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image of people flexing their arms showing where they got vaccinated

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

Headlines

1) Vaccinations of children ages 5-11 years underway to begin this week 

2) REMINDER: Vaccination of health care workers at Kingston Health Sciences Center -booster doses now being administered 168 days from 2nd vaccine dose

3) KFL&A update: KFL&A continues to see a surge in COVID-19 cases a (213 local active cases, 13 KFL&A residents hospitalized (6 in ICU) despite 87.2% of eligible residents > age 12 years fully vaccinated)

4) Paxlovid: A new oral therapy for COVID-19Pfizer’s investigational antiviral PF-07321332 plus a low dose of ritonavir, an antiretroviral medication, reduces hospitalization/death by 89%

5) Ontario’s 4th wave627 new cases and active cases are up 16% and hospitalizations are up 1%, with a positive test rate of 3.4% and 75.7% of eligible people fully vaccinated.

6) Canada’s COVID-19 4th wave stabilizes: A 3% decrease in new and active cases 4% decrease in hospitalizations (click here)

7) World vaccine roll-out tops 7.71 billion people and the vaccine safety record remains excellent

8) The global pandemic is not yet controlled: ~257.9 million cases to date. 5.1 million deaths with most deaths in past the 28 days in the USA UK, Russia, Germany, Turkey and Ukraine 

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1) Vaccinations of children ages 5-11 years underway to begin this week 

The pediatric COVID-19 vaccine from Pfizer (a reduced dose of the adult mRNA vaccine) is 90.7% effective with few adverse effects. KFL&A Public Health is gearing up to give 13,000 eligible kids their shots. Canada has received over 2.9 million doses of the pediatric Pfizer formulation-so supply should not be an issue for 1st doses. My understanding is that vaccines will be administered this week-stay tuned for details. Click here for the website that KFL&A will use to allow parents to book the pediatric vaccine. Clinic locations and booking links will soon be available at kflaph.ca/Vaccine.

animated of people flexing their arms showing vaccination spots

The graph below is a reminder why the vaccine is important. Even though children tend to have less severe infections some do get very ill (even landing in ICU) and children aged 5-11 have been getting infected at substantial rates (over 1000 infections in past 2 weeks in Ontario).

colourful bar and lines

Children ages 5-11 are at risk of COVID-19 infection-a reminder why vaccinating them is critical! (for their own protection and so they don’t spread it to older adults who suffer worse disease)

2) REMINDER: Vaccination of health care workers at Kingston Health Sciences Center -booster doses now being administered 168 days from 2nd vaccine dose). The vaccines will be made available ONLY 168 days after the second dose of vaccine. They will be delivered in the Burr gym (as before). The number of 3rd dose vaccines anticipated at KHSC will be high (>2000 health care workers in November, >4600 in December). If you are a health care worker and your 168 day anniversary occurs in November, you can book your vaccine here: https://khscnow.kingstonhsc.ca/covid19/information-staff/covid-19-vaccination. He site has a calculator to help you determine when you are eligible. December vaccine appointments are now available. In addition, you can get your 3rd shot from local pharmacies (again only once >168 days post 2nddose). If you exercise this option, please let Occ Health at KHSC know that you are vaccinated.

I want to offer some perspective on the need for 3rd doses. Many Canadian are concerned that if they are not elderly, immunocompromised or health care workers they are not eligible for a booster. Is the lack of a booster dangerous? While it is true that immunity against infection wanes with time after the 2nd vaccine does (as shown in this NY Times graphic). Immunity falls from ~95% to ~80% in the two Canadian studies (top lines in graph below).

colourful graph

However, the main benefit of vaccination is to prevent serious complications (hospitalization and death). In this domain the standard 2 shot vaccination regimen yields persistent benefit) see below. Note that hospitalization protection only declines modestly over time in both Canadian studies, remaining at 80% protection whether using Pfizer or Moderna 30 weeks post 2nd dose. While 3rd doses are recommended for people with impaired immunity, the elderly and health care workers for now it appears the benefits of 2 doses are quite sustained. In 2022 we will all likely be advised to get 3 shots (as in the USA and Israel), but that public policy decision has yet to be made in Canada-stay tuned.

colourful graph

Protection from hospitalization is sustained 30 weeks post 2nd vaccine does in two Canadian studies

3) KFL&A update: KFL&A continues to see a surge in COVID-19 cases a (213 local active cases, 13 KFL&A residents hospitalized (6 in ICU) despite 87.2% of eligible residents > age 12 years fully vaccinated).

tweet with yellow line graphs

COVID-19 headed the wrong way in KFL&A

We are experiencing a dramatic rise in COVID-19 cases in KFL&A. The virus is circulating in the community. This is a reflection of the low infection rates within KFL&A in waves 1-3. As a result there is little natural immunity and we are relying on vaccine-induced immunity. Although we have good vaccination rates, 10% of eligible people aged 12 years and over are still not vaccinated, as are all children under age 12. Thus, there is a large reservoir where the virus is every bit as infective as it was on the day the pandemic began. In this regard, contrast the status of the 4th wave in Ontario vs KFL&A. Regions that were previously harder hit with infections are now doing better (because they have more people who have been infected and are immune). In KFL&A where infection was rare the many susceptible unvaccinated people are now elevating local rates,

Wave 4 in Ontario is not too severe-although there has been a “second hump” with a rise in COVID-19 case (right end of graph below).

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In contrast in KFL&A, wave 4 is looking much more severe, largely reflecting our vulnerable unvaccinated population (graph below).

blue bar graph with red dotted line graph

Wave 4 in KFL&A

This emphasizes the need to complete vaccination of all people over age 5 years asap! Meanwhile we need to continue with public health measures and adhere to handwashing and mask use in indoor spaces.

The consequences for the running of KHSC are significant. We currently have 2 declared outbreaks and after a summer with virtually no cases now are caring for 13 patients with COVID-19 (see graph below). Most are care for by Medicine on our COVID ward (yellow bars; but there is a concerning rise in ICU cases (red).

colourful bar graph

Hospitalizations for COVID-19 at KHSC

In light of the 4th wave some wonder if vaccinations are protective. The answer in the real world (Ontario data) is a resounding yes. Vaccines were advertised to be 90% effective and as the graph below shows, the vast majority of infections are in unvaccinated people (purple and pink lines) with much less infection in fully vaccinated people (green). The unvaccinated are fertile soil for infection and expose the population, including the fully vaccinated, to virus which might not otherwise have been circulating in the community. Of course, if you are immunosuppressed or elderly even two vaccines may not be enough which is why a booster dose is recommended for older individuals and those with suppressed immunity (and health care workers).

purple green and yellow line graph

Vaccinations reduce infection

Vaccines not only reduce infection risk by 90%+; they also reduce risk of ICU admission. This slide below, courtesy of Dr Gerald Evans shoes full vaccinated people account for only 20% of COVID-19 patients in ICUs are fully vaccinated and most of them have many co-morbidities (i.e. other diseases like immunosuppression, chronic lung disease, cancer such that it it doesn’t take a severe COVID-19 infection to tip them over the edge).

shades of brown pie graph

Few doubly vaccinated people in ICUs

We are in a state of high COVID prevalence and local test positive rates (see below-green line shows rates in KFL&A). There are 5 local outbreaks in KFL&A and 2 hospital wards at KHSC with designated outbreaks. 

red and green line graphs

Highest test positivity rates to date indicate that SARS-COV-2, the virus that causes COVID-19, is circulating in our area (green line)

This recent surge in infections is driven by lack of vaccination, relaxation of public health measures and the highly infectious nature of the delta variant of SARS-CoV-2. With continued attention to public health and ongoing efforts to vaccinate the unvaccinated (including children 5-11 years of age) this outbreak will take several weeks to improve. We need to practice good public health measures (masks, physical distancing, honesty when answering COVID-19 screening questions) and should stay home when symptomatic. Ending this new surge in cases is a mutual responsibility. If you know an unvaccinated person, please share this information with them. Vaccines aren’t perfect but they do dramatically reduce the risk of infection and even more effectively prevent death and ICU admission! 

4) Paxlovid: A new oral therapy for COVID-19: Pfizer’s investigational antiviral PF-07321332 plus a low dose of ritonavir, an antiretroviral medication, reduces hospitalization/death by 89%

There is a new pill that if taken within 3 days of COVID-19 infection reduces the risk of hospitalization or death 89%. The idea is to treat mild to moderate disease early with a pill, at home, and thereby avoid severe complications like hospitalization and death. Paxlovid is a combination of Pfizer’s investigational antiviral PF-07321332 and a low dose of ritonavir, an antiretroviral medication used to treat HIV. The treatment disrupts the replication of SARS-CoV-2 in the body by binding to the 3CL-like protease, an enzyme crucial to the virus’ function and reproduction. In interim analysis of the study results only 1% of people that took the drug vs 6.7% of placebo -treated patients with COVID-19 were admitted to hospital. The results were so positive the US FDA ended the Phase II/III study early (which is the normal practice when a treatment is far superior to the placebo). The Biden administration is set to buy 10 million courses of the pills. The beauty of this treatment is that it can be taken at home. There is also a similar pill from Merck, molnupiravir, the first pill for Covid-19 (approved in the UK). This drug reduced hospitalisation and mortality risk by around 50%.

There are two problems with these new drugs: They have to be taken within five days of the onset of symptoms which is a potential problem because often symptoms are very mild during this timeframe. Also, neither the Merck nor Pfizer drugs are currently approved for use in Canada. I am not sure when this drug will be approved in Canada-soon hopefully! As an adjunct to vaccines these drugs are likely to allow us to make COVID-19 a manageable seasonal disease rather than a pandemic.

5) Ontario’s 4th wave627 new cases and active cases are up 16% and hospitalizations are up 1%, with a positive test rate of 3.4% and 75.7% of eligible people fully vaccinated.

There is a concerning uptick in COVID-19 in Ontario. This is why the province has delayed further relaxation of public health rules (wisely) for another 28 days. In the meantime we need to get people vaccinated as outbreaks are largely occurring amongst unvaccinated people, which is particularly problematic in remote areas. The graph below (courtesy of Dr Gerald Evans) also shows the contribution of SE Ontario to the povincial total (the small red bars at each time point). Even though SE Ontario is not populous, we now are having a sufficiently high rates of infection as to be visible provincially (a new and negative trend).

blue bar graph with numbers on top

Ontario’s 4th wave

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Ontario seeing rises in rates of new and active cases, Nov 22nd 2021

6) Canada’s COVID-19 4th wave stabilizes: A 3% decrease in new and active cases 4% decrease in hospitalizations (click here)

map of Canada

Canada’s wave 4 has is stable but not resolved. The disease remains highly prevalent and in some areas is surgingThe map below shows that despite 59.6 million vaccines administered to date, many parts of Canada have rising COVID-19 rates (yellow arrows).

map of Canada with yellow arrows pointing up and teal arrows pointing down

COVID-19 in Canada: How bad wave 4 is depends on where you live 

Most hospitals have capacity but are very busy with non-COVID care. However, if case rates continue to rise hospitalizations will follow in 2-3 weeks.

various types of colourful graphs

Canada has had 1.77 million cases of COVID-19 since the pandemic began. The case mortality rate remains ~1.5% with 29,492 deaths. 76.5% of Canadians that are eligible are fully vaccinated.

When Alberta and Saskatchewan were spiralling, with case rates on the rise several months ago (Sept-Oct), I pointed out their very low vaccination rate. The graphs below show that both provinces have significantly improved their vaccination programs and I’m pleased to report their case rates are way down-vaccines work!!!

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Improved rates of vaccination in the prairie provinces coincides with resolution of severe outbreaks

6) World vaccine roll-out tops 7.71billion people and vaccine safety record remains excellent (click hereCanada remains near the top of the international pack when it comes to vaccinating its population with over 75% of the population vaccinated fully.

horizontal bar graphs

As many countries begin to saturate the administration of both doses of vaccine; other countries like Brazil are beginning to catch up (see graph below showing vaccines/100 people in recent weeks).

horizontal bar grpah

Brazil begins to vaccinate more rapidly

Vaccines are safe: In addition to many clinical trials showing safety, the safety record of vaccines has been established in the real world (see item 1 in today’s note). The complication rates remain very low based on Canadian data showing that vaccines are safe (click here for Canada’s safety data), as well as being effective against all forms of the coronavirus. Getting vaccinated reduces your risk of hospitalization for COVID-19 33-fold! It carries a very small risk of serious adverse reactions (10/100,000 vaccines given) and virtually no risk of death. There are virtually no medical reasons not to get the vaccine for, apart from: severe allergy with a 1st does of the vaccine (a condition called anaphylaxis) and documented allergy to a vaccine component. Sadly, some people are using “fake science”, pseudo-religion and Canada’s human rights legislation to justify their vaccine hesitancy-ergo, we have wave 4!

six boxes with numbers and text

The serious complication rate of vaccines in Canada remains low (10 serious adverse events/100,000 vaccines administered). Data as of Nov12th, 2021

8) The global pandemic is not yet controlled: ~257.9 million cases to date. 5.1 million deaths with most deaths in past the 28 days in the USA UK, Russia, Germany, Turkey and Ukraine 

satellite image of earth taken from spaceranking of countries, world map and various graphs showing world covid numbers

Global COVID-19, Nov 22nd, 2021

Here is today’s map of the global pandemic. Daily cases are rising (red graph), deaths have plateaued (white graph). Vaccine administration is seen in the green graph is rising.

Final Thoughts (the same as last week)

1) It’s influenza season-Get ready to roll up your sleeve again…for your annual flu shot The predicted influenza rates may be higher this year, and the similarity between symptoms of flu and COVID-19 can make it difficult to self-diagnose. Reduce your risk of the flu by getting the influenza vaccine. My team and I did this several weeks ago (see below). 

group of masked DOM staff getting vaccinated by nurse

2) Please encourage your friends and family to get vaccinated! Unvaccinated people not only put themselves at risk; but when they fall ill, risk overwhelming our hospitals, blocking care for the 99% of people who do not have COVID-19. Unvaccinated people are also a major pool in which the virus can circulate. This source of virus can potentially infect our children (under age 12 years), who are not protected since they are not yet eligible for vaccination.

3) Don’t be discouraged-we will emerge from this pandemic and this recent surge will pass!

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