub or soap and water.
      4. Replace the mask with a new one as soon as it is damp and do not re-use single-use masks.
      5. To remove the mask: remove it from behind (do not touch the front of mask); discard immediately in a closed bin; clean hands with alcohol-based hand rub or soap and water.
  3. Commercial surgical masks are in short supply. Some groups are 3D-printing masks; others recommend items such as scarves pulled around the face. There is no scientific evidence available as to the effectiveness of these methods.
  4. Public Health Authorities still believe that the best evidence is that:
    “Transmission of the disease requires a ‘significant’ exposure to Covid-19, defined as face-to-face contact within 2 meters of a patient with symptomatic Covid-19, exposure that is sustained for at least a few minutes (some say more than 10 minutes or even 30 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal.”


  1. The criterion for “cure” is ideally two negative Covid-19 tests for the patient, 24 hours apart.
  2. However, in many areas, health-care professionals are overwhelmed, testing is difficult to get, and results are often delayed.
  3. The U.S. Center for Disease Control (CDC) suggests that if testing is not available, the following “non-testing strategy” is safe for ending “home isolation”:
    • The patient has had no fever for at least 72 hours (that is three full days of no fever without the use of medicine that reduces fevers)
    • The patient’s other symptoms have improved (for example, cough or shortness of breath)
    • At least 7 days have passed since the patient’s symptoms first appeared.
  4. Returning employees need to pay special attention to social distancing, handwashing and cough etiquette (cover nose and mouth when coughing or sneezing, dispose of tissues in waste receptacles) for two weeks following return-to-work.
    • Note that each workplace is different, and employers are advised to keep Human Resources aware of the evolving information on ideal policy and interval for safe return to work.