The clock is ticking on your civic duty. Canadians have once again been tasked with completing the Census, which has been required by law since 1871 when the first Canadian Census was taken. But if you’re wondering if you can just conveniently “forget” to fill out the questionnaire this time, don’t. Statistics Canada has a very precise way of counting the procrastinators within the population, too. Just like Santa, they know who’s been naughty and who’s been nice when it comes to helping the nation build a profile of its people. More to the point, they have your contact information and aren’t afraid to follow up.

Get the scoop from a Census representative on what the penalties are for leaving StatsCan on read.

Can I go to jail if I don’t fill out the Census?

Not anymore, says Geoff Bowlby, director general of the 2021 Census and Population at Statistics Canada. “It’s possible to be fined but the jail part has been removed from the Statistics Act,” Bowlby explains. That crucial change happened right before the previous Census was conducted in 2016. Nowadays, failure to complete the questionnaire could land you with a $500 fine as well as a criminal record.

Why is it a legal obligation to fill out the Census?

“Because it’s a fundamental piece of the statistical infrastructure of the nation,” says Bowlby. The numbers gathered by the Census influence decision-making across a broad spectrum, from municipal and federal governments to the private sector, he explains. “For example, one is the required use of the Census under the Federal-Provincial Fiscal Arrangements Act. This act is what determines how the federal government provides funding to the provinces and territories for various health and social programs and allocation of that funding is on a per capita basis, which means per person and based on the census population counts.”

In terms of recent practical applications, consider this: Census data was used to determine how much COVID-19 vaccine Canada bought.

If I don’t fill out the form, I can expect a knock on my door in June, right?

“That’s right,” confirms Bowlby. “We only go to homes where we haven’t received a questionnaire.” This year, enumerators will be equipped with PPE, including double-masks and hand sanitizer, and are instructed to maintain social distancing.

However, the follow-up at the doorstep is relatively rare. “In 2016, we had a 98.4 per cent response rate. We expect nine out of ten homes in the country will respond on the Internet or on paper.”

What happens if I refuse to open the door or tell the enumerator to scram?

If Statistics Canada doesn’t get a response at all, even after following up, they’ll pass the information on to the Public Prosecution Service of Canada (PPSC), says Bowlby. Once a case is referred to the PPSC, the decision to impose a fine and the ultimate outcome of the case rest exclusively with the PPSC.

I got the short form questionnaire. Why didn’t I get the long one like my neighbour?

Blame chance. “It’s a random allocation,” says Bowlby. For every 100 dwellings, 25 will get the long form and 75 will get the short form.”

This is the first Census undertaken during a pandemic year. What’s different as a result?

“We drew up our plans to ensure this is a safe Census and also an accurate Census,” says Bowlby. The most significant change is that the online questionnaire is now available to all Canadians, with a paper version available upon request. “It doesn’t matter if you’re in St. John’s or Victoria, you can respond to the Census online as long as you have an Internet connection,” Bowlby says.

Next, find out the strangest fact about every Canadian province and territory.

The important role of the brake booster

The brake booster plays an important role in stopping a car equipped with disc brakes. Located under the hood, the device delivers additional force to the brakes and assists in stopping your vehicle. Without it, stopping distances would increase dramatically, putting the driver and passengers at greater risk of collision during an emergency stop.

Inside the brake booster, two chambers, separated by a diaphragm, experience a similar drop in pressure as air rushing into the engine, through the air intake, creates a vacuum. Engaging the brake pedal opens a valve and air is drawn into one side of the booster. This allows the vacuum, present on the other side, to pull on the diaphragm. A rod, attached to the brake pedal assembly, runs through the centre of the diaphragm on its way to the master cylinder piston.

As the rod transfers the force applied to the brake pedal, the diaphragm also pulls on the rod and increases the force against the master cylinder piston. The combined force slows the car quickly and easily. By releasing the brake pedal, the valve closes and the system returns to balance.

If you recognize the following bad brake booster symptoms, take action immediately—don’t ignore them. They indicate that your car has become unsafe to drive. (Here’s what it could mean when your brake light comes on.)

Stiff brake pedal action

A bad brake booster makes the brake pedal much harder to depress. As the booster fails, it loses its ability to provide additional force against the master cylinder piston. The driver of the vehicle must now provide all of the braking power—a difficult task.

Increased braking distance

Sometimes a brake booster will fail gradually, making the decline in performance harder to notice. If you feel like you must brake earlier than you should to come to a stop, have the brakes checked. If the pads and rotors look good, the cause could be the brake booster. (Check out these DIY brake tips to improve performance and extend wear.)

High brake pedal position

Along with the stiffer resistance of the brake pedal under pressure, you may also notice the pedal “travels” less than normal when the brakes are engaged. With the booster chambers out of balance, pedal return may be slower than normal.

Poor engine function

A hole in the diaphragm allows the booster to draw air into the induction system. This situation can effect the fuel mix in the engine because of the booster’s connection to the main air intake. In newer, fuel-injected vehicles, this results in reduced fuel economy because the computer compensates for the difference. In older cars, brake booster failure may cause the engine to run lean with insufficient fuel in the cylinder.

Without the full cooling action of the proper measure of gas, friction increases and the temperature of engine parts rise, leading to pre-ignition (the fuel ignites before the spark plug fires). This might be heard as pinging, or felt as a loss of engine power. Allowed to continue, pre-ignition can lead to burnt valves or piston damage, requiring a costly repair. (Learn what to do when your engine is knocking.)

Test your brake booster

Starting with the engine off, pump the brakes several times. Brake booster design allows the mechanism to hold enough vacuum to engage the brakes once or twice without the engine running. This helps you stop the vehicle in the case of engine failure.

Next, press on the brake pedal lightly while starting the engine. You should feel the pedal give a bit and then firm up. If it becomes hard or if you feel no change at all, then the brake booster has failed.

Next, check out the ultimate roadside emergency guide to be prepared for any situation.

It’s been a while since blood clots last made the news. In the mid-’90s, doctors raised the alarm about a connection between blood clots and oral contraception. Known as The Pill Scare, reports that new higher-dose formulations of oral contraception increased the risk of venous thromboembolism (VTE) prompted many women to switch brands or stop using oral contraception all together.

Recently, blood clots are back in the headlines because of reports of a very small number of cases associated with the AstraZeneca and Johnson & Johnson vaccines for COVID-19.

What are blood clots?

Far from being a bad thing, clotting is one of the body’s natural, life-saving processes.

“Your body intrinsically has a clotting system and a blood thinning system, and they work in balance,” explains Dr. James Douketis, Professor of Medicine and Chair in Thromboembolic Disease at McMaster University in Hamilton, Ont.

Cut your finger on a piece of glass and your body kicks into clot mode to stop the bleeding. Tiny blood cells called platelets rush to the scene and begin to stick together. A chemical reaction is then initiated in which a clot is formed, and the process of repair begins. Eventually, a reverse chemical process occurs to dissolve the clot. Normally, a blood clot will dissolve on its own.

When the body’s natural clotting and blood thinning system is out of balance, however, you bleed when you shouldn’t or form blood clots when you shouldn’t—and that can be a problem.

How do you get a dangerous blood clot?

Three factors can influence the development of a blood clot, says Douketis. They are injury to a blood vessel, poor blood circulation or biochemical changes to the blood that predispose you to clotting.

Cancer, recent surgery or an existing medical condition are all factors that are associated with elevated risk of developing a blood clot. Pregnancy heightens the risk for blood clots for women as does the use of oral contraceptives, to about five times more than normal and between two to four times more, respectively. (Contraceptive patches and rings also have elevated risks.)

With age comes a greater risk of developing a blood clot. About one in 1,000 adults over the age of 45 will develop a blood clot each year, says Douketis. For younger people, the risk is lower and hovers around one in 10,000 each year.

The most common spot to get a blood clot is in the legs, which is known as deep vein thromboembolism (DVT). DVT has the potential to see particles from that clot travel through the bloodstream to the blood vessels in the lungs and create a blockage (known as pulmonary embolism), a far more serious clot.

Clots can also cause heart attacks and strokes.

“The way most heart attacks start is that you have a fatty deposit in the wall of an artery, [part of] that fatty deposit cracks and the body thinks, ‘Oh, there’s a cut! I’d better clot.’ It forms a clot, blocks the artery and you have a heart attack,” explains Dr. Harry Rakowski, a cardiologist at the Peter Munk Cardiac Centre in Toronto.

A blood clot that causes heart attack or stroke can develop over a period of years, whereas a blood clot in the venous system of the leg or groin can spring up suddenly over a period of days.

How do you treat blood clots?

How you get a blood clot—what Douketis calls the “disease process” of the clot—can affect how it is treated.

For example, aspirin is sometimes used as a treatment for clots related to heart attack and stroke. Other clots may be treated with anti-coagulant drugs (a.k.a. blood thinners).

What’s different about the blood clots associated with the AstraZeneca vaccine from other types of blood clots? 

The blood clots associated with the AstraZeneca vaccine are known as vaccine-induced immune thrombotic thrombocytopenia (VITT). The main difference between these blood clots and “garden variety” blood clots, says Douketis, is the way they develop.

These clots are not linked to traditional risk factors but appear to be the result of a rare but abnormal immune response to one component of the vaccine’s adenovirus vector or immune response trigger, explains Douketis.

The AstraZeneca vaccine uses a weakened version of a common cold virus (adenovirus) that contains the genetic material of the now-familiar SARS-CoV-2 virus spike protein to prime the immune system to fight the virus.

It’s the same technology used in the Johnson & Johnson vaccine, which has also been associated with a small number of rare blood clot reactions.  (The U.S. resumed use of the Johnson & Johnson vaccine in late April after 15 reported cases of blood clots occurred out of eight million doses administered. On May 3, Canada’s National Advisory Committee on Immunization (NACI) deemed the vaccine safe for use in people 30 and over if they can’t wait for mRNA COVID-19 vaccines, which NACI admits to preferentially preferring.)

It’s not clear what component of the vaccine’s vector causes VITT, but the reaction is essentially an abnormal immune response that activates the platelets, the tiny blood cells that help the body form clots, that then sets off a dramatic clotting response within the body. Clots can form in the veins and arteries, and even the brain.

Rakowksi likens this “idiosyncratic” reaction to a similar drug-induced clotting condition known as heparin-induced thrombocytopenia (HIT). (Heparin is an anti-coagulant, and in around 5 per cent of patients taking it, it triggers a similar adverse clotting response in the body.)

The kind of clotting associated with this adverse reaction, however, can be more serious because it can cause clots to form in many places and can cause a cerebral venous sinus thrombosis (CSVT), or brain clot.

What’s the risk of getting a blood clot with the AstraZeneca vaccine for COVID-19?

While the clots can be serious, the incidents of these complications are rare and occur in approximately 1 in 100,000 people, according to the European Medicines Agency, which paused use of the vaccine to investigate adverse reaction reports in early March (the agency deemed the vaccine safe, arguing its benefits to all age groups outweighed its small risk to VITT shortly after).

As of April 29, more than 2.3 million doses of AstraZeneca have been administered in Canada. In total, only seven cases of blood clots have been reported. In Ontario, there have been three reported cases among over 700,000 vaccinations; in Quebec, where more than 500,000 AstraZeneca vaccines have been administered, there have been three cases reported by the province’s health ministry. Of the three, one was fatal.

What is the treatment for VITT?

The unique process by which the clots develop, however, means that treatment needs to be specific, too. Douketis speculates that the high rates of mortality related to this reaction in Europe where the vaccine was initially given, may have had a lot to do with evolving understanding of the reaction itself. Doctors may have assumed the clots could be treated with blood thinners immediately, an unintentional error that may have accelerated the clotting process.

“This is a very unusual type of blood clot and has to be treated in a very different way,” he explains.

The current thinking is that before the clots can be treated, the hyperactive immune response needs to be dealt with.

“The frontline treatment is anti-immune medications to suppress or put down the fire and the blood thinners clean things up, in a manner of speaking, by helping the body melt away the existing blood clots.”

The necessity of specific intervention makes awareness of the symptoms of VITT vital. This rare but serious reaction tends to occur within four to 30 days of vaccination and can include:

• Severe headache
• Visual changes
• Abdominal pain
• Leg pain or swelling
• Easy bruising or bleeding
• Nausea and vomiting
• Back pain
• Shortness of breath

Should those symptoms present themselves and linger after the normal 24- to 48-hour window associated with regular vaccination reactions such as fever or muscle aches, immediate medical attention is advised.

Rakowski points out that a blood test to determine platelet count taken five to seven days after vaccination could help identify VITT, though it may not be a cost-effective approach given the small risk of developing clots.

The nature of the rare adverse reaction means most people, even if they have a history of blood clots, do not have increased risk of blood clot if they take the AZ vaccine. (People who have a history of brain clots, however, are advised to take another vaccine.)

How should Canadians weigh the risks and benefits of the AstraZeneca vaccine?

The risk of hospitalization and death from COVID-19 currently outweigh the comparatively minimal risk of experiencing a rare adverse event due to vaccination. As Douketis points out, COVID-19 itself presents a heightened risk for developing serious blood clots in the lungs.

More than 24,000 Canadians have died from COVID-19 since the pandemic began. While age is associated with an increased risk for the most serious outcomes, rates of severe illness have increased in the third wave, particularly among those aged 40 to 59, while those aged 20 to 39 account for highest cases overall.

In addition to potentially reducing transmission rates, vaccination appears to confer some protection against developing the more serious complications that can result from COVID-19 infection.

Risk-to-reward ratios are at the centre of every public health measure, from speed limits to oral contraception. They also form a fairly common personal basis for decisions that individuals make on a daily basis, says Rakowski. While concerns around vaccines should not be dismissed, he says those concerns should be vetted within the context of the pressing and significant threat of COVID-19.

“Take the first vaccine offered to you because the benefits outweigh the risk right now,” says Rakowski.

Next, find out what you can (and can’t) do after getting your first dose of the COVID-19 vaccine.