Let’s discuss the AstraZeneca vaccine. I am just going to give you some facts. You can make your own decision about the AstraZeneca vaccine.
On March 29th, Canada’s National Advisory Committee on Immunization (NACI) recommended provinces pause on the use of the AstraZeneca-Oxford COVID-19 vaccine on those under the age of 55 because of safety concerns. NACI’s priority is vaccine safety. Their decision came after the European Medicines Agency ( EMA), Europe’s Health Canada equivalent, investigated 25 cases of very rare blood clots out of about 20 million AstraZeneca vaccines given. On March 18th the EMA concluded that the benefits of the AstraZeneca vaccine far outweigh this risk if there is a true increased risk of the blood clots.
Most of these rare blood clots occurred in women under the age of 55 ( 18 out of 25). Thus, NACI’s recommendation to halt the use of the AZ vaccine in this age group pending further review of the ongoing real-time research.
So, 25 cases out of 20 million vaccinations is a risk of about 1 in a million. That means that if there actually is an increased risk, the risk is 1 case of the rare blood clots out of 1 million vaccines given. One in a million.
Let’s shed some light on that: The risk of blood clots developing among new users of oral contraceptive pills ( birth control pills) is 8 out of 10,000. Thirty four out of 10,000 women who use hormone replacement therapy ( HRT ) will develop a blood clot at some point. And, the risk of developing a blood clot in women in general is is 16/100,000.
The Canadian maternal mortality rate ( the rate of death in women during childbirth) is 8.3 deaths per 100,000.
No medical intervention is without risks. The question is, should we take that risk? That is what NACI will try to figure out in the coming weeks. Let’s balance that risk of 1 in a million with the risk of COVID-19.
A new briefing note from a panel of science experts advising the Ontario government on COVID-19 shows a province at a tipping point. Variants that are more deadly are circulating widely, new daily infections have reached the same number at the height of the second wave, and the number of people hospitalized is now more than 20 per cent higher than at the start of the last province-wide lockdown.
These variants are more dangerous and more easily transmitted. They cause 2.5 to 4.1 deaths per 1000 detected cases. That’s deaths. The risk of serious complications with the variants is double the risk of the original COVID-19 virus: 20 out of 100.
Here’s a quote that scared me. “Right now in Ontario, the pandemic is completely out of control,” Dr. Peter Juni, the scientific director and a professor of medicine and epidemiology with the University of Toronto and member of Ontario’s COVID-19 science advisory table.
The AstraZeneca vaccine is over 70% effective up front and almost 100% effective at preventing deaths and hospitalizations from COVID-19. Breathe. It is not time to throw out the baby with the bath water. No blood clots have occurred in people over 60. We should continue using the AstraZeneca vaccine in this age group which is most at risk of serious complications and death from COVID-19.
I wrote this email on March 23, 2021 to the Emergency Operations Centre of the Ministry of Health in regards to Directive #3 which places significant restrictions on the residents of Long Term Care homes during the pandemic. The email has gone unanswered and so I making it public today.
I’m currently the medical director for Bay Haven Long Term Care in Collingwood Ontario. I had sent the email below asking for some easing of restrictions for our LTC as we now have all but two residents (new admits) who were fully immunized for COVID-19. Our medical officer of health, Dr. Colin Lee expressed that while he was sympathetic, he could not overturn Directive #3, and asked that forward you with my original email. I would ask that you please consider the overall well being of the residents in LTC centres like mine, where we have almost full immunization.
Begin original letter:
I understand you are the contact person at Public Health for Bay Haven. I’m hoping that you can help me advocate for the residents of the nursing home. As you are aware, most nursing home residents throughout the province are suffering from “confinement syndrome”. The year long isolation caused by the COVID pandemic has had a devastating effect on their emotional health and the residents are really struggling as a result.
As the Medical Director, I see these issues when I visit, and it pains me to see how much the mood of the residents has gone down in the past year. Don’t get me wrong, I do understand the rational behind some of the restrictions that have been put in place, and I have supported those restrictions. They were important to protect the health and safety of Bay Haven, and we have been fortunate to not have a COVID outbreak in our facility.
But we also now are in a situation where all but two of the residents (new admits) are immunized for COVID and a good number of staff are immunized as well. With that, I need to focus on the other aspects of care for the residents.
The blunt reality however, is that Bay Haven will not go against Public Health directives, no matter what I personally think of them. So I need your (or somebody in public health’s) support to change some of the directives.
With that, I would like to implement the following changes (and need Public Health to support):
1) We continue to have less than 100% of our staff immunized. To encourage more of them to be immunized, I would like to stop screening with np swabs, those that have been immunized (two weeks after their second shot). Nobody likes getting an NP swab. If the un-immunized staff see that they will not be subjected to this test, it might encourage them to get their own shots. And we get to save our swabs for those who really need it. (Addendum – Since this letter is public, what I was not aware of when I wrote the original is that Bay Haven actually has one of the highest percentages of nursing home staff who’ve been immunized in the province – almost 80%! Having said that, nothing wrong with going for the other 20%)
2) All the residents who have been immunized need to be allowed to go back to congregating as usual. This includes all their group activities and sessions.
3) We should allow an increased number of visitors to the facility. I would agree the visitors should have proof of either immunization, a recent negative COVID swab, or be willing to have a rapid swab done in our facility. I think each resident can assign 4 people who can come and visit, and we can work on putting a limit on the number of visitors at any one time.
4) If a resident has been immunized, they should be able to leave the facility for social gatherings, not just medical appointments. Whoever drives them would need to have proof of immunization, a recent swab or have an NP swab in our facility since they presumably enter the building. But the immunized resident cannot (as per the articles above) bring back and transmit the infection themselves.
If Public Health could support this, it would go a long way to improving the mental health of the residents and improve their quality of life. It’s the least we can do after all they have done for society over their years.
Disclaimer: Just a reminder that, once again, I am not speaking on behalf of the Ontario Medical Association. The opinions expressed in this blog are mine, and mine alone.
Many who read this will wonder why I’m talking about a potential physicians agreement in another province. Some will point to my role at the Ontario Medical Association (OMA) as past-president and suggest that I should stay out of the affairs of another Provincial, Territorial Medical Association (PTMA). Normally I would. But the situation in Alberta has implications for physicians across the country, including Ontario, so I feel compelled to speak out. Besides, considering the then President of the Alberta Medical Association (AMA) commented on our own tentative agreement in 2016 (and he was right by the way), I think it’s ok for me to speak out as well.
I don’t know all the details about the ins and outs of how the AMA works, nor do I know all minutiae about their negotiations process.
But I know when doctors are getting screwed by a government.
Last week, the Alberta Medical Association (AMA), announced a tentative agreement with their government. The agreement allows their volatile, combustible Health Minister Tyler Shandro almost unlimited, and truly unprecedented power over Alberta Physicians:
It reduces their physician pay to 2018 levels
It gives the temperamental Shandro Ultimate authority over how much physicians get paid. Just read this truly scary statement by the AMA:
“The AMA acknowledges that the physician services budget is established by the minister in the minister’s sole discretion,” it states.
“The AMA further acknowledges that nothing in this agreement fetters the minister’s authority or discretion with respect to the physician services budget.”
It places a hard cap on the physicians services budget, meaning that if the demand for care went up above the predicted level, physicians incomes would be clawed back to make up the difference. As an aside, demand will almost certainly exceed the projections. We are coming out of a pandemic and are facing an enormous backlog of care. How eager do you think the volatile Shandro will be to allow an overage of the physicians service budget going forward?
Worse, the AMA is required to discontinue their lawsuit demanding binding arbitration, which all physicians should view as an inherent right.
For me personally, the whole Alberta situation has brought back some particularly bad memories. In 2012 the OMA accepted a 0.5% fee cut in the hopes that appeasement of a bullying government would lead to better things in the future. This of course is not the way to stand up to bullies, and Ontario physicians felt the brunt of this as the now second worst health minister I have ever seen, “Unilateral Eric” Hoskins, sensing weakness, imposed unilateral cuts to physicians in 2015.
After a couple of years of internecine warfare, the OMA and Unilateral Eric came to a tentative agreement in 2016 as well. That agreement:
Reduced physicians pay to levels from a few years back setting a lower base rate for the Physician Service Budget
Allowed for a hard cap on physicians billing
Allowed the Health Minister to claw back physicians billings if usage exceeded projections
Sound familiar? At least the Ontario agreement allowed our own Charter Challenge on Binding Arbitration to continue (which it painfully, slowly does to this day).
We were told by the OMA Board at the time that this agreement was the “best that could be done” and that we were going be faced with even more clawbacks and cuts if we turned it down. As is well known now, the agreement was soundly rejected, the increased clawbacks never materialized and when faced with the prospect of an election, the government of then Premier Kathleen Wynne finally had to recognize that Arbitration was an inherent right for all essential workers, physicians included, and we secured a fair Binding Arbitration Framework.
All of which is my way of encouraging Alberta Physicians to realize that they don’t have to simply roll over and accept the “best we can get”. While there will be some pain in rejecting the agreement, at the end of the day, governments need to go to the polls. That’s when having angry doctors makes them vulnerable. It will not be pleasant to hold out, and say no (it certainly wasn’t in Ontario!) but I submit that it is better to keep your integrity intact and stand up to a patently unfair deal.
But wait, what about these implications for physicians across Canada I referred to? It all has to do with negotiations.
Obviously, I can’t talk in detail about negotiations. BUT, what I can confirm is what many of us have long suspected. Bureaucrats from Provincial Governments talk to each other all the time. They share data. They share information, and they share tactics. They may or may not (depending on their political masters) use a particular tactic/program/scheme etc, but they do share.
Which means, that IF Alberta docs pass an agreement like this, which chains them to a hard cap and allows even a minister as incendiary as Shandro, free, unfettered reign, then we can expect other governments to attempt this as well. “Your colleagues in Alberta accepted this, why can’t you be as reasonable and co-operative as them?”will be the opening position in negotiations in many provinces after this.
That is why physicians across the country should follow the situation in Alberta with interest. That is why we should support our Alberta colleagues. That is why, for the sake of physicians in Alberta, and everywhere in Canada, this deal needs to be rejected.
If you want more, a colleague has prepared a helpful Q&A about our situation, and you can access it here.
Recently, the National Advisory Council on Immunizations, or NACI, announced that it was reasonable to wait up to sixteen weeks between your Covid-19 vaccination shots. This applies to the three, Health Canada approved, two shot vaccines (Pfizer/BioNtech, Moderna, and AstraZeneca). Canada is the only country in the world to stretch out the interval between shots to four months. The manufacturers of the vaccines continue to suggest three weeks between shots.
But NACI is made up of some really smart people as well. They’ve been providing independent and unbiased advice on all vaccines to the Federal government since 1964. No doubt NACI looked at data from countries around the world, and found that in countries like the UK and Israel, the incidence of COVID19 fell dramatically in the general population after just one dose. This was particularly of note in the UK because they had delayed their second shot (to 12 weeks) despite being called reckless by other countries.
So, we have one group of extremely bright and knowledgeable people saying delaying the second shot up to 16 weeks is ok. Another group of extremely bright and knowledgeable people is saying that this is a problem.
Look, I’m just an old country doctor, not a virologist or immunologist or population health specialist or so on. There is no way I could get into an educated discussion about whether going to 16 weeks between shots will be safe and effective or not because my brain is just not big enough to understand all the minutiae around rising and falling antibody levels.
But I’ve been around long enough to have read multiple statements and press releases from bodies like this, and I’ve learned to read between the lines. Here’s what’s really going on, that nobody (including the press) is talking about.
NACI recommends that in the context of limited COVID-19 vaccine supply, jurisdictions should maximize the number of individuals benefiting from the first dose of vaccine by extending the interval for the second dose of vaccine up to four months
“The context of limited COVID-19 vaccine supply.” See the reason that NACI felt obliged to have Canada be the only country in the world that extends the interval to 16 weeks, is because Justin Trudeau and the Liberal government have botched the procurement of COVID-19 vaccines. If we had more COVID-19 vaccines, NACI would never have been put in a position of having to explore a population level experiment.
Trudeau has been saying for weeks now that more vaccines are coming. Heck back on Feb 19 he promised a “big lift” of vaccines. But despite all the hyperbole, the simple fact remains that as I write this blog, Canada is 62nd in the world when it comes to delivering COVID-19 vaccines to our population. We’re behind such illustrious world powers like Dominica, Serbia, Estonia and Aguilla to name a few. For a G-7 country, that’s just embarrassing.
This source for all the above information is Our World in Data and you can link to the relevant page here. It is updated daily so my comments are based on what I saw as of March 14, 2021.
Look, I, like you, am acutely aware that the Trudeau government has signed lots of deals with vaccine manufactures to get Canadians the vaccine. But it’s also extremely telling that Trudeau has refused to release the vaccine contracts. These contracts undoubtedly have a delivery schedule in them, so the fact Trudeau won’t let us see them really incriminates his government. It does nothing to dispel the concerns around the competence of how his government handled the vaccine procurement process.
Th main role of a national government is to protect the welfare of its citizens. If Canada had been in the top ten in vaccines procured per capita (surely not unreasonable for a G-7 country), NACI would not have needed to explore a 16 week vaccination interval. And we likely wouldn’t be looking at a third wave in Ontario.
By not procuring COVID-19 vaccines in a more timely manner, the Trudeau Liberals have failed the people of Canada.
Canada now has 4 different vaccines to help us fight COVID-19, BioNtech/Pfizer, Moderna, AstraZeneca and Johnson and Johnson. While that’s a (very) good thing, this has led to some inevitable questions about which vaccine is “better” and whether people should wait for one or the other. An email from a friend who questioned the AstraZeneca vaccine inspired me to write this.
First, to re-iterate once again, while is true that all of these vaccines were developed at a rapid pace, the reality is that they all have been thoroughly tested. The shortcuts that were made were made in the bureaucracy, not the human trials. You can read my thoughts on that here, or see my colleague Dr. Greg Rose explain it better here.
There will likely never, ever be a vaccine (of any kind) that is 100 per cent safe (ever), but overall these vaccines are extremely safe for the general population.
The difficult part in sorting out information about the COVID vaccines is two fold. First, there is a whole lot of information that comes out, almost on a daily basis. It’s hard for not just physicians to keep track of it all, but also members of the general public. Second, some of the information that is released is extremely premature, without a full analysis being done. First impressions being lasting impressions, this often times creates an incorrect perception of a vaccine, that is hard to refute later on.
For example, the BioNtech/Pfizer vaccine was initially plagued by concerns that it caused Bell’s palsy (based on a report that 4 people got it after taking the vaccine) and that death was a side effect (based on report in Norway of 33 people over the age of 80 dying after taking the vaccine). It wasn’t until later that a through review showed that the Bell’s palsy issue was actually the same or less than the background rate. Essentially, you would expect about 12 people a year in the vaccine group to get Bell’s palsy anyway, regardless of whether they got the vaccine or not, so the fact that 4 got it didn’t mean it was linked to the vaccine, just that they were going to get it anyway. As for the 33 deaths, turns out that was in keeping with Norways normal death rate for their population of over 80 year olds, so again, not related to the vaccine.
Think of it this way. The most common time to get a heart attack is actually three hours after you wake up. Does this mean eating breakfast causes a heart attack? Of course not. Just because those two things happen close together, doesn’t mean that one caused the other. In statistics this is referred to as “correlation does not imply causation.” Sadly, there is rather a lot of correlation that is brought up about all of these vaccines, and the assumption is made that they are causing problems.
It was initially claimed the Moderna vaccine had more side effects than the BioNtech/Pfizer one. But it was only after studying it more that people realized that these aren’t really side effects, but proof that the vaccine is working. Your second shot of the Moderna vaccine made your immune system mount a response to what it viewed as a foreign body. Thus the muscle aches, fever and headaches that went along with it.
Now most recently there is some sub-optimal information circulating around the AstraZeneca vaccine. First, there was concern that they would not work against certain strains of COVID19, particularly the South African strain. Second is concern about blood clots.
The South African strain issue was particularly overblown. “Only 10% effective” screamed out some headlines. South Africa even stopped using this vaccine as a result. The full story is somewhat different.
Turns out the study that suggested AstraZeneca wouldn’t work against the SouthAfrica variant was very small (2,000 people), and not well done. Further more, what really matters, is preventing deaths, hospitalizations and severe disease and AstraZeneca works for this with the South African strain. Perhaps you may get a mild case of COVID19 (cough, fever, mild muscle aches for a couple of days). But the point of the vaccine is prevention of severe cases and deaths.
Similarly, the blood clot issue again appears to be one of correlation, not causation. The background rate of blood clots in the population would explain the ones found in Europe. Health Canada and Thrombosis Canada is not worried, and you shouldn’t worry either.
So back to the question at hand. Which vaccine should you get? My personal feeling is the J&J one would be the best simply because, logistically it’s much easier. Get one shot and it’s done. The problem with that one is that we have an effete Prime Minister who’s totally botched vaccine procurement for Canadians. There’s a reason #trudeauvaccinefailure is on twitter. Last I checked we are 61st in the world for procurement of vaccines (and for a G-7 country, that’s just embarrassing).
While happily announcing the approval of the J&J vaccine, Trudeau and the Liberals neglected to emphasize the fine print. Namely that the vaccine would likely not start to arrive until the end of April or early May, and that would only be in small amounts. The bulk of this vaccine won’t be in Canada until September.
Of course, right on queue, a few days after boasting about J&J, it was announced there would be production delays. Why the media isn’t talking about the outright incompetence of Trudeau and his government in protecting Canadian lives is beyond me.
Therefore, the best thing you can do is get the first vaccine that you are offered. When you get notified to get your shot, don’t ask which one, just get it. For what matters the most (keeping you out of hospital or dying from COVID19), they all work roughly the same.
I urge you all to do your part, protect yourself, protect others, and let’s get ourselves out of this pandemic, and back to a normal life.
A Great Cause.
As an addendum I would like to encourage all of my readers to consider buying some merchandise from Conquer Covid 19. This all volunteer group did yeoman’s work providing PPE to physicians, health care workers and others in need. Last year they raised $2.4 million and donated around 3 million (!) pieces of PPE.
This year they are selling their extremely boring merchandise (check Ryan Reynolds take on it here) and proceeds will go to LTCfrontline foods, providing hot meals to those workers who are struggling in long term care homes and Call Auntie, an organization that helps Indigenous people navigate issues around COVID19.
This week, much of Ontario moves out of a complete lockdown (I finally get a hair cut!). The move itself has not been without controversy, with some critics saying the government is opening too fast, and others saying they’re opening too slowly.
There is no doubt in my mind that if we can re-open the economy safely, we should. COVID19 has done terrible damage over the past year. Lives lost. Families unable to say goodbye to their loved ones. On going health issues in those who survived COVID19 infections and much, much more. But there is also an increase in the number of people suffering from mental illness, a rise in domestic abuse, and very real economic hardships faced by millions of Canadians.
It has been noted that there were were more deaths than expected in Canada last year, and not all of these “excess deaths” were directly caused by COVID19. We are starting to realize that some of deaths are “indirect”. That’s to say, the social isolation, the lack of emotional, financial and other support, the delayed medical procedures and more, have caused these deaths.
This situation is particularly bad in British Columbia and Alberta, where there were 270 and 360 more deaths than expected between March 15 and April 25 alone, and these were not directly attributed to COVID19.
It’s just that we cannot ignore the pain and suffering that occurs by a lockdown as well.
That’s why to my mind the focus needs to be on how to re-open safely. We have one of the worst pandemic responses in the world, so we must do better. Is there something we can do, that hasn’t been done in Canada yet?
Turns out, there just might be.
For far too long, Health Canada did not focus on airborne spread of COVID19. They stressed the “droplet” method of transmission, where fluid particles are expelled from your mouth, land on a surface and are then when you touch them, wind up on your fingers, and then into your body when you touch your eyes, nose or mouth. Full disclosure, if you search hard enough, you can find a video of me somewhere on the net saying exactly that, and telling people not to wear masks. It is clearly outdated now, and should be ignored.
Japan, by contrast, focused on airborne spread as far back as February of 2020. Their whole focus was to ensure proper ventilation and using air purifiers with HEPA (High Efficiency Particulate Air) filters in rooms. Everybody was asked to wear a mask early last year. Granted it is culturally more accepted to wear masks in Japan. But the focus was on airborne spread right from the start.
How well did Japan do? Japan has a population of 125 million people in a country about 3/4 the size of Baffin Island. As I write this, data from their COVID tracking system shows that 417,116 people have been infected (0.33% of the population) and 7,038 have died (.0056% of the population).
These numbers are all the more remarkable considering that Japan did just about everything else wrong. They did not test enough (at least at the beginning), the lockdown measures were half hearted and voluntary, many pachinko parlours (a mix of gambling and alcohol) stayed open, and traffic on their notoriously crowded commuter trains to work was only down 18%.
Health Canada did not even acknowledge airborne spread of COVID19 until November 2020 (9 months after Japan and 4 months after the World Health Organization). Our Covid19 tracker shows terrible results. We have a population of 38 million. Yet as I write this, we have had 826,528 cases (2.17 % of the population or 6.6 x as many as Japan on a pro-rated basis) and 21,309 deaths (.056% of the population or almost exactly 10 x as many deaths as Japan on a pro-rated basis).
It does make one wonder, if we had approached COVID19 as having airborne spread right from the start, could we have saved a number of lives, and limited the lockdowns we endured? And now that the evidence is strong that COVID19 is airborne, should we not have businesses focus on safe ventilation as a condition for opening?
What’s required for optimal ventilation? Well ideally, you should have an HVAC system that exchanges the air in a given room 6 times an hour with an HEPA filter. HEPA filters can remove the vast majority of droplets that the COVID19 virus (and other viruses!) live in. But the reality is that this would be ultra costly and take far too long to replace every HVAC in most commercial buildings. (Should definitely be a requirement for new commercial properties and especially the new nursing homes Ontario is building).
What can other businesses do instead? One of my patients is a manager at a Tim Hortons. They have 14 tables at the Tim’s. What if the restaurant put a portable air purifier with a HEPA filter on each table? There are many brands that cost $80-$100 each for a small size one. But with one on each table (where people would be talking and eating without masks, thus expelling the virus), you could reduce viral spread.
Granted at that price, the air purifiers would only last about six months, but by that time hopefully we will all be vaccinated anyway.
Similarly, we could mandate appropriate air purifiers in other businesses as requirement for opening. To be clear, people should still wear masks, wash hands regularly and physically distance as much as possible. Those are important and necessary precautions for re-opening. But the HEPA filter purifiers would simply provide that extra level of protection. It’s why I asked my nursing home to install them in their facility (and thank you to the owners of Bay Haven for doing that).
Canadians have suffered terribly over the past year. For the sake of our physical and mental health we need to re-open the economy, but do it in away that will not increase COVID19 infections, and not have us yo-yo between lockdowns and re-opening. Focusing on ventilation and HEPA filters can help us do this safely.
“Be hard on the problem, not on the people.” – unnamed OMA Executive
When I was President of the Ontario Medical Association (OMA), I had the privilege of touring the province. The tour was during flu shot season, so I took the opportunity to meet many Public Health physicians and staff. They are all good, hard working people who are dedicated to their communities and doing their best to advocate for the health care needs of the population.
Unfortunately, the Public Health system in Ontario (and Canada) is fragmented and disjointed. This really impeded the ability of Public Health to act in a unified manor prior to the pandemic. But because Public Health wasn’t as “visible” at the time, the flaws in the system remained hidden.
To understand just how this fragmentation affected our health, one only looks at the situation around trans fats. I wrote about this previously, but in short:
– We’ve known since 1993 that trans fats are linked to increased heart disease
– We’ve known since 1995 that Canadians are one of the highest consumers of trans fats in the world
– The results were so good that many other European countries followed suit.
If we apply the Denmark results to Canada, we could prevent 600 heart attacks a year. Banning trans fats would seem to be a no-brainer, and clearly the type of thing Public Health should effectively advocate for.
But here in Ontario, outside of the City of Toronto trying to ban trans fats in restaurants in 2007 not much has been done about this. Part of this is because Ontario has 35 different Public Health units, who all function independently. They may not even have the same software when collecting data, and some still use paper charts. Because they all function independently, just because Toronto Public Health wants a ban, doesn’t mean all the other units would even know about it, much less share information on it, or advocate for it. And of course, every Province and Territory has their own autonomous Public Health System.
It wasn’t even until 2017 that Health Canada got around to proposing a ban on trans fats, and 4 years later this still hasn’t happened. It’s worthwhile noting that over 10,000 heart attacks could have been prevented if we had acted at the same time as Denmark.
If in “normal”, non-pandemic times, the Public Health system was so fragmented, and disjointed, that something this straightforward couldn’t be accomplished, how would they perform in a once in century pandemic?
The answer, sadly, is not very well.
Just as the various Public Health Units couldn’t co-ordinate on the same message for Trans Fats, it appears the various units can’t co-ordinate on the same messaging around COVID. Case in point, on Nov 4, 2020, Health Canada finally (!) announced that yes, indeed, the coronavirus has airborne spread, and all facilities should take airborne precautions.
Yet a look at the website for my Public Health unit (Simcoe Muskoka) on Jan 10, 2021 (2.5 months later!) still shows the same guidelines that’s before the announcement. Namely, that the virus is spread through droplets and so cleaning surfaces is more important.
So here we have two different messages coming from public health authorities.
By comparison, take a look at Japan. Japan decided back in February 2020 that the virus was aerosolized. They too have many regional public health offices, however, the regional branches send the information to the national office, and the national office makes decisions. Those decisions are clearly communicated to the public, so the same message goes through the country.
They very quickly focused on things such as air purifiers with HEPA filters in rooms, improving ventilation by leaving windows open (even in the crowded community trains) mask wearing, and improved HVAC systems.
But it’s not just messaging that’s the problem. Public Health Units are hampered by their archaic systems from adequately preforming the test/trace/isolate process so important to controlling the spread of COVID19.
My practice is close to the border of the Simcoe Muskoka District Health and the Grey Bruce Health Unit. If one of my patients comes down with a reportable illness, I have to figure out which health unit to report to. But they use separate forms. Additionally because they use separate data systems, they can’t share information between the two.
Supposing one of my patients were test to positive for COVID-19. What if they live in Grey Bruce, but work in Simcoe Muskoka. Who should I report this to? And more importantly who is responsible for the contact tracing considering they work in one area and live in another? Especially since they can’t share data.
The result? Effective test/trace/isolate does not occur in Canada.
Compare this to South Korea. South Korea has multiple regional offices for public health, but they’re integrated by the Korean Ministry of Health and Welfare (KMHW). They share software, and so can share data and information.
By having all of Public Health integrated, South Korea was able to have one source for information. So not only did they have a consistent message (the KMHW gave two press conferences a day), but they were able to effectively test/trace/isolate.
Canada’s response to the COVID pandemic is among the worst in the world. Only the fact that we are next door to a country that has had arguably the worst response in the world seems to prevent Canadians from recognizing this fact. If there is one learning that me must take forward from this, it is that lack of an integrated, seamless and co-ordinated Public Health system has cost us many lives.
As a country, we need to support the people working in Public Health by improving the systems they have, so they can protect us in the future.
Note: This blog is based on the first part of a presentation I gave to the Public Health Youth Association of Canada (my thanks to them for asking me to speak). If you are suffering from insomnia, or if you are generally good person and want to support young people who are keen to improve the world, feel free to watch the presentation here:
Disclaimer: As always, the information I present here is meant to be an overall summary of what we know, and not specific medical advice for one person. If you have questions, please talk to your doctor.
As I write this blog, almost 52 million doses of the new COVID vaccines have been delivered to people around the world. Our knowledge about COVID (and the vaccines) continues to increase almost exponentially, and while we don’t know everything yet, here’s what we’ve learned so far.
Time to put the whole “Guinea Pig” argument to rest.
Many people have told me they don’t want to be a human “guinea pig” to test the vaccine on. The clinical trials on the vaccines (while quick) were thorough. More people have gotten their first dose of the vaccine than the entire population of Canada. If you get it now, you won’t be first. In fact you’ll be after this guy:
I’m Worried About a Sore Arm and Other Symptoms After
Sore arm, fever, and muscle aches are all symptoms people can get after any vaccine. However, what’s important to note is that these are not side effects. A vaccine works by stimulating your immune system. If you get a cold, your immune system activates to fight the virus, and as part of that, will often give you a fever, and muscle aches. You may feel crummy, but your immune system is doing its job.
If this happens to you after a vaccine, it may be miserable to experience but at least you can take it as a sign your immune system is working, and you are getting a response to the vaccine.
It’s off label but I ensured that all of the resident of Bay Haven Nursing home got 1,000 mg of Acetaminophen three times a day the day before, the day of and the day after the vaccine. We have had no reports of flu like illnesses after the vaccine. I intend to take this myself before my second shot, and you may want to consider this as well.
I Am Pregnant or Trying to Get Pregnant
There were women of child bearing age in both the Moderna and Pfizer studies (although no pregnant women). The vaccine did not appear to cause issues. We routinely give other vaccines (like the flu shot) to pregnant women and it is felt to be safe.
But I Still Have to Wear a Mask/Get Swabbed/Get Screened!
Alas, yes you do. I share the frustration on this one. Health Canada only approves what it knows. The evidence from the studies on the vaccines was very strong that they would reduce your chance of getting COVID. However, to study whether the vaccine will reduce the risk of transmission is much more complicated. It requires a high level contact tracing which we don’t have in Canada.
However, every other successful vaccine in the past has reduced the ability to transmit whatever disease we were protecting against. That’s why we no longer have small pox, and until the rise of the renowned neurobiologist/brain surgeon Jenny McCarthy, had almost eliminated measles. I’m hoping that Health Canada will lift the requirement to wear masks for people vaccinated in the near future.
This should at least show you how much confidence they have in the Covid vaccines. I mean if an organization that historically takes it’s time to approve things moved so quickly when they saw the evidence for the Covid vaccines.
Are You Sure These Vaccines Were Tested Properly? They Were Approved Awfully Fast.
There was good reason to be approved quickly. As I mentioned in a previous blog, there was a significant reduction in bureaucracy. Everybody (drug companies/regulatory bodies/politicians) agreed we needed a vaccine as soon as possible, so the five years (!) of red tape was cut.
The second thing to keep in mind is that to test a vaccine, you have to expose people who had the vaccine to the illness. For a condition like shingles, you often times have to wait for years to see if the virus is effective, because as painful and awful as it is, Shingles is still relatively rare. It takes a LOT of time to accumulate the data needed to see if enough people benefited.
For COVID, one perverse benefit of the fact that the United States has one of, if not the worst responses to the pandemic in the world is that the virus is, well everywhere. That means the over 70,000 people in the studies could be exposed to the virus very quickly, and we could see very quickly if the vaccine worked.
Moreover, it’s a myth that all the drug companies who developed a vaccine were approved. There are 14 vaccines for COVID that were being developed. But if flawed, the trials were halted (like CSL in Australia or Sanofi-Glen‘s vaccine).
The Vaccine Is Genetic and Will Affect My DNA
Simply not true. The mRNA used in the vaccine will not affect your DNA. DNA is the stuff that makes you, well you. I can’t explain it any better than Dr. Abdurrahman:
I Don’t Trust Big Pharma/Bill Gates is Injecting Nanochips Into My Body/It’s an Illuminati Conspiracy
………. I got nothing. If you really believe this there’s nothing I can do to convince you otherwise.
Should I Get The Vaccine (Whichever one) When It’s My Turn?
YES! The lockdowns and economic harm caused by this pandemic are having a terrible toll on us. The social isolation, job loss, economic harm, mental illness and much, much more is devastating society.
If we want to visit our friends, if we want to go to a restaurant, if we want to go to Church/Mosque/Synagogue/Temple, if we want to travel, if we want to……..simply live a normal life again, we need to get everyone possible immunized. Without this, the pain we all suffer from this pandemic will continue.
The following blog was co-written by Dr. Samantha Hill (current OMA President) and Dr. Adam Kassam (OMA President-Elect). It first appeared in the online version of the Toronto Star on January 11, 2021 and is reproduced here with the permission of the authours.
Images of elated physicians and other health care workers being immunized has been an emotional experience for our community. Our professional stoicism has given way to more fundamental and broadly shared human feelings: joy and optimism.
For close to a year now, we have had to work at the very tip of the spear against the pandemic. This dangerous, exhausting and unpredictable work has taken its toll. That is why the vaccine represents a literal infusion of hope for us, our patients, families and communities.
We are thoroughly delighted for every colleague, long-term care resident and vulnerable person who is now a little bit safer. However, collectively, we are still a long way from defeating this disease. As we encounter record highs of cases, hospitalizations and — sadly — deaths, only a fraction of Ontario’s physicians have received a first dose of the vaccine.
For understandable logistical reasons — which include the need for special cold storage — most of the first vaccines were administered in tertiary hospital centres, which have admirably risen to the immense challenge of organizing the safe and efficient deployment of the vaccines.
Getting everyone vaccinated successfully relies on two key factors: the federal government’s continuous and predictable procurement and delivery of the vaccines to Ontario, and the provincial government’s ability to distribute and administer the vaccine to Ontarians.
To that end, as approvals for other vaccines occur nationally and vaccine supplies ramp up across the country, we will need to move beyond hospitals to build capacity to be provincially successful in rapidly immunizing our population. These centres are already stretched thin, simultaneously treating a growing number of sick COVID-19 patients and the usual hospital health care needs of Ontario.
Which is precisely why, the next leg in this crucial vaccine race requires a co-ordinated community effort to vaccinate front-line health-care workers and the vulnerable patients both within and outside of congregate care settings.
Approximately 60 per cent of physician services occur outside of the hospitals. Many of these community doctors — both primary care and specialists — have direct knowledge of their vulnerable patients. They have developed relationships, credibility and bonds of trust through their continuity of care, all of which are crucial for success of any province-wide vaccination program. Grassroots, community doctors will also be essential to co-ordinating the necessary two-dose schedule.
Community doctors must have clarity on access to vaccines, not only for their own well being, but also for planning purposes for their patients. They have been caring for their communities for years, and these doctors are an invaluable resource with experience, expertise and capacity that must be leveraged. Even now, in this next stage, Ontarians deserve a trusted medical professional — many of whom come from, live and work in diverse communities — upon whom to rely.
This pandemic has challenged every facet of our society. In Ontario, thousands of people have contracted and died from this terrible disease. Our already-precarious health care system has been buckling under this added pressure. Disruption to businesses, communities and families has been widespread.
We all desperately want this devastation to stop. Our path out of this is with these vaccines. Doctors are, unfailingly, at our posts and prepared to help. While this pandemic has been a marathon, we need to now think of the vaccine rollout as a sprint. Because in this race, lives and livelihoods are at stake.
The following blog was written by Dr. Samantha Hill, a Cardiovascular Surgeon, owner of a Masters in Biostatistics and Epidemiology AND another Masters in Health Practioner Teacher Education. In her spare time she is the current President of the Ontario Medical Association, which represents 44,000 physicians, medical students and residents.
It’s time for some serious advice from your doctors to ensure that everyone has the safest and happiest holiday season.
The recently announced lockdown is effective Boxing Day, but Ontarians do not have to wait. All of us can, and should, take action now, including cancelling plans to visit family and friends on Christmas.
COVID-19 is serious. The numbers of Ontarians confirmed positive for COVID, hospitalized, admitted to the ICU, and ventilated continue to rise dramatically. Hospitals are again reducing non-emergent care and preparing for surge capacity. LTCs are overwhelmed and calling out for help, as their patients, our elderly, suffer.
Clearly, we need to do better.
This spring, we demonstrated severe lockdowns save lives from COVID. But, we failed our most vulnerable, saw high health costs (late presentations of other illnesses, marked increase in mental health challenges, and a staggering pandemic deficit of health) and severe economic consequences.
In September, we moved indoors again. Despite most people following public health guidelines, labs and contact tracers are again overwhelmed. Lockdowns are present and imminent.
Let me be clear, that means we are failing.
Lockdowns are a last resort, imposed when we fail to live safely within tenuous new normals and escalating precautions are not enough to protect us. There is no space for blame. We are all in this together, and we all have a role to play.
I find myself needing to remind you, that during lockdowns, essential workers still go to work: your doctors, all front-line health-care providers, teachers, but also “invisible” essential workers who stock grocery store aisles, work the cash register, service the TTC, support LTCs and hospitals, etc. Many ride the TTC to do so.
Doctors know that being deemed essential does not equate with being safe from COVID-19. A grocery store is no safer than a clothing store. Lunch in the work breakroom is no safer than lunch with others anywhere else. An hour on public transit is no safer than a one-hour flight. Over the past nine months, we have seen outbreaks, illness and deaths stemming from essential services. These services stay open because we need them.
Essential workers are exposed to increased risks for the well-being of others. We decided we can’t live without them. So we have an obligation to protect them, not just bang pots. Their lives, literally, depend on our choices.
So how do we keep people safe? You already know: Mask up, wash your hands, maintain social distancing. Always choose the safer activity, skip the social event or stay home. When we get it right, we decrease the spread of COVID in our communities, avoid lockdowns, protect our most vulnerable, our essential workers and everyone else, without sacrificing everything else.
A COVID vaccine is on the way for all of us – we can finally see the light at the end of the tunnel. But we are still squarely in the tunnel, and will be until the majority of Ontarians have been vaccinated (and the timeline for this is the end of 2021). Worse though, one-third of Ontarians are planning to ignore the public health recommendations to not socialize over the holidays. Worst-case modelling projections predict nearly 10,000 cases daily by January. Our choices today determine that.
So, this doctor’s advice?
Assess the risk and benefit of each action, job, trip or interaction, particularly during the holidays. Is it worth the risk not just to you, but to all of Ontario? For those scanning: ALMOST EVERYONE SHOULD STAY HOME FOR THE HOLIDAYS.
When worth the risk,
wear your mask and distance yourself from those who will not
wash or sanitize your hands frequently
stay two metres apart
minimize the time you spend in close quarters with others, the number of people involved, how often you interact with others.
Don’t grow complacent. Small actions matter: start a line when a store is full; redirect friends to gather outdoors or skip eating; keep your kid with a runny nose home; no one can tell if it’s just a cold.
Keep getting tested for COVID-19. We need to know where it is to eradicate it.
2020 has been a long, dark, year but the vaccines are arriving, bringing renewed hope. Let’s all do our part and ensure that as many of us as possible make it into the daylight 2021 promises.