September 16, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program
1) Why returning to in person school is safe: Data from Scotland show in person education is safe for school teachers and their families.
2) New study shows the safety of mRNA vaccines for COVID-19 after 11 million doses in 6.2 million people.
3) KFL&A update: 46 local active cases (up from 9 cases 2 weeks ago), 0 KFL&A residents hospitalized and 79.6% of eligible residents > age 12 years fully vaccinated.
5) Canada’s COVID-19 4th wave continues to rise: 15% increase in new cases and 16% increase in hospitalizations (driven by Western Canada).
8) The global pandemic is not yet controlled: ~222 million cases (17 million in the past month) with 4,662,628 deaths to date with most deaths in the USA, India, UK and Iran (left column below).
1) Why returning to in person school is safe: Data from Scotland show in person education is safe for school teachers and their families (suggested by Dr Charlie Hindmarch, QCPU).
There is understandable concern amongst teachers about risk of acquiring COVID-19 during the course of in person education. There are now real-world data from Scotland that support the safety of properly run school rooms operating in person (even prior to vaccine availability). In this study the authors look at the likelihood of hospitalization for COVID-19 (defined as a positive PCR test and hospitalization for COVID-19), or hospitalization for severe COVID-19 (positive test plus admitted to ICU or death). Teachers were compared to the general working population and …they did better!
This study examined the risk of COVID-19 in teachers in Scotland. Scottish schools closed during the first wave of the pandemic but were fully open with in-person teaching from August to December 2020 (the pre-vaccine era). The study also includes later time points when both the delta variant and vaccines were factors. In May and June 2021 the delta variant was present in Scotland and the country had some of Europe’s highest infection rates. Vaccination was underway with many adults of working age having a 1st vaccine dose. Schools were fully open.
Class sizes were unchanged from those before the pandemic, and physical distancing was not required between primary school pupils but was recommended between staff and pupils and encouraged among secondary school students when possible. Most teachers were young (mean age 42 years, were women (80%), and had no comorbidities (84%). The risk (cumulative incidence) of hospital admission with COVID-19 was <1% for all adults of working age in the general population of 132,00 teachers and 1.3 million control subjects matched for age and sex. Teachers showed a lower risk of hospital admission with COVID-19 (relative rate ratio 0.77) and of severe COVID-19 (relative rate ratio 0.56). Values less than 1 meaning lower risk than the general population.) Both rates were statistically significant in this study. It was noted that school teachers did have more positive testing during the fall when school was in session vs the summer (but hospitalizations were not increased). It remains unclear if teachers are healthier or better follow public health guidelines; but the bottom line is that in person school teaching is safe during the pandemic, despite a 4th wave of delta variant.
Teaching school in person is safe during the pandemic (see bottom right panel)
2) New study shows the safety of mRNA vaccines for COVID-19 after 11 million doses in 6.2 million people (suggested by Dr Kathie Doliszny).
A population-based surveillance study by Klein et al conducted in the USA found only 23 serious adverse events in 6.2 million vaccinated people and noted no difference in the rate of these adverse events between the time when they might be considered vaccine complications (days 1-21) vs later (days 22-42), when they might well be considered coincidences. They look proactively at all real and theoretical complications attributed or suggested to be related to the vaccines, including all the diseases/ complications in Table 3 (below). No complication was common nor were any more likely to occur in the 3 weeks around the time of vaccination, except anaphylaxis!
Vaccines don’t increase the risk of any of these adverse outcomes in the 21 days post vaccine
This is not to say there are no complications. There were 53 confirmed cases of anaphylaxis (95% in women). This is a rate of ~5 cases of anaphylaxis/million vaccines given. There was no association with VITT (Vaccine Induced Thrombocytopenia and Thrombosis) or Bell’s palsy. This is further evidence of the safety of mRNA vaccines and should reassure any hesitant person to proceed with vaccination.
3) KFL&A update: 46 local active cases (up from 9 2 weeks ago), 0 KFL&A residents hospitalized and 79.6% of eligible residents > age 12 years fully vaccinated.
The local case rate is increasing, particularly in KFL&A. This mostly reflects cases in young people and contact tracing points back to groups assembling for parties. Nonetheless, with a highly vaccinate population hospitalizations remain low and fortunately the rates have plateaued in Ontario as a whole during wave 4. The priority will continue to be a) vaccination of the remaining 20% of the population, b) continued public health measures and c) vaccination of children aged 5-11 (which hopefully will be approved soon and start in the late fall-stay tuned).
Increase case rates in SE Ontario (particularly in KFL&A) in wave 4 of the COVID-19 pandemic
The rate of positive tests in KFL&A has increased (1.4% positive). This rate of positive tests is up from 0.34% 2 weeks ago (see graph below). The reality is that we live in Canada, where the 4th wave is rising, and are part of a global society, in which the pandemic continues to rage. I would anticipate that we will see a rise in cases this fall however, due to the 20% of people that are unvaccinated, the rise in the delta variant, and the relaxing of mask policies. The good news is that this is a future we can influence and change; we just need to advocate for vaccination, ensure vaccination of younger children occurs (once approved) and continue to use masks in indoor spaces.
Rise in positive test rates in SE Ontario
The Medicine program at KHSC remains extremely busy with non-COVID-19 care. We are looking after 188 patients at KHSC. Clinics are continuing to ramp up toward pre-pandemic levels (although volumes are still limited by the size of waiting rooms and ongoing masking/physical distancing requirements). All physicians are being asked to see patients in person whenever possible and appropriate.
I can also reassure patients that all trainees, staff and faculty are required to be vaccinated to work at KHSC or Queen’s University.
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 a plateau in wave 4-although time will tell if this can be sustained (see below).
Wave 4 has plateaued in Ontario
In stark contrast is the situation in Alberta below. Alberta’s self-inflicted wave-4 crisis relates to failure to implement logical public health policies (they were not using masks, tracking contacts or restricting public association of infected people) and have a large population of unvaccinated people (30%). Sadly, for Albertans these decisions have shut down elective health care and threatens to over run their health care system.
Premiere Kenney has apologized for his mistaken policy decisions; but that is cold comfort for the people of Alberta. Wednesday marked the most Albertans ever occupying ICU beds in the history of the province, with the CEO of Alberta Health Services announcing it was asking neighbouring provinces for help managing the situation. It remains to be seen if the contrarian, libertarian, anti-scientific attitudes of the large numbers of unvaccinated Albertans can be corrected in time to flatten wave 4. Leadership matters and science/public health should not be subject to modification by politicians.
The graph below shows on the left that Alberta and Saskatchewan have the lowest rates of vaccination amongst provinces (left) and the highest case rate (right). There is a straight line between these facts. The line is made even bolder by the fact that people and province that don’t vaccinate also tend not to follow public health rules-a lethal double whammy!
Data above show that when it comes to COVID-19 it is “Get vaccinated or suffer the consequences”
Plateau in Ontario’s 4th wave? Slide courtesy of Dr. Gerald Evans
Canada is experiencing an 15% weekly rise in new cases and 16% rise in hospitalizations despite 69.5 % of the eligible population being fully vaccinated (click here) (click here). This is driven by unvaccinated people (particularly in BC, Alberta, Saskatchewan), the highly infectious delta variant, lack of vaccination approval for children ages 5-11 years, and premature relaxing of public health policy (in some jurisdictions).
We have had 1.56 million cases of COVID-19 since the pandemic began. The case mortality rate remains ~1.5% with 27,305 deaths (42 yesterday). We administered 86,358 vaccines yesterday, bringing total jabs up to >54.5million!
4th Wave in Canada Sept 16th 2021- infection rates continue to rise driven Alberta and Saskatchewan
Canada’s pandemic today-Sept 16th, 2021
6) World vaccine roll-out tops 5.8 billion people and safety record remains excellent (click here) Canada remains near the top of the international pack when it comes to vaccinating its population (see dark green on map below). However, vaccination rates are appallingly low in African countries. These vaccine deserts cause human death and suffering and allow the virus fertile ground to mutate and create new variants.
Africa remains a vaccine desert
Vaccines are safe: In addition to many clinical trials, 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 here 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!
The serious complication rate in Canada remains low (7 serious adverse events/100,000 vaccines administered). Data as of Sept 3rd, 2021
8) The global pandemic is not yet controlled: ~222 million cases to date (17 million in the past month) with 4,662,628 deaths with most deaths in the USA, India, UK and Iran (left column below)
Global COVID-19, Sept 16th 2021
Here is today’s map of the global pandemic. Daily cases are at a plateau (red graph), as are deaths (white graph). However, these are very high case load plateaus and the pandemic is not yet under control. Vaccine administration is somewhat down, which is concerning (green graph).
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. You might enjoy this myth-buster article.