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pharmacy worker looking at a pill bottle

March 25, 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)

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.

Anti-Asian Racism (click here): There is a shocking and sad rise in anti-Asian racism in Canada. The statistics below speak for themselves. Asian Canadians are being harassed, spit on and blamed for a pandemic they did not cause. As Canadians we need to own this behaviour and change it by speaking up against racism and standing should to shoulder with Asian Canadians. This is not a problem that only happens in big cities. I have personally seen it here in Kingston. We need to open our eyes and see it is happening, open our mouths and speak in support of the victims of this abuse and open our hearts to let them know an attack on them is an attack on the principles and values most Canadians aspire to uphold. Fighting anti-Asian racism does not take away from our need to combat anti-Black or anti-Indigenous racism. However, the pandemic has particularly caused a rise in this sad form of racism. So, if you see something-say something and stand up against hatred-it’s the Canadian thing to do.

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1) Local KFL&A pharmacies are out of vaccine (for now-click here)- More than 20,000 doses of the AstraZeneca vaccine have been given out 

2) Astra-Zeneca vaccine (and all others offered in Canada) are STILL safe: (click here) (click here) (click here): Revised data from A-Z shows 76% protection (revised down from 79%) and 100% protection from a severe COVID-19 infection or COVID-19 related death.

3) The short list of drugs that actually work for treating COVID-19 (supportive treatment, high dose prophylactic low molecular weight heparin, oxygen, dexamethasone, and perhaps Tocilizumab ….and that’s about it!

4) World vaccine roll-out tops 489 million people (click here)! Real world evidence that vaccination is safe and effective.

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

6) KFL&A COVID-19 active cases rise in KFL&A by 50 cases since Monday-and there are 242 active cases in our part of SE Ontario-a new high (see update from KFL& A Public Health)-Also note Lanark-Leeds-Grenville is now a red zone

7) Ontario infection rates are up from Monday with 2380 new cases yesterday. New and active cases are up 23% and 20%, respectively but deaths are down 14% while hospitalizations are up 22%. Ontario has a 3.8% rate of positive testing (click here(click here).

8) Canada’s COVID-19 epidemic: There were 4,050 new cases yesterday (up markedly form Monday) and a total of 4.5 million vaccines administered: Rates of hospitalizations have begun to rise and positive test rates nationally are at 3.4% (click here) (click here). 

9) The global pandemic: Almost 125 million cases and new case rates increasing (click here)-global vaccination is required to protect people and reduce rising incidence of mutant virus

10) KHSC capacity is low-with only 54 beds available (including 8 intensive care beds)

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

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1) Local KFL&A pharmacies are out of vaccine (for now-click here)- More than 20,000 doses of the AstraZeneca vaccine have been given out.

female pharmacy worker in pharmacy looking at pill bottle

Because of a local pilot program we were fortunate to get 20,000 Astra Zeneca vaccines for people age 60-64. This pilot program was designed to see how pharmacies would work for vaccine delivery. From reports I have received from friends and neighbours, the pharmacies were efficient and the process smooth. If you were vaccinated make sure you contact the pharmacy to book your booster shot! If you are still interested in getting the vaccine at a pharmacy you will need to wait for resupply as they have given (or have committed) their entire initial supply-stay tuned for updates on resupply of vaccine.

2) Astra-Zeneca vaccine (and all others offered in Canada) is STILL safe: (click here) (click here) (click here): Revised data from A-Z shows 76% protection (revised down from 79%) and 100% protection from a server COVID-19 or COVID-19 death.

There was some concern raised about whether Astra Zeneca included all relevant data in its US study of the vaccine. They reviewed and raised the data to accurately reflect the prespecified study duration and protocol. The results did not substantially change. Instead of being 79% effective changing the days reported (which added new cases) showed the vaccine to be 76% effective. The good news is that the vaccine remained 100% effective in preventing death from COVID-19 and in preventing severe COVID-19 pneumonia.

screenshot of news article saying Astra-Zeneca vaccine is safe

As previously mentioned the A-Z vaccine also does not increase the risk of blood clots. 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. When considering whether bad outcomes in people who have received a vaccine relate to the vaccination, one must determine whether 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. 

Vaccine hesitancy: Nonetheless, many people remain “hesitant” to get vaccinated despite reassurance (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.

colourful horizontal bar graph

Most countries have >25% of residents who would not take the vaccine for COVID-19 if offered “this week”-Don’t be one of them!

Despite enthusiasm by most Canadians ~40% of us 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 is 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) 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)! 

What about the elderly and the A-Z vaccine (>70 years old)? The initial studies for approval of this vaccine only included 1418 people over age 65 years (12% of study population) (click here). Subsequently, a real-world 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 >90% 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 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 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. 

cartoon of a large wave that is labelled 3rd wave curling over two people standing looking at it

Opinion on vaccine passports: Canada should first ensure an adequate supply of vaccines so that all willing people can be vaccinated and then, in my view, issue vaccine passports to vaccinated persons offering better access to public spaces and services, thereby incentivizing vaccination. We don’t have a choice about which side of the road we drive on and in a pandemic my personal view (and it is only my view not hospital/university policy) is that if one agrees to be vaccinated life should become easier (easier access to restaurants, theaters, sporting events, airplane and train travel etc) than if one chooses not to be vaccinated. I acknowledge that until vaccines are widely available, vaccine passports are likely to be perceived as being a problem from a social justice perspective. We shouldn’t disadvantage people who would willing take the vaccine when it is not yet universally available; but once vaccines are available for all-we need passports!

3) The short list of drugs that actually work for treating COVID-19 (supportive treatment, high dose prophylactic low molecular weight heparin, oxygen, dexamethasone, and perhaps Tocilizumab ….and that’s about it!

After a year of hype with proposal for therapy using anything from chloroquine to bleach what do we know about COVID-19 therapy. We had a visiting speaker this morning at Medical grand rounds this morning, Dr. McGuinty an infectious diseases doctor from the University of Ottawa. She provided a review of all the medications that have proven effective for treating people with COVID-19 pneumonia. While there are some differences of opinion, often between practices in one country vs another the following is generally true. Antivirals, like Remdesivir are of minimal benefit (although they are routinely used in the USA). This may not be as surprising as it sounds since by the time a person is sick enough to be hospitalized their major problem is more the inflammatory response to the virus than the viral replication per se. Chloroquine has been shown not to work (for prevention or therapy) despite huge numbers of clinical trials. Antiviral antibodies targeting the virus have minor beneficial effects (at best) and the published data showing efficacy for Regeneron® antibodies (famous for being given to Mr Trump) is still not available. We have to be careful not to confuse press releases from Pharma with peer reviewed clinical research! Dexamethasone, which damps down the excessive inflammation that occurs in some people in response to the virus, is effective in reducing death and complications in moderately-severely ill patients. There are also unpublished data showing that preventive low molecular weight heparin (a blood thinner) is beneficial (Canada research in progress). There is also an antibody against an inflammatory mediator (IL-6), called tocilizumab, which is likely of modest benefit, when given as an addition to dexamethasone in moderately-severely ill patients. Dr. McGuinty stressed there is little need for antibiotics, since <5% of patients with COVID-19 pneumonia have an accompanying bacterial infection. 

Thus for most patients requiring therapy for COVID-19 (and remember 80-90 of patients require only rest at home) the effective therapies are:

  • oxygen 
  • supportive care 
  • dexamethasone 
  • prophylactic low molecular wight heparin.

The real key therefore is get vaccinated asap and avoid the illness!

tweet with photo of virtual presenter and her slides

4) World vaccine roll-out tops 489 million people (click here)! Real world evidence that vaccination is safe and effective.

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Vaccines in arms as of March 24th 2021

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 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 map below shows the fall (coloured in blue and expressed as % change) in confirmed infection COVID-19 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. 

world map colour coded showing # of covid 19 cases

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 has been accelerated in the case of the OCVID-19 vaccines was their production and the duration of initial study prior to approval. 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 490,000,000 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 490 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!

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

grey human faceless figure holding hands up to head and orange question marks surrounding 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 for those getting vaccine and on blood thinners

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 and 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.

6) KFL&A COVID-19 rates rise in KFL&A by 56 cases since Monday-and there are 242 active cases in our part of SE Ontario-a new high (see update from KFL& A Public Health)

The total number of cases in KFL&A since the pandemic began is 874, not counting the prison outbreak. This is up 56 cases since Monday and most new cases are caused by a variant of concern (i.e. mutant virus) (see below). This is the fastest rise in cases we have seen in our region to date. There are 95 active cases in the region. 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. 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. 

We have done 2850 COVID-19 tests at KHSC since Monday with 38 positive tests, most from Lanark, Leeds Grenville and Haliburton. In addition to KFL&A’s 95 cases, there are 7 cases in Hastings Prince Edward County and 140 cases in Lanark Leeds Grenville for a total of 242 active cases, by far our highest rate of active infections. There are also 13 regional outbreaks, a number of which are in schools. 93% of positive tests in Ontario are B117 variants. In our region we are now seeing a 60% rate of variants. 

table of KFL&A covid data

The rate of cases is rising rapidly in KFL&A (above) and more variant viruses are being detected (below)

three types of graphs on top of each other

There has only been one death of a KFL&A resident since the pandemic began. There are 4 patients in hospital with 17 under quarantine at KGH (the most we have had since the peak of wave 2). Active cases in our SE region are rising back to levels seen in mid-December, 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) and which is now the most common isolate in our region.

7) Ontario infection rates are up from Monday with 2380 new cases yesterday. New and active cases are up 23% and 20%, respectively and deaths are down 14% while hospitalizations are up 22%. Ontario has a 3.8% rate of positive testing (click here(click here).

salmon coloured bar graph with red line and 4 text boxes below with arrows and data

Ontario’s COVID-19 prevalence new case rates show continued increases (March 25th)

number graphic with current covid data for Ontario

We have done 12.23 million COVID-19 test thus far. The rate of test positivity in Ontario is rising and is rising from 3.1% (on Monday) to 3.8% yesterday. 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! 

8) Canada’s COVID-19 epidemic: 4,050 new cases yesterday (up markedly from Monday) and a total of 4.5 million vaccines administered: Rates of hospitalizations have begun to rise and positive test rates nationally are at 3.4% (click here) (click here). 

map of Canada and the surrounding bodies of watersalmon coloured bar graph with red line and 4 text boxes with arrows and text

A rise in new/active cases and hospitalizations raises concerns about a 3rd wave of COVID-19 March 25th2021

There have been 22,780 COVID-19 deaths thus far and a cumulative national case mortality rate of 1.94%. Canada has performed ~27.7 million COVID-19 tests 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.

many types of graphs yellow orange and green showing current covid data for Canada

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 show a concerning rise in hospitalizations.

Canada’s vaccination roll-out: 4.5 million vaccines administered thus far (click here): To date, 5,866,250 doses of COVID-19 vaccines (including Moderna, Pfizer-BioNTech and Astra-Zeneca) have been delivered (a million more than on Monday). Thus far, 77% of delivered doses have been administered. 644,187 Canadians are fully vaccinated (click here). Still, Canada is well back in the pack with only 10.184% of the population vaccinated (see below).

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

satellite photo of earth taken from space

Global COVID-19, March 5th, 2021: The number of active cases (yellow dots on map) continues to increase (orange graph, bottom right)

world map with yellow dots showing prevalence of Covid-19 and ranking of countries listed on the sides

There have been 124,985,317 cases since the pandemic began, up almost 1.5 million cases since Monday! There have been 2,746,720 deaths since the pandemic began. Active case rates are rising (orange graph above) but 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 30, million cases and 545,422 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 130,000,000 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 4.4% positive test rate, down from 6% last Monday and very similar to Canada (3.4%) (click here; see below). Texas now has a positive test rate of 6.1% while South Dakota is back up to >28%! (a reminder that public health measures matter). 

graph showing current increase in cases in South Dakota

The sad case of South Dakota under the leadership of anti-masking Governor Kristi Noem

10) KHSC capacity is low-with only 54 beds available (including 8 intensive care beds)

The hospital is getting very full with only 54 beds available and very few critical care beds. While the hospital remains a very safe place to work and receive care with a vaccinated and PPE wearing work force (86% of our staff are already vaccinated), this crowding limits our capacity for elective care. As discussed in many prior notes I don’t view the care we provide as elective in the conventional sense. Most of the services provided at KHSC are time-sensitive and delays can worsen the quality and/or quantity of people lives. We main 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. Lack of beds threatens to limit procedural care that only we can provide. Thus we will also need to discharge or relocate people classified as ALC (Alternative Level of Care), who by definition should not be in a hospital. They will need to move back home, to nursing homes, retirement homes or to subacute care settings. These tough decisions re the ALC population must be made for the greater good of people who can only receive the care they need in a tertiary care academic health sciences center hospital like KHSC. Thank you to our Medicine nurses, trainees and staff who are looking after the people in 182 of our inpatient beds. Your dedication to providing quality care is inspirational! 

number graphic of bed availability at KHSC hospitals

KHSC bed capacity is limited

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

three senior citizens 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 7244 deaths in Ontario. As of today, the 3,753 deaths in nursing homes (NO DEATHS SINCE MONDAY) account for ~57% of all deaths. There are 8 active COVID-19 cases in LTC residents and 95 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. The 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!

solid and dotted line graph showing decrease 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 are underway (click here): Children of school age have relatively high rates of COVID-19 infection (but low rates of morbidity and almost no mortality) (see graph below-click here). The situation is exactly the opposite for people over age 70 years.

purple and blue bar and line graph of covid cases by sex

That said, the challenges of running in person education with wave after wave of COVID-19 outbreaks in schools is evident to everyone and a vaccine for teenagers would be most welcome. There is little reason to believe the vaccines will not be safe and effective (likely more effective) in children than they are in 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. 

Prince Edward Island has announced that it will start vaccinating young adults-a wise move as this is the population where most infections occur and which serves as a vector for the spread of COVID-19 to older adults (click here)

young masked barista serving coffee behind a counter to a customer

COVID-19 in toddlers and young 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 8737 students with COVID-19 since the pandemic began with 1613 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 iPad, iPhone and book

Here are the parallel data from licensed child care facilities in Ontario-where there have been 1846 children infected since the pandemic began, 337 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 the floor of a classroom

Regular reminders-On hiatus today

Final thoughts: There is a 3rd wave of COVID-19 rising in KFL&A, Ontario, in Canada and globally. 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 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 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 Chicago Blackhawk’s Patrick Kane seen below…apologies to Leaf fans)!

Chicago Blackhawk player taking a shot playing hockey in from of crowd

Stay well! 

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