September 3, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

Dr. Archer's Updates on COVID-19

General DOM News & Events

| 3 September 2021

^{Breaking News}

^{For Queen’s Faculty and students: Elentra screening switching to SeQure Sept 1}^{: As of September 1st, FHS is no longer issuing daily Elentra screening emails. Staff,}^students^{and faculty who are coming to campus should download the}^{SeQure App}^{and use it to perform daily screening beginning September 1st.}

^{Vaccine certificates are required for all KHSC staff and for all Queen’s Faculty}^{(via separate uploads) The instructions for Queen’s faculty and trainees is here:}^{https://www.queensu.ca/safereturn/vaccination}^{If you are a faculty member you will be required to upload your vaccine certificate. When successful you receive the following e-mail}

I am back after a PEI hiatus full of sun, lobster, red sand and CIHR grant writing

PEI Photos - Flowers, a fox, a glass globe, hay

1) Vaccines are like seatbelts (but better): Two thirds of COVID-19 cases in Ontario are in unvaccinated people!

2) How long does immunity last post vaccination-the San Diego experience: the case for a 3^rd dose booster

3) KFL&A update: 9 local active cases, 0 KFL&A residents hospitalized and 77.8% of eligible residents (12-years and older) fully vaccinated (see update from KFL& A Public Health)

4) Ontario’s 4^th wave: Despite 9.9 million people fully vaccinated case rates are increasing by 12%/week (865 new cases yesterday), hospitalizations have risen 10% as well and there is a concerning 3.0% positive COVID-19 test rate (click here) (click here):

5) Vaccine certificates in Ontario: A necessary tool as fall approaches and schools reopen.

6) Canada’s COVID-19 4^th wave: driven by unvaccinated people, the highly infectious delta variant, lack of vaccination approval for young children, and relaxing of public health policy in some jurisdictions: A concerning 16% weekly rise in new cases and 27% rise hospitalizations despite 67% of the eligible population being fully vaccinated (click here) (click here)

7) World vaccine roll-out tops 5.4 billion people and safety record remains excellent (click here)

8) The global pandemic is not yet controlled: ~218.7 million cases with 4,547,761 deaths to date with most deaths in the USA, India and Iran

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1) Unvaccinated people and the 4^th wave of COVID-19: Two thirds of COVID-19 cases in Ontario are in unvaccinated people!

Ontario reported 656 new cases of COVID-19 on Wednesday this week. Does that mean vaccines aren’t effective? No, in fact vaccines remain the most effective way to protect yourself and your loved ones. Most infected people are now unvaccinated people. Here is the breakdown of Wednesday’s cases: 2/3 infected people were unvaccinated or incompletely vaccinated!

Of the 601 cases on Wednesday with a known vaccination status:

397, or 66 per cent, were in those unvaccinated.
52, or nine per cent, had a single dose.
152, or 25 per cent, had two doses.

Even if one gets infected after vaccination the results are starkly different from getting an infection when not vaccinated. Vaccinated people usually get mild infections (often asymptomatic); unvaccinated people have a 5% hospitalization rate with a 1.5% risk of death! In the USA nearly 99% of COVID-19 deaths are now in unvaccinated people. In fact the CDC has done a study that shows unvaccinated people are 29X more likely to be hospitalized than vaccinated people! I encourage my patients to think of a vaccine like a seatbelt. Seatbelts don’t prevent car accidents but keep people alive; likewise, vaccines don’t always prevent infection but they reduce bad outcomes. In fact, vaccines are better than seatbelts in that they also prevents 90% of infections (AND keep you alive).

Vaccines work-note the low rate of hospitalization amongst vaccinated people (green line)

2) How long does immunity last post vaccination? the San Diego experience: the case for a 3^rd dose booster Colleagues at the University of California San Diego (UCSD) recently reported that vaccine effectivess declines over time, part due to a fall in immunity and part due to the rise in the delata variant, which is sligtly less amenable to vaccine immunity. In a leter to NEJM they reported their experience with increasing indections of vaccinated staff with the SARS-CoV-2 delta variant.

UCSD vaccination of faculty and staff with mRNA vaccines (Pfizer and Moderna)began in mid-December 2020; by March, 76% of the workforce had been fully vaccinated, and by July, the percentage had risen to 83%. Infections had decreased dramatically by early February 2021. However, in mid-June (coincident with the end of a mandatory mask policy in California and the rise of the delta variant) cases began to rise amongst even vaccinated health care workers (see graph below). In this study, people were identified as infected if they had a positive test and at least one COVID symptom. There were no deaths in the small groups of vaccinated or unvaccinated people; however the only hospitalization was in an unvaccinated person.

Top panel-although protected from severe adverse outcomes, the top panel shows vaccines are increasingly less likely to protect form infection over time (this supports the case for booster shots and ongoing use of masks in indoor spaces).

Rightly or wrongly this is why the USA has decided to recommend 3^rd shot boosters 8 months post vaccination. Booster shots for North Americans do raise social justice issues (since most of the worl is unvaccinated); however, boosters are likely this is coming our way. Meanwhile, with the delta variant afloat and no current booster plans in Canada, it will remain necessary (or at least wise) to wear masks in indoor spaces for the forseeable future.

3) KFL&A update: 9 local active cases, 0 KFL&A resident hospitalized and 77.8% of eligible residents (12-years and older) fully vaccinated (see update from KFL& A Public Health)

The local incidence of COVID-19 remains low (3.3/100,0000 people in the past week). Additional good news is that the rate of positive tests in KFL&A remains low (0.34% for the past week). Although not listed on the dashboard yet there is one patient with COVID-19 in ICU at KHSC. I would anticipate that we will see a rise in cases this fall however, due to the 20% of people that are unvaccinated, the rise in the delta variant, and the relaxing of mask policies. The good news is that this is a future we can influence and change; we just need to be prepared and advocate for vaccination, ensure vaccination of younger children (once approved) and continue to use masks in indoor spaces.

The Medicine program at KHSC remains extremely busy with non-COVID-19 care. We are looking after 200 patients at KHSC. We have closed the Johnson 3 ward we ran at Hotel Dieu hospital. 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.

4) Ontario’s 4^th wave: Despite 9.9 million people being fully vaccinated case rates are increasing by 12%/week (865 new cases yesterday), hospitalizations have risen 10% as well and there is a concerning 3.0% positive COVID-19 test rate (click here) (click here):

These data a very concerning, especially when view based on the trends seen elsewhere in Canada (where cases and hospitalization rates are on the rise). Some of this increase in COVID-19 may be seasonal; but a lot is driven by unvaccinated people and the relaxing of public health policies. To keep our hospitals open for the care of the 99% of people who don’t have COVOD-19 we will need ongoing mask policies, ongoing testing, improved rates of vaccination and vaccination of younger children as soon as it is approved.

5) Vaccine certificates in Ontario: A necessary tool as fall approaches and schools reopen.

In July the Ontario science table advocated for vaccine certificates to safely accelerate reopening of the province. They published a 21-page brief Wednesday providing their key considerations on a possible vaccination certification program, concluding Ontario could use vaccine certificates a short-term basis to help reopen higher risk settings (click here). The province has now begun to action this policy. For people over age 12 (i.e. those currently vaccine eligible) vaccine certificates, confirming full vaccination, will be required to visit casinos, concert venues, theatres, cinemas, sporting facilities and events, banquet halls, bingo halls , convention centres, nightclubs and to eat at indoor food and drink establishments. Apparently, the certificate is not necessary for retail shopping, salons and barbershops, banks, places of worship, essential services, workplaces or patios and other outdoor spaces. Sadly, these certificates are not yet available from the province. Meanwhile people will meanwhile use their vaccine receipts given to them at the time of vaccination, which they can present as paper documents or display as PDFs on their smart phone.

To be permitted to work at KHSC or attend Queen’s University you must now have a vaccine certificate. For KHSC we have been required to submit proof of vaccination. This certification will be reflected on your badge and detected by scan when you enter the building. I also carry my proof of vaccinations a s a pdf on my iPhone in the NOTES app!

Here is a list of where certificates are required (top) and are not required (below) in Ontario: If you have a sense of irony, you may ponder the provinces focus on strip club; certainly the risk of transmission of infections (only one of which is COVID-19) in these institutions is high!

List of establishments that require vaccine passport

6) Canada’s COVID-19 4^th wave: Driven by unvaccinated people, the highly infectious delta variant, lack of vaccination approval for young children, and relaxing of public health policy in some jurisdictions: A concerning 16% weekly rise in new cases and 27% rise in hospitalizations despite 67% of the eligible population being fully vaccinated (click here) (click here)

4th Wave begins in Canada Sept 2^nd 2021

We have had 1.5million cases of COVID-19 since the pandemic began. The case mortality rate remains ~1.5% with 26,977 deaths (465 in the past month). Hospitalizations which had been declining in July, are on the rise again and this is always followed by an increase in mortality in 1-2 weeks.

Canada’s vaccine story: 73.4% of Canadians have had at least one shot and 66.9% are fully vaccinated! 53 million doses have been administered (click here): 63.5 million doses of COVID-19 vaccines have been delivered but only 84.3% of delivered doses have been administered. We delivered 65,848 new vaccines yesterday. Canada is near the top of the pack in vaccines administered per day now! The graph below shows the % of people vaccinated by country as of Sept 2nd, 2021 (see below) (note Canada, 5^th from top in vaccines/100 people).

Canada is now a top vaccinator country (more than 2/3rds of eligible people are fully vaccinated)

7) World vaccine roll-out tops 5.4 billion people and safety record remains excellent (click here): If you have a vaccine hesitant friend you might want to show them the graph below.

In addition to many clinical trials, the safety record of vaccines has been established in the real world, where we have administered 5.4 (+) billion jabs! The complication rates remain very low. Vaccines are safe (click here for Canada’s safety data) and effective against all forms of the coronavirus. They are particularly good at preventing hospitalization or death (which is what matters most)+.

The serious complication rate in Canada remains low (7 serious adverse events/100,000 vaccines administered). Data as of Aug 20th, 2021

8) The global pandemic is not yet controlled: ~218.7 million cases with 4,547,761 deaths to date with most deaths in the USA, India and Iran (left column below)

Here is today’s map of the global pandemic. Daily cases are rising (red graph). Deaths too are increasing (white graph). This shows that globally the pandemic is not yet under control. Vaccine use is on the rise (green graph).

Global COVID-19, Sept 2nd 2021

COVID-19 Vaccine FAQs and report on Long Term Care Facilities are on hiatus (no updates of significance)

Stay well, get vaccinated, continue to use masks in public place!

September 3, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program

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September 3, 2021 - Dr. Archer's Update on COVID-19 response from the DOM and Medicine Program