Tag: #LTC

Letter to the Staff of My Nursing Home

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.


If you want additional material, there is a nice thread from one of Ontario’s leading infectious disease specialists here:
https://threader.app/thread/1338610832884854784


There’s also a great interview with one of Ontario’s leading allergists/immunologists here:
https://twitter.com/jkwan_md/status/1339344606555746305


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!


Dr. M. S. Gandhi

Medical Director, Bay Haven

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COVID19 and Nursing Homes

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.

There’s been evidence that Vitamin D can help fight viral infections for some years now. Recently however, a large clinical trial showed that people with low vitamin D levels were more likely to get COVID19.  It’s a very large trial, and the first one I am aware of where the benefits vitamin D were proven for one specific virus.

What can you do?

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.

Your sincerely, 

Dr. M. S. Gandhi, MD, CCFP

Medical Director,

Bay Haven Seniors