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US border guard talking to someone in a car

October 14, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Headlines

1) How to download your vaccine application to the wallet of your iPhone: There is an app for that.

2) What do Queen’s University and the National Basketball Association (NBA) have in common?  You have to be vaccinated to play (or be paid).

3) On the road again-how to travel to the USA.

4) Who qualifies for a 3rd dose of vaccine in Ontario?

5) KFL&A update: 41 local active cases, 0 KFL&A residents hospitalized and 83.8% of eligible residents > age 12 years fully vaccinated. 

6) Ontario’s 4th wave has plateaued: New cases (306 yesterday) and active cases are down 13 and 10%, respectively and hospitalizations are down 11%, with a positive test rate of 1.7%.

7) Canada’s COVID-19 4th wave declining: A 14% decrease in both new and active cases and 4% decrease in hospitalizations (click here) (click here).

8) World vaccine roll-out tops 6.6 billion people and safety record remains excellent (click here).

9) The global pandemic is not yet controlled: ~239 million cases to date with most deaths in the USA, India, Turkey UK, Russia and Brazil (left column below).

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1) How to download your vaccine application to the wallet of your iPhone: There is an App for thatDr. Stephen Vanner and Dr. Salwa Nihal (from our Translational Institute of Medicine -TIME) sent out a useful link regarding a convenient way for iPhone users to store proof of vaccination on their iPhones (apologies to my Android friends). The App is simple to use and you can either go (via their link) to the Ministry of Health site and retrieve your vaccine verification document or if you already have a pdf on your phone use that. When the official QR system (vaccine passports) arrive on Oct 22nd this App will be updated. I encourage you to check the App out for your convenience. The layout of the App is shown below. Thanks for a TIMELY TIP Drs Vanner and Nihal.

screenshot of App to download and save vaccination proof to your iPhone

2) What do Queen’s University and the National Basketball Association (NBA) have in common?  Basketball is a team sport. Players have to pass the ball if they want to score and win. Players that don’t distribute the ball effectively are first coached and then, if coaching fails, benched. Likewise in the high-stake game of Humans vs COVID-19 we are all players on the Team Humanity. We need to get vaccinated and encourage others to be vaccinated if we want victory over the virus. The NBA tried to establish a vaccine mandate for players during off-season talks with the National Basketball Players Association but failed. “The NBA has made these proposals, but the players’ union has rejected any vaccination requirement,” spokesman Mike Bass said.

The stakes have now been increased. In early October it was announced that if you’re not fully vaccinated you can’t play in the NBA and you won’t be paidA nice article in the Washington Post by Ben Golliver contrasts the approaches of several NBA stars. As in off-court life there are vaccine advocates (like Kareem Abdul-Jabbar) and there are libertarians, like LeBron James…both of whom are vaccinated. There are of course anti-vaxers; but it is more interesting to consider people who get vaccinated but won’t speak to its virtues for their “teammates”. Likewise at Queen’s University you must be vaccinated to attend or teach (see policy). Those who decline vaccination are placed on leave without pay. The only exemptions are for the miniscule number of people who legitimately qualify for medical exemptions. Medical exemptions are only given in the case of demonstrated anaphylaxis in response to a first dose of vaccine or severe allergy to a vaccine component. Staff and faculty who are not vaccinated are given some time to “reflect” but if they decline are placed on an unpaid 3-month leave. A similar policy applies at Kingston Health Sciences Center. 

KHSC existing employees, physicians and credentialed staff must be fully vaccinated in accordance with the following dates, unless they have a medical contraindication, or an exemption based on a protected ground in the Ontario Human Rights Code. Thus they must receive dose #2 of the vaccine no later than October 22, 2021, unless there is an exemption and these will be exceptionally rare since few medical reasons not to be vaccinated exist.

Another sporting story you might want to mention comes from the NHL. One of the Edmonton Oilers, Josh Archibald, who declined to be vaccinated and has social media postings indicating a COVID-19 denial mindset, contracted COVID-19 and suffered severe heart muscle damage (myocarditis), a known consequence of SARS-CoV-2 infection. Ironically in worrying about the 8/100,000 risk of vaccines people like this young athlete expose themselves to the much higher risk of life altering consequences of COVID-19 infection.

news article showing hockey player infront of goalie jumping

So I encourage all, not only to get vaccinated, but to speak up and encourage the 20% of folks who remain vaccine hesitant.

3) On the road again-how to travel to the USAHere is an account of how my daughter, Elizabeth Archer crossed from the USA to Canada and returned home successfully. It highlights some pro-tips on the different test requirements of Canada for entry (PCR testing) vs the USA (PCR or Rapid Antigen Testing). I recently tweeted about this since policies are changes and travellers are often left to be detectives in a confusing morass of rules that vary over time and by country.

Here is the tweet on this from last week.

screenshot of tweet stating covid 19 testing available at Shoppers Drug Mart


Elizabeth Archer:

To get into Canada, I had to get a PCR test done within 72 hours of my departure. Luckily, I have a testing place near me, and surprisingly, the test cost me $0 (and would have even without insurance.) I got the results in on the night before I left, and I printed them out.

Message-to get into Canada you need a PCR test

I also downloaded the ArriveCAN app and checked in on that before leaving the states. 

screenshot of ArriveCan App

Message-use this app to facilitate your arrival

Before leaving Chicago, I called around to different facilities around Kingston, trying to find a travel-friendly test. Most sites only test those with symptoms and make it clear the test isn’t for travel. After a few hours of hunting around, I found a drugstore that did travel testing near my parents’ place and made an appointment. To re-enter the US, you must have a negative COVID test taken within the past three days (a little more flexible than measuring in hours.) The US allows PCR and antigen tests for entry…including rapid antigen. I went to the drug store, checked in, and they swabbed my nose. I waited 15 minutes to get my results.

Message- You need to book a test to enter the USA in advance from places like Shoppers Drugs. The Rapid Antigen test ($40) (plus proof of full vaccination) gets you across the USA border.

The testing confusion I mentioned is echoed in a recent CBC article which is timely as the USA border is opening in November for land crossings which make the testing inconsistencies between the USA and Canada even more difficult to deal with. The U.S. is about to reopen its land border with Canada to non-essential travel. And the USA won't require visitors to show a negative COVID-19 test; proof of vaccination will suffice. I  agree with the American position that we will soon need to evolve our acceptance of risk so that vaccinated people don’t require testing for travel or at very least are offered a simple, free travellers test that is the same coming and going! The Canadian government is considering their response to the impending border opening as it pertains to testing-stay tuned!

photo of US border guard speaking to someone in a car

Like everything else in this pandemic people have strong opinions. Some Canadians still view travel as an unnecessary luxury, unwise, and frivolous. Many that hold these views do not have family in other countries. We clearly need to “walk a mile” in the shoes of our fellow man/woman to understand why travel is not a simple luxury form the many Canadians who have not seen loved ones for many months (or for some over 1 year).

4) Who qualifies for a 3rd dose of vaccine in Ontario? It remains uncertain that members of the general population require a 3rd dose of vaccine, although some countries like Israel have made the choice to do this universally. It appears in Canada that protection is sustained in most people and there is a social justice issue in that 3rd doses given to vaccinated Canadians may take away first dose from people in low-income countries.

New Ontario data (awaiting peer review) from Toronto’s Institute for Clinical Evaluative Sciences (ICES) show that 8 months after being vaccinated, protection against infection and severe outcomes is still very high in non-immunocompromised adults (and remains good even in seniors living in retirement homes). This argues against widespread use of 3rd doses.

screenshot of news article female healthcare worker drawing vaccine from bottle into syringe

Here is a brief summary of who is eligible for a 3rd dose of vaccine at the moment in Ontario:

At this time 3rd doses of the COVID-19 vaccines will be offered for the following populations eligible for vaccination with the vaccine product authorized for their age group:

  • Individuals receiving active treatment (e.g., chemotherapy, targeted therapies, immunotherapy) for solid tumour or hematologic malignancies.
  • Recipients of solid-organ transplant and taking immunosuppressive therapy.
  • Recipients of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy). 
  • Individuals with moderate to severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome). 
  • Individuals with stage 3 or advanced untreated HIV infection and those with acquired immunodeficiency syndrome. 
  • Individuals receiving active treatment with the following categories of immunosuppressive therapies: anti-B cell therapies2 (monoclonal antibodies targeting CD19, CD20 and CD22), high-dose systemic corticosteroids (refer to the CIG for suggested definition of high dose steroids), alkylating agents, antimetabolites, or tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive (See Table 1). 

At this time third doses of the COVID-19 vaccines will also be offered for the following groups to boost the primary COVID-19 vaccine series: 

  • Residents of Long-Term Care Homes (LTCH), Retirement Homes (RH), Elder Care Lodges, and elderly living in other congregate settings (e.g. assisted-living facilities, chronic care hospitals, naturally occurring congregate retirement settings/congregate senior’s apartment buildings, etc.). 

5) KFL&A update: 41 local active cases, 0 KFL&A residents hospitalized and 83.8% of eligible residents > age 12 years fully vaccinated The pandemic remains under control in SE Ontario in general and in KFL&A in particular. All regions of SE Ontario have very high (>80%) rates of vaccination. The local positive test rate has plateaued at 1.0%.

table showing KFL&A data for cases in Step 3 of reopening

What’s happening at Kingston Health Sciences Center? We have 0 active COVID-19 cases at KHSC (2 resolved cases). The Medicine program at KHSC remains extremely busy with non-COVID-19 care. We are looking after 195 patients at KHSC. Clinics are continuing to ramp up and all physicians are being asked to see patients in person whenever possible and appropriate.In all disciplines we are seeing the consequence of pandemic-induced wait lists and delayed care. Patients are arriving in clinics and at the hospital with more advanced disease. We are doing our very best to catch up and ensure care is provided in a timely a manner (but it is a challenge, exacerbated by shortages of nurses and technologists and limited capacity in procedural suites and operating rooms). 

The CPSO has recently made a statement (consistent with our longstanding policy in the DOM) requesting that all physicians to return to predominantly in person health care. They state in a letter to all MDs on Oct 13th, “It is the joint position of the Chief Medical Officer of Health, Ministry of Health and the College of Physicians and Surgeons of Ontario that in-person care can be provided safely and appropriately and it is expected that all physicians are providing in-person care based on clinical needs and patient preference. Vaccination is the most effective measure to reduce the risk of COVID-19 in individuals and in our community.”

6) Ontario’s 4th wave has plateaued: New cases (306 yesterday) and active cases are down 13 and 10%, respectively and hospitalizations are down 11% as well, with a positive test rate of 1.7% The good news is that with high rates of vaccination in Ontario and ongoing reasonable (if relaxed) public health measures (like indoor masking) we are seeing gradual resolution of wave 4 (below). 

salmon coloured line graph

7) Canada’s COVID-19 4th wave declining: 14% decrease in both new and active cases and 4% decrease in hospitalizations (click here) (click here)

map of Canadasalmon coloured line graph with 4 text boxes along bottom

Canada’s part of the pandemic is improving as vaccination rates rise (click here) (click here). The 4th wave has peaked in Alberta and BC, although not in the Yukon. Here is a snapshot of the still highly stressed situation in Alberta today (below).

various types of graphs

Canada has had 1.67 million cases of COVID-19 since the pandemic began. The case mortality rate remains ~1.5% with 28,374 deaths. We administered 92,790 vaccines yesterday, bringing total jabs up to >57.1 million! (see below). 73% of Canadians that are eligible are fully vaccinated.

8) World vaccine roll-out tops 6.6 billion people and safety record remains excellent (click hereCanada remains near the top of the international pack when it comes to vaccinating its population. However, vaccination rates are appallingly low in low-income countries. These vaccine deserts cause human death and suffering and allow the virus fertile ground to mutate and create new variants.

horizontal colourful bar graph

Global vaccination continues to increase

Low-income countries have barely begun vaccination: A reason to hold off on booster doses in rich countries and divert doses to where they are most needed.

Vaccines are safe: In addition to many clinical trials showing safety, the safety record of vaccines has been established in the real world (see item 1 in today’s note). The complication rates remain very low based on Canadian data showing that vaccines are safe (click her for Canada’s safety data), as well as being effective against all forms of the coronavirus. Getting vaccinated reduces your risk of hospitalization for COVID-19 33-fold! It carries a very small risk of serious adverse reactions (8/100,000 vaccines given) and virtually no risk of death.

six text boxes

The serious complication rate in Canada remains low (8 serious adverse events/100,000 vaccines administered). Data as of Oct 1st, 2021.

9) The global pandemic is not yet controlled: ~239 million cases to date with most deaths in the USA, India, Turkey UK, Russia and Brazil (left column below).

satellite image of earth from space

 

world map, colourful graphs numbers and rankings for World Covid Data to date

Global COVID-19, Oct 14th 2021

Here is today’s map of the global pandemic. Daily cases are declining (red graph), as are deaths (white graph). Vaccine administration is somewhat down, which is concerning (green graph).

Final Thought

Please encourage your friends and family to get vaccinated! Unvaccinated people not only put themselves at risk; but when they fall ill, risk overwhelming our hospitals, blocking care for the 99% of people who do not have COVID-19. Unvaccinated people are also a major pool in which the virus can circulate. This source of virus can potentially infect our children (under age 12 years), who are not protected since they are not yet eligible for vaccination.

Stay well!

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