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Is it strep throat? Pharmacies say they could give you the answer and maybe save a trip to the doctor

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‘Tis the season for colds, flu and sore throats. And anguishing over whether you — or your child — need to go to the doctor. Maybe it’s better to stay in bed — but what if it’s strep throat and antibiotics are required?

In three Canadian provinces (B.C., Alberta and Nova Scotia), you can walk into some pharmacies and get a rapid « point-of-care » strep throat test.

The pharmacist takes a throat swab, and within a few minutes, tells you whether it tested positive or negative for group A streptococcus — the bacteria that cause strep throat.

Now pharmacy owners want that test to be available across the country.

It’s a quick and easy way, they say, to confirm whether a sore throat is caused by strep bacteria or by a virus.

That’s important because only about a third of sore throats in children between five and 15 years old are caused by strep. The rest of the time it’s usually a virus, in which case antibiotics won’t do any good and shouldn’t be prescribed. 

So if the test comes back positive for strep, the pharmacist will advise you to go to the doctor and get the appropriate prescription. In Alberta, you could get the antibiotic right away, as pharmacists have prescribing authority in that province.

If the test comes back negative, « you may just need fluid and rest, which a pharmacist could advise you on, » said Sandra Hanna, vice-president of pharmacy affairs for the Neighbourhood Pharmacy Association of Canada and a pharmacist in the Toronto area.

« In the majority of cases, an antibiotic … would not be required, because it’s a viral sore throat, » she said.

Since about two-thirds of sore throats are viral and antibiotics shouldn’t be prescribed, ruling out strep infections in a pharmacy setting can help save patients unnecessary trips to the doctor’s office, says Sandra Hanna, vice-president of pharmacy affairs for the Neighbourhood Pharmacy Association of Canada and a practising pharmacist. (Neighbourhood Pharmacy Association of Canada)

The test, which costs patients about $15, allows people « to determine whether they need to go to the doctor or not, » Hanna said.

That, in turn, could help prevent the unnecessary antibiotic prescriptions which contribute to antibiotic resistance, she said.

For all those reasons, the association, which represents pharmacies (including chains such as Shoppers Drug Mart and mass merchandisers with pharmacy services such as Costco and Walmart), says strep point-of-care testing should be available across the country, and is currently lobbying to start it in Ontario.

Sounds great, right?

Not so fast, say infectious disease specialists.

When it comes to kids, point-of-care tests (also called rapid antigen tests) shouldn’t be used on their own to rule out strep throat, said Dr. Jeffrey Pernica, head of the Division of Pediatric Infectious Disease at McMaster University in Hamilton, Ont.

« These tests that they’re talking about don’t work well enough to be reliable in children. And children are the ones who are the most at risk from complications of strep throat, like rheumatic fever. And they’re the ones who get strep throat the most, » he said.

(For adults, strep throat is less common.)

When doctors suspect a patient has strep throat, they usually do a throat swab and send it off to a lab for a « throat culture test, » where the sample is left for a day or two to see if it grows into strep bacteria.

Dr. Jeffrey Pernica, head of the division of pediatric infectious disease at McMaster University, says he understands the appeal of rapid strep tests, but they shouldn’t be used in isolation when it comes to ruling out strep throat in children. (McMaster University)

That’s the « gold standard diagnostic test » for strep throat, according to the U.S. Centers for Disease Control and Prevention.

It’s also the accepted medical guideline for treating strep throat in children, said Dr. Jonathan Gubbay, a Toronto pediatrician specializing in infectious disease, as well as a medical microbiologist for Public Health Ontario.

Gubbay actually uses a point-of-care test in his clinic when he suspects a child has strep throat because he can get the result back in five or 10 minutes. If it’s positive, he can start antibiotic treatment right away.

But if it’s negative, he sends a sample to the lab for the culture test to make sure the point-of-care test wasn’t a false reading.

It’s important to make sure a strep diagnosis isn’t missed in children, Gubbay said, because although rare, it can progress into an invasive form of the disease or heighten the risk of rheumatic fever, which can damage the heart and joints.

« The sensitivity [of rapid tests] isn’t as good as we’d like, » he said.

So how reliable are they? It depends on who you ask.

The Neighbourhood Pharmacy Association says the point-of-care tests are accurate more than 90 per cent of the time. But both Gubbay and Pernica say that’s unlikely.

Dr. Jonathan Gubbay, deputy chief of medical microbiology at Public Health Ontario and a pediatric infectious disease physician, says a comprehensive physical exam of a child with a sore throat can sometimes rule out strep throat without requiring a swab at all. (Public Health Ontario)

Although studies that show such high accuracy do exist (including those cited by test manufacturers themselves), the doctors say a broader look at the research puts the number closer to 70 per cent.

Dr. Lynora Saxinger, an infectious disease specialist at the University of Alberta, also questions whether point-of-care tests are as accurate as they claim to be.

« There are lots of tests that are licensed and the packages always tell you that they’re fantastic. In the real world, they vary a lot, » she said.

Both Saxinger and Gubbay also point out that diagnosing strep goes beyond the throat swab — regardless of how the results are processed, because physicians and nurse practitioners do complete physical exams. In many cases, they’re able to rule out strep throat without even doing a swab — a level of diagnosis they’re not sure all pharmacists are equipped to provide.

But Hanna said in the provinces where point-of-care tests are in place, pharmacists do have comprehensive conversations with patients — and also guard against missed strep diagnoses.

« Tests that show a negative result in patients where the pharmacist strongly suspected them of having strep throat, based on their symptoms, were referred to a physician for further evaluation, » she said.

The manufacturers of point-of-care tests, including those for strep throat, ‘always tell you that they’re fantastic. In the real world, they vary a lot [in accuracy],’ says Dr. Lynora Saxinger, an infectious disease specialist at the University of Alberta. (University of Alberta)

The in-pharmacy tests could also save the health-care system money, the Neighbourhood Pharmacy Association says, citing a study published in the Canadian Pharmacists Journal in August. It concluded the pharmacy-based treatment saved an average of $12.47 to $24.36 per patient.

However, the study did not account for the fact that patients pay about $15 out-of-pocket for the strep test — and it was funded by Loblaw Companies Limited, which runs pharmacies and owns the Shoppers Drug Mart chain.

That raises questions for Pernica about how impartial the findings are.

« There’s a clear incentive for the drug stores to get people [in], » he said. « Because if they have strep throat, they’ve done them a service. If they don’t have strep throat, they’re still there. And I think that people will be walking out of those drug stores with cough and cold remedies. »

Regardless, Pernica said he understand the appeal of the pharmacy-based tests for patients.

« Pharmacists will make a good point in saying that sometimes it’s hard to get in to see your doctor or nurse and it’s sometimes easier for people to access pharmacies. I completely agree with that, » he said.

But he’s not convinced there’s enough independent research to back up the claims that false negatives aren’t happening — or even that there’s a cost-saving to the health-care system.

« I’m not sure of the data yet, » said Pernica. « Will people actually get treated more appropriately faster? Will the overall costs be lower? I think these are answers we don’t have yet. »


This is an excerpt from Second Opinion, a weekly roundup of eclectic and under-the-radar health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.

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Anglais

‘Business as usual’ for Dorel Industries after terminating go-private deal

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MONTREAL — Dorel Industries Inc. says it will continue to pursue its business strategy going forward after terminating an agreement to go private after discussions with shareholders.

« Moving ahead. Business as usual, » a spokesman for the company said in an email on Monday.

A group led by Cerberus Capital Management had previously agreed to buy outstanding shares of Dorel for $16 apiece, except for shares owned by the family that controls the company’s multiple-voting shares.

But Dorel chief executive Martin Schwartz said the Montreal-based maker of car seats, strollers, bicycles and home furniture pulled the plug on a deal on the eve of Tuesday’s special meeting after reviewing votes from shareholders.

“Independent shareholders have clearly expressed their confidence in Dorel’s future and the greater potential for Dorel as a public entity, » he said in a news release.

Dorel’s board of directors, with Martin Schwartz, Alan Schwartz, Jeffrey Schwartz and Jeff Segel recused, unanimously approved the deal’s termination upon the recommendation of a special committee.

The transaction required approval by two-thirds of the votes cast, and more than 50 per cent of the votes cast by non-family shareholders.

Schwartz said enhancing shareholder value remains a top priority while it stays focused on growing its brands, which include Schwinn and Mongoose bikes, Safety 1st-brand car seats and DHP Furniture.

Dorel said the move to end the go-private deal was mutual, despite the funds’ increased purchase price offer earlier this year.

It said there is no break fee applicable in this case.

Montreal-based investment firm Letko, Brosseau & Associates Inc. and San Diego’s Brandes Investment Partners LP, which together control more than 19 per cent of Dorel’s outstanding class B subordinate shares voiced their opposition to the amended offer, which was increased from the initial Nov. 2 offer of $14.50 per share.

« We believe that several minority shareholders shared our opinion, » said Letko vice-president Stephane Lebrun, during a phone interview.

« We are confident of the long-term potential of the company and we have confidence in the managers in place.”

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Anglais

Pandemic funds helping Montreal businesses build for a better tomorrow

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Many entrepreneurs have had to tap into government loans during the pandemic, at first just to survive, but now some are using the money to better prepare their businesses for the post-COVID future.

One of those businesses is Del Friscos, a popular family restaurant in Dollard-des-Ormeaux that, like many Montreal-area restaurants, has had to adapt from a sit-down establishment to one that takes orders online for takeout or delivery.

“It was hard going from totally in-house seating,” said Del Friscos co-owner Terry Konstas. “We didn’t have an in-house delivery system, which we quickly added. There were so many of our employees that were laid off that wanted to work so we adapted to a delivery system and added platforms like Uber and DoorDash.”

Helping them through the transition were emergency grants and low-interest loans from the federal and provincial governments, some of which are directly administered by PME MTL, a non-profit business-development organization established to assist the island’s small and medium-sized businesses.

Konstas said he had never even heard of PME MTL until a customer told him about them and when he got in touch, he discovered there were many government programs available to help his business get through the downturn and build for the future. “They’ve been very helpful right from day one,” said Konstas.

“We used some of the funds to catch up on our suppliers and our rents, the part that wasn’t covered from the federal side, and we used some of it for our new virtual concepts,” he said, referring to a virtual kitchen model which the restaurant has since adopted.

The virtual kitchen lets them create completely different menu items from the casual American Italian dishes that Del Friscos is known for and market them under different restaurant brand names. Under the Prasinó Soup & Salad banner, they sell healthy Greek options and their Stallone’s Sub Shop brand offers hearty sandwiches, yet the food from both is created in the same Del Friscos kitchen.

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Anglais

Downtown Montreal office, retail vacancies continue to rise

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Some of downtown Montreal’s key economic indicators are heading in the wrong direction.

Office and retail vacancies in the city’s central core continued to climb in the fourth quarter of 2020, according to a quarterly report released Thursday by the Urban Development Institute of Quebec and the Montréal Centre-Ville merchants association. The report, whose first edition was published in October, aims to paint a socio-economic picture of the downtown area.

The survey also found office space available for sublet had increased during the fourth quarter, which may foreshadow even more vacancies when leases expire. On the residential front, condo sales fell as new listings soared — a sign that the downtown area may be losing some of its appeal to homeowners.

“It’s impossible not to be preoccupied by the rapid increase in office vacancies,” Jean-Marc Fournier, the former Quebec politician who now heads the UDI, said Thursday in an interview.

Still, with COVID-19 vaccinations set to accelerate in the coming months, “the economic picture is bound to improve,” he said. “People will start returning downtown. It’s much too early to say the office market is going to disappear.”

Public health measures implemented since the start of the pandemic almost a year ago — such as caps on office capacity — have deprived downtown Montreal of more than 500,000 workers and students. A mere 4,163 university and CEGEP students attended in-person classes in the second quarter, the most recent period for which figures are available. Border closures and travel restrictions have also brought tourism to a standstill, hurting hotels and thousands of local businesses.

Seventy per cent of downtown workers carried out their professional activities at home more than three days a week during the fourth quarter, the report said, citing an online survey of 1,000 Montreal-area residents conducted last month.

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