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healthcare worker drawing vaccine from a bottle using a syringe

September 23, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Headlines

1) COVID-19 vaccine booster shots: The US FDA makes a decision to authorize for select groups.

2) Vaccination for Children ages 5-11 years: Coming soon!

3) KFL&A update: 34 local active cases (down from 46 last week), 0 KFL&A residents hospitalized and 80.7% of eligible residents > age 12 years fully vaccinated.

4) Ontario’s 4thwave has plateaued: New cases (463 yesterday) and active cases are down 4 and 1%, respectively and hospitalizations are down 13% as well, with a positive test rate of 1.8% (a marked contrast to Alberta).

5) Canada’s COVID-19 4th wave continues to rise: 0% increase in new cases, 6% increase in active cases and 11% increase in hospitalizations (driven by Western Canada) (click here) (click here)

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

7) The global pandemic is not yet controlled: ~230 million cases to date with 4,723,172 deaths with most deaths in the USA, India, UK and Iran .

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1) COVID-19 vaccine booster shots: The US FDA makes a decision to authorize for select groups

On Wednesday evening, the Food and Drug Administration authorized booster shots of the vaccine for people over 65 who received their second jab at least six months earlier. Approximately 11 million Americans would qualify based on age a vaccination date. The FDA also approved use of a booster vaccine dose for adult Pfizer-BioNTech recipients who are at high risk of severe Covid-19, or who are at risk of serious complications because of exposure to the virus in their jobs. Booster shots (in the US) are also recommended for immunocompromised people. Note: this is US policy not Canadian policy.

masked healthcare worker drawing vaccine into syringe

What is the evidence we need booster shots? In Israel, which has the world’s highest vaccine rate with 78% of people fully vaccinated (mostly Pfizer), there has been a resurgence of cases (650/day); 60% in fully vaccinated people. As a result they are offering boosters to people over age 30 years. Make no mistake-vaccinated people are highly protected with 2 doses of vaccine; most deaths and hospitalizations are in unvaccinated people. Also, these breakthrough infections in Israel relate to the rise of the more infectious and dangerous delta variant. However, the booster is a logical strategy in light of an observed decline in immunity 6 months out from the 2nd vaccine dose. The latter evidence is early (and has weaknesses). A preprint by Tal Patalon et al at found that protection from COVID-19 infection in Israel during June and July dropped in proportion to the length of time since an individual was vaccinated. People vaccinated in January 2021 had a 2.26 times greater risk for a breakthrough infection than those vaccinated in April 2021. However, older people were vaccinated earlier and might have a high risk of break through infection. Israel has made third doses of COVID-19 available to everyone aged 30 or older.

There is a different perspective if one looks globally. One could argue that it is more just (and even more effective in suppressing the emergence of new variants) to ensure low income countries and other vaccine deserts are vaccinated first before adding a booster shot in rich countries. The World Health Organization (WHO) called for a moratorium on boosters until at least the end of September. I like this quote from Dr Mike Ryan, the World Health Organization's top emergencies expert: "We're planning to hand out extra life-jackets to people who already have life-jackets, while we're leaving other people to drown without a single life-jacket". However, Israel and the USA and other rich countries are still planning on (or already administering) booster shots— including parts of Canada.

What about Canada? There is no decision on booster shots yet; but as with everything in this pandemic it is complicated! Saskatchewan and Quebec previously announced plans to offer additional doses of mRNA vaccines—not to boost immunity or because of the delta variant but to facilitate international travel to countries that will not allow entry to Canadian’s with mixed-vaccination status (ie Canadians who received one dose of Astra Zeneca and one dose of Pfizer vaccine).

pfizer and astra Zeneca bottles of vaccine.

It is likely NASCI will recommend a 3rd vaccine for immunosuppressed Canadians and perhaps older people who got vaccines early in the pandemic at short intervals (i.e. dose 1-2 separated by only 3 weeks). Stay tuned; but be reassured that while sterilizing immunity (i.e. no chance of infection) may decline with time; there is not much evidence that protective immunity (freedom from death or hospitalization) wanes with time.

2) Vaccination for Children ages 5-11 years: Coming soon! Pfizer is providing Health Canada with the data showing its vaccine is safe and effective in children ages 5-11 years. The study included 4550 children from age 6 months to 11 years at 90 sites in the USA, Poland, Finland and Spain. It tested a 2-dose regimen (21 days between doses) and looked at safety and effectiveness in increasing protective antibody levels. Pfizer just announced results of the Phase 2/3 trial (not yet peer reviewed) which showed that at a low dose ( 1/3rd that given to older children and adults) the vaccine was safe and caused robust neutralizing antibody levels (immunity) with doses given 21 days apart. This is timely because COVID-19 case rates amongst children have more than doubled since July in the US….yet another compelling reason to vaccinate to keep our children safe and schools open!

article re clinical trial for vaccines

Once Health Canada reviews the data (likely in October) we will almost certainly get approval to vaccinate young children. While younger children usually don’t get as sick as adults, some do. Also this age group is a reservoir to infect older adults who tolerate COVID-19 less well. BC has announced it is preparing to give the vaccine to 6–11-year-old children as soon as Health Canada provides its approval. I suspect we will have a “go” from Health Canada in October. The good news is that once approved Canada has quite a few million doses of mRNA vaccine in storage. Vaccination of children will be key to ending the 4th wave and keeping schools open. We should also remember that almost all vaccines are well tolerated and effective in children, who have superb immune systems!

3) KFL&A update: 34 local active cases (down from 46 last week), 0 KFL&A residents hospitalized and 80.7% of eligible residents > age 12-years fully vaccinated. 

The local positive test rate has plateaued at 0.62% (staying below the critical 1.0% level)-see below. 

red line graph

Test positivity in KFL&A below critical 1% rate-Sept 23rd 2021

When rates of test positivity are less than 1% the disease is not spreading in the community and case numbers usually fall. We have had 1713 cases since the pandemic began and a total of 6 deaths. There are 34 active cases in our region. Overall, this data is very encouraging (especially as this is occurring despite opening of schools). This reflects both high local vaccination rates and reasonably good adherence to public health policy-well done residents of KFL&A!

What’s happening at Kingston Health Sciences Center? We have 2 active COVID-19 cases one on Medicine and one in ICU. The Medicine program at KHSC remains extremely busy with non-COVID-19 care. We are looking after 197 patients at KHSC (see below). 

colourful graphs bed map for KHSC

The Medicine program at KHSC is busy.

Clinics are continuing to ramp up toward pre-pandemic levels (although volumes are still limited by the size of waiting rooms and ongoing masking/physical distancing requirements). All physicians are being asked to see patients in person whenever possible and appropriate. In all disciplines we are seeing the consequence of pandemic-induced wait lists and delayed care. Patients are arriving in clinics and at the hospital with more advanced disease. We are doing our very best to catch up and ensure care is provided in a timely a manner (but it is a challenge, exacerbated by shortages of nurses and technologists and limited capacity in procedural suites and operating rooms).

I can also reassure patients that all trainees, staff and faculty are required to be vaccinated to work at KHSC or Queen’s University. The use of antigen testing for those partially vaccinated will be ending shortly and after that full vaccination will be the only status accepted.

4) Ontario’s 4th wave has plateaued: New cases (463 yesterday) and active cases are down 4 and 1%, respectively and hospitalizations are down 13% as well, with a positive test rate of 1.8% (a marked contrast to Alberta)

The good news is that with high rates of vaccination in Ontario and ongoing reasonable (if relaxed) public health measures (like indoor masking) we are seeing a plateau in wave 4 (see below). 

salmon coloured graphs

Wave 4 has plateaued in Ontario!

In stark contrast is the situation in Alberta below. Alberta’s self-inflicted wave-4 crisis relates to failure to implement logical public health policies (they were not using masks, tracking contacts or restricting public association of infected people and have a large population of unvaccinated people, 30%). Sadly for Albertans, these decisions have shut down elective health care and threaten to over run their health care system. Patients are being transported out of the province and health care workers imported. Their new vaccine passport system still allows unvaccinated people in enclosed public spaces using antigen testing as a substitute for vaccination (which is an unreliable means of limiting disease spread).

salmon coloured bar graphs

Wave 4 continues to challenge Alberta’s health care system.

Premiere Kenney has apologized for his mistaken policy decisions; but that is cold comfort for the people of Alberta. Wednesday marked the most Albertans ever occupying ICU beds in the history of the province, with the CEO of Alberta Health Services announcing it was asking neighbouring provinces for help managing the situation. It remains to be seen if the contrarian, libertarian, anti-scientific attitudes of the large numbers of unvaccinated Albertans can be corrected in time to flatten wave 4. Leadership matters and science and public health policy should not be subject to modification by politicians. The province just reported its first death in a young adult. Meanwhile only 73% if eligible Albertans are fully vaccinated! 

Doctors behaving badly: Sadly it’s not just lay people who are fueling Alberta’s COVID-19 fire. While the vast majority of Alberta doctors are fighting this pandemic, a small but significant number of doctors in Alberta are behaving unprofessionally and 7 have been sanctioned for spreading false information by the CPSA (see below). Doctors are also being reminded not to spread false information and to support public health measures and vaccination. This is a shameful situation and a reminder that Canadian Medical schools need to continue to focus on advancing science in Medicine and ensuring graduates have high standards of professionalism and a working knowledge of public health measures.

article about 7 Alberta physicians spreading false info

A sad comment on a small group of Alberta physicians.

The graph below shows on the left that Alberta and Saskatchewan have the lowest rates of vaccination amongst provinces (left) and the highest case rate (right). There is a straight line connecting these facts. The line is made even bolder by the fact that people and province that don’t vaccinate also tend not to follow public health rules-a lethal double whammy!

horizontal orange bar graphs

Data show that when it comes to COVID-19 it is “Get vaccinated or suffer the consequences”-Sept 23rd2021.

5) Canada’s COVID-19 4th wave continues to rise: 0% increase in new cases, 6% increase in active cases and 11% increase in hospitalizations (driven by Western Canada) (click here) (click here)

map of Canada

Canada is experiencing a continued rise in active cases and hospitalizations despite 70.43 % of the eligible population being fully vaccinated (click here) (click here). This is driven by unvaccinated people (particularly in BC, Alberta, Saskatchewan), the highly infectious delta variant, lack of vaccination approval for children ages 5-11 years, and premature relaxing of public health policy (in some jurisdictions). 

salmon coloured bar graphs

We have had 1.59 million cases of COVID-19 since the pandemic began. The case mortality rate remains ~1.5% with 27,536 deaths (>200 since last week). We administered 101,924 vaccines yesterday, bringing total jabs up to >55.2 million! (see below).

various types of colourful graphs

30% of eligible Canadians are still not fully vaccinated.

various types of graphs

4th Wave in Saskatchewan Sept 23rd 2021- infection rates continue to rise.

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

colourful horizontal bar graph

However, vaccination rates are appallingly low in low-income countries (see below). These vaccine deserts cause human death and suffering and allow the virus fertile ground to mutate and create new variants.

colourful wave type graphs

Low-income countries have barely begun vaccination: A reason to hold off on booster doses in rich countries and divert doses to where they are most needed,

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!

6 boxes with text and numbers

The serious complication rate in Canada remains low (8 serious adverse events/100,000 vaccines administered). Data as of Sept 10th, 2021

7) The global pandemic is not yet controlled: ~230 million cases to date with 4,723,172 deaths with most deaths in the USA, India, UK and Iran (left column below).

satellite image of earth taken from spacegraphs, world map with red dots, numbers and ranking of countries

Global COVID-19, Sept 23rd 2021

Here is today’s map of the global pandemic. Daily cases are at a plateau (red graph), as are deaths (white graph). However, these are very high case load plateaus and the pandemic is not yet under control. Vaccine administration is somewhat down, which is concerning (green graph).

Final Thought

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.

Stay well!

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