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cartoon of man about to go over a waterfall refusing the life preserver labelled AstraZeneca

March 22, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Headlines

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)There have been some initial glitches but the process is underway!

1) Astra-Zeneca vaccine (and all others offered in Canada) are safe: (click here) (click here): If you get vaccinated you have a 1/10,000 chance 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.

2) World vaccine roll-out tops 450 million people (click here)! Real world evidence that vaccination is safe and effective.

3) All about COVID-19 Vaccines: Updated FAQs about vaccination 

4) KFL&A COVID-19 rates rise by 20 cases since Thursday in part due to outbreak amongst Queen’s University students (see update from KFL& A Public Health)

5) Ontario infection rates are up from Monday with 1699 new cases yesterday, a rise in deaths and hospitalizations and a 5.4% rate of positive testing (click here(click here).

6) Canada’s COVID-19 epidemic: 4 million vaccines administered (8.88% of population): There were 3,269 new cases yesterday. Rates of hospitalizations have begun to rise and positive test rates are at 3.4% (click here) (click here). 

7) The global pandemic: New case rates on the rise (click here); up almost 2 million cases since Thursday!

8) Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)-evidence vaccines work: click here

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1) Astra-Zeneca vaccine (and all others offered in Canada) are safe: (click here) (click here):

I am being asked a lot lately whether people should take the Astra Zeneca (A-Z) vaccine. People are wondering whether they should wait a bit longer before being vaccinated to let more information come out. They are concerned that the A-Z vaccine is less effective, might cause blood clots and may need a booster shot. The fact is it does not increase the risk of blood clots, is safe based on millions of doses used (including in senior citizens) and it reduces one’s risk of death and severe COVID-19 by 90%. For some these facts are enough...others remain “hesitant” despite facts (from clinical trials and massive real-world experience). It is not just Canadians who are hesitant (see graph below)…and that’s bad news for global health.

horizontal colourful bar graph

Most countries have >25% of residents who would not take the vaccine for COVID-19 if offered “this week”

Despite enthusiasm by the majority of Canadians ~40% don’t want the vaccine. There is a litany of reasons for this hesitancy and they are not readily persuadable that getting the vaccine is good for them and good for society. We use the label vaccine “hesitancy” to excuse vaccine refusal; but in the end this personal choice would be a problem for the restoration of an open Canadian society. 

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) rendered us complacent. Did we really need those 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, a reputable medical journal. 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?-You can find a home on the internet (click here)! 

Cartoon showing huge wave labelled 3rd wave and two people under it

Let’s be clear: COVID-19 vaccines are safe. Yes, there have been 30 cases of thromboembolic events had been reported among the five million people given the AstraZeneca vaccine in Europe (click here). However, the European Medicines Agency (EMA) reviewed the data and concluded the vaccine is safe and effective and does not increase the risk of clots (click here). When one vaccinates people for COVID-19 all events that normally occur continue to occur (except COVID-19). Vaccinated people will continue to have strokes, heart attacks, cancer, blood clots etc. The question is what is cause vs what is coincidence. When considering whether bad outcomes in people who have received a vaccine relate to the vaccination, one must determine whether the the “bad event” (in this case blood clots) is more common in those receiving the vaccine than would occur without it. The answer in the case of COVID-19 vaccines (all of them) is no! Indeed, rates of venous clots are lower in the vaccinated people than expected. Italy has announced it will resume vaccinations tomorrow with other countries expected to follow suit shortly. 

A new US study further supports the safety and effectiveness of the A-Z vaccine (click here). In this study there were 30,000 volunteers, of whom two-thirds were given the vaccine while the rest got dummy shots. AstraZeneca said its COVID-19 vaccine had a 79 per cent efficacy rate in preventing symptomatic COVID-19 and was 100 per cent effective in stopping severe disease and hospitalization. The vaccine was effective across adults of all ages, including older people — which previous studies in other countries had failed to establish.

In Ontario, vaccinations have begun for people age 60-64 in a local KFL&A pilot program. This program administers (by appointment) the Astra Zeneca vaccine via local pharmacies (click here). What about the elderly (>70 years old)? The initial studies for approval of this vaccine only included small numbers of people over age 55 years (1418 people over age 65 years-12% of study population) (click here). A study looking at all vaccinated people over age 70 years in the UK (millions of people) (click here), found substantial benefit in the elderly, noting “a single dose of either vaccine (Pfizer or Astra-Zeneca) is approximately 80% effective at preventing hospitalization and a single dose of the Pfizer vaccine is 85% effective at preventing death with COVID-19. Moreover, in people over age 70 years, the Astra Zeneca vaccine (one dose) results in protective effects within “14-20 days after vaccination reaching an effectiveness of 60% from 28-34 days and further increasing to 73% from day 35 onwards”.

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 ~80% effectiveness (including the Astra Zeneca vaccine). We will not be able to reopen society if 40% of Canadians indulge their anxieties and 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 local 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). The bottom line? If you get vaccinated you have a 1/10,000 chance 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. 

table listing data on side effects from receiving vaccines

I could go on…but this final cartoon says it all:

cartoon man in water heading for waterfall and life saver within reach labelled astra Zeneca

2) World vaccine roll-out tops 450 million people (click here)! Real world evidence that vaccination is safe and effective.

colourful line graph ranking countries who have administered the most vaccines

Global vaccine total reaches 450,000,000

The good news is our vaccines work; however the emergence of increasing numbers of variant viruses (which are 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 not work. For the undecided 40% of Canadians who are unsure they want to commit to taking a vaccine now, please believe me when I say that time is of the essence. The more 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 shows the fall in confirmed infection rates in countries that have an effective vaccine roll out, like the UK and the USA. Note the rates of infection are rising in areas like Canada (and the rest of the world) where the roll out has been slower.

colourful graph showing covid case increase in countries where vaccine rollout has been slower

Real world evidence vaccines work: note reduction in cases in countries where a high proportion of the population has been vaccinated (like the UK-which uses Astra Zeneca) vs Canada! (click here)

All approved vaccines in Canada are safe and effective. No corners have been cut in the Health Canada review of their safety. What was accelerated was their production and the duration of initial study prior to approval shortened. Vaccine production was accelerated because we can now safely use mRNA and adenoviruses, courtesy of lessons learned in the past 2 decades from the Human Genome project. While the vaccine studies for initial approval were compressed (because we are fighting a pandemic), the ongoing results are shared with the medical profession weekly. We now have unprecedented evidence of safety from the tens of millions of people vaccinated world-wide (click here). To date over 450,000,000 people have been vaccinated! So if you are “waiting” for more safety data I would argue that all the data a reasonable person should need are there already. If you were vaccinated today you are benefitting from the safety data generated on the 450 million people who were vaccinated before you. We also have safety data from numerous clinical trials, which in combination with the re-world experience, should be reassuring!

3) 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 holding hands to head with orange question marks floating around head

FAQ 1) 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 2) 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 3) 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 4) 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 of important information for those on blood thinners getting the vaccine

FAQ 5) 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.

chart of side effects of Pfizer vaccine 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 6) 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 7) 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.

syringe with needle drawing vaccine from a bottle

FAQ 8) 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 9) 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 10) 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 to 40 days (and longer) 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.

4) KFL&A COVID-19 rates rise in KFL&A by 20 cases since Thursday in part due to outbreak in Queen’s University students (see update from KFL& A Public Health)

The total number of cases in KFL&A since the pandemic began is 828, not counting the prison outbreak. This is up 31 cases since Thursday and most new cases are caused by a variant of concern (i.e. mutant virus) (see below). There are 73 active cases in the region (up 20 since Thursday). This relates in part to an ill-advised large party by Queen’s University students. Last week 8 cases were linked to the University, all involving students living off-campus, but the ongoing outbreak that started at Watts Hall residence has been linked to 28 cases (click here). This is a reminder young people transmit COVID-91 readily; moreover, the mortality is borne by older people. Adherence to Public Health adherence is thus a mutual responsibility of young and old alike. While most of our students take the pandemic seriously and behave responsibly, egregious departures in compliance with public health put the community at risk and there should be consequences to dangerous behavior of this type. Unless there are consequences these super spreader events will likely continue to occur.

photo of kids walking out of University building with a sign stating not to ignore covid 19 guidelinesKFL&A  info graphic with numbers and graphspie graph and line graph yellow and red

The rate of cases is rising rapidly in KFL&A: and more variant viruses are being detected (March 22 2021)

There has still only been one death of a KFL&A resident since the pandemic began. There are 2 COVID-19 patients hospitalized at KGH (both transfers from other regions). Active cases in our SE region are rising back to levels seen in mid-January, a cause for caution and ongoing adherence to public health policies. This largely relates to the rise in the B117 variant (which is more infective). This variant spreads rapidly, particularly in children, and accounts for 3% of recent positive tests -see below (still better than in most of the province where they cause 35% of all cases).

5) Ontario infection rates are up from Monday with 1699 new cases yesterday, a rise in deaths and hospitalizations and a 5.4% rate of positive testing (click here(click here).

salmon coloured bar graph with info graphic underneath

Ontario’s COVID-19 prevalence new case rates show continued increases (March 22th)

In the past week there were 10,768 new cases, a 10% week-week increase. Death and hospitalizations are starting to increase (+0.6 and +9.0% respectively). As a result, patients are once again being transferred around the province to relieve stress on Toronto area hospitals, which remains the disease epicenter. We have done 12.08 million COVID-19 test thus far. The rate of test positivity in Ontario is rising and is rising from 3.1% (on Thursday) to 5.1% yesterday. Positive tests due to N501Y mutation variants account for 30-35% of cases. This is a reminder we are in a race to get vaccines into arms before the more infectious mutant virus causes a 3rd wave. This is no time for vaccine hesitancy! 

6) Canada’s COVID-19 epidemic: 4 million vaccines administered (8.88% of population): There were 3,269 new cases yesterday. Rates of hospitalizations have begun to rise and positive test rates nationally are at 3.4% (click here) (click here). 

map of Canada  with the surrounding bodies of watermultiple types of graphs

A rise in hospitalizations raises concerns about a 3rd wave of COVID-19-March 22nd 2021

There have been 22,694 COVID-19 deaths thus far and a cumulative national case mortality rate of 1.95%. Canada has performed ~27 million COVID-19 tests (revised down from 30 million in last report-not sure why) with a cumulative test positivity rate of 3.41%. Rates of COVID-19 are back to baseline in PEI. Rates of infection remain at a low plateau in all other provinces and territories, as a result of introduction of more aggressive public health measures; however, there is an upward trend in new cases developing in Alberta.

Canada’s vaccination roll-out is accelerating-4 million vaccines administered thus far (click here): To date, 4,773,170 doses of COVID-19 vaccines (including Moderna, Pfizer-BioNTech and Astra-Zeneca) have been delivered. Thus far, 84% of delivered doses have been administered. 632,231 Canadians are fully vaccinated (click here). Still, Canada is well back in the pack with only 8.88% of the population vaccinated (see below).

7) The global pandemic: New case rates on the rise (click here); up almost 2 million cases since Thursday!

satellite picture of planet earth taken from space

Global COVID-19, March 22nd, 2021: The number of active cases (yellow dots on map) continues to increase (orange graph, bottom right) 

world map with yellow dots and ranking of countries with highest cases, deaths and test results

There have been 123,386,930 cases up almost 2 million cases since Thursday! There have been 2,718,137 deaths since the pandemic began. Active case rates are rising (~2 million since last Thursday (click here)). Daily death rates are continuing to decline. 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.

The USA, with 29,834,364 cases and 542,452 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 100,000,000 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 4.0% positive test rate, down from 6%, last Monday and very similar to Canada (3.4%) (click here; see below). In states with populist governors and no masking policies, like Texas and South Dakota, rates remain higher (Texas now has a positive test rate of 6.9%). However, as vaccine uptake accelerates even these states will see the benefits of herd immunity form vaccines (hopefully).

8) Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)-evidence vaccines working: click here

three people all wearing masks sitting at a table

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 (up 1 deaths since Thursday) account for ~57% of all deaths. There are 12 active COVID-19 cases in LTC residents and 110 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 <5/week; still too many but heading in the right direction rapidly. 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!

colourful line graph showing decline in LTC cases

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)

COVID-19 vaccination for children-studies underway (click here): Children of school age have relatively high rates of COVID-19 infection (but low rates of morbidity and almost no mortality). That said, the challenges of running in person education with wave after wave of COVID-19 outbreaks in schools is evident to everyone. There is little reason to believe the vaccines will not be safe and effective (likely more effective) in children than adults. In general, vaccines work best in young people with healthy immune systems. Pfizer is testing their vaccine in adolescents as young as age 12. Moderna is currently recruiting for a clinical trial for 12- to 17-year-olds. And on February 12, AstraZeneca announced the start of a trial for their vaccine in children ages 6 to 17. The graphic below show there are 2,259 children age 12-15 years enrolled in a Pfizer trial. Moderna is studying a cohort of 3000 12-17 year olds.

COVID-19 in toddlers and young children: (click here). It has remained true throughout the pandemic that children in general are less severely affected by the virus and young children are somewhat less infectious (perhaps because they are less sick). Rates of infection are very low in preschool children. The hope is children will be approved for vaccination by the fall but research proving safety and efficacy are pending (click here). With more kids back in school we are seeing more infections (although not at alarming rates). 

There have been 8086 students with COVID-19 since the pandemic began with 1432 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. 19% 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 late wave 2-early 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!

four teenagers sitting on a bench holding a book, 2 iPhones and an iPad

Here are the parallel data from licensed child care facilities in Ontario-where there have been 1708 children infected since the pandemic began, 259 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 a classroom floor

Regular reminders-On hiatus today

KHSC capacity: Bed and ventilator capacity at KHSC remain adequate. The Medicine program continues to care for 179 inpatients today. The hospital is a safe place to receive COVID-19-free care. If you need to be seen in person in clinic or as an inpatient be reassured we can do this safely! There are 10 ICU beds (including cardiac beds) available. This is a modest capacity in light of patient acuity.

numbers and graphs showing bed capacity at KHSC

Final thoughts: Taking the vaccine is safe and it’s the right thing to do. I am one of the 450,000,000 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 being offered at pharmacies is safe and effective. You can now book your vaccine on line if you are over age 80 years (click here).! In addition 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. Join me and take your shot (like Dave Keon seen below)!

hockey player shooting puck and sprawling goalie

Stay well! 

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