December 20, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Dr. Archer's Updates on COVID-19

General DOM News & Events

| 20 December 2021

1) KFL&A update: Wave 4 rising with over 133 new cases, 1355 active cases (more than double the number a week ago) positive test rates of ~7% and a surge in local Omicron variant cases.

2) New restrictions on visitors to KHSC: Effective Dec 17th few visitors will be allowed, regardless their vaccine status.

3) Why you should get your child vaccinated: rising rates of omicron in unvaccinated children.

4) Ontario’s 4th wave rising: New and active cases are both up a record 72% and hospitalizations rose 10%.

5) Canada’s COVID-19 4th wave is resurgent: A 55% increase in new cases and a 48% increase in active cases with a 4% increase in hospitalizations (click here) (click here).

6) Global vaccine roll-out: 3.7 billion people fully vaccinated (2 doses); but low-income countries lag behind and boosters still not widely available. Vaccine safety record remains excellent (click here).

7) The global pandemic is not yet controlled: ~274.9 million cases and 5,357,096 deaths to date, with most deaths in the past month in the USA, UK, Germany, France, and Russia.

8) Question of the day: I had 2 Moderna vaccines (or 2 Pfizer vaccines) initially: Can I take the other brand for my booster? Short answer YES!

Before we go to the facts of COVID-19 today; the note starts with reasons for hope, and we certainly need them, and then offers some holiday humor. If you survive these first two missives, read on for the usual COVID-19 news.

Six reasons for hope in 2022:

We are each, in our own way, a bit (or a lot) tired, discouraged, dismayed, sad, and hurt by losses, disappointments and setbacks caused by two years of a relentless virus. But, as we enter 2022 in the midst of a 4th wave, facing a virus that has mutated into the more infectious omicron variant, there are paradoxically causes for hope and optimism.

We have vaccines that really work. Vaccines afford huge protection against infection; don’t be discouraged by disinformation to the contrary. Vaccines even protect against the omicron variant; but to get this benefit fully, you will need to get a booster. Pfizer’s data shows the 3rd shot (which is now available to Ontarians 18 years of age and older) boosts antibody levels 25-fold beyond the levels achieved with 2 doses. Moreover, most spike mutations in the omicron variant only affect humoral immunity (antibodies); this leaves your cell-based immune system fully primed and prepared to protect you-so even two doses is partially protective against omicron. Our current vaccines greatly reduce disease transmission and dramatically reduce the risk of hospitalization and death. This holiday when some family member or friend starts holding forth on the failings of vaccines, tie them to a chair and have them read this note (or maybe just have them double mask). Vaccines work-as measured globally or locally and as studied in the real world or in clinical trials. The graph below shows why you want a booster shot-although it also shows that even two doses prevent against severe adverse effects.

Vaccines work-even against the Omicron variant

Public health measures work: Painful as it is, you can protect yourself and your loved ones by masking, handwashing, assembling only with people you know (i.e. those in your bubble) and ensuring you self-isolate if sick. This is why Ontario has put in place new rules: Maximum gathering sizes have dropped to 10 people indoors and outdoors gathering limits are now 25 people. Ontario is reintroducing capacity limits of 50% of the maximum at most indoor settings across the province. This includes places like restaurants and bars, personal care services, retailers, and shopping malls. The number of people permitted to sit at a table will be restricted to 10 people, and patrons will be required to remain seated in restaurants, bars and other food or drink establishments.
Effective drugs are approved or nearing approval: The experimental antiviral pill, Paxlovid, cuts the risk of hospitalization or death by 89%if given to high-risk adults within a few days of their first COVID-19 symptoms. It is approved by the FDA in the USA and is submitted for review in Canada. Merck’s anti-COVID pill (also very effective) is already under review by Health Canada, and has been approved in the U.K. and the U.S.
Hospitals are experienced at handling the care of patients with COVID- Provided the numbers admitted do not swamp our capacity, we are experienced and know how to deal with these patients. Canada’s COVID-19 mortality rate remains ~1.6%.
Omicron may have a lower hospitalization/mortality rate than the delta variant:It’s too early to be sure about much re: omicron, apart that it is >5.4 times more infectious than delta and symptoms present sooner after exposures (within 1 week). The reports from South Africa, where the Omicron variant was first described, are encouraging. The number of cases from the Omicron variant in South Africa’s 4^th wave exceeds those from any previous mutation of the virus, but only 1.7% of COVID-19 cases were hospitalized during this wave—with an average of 350 new hospital admissions/day. The third wave, which was dominated by the Delta variant, saw 800 people hospitalized daily, an average of 19% of those infected. Potentially good news-stay tuned!
Rapid antigen tests give us tools to make sure we are not infected at home: While admittedly the roll out of this test is slower than hoped for these self-administered tests are very helpful. The tests detect specific proteins — known as antigens — on the surface of the virus. They aren’t as sensitive as the gold-standard PCR test; but you can do them yourself! Ontario has given away (or is in process of giving away) 2 million tests to help people test themselves over the holidays. The rapid tests are intended to be used to detect asymptomatic carriage of the virus (i.e. not for diagnosis when you are having symptoms). For a full list of pop-up testing locations where free rapid tests are being distributed, as well as LCBO stores, click here....another reason to go to the LCBO, LOL. Rapid test kits are also available to purchase at pharmacies. At Shoppers Drug Mart, for example, you can purchase a rapid test for about $40.

Some holiday humor ripped from the pages of our family holiday card: Each December my family writes a holiday card which attempts to bring some humor to a time of year that paradoxically often is challenging (and that was before we had a pandemic!). The name of the publication changes depending on where we are living. Currently it is called The Maple Leaf Rag (MLR). The MLR goes to friends around the world. It has a storied history, dating back to the 20th century. Founded in Minnesota in 1989 as The Swede Hill Snooper, this holiday periodical transformed into The Alberta Clipper in 1998 when the editors moved to Edmonton. In 2007 it morphed into The Windy City Zephyr when Chicago won the rights to the editorial office. In 2012, when Dr. Archer was deported (I mean moved) to Queen’s, the Maple Leaf Rag was born. The editorial staff picked a couple of articles from this year’s card to share with weary COVID-19 note readers. Ripped from the pages of this year’s card, please enjoy one Corrupted Carol, one Holiday Cross word puzzle, one test, telling you how you might know you are in a pandemic, and some proposed new COVID-19 therapeutics! This makes you each an honorary MLR subscriber!

CROSSWORDS FOR COVID-19

DON’T CHEAT-ANSWERS BELOW

COVID-19 Update

1) KFL&A update: Wave 4 rising with over 133 new cases, 1355 active cases (more than double the number a week ago) positive test rates of ~7% and a surge in local Omicron variant cases

The rate of new cases in KFL&A is unprecedented, with over 133 new cases in one day.

Fortunately hospital admission at KHSC remain down from last week, with 9 admitted people, 5 on the Medical COVID-19 unit. The medical unit remains very busy with 190 in patients (see below). Thanks to the many doctors who have stepped up to provide back-up coverage just in case we need reinforcements!

various graphs showing bed management for KHSC

Our region now accounts for 10% of all cases in the province (see blue bars below).

The rise of COVID-19 in SE Ontario

Test rates soar in Ontario

The rate of positive tests in our area is the highest it has ever been (~6% of tests are positive). This means there is uncontrolled community spread and so we need to socially distance, wash our hands, wear masks, and ensure we are vaccinated.

Currently the omicron variant accounts for most (72%) of the new cases in KFL&A (see below).

Currently, 82.9 % of people in KFL&A over age 5-years are vaccinated with 2 doses (including 89.5% of people 12 years of age and over). Likely because of omicron and the fact booster doses have only recently been approved for all people 18 years and over, we are seeing a rise in infection even in vaccinated people in KFL&A (graph below).

Rising rates of infection in vaccinated and unvaccinated people-but vaccinated people still protected and their illnesses are less severe (data not shown)

2) New restrictions on visitors to KHSC: As of Friday December 17^th, most of our inpatients will no longer qualify for in-person visits by family members, even fully vaccinated family members. A small portion of inpatients may still have in-person visits as noted on the attached chart. In those cases, only fully vaccinated family visitors who comply with all other COVID safety regulations in place at KHSC may visit in-person. Please see the attached chart for full details of the exceptions. We have a centralized process is in place to review requests for an exception to the family visitor policy. This team may be accessed through email: VisitorExceptions@KingstonHSC.ca. This restriction of loved ones is one of the most difficult aspects of the pandemic; but we need to keep the hospital safe for our patients!

3) Why you should get your child vaccinated: rising rates of omicron in unvaccinated children Throughout most of the pandemic there have been three truths in terms of COVID-19 infections: 1) children get infected (but generally have milder illness), 2) people 18-40 get most of the infections (also usually well tolerated), and 3) people over 70 years of age suffer most of the morbidity and mortality. While this is still generally true, recent data show a concerning rise in infection, likely due to the Omicron variant, in children ages 0-11 (see graph below). Children aged 5-11 now account for 23% of all December infections (while those between 30-39 years only account for 16% of new cases). The main message for parents is not to panic (children still seem to tolerate the virus in the vast majority of cases); rather the message is, please get your eligible, 5–11-year-old child vaccinated, ASAP!

The rising green curve shows recent infections in children ages 0-11 years in Canada (Oct-Dec 2021): Please get you eligible child (age 5-11 years) vaccinated asap to protect them

As you can see from our local data, children aged 5-11 have only received the first vaccine dose in 48% of cases and few have received the necessary minimum of two doses. An urgent plea to all parents teetering with this tough decision. The vaccines are safe and effective in children and now is the time to get them protected!

Children ages 5-11 years are largely still unprotected

4) Ontario’s 4^th wave rising: New and active cases are both up a record 72% and hospitalizations rose 10%.

salmon coloured graph with 4 text boxes underneath

So what to do? Ensure you and your children are vaccinated and if eligible, get the 3^rd dose booster shot. Also, please engage in good public health measures, including physical distancing, hand washing and use of masks.

5) Canada’s COVID-19 4^th wave is resurgent: A 55% increase in new cases and a 48% increase in active cases with a 4% increase in hospitalizations (click here) (click here).

Cases in Canada are rising again

Canada’s part of the pandemic is worsening with 4899 cases yesterday and 1455 people in hospital despite reasonable (but not stellar) vaccination rates (78.6% of people 12-years of age and older are vaccinated) (click here) (click here). Canada has had 1.89 million cases of COVID-19 since the pandemic began. The case mortality rate remains ~1.59% with 30,048 deaths. We administered a total of >64.8 million vaccines! He map below shows COVID-19 surging nationally, with a rapid rise in new cases due to the emergence of the omicron variant and relaxing of public health measures in November.

map of Canada with arrows showing increases in covid cases

COVID-19 Cases surging nationally-Dec 20, 2021.

6) Global vaccine roll-out 3.7 billion people fully vaccinated (2 doses); but low-income countries lag behind and boosters still not widely available. Vaccine safety record remains excellent (click here)

The graphic below has a new format and shows fully vaccinated people (vs those receiving just one vaccine in previous versions). What a source of pride that almost half the world’s people are fully vaccinated in just 1-year!!

However, vaccination rates remain appallingly low in low-income countries, many of which are in Africa These vaccine deserts cause human death and suffering and allowed the virus fertile ground to mutate, which lead to the genesis of the Omicron variant. We need to learn to help ourselves by helping others!

Vaccine deserts remain in Africa-past time for rich countries to share vaccines!

world map with different shades of green showing areas not vaccinated yet

Low-income countries have barely begun vaccination:This is the main explanation for why omicron variants emerged from South Africa-lots of susceptible people and no vaccines!

Vaccines are safe: You may be interested in this recent blog, “Vaccines for COVID-19: Why are some Canadians allergic to the truth?” The blog reminds us how effective vaccines are (see graphic below) and how rare true allergic reactions are. Thanks to Drs Badawod and Ellis for co-authoring this useful blog!

In addition to many clinical trials showing safety, the safety record of vaccines has been established in the real world. The complication rates remain very low based on Canadian data showing that vaccines are safe (click here for Canada’s safety data), as well as being effective against all forms of the coronavirus. Getting vaccinated reduces your risk of hospitalization from COVID-19 33-fold! Vaccination carries a very small risk of serious adverse reactions (11/100,000 vaccines given) and virtually no risk of death.

The serious complication rate in Canada remains low (11 serious adverse events/100,000 vaccines administered). Data as of December 10th, 2021

The graph below shows the side effects of each type of vaccine:

The graph below shows the types of adverse effects people experience with vaccines (most of which are minor and resolve within 24-48 hours without medical intervention).

7) The global pandemic is not yet controlled: ~274.9 million cases and 5,357,096 deaths to date with most deaths in the past month in the USA, UK, Germany, France, and Russia (left column below)

satellite image of earth taken from space

Here is today’s map of the global pandemic. Daily cases are rising (red graph) and deaths have plateaued (white graph). Vaccine administration is up (green graph).