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bottles of vaccine

May 20, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Headlines

1) Pfizer vaccine can now be stored longer with less refrigeration in Europe (Health Canada considering this game changer too): click here

2) Canada may have a B- on the vaccine roll-out report card but we earned an A+ for timely and effective vaccine approval-a story from the front line of Health Canada’s vaccine team (click here)

3) 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)

4) The KFL&A’s vaccine guarantee: 10,000 vaccines/week with all vaccines going into arms ASAP! (click here)

5) KFL&A kids ages 12-17years can get vaccinated start in June (with 2nd dose by August for safe school reopening) (click here)

6) What we know about vaccine induced thrombosis and thrombocytopenia (VITT) (click here) (click here).

7) KFL&A update: vaccine rates high (>501%) and new infection rates falling (see update from KFL& A Public Health)

8) World vaccine roll-out tops 1.56 billion people (click here)! 

9) Wave 3 begins to subside as Ontario infection rates fall with 2400 new cases and a 5.2% positive test rate (click here(click here): 

10) Canada’s COVID-19 epidemic shows a decrease in new and active cases (down -24 and -20%, respectively) and hospitalizations (-4%) and hot spots in Nova Scotia and the Northwest Territories are resolving (click here) (click here): 

11) The global pandemic continues to escalate: ~165 million cases and 3,420,173 deaths to date and new case rates on the rise, particularly in India (click here): 

12) FAQs-answers to common questions about the COVID-19 vaccines: New FAQ1 (Is VITT less common with the second dose of AstraZeneca vaccine? and updates of #7 and 8

13) Continued Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)…3 deaths in the past week-evidence vaccines working: click here

14) Nonrandom acts of kindness by KHSC staff as they discharge patients who recovered from COVID-19 back to their homes in Toronto with a special care bag-Congrats to Sarah Moore-Vasram, Lynda Laird and colleagues!

Reminders

  • A single shot of vaccine is very protective (although 2 shots are still recommended).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)
dark and light green bar graphs
  • Ontario Website to book vaccines for people over age 18 for all people (click here). 
screenshot of covid registration page
  1. Pfizer vaccine can now be stored longer with less refrigeration in Europe (and Health Canada is considering this change too): click here

One of the reasons it has been so hard to get mRNA COVID-19 vaccines into arms is that we thought these vaccines had to be kept in a medical grade, super deep freeze up to the point of administration. This made it hard to ship to sites remote from hospitals and required -80C freezers (which are expensive and not widely available). More research by the makers of the vaccine now shows the vaccines are much more stable than first thought. They have submitted the new data to the regulatory agencies requesting a change to a more flexible storage regimen, which has been granted in Europe and is pending approval in Canada. The European Medicines Agency (EMA) recommended the change to the "more flexible" storage conditions for the Pfizer vaccine on Monday, saying it could have a "significant impact" on the deployment of vaccines throughout the European Union. The EMA made the change because data show that unopened, thawed vials of the vaccine can be stored at temperatures of between 2 - 8 C for 31 days, up from the previously approved five days, after it analyzed additional data from Pfizer on the stability of the vaccine. Health Canada is reviewing the same data and will make a determination shortly! This will be good for Canada and is absolutely vital for the rest of the world where the simplified storage protocols will accelerate vaccine distribution.

2) Canada may have a “B-“ on the vaccine roll-out report card but we earned an A+ for timely and effective vaccine approval-a story from the front line of Health Canada’s vaccine team (click here)

tweet screenshot of women

With so much information and misinformation circulating recently about COVID-19 vaccines, people are understandably confused. We felt that it was important to help us all understand the rigorous process that led to vaccines being approved for use in Canada, and to assure the public that they are safe. What better way to do this than to talk to someone who has dedicated her career to the vaccine approval process? During the pandemic, there has been ample attention to thanking front-line workers; however there are many other individuals who are unsung heroes. Representing one such group is today’s guest – Dr. Gayle Pulle from Health Canada. Gayle is a long-time friend and previous colleague of Anita Ng, our DOM manager. Gayle agreed to chat with us about the COVID-19 vaccine approval process. Even more remarkable, Gayle shares her personal story, which is humbling and shows her dedication and passion for ensuring that Canadians have access to safe and effective vaccines.

3) 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 convinced 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). 

dark and light purple bar 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, about 4.4 million people in the U.K. have received a second dose of the vaccinewith 4 a cases of rare clotting were reported following the second shot (1 in a million people).

So one possibility is that Canada will authorize second dose administration of AstraZeneca. In BC for example, Dr. Henry has 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!

The other possibility is that those who had AstraZeneca for a first does will be offered Pfizer or Moderna vaccines. 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 AstraZenca 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).

photo of a bunch of vaccine bottles

4) The KFL&A’s vaccine guarantee: 10,000 vaccines/week with all vaccines going into arms ASAP! (click here)

Dr Keiran Moore standing beside a flip chart

At a recent press conference Dr. Kieran Moore indicated KFL&A would be receiving and administering 10,000 vaccines per week throughout June 2021 (the short clip is worth a listen). This means that virtually all residents of KFL&A who are willing will be vaccinated by the end of June. It’s also a reminder that to return to normal we need herd immunity levels of vaccination (meaning 70%, and ideally 80%+ of all adults with full vaccination completed).

5) KFL&A kids ages 12-17years can get vaccinated start in June (with 2nd dose by August for safe school reopening) (click here)

At this same press conference Dr. Moor indicated that children ages 12-17 years of age would be offered the vaccines in June and those vaccinated in June would get second shots in August. This will, if completed on schedule, ensure schools will open and stay open in the fall! Remember children, though rarely severely ill because of SARS-COV-2 infection are a commonly infected age group and serve as vectors for community spread of the disease. The vaccination of 12-17 year olds (and any willing family members at the same time) is safe, effective and is a wise public health policy that will ensure a normal school year this fall.

6) 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 unusal clost in veins in the brain and elsewhere. In my opinion this decision is unjustified. However, I acknowledge this is a challenging public helath policy. We do not yet know whether the province will approve the use of a 2nd dose of AstraZeneca in thos who already received a first dose. I present a summary of the data below to help inform you. 

screenshot of research papertitle page for editorial
  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 text

7) KFL&A update: vaccine rates high (>501%) and new infection rates falling (see update from KFL& A Public Health)

The flow of patients form Toronto is slowing but we still have 17 patients with COVID-19 at KHSC; 10 on critical care and 7 on Medicine’s COVID-19 ward, Connell 3. We also have 21 patients who are admitted, recovering from COVID-19 (green bar, see below). The Medicine service remains very busy with >180 patients at KHSC and a ward of patients at Hotel Dieu hospital.

various colourful graphs showing bed allocation and occupancy at KHSC

KHSC has adequate bed capacity for care of local patients

The total number of cases of COVID-19 in KFL&A since the pandemic began is 1507, not counting the resolved prison outbreak or people from other regions (see below). This is up 53 cases in the past week. There are now 63 active cases in KFL&A, down from 124 cases last week (see below). There are 4 residents of KFL&A in hospital. At KHSC the other 13 COVID-19 patients are from the greater Toronto area (GTA). To date we have cared for 133 patients from the GTA with COVID-19 at KHSC. 

table providing current kfl&A covid cases data

Our lab has done 1701 SARS-Cov-2 tests since Monday (fewer tests being done in recent weeks) and the positive rate is 0.8% for residents of KFL&A The green line below shows the rate of test positivity in SE Ontario (1.4%-much lower than for the province as a whole-5.2%; courtesy of Dr. Evans).

colourful line graphs

There have been three deaths of KFL&A residents since the pandemic began but we have had several additional deaths at KHSC of non-resident patients. In Leeds Lanark Grenville county there have been 58 deaths with 8 deaths in Hastings-Prince Edward County. There are currently 140 active cases in the region, which is a plateau (see below). 

blue bar graphs with red dotted line graph

Active cases of COVID-19 in SE Ontario fall

51.2% of people in KFL&A over age 16 years of age have received at least 1 dose of a vaccine (see update from KFL& A Public HealthWe are still seeing active community spread. Most cases in KFL&A are due to variant strains of the SARS-CoV-2 virus.

8) World vaccine roll-out tops 1.56 billion people (click here)! 

Vaccines are they key to ending COVID-19 and the graph above shows some vaccine champs (China in the lead). Unfortunately, the good news about progress in vaccine administration largely applies to a few countries (China, USA, India, and UK). However, if we show not the total number of vaccines given but the number given per 100,000 residents, it becomes clear that India (and most of the world, especially Africa) has had little vaccination.

horizontal colourful bar graphs

Note very low vaccine rates in African countries and in India (vaccines/100 people)

There is real world evidence that the vaccines work. Look at the fall in confirmed COVID-19 cases in the USA and UK. Canada is beginning to show benefits of our vaccine program (green line below). The percent of Indian people vaccinated remains low and the country is paying a high price, although new cases rates are now falling. 

colourful line graphs of daily new covid cases by country

Vaccinated countries head toward a post-COVID-19 era with low rates of infection 

There is “made in Canada”, evidence that the vaccines are safe. Below are the Canadian vaccine safety data for all vaccines (updated May 7thclick here). After > 15.3 million vaccinations in Canada there have been 5015 individual reports of vaccine side effects (0.033%). Only 872 side effects were serious (0.006% ) and there has been ~28 cases of VITT (estimated), and 2 people with VITT have died.

six text boxes with text and numbers

The bottom line: If you get vaccinated you have less than a 6/100,000 risk of a serious allergic reaction and only two people have died from a COVID-19 vaccine in Canada. In return you get >90% protection from a serious COVID-19 infection and almost complete protection from a COVID-19 death. 

9) Wave 3 begins to subside as Ontario infection rates fall with 2400 new cases and a 5.2% positive test rate (click here(click here): 

salmon coloured bar graph with 4 text boxes with down arrows

Weekly rolling average of new cases show wave 3 is subsiding

New and active cases are down 23% and 22%, respectively, reflecting the stay home order and increased rates of vaccination (see below). The 14% decline in hospitalization is welcome relief and bodes well for reopening in the first week of June.

10) Canada’s COVID-19 epidemic shows a decrease in new and active cases (down -24 and -20%, respectively) and hospitalizations (-4%) and hot spots in Nova Scotia and the Northwest Territories are resolving (click here) (click here): 

map of Canada and surrounding waterssalmon coloured bar graphs

With many provinces having enacted stay home orders and with rising vaccine rates in Canada we are seeing new and active case rates fall modestly and hospitalizations decrease 4% (above). This will only be sustained if we follow public health rules while we await vaccination!

various coloured graphs

COVID-19 in Canada May 20th, 2021 (with resolving outbreaks in NS and NWT)

To date we have had 1,344,788 cases of COVID-19 since the pandemic began. The case mortality rate is 1.47% with 24,804 deaths. The current hospitalization numbers are much higher than in the 2nd wave of COVID-19 in late 2020 (with 3289 people in hospital today-down from >4100 on Thursday last week). We have done ~34.4 million COVID-19 tests with a cumulative positive test rate of 3.89%. We each need to do our part to keep the health care system afloat so that people who do not have COVID-19 can continue to receive essential health care. The state of hospitals is slowly improving. Rates of COVID-19 remain are falling in both Nova Scotia and the Northwest Territory.

Canada’s vaccination roll-out: 19.7 million vaccines have been administered thus far (47.8% of population have received at least 1 dose) (click here): To date, 22.3 million doses of COVID-19 vaccines have been delivered and 88.2% of delivered doses have been administered. This vaccine gap reflects recent arrival of vaccines but also our relative inability to quickly administer the vaccine to patients (although 256,070 people per day are being vaccinate). 1,519,688 Canadians are fully vaccinated (click here).

11) The global pandemic continues to escalate: ~165 million cases and 3,420,173 deaths to date and new case rates on the rise, particularly in India (click here): 

satellite image of earth from space

There have been 5 million new cases in the past week!

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COVID-29 May 20th, 2021: a global snapshot 

The situation is particularly dire in India (see below), although new case numbers appear to have peaked. India’s Health Ministry reported 4,529 deaths in the past 24 hours, resulting in a total number of confirmed fatalities to 283,248. It also reported 267,334 new infections, as daily cases dropped below 300,000 for the third consecutive day. These numbers are likely underestimation based on their health care system’s limited reporting capacity. The previous record for most daily deaths from the coronavirus was set on Jan. 12 in the United States, when 4,475 people died, according to data from Johns Hopkins University (click here).

maps graphs and news articles with photos of India

The pandemic rages in India

Helping India The Department of Medicine has collaborated with the Red Cross through a fundraising page to help support the Red Cross efforts on the ground in India. To date we have raised over $7150. This funding will provide COVID-19 education, hygiene items and handwashing stations as well as supporting the health care system and quarantine centres. You are most welcome to join this effort and will receive a personal tax receipt form the Red Cross Canada.

screenshot of fundraising page

The USA is a success story: The pandemic is improving in the USA largely due to an effective vaccine program. America now has a 3.0% positive test rate (up from 3.1% on Monday) (click here; see below). The American turnaround should offer hope to Canadians-this should be us in 2-3 months and hopefully will mean border opening is imminent!

12) FAQs-answers to common questions about the COVID-19 vaccines: New FAQ1 and updates of #7 and 8

grey human looking figure with hands to head and orange question marks surrounding head

New FAQ 1: 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 2: Can I take a different second vaccine for COVID-19 (click here)

Chances are you can mix and match (i.e. one shot Pfizer; one shot AstraZeneca); but the science is not in yet. Researchers in Britain have launched a study to determine if it’s safe and effective to mix different vaccines (Pfizer and A-Z) that protect against SARS-CoV-2, the coronavirus that causes COVID-19. Participants will be allocated, at random, (rather like a flip of a coin) to receive one dose of one approved vaccine and a second dose of either the same approved vaccine, or a dose of a different approved vaccine. Participants will also be allocated at random to the timing of receiving these doses – some will get a boost dose four weeks after the first dose and some will get a booster at twelve weeks. Some believe that one vaccine type (mRNA vs adenoviral) may be better than the other in triggering the various aspects of the immune response. While we await the research results I would suggest taking the two doses of the same vaccine brand (but stay tuned for updates).

FAQ 3: 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.

pregnant woman getting vaccine from healthcare workertweet with graphs re pregnancy vs vaccine risks

FAQ 4: 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 5: If I have a solid organ transplant or I am a cancer patient should I have my second vaccine dose at the original interval? 

The short answer is yes (although it is not based on clinical trial data). Emerging “real world” data (aka experience) suggests that transplant recipients and active cancer chemotherapy patients (with specific treatment and timing considerations) are now eligible to have their 2nd dose of COVID-19 vaccine at the original interval (<30 days from dose 1); rather than the revised 16-week interval. KHSC is currently in the process of operationalizing this new recommendation (which was issued at noon today).

FAQ 6: 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 7: (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 of authorized vaccines approved

FAQ 8: 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 9: 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 vaccine risks

FAQ 10: 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):

tweet re allergies and covid vaccines

The adverse effects of the COVID-19 vaccines in clinical trials are similar in vaccinated people vs people who got a placebo-saline injection except for: local pain at the vaccine site and increased muscle ache and headache, all of which were more common with the vaccine but were short-term (see below). This is a very good safety profile relative to other vaccines.

table of vaccine 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 11: 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 12: 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 out of a bottle

FAQ 13: 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 14: 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 April 16th).

FAQ 15: 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.

13) Continued Improvement in COVID-19 in Ontario’s Long Term Care facilities (LTC)…3 deaths in the past week-evidence vaccines working: click here

three senior citizens sitting around 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 3,767 deaths in nursing homes account for ~46% of all deaths. There were 3 new deaths in LTCs due to COVID-19 in the past week. There are 52 active COVID-19 cases in LTC residents and 101 active cases in LTC staff, the lowest numbers in months. These numbers remain low and stable, which is testimony to the effectiveness of mass vaccination in a high risk population! For example 2 months ago we were seeing death rates of >100/week; now it is 0-5/week.

14) Non-random acts of kindness by KHSC staff as they discharge patients who recovered from COVID-19 back to their homes in Toronto with a special care bag-Congrats to Sarah Moore-Vasram, Lynda Laird and colleagues!

Recognizing that some of our COVID-19 patients coming from the GTA often do not have clothing for the return trip home, Sarah Moore-Vasram and colleagues did some brainstorming and Lynda Laird and her fabulous team of volunteers put together Patient Discharge Bags. The paper bags were hand decorated and have a beautiful lap quilt or knitted blanket in them. The cloth bags are from Tourism Kingston and contain a Kingston fleece. A big thank you to Ann Van Herpt for organizing the scrubs, Kim Miller for ordering the socks and Rachel Smith-Tryon for assisting with coordination. They contain: Scrubs-Socks, A note from Dr Pichora, Small hand sanitizer, Kleenex pack etc. Your kindness does not go unnoticed!

        quiltspaper bags with healing thoughts written on them

socks hand sanitizer scrubs Kleenex and note from KHSC

Stay calm, Stay informed, Stay Home, Stay Well! …. Get Vaccinated!!!

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