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June 24, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

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A reward for returning Canadians who are fully vaccinated: Effective July 5 at 11:59 p.m. EDT travellers who are currently able to enter Canada under the existing rules will be able to do so without having to self-isolate for 14 days, taking a test on day eight, or having to stay in a quarantine hotel upon arrival, if they are fully immunized against COVID-19 (click here). I suspect this is one of many necessary public policies which will favour those who are fully vaccinated and who thus pose very low risk of disease transmission and who are themselves at low risk of contracting COVID-19.

canada flag and welcome back to canada eh

1) Rare, reversible heart complications of COVID-19 vaccination (click here)


2) The politics of COVID-19 vaccines: lessons about vaccine hesitancy from the United States (click here)

3) KFL&A update: 3rd wave resolving locally (10 patients in hospital-only 2 from KFL&A), and 75.5% of eligible residents (12-years and older) vaccinated at least once and 24.6% fully vaccinated (see update from KFL& A Public Health)

4) Wave 3 continues to subside as Ontario exceed vaccine targets and infection rates fall with 255 new cases yesterday and a 1.2% positive COVID-19 test rate (click here(click here): an accelerated plan to move to phase 2 reopening next Wednesday (click here

5) Canada’s COVID-19 epidemic rapidly resolving with > 33.7 million doses of vaccines administered: New and active cases (down -30% and -32%, respectively) and hospitalizations falling (-18%) (click here) (click here)

6) World vaccine roll-out tops 2.79 billion people (click here): but it is mainly rich countries benefiting

7) The global pandemic: ~180.5million cases and 3,909,688 deaths to date click here

8) Reopening the USA-Canada Border? Weeks not months!

9) FAQs-answers to common questions about the COVID-19 vaccines 

10) Continued Stability in COVID-19 in Ontario’s Long Term Care facilities (LTC)…1 death in the past week-evidence vaccines working: click here

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1) Rare heart complications of COVID-19 vaccination (click here): 

young boys in gymnasium getting vaccines

1) There is a rare and usually mild complication of mRNA vaccines for COVID-19 that is worth mentioning and putting in perspective. It is a form of heart inflammation, called myocarditis, which is usually mild and reversible. Researchers at the Center for Disease Control (CDC) estimate that for every million second doses of vaccine given to boys ages 12 – 17 years of age a maximum of 70 myocarditis cases may occur; but these vaccines would prevent 5,700 infections, 2,215 hospitalizations and two deaths. The cases of myocarditis and pericarditis (heart inflammation) are mostly occurring in males (often younger males) and usually occur after the second vaccine dose. Most cases are mild, with symptoms like fatigue, chest pain and disturbances in heart rhythm that quickly resolved. Of the 484 cases reported in Americans under age 30, the C.D.C. has definitively linked 323 cases to vaccination. In Israel, where this side effect was first found, 95% of the 148 cases were considered mild and were reversible. Most people with this complication fully recover. It turns out that infection itself can also cause cardiac problems, even in healthy adults. A large study of collegiate athletes showed that 2.3 percent of those who had recovered from Covid-19 had heart abnormalities consistent with myocarditis. Only 25% of these people, all of whom recovered form COVID-19, had any heart symptoms.

Bottom line-The vaccine’s benefits far outweigh the risk of all adverse effects (alone or in combination). While the possibility of myocarditis will no doubt stress parents considering vaccination of their teenagers, there is much less risk of getting myocarditis from the vaccine then there is it these same young people getting myocarditis from a SARS-CoV-2 infection!

2) Vaccine hesitancy in red states: Political and religious preferences are matters of personal choice and people have the right to their own beliefs. However, the SARS-CoV-2 virus does not respect pollical, religious or ideologic preferences. For better or worse, we (the human race) are in this pandemic together. Until there is widespread vaccination (both within one’s own country and globally) coronavirus infections will remain a major impediment to getting back to normal. There is a lesson about the adverse impact of politics, religion and pseudoscience as drivers of vaccine hesitancy emerging south of the border. These lessons are highly relevant in Canada. In the United States of America data show that states in which people voted Republican have disproportionality high rates of vaccine hesitancy. This has been reported by the New York Times and other outlets, like this article in Fortune magazine (click here).

screenshot of news article woman sitting at a desk with framed photos behind her

Louisiana has stopped asking the federal government for its full allotment of COVID-19 vaccine. About three-quarters of Kansas counties have turned down new shipments of the vaccine at least once over the past month. And in Mississippi, officials asked the federal government to ship vials in smaller packages so they don’t go to waste.

The basis for vaccine hesitancy is not singular. It has roots in legitimate failures of research ethics (concerning many racial groups). However, far more commonly this hesitancy is fed or reinforced by pseudoscience and idiosyncratic religious/political beliefs. Many people (including some of my own patients) believe the vaccine was “rushed”-they want to “wait and see”. I have dealt with numerous patients in Kingston who say much the same thing as the 32 year old Ms Farr, old quoted in this Fortune article (click here)” “I believe in vaccines that have eradicated terrible diseases for the past 60, 70 years. I totally and fully believe in that,” said Farr, who works at an accounting firm. “Now a vaccine that was rushed in six, seven months, I’m just going to be a little bit more cautious about what I choose to put into my body.”

Others site the advice of their religious leaders or political gurus. I have dealt with both these concerns in my own clinical practice. I have heard quotes in Kingston virtually identical to this quote from a Ms Gennaro in Yazoo city: ““All of the strong Christians that I associate with are against it,” she said. “Fear is what drives people to get the vaccine — plain and simple. The stronger someone’s trust is in the Lord, the least likely they are to want the vaccine or feel that it’s necessary.”

I try to use patient explanation to counteract these drivers of vaccine hesitancy; and for those who are simply concerned but open to explanation, this approach often works. However, it is clear that misleading advice from politicians, religious leaders and news media outlets inspires and reinforces vaccine hesitancy. Conversely these same sources of information can be redirected to promote vaccine acceptance. The consequences of disinformation and misinformation regarding the risks and benefits of COVID-19 vaccines whether based on religion, politics or pseudoscience is clear. In the very red state of Mississippi, where 57.5% of people voted for Mr Trump, only 29% of adults are fully vaccinated, 16% below the national average (see below). This low vaccine uptake is true for many “red states”. While Mr Trump now advocates for vaccines; pre-COVID-19 he promoted the false notion that vaccines cause autism (click here). Once incorrect messages, that prey on people fears, are released into the world it is hard to put the genie back in the bottle, even when the messenger changes his story! 

table of stats for Mississippi and USA vaccinated

Vaccine distribution to all people willing to be vaccinated will remain a challenge for years to come. However, in our Canada we will be fighting a different battle. In the coming year we will be working on overcoming vaccine hesitancy amongst people who have easy access to safe and effective vaccines but choose not to be vaccinated.

3) KFL&A update: 3rd wave resolving locally (10 patients in hospital-only 2 from KFL&A), and 75.5% of eligible residents (12 years and older) vaccinated at least once and 24.6% fully vaccinated (see update from KFL& A Public Health)

The 3rd wave of COVID-19 has largely resolved in SE Ontario. A since the pandemic began we have had 1556, cases in KFL&A, not counting the resolved prison outbreak or people from other regions (see below). There have been 10 new cases in the past week. The pandemic is clearly resolving in SE Ontario (due initially to a painful lockdown and now due to widespread vaccination).

We continue to receive patients with COVID-19 from Northern Ontario (the Porcupine health region), where the 3rd wave is not well controlled. We have only 10 patients with COVID-19 at KHSC and 66% are being cared for by Medicine (Connell 3-see below). Only 2 patients are from KFL&A, the rest were transferred from the Porcupine region. We also have 9 patients recovering from COVID-19 at KHSC, also cared for by the Medicine Program. To date we have cared for >150 patients from the GTA and Northern Ontario with COVID-19 at KHSC. KUDOS colleagues and staff!!!

The Medicine program remains extremely busy with non-COVID-19 care. We are looking after >200 patients at KHSC and run an additional ward at HDH. We are ramping up clinics toward pre-pandemic levels (although volumes will still be limited by the size of waiting rooms and ongoing masking/physical distancing requirements).

Vaccination is proceeding very well in our region (see below) with 75.5% of people over age 12 having one vaccine dose and 24.6% having had two doses. 

horizontal bar graphs re kfla people vaccinated by age

Over half of eligible people age 12-17 have had their first COVID-19 vaccine

4) Wave 3 continues to subside as Ontario exceed vaccine targets and infection rates fall with 255 new cases yesterday and a 1.2% positive COVID-19 test rate (click here(click here): an accelerated plan to move to phase 2 reopening next Wednesday (click here

Ontario has made amazing progress toward quashing wave 3 with 9.5 million partially vaccinate people and 2.2 fully vaccinated people. We are poised to more fully reopen next Wednesday (announcement to come shortly). 

Phase 2 reopening will allow (click here):

  • indoor, masked social gatherings of up to 5 people. 
  • up to 25 people would be able to attend outdoor functions
  • as many as 6 people could dine together on a patio.
  • Personal care services like hair stylists and nail salons would also reopen, as long as masks are worn at all times.
  • capacity limits on essential retail will increase to 50 %
  • non-essential retail capacity will increase to 25 %

All metrics (new infections -34%, hospitalizations -24%, and positive test rates) are headed in the right direction (see below). There have been 107 deaths from COVID-19 in Ontario in the past week, unchanged from the prior week.

salmon coloured bar graph

Wave 3 resolving in Ontario

5) Canada’s COVID-19 epidemic rapidly resolving with > 33.7 million doses of vaccines administered: New and active cases (down -30% and -32%, respectively) and hospitalizations falling (-18%) (click here) (click here).

map off Canada and surrounding waterssalmon coloured bar graph

Resolution of Wave 3 in Canada June 24th, 2021

New and active case rates are falling rapidly and hospitalizations declining in Canada (see above). We have had 1.41 million cases of COVID-19 since the pandemic began. The case mortality rate remains at 1.45% with 26,181 deaths (see below). We have done 37 million COVID-19 tests (with a cumulative positive rate of 3.81%). We have administered a cumulative 33.7 million COVID-19 vaccinations. Hospitalizations are also declining (falling below 1000 people for the first time this week, with 968 people in hospital today). 

various types of graphs showing Canada pandemic stats

COVID-19 vaccinations rising and hospitalizations falling across Canada June 24th 2021

Canada becomes a vaccine success story: 66% of Canadians have had at least one shot and 22.5% are fully vaccinated! 34 million doses have been administered, up over 3 million vaccines from 1 week ago (click here): To date, 38 million doses of COVID-19 vaccines have been delivered and 88.8% of delivered doses have been administered. 359,877 people per day are being vaccinated (the highest daily total I have seen so far). Canada is near the top of the pack in vaccines administered per day now! (see below).

colourful horizontal bar graphs showing world vaccines administered

6) World vaccine roll-out tops 2.79 billion people (click here): but it is mainly rich countries benefiting

colourful horizontal bar graphs showing world vaccines administered

Vaccines are they key to ending COVID-19 and the map below shows some vaccine champs (Canada, UAE, Israel, USA, Bahrain and the UK in the lead); however, low-income countries remain vaccine deserts (see below). 

horizontal wave looking type graphs

Vaccines are rare in low-income countries (click here

Progress in vaccine administration largely applies to wealthy countries. This is not only unjust; it also allows the creation and spread of new viral mutants, like the delta variant, which are more infectious and may lead to immune evasion, thereby keeping the pandemic going. Both the USA es (click here). and Canada (click here) have committed to sharing vaccines abroad by the end of 2021 

7) The global pandemic: ~180.5million cases and 3,909,688 deaths to date click here.

satellite image of earth taken from space

New case rates are declining globally (see below). That is good news but there are 2 caveats! First, in some countries the accuracy of case counts and death rates is uncertain. India recently acknowledged a serious undercounting of deaths. 

numbers and graphs

Global decline in new cases of COVID-19

Second rates of new infection are on the rise in many parts of India, Africa and South America (see map below).

world map with shades of yellow orange and red

The world still has many COVID-19 hotspots (most of South America and Southern Africa)

8) Reopening the USA-Canada Border? 

The pandemic is improving in the USA largely due to an effective vaccine program. America now has a 1.8% positive test rate, the lowest rate since the pandemic began (click here; see below). With the pandemic under control on both sides of the border, Prime Minister Justin Trudeau on Tuesday said the next phases of reopening the Canadian-U.S. border could come within weeks and not months (click here). 

9) FAQs-answers to common questions about the COVID-19 vaccines: 

grey human figure holding hands to head with orange question marks surrounding

FAQ 1: Is a single shot of the mRNA COVID-19 vaccine protective  For those who are anxiously awaiting shot 2: be reassured that there is excellent protection from shot 1. The slide below shows the effectiveness of 1 shot vs 2 shots of each of the mRNA vaccines in health care workers. So, while you wait for shot 2 you are highly protected (slide courtesy of Dr. Gerald Evans). (2 shots are still recommended).

light and dark green bar graphs

FAQ 2: If your first vaccine was AstraZeneca what to do for the second shot? A reminder VITT is rare with shot 1 (click here) and even rare with shot 2 (1/million) (click here)

If you had AstraZeneca as your first vaccine you are likely frustrated/confused/annoyed about the lack of information re: shot #2 (click here). The cause of the uncertainty is not vaccine supply (we have lots of AstraZeneca vaccine available). The cause of the uncertainty re your second shot is the very confusing data on the incidence of a rare clotting/bleeding complication called VITT which is associated with the AstraZeneca vaccine. VITT has occurred in 28 Canadians (click here) and likely occurs in 1/100,000 people that receive this vaccine. Unfortunately, reported rates of VITT vary widely by country from 1/25,000 to 1/200,000, which has been a challenge to understand and has made health policy to say the least confusing (click here). 

Personally, I am convince the vaccine is safe and our monitoring systems (with 15 million vaccines given thus far) shows that adverse reactions are not higher with AstraZeneca than other vaccines (they actually are lower-click here and see below).

light and dark purple graphs

In the UK where lots of AstraZeneca has been used it is clear risks of VITT are low and are even lower for the second shot (click here)! More than 22 million first doses of the AstraZeneca vaccine have been administered with only 209 cases of VITT reported (~1/100,000 people).To date, vaccine with 4 a cases of rare clotting were reported following the second shot (1 in a million people).

In the past week (May 21st) many provinces (including Ontario and BC) authorized second dose administration of AstraZeneca. In BC for example, Dr. Henry indicated “British Columbians who opted for the AstraZeneca plc COVID-19 vaccine for their first dose will be able to get their second doses from the same manufacturer” (click here). I fully support this policy…this vaccine is very effective and has changed Britain from a COVID-19 plagued country to a reopening society!

FAQ 3: Are mix and match vaccine strategies safe and effective? Another possibility for those who had AstraZeneca for their first dose is to take Pfizer or Moderna vaccines for dose 2. This strategy does appear safe and we are awaiting proof it is effective. There is a small clinical trial of 663 people underway in Spain assessing this mixed and match vaccine strategy and results look encouraging (it is tolerated and safe-click here); but it’s still too early to know if it as effective as the two dose of the same vaccine regimen. The data to date shows that a Pfizer booster in people that got an AstraZeneca first shot increased protective antibody levels. The study investigators state: “After this second dose, participants began to produce much higher levels of antibodies than they did before, and these antibodies were able to recognize and inactivate SARS-CoV-2 in laboratory tests. Control participants who did not receive a booster vaccination experienced no change in antibody levels.

One cautionary note of a mix and match approach is that a UK study called Com-COV, which analysed combinations of the same two vaccines, found that people in the mix-and-match groups experienced higher rates of common vaccine-related side effects, such as fever, than did people who received two doses of the same vaccine (click here) (34% vs only 10% if the two doses of vaccine were the same brand).

hundreds of bottles of vaccines in a pile

FAQ 4: What we know about vaccine induced thrombosis and thrombocytopenia (VITT) (click here) (click here)-any why the Astra Zeneca vaccine is still a safe and effective Many provinces including Ontario have put a hold on using the AstraZenca vaccine because eof a rare complication called VITT (click here), which involves unusual clots in veins in the brain and elsewhere. In my opinion this decision is unjustified. However, I acknowledge this is a challenging public health policy. We do not yet know whether the province will approve the use of a 2nd dose of AstraZeneca in those who already received a first dose. I present a summary of the data below to help inform you. 

research paper titleEditorial paper title

 

  1. The risk of VITT in Canada as of May 8, 2021 is estimated to be approximately 1 per 55,000 doses (click here).
  2. There is tremendous and unexplained variation in the incidence of VITT between countries, ranging from 1 case per 26,500(Norway) to 1 case per 127,300
  3. No major safety warnings, other than rare anaphylaxis, were reported in the A-Z clinical trials with tens of thousands of adults.
  4. Cerebral venous thrombosis occurs (as seen in VITT) spontaneously in people who are not vaccinated! The incidence of cerebral thrombosis of the venous sinuses in the head is 0.22-1.57/100,000 unvaccinated people which is similar to the incidence of VITT post vaccine (1 case per 100,000 exposures). This raises question about the extentto which the AstraZeneca vaccine actually increases the incidence of cerebral venous sinus thrombosis above that seen normally in the general population
  5. The European Medicines Agency has identified 169 possible cases of cerebral venous sinus thrombosis and 53 possible cases of splanchnic vein thrombosis among 34 million recipients of the AstraZeneca vaccine
  6. Adverse reactions to the AstraZeneca vaccine (as tracked by Canada) are lower than with the other COVID-19 vaccines
  7. Immune thrombocytopenia and bleeding (without thrombosis-clots) have also been reported with Moderna and Pfizer vaccines. The European Medicines Agency has reported 35 possible cases of VITT among 54 million recipients of the Pfizer–BioNTech mRNA vaccine,and 5 possible cases of cerebral venous sinus thrombosis among 4 million recipients of the Moderna mRNA vaccine.
screenshot of tweet

FAQ 5: Is VITT less common with the second dose of AstraZeneca vaccine? (short answer yes-1/million cases).

Yes it is! In the UK where lots of AstraZeneca has been used it is clear risks of VITT are low and are even lower for the second shot (click here)! More than 22 million first doses of the AstraZeneca vaccine have been administered with only 209 cases of VITT reported (~1/100,000 people).To date, about 4.4 million people in the U.K. have received a second dose of the vaccine with 4 a cases of rare clotting were reported following the second shot (1 in a million people).

FAQ 6: I’m pregnant, should I get the vaccine? 

Vaccination is recommended for all women who are pregnant or breast feeding at any time in pregnancy unless there is some specific reason not to be vaccinated. The reason for this advice is that the mRNA vaccines for COVID-19 appear to be safe in pregnant women (click here) whereas COVID-19 has higher morbidity (is more severe) when contracted during pregnancy.

female healthcare worker administering vaccine to a pregnant womanscreenshot of tweet with graphs

FAQ 7: New FAQ: Does one dose of vaccine provide protection from COVID-19? Short answer: yes (within 2 weeks). Pfizer vaccine confers 80% immunity within 2 weeks of first shot (click hereA 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. BothCOVID-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.

FAQ 8: If I have a solid organ transplant or I am a cancer patient should I have my secondvaccine 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 9: 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 10: (updated May 20th, 2021): Which COVID-19 Vaccines have been approved by Health Canada? Currently Canada has 4 approved vaccines: Pfizer, Moderna, and Astra-Zeneca and J&J (click here). Pfizer and Moderna are mRNA-based vaccines while AstraZeneca and J&J vaccines use a non-infectious adenoviral vector. All vaccines target the viral spike protein and none containing the SARS-COV-2 virus. The J&J vaccine is a single shot vaccine (all others require two shots). The bottom line: All approved vaccines are protective against severe adverse outcomes and I would still advise you to take the first vaccine you are offered!

table listing authorized vaccines for canada

FAQ 11: updated May 20th 2021: Does the vaccine work against new variants (mutations) in the SARS-CoV2 virus? Short answer is 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). Recent data shows levels of neutralizing antibodies are lower against mutant strains than the original SARS-CoV-2 virus BUT (and this is important) the levels of antibody produced appear to be sufficient to prevent (or at least markedly attenuate the severity) of COVID-19 (click here ) Thus, despite variant viruses the vaccines are lifesavers!

FAQ 12: 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 re vaccines

FAQ 13: 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 Canadian Society of Allergy and Clinical Immunology has recently updated and reinforced this advice (see Tweet below):

screenshot of tweet re allergies

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.

side effects Pfizer vs placebo

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 14: 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-19in 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 15: 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 interval is necessitated by our vaccine shortage and has been approved by Health Canada. 

syringe with needle drawing vaccine from bottle

FAQ 16: Can I contract a COVID-19 infection 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. The J&J vaccine also uses an adenoviral vector but again, there is no SARS-CoV-2 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 17: Are vaccines safe? Yes, serious adverse effects of vaccines are rare (occurring in only 1391 of 25.3 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 June 4th 2021). Note there are only ~5 serious adverse responses for every 100,000 vaccines administered in Canada.

6 text boxes with numbers and text

FAQ 18: 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. My second dose of Pfizer vaccine will occur 4 months after the first dose I received.

10) Continued Stability in COVID-19 in Ontario’s Long Term Care facilities (LTC)…1 death in the past week-evidence vaccines working: click here

3 senior citizen sitting at a table all 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 8029 deaths in Ontario. As of today, the 3,782 deaths in nursing homes account for ~46% of all deaths. There was 1 new death in LTCs due to COVID-19 in the past week. There are 13 active COVID-19 cases in LTC residents and 11 active cases in LTC staff, a new record for the lowest numbers of cases. These numbers remain low and stable, which is testimony to the effectiveness of mass vaccination in a high risk population! 

Stay Well! …. Get Vaccinated!!!

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