This story is part of CBC Health's Second Opinion, a weekly analysis of health and medical science news emailed to subscribers on Saturday mornings. If you haven't subscribed yet, you can do that by clicking here.
Four years — yes, four whole years — after the virus behind COVID-19 exploded into public consciousness, health-care teams and scientists are tackling a host of pressing health issues that took a backseat during the pandemic.
Around the world, researchers are exploring new applications for groundbreaking CRISPR gene therapy. Scientists are also bracing for the ongoing health impacts of antimicrobial resistance and climate change. And teams of virologists, epidemiologists and physicians are racing to prevent the next pandemic by tracking instances of viral spillover from animals to humans, ranging from well-known threats like bird flu to the looming unknowns of tomorrow.
All the while, Canada's hospital system is in crisis, and drug toxicity deaths keep going up.
Here are the top medical stories CBC health and science reporters will be watching in the year ahead:
The health-care crisis, and how to fix it
A shortage of family doctors is sending more Canadians into emergency rooms. A lack of total hospital beds leaves people sitting in emergency rooms. Nurses, often referred to as the beating heart of the health-care system, are in short supply. And, waitlists for non-life threatening surgeries are far too long.
We know what's broken in Canada's health-care system, but will the changes provinces are making fix those problems? That's what we'll be watching in 2024.
Politicians in Alberta and Quebec are making seismic changes to health care. Both are continuing to embrace an "entrepreneurial vision" to delivering health care, despite evidence showing a "social vision" may be more beneficial. Based on what's been disclosed so far, experts don't think either province will adequately address the real problems and deliver better care.
Manitoba's new premier promised fixes that have some health-care workers feeling more hopeful. We'll continue to watch how that progresses, along with Ontario's bill that's allowing for more publicly covered, private for-profit care.
The federal government is now gathering more data from provinces — hopefully it will reveal what's working, where and why.
Either way, health care in Canada is changing, and it affects all of us. We'll keep you posted.
— Christine Birak and Marcy Cuttler
WATCH | Staff shortages, surgery backlogs plague health-care system:
The ripple effects of record-breaking heat
After a year of record-breaking temperatures, I'll be watching to see how climate change affects the world's population in 2024, and what we do collectively to address the problem.
A major report released last month in The Lancet medical journal projected heat-related deaths, food insecurity and the transmission of infectious diseases will skyrocket by mid-century if we don't limit warming to 1.5 C above pre-industrial levels.
The effects of climate change are already being felt, particularly in the developing world. In Bangladesh, for instance, roughly 300,000 people have been infected with dengue this year, during the country's worst-ever outbreak of the mosquito-transmitted disease. A years-long drought in the Horn of Africa, punctuated by periods of extreme rain, has resulted in an acute food shortage that could bring the region to the brink of famine. That same Lancet report — like so many others this year — stressed the need for an urgent transition away from fossil fuels toward renewable energy.
There are signs those concerns are being taken seriously. For the first time, this year's climate meeting in Dubai included a "Health Day," where doctors stressed the need for urgent action and more public health funding, but the final agreement at COP28 fell short of expectations. 2024 will be pivotal in determining what happens next.
— Ben Shingler
WATCH | Insect-transmitted infections on the rise thanks to climate change:
The rise of drug-resistant infections
I'm following the rise of bacterial infections resistant to antibiotics, as well as efforts to counter them, to keep the cures available to patients. Resistance happens because pathogens like bacteria and fungi evolve to stop responding to drugs meant to kill them, creating superbugs. These infections are hard — even impossible — to treat.
Antimicrobial resistance (AMR) already kills 5,400 a year in Canada, the Public Health Agency of Canada estimates. The problem is forecast to take 256,000 lives in this country by 2050, if we don't make any changes.
As I reported, doctors worry AMR could increase the risk of routine surgeries that often killed people before medications like penicillin. (Penicillin mould naturally stops Staph bacteria from growing. To become a successful drug, though, it had to be purified, scaled up and proven not to harm people.)
That's why I'll be watching as Canadian hospitals and long-term care homes try to prevent resistance with surveillance and hand hygiene. At the same time, scientists are searching for new classes of antibiotics using modern technology.
AMR is a global story, since people around the world need antibiotics. Not helping more populated places is like "mopping the floor with the tap running," as one veterinarian put it.
— Amina Zafar
The toxic — and evolving — drug supply
Canada's toxic drug supply keeps making headlines, as the death toll grows year over year. The situation facing drug users, advocates and experts say, is increasingly horrifying. And it's evolving.
The B.C. Coroners Service says the number of toxic drug deaths is rising faster than expected. Now, the province is averaging about seven toxic drug deaths per day. In Ontario, opioid-related deaths among teens and young adults tripled from 2014 to 2021, while drug treatment rates significantly decreased.
And country-wide, grim new numbers show that between January and June 2023, there were nearly 4,000 opioid-related deaths and close to 40,000 hospitalizations for opioid-related poisonings. Those are the highest numbers reported in the first half of a year since surveillance began in 2016.
So what's the solution? It depends on who you ask. There are heated debates over the best approach, whether that's more harm reduction sites or treatment centres, or as some former drug users say, a combination of both.
In the meantime, Canada's supply is growing more toxic. Earlier this year, Health Canada released a report saying xylazine is now spreading widely across Canada, and Ontario's coroner said the infamous drug has been detected in 184 toxicity deaths since 2020. Dubbed "tranq" when it's mixed with fentanyl, the potentially deadly combination is known for causing users to develop seeping wounds.
We'll be watching for real solutions, because as it stands, tens of thousands of Canadians are dead — people who were artists, parents, athletes or youth workers — and there's no end in sight.
— Lauren Pelley
WATCH | Tranq dope infiltrates Canada's toxic drug supply:
The promise of gene-editing
In November, I covered the U.K.'s approval of the world's first therapy using the gene-editing tool CRISPR. Weeks later, the U.S. announced its approval. Is Canada next?
That's one question I hope we can answer next year.
The promise of gene-editing is a bold one: the power to edit the part of a gene that causes disease and put that fixed gene back into a patient to cure them. The inventors of CRISPR, the technology that can be used to edit genes, won the 2020 Nobel Peace Prize in Chemistry.
The treatment Casgevy was approved for blood disorders, sickle cell anemia and thalassemia. In clinical trials, 97 per cent of sickle cell patients who underwent treatment lived pain-free for up to one year. And for the thalassemia patients who participated, the majority did not need red blood cell transfusion for at least a year afterwards.
It's a potentially life-changing, one-time treatment for people who live with the genetic blood disorders and experience debilitating chronic pain, organ damage and are in and out of hospitals for blood transfusions. Sickle cell disease affects millions of people around the world and is particularly common in people of African or Caribbean descent, while thalassemia affects people of Mediterranean, Asian and Middle Eastern origin.
But there are hurdles.
A big one is cost. The approved therapies run from $2 million to $3 million U.S. per patient. How can the average person afford that? The treatment also requires weeks in hospital, and includes a stem cell transplant and chemotherapy, presenting other significant challenges. And there is a need for long-term health data, which is still being researched.
Still, the potential to improve the quality of life for millions of people around the world is possible. I'll be watching for developments as they unfold and the real-world application and other medical breakthroughs using this game-changing technology.
— Tashauna Reid
WATCH | First-ever approval of gene therapy for sickle cell in U.K.:
The booming business of weight loss drugs
Unless you have been living under a rock — on Mars — chances are you've heard of Ozempic.
2023 was a big year for the diabetes-turned-weight loss drug. It left me wondering, what's in store for Ozempic in 2024?
But first, a look back. This year, Ozempic use exploded in Canada and the medication is running out across the country. So why do you still see so many Ozempic ads when the company can't keep up with demand?
Pharmacists have been told to ration supply, and just last week, Health Canada urged doctors not to prescribe Ozempic to new patients unless there's no alternative. On the practical side, supply is supposed to improve by February, at least according to the manufacturer Novo Nordisk. Then there's Wegovy — essentially the same drug as Ozempic — that's approved specifically for weight loss in Canada but still not available. What's happening with that?
Then there are the side-effects. Canadian research in the Journal of the American Medical Association found the drug could lead to abdominal pain, nausea, vomiting and in rare cases gastroparesis. Health Canada is also reviewing reports that Ozempic and other drugs in the same class may lead to suicidal thoughts.
A whole lot of questions surrounding these drugs — and hopefully some answers in 2024.
— Melanie Glanz
WATCH | Weight-loss drugs under review:
The risks of pathogens spreading from animals — to us
In the summer of 2022, while the world was still grappling with the threat of COVID-19, another curveball hit: Mpox, the disease previously known as monkeypox, suddenly appeared in dozens of countries around the world. The outbreak was unprecedented, and the virus spread quickly through sexual networks, even though it was long thought to transmit mainly through contact with infected animals.
It was a wake-up call — and another grim reminder — that pathogens commonly carried by animals can make the leap to humans at any time, and eventually evolve to spread from human to human. The mpox outbreak, thankfully, fizzled out, but the virus is likely here to stay. What's more worrisome now is what could strike next.
The world is still in the midst of a vicious outbreak of highly pathogenic avian influenza, or in layman's terms, a deadly form of bird flu. It's ravaging an array of bird species, and even killing mammals in droves, including more than 900 sea lions and seals in south Brazil. Human cases are occasionally reported as well, usually among people working closely with poultry. So what happens if bird flu adapts to transmit among humans? Or if another, similarly deadly virus makes that kind of leap?
If that happens, we've got a major, major problem on our hands. It's one scientists are certainly watching for, through global surveillance, on-the-ground sampling of various animal species and even artificial intelligence. Still, predicting the next virus with pandemic potential is a bit like finding a needle in a haystack. There are millions of animal species around the globe, and even more viral and bacterial threats lurking in their bodies. We've got our work cut out for us.
— Lauren Pelley
WATCH | Avian flu strain spreading:
With everyone's attention on COVID-19, these health issues kept festering. Now they demand attention - CBC.ca
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