From Alzheimer’s Drugs to Long COVID, the Top Health Stories of 2022
This year we were flummoxed about exactly what was happening with infectious diseases, with the outbreak of another respiratory virus and long COVID-19. Photo: DrAfter123/Getty Images
This was a year when pharmaceutical and biotech research made significant advances — a new tool for early diagnosis of pancreatic cancer, progress with immunotherapy in treating cancer, the first gene therapy for hemophilia, a cure for sleeping sickness, a drug to potentially treat Alzheimer’s disease.
But it was also a year when physicians and patients alike were flummoxed about exactly what was happening with infectious diseases, with the outbreak of another respiratory virus and the challenge of mysterious long COVID-19 and its likely link to cardiovascular deaths.
Notably, 2022 was a year when health care accessibility — family physicians, hospital emergency departments, pediatric ICUs — became personally distressing and politically challenging.
Still No Breathing Easy
Two years after COVID became part of our everyday vocabulary, another acronym entered the conversation in 2022.
RSV stands for respiratory syncytial virus, which is typically experienced as a cold or mild flu by children during the fall and winter months. But it can be dangerous for infants and toddlers, and for adults with chronic heart or lung disease and people over the age of 65.
And that’s exactly what happened this year when an unusually large outbreak of the disease brought heightened awareness of RSV. No longer could we assume that a cold was just a cold. Could it be COVID, RSV or seasonal flu? There was talk of a “twindemic” or even a “tripledemic” and the challenge of comorbidities: two or more viral or bacterial diseases at the same time.
“I’m expecting a rough season ahead, particularly for older people,” Sinai Health geriatrician Dr. Samir Sinha told the Globe and Mail in November. “We are worried this year that we are going to see a record number of older adults get exposed to RSV,” he said. There is already “a growing number” of adults admitted to hospital for RSV, along with influenza and COVID-19, Sinha said.
Earlier, an informal grass roots coalition of parents, educators and health-care professionals were campaigning for the return of mask mandates as fall and school began, but Canadian health authorities settled on recommendations instead of mandates.
Meanwhile, another infectious disease made a menacing reappearance in 2022. In July, the World Health Organization (WHO) Director General issued a statement declaring that the global monkeypox outbreak represents a public health emergency of international concern.
As of late November, there were 1,456 cases of the disease in Canada. Monkeypox can be accompanied by flu-like symptoms, but is characterized by a rash that may be painful or itchy and form scabs before healing.
Recently, the WHO said it would start using “mpox” as a synonym for monkeypox and urged others to follow suit after receiving complaints that the current name for the disease was racist and stigmatizing. “Both names will be used simultaneously for one year while ‘monkeypox’ is phased out,” the global health organization said.
COVID-19 Is/Is Not Over; Long COVID Is a Concern. So Is Neuro-COVID and Clotting.
Coming up to the 2022 Christmas holidays, case counts of COVID-19, positivity per cent and hospital use by COVID-19 patients were decreasing in Canada, with a continued decline in COVID-19 deaths.
Nevertheless, the weekly rate of COVID-19 patients either hospitalized or admitted to ICU remained highest among people aged 60 and older. As well, there’s evidence that the top BA.5 lineages, which have been stable over recent weeks, are declining, with clinical sequencing showing steady increases in immune evasive variants BQ.1, BQ. 1.1 and BF.7.
But the biggest news about the disease in 2022, once the peaks of case counts started flattening, has been concern over “long COVID” or post-COVID syndrome. According to data from Statistics Canada, approximately 14.8 per cent of COVID-19 patients suffer from symptoms at least three months after an infection. These symptoms can fade within months or persist for years after an infection, and can even disappear only to reappear later. They can occur in both unvaccinated people and people vaccinated against COVID-19.
The U.S. Centers for Disease Control and Prevention report that most patients’ symptoms slowly improve with time. The list of symptoms is long — more than 100, according to Health Canada. The most common symptoms include fatigue, memory problems, sleep disturbances, shortness of breath, anxiety and depression, general pain and discomfort, difficulty thinking or concentrating and post-traumatic stress disorder, though some patients suffer from other neurological, vascular, pulmonary and cardiac complications.
A new word coined in 2022 is neuro-COVID, referring to neurological complications. “The virus triggers such a strong inflammatory response in the body that it spills over to the central nervous system,” explained University of Basel researcher Gregor Hutter in ScienceDaily. “This can disrupt the cellular integrity of the brain.” Researchers also identified excessive activation of the immune cells specifically responsible for the brain — the microglia.
There’s also been great and increasing concern about post-COVID cardiac complications and deaths. According to Nature, researchers found that people who had had COVID faced substantially increased risks for 20 cardiovascular conditions — including potentially catastrophic problems such as heart attacks and strokes — in the year after infection with the coronavirus. Researchers say that these complications can happen even in people who seem to have completely recovered from a mild infection.
One of the most serious complications of COVID-19 infection is the risk of developing dangerous blood clots in the veins and arteries, advises the British Heart Foundation. Research published in September 2022 showed that people who caught COVID-19 during the first wave of the pandemic (when vaccines were not yet available) had an increased risk of developing a blood clot for almost a year after infection.
The research, looking at the health records of 48 million people registered to a GP practice in England and Wales, found that in the first week after a COVID-19 diagnosis, the risk of conditions caused by blood clots in the arteries, such as a heart attack or stroke, was 21 times (2,100 per cent) higher compared to people without a COVID-19 diagnosis. By six months to a year after diagnosis, the risk had gone back down, although remained higher than before the diagnosis — a 1.3 times (30 per cent) increase in risk.
Researchers also looked at other conditions that are caused by blood clots in the veins, such as deep vein thrombosis (DVT) and pulmonary embolism (a blood clot in a lung). The risk of blood clots in the veins was found to be 33 times (3,300 per cent) higher in the week after a COVID-19 infection compared to people without a COVID-19 diagnosis, dropping to 1.8 times (80 per cent) higher after 26 to 49 weeks.
Drug Therapy Breakthroughs — At a Cost
The first gene therapy to treat people with hemophilia B, an inherited blood-clotting disorder, was approved by the U.S. Federal Drug Administration. The one-time treatment, called hemgenix, became the world’s most expensive drug, costing US$3.5 million per dose. Queen Victoria of England is believed to have been the carrier of hemophilia B. She passed the trait on to three of her nine children. It is expected that the drug will be submitted for review by Health Canada in mid-2023, advised the Canadian Hemophiliac Society. Marketing approval could come as early as late 2023 or early 2024. Decisions on reimbursement would follow.
Another gene therapy is in development for Huntington’s disease, a rare, genetic disease that causes the progressive breakdown of nerve cells in the brain. AMT-130, was generally well-tolerated and led to reductions in the levels of mutant protein a year after treatment, according to an update from an ongoing trial reported by uniQure.
In October, Health Canada approved nubeqar (darolutamide), an androgen receptor inhibitor drug for metastatic, hormone-sensitive prostate cancer after research published in March in the New England Journal of Medicine showed that darolutamide, in combination with docetaxel plus androgen deprivation therapy (ADT), demonstrated a 32.5 per cent reduction in the risk of death compared to ADT plus docetaxel.
The first precision treatment for certain kinds of prostate cancer that combines a targeting compound (ligand) with a radioactive particle was approved in September by Health Canada. After being injected into the bloodstream, pluvicto binds to target cells, including prostate cancer cells that express PSMA, a transmembrane protein. Once attached, energy emissions from the radioisotope damage the target cells and nearby cells disrupting their ability to replicate and/or triggering cell death.
A single dose of a drug called acoziborole was found to be 95 per cent effective in patients with severe sleeping sickness, and 100 per cent effective in those diagnosed early, The Lancet reported in November. The results have been described as a major breakthrough, as previous treatments have been complicated and costly, with long hospital stays and invasive procedures. Sleeping sickness is spread by tsetse flies. The disease can cause disruption of sleep patterns, uncontrollable aggression and psychosis and can be fatal without treatment.
New Drug for Alzheimer’s
“The first drug to slow the destruction of the brain in Alzheimer’s has been heralded as momentous, declared the BBC in November. “The research breakthrough ends decades of failure and shows a new era of drugs to treat Alzheimer’s — the most common form of dementia — is possible.”
The positive result of a clinical trial of monoclonal antibody drug lecanemab was published in the New England Journal of Medicine at the end of November.
Nevertheless, the NEJM cautioned that lecanemab has only a small effect and was associated with adverse events, including two deaths. As well, the drug works only in the early stages of the disease, not at later stages when Alzheimer’s is most often diagnosed.
“The numbers are the best that I have yet seen for such an antibody, and at the same time I doubt if the drug will actually make a difference in the treatment of Alzheimer’s,” wrote drug expert Derek Lowe in Science magazine.
The Lancet was also circumspect: “Whether lecanemab is the game changer that some have suggested remains to be seen.”
Another monoclonal antibody drug for Alzheimer’s, aducanumab, was approved by the U.S. Federal Drug Administration last year under the brand name Adulhelm. But physicians have been split over whether clinical trial data proved that the monoclonal antibody actually does slow cognitive decline, reported CNBC, and sales for the drug were low.
In June, drug-maker Biogen withdrew aducanumab from review with Health Canada. This decision followed an indication from Health Canada that Biogen’s data was not sufficient to support marketing authorization, according to the Alzheimer Society of Canada.
New Off-Label Way to Weigh Way Less
While heavily advertised Ozempic and Wegovy, brand name semaglutide drugs for Type 2 diabetes, have been getting a lot of attention and use this year as off-label weight loss drugs, a new injectable drug for treating Type 2 diabetes promises to be an even bigger game changer for weight loss.
Eli Lilly’s tirzepatide was approved in the U.S. in May 2022, where it’s sold at pharmacies under the brand name Mounjaro. The drug is currently awaiting approval by Health Canada.
The difference in weight loss achieved between the drug recipients and the control group was dramatic.
On the highest dose (15 mg), participants saw average weight reductions of 22.5 per cent of their body weight (24 kg or 52 lb), while the 10 mg dose achieved 21.4 per cent weight loss (22 kg or 49 lb), and 5 mg saw a 16 per cent body weight reduction (16 kg or 35 lb).
Tirzepatide is the same class of drugs as semaglutide. But in a trial last year, tirzepatide outperformed semaglutide in diabetic patients. The really exciting news, wrote Dr. Christopher Labos in May, is that the preliminary results of another trial suggested that even in patients without diabetes, tirzepatide resulted in a remarkable average weight loss of 52 lb over 72 weeks. “Such profound weight loss, if borne out in the final publication, would be massively impressive,” he predicted.
Canadians Lose Confidence in Health Care
All across Canada, it was the same story in 2022: lack of access to family physicians, up to 12-hours waits in emergency rooms, patients treated in busy corridors, cancellations of children’s surgeries because of overcrowded pediatric ICUs.
“Ontario’s health care system is in crisis, and that includes family doctors,” said OCFP President-Elect Dr. Mekalai Kumanan in September. “The family doctor shortage will be felt by all, regardless of where we live in Ontario.”
As well, Canadian hospitals “are straining to care for an influx of sick children, many with respiratory illnesses, in the midst of staffing constraints and as a shortage of children’s over-the-counter medication sends more kids to hospital,” reported Reuters.
Results of an international 2022 Ipsos survey asking people to rate the quality of health care “that you and your family have access to in your country” showed that only 54 per cent of Canada respondents agreed it was “very good,” with Canadians ranking 17th, behind Great Britain, the U.S. and Malaysia, among others.
Reversing Aging, Treating Aging, Improving the Lives of Older Women
In March, researchers at the Salk Institute In California reported using cellular rejuvenation to reverse signs of aging in mice without any increase in cancer or other health problems later on.
The anti-aging regimen, developed with Genentech, a division of Roche, safely and effectively reversed the aging process in middle-aged and elderly mice by partially resetting their cells to more youthful states.
“We are elated that we can use this approach across the lifespan to slow down aging in normal animals,” said study author Juan Carlos Izpisua Belmonte. The technique is also expected to be used as a tool to restore tissue and organs.
The year 2022 began with the launch in January of California’s Alto Labs, with a US$3 billion initial commitment. The new biotech company has been described as a “disease-reversal” company by StatNews, that aims to “battle disease by reprogramming the fundamental machinery of living cells.” The goal of Altos, said CEO Dr. Hal Barron, is to “reimagine medical treatments where reversing disease for patients of any age is possible.” Cellular rejuvenation expert Belmonte has also joined the company.
Meanwhile, closer to home, Women’s College Hospital in Toronto announced in September the launch of the Women’s Age Lab, the first and only centre of its kind in the world, dedicated to addressing the health inequities faced by older women. The goal of the Women’s Age Lab: “to improve the lives of older women using science to transform care and practice, ultimately driving the health system and social change.” The lab will focus on four key areas: gendered ageism; reimagining aging in place and congregate care; optimizing therapies; and promoting social connectedness.
Artificial Intelligence Arrives at the Bedside
Patients are 20 per cent less likely to die of sepsis because a new AI system developed at Johns Hopkins University catches symptoms hours earlier than traditional methods. The early warning system scours medical records and clinical notes to identify patients at risk of life-threatening complications, according to ScienceDaily. The research, which could significantly cut patient mortality from one of the top causes of hospital deaths worldwide, was published in July in Nature Medicine.
“It is the first instance where AI is implemented at the bedside, used by thousands of providers, and where we’re seeing lives saved,” study author Suchi Saria told ScienceDaily. “This is an extraordinary leap that will save thousands of sepsis patients annually. And the approach is now being applied to improve outcomes in other important problem areas beyond sepsis.” Sepsis occurs when an infection triggers a chain reaction throughout the body. About one in 18 deaths in Canada involves sepsis, according to Statcan. Deaths from sepsis are highest among older people.
Alberta Pioneers Legal Psychedelic Therapy
In October, the Alberta government announced that it would be the first Canadian province or territory to regulate psychedelic drugs for therapeutic use. These include psilocybin (the active ingredient in magic mushrooms), MDMA (an amphetamine also called ecstasy or molly), mescaline (peyote) and ketamine.
Alberta’s new regulations go into effect on Jan. 16, 2023.
Providers are required to apply for a license before treating patients with psychedelics for mental health disorders, and a psychiatrist would have to oversee any treatment. The drugs are still illegal in Canada, although physicians and researchers are permitted to apply to Health Canada for permission to use psychedelics in clinical research or provide special access to patients for therapeutic use.
The regulations are less restrictive for ketamine and doses of other drugs too low to cause psychedelic effects.
There are currently clinics in Toronto, Vancouver and Fredericton that provide ketamine therapy to treat depression and anxiety. Ronan Levy, CEO of Field Trip Health & Wellness, which operates the ketamine clinics, told CBC News, “For the first time anywhere, people will have access to legal, doctor-supervised psychedelics and psychedelic-assisted therapies across just about all classic psychedelics.
“This is a tectonic shift in the cultural relevance and awareness of psychedelics, and is almost certainly a major catalyst for both legal and regulatory change in the industry. Almost certainly other jurisdictions will follow suit.”
As well, in July, Toronto’s Centre for Addiction and Mental Health (CAMH) received the first-ever federal grant to study whether the active component in magic mushrooms can be used to treat depression without the psychedelic effect.
More Concern About Mental Health, MAiD Changes Are Coming
In 2022, for the first time, mental health is a higher health concern globally than cancer, according to the Ipsos Global Health Service Monitor. It’s the second-greatest health concern now, after COVID-19.
In Canada, an Angus Reid survey reported in March that 54 per cent of Canadians said their mental health had worsened during the past two years. Women fared worse than men with almost two out of three (63 per cent) of women aged 35 to 54 reporting worsening mental health.
Meanwhile, as 2022 winds down, attention is focusing on the upcoming and controversial change in the Medical Assistance in Dying Act (MAiD). On March 17, the act will allow people whose sole underlying medical condition is mental illness to be eligible for an assisted death.
MAiD became legal in 2016 for people with terminal illnesses such as cancer. Last year, the law was changed to include non-terminal physical conditions such as chronic pain. Mental illness was excluded until an expert panel of psychiatrists came up with safeguards. These were recommended in May of 2022, reported CTV News.
Just as for physical illnesses, Canadians with mental disorders will need to show “grievous and irremediable” illness, suggesting their mental condition was incurable, with an advanced state of decline and intolerable suffering.
Two assessors need to confirm the request. And the patient must be found to be competent to make the decision, with a minimum 90-day assessment period before death is provided.