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screenshot of Doug Ford announcing Provincial

April 1, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Headlines

Provincial 4-week shut down announced (click here)

screenshot of Doug Ford and Christine Elliott in the background

The government just issued a “shutdown” order (similar to the old grey zone rules in which retail is allowed to open with strict capacity limits).

Under the guidelines:

  • Personal care services and gyms will be closed. 
  • Essential retail stores will be able to operate with a 50 per cent capacity limit
  • Other retail businesses, including big box stores, can operate at 25 per cent capacity.
  • Residents will not be able to gather with anyone outside of their household indoors and outside gatherings will be capped at five people, as long as physical distance can be maintained. 
  • Residents are also being asked to limit trips outside of their home, unless it's for essential reasons (trips for food, medication, medical appointments, supporting vulnerable, community members, or exercising outdoors with members of their household).
  • Schools and child-care centres will remain open and the planned April break for students and teachers will go ahead as planned. Day camps, however, will be required to close

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)

New KHSC policy for staff, trainees and faculty who live and work in a red/gray zone: Weekly swabs and work place isolation are now recommended and you will be required to work under work place isolation rules. This is very relevant since Lanark Leeds Grenville is now a nearby red zone in which some of our workers reside.

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).

KHSC Staff, trainees and faculty please note:***Beginning March 30th invitations to register for 2nd vaccine dose (4 months after 1stdose) were sent out to KHSC staff-please watch your email

1) Variants vs Vaccines: Why Canada needs to accelerate its vaccine program and overcome vaccine hesitancy

2) COVID-19 vaccines available for people 70 years of age and over in Kingston (click here): register for a vaccine appointment online at www.ontario.ca/bookvaccine or by calling 1-888-999-6488.

3) Pfizer COVID-19 vaccine 100% effective in children (age 12 and older) (click here)

4) Pfizer vaccine confers immunity within 2 weeks of first shot (click here

5) COVID-19 Vaccines and Vaccine Hesitancy: Staring at the Clouds of Vaccine misinformation (click here)

6) World vaccine roll-out approaches 600 million people (click here)! Real world evidence that vaccination is safe and effective.

7) All about COVID-19 Vaccines: Updated FAQs about vaccination: New FAQ: If I have a solid organ transplant or I am a cancer patient should I have my second vaccine dose at the original interval? 

8) KFL&A COVID-19 rates rise by 17 cases since Monday-201 active cases in our part of SE Ontario (see update from KFL& A Public Health)20% reduction in elective surgery at KHSC to deal with provincial surge in COVID-19

9) Ontario infection rates are up from Monday with 2557 new cases yesterday. New and active cases are up 38% and 34%, respectively and Ontario’s case rate of positive tests has soared to 4.8% (click here(click here).

10) Canada’s COVID-19 epidemic: 985,950 cases and 22,991 deaths in total so far with 5,519 new cases yesterday (click here) (click here): COVID-19 Wave 3 rising in Western provinces and Ontario and 13.5% of population vaccinated. 

11) The global pandemic continues to escalate: >129 million cases to date and new case rates on the rise (click here); up almost 2 million cases since Monday!

12) KHSC capacity is better but elective surgery reduced 20% to accommodate influx of COVID-19 patients from greater Toronto area 

13) Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)-no deaths in 2 weeks…evidence vaccines working: click here

14) Increased COVID-19 in school age children: (click here).

________________________________________________________

1) Variants vs Vaccines: Why Canada needs to accelerate its vaccine program and overcome vaccine hesitancy

Variants of SARS-CoV-2, the virus that causes COVID-19, are now the dominant form of the virus in much of Canada. The good news if the vaccines protect against these variants. The bad news is that the new variants spread faster and cause more death and hospitalization than the original virus. The new variants are also infecting and causing more severe illness in younger people. The graph below shows that infections with a variant of concern (meaning mutant virus) increases the risk of hospitalization 64%, ICU admission by 104% and death by 56%! On the right the stacked bar graph shows the mutant virus have increase the flow of young people (<50 years old) from 30% to 46%. This is the time for definitive national and personal action. We need to vaccinate quickly! One shot provides initial immunity and that is the policy Canada is following. The second shot can (in most groups) be delayed so more people get shot one! For hesitant people-it is time to re-think your position. If you are young-you are not safe; if you are old, you are even less safe than before the mutant viruses became common. Bottom line-don’t panic; do act! Get the vaccine as soon as it is offered.

horizontal and vertical graph orange and yellow colour

Mutant viruses (variants of concern) are more infectious and cause more severe illness in younger people (courtesy of Dr. Gerald Evans).

2) COVID-19 vaccines available for people 70 years of age and over in Kingston (click here)

50,000 KFL&A residents have already been vaccinated (>24% of all residents)! Beginning Monday, those 70 years old and older (born in 1951 and earlier) 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.

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) 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. Both COVID-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.

5) COVID-19 Vaccines and Vaccine Hesitancy: Staring at the Clouds of Vaccine misinformation (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 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-wrong as it is). The second cloud provides the correct information. 

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 (~30) 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 600,000,000 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! 

 A Cloud full of Misinformation about COVID-19 vaccines

word cloud of mis information about vaccine

The truth about COVID-19 vaccines

word cloud or vaccines truths

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.

colourful horizontal graph

Vaccine hesitancy is widespread-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. If you want some data for your next cocktail party (with you and your 4 friends), here are the Canadian vaccine safety data for all vaccines as of March 12th (click here). Of the 2,530 individual reports (0.068% of all doses administered), 320 were considered serious (0.009% of all doses administered).

sizes text boxes with numbers in them

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 600 million people (click here)! Real world evidence that vaccination is safe and effective.

colourful horizontal graphs

Vaccines in arms as of April 1st 2021

The good news is that COVID-19 vaccines work; however the emergence of increasing numbers of variant viruses (which are slightly less vaccine sensitive) is a reminder of the urgency of a global vaccine roll-out. 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. For the undecided 40% of Canadians who are unsure they want to commit to taking a vaccine now, please believe that time is of the essence. The more time the virus has to infect unvaccinated people the more time it has to mutate and develop the ability to evade vaccine-induced antibodies. 

There is real world evidence the vaccines work. The graph below that in countries that have an effective vaccine roll out, like the UK, USA and Israel rates of infection in these countries fell rapidly with the introduction of the vaccine in 2021. 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! 

colourful dotted line graph showing decline in covid

Real world proof that vaccines (introduced at end of Dec 2020) work to reduce cases of COVID-19-April 1st 2021 (click here

7) Here are answers to some updated FAQs with answers to common questions about the COVID-19 vaccines (most recent at the top).

grey faceless human figure with orange question marks surrounding head

1) New FAQ: 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 2) 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 3) 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 4) 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 5) 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

memo from Thrombosis Canada for those getting the vaccine

FAQ 6) 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.

table of pfizer vs placebo side effects

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 7) 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 8) 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.

needle and syringe drawing vaccine from a bottle

FAQ 9) 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 10) 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 11) 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.

8) KFL&A COVID-19 rates rise by 17 cases since Monday-201 active cases in our part of SE Ontario (see update from KFL& A Public Health)

The total number of cases in KFL&A since the pandemic began is 926, not counting the prison outbreak. This is up 17 cases since Monday and most new cases are caused by a variant of concern (i.e. mutant virus) (see below). The regional new case rate has plateaued after a peak last week. There are 10 people hospitalized at KHSC with 23 in quarantine. Only 2 are from our region; the other 5 are from Lakeridge/Scarborough. Lanark Leeds Grenville has had a decrease in active cases to 71 cases. Hasting Prince Edwards County active case rate is up rapidly last week with 71 new active cases. Thus, with our 59 active cases there are 201 active cases in our part of SE Ontario, down from 242 last week. There are 15 active regional outbreaks (8 in schools). We have done 2733 COVID-19 tests at KHSC since Monday with 32 positive tests for a positive test rate of 1.2%. Of people tested from KFL&A there was 0.8% test positivity. 

table of COVID-19 data for KFL&A3 different types of graphs yellow in colour

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. 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.

9) Ontario infection rates are up from Monday with 2557 new cases yesterday. New and active cases are up 38% and 34%, respectively and Ontario’s case rate of positive tests has soared to 4.8% (click here(click here).

salmon coloured bar graph with 4 text boxes with arrows and info

Ontario’s COVID-19 hospitalization rate rises 24%

number graphic outlining Ontario's Covid-19

Ontario’s positive test rate rises to 4.8%

We have done 12.58 million COVID-19 test thus far. The rate of test positivity in Ontario is rising and has reduced from 6.1% to 4.8% (see above), 4X 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 a large 3rd wave. This is no time for vaccine hesitancy! 

salmon and green graph

Here is an illustration of the 3rd wave of COVID-19 that we are currently experiencing.

10) Canada’s COVID-19 epidemic: 985,950 cases and 22,991 deaths in total so far with 5,519 new cases yesterday (click here) (click here): COVID-19 Wave 3 rising in Western provinces and Ontario and 13.5% of population vaccinated. 

map of Canada and surrounding waters

Wave 3: 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 the beginning of a 3rd wave. In addition the bottom panels continues to show a concerning rise in hospitalizations-April 1st 2021

various graphs

Canada April 1st 2021

There have been 22,991 COVID-19 deaths thus far and a cumulative national case mortality rate of 1.9%. Canada has performed ~28.5 million COVID-19 tests with a cumulative test positivity rate of 3.44%. Rates of infection are rising in BC, AB and Saskatchewan, 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

Canada’s vaccination roll-out: 5.8 million vaccines administered thus far (13.5% of population) (click here): To date, 7.4 million doses of COVID-19 vaccines (including Moderna, Pfizer-BioNTech and Astra-Zeneca) have been delivered. Thus far, 78.4% of delivered doses have been administered. 689,975 Canadians are fully vaccinated (click here). Still, Canada is well back in the pack (not in the top 30 countries) with only 13.5% of the population vaccinated.

11) The global pandemic continues to escalate: >129 million cases to date and new case rates on the rise (click here); up almost 2 million cases since Monday!

satellite picture of earth from space

There have been ~129 million cases since the pandemic began, up almost 2 million cases since Monday! There have been 2,819,141 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.

world map with yellow dots and ranking of countries cases

The USA, with 30.47 million cases and 552,246 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 % of the global pandemic but things are improving rapidly in the USA, with over 150,000,000 vaccinations completed and a promise to have all Americans vaccinated by May. Also helping the US epidemic is natural immunity (due to infections) and better adherence to public health measures (in some states). 

Americanow has a 4.7% positive test rate, roughly the same as Ontario 4.8%) (click here; see below). Many states have canceled their masking policies and there has been an associated rise in positive test rates over the past 1-2 weeks.

12) KHSC capacity is adequate but we are reducing elective surgery 20% by provincial mandate to accommodate influx of COVID-19 patients from other regions

The hospital has done a good job making bed space available for current and potential COVID-19 cases by discharging people when possible, operationalizing surgical inpatient beds at the Hotel Dieu site, and moving ALC people to other facilities-KUDOS team KHSC! We are down from >500 to 460 admitted people and 180 of them are on the Medicine service. We now have 81 beds available. Critical care beds remain available (13) but there is an ongoing influx of COVID-19 patients from the greater Toronto area. We have 10 in-patients with COVID-19 (our first day in double digits).

KHSC bedmap

KHSC April 1st 2021: Making room as we expect influx of COVID-19 patients from Toronto area

Because we are part of a provincial system we are making room for the influx of patients from the greater Toronto area, where ICU capacity is at or over capacity. Unfortunately to do this we have had to recue elective surgery and surgery requiring ICU recovery by 20%. We ,will do this for the shortest time possible. We are all painfully aware that most of the services provided at KHSC are time-sensitive and delays can worsen the quality and/or quantity of people lives. We remain committed to continuing as much of our “elective” procedural and other care as is possible. We have opened new beds here at KHSC and Hotel Dieu, reactivating it as a site for inpatient care for surgical patients. 

13) Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)-no deaths in 2 weeks…evidence vaccines working: click here

3 seniors sitting at a table wearing masks

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 3,753 deaths in nursing homes (NO DEATHS X 2 WEEKs) account for ~57% of all deaths. There are 9 active COVID-19 cases in LTC residents and 103 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 0/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!

graph showing positive effect of vaccines

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)

14) Increased COVID-19 in school age children: (click here). 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 9936 students with COVID-19 since the pandemic began with 2,487 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. 23% 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 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!

4 teenagers sitting on a bench each with iPhone and iPads

Things are better in the toddler age group. Here are the parallel data from licensed child care facilities in Ontario-where there have been 2056 children infected since the pandemic began, 420 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.

group of young children sitting on classroom floor

Regular reminders-On hiatus today

Vaccine vs Variants: There is a 3rd wave of COVID-19 rising in KFL&A, Ontario, Canada and globally. The next month is going to be one of the most challenging in the pandemic, as the race between vaccinations and variants continues. We will only turn the corner on this pandemic permanently when vaccinations are universally available and when the public agrees to be vaccinated.

While we need to follow public health guidance, getting the vaccine as soon as it is offered is the key to returning to a pre-COVID-19 world.Taking the vaccine is safe and it’s the right thing to do. I am one of the 520,000,000 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 because the benefits in preventing severe adverse outcomes (death and mechanical ventilation) are provided by all approved vaccines. The Astra Zeneca vaccine is safe and effective for all approved age groups (and hopefully we will sort out the case of those under age 55 years soon-click here). 

You can now book your vaccine on line if you are over age 70 years (click here)! 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. Vaccine hesitancy puts you and your loved ones at unnecessary risk. 

Stay well! 

 

 

 

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