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.
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.
Note: The following is a letter I sent to all the staff of Bay Haven Seniors, a joint Retirement and Nursing Home. There has been rather a lot of variable information about the new Covid vaccines out there, and I wanted to address that up front. Some of this information may help you as well, so I’m copying it here.
To: All Staff at Bay HavenFrom: Dr. M. S. Gandhi, Medical Director Re: New Vaccines for COVID19
As I think all of you are now aware, Bay Haven has been fortunate to have our staff given the opportunity to immunize early with the new vaccines for COVID19. There has been much written about the vaccines in print and on Social Media (unfortunately!!) . I wanted to let you know about some information on the development of the vaccine, and why I do strongly encourage people to get the vaccine.
In “normal” times (remember those?), when a drug company thinks about whether it’s a good idea to develop a vaccine for a certain disease, there is a bit of convoluted process that has to happen first. Some officious bureaucrat at the drug company does a cost analysis on how much it will cost to make the vaccine and how much profit could be made from it. Then it goes to a regulatory body in the host country where some other pointy headed bureaucrat looks at how widespread the disease is and whether it’s worth while to approve a trial. Then it goes back to the company where some lawyer reviews the cost/benefit ratio, whence it goes back to the officious bureaucrat and then back to the pointy headed one. Amazingly enough (and I’m not kidding here) this process can take 2,3, even 5 years before a trial even begins.
This time, every body agreed right off the bat that it was good idea to have a vaccine for COVID19, and so the up to five years of paperwork was eliminated. Seriously, that bureaucratic bafflegab can take that long.
The next step after the paper work is done is for a vaccine to undergo three phases of trials. It’s important to know that both the Pfizer and Moderna vaccines DID undergo all three phases of trials. Given the catastrophic situation around COVID, the trials were done quickly, but they were fully completed. The Pfizer trials had about 42,000 people (by the way about 35% were people of colour ). The Moderna vaccine had over 30,000 people (also with 35% people of colour). The trials were extremely successful (94-95% effectiveness).
The main side effects are the same as you would get from just about every other vaccine (pain at the injection site, fatigue, muscle pain, joint pain, fever). These side effects are rare and and if they occur, go away in a couple of days.
There has also been a lot of talk about the fact that these are the first vaccines to be developed using “mRNA” technology. I appreciate that when people talk about genetics, it can cause many people to have second thoughts. But, mRNA technology has been studied for something like 30 years now in the oncology field. Additionally, mRNA cannot and will not affect your genes. It’s your genes that make mRNA in your body. Your mRNA can’t go backwards and affect your genes.
In short mRNA vaccines are an efficient, safe process. They actually herald a new era of vaccine development that promises rapid and effective prevention for new pandemics in the future. This is a good thing.
I also want to address some concerns about side effects circulating on social media. The first is with respect to Bell’s Palsy. There were four people in the Pfizer trials who developed Bell’s Palsy (now recovered) after getting a dose of the vaccine. This translates to a side effect rate of .01%. However, the “background rate” for Bell’s Palsy is .03%. Put another way, if we were to simply pick 40,000 people at random, and watch them for a year, we would expect 12 people to get Bell’s Palsy. This is why health professionals don’t feel that Bell’s Palsy is related to the vaccines.
Second, there is some talk about anaphylactic reactions (which can happen with any vaccines). With the Pfizer vaccine the concern is polyethylene glycol. Moderna has this in their vaccine too, but it seems in a different manner. There may be some concern about this for patients who have severe allergies (to the point that you carry an epi-pen). The best recommendation I could give is that if, and only if, you allergies are so bad that you need an epi-pen, it would be reasonable to wait for the Moderna vaccine (which just got approved today). We expect this vaccine to be available for distribution in February. If you do not need an epi-pen, then you should get the Pfizer one as it is out already.
Finally, I would like to thank all of you for all the hard work you have done this year. 2020 is a year that we will never forget, and I suspect a year that we are all anxious to give the boot too. Yet despite the hardship, the challenges and the seemingly unending (bad) surprises, you have continued to keep the residents safe, clean and comfortable. Providing this at the latter stages of peoples lives is the absolute minimum sign of respect we can show, and the staff have done that in spades this year.
Thank you again, and allow me to wish all of you a Merry Christmas and a Happy New Year!
The following letter was sent to local media outlets by the Medical Staff of the Collingwood General and Marine Hospital. It has been re-produced here with permission.
To All Residents of Georgian Bay:
A day that we had hoped would never come has sadly arrived. A concerning rate of COVID19 has been demonstrated in our community and has been reflected in recent hospital admissions, as high as almost 10 per cent of all patients in Collingwood Hospital this past weekend. The surge in patients hits us at a time when all of us would normally be planning Christmas dinners, trips with friends and family, and looking forward to well deserved vacation time.
As your physicians we have volunteered much of our time preparing for a day like this all the while hoping it wouldn’t come. We have helped to set up our Covid Assessment Centre. We have ensured that the hospital continues to have physician coverage and that Emergency care remains unchanged. We have helped set up drive through flu shot clinics. We have helped set up an Alternate Health Facility to offload the Collingwood Hospital. We have attended many extra meetings outside of our normal clinical time. We have kept local Family Physician offices and the After Hours Clinic open for both virtual and in-person visits. Our Hospital remains open for emergencies as well as routine, scheduled care.
But now we need your help.
If all of us don’t take necessary precautions to protect our community our hospital is in danger of being overwhelmed, and we may not humanly be able to take care of a large influx of patients.
So we ask all of you:
– Please shop locally but wear a mask in stores, and at all public places
-Please maintain physical distancing of two metres (or one moose length)
-Please stay in your own social bubble of 10 people
-Please ask your friends and family not to come visit you this year
-Please stay home and do not travel to other areas
What we ask of you is difficult. These asks come at a time of year when social events are the norm. A time of year when many of us attend celebrations and a time of year when we normally enjoy fellowship with others.
But historically, it is also a time of year when our sense of community and our love for our fellow citizens, has always shone through. This year, there is no better way of showing our commitment to our community by following the asks we have of you. In this way, you will show that you care enough about our community to keep it safe and healthy.
We promise to continue to do our part to provide the best possible care to you. We ask that you help us, help you and those you love.
President, Collingwood General and Marine Hospital Medical Staff
For those of you who don’t know, I am the Medical Director of Bay Haven Care Community, a combined retirement and nursing home. Below is a letter that I sent to the family members of all the residents of the nursing home, updating them with information about COVID19. Reproduced here so it can be shared if others wish to copy it.
Dear Family Members of Residents of Bay Haven,
As the Medical Director of Bay Haven, I wanted to write to all of you to update you on some important new information about COVID19.
As you are likely aware, Ontario is now firmly in the second wave of the seemingly never-ending COVID19 pandemic. As I write this, 99 out of 626 nursing homes in Ontario are in outbreak from COVID19. Thankfully, Bay Haven is not one of them. I hope and pray that it will stay that it will stay that way, and that the other nursing homes get out of outbreak as soon as possible.
Our knowledge of the COVID19 virus has increased significantly over the past few months. We still don’t know everything about it, nor do we have a cure, but we can be better prepared than we were in the past.
We now know that the virus is largely spread by what’s called “aerosolized” means. That’s to say that it is expelled by your mouth when you breath/talk/sing and floats in the air for a large period of time, thus spreading to others. This is why wearing a mask is so important. All of our staff and visitors have been required to wear masks for many months, in addition to all the other screening that we do.
With this knowledge, it is becoming more and more apparent for the need for high quality ventilation and air purifiers, particularly those with HEPA filters. While the physical plant at Bay Haven is quite old, I am extremely grateful that the management of Bay Haven invested in HEPA air purifiers for all the large common areas, even before Health Canada updated their website to indicate the risk of airborne spread. I applaud their commitment to keeping residents safe.
Additionally, there has been much speculation about the benefits of Magnesium, Zinc and Vitamin D in fighting viruses. To be candid, the evidence for Magnesium is not that great. Magnesium may kill viruses “in-vitro” – that’s to say, in a petri dish in a lab – but more study is needed to see how it works in a human body. But at least it’s not harmful.
There is actually decent evidence that Zinc can help fight off viral infections. Taking 25 mg of Zinc daily is not harmful and has benefits.
First, of course we ask that you abide by our visitor polices, that have been mandated by the Public Health Departments. These policies are sometimes frustrating to follow, but they have been implemented to keep our residents safe. We ask that you please help us keep your loved ones safe.
Second, if you wish to provide additional protection, you could purchase a small room HEPA air purifier for your loved one. These would stay next to the head of the bed in the room, and provide additional protection. Currently they range in price from about $60 to $90 from Amazon. There are other models as well, of course, but they should be HEPA certified to be effective. At that price, frankly these devices will only last 6-9 months before going bad, but hopefully by that time we will have a vaccine. (While a vaccine is expected shortly, there are many distribution problems with them, and I don’t expect them to be available for a few months).
Finally, if you would like your loved ones to start Magnesium, Zinc and Vitamin D, please let me know by replying to this email, and I will ensure these are ordered. To be clear, this is “off label”- it’s not specifically an approved therapy, but it is at least very safe, and not harmful at standard doses.
None of these measures of course, is guaranteed to prevent a COVID infection, or an outbreak, but right now, represents the best possible protection we can provide.
I hope and pray you all continue to stay safe and well.
An advantage of being old is that whatever is happening, you have likely seen it, or something like it before. Every so often, society undergoes an upheaval and people have to change behaviours. For those of us who were around in the 1980s, there are some stark parallels to what happened then, and what society must do now in 2020.
The early 1980s were a different time not only for how we lived as a society, but for how medicine was practiced. This was particularly true with how we handled body fluids. As surprising as it may be to some younger readers, there was no such thing as universal body fluid precautions back them. If you had a known blood born illness like hepatitis, then sure, extra precautions were taken. But not for every body. When I was in medical school, there were multiple stories of a particularly nasty vascular surgeon who would squirt blood on trainees during surgery if they got an answer wrong to his questions. Needle prick injuries were routinely ignored. There was not a robust sharps disposal system. In short, it was very different.
A huge shift in society, and medicine, came when reports of a novel virus (sound familiar?) became publicized. This virus was new, deadly, and little was know about it. At first, this strange new illness seemed to only affect gay men. This led to all sorts of additional discrimination against the gay community, and even more ostracization then they were already experiencing. Mainstream media outlets routinely referred to it as “The Gay Plague” which clearly didn’t help matters. This also led to whack job conspiracy theories about its origins, some of which persist to this day.
This strange new illness was, of course, eventually named “Acquired Immune Deficiency Syndrome” or AIDS and the virus that causes it was identified (Human Immunodeficiency Virus or HIV). It was recognized that body fluid transmission could spread it and that it was not limited by sexual orientation. We learned it was possible to carry the virus and not have symptoms and you could get it from anyone.
And so, the age of universal blood and body fluid precautions began, and policies around this were implemented in hospitals and other health facilities between 1985-1988.
But there was also a shift in how society responded. Until then, most public service announcements around Sexually Transmitted Disease (like this painfully dated one from 1969) focused simply on encouraging people to get treatment after the fact. And accepting that it was possible for you (yes, sweet innocent you) to get an STD.
AIDS changed all that. Suddenly, an STD could be deadly. Suddenly there was no cure or vaccine. Suddenly, just getting treatment wasn’t an option, and education around prevention was mandatory.
With education, the public took precautions. “No glove, no love” was a popular catchphrase used to promote latex condom use as these were proven to significantly reduce the risk of transmission of STDs (including HIV). Public service announcements shifted to openly talking about prevention.
In short, people and society adapted, and changed behaviours to deal with this new virus.
Today of course, we are faced with a novel new virus, that is clearly deadly and is widely publicized. Little was know about it at the start, and we continue to learn about it. The virus seems to have originated out of China, and this has led to all sorts of anti-Asian racism (including from the President of the United States). There are whack job conspiracy theories about it. As we learn more about the virus, we know asymptomatic spread is possible, and that, yet again, anyone can get it. There is no vaccine (and despite Dr. Fauci’s optimism I’m not holding my breath) and no effective cure.
In response, hospitals and other health facilities are implementing new polices around Personal Protective Equipment (PPE). Hospitals are taking extra precautions around elective surgery as the risk of mortality in patients who get COVID19 infections peri-operatively is ridiculously high. In my office I now see patients wearing a mask, eye protection, and surgical scrubs that I immediately remove after my day is done.
And now too, society will be asked to change in response to this most awful virus. The simplest thing to do of course, is to wear masks when you are in an indoor public place, or better yet whenever you leave the house. As mentioned in an earlier blog, one only has to look at Japan where there was poor social distancing, packed public transit and no closure of their famous karaoke bars, but people wore masks, and the number of infections was extremely low. Wearing them also is key to restarting the economy so we can get on with our lives.
The big difference between the AIDS epidemic of the 1980s and COVID19 now is, of course, the economic costs. The economy was never shut down then, and the kind of wholesale level of job loss we are experiencing now in (hopefully) once in a life time.
But if we are to get the economy running (and we must for a whole bunch of reasons, including the fact a good job improves overall health care), then society will need to adapt again. We did it forty years ago, and I believe we can do it again.
The past three months have seen us undergo a stress like we’ve never seen before in our lives. People have lost their jobs, been socially isolated, and, importantly, non COVID healthcare has been delayed significantly. It’s estimated that 12,200 hospital procedures are delayed each week in Ontario alone. (Back of napkin math suggests 125,000 procedures have been delayed since the start of the pandemic).
In Ontario, these sacrifices have had the desired effect. The number of patients with serious complications from COVID has been trending down. Because we are not able to test everyone, I look at the number of patients who are in hospital due to COVID, and especially those who are on a ventilator, as an indication of how widespread the disease is. Because Canadians did what was necessary to protect others, our hospitals have not been as overwhelmed as many had feared.
However, we are now facing another critical situation in healthcare. The complications that are arising in the people who had their healthcare delayed are reaching alarming proportions. Even at the best of times, our healthcare system was overburdened and overwhelmed. To add to all of that this additional backlog, and the fact that many of those patients have deteriorated and are sicker, and, well, you understand the dilemma we are facing.
I don’t have a degree in biostatistics, like current Ontario Medical Association (OMA) President Dr. Samantha Hill. I can’t crunch all the numbers and give you a statistically valid analysis of what we are facing. I can only speak to what I’m seeing in my own practice.
a patient with significant stomach pain who had scans delayed for a month, only to discover cancer
a patient who I diagnosed with melanoma, who still hasn’t gotten the required wide excision, and lymph node biopsy 8 weeks later
a patient who sent me an email clearly indicating the desire to commit suicide because of the mental health effects of this pandemic (I got a hold of them and appropriate measures have been taken)
a patient with a cough since January who still hasn’t seen a specialist
a sharp increase in patients requesting counselling or medications for the stress and depression directly caused by the effects of the pandemic
at least 5 patients who were already waiting for joint replacement surgery now delayed even more
Keep in mind that I am just one comprehensive care family in doctor in a province that has almost 10,000, and you get a sense of the scope of how much these delays are going to affect people.
This is why there is a real dilemma for those who make decisions about when and how to open up health care (and everything else). If we loosen restrictions, start opening the economy, and allow scenes such as what happened at Trinity Bellwood’s park, the number of patients with COVID will increase. But if we don’t, other people will die, or at least suffer life altering illnesses, from non-COVID related diseases.
So what can be done? The OMA has released a document on emerging from the lockdown, referred to as “The Five Pillars” paper. This is an excellent paper and it is worth reading. I would, however, add the following thoughts.
Second, we need to move procedures out of the hospitals where possible. Many procedures like colonoscopies, cataract surgeries, diagnostic imaging, minor surgeries and so on, can be done outside of hospitals. Ontario has an Independent Health Facilities Act which licences these premises and ensures that they follow a high level of standards. They tend to operate more efficiently than hospitals and can see more patients than hospitals (whole bunch of reasons why). Previous Ontario Health Minister, “Unilateral” Eric Hoskins stopped licensing them, and it’s a decision that desperately needs to be reversed.
Third, we need to get our health data collection done properly. In Ontario, the plan was to develop Ontario Health Teams (OHTs) throughout the province that would allow the different agencies that cared for a patient (hospital, home care, physicians etc) to co-ordinate care. As Drs. Tepper and Kaplan point out, “fighting this pandemic requires collaboration from every part of the system and the patient voice. That is the promise of OHT.” To do this properly requires seamless electronic integration of a patient’s health record, and this should also serve as the basis for collecting COVID data. A system like this could also aid with contact tracing if done properly.
For the sake of the health care of all Ontarians, we need to open up health care and the economy, and we need to do that sooner rather than later. With a little bit of vision and forward thinking, it’s possible to do this in a safe manner. Let’s hope that’s what we see in the next few weeks.