April 8, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
Provincial 4-week stay at home order (click here)
Premiere Ford has issued a provincewide stay-at-home order which is in effect as of Thursday, April 8, at 12:01 a.m. The goal of this measure is to stop the rise in COVID-19 infections due to various mutant viruses in efforts to ensure that our hospitals do not become so full that we cannot provide lifesaving care. The stay home order also allows us time to distribute vaccines (which is THE key to ending the pandemic). The next 4 weeks will be challenging; however, we have done this before and we can do it again! Here is a list of what is allowed (and what is not allowed). Each of us needs to do our part.
- All patients admitted to KHSC will undergo Covid-19 testing and all people entering the hospital will be required to wear medical grade masks.
- Ontario Website now open to book vaccines for people over age 55 (initially):https://covid-19.ontario.ca/book-vaccine/ (click here).
- Universal masking: All patients and visitors to KHSC will be provided with medical masks at the doors of KHSC (to replace their cloth masks upon entry).
1) Who is COVID really affecting? (and why aren’t they being vaccinated):
3) Pfizer COVID-19 vaccine 100% effective in children (age 12 and older) (click here)
4) COVID-19 Vaccines have a strong safety record (and yet there remains Vaccine Hesitancy): After 5 million vaccinations in Canada there have been the 2,859 individual reports of vaccine side effect (0.06%), only 384 side effects were serious (0.008% of all doses administered) and no one died! (click here)
5) World vaccine roll-out tops 710 million people (click here)! Real world evidence that vaccination is safe and effective.
6) All about COVID-19 Vaccines: Updated FAQs about vaccination: New FAQ Does one dose of vaccine provide protection from COVID-19? Short answer: yes (within 2 weeks).
7) KFL&A COVID-19 rates rise by 81 cases since last Monday and there are 341 active cases in our part of SE Ontario: consequences of a high rate of variant viruses in KFL&A (see update from KFL& A Public Health)
9) Canada’s COVID-19 epidemic: We have exceeded 1 million cases and 23,201 deaths, with 7,148 new cases yesterday (click here) (click here): COVID-19 Wave 3 rising in Western provinces and Ontario and 16.9% of Canadians are vaccinated.
10) The global pandemic continues to escalate: >133 million cases to date and new case rates on the rise (click here); up 4 million cases since last Monday!
11) KHSC capacity is adequate but we are reducing elective surgery, opening new beds, expanding ICU capacity and more…as we deal with provincially mandated transfer of COVID-19 patients from other regions
12) Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)-2 deaths in past week…evidence vaccines working: click here
13) Increased COVID-19 in school age children: (click here): Schools in parts of Toronto close for in person learning
14) A big shout out to our ICU colleagues, led by Dr. Dan Howes, for handling a large influx of intubated, critically ill patients with COVID-19 from other regions.
1) Who is COVID really affecting? (and why aren’t they being vaccinated) (click here):
Canada has 3 major problems when it comes to vaccines: Getting enough vaccine supply, distributing the vaccine efficiently and getting the vaccines into the arms of those who most need it. The latter issue is now very evident in Canada. Many communities within Toronto that have high levels of COVID-19 hospitalization and death have low vaccination rates (see figure below, from The Local). For example, people living in postal codes beginning with M3N, the Jane and Finch area, have the worst COVID rates in the city and the second worst rates of hospitalizations and deaths. Despite this, on ly5.5 % of residents of this area have received one or more vaccinations, the lowest rate in Toronto (per article in THE LOCAL by Nicholas Hune-Brown).
This is not simply an equity issue it holds the key to stopping wave 3. Multigenerational households and essential workers who cannot work from home are bearing the brunt of COVID-19. This is particularly true for people of colour, especially in the black community. The reasons for vaccine rates being low in these areas (the west and north of Toronto) are complex. There are cultural and language barriers, there are transportation barriers and there are trust issues. There are also simple logistic issues (as discussed in earlier notes)-no sick time pay, no time off to get vaccines. This reflects poor employment practices by large companies in Ontario.
The table below shows the top vs bottom 5 areas in Toronto in terms of COVID-19 vs vaccines. This is a stark warning.. There will be no end to this pandemic until we are all vaccinated. This is true whether the folks left behind are in a Toronto neighbourhood or a country in Africa or Asia. The virus exploits inequalities, ignorance, fear (and arrogance) allowing it to spread rapidly. We need to be innovative and work with community leaders to get people of all races, colours and ethnicities vaccinated. The province is now attempting to refocus from simple age- based criteria to have more pop-up clinics in affected neighbourhoods. On Tuesday, Ontario announced changes to Phase 2 of its vaccine rollout. Soon, people over the age of 50 in hot-spot neighbourhoods will be able to register for a vaccination. The province also moved up its timeline for vaccinating essential workers, by two weeks, to mid-May.
Bottom line? We need to do right by essential workers and ensure we vaccinate people at risk. Age is no longer the major predictor of bad outcomes! We need to be nimble and adjust our vaccine strategy.
2) COVID-19 vaccines available for people 55 years of age and over in Kingston (click here)
Over 50,000 KFL&A residents have already been vaccinated (>27.8% of all residents) see below!
People over age 55 years old and older (born in 1951 and earlier) can now register for a vaccine appointment online at www.ontario.ca/bookvaccine or by calling 1-888-999-6488. You need an appointment to get vaccinated. The best way to get an appointment is to register on-line. Just enter your postal code and click the eligibility group you belong to.
For individuals who do not have a health card, phone number or email address, Call 343-477-0172. This telephone service is only available to local residents from Monday to Friday from 8:30 a.m. to 4:30 p.m.
3) Pfizer COVID-19 vaccine found to be 100% effective in children (age 12 and older) (click here):
Vaccinating children will be critical to keeping schools and daycare centers permanently open. Studies are underway to show whether the vaccines are safe and effective in infants, toddlers, school age children and teenagers. The first report in children is from Pfizer. Their vaccine is currently approved in Canada for use in people from age 16 years on up. However, a new study shows it is safe and effective in children from age 12 years and older. In unpublished data Pfizer released results of a trial of 2,260 adolescents aged 12 to 15. There were 18 cases of COVID-19 in the group that got a placebo shot and none in the group that got the active vaccine. This translates to a 100 % efficacy in preventing COVID-19. While we await Health Canada approval to include these younger people, Pfizer is proceeding with studies of the vaccines in children down to 6 months of age. We anticipate results of Moderna’s study of vaccinations in children should report soon. AstraZeneca has also begun a study of its vaccine among 6- to 17-year-olds in Britain.
4) COVID-19 Vaccines have a strong safety record (and yet there remains Vaccine Hesitancy): After 5 million vaccinations in Canada there have been only 2,859 individual reports of vaccine side effect (0.06%), only 384 side effects were serious (0.008% of all doses administered) and no one died! (click here): The COVID-19 vaccines are desired by most people but vilified or feared by others. These vaccines, created in 1 year during a pandemic, stand as an amazing achievement. They are safe, effective, contain no virus, cannot give you COVID-19, have a low rate of serious adverse events (<1/10,000/vaccination) and have crushed COVID-19 rates in nursing homes and in countries where they are widely used…and yet the fake news machines have inundated people with false information that makes some people hesitant. I offer two word clouds for your consideration. Cloud 1 acknowledges the fake news about vaccines (it’s important to know the stuff people in our society are reading and hearing-even if it is wrong). The second cloud provides the correct information.
Below: A Cloud full of Misinformation about COVID-19 vaccines
Below: The truth about COVID-19 vaccines
Should you take the vaccine? This question has a simple answer-yes! I acknowledge that the frequent changes in policy (like Canada’s confusing decision to hold Astra Zeneca vaccine for people under age 55 years) don’t help! In life there are risks and benefit and the tiny number of cases of cavernous sinus thrombosis and thrombocytopenia (~80 cases/25,000,000 vaccinated people) must be balanced again the people that will die from lack of a vaccine. That said, its critical for health agencies to be transparent (even if the truth is confusing and changes over time). We do know that all vaccines are safe with great confidence based on clinical trials and real-world experience in 700,000,000 people! You are exposing yourself to risk by declining vaccination and equally importantly you are causing potential harm to your loved ones, your neighbours and for the rest of society. Your personal choice to get vaccinated is one to take seriously and I encourage a high-minded approach to accept it when offered so that we can get back to normal soon!
It is not just Canadians who are hesitant (see graph below)…and that’s bad news for global health. Most countries have >40% of residents who would not take the vaccine for COVID-19 if offered “this week” (see below)-If you are vaccine hesitant please read, educate yourself (from reliable sources) and think carefully about risks and benefits. It is unlikely we will be able to end this pandemic if 40% of the population refuse the vaccine (see graph below).
Vaccine hesitancy is widespread-as of April 1st 2021
Despite enthusiasm by most Canadians ~40% of us don’t want the vaccine. There was a time in Canada when it passed as common sense that we got our children vaccinated for polio, smallpox, measles, mumps, and rubella, diphtheria, tetanus, typhoid and meningitis. People of a certain age remembered when these diseases were scourges. They also had confidence in the medical profession. Oddly the emergence of general good health in Canadian society (in part due to antibiotics and vaccines) has rendered us complacent. Do we really need these shots? Perhaps we can be forgiven for complacency when we haven’t seen a disease in a while. However, two events occurred that set us up for the intensification of vaccine hesitancy. The first event was a lie, the second a vehicle to deliver incorrect information. First the lie: In the late 1990s and early 2000 there emerged an incorrect and fraudulent narrative that vaccines were causing all manner of adverse effects. Whether it was mercury in the vaccine vehicle or the vaccine itself people were told the vaccines caused autism. They do not! Andrew Wakefield, then a physician, was a standard bearer for concerned parents who wanted an explanation for their child’s ill health. Mr Wakefield told a lie and managed to publish it in The Lancet. He fabricated data and suggested that the measles mumps and rubella vaccine cause autism; it does not. The paper has been retracted. The paper was subsequently shown to be not only incorrect; it was fraudulent (click here). The second event that set us up to be hesitant was rise of an unedited internet which made everyone a medical expert and deluges us with fake news. Do you believe the government is in collusion with Bill Gates to poison you with microchips through vaccines?-If you do, you can find a home on the internet (click here)!
The evidence in hand strongly justifies that one accept the first vaccine one is offered (click here). Waiting exposes you and your loved ones to the risk of infection with a variant coronavirus. Waiting is unwise, since all vaccines prevent death and serious adverse outcomes with >90% effectiveness (including the Astra Zeneca vaccine). We will not be able to reopen society if 40% of Canadians refuse vaccination. This is particularly important for health care workers and other people who are entrusted with the care of their fellow Canadians. Here are the Canadian vaccine safety data for all vaccines as of March 26th (click here). After 5 million vaccinations in Canada there have been the 2,859 individual reports of vaccine side effect (0.06%), only 384 side effects were serious (0.008% of all doses administered) and no one died!
The bottom line? If you get vaccinated you have a 1/10,000 risk of a serious allergic reaction and no one has died of the vaccines in Canada. In return you get >90% protection from a COVID-19 death.
6) World vaccine roll-out tops 710 million people (click here)! Real world evidence that vaccination is safe and effective.
Vaccines in arms as of April 7th 2021
There is real world evidence the vaccines work.
The graph below shows that in countries that have an effective vaccine roll out, like the UK, USA and Israel, rates of infection fell rapidly. In contrast rates of infection are rising in Canada, where vaccine roll out has been slower. This is a global “real world” illustration that vaccines work!
Real world proof that vaccines (introduced at end of Dec 2020) work to reduce cases of COVID-19-April 7th 2021 (click here)
If we think Canada is a laggard (and we are), consider the continent of Africa. The graph below shows African countries has barely begun to vaccinate people. Variant viruses emerge when large numbers of people are infected. Ultimately if new viruses vary too much from the “vaccine-targeted virus” the vaccine might eventually not work. The longer vaccines are delayed the greater the emergence of variant viruses (which are slightly less vaccine sensitive and more infectious. This is a reminder of the urgency of a global vaccine roll-out.
Vaccination has barely begun on the African continent (gold above).
6) Here are answers to some updated FAQs with answers to common questions about the COVID-19 vaccines (most recent at the top).
1) New FAQ: Does one dose of vaccine provide protection from COVID-19? Short answer: yes (within 2 weeks). Pfizer vaccine confers 80% immunity within 2 weeks of first shot (click here) A real world study by the U.S. Centers for Disease Control and Prevention (CDC) evaluated the vaccines’ ability to protect against infection, including infections that did not cause symptoms. The study looked at the effectiveness of the mRNA vaccines among 3,950 participants in six states over a 13-week period. About 74 % of people had at least one shot, and tests were conducted weekly to catch any infections without symptoms. BothCOVID-19 vaccines developed by Pfizer-BioNTech and Moderna reduced risk of infection by 80% two weeks or more after the first shot. Immunity rises to >90% 2 weeks after the booster shot. This is reassuring, since Canada has spread out the interval from 1 month to 4 months, due to limited vaccine supply, as we try to get more people their 1st shot.
FAQ 2) If I have a solid organ transplant or I am a cancer patient should I have my second vaccine dose at the original interval?
The short answer is yes (although it is not based on clinical trial data). Emerging “real world” data (aka experience) suggests that transplant recipients and active cancer chemotherapy patients (with specific treatment and timing considerations) are now eligible to have their 2nd dose of COVID-19 vaccine at the original interval (<30 days from dose 1); rather than the revised 16-week interval. KHSC is currently in the process of operationalizing this new recommendation (which was issued at noon today).
FAQ 3) Which vaccine will/should I get? The short answer is that all vaccines effectively prevent COVID-19 death and severe adverse outcomes-so take the one that you are offered. They are all safe. That said, the vaccine someone receives will depend on your age, where you live and where you are vaccinated. The AstraZeneca-Oxford vaccine, which has an overall effectiveness of 62%-vs >90% for Moderna and Pfizer, will be administered mostly through pharmacies and primary care clinics, as will the Johnson & Johnson vaccine (I suspect). This is the case because they both can be stored safely in a regular freezer (click here). The AstraZeneca vaccine is recommended for people between 18-64 years of age. The mRNA viruses (Pfizer/Moderna) are recommended for people over age 64 years. The advantages of getting a vaccine earlier (even if it’s a little less effective) outweigh waiting longer for a more effective vaccine. This is especially true since all vaccines seem to prevent death and severe COVID-19 complications. Emerging data show that the Astra-Zeneca vaccine is safe and effective in people over age 70 years (based on real-world data emerging from its use in the UK) (click here). In the recent US study it was over 90% effective in preventing severe COVID-19 and prevented death with 100% effectiveness!
FAQ 4) Which COVID-19 Vaccines have been approved by Health Canada? Currently Canada has 3 approved vaccines: Pfizer, Moderna, and Astra-Zeneca (as of last week). The Astra Zeneca vaccine was approved on Friday and may arrive as soon as Wednesday (click here). Canada is expecting 445,000 doses of this vaccine this week. The vaccine appears to prevent COVID-19 spread and severe COVID-19 pneumonia and death; however, it has the lowest effectiveness overall (62% protection).The J&J vaccine was just approved by the FDA in the USA (click here). It has not been approved in Canada yet but this is expected to occur in the next 2-3 weeks. The J&J vaccine has several advantages. In a study with people in 3 continents one dose of J&J was 85 per cent protective against the most severe COVID-19 illness and the safety profile was as good as other vaccines. The J&J vaccine is a single shot vaccine (unlike two shots for Pfizer and Moderna). In addition it can be stored in a simple office refrigerator, allowing it to be rapidly deployed in the community. The bottom line: All approved vaccines are protective against severe adverse outcomes and I would advise you to take the first vaccine you are offered!
FAQ 5) Does the vaccine work against new variants (mutations) in the SARS-CoV2 virus? Short answer is a qualified YES. The vaccines work albeit not quite as well for the variants. In the 144,000 participants in all randomized clinical trials of vaccines to date, those receiving any active vaccine had only 3 cases of severe COVID-19 (vs 37 in the control group). There were no deaths in people who were vaccinated with any of the vaccines versus 5 deaths in the control group. Even though absolute protection is slightly less for UK and South African variants the vaccines (including the AstraZeneca vaccine and J&J) prevent serious adverse outcomes (like hospitalization and death). Thus, despite variant viruses the vaccines are lifesavers!
FAQ 6) I’m on a blood thinner, can I be vaccinated for COVID-19? Short answer YES. Here is a more detailed answer from an Canadian agency with expertise on the use of blood thinners, Thrombosis Canada.
FAQ 7) I have a history of allergic reactions, can I be vaccinated for COVID-19? Short answer YES. Out of ~1.8 million vaccinations there have only been 21 reported episodes of anaphylaxis (the most serious type of allergic reaction). Most (70%) of these events occurred within 15 minutes of the vaccine (which is why you will be monitored for this period of time post vaccine). There were also 83 cases of non-anaphylaxis allergic reaction after Pfizer-BioNTech COVID-19 vaccination with symptom onset within a 0–1-day risk window. Most (87%) of these allergic reactions were classified as nonserious. Thus, the risk of severe allergic reactions to the Pfizer vaccine are low and manageable. Allergy testing is NOT necessary prior to COVID-19 vaccination even in people with history of allergies. It is important note that none of the people who developed anaphylaxis after vaccination died and most did not have a prior history of anaphylaxis (see table below). The incidence of anaphylaxis is lower still with the Moderna vaccine.
The adverse effects of the COVID-19 vaccines in clinical trials are similar in vaccinated people vs people who got a placebo-saline injection except for: local pain at the vaccine site and increased muscle ache and headache, all of which were more common with the vaccine but were short-term (see below). This is a very good safety profile relative to other vaccines.
The CDC does advise against the use of the two mRNA vaccines for a very select group of people with the following allergy histories (click here):
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose of an mRNA COVID-19 vaccine or any of its components
- Immediate allergic reaction of any severity to a previous dose of an mRNA COVID-19 vaccine or any of its components (including polyethylene glycol [PEG])*
- Immediate allergic reaction of any severity to polysorbate (due to potential cross-reactive hypersensitivity with the vaccine ingredient PEG)*
FAQ 8) I’m immunosuppressed, should I get vaccinated? This question has a less clear answer. First, be reassured is no virus (dead or alive) in the Pfizer or Moderna vaccines so it is not possible for a person to get infected from the vaccine. However immunosuppressed people were not included in the initial clinical trials. That said, they probably are safe to be vaccinated but this is more a matter of expert opinion. In Canada the National Advisory Committee on Immunization (NACI) currently advises that the COVID-19 vaccine should not be offered to populations excluded from clinical trials “until further evidence is available.” However, they also say “an immunosuppressed person or those with an autoimmune disorder can still be vaccinated if a risk assessment deems that the benefits of vaccine outweigh the potential risks for the individual.” (click here).
The British Society for Immunology recently issued a statement indicating that vaccination is safe in immunosuppressed people (click here), albeit the resulting immune response may be weaker. They remind us that because there is no virus in the vaccine there is absolutely no risk of acquiring COVID-19 from the vaccine. Dr. Mike Beyak (gastroenterology) nicely summarized evidence from a registry of ~4500 patients who were immunosuppressed for their inflammatory bowel diseases (Crohn’s disease and ulcerative colitis). There was no increased risk of contracting COVID-19 in these 4500 patients. Apart for patients on prednisone, there was also no increased complications from COVID-19 when it occurred. Interestingly, some biologic therapies (antibody treatments for IBD) actually appear to reduce adverse outcomes in IBD patients who contracted COVID-19. This is not surprising since the truly bad outcomes in COVID-19 seem to occur in people who mount a hyper-aggressive immune response. Overall these data are good news for our many patients with rheumatoid arthritis, asthma and IBD who are on immunosuppressive therapies. However, since these people were not included in the vaccine clinical trials, it is advised they consult the physicians/clinic that is managing their care to inform their vaccine decision.
FAQ 9) How long can I wait after my first dose to get a second vaccine dose? It appears a second dose at day 42 is as effective in producing a neutralizing antibody response as when the dose is given at day 21 (the normal interval from dose 1). This more lenient 42-day protocol has been approved by Health Canada.
FAQ 10) Can I get COVID-19 from the vaccines? This answer is simple-NO! None of the approved vaccines in Canada contain the virus itself. They do not contain live virus; they do not contain dead virus. Canada’s approved vaccines (from Pfizer and Moderna) contain only the messenger RNA (genetic code) to allow you cells to make the viral spike protein which then triggers your immune cells to build anti-spike antibodies which protect you. The Astra Zeneca vaccine is much the same but delivers the SARS-CoV-2 spike protein gene via a chimpanzee adenovirus-vector. Again, there is no virus (not dead; not alive) in this vaccine (click here). So, while you might get a sore arm or a fever from vaccination this is just your immune system responding as it should; there is no chance of getting COVID-19. Obviously one could contract COVID-19 around the time of vaccination the normal way, before the vaccination’s protection develops (i.e. in the first 2 weeks after vaccination).
FAQ 11) Are vaccines safe? Yes, serious adverse effects of vaccines are rare (occurring in only 167 of 1.4 million Canadians vaccinated). Most people get (at worst) sore arm at the injection site, fatigue, or fever, all signs the immune system is being activated. Based on the clinical trials and experience in millions of people who have been vaccinated world-wide we can be reassured of vaccine safety and efficacy. All the side effects (called adverse events and abbreviated AEFI) are tracked and reported by the government of Canada (see below). (click here) (last updated Feb 26th).
FAQ 12) Is it safe to increase the time span between dose 1 and 2 of the COVID-19 vaccine? Most vaccines are given with an initial dose and a booster dose 3 months later. The reason the COVID-19 vaccine regimen initially specified a shorter interval was simply the rapid pace of the clinical trials which compressed the vaccination interval. Regulators approved the vaccine based on the information that came from these trials. With time it is now clear that spacing out the interval up to 4 months is safe and effective. This longer interval between vaccines allows more people to get the first dose asap and as the data have shown, the first dose yields substantial immunity within 1-2 weeks. That said, once vaccines become more available it would be prudent to return to the initial interval between vaccine doses.
7) KFL&A COVID-19 rates have risen by 81 cases since last Monday-341 active cases in our part of SE Ontario: a result of a high rates of variant viruses in KFL&A(see update from KFL& A Public Health)
The total number of cases in KFL&A since the pandemic began is 1005, not counting the prison outbreak. This is up 81 cases in the past week and most new cases are caused by a variant of concern (i.e. mutant virus) (see below).
High incidence of variant (mutant) viruses in KFL&A-this accounts for the rapidity of spread (courtesy of Dr. Gerald Evans).
On the bright side: PPE is as effective in preventing variant virus as they are in preventing the original form of the SARS-CoV-2 virus. Indeed we have the second highest rate of variant viruses in Ontario. There are 17 people hospitalized at KHSC with 23 in quarantine and 16 patients are on ventilators in the ICU. These are largely people transferred to KHSC from the greater Toronto area. There are 341 active cases in our part of SE Ontario, up 141 cases from last week. There are 12 active regional outbreaks In the past 3 days our KHSC lab has done 2189 COVID-19 tests at KHSC since Monday with 47 positive tests for a positive test rate of 2.1% (the rate of positive tests for KFL&A is lower-1.2%).
The rate of cases is rising rapidly in KFL&A (above) and more variant viruses are being detected (below)
There has only been one death of a KFL&A resident since the pandemic began but we have had several deaths at KHSC of non-resident patients. These data are a reminder that COVID-19 is actively spreading in our region and reminds is of the ongoing need for following public health measures remains extremely carefully. A concerning note is that all tertiary care hospitals in eastern Ontario are over capacity.
Patients with COVID-19, particularly those in ICU, are being distributed from the greater Toronto area around the province as hospitalizations reach new highs (relative to any prior point in the pandemic). All ICUs in Ontario are essentially full. We are part of the provincial health care system and will do our part. This includes temporarily curtailing “elective” surgery and procedures. However, most of this elective care is not truly elective and the number 1 and 2 causes of death in Canada during the pandemic remain heart disease and cancer. Thus. we are acutely aware of our responsibility to provide care for the 99% of people who don’t have COVID-19. Our hospital is providing leadership and collegial support for the provincial mandate; while at the same time reminding the provincial incident command structure of the need to care for the half million people in SE Ontario.
The figure below shows things are going the wrong way in Ontario (thus the stay at home order). New and active cases are up (29 and 36%, respectively). Deaths are up 6% and hospitalizations are rising 25%/week. If you or a loved one are hesitant to follow public health rules or to get vaccinated think long and hard about these data.
Waves 2 and 3-note wave 3 is nowhere near peak yet. The graph above shows weekly cases beginning in Nov 2020. The solution to wave three is the lockdown combined with vaccination
Ontario’s COVID-19 hospitalization rate rise with 4.8% of cases being hospitalized
We have done 12.9 million COVID-19 tests thus far. The rate of test positivity in Ontario is rising back to 6.0% from 4.8% a week ago (see above). This is 6X the rate in KFL&A. Positive tests due to N501Y mutation variants account for most cases in Ontario. We are in a race to get vaccines into arms before the more infectious mutant virus causes an even larger 3rd wave. The variants are now shown to be more transmissible (infectious) and more lethal. The red line below shows reduced survival in people infected with the UK variant (vs the original virus-blue line).
Higher mortality with mutant SARS-CoV-2 viruses (red line on survival graph above)
9) Canada’s COVID-19 epidemic: we have exceeded 1 million cases and 23,201 deaths so far, with 7,148new cases yesterday (click here) (click here): COVID-19 Wave 3 rising in Western provinces and Ontario and only 16.9% of population vaccinated.
Wave 3-ICUs full: Although the orange line above (showing active cases) may not look concerning this is a matter of scale. If you look at the right end of the line you can see it turning upwards-evidence of a 3rd wave. In addition the bottom panels continues to show a concerning rise in hospitalizations-with all ICU beds in Ontario and most of Canada full!
Canada April 8th 2021
There have been 23,201 COVID-19 deaths thus far and a cumulative national case mortality rate of 1.8%. Canada has performed ~29.4 million COVID-19 tests with a cumulative test positivity rate of 3.5%. Rates of infection are rising in BC, and AB, as well as in Ontario. Quebec has put 3 cities including Quebec City into a 10 day hold, meaning intensified public health measures are in force. April will see a race to vaccinate!
Canada’s vaccination roll-out: 7.1 million vaccines administered thus far (16.9% of population) (click here)-see below: To date, 10.5 million doses of COVID-19 vaccines (including Moderna, Pfizer-BioNTech and Astra-Zeneca) have been delivered. Thus far, only 68% of delivered doses have been administered. This reflects recent arrival of vaccines but also our relative inability to quickly administer the vaccine to patients. 751,745 Canadians are fully vaccinated (click here). Still, Canada is well back in the pack (not in the top 30 countries) with only 16.9% of the population vaccinated.
Only 68% of received vaccines administered in Canada
10) The global pandemic continues to escalate: >133 million cases to date and new case rates on the rise (click here); up 4 million cases since last Monday!
There have been ~133.3 million cases since the pandemic began, up almost 4 million cases since last Monday! There have been 2,892,713 deaths since the pandemic began. Active case rates (orange graph below right) are rising (orange graph above) and daily death rates have plateaued at a high level (which is not good). This is a reminder of the need for global vaccination. We will not end this pandemic until the entire world has access to vaccines. Until then we will continue to have the development of mutant viruses that not only hurt the unvaccinated people but threaten to defeat the protection conferred by vaccination.
The USA, with 30.95 million cases and 559,494 deaths has roughly the same total number of cases as the next 3 most affected countries combined (Brazil, India and France). While the USA has accounted for ~25 % of the global pandemic things are improving rapidly, with over 160,000,000 vaccinations completed and a promise to have all Americans vaccinated by April, 2021. Americanow has a 4.8% positive test rate, lower than Ontario’s 6.0%) (click here; see below). We are now in the sad position where the US government is advising Americans not to come to Canada because of our poorly controlled epidemic. Canada can and must do better; but congrats to the Biden administration for turning the US around!
US advises against travel to Canada!
11) KHSC capacity is adequate but we are reducing elective surgery, opening new beds, expanding ICU capacity and more…as we deal with provincially mandated transfer of COVID-19 patients from other regions
The volume and pace at which COVID patients are presenting in the GTA and hospitals in Scarborough, Lakeridge and Peterborough hospitals is unprecedented. ICUs in these hospitals are at or over capacity. They are now moving a large number of ICU patients to Kingston Health Sciences Centre (KHSC). The hospital and region are responding to maintain capacity to provide non-COVID-19 critical services. The landscape is changing dynamically as we accommodate to a rapid rising 3rd wave. Medicine has 173 people in hospital and the hospital has 90 beds available, only 6 of which are ICU beds and these are being filled with patients coming from other regions with COVID-19.
I am impressed by the dedication, flexibility and collegiality of the physicians and administrators in the DOM and Medicine program and by the incident command leadership team at KHSC. We will continue to work hard to ensure care for all residents of SE Ontario, while we assist colleagues in Toronto.
KHSC April 8th 2021: Making room as we experience a large influx of COVID-19 patients from Toronto area
12) Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)-no deaths in 2 weeks…evidence vaccines working: click here
Most COVID-19 deaths occur in people who are not only old but who are also frail and live in nursing homes and LTC facilities. While LTC residents account for only 5.3% of all cases in Ontario, they account for 51.8% of all 7244 deaths in Ontario. As of today, the 3,755 deaths in nursing homes (2 DEATHS in the past week) account for ~57% of all deaths. There are 10 active COVID-19 cases in LTC residents and 119 active cases in LTC staff, the lowest numbers in months. These numbers continue to decline, which is very encouraging! For example a month ago we were seeing death rates of >100/week; now it is 2/week. These graph below shows the beneficial impact of the province’s decision to prioritize its limited initial vaccine supply of health care workers and residents of Ontario’s LTCs. Note the rapid decline in both staff (yellow) and resident (orange) COVID-19 case numbers coincident with vaccination!
Vaccines crush COVID-19 in LTCs (leaving this graphic in the note because it is such an awesome testimonial to the power of vaccines in vulnerable people)
13) Increased COVID-19 in school age children: (click here): Schools in parts of Toronto close for in person learning Teenagers and young adults are the demographic most likely to be infected by SARS-CoV-2 but in general are less severely affected. Young children are less likely to get infected and when infected are less infectious (perhaps because they are less sick). My hope is that children will be approved for vaccination by the fall but research proving safety and efficacy are pending, as discussed above (click here). With more kids back in school we are seeing more infections (although not at alarming rates).
There have been 10,909 students with COVID-19 since the pandemic began with 2,133 new cases in the past 2 weeks (see below). This is a continued increase compared to last week, consistent with more young people being back in school. 26.8% of Ontario schools have reported at least one active case (see below) and 1.28% of all schools have closed. This reflects a growing instability in the school system’s ability to deal with wave 3 of COVID-19. It is also why studies examining vaccination of children are crucial! We need to vaccinate children to stop disease transmission!
Things are better in the toddler age group. Here are the parallel data from licensed child care facilities in Ontario-where there have been 2310 children infected since the pandemic began, 537 new cases in the past 2). This relatively stable number of infections in the licensed child care facilities is a reminder that it is the older school age children (>10 years old) not the toddlers, who are contracting COVID-19 most often.
Regular reminders-On hiatus today
14) A big shout out to our ICU colleagues, led by Dr. Dan Howes, for handling a large influx of intubated, critically ill patients with COVID-19 from other regions-KUDOS.
Stay calm, Stay informed, Stay Home, Stay Well! …. Get Vaccinated