March 18, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
All patients admitted to KHSC will undergo Covid-19 testing
Ontario Website now open to book vaccines for people over age 80 (initially): https://covid-19.ontario.ca/book-vaccine/ (click here). There have been some initial glitches but the process is underway!
1) The European Medical agency has confirmed that the Astra Zeneca vaccine is safe and does not increase risk of blood clots (click here)
2) Astra-Zeneca vaccines for people age 60-64 now available in local pharmacies: Emerging evidence shows vaccine effective in people over age 70 years and they are being offered this vaccine in some Ontario pharmacies (click here)
3) World vaccine roll-out tops 400 million people (click here)! Real world evidence that vaccination is safe and effective.
4) Vaccination of frontline health care workers at KHSC: Team Vaccine has now administered over 10,000 doses of vaccine KUDOS and thank you!
5) All about COVID-19 Vaccines: Updated FAQs about vaccination
6) KFL&A COVID-19 rates double in KFL&A since Monday and there is a school outbreak with variants of concern (which account for 5% of all cases of COVID-19 in our area) (see update from KFL& A Public Health)-also KUDOS Dr. Kieran Moore (click here)!
8) Canada’s COVID-19 epidemic: A change in epidemiology reinforces urgency of completing mass vaccination before a 3rd wave takes hold: There were 3,372 new cases yesterday. Rates of hospitalizations have begun to rise (click here) (click here).
9) The global pandemic: New case rates on the rise (click here)
10) Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)-evidence vaccines work: click here
11) COVID-19 vaccination for children-studies underway (click here)
12) Anti-Asian Racism in the COVID-19 era-we stand side by side with our Asian-Canadian colleagues and will not tolerate racism: if you see something say something! (click here)
1) European Medical agency has confirmed that the vaccine is safe (click here)
This is a quick follow-up re: the concern in Europe about the possibility of increased blood clots with the Astra Zeneca vaccine. This concern caused Denmark, Austria and eight other countries to put a temporary hold on the vaccination. As of 10 March, 30 cases of thromboembolic events had been reported among the five million people given the AstraZeneca vaccine in Europe (click here). I am happy to report that as of this afternoon the European Medicines Agency (EMA) reviewed the data and concluded the vaccine is safe and effective and does not increase the risk of clots (click here). When one vaccinates people their lives and all events that normally occur in continue to occur. Vaccinated people will continue to have strokes, heart attacks, cancer, blood clots etc. The question is what is cause vs what is coincidence. When considering whether bad outcomes in people who have received a vaccine relate to the vaccination, one must determine whether the “bad event” (in this case blood clots) is more common in those receiving the vaccine than would occur without it. The answer is no! Indeed, rates of venous clots is lower in the vaccinated people than expected. That said, prudence is advised and safety monitoring for side effects continues for all vaccines. Italy has announced it will resume vaccinations tomorrow with other countries expected to follow suit shortly. The evidence in hand strongly justifies that one accept the first vaccine one is offered (see the Globe and Mail article on this not being the time to “comparison shop” for a vaccine (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 >80% effectiveness (including the Astra Zeneca vaccine).
For KHSC employees if you get vaccinated elsewhere please notify occupational health so we can remove you from our list of people who need to be vaccinated.
2) The Astra-Zeneca vaccine is effective in people over age 70 years and is now being rolled out in some pharmacies in Ontario (click here) Vaccinations have begun for people age 60-64 in a local pilot program. This program administers (by appointment) the Astra Zeneca vaccine via local pharmacies (click here). What about the elderly (>70 years old). The initial studies for approval of this vaccine only included small numbers of people over age 55 years (1418 people over age 65 years-12% of study population) (click here). A study looking at all vaccinated people over age 70 years in the UK (click here), where this vaccine is widely used, found substantial benefit in the elderly, noting “a single dose of either vaccine (Pfizer or Astra-Zeneca) is approximately 80% effective at preventing hospitalization and a single dose of the Pfizer vaccine is 85% effective at preventing death with COVID-19. Moreover, in people over age 70 years, the Astra Zeneca vaccine (one dose) results in protective effects within “14-20 days after vaccination reaching an effectiveness of 60% from 28-34 days and further increasing to 73% from day 35 onwards”. This article (see below) is awaiting peer review.
The York region in Ontario is starting to vaccinate people ages 75-79 years in pharmacies (using the Astra Zeneca vaccine) starting today (click here). If you are eligible, please take the Astra Zeneca vaccine. The totality of the evidence is that it is safe and effective regardless of your age.
3) World vaccine roll-out tops 400 million people (click here)! Real world evidence that vaccination is safe and effective.
The good news is our vaccines work against these variants; however the emergence of increasing numbers of variants is a reminder of the urgency of vaccine roll-out globally. Variants emerge when large numbers of people are infected. For the undecided 20% of Canadians who are unsure they want to commit to taking a vaccine now, please believe me when I say that time is of the essence. The more the virus has to infect unvaccinated people the more time it has to mutate and develop the ability evade vaccine-induced antibodies. All approved vaccines in Canada are safe and effective. No corners have been cut in the Health Canada review of their safety. What was accelerated was their production and the duration of initial study prior to approval shortened. Vaccine production was accelerated because we can now safely use mRNA and adenoviruses, courtesy of lessons learned in the past 2 decades from the Human Genome project. While the vaccine studies for initial approval were compressed (because we are fighting a pandemic), the ongoing results are shared with the medical profession weekly. We now have unprecedented evidence of safety from the tens of millions of people vaccinated world-wide (click here). To date over 400,000,000 people have been vaccinated! So if you are “waiting” for more safety data I would argue that all the data a reasonable person should need are there already. If you were vaccinated today you are benefitting from the safety data generated on the 400 million people who were vaccinated before you. We also have safety data from numerous clinical trials, which in combination with the re-world experience, should be reassuring!
4) Vaccination of frontline health care workers at KHSC: 4965 KHSC health care workers have been vaccinated (and interval to second dose will be prolonged to as long as 16 weeks). As of today, KHSC has been allotted approximately 5930 vaccine doses by KFL&A Public Health for frontline health care workers. The dashboard below shows the amazing job Team Vaccine has done. They have issued 7658 invitations to health-care workers , people who are in Phases 1-6 of the MOHLTC’s priority grid. Currently they have booked 5683 people to be vaccinated by weeks end and 4965 KHSC health care workers (staff, trainees, faculty) have already received their first doses of vaccine (84% of the workforce). The interval between dose 1 and 2 will be extended for varying intervals (up to 16 weeks). The vaccine uptake rate (offered/accepted) is 74%, although it is likely higher as some people are still scheduling appointments and other have bene vaccinated elsewhere. Also for those in Groups 7-8, invitations are being issued and vaccinations will start March 24th; invitations are being issued (stay tuned for a date). Some people in Group 8 are still pending invitation (such as research assistants).
Progress in vaccinating front line health care workers at KHS March 18th 2021
5) Here are answers to some updated FAQs with answers to common questions about the COVID-19 vaccines (most recent at the top).
FAQ 1) 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)
FAQ 2) 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 3) 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 4) 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 5) 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 6) 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 7) 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 8) 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 9) 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 10) 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 to 40 days (and longer) 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.
6) KFL&A COVID-19 rates double in KFL&A since Monday and there is a school outbreak with variants of concern (see update from KFL& A Public Health)
Although we are not out of the COVID-19 woods, we in SE Ontario have a lot to be grateful. In addition to a highly competent hospital system we have a wonderful Public Health Unit. I was proud to see the work of Dr. Moore and his team acknowledge recently. Check out this article which lays out the steps that were taken to keep us safe and how they have largely been successful. KUDOS Dr. Kieran Moore (click here)!
The total number of cases in KFL&A since the pandemic began is 797, not counting the prison outbreak. This is up 35 cases since Monday and most new cases are caused by a variant of concern (i.e. mutant virus) (see below). There are 53 active cases in the region (double the number on Monday of this week). The case rates are rising in SE Ontario, particularly in Leeds-Grenville county (74 active cases). There are 155 active cases in our part of SE Ontario. These include the following active case broken down by county: KFLA = 53; Hastings Prince Edward County = 8; Lanark Leeds Grenville = 94.There are 3 outbreaks in our region, including one school outbreak with variants of concern, accounting for 3 active cases. This has resulted in a significant increase in testing and quarantining of contacts.
The rate of cases is rising rapidly in KFL&A: March 18th 2021
There has only been one death of a KFL&A resident since the pandemic began. There are 2 COVID-19 patients hospitalized at KGH (both transfers from other regions). Active cases in our SE region are rising back to levels seen in mid-January, a cause for caution and ongoing adherence to public health policies. This largely relates to the rise in the B117 variant (which are more infective). These variants spread rapidly particularly in children and account for 5% of recent positive tests -see below (still better than in most of the province where they cause 35% of all cases).
Rise in the frequency of mutant viruses (also called variants of concern)-bottom panel
Vaccination is proceeding well in KFL&A, as shown below. Most residents and staff at LTCs are vaccinated and a total of 29,615 residents of KFL&A have had at least one vaccine dose. This is important because a single dose of vaccine makes a person immune within ~14 days. The second dose is important but can be safely delayed for several months to ensure as many people as possible get the first dose as soon as possible.
Ontario’s COVID-19 prevalence new case rates show recent increase (March 18th)
There were 1553 cases yesterday. It continues to be the case that ~ 5% of infected people require hospitalization. Death and hospitalizations are starting to increase (+4 and +8% respectively). As a result, patients are once again being transferred around the province to relieve stress on Toronto area hospitals, which remains the disease epicenter. We have done 11.89 million COVID-19 tests thus far. The rate of test positivity is rising and is now 3.1% (up from ~2.5% on Monday). Positive tests due to N501Y mutation variants account for 30-35% of cases.
Ontario numbers as of March 18th 2021
8) Canada’s COVID-19 epidemic: A change in epidemiology reinforces the need to complete mass vaccination before a 3rd wave takes hold: There were 3,372 new cases yesterday. Rates of hospitalizations have begun to rise (click here) (click here).
A rise in hospitalizations raises concerns about a 3rd wave of COVID-19
There have been 22,577 COVID-19 deaths thus far and a cumulative national case mortality rate of 1.98%. Canada has performed ~30 million COVID-19 tests with a cumulative test positivity rate of 3.41%. 3.59 million people have now received at least 1 vaccine dose. Rates of COVID-19 are back to baseline in PEI. Rates of infection remain at a low plateau in all other provinces and territories, as a result of introduction of more aggressive public health measures.
Canada’s vaccination roll-out is accelerating-1 million vaccines administered since Monday (click here): To date, 4,773,170 doses of COVID-19 vaccines (including Moderna, Pfizer-BioNTech and Astra-Zeneca) have been delivered. Thus far,73.7% of delivered doses have been administered (reflecting a surge in supply). 3,516,197 Canadians have received at least one dose of an approved COVID-19 vaccine (see below). This is up by 1 million vaccines since Monday. 614,737 Canadians are fully vaccinated (click here). Still, Canada is well back in the pack with only 7.63% of the population vaccinated (see below).
9) The global pandemic-new case rates on the rise (click here)
Global COVID-19, March 18th, 2021: The number of active cases (yellow dots on map) has continued to increase again (orange graph, bottom right)
There have been 121,478,235 cases and 2,684,620 deaths since the pandemic began. Active case rates were declining but have now are rising slightly which is concerning (click here) Daily death rates are continuing to decline. This is a reminder of the need for global vaccination. We will not end this pandemic until the entire world and all its people have 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 29,628,235 cases and 538,430 deaths has roughly the same total number of cases as the next four most affected countries combined (India, Brazil, Russia and the United Kingdom). The USA has accounted for ~25.2% of the global pandemic but things are improving rapidly in the USA, due likely to natural immunity, vaccine acquired immunity and better adherence to public health measures (in some states).
America now has a 4.7% positive test rate, down from 6%, last Monday (click here; see below). Unfortunately in states with populist governors, like Texas and South Dakota, rates remain higher (Texas now has a positive test rate of 8.4%). South Dakota (though improved from its 30%+ rate 2 months ago) is now at 20%. This epidemiology is a testimonial of the importance of adherence to public health measures while we await completion of mass vaccination (which in the USA should be May 2021).
Rates of positive tests are down in the USA but still ~2% (absolute) higher than in Canada
10) Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)-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, click here, they account for 52.7% of all 7109 deaths in Ontario. As of today, the 3,752 deaths in nursing homes (up 2 deaths since Monday) account for ~57% of all deaths. There are ~ 51 active COVID-19 cases in LTC residents and 137 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 <5/week; still too many but heading in the right direction rapidly. 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
COVID-19 vaccination for children-studies underway (click here): Children of school age have relatively high rates of COVID-19 infection (but low rates of morbidity and almost no mortality). That said, the challenges of running in person education with wave after wave of COVID-19 outbreaks in schools is evident to everyone. There is little reason to believe the vaccines will not be safe and effective (likely more effective) in children than adults. In general, vaccines work best in young people with healthy immune systems. Pfizer is testing their vaccine in adolescents as young as age 12. Moderna is currently recruiting for a clinical trial for 12- to 17-year-olds. And on February 12, AstraZeneca announced the start of a trial for their vaccine in children ages 6 to 17. The graphic below show there are 2,259 children age 12-15 years enrolled in a Pfizer trial. Moderna is studying a cohort of 3000 12-17 year olds.
COVID-19 in toddlers and young children: (click here). It has remained true throughout the pandemic that children in general are less severely affected by the virus and young children are somewhat less infectious (perhaps because they are less sick). Rates of infection are very low in preschool children. The hope is children will be approved for vaccination by the fall but research proving safety and efficacy are pending (click here). With more kids back in school we are seeing more infections (although not at alarming rates).
There have been 7858 students with COVID-19 since the pandemic began with 1370 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. 19% of Ontario schools have reported at least one active case (see below). This reflects a growing instability in the school system’s ability to deal with late wave 2-early 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!
Here are the parallel data from licensed child care facilities in Ontario-where there have been 1669 children infected since the pandemic began, 247 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.
12) Anti-Asian Racism in the COVID-19 era-we stand side by side with our Asian-Canadian colleagues and will not tolerate racism: if you see something say something! (click here)
Racism is on the rise. This is not new to the COVID-19 era; however, the nature of the infection, the finger pointing around the origin of the virus, and the dog-whistling of some politicians has fanned the flames of racism in Canada and the USA. While Asian Canadians are not the only victims of these racists attacks, recent events (local and international) have reminded me that I need to speak up when I see something wrong and combat racism. Members of our Department have experienced unprovoked racist attacks during the pandemic. As a person and as a representative of the DOM, I (we) stand hand in hand with our Asian-Canadian colleagues and staff. We are unified; and an attack on them is an attack on all of us. Several local episodes of anti-Asian racism combined with the recent killing of 8 people, 6 Asian American in Atlanta, and a well-publicized assault of an elderly Asian American woman in San Francisco remind me the battle for equality and respect is ongoing. This article may be of interest (click here). My request to all colleagues is to stand up for each other (students staff, trainee, faculty, community member) and through our words and actions make it clear that racism and anti-Asian racism has no place in Canada.
Regular reminders-On hiatus today
Final thoughts: Taking the vaccine is safe and it’s the right thing to do. I am one of the 400,000,000 people globally that have been vaccinated. It was an experience like all other vaccines I have had (uneventful). I recommend that when you are called you confidently roll up your sleeve and help us end the pandemic! I would also advise taking whatever vaccine you are offered as the benefits in preventing severe adverse outcomes (death and mechanical ventilation) are provided by all approved vaccines. The Astra Zeneca vaccine being offered at pharmacies is safe and effective. You can now book your vaccine on- line if you are over age 80 years (click here).! In addition by “going earlier” (rather than waiting for your vaccine of choice) you are accelerating the creation of herd immunity and protecting the public at large.