COVID-19. We’re still in the tunnel!

Posted on May 4, 2021 by johnageddes

The COVID-19 news, both globally and in Ontario, has been discouraging in the past few weeks. In Kingston, we have done remarkably well throughout the pandemic but new cases are currently occurring at greater daily counts than our usual and today we have the highest active case count that we have had since all this began. A recent B117 outbreak involving a local construction site where there were “workers from multiple jurisdictions” will probably impact our community for some time as it can spread to close contact family members.

Is there any light at the end of this seemingly endless tunnel?

Unfortunately, Canadians were a bit smug about our case numbers when comparing them to other parts of the world, including the U.S.A. and U.K. We became complacent about continuing the recommended Public Health measures that have been advised since the beginning of the pandemic. We were tired of the restrictions and our Health Care System was managing, so we let down our guard. Although we ought to have heeded the February warnings about variants on the horizon that had caused high caseloads in the UK, Brazil and South Africa, we ignored those foreboding predictions and continued to be open for business with minimal personal or business restrictions. We responded too late and too little. Can we find any hope in looking at how other countries have emerged from this dilemma that is pushing our provincial health care systems to the breaking point?

Bear with me as I throw a few graphs your way. My story ends with a possible positive outcome if that will encourage you to read on. Not surprisingly, it appears that successful reduction in COVID-19 case numbers relates directly to vaccination rates and countries following disciplined public health restrictions.

Not long ago the UK was in bad shape with COVID-19. The new B117 variant that is plaguing us now had gained hold there and was causing surging in caseloads that peaked in January They locked down and vaccinated extensively, mainly using the Astra Zeneca vaccine. What happened? Their number of new cases has been dropping continuously. Today they report that over 50% of their population has had at least one dose of vaccine. Persistence with lockdown restrictions and a good uptake of vaccinations seems to have helped to turn the COVID corner for the UK. They now have a graduated schedule of return to “normal” that will slowly open things up, stretching until late June.

Is this just a fluke? We can also look at Israel’s experience where the combination of lockdown and vaccination (mostly Pfizer) also had a significant effect. In January, Israel was also experiencing a serious second wave of COVID-19. However, they got an early start with aggressive vaccination while imposing significant restrictions including mandatory mask-wearing outdoors, school closures and restricted travel into the country . Now their numbers are very low and they are starting to open up and have reduced restrictions. Last week Israel reported their first day in 10 months without a COVID-related death in the country. They are being cautious as they slowly reopen but it appears that things are getting back to “Normal”.

India, with a huge population, had a false sense of security when numbers started to abate early in 2021 and led to them quickly reopening the country to things like large social and religious gatherings and sporting events. Even though they produce vaccine, some of which has been sold to Canada, their own programme has been slow to develop. They are now faced with a new variant and in the past few days their numbers have been astronomical and the death toll is staggering. The current surge in cases and deaths is having an absolutely devastating effect in India that will be felt around the world. The COVID virus knows no boundaries and as millions become infected quickly there is even more potential for new mutations to occur that could cause international concern.

Here in Canada we have been dependant on vaccine supplies from abroad that were slow to arrive and the process was complicated by international bartering. In the past month, things have ramped up well and we are projected to receive increased supplies over the next few weeks. In Ontario we are now vaccinating at a per-population rate that is second only to the U.S. That will certainly help us to achieve a lower rate of infection if we can continue to disperse vaccines at this pace and a significant proportion of our population accesses them. The Globe and Mail reported today that if our vaccine supplies arrive as scheduled, all eligible Canadians could be fully vaccinated by the end of July!

What can we learn from what we have seen in other countries? It appears that keeping the long-requested restrictions on mingling, shopping, meeting indoors, and traveling combined with aggressive roll-out of vaccination is the key to gaining some control over the virus. In the past week our COVID new case numbers in Canada seem to be plateauing but it is discouraging that they do not seem to be dropping very quickly. In Kingston where over 40% of our population have received one dose of vaccine and have been under a “stay at home” order for the past two weeks, new case numbers are not falling significantly (yet). Our Canadian provincial governments, faced with Health Care systems that are at capacity, have needed to impose increased restrictions. We all have been quite aware what we need to do but many of us are just not following the requested behaviours. We will soon have four vaccines available with age limits dropping almost daily. Vaccine supplies will be coming at a much better rate in May and June. If Canadians accept whatever vaccine they can get soonest there will be more of us who are protected and the virus will have fewer hosts to infect. We are doing pretty well, in fact, with almost 40% of our population having received at least one dose of vaccine. According to the graph below, this puts us about two months behind the UK and three months behind Israel in this regard. So, if we keep the restrictions in place for a while longer, comply with the requests of our Public Health officials and reopen gradually, and if vaccine supplies continue as predicted and are administered as quickly as possible to a willing population we should be able to see great improvement over the next few weeks.

Does it matter which vaccine you get? In the long run, not really. The numbers are sometimes confusing and variable but the bottom line is that they are all effective at significantly reducing infection and all are very effective at preventing severe illness if you do become infected after two doses. Although there is some benefit two weeks after the first dose, this is variable and may not protect quite as well against the Variants of Concern. After one dose only, we are advised to still protect ourselves and others as though we have not had the vaccine yet. The delay of the second dose to complete the vaccination protocol will help our communities to achieve at least partial protection in that vaccines can be distributed to more people as first doses and offering at least partial protection to more people and bring down case numbers. To me, this makes sense. The booster dose, although delayed, will add to that effectiveness.

Significant side effects caused by COVID vaccination are rare. Any medical treatment has the potential for significant adverse effects. Physicians are always weighing the Risk/Benefit ration when we prescribe anything or do any medical procedure. Even low-dose aspirin can, in a small number of patients, cause serious gastrointestinal bleeding. Unfortunately, bad news gains attention so we all learn first about the unlikely exceptions, rather than the rules. The potential for a rare blood clotting disorder (not at all similar to usual blood clotting problems like deep vein thrombosis or pulmonary embolus, by the way) may be real but is extremely rare. The chances of serious consequences of a COVID-19 infection are much greater.

People who choose not to be vaccinated can make that choice but, in doing so, they may be giving up certain opportunities for travel or certain other activities or gatherings that will require a “vaccine passport”. I think that is fair.

Can we look forward, then, to achieving the kind of curve that has happened in Israel and the UK? How will can we achieve that?

We stick to the restrictions requested by our public health leaders and be glad if our politicians are careful about slowly reopening.

We limit close indoor contact to a people within our household bubble.

We avoid spending time indoors at restaurants, gyms, churches or theatres until the virus is much better controlled. We now know that airborne transmission is part of how this virus spreads so any indoor gatherings without a mask for any period of time puts us at risk for infection, no matter if we are 2 metres away or not so we avoid spending indoors with a group of people.

We avoid travel outside our district or having visitors from outside because this increases the risk of introducing new variants to our community. The MOH at the Kingston, Frontenac, Lennox and Addington Health Unit has repeatedly expressed that most of the surges in virus activity in our district have been initiated by travel in or out of our community.

We continue to wear a mask in stores and many other indoor settings and even outdoors if there are a number of people around and you can not adequately distance. This may be a requirement for some time to come.

We take whatever vaccination we can get soonest. The more of us who are vaccinated, the fewer will be vulnerable to infection and spread it to others. It may be that a third or annual booster is required to keep us safe from new variants (much like annual Influenza shots).

We stay off work and isolate from others as much as possible when we are ill. Our provincial governments must not be too eager to drop the restrictions but follow a slow and graded reopening process.

What might slow down progress? New variants that are more easily spread and/or more virulent may arise spontaneously. Hopefully the vaccines we have and any modifications that ensue will be able to continue to be effective at combating them. We also need a substantial acceptance of complete vaccination to achieve herd immunity. When it comes time to open up again it would be best to do it very gradually. Reopening too quickly was a factor in making this third wave more serious. We also need global cooperation and assist lower income countries because as long as the virus is not contained, spread internationally will occur.

And finally, the Globe and Mail estimates that by the end of July, the country should receive enough doses for all eligible people to be fully vaccinated. When we complete our vaccination we can joyously dance the bhangra like Gurdeep!

COVID-19. We have a choice.

Posted on November 25, 2020 by johnageddes

COVID-19 numbers are escalating in Canada and around the world. This is no surprise. We have been warned for weeks that a “second wave” was likely to happen in the fall. We have also been repeatedly told how to minimize the extent of this surge so as to keep ourselves and our communities safe.

The dip in case numbers over the summer months gave us a false sense of security and allowed us to let down our guard. It was safer in the summer months to interact outdoors, socialize on patios and in parks and even visit family and friends or go to a movie or the gym. We were lured into thinking that things were getting back to something close to “normal”. But the virus was sleeping, not gone.

The weather has cooled. We are drawn indoors. Schools are open. Post secondary students are back. Restaurants are open for indoor dining. Our social bubbles grew over the summer and we are resisting and reluctant to scale back again even though our politicians and public health officials are advising – begging – us to do so.

Projections released this week indicate that, without changing our present behaviour, we could have 20,000 new cases a day in Canada by late December. Our current daily new case rate is about 5500 a day. We’ve been warned that If we neglect to follow the recommended paths it may be much worse by the end of December. These forecasts are startling. And unacceptable.

Why is this getting out of control? It’s human nature to look for someone or something to blame for this. Well, we can only blame ourselves. We have been told repeatedly how we must restrict our activities and social interactions, wash our hands and wear a mask when less than 2 meters from anyone but our very closest family unit.

Anyone who is not aware of the recommendations must have been living on a deserted island for the last few months. As a reminder, here they are again.

Wear a mask when not able to socially distance (2 metres) in the company of people who are not in our restricted close contact bubble (i.e. household contacts). This can apply outdoors as well as indoors. Don’t mingle face to face with folks who are not in your immediate circle.

Minimize indoor contacts as much as possible. Be aware of breaks in your comfort zone in this respect in restaurants, stores, theatres and gyms. Close contact indoors without appropriate protection (face coverings, distance, barriers) is our biggest risk.

Wash our hands frequently. This minimizes the unlikely chance that you will transfer the virus from to your face if you have touched something that has been contaminated by someone else’s sneeze or cough. Spread in this way is much less likely than droplet spread from an infected patient but is not impossible.

Don’t travel outside our community. Stay put. This will stop spread from one community to another. Dr Kieran Moore, in a recent press conference is quoted as saying the following. “Any of the major outbreaks in our area have been secondary to travel to the GTA or the other high-risk municipalities. The risk correlates to going into high-risk areas and the number of close contacts.” Stay home. Don’t have friends or relatives from out of town come to visit. This is the best way to limit inter-community spread.

Postpone indoor gatherings with family and friends this Christmas season. Look forward to a huge celebration for many reasons on July 1, instead.

Set strict limits on the number of people that you interact with face to face. This is difficult but essential.

Unfortunately, many of us seem unable or unwilling to follow these recommendations. The result is that case numbers go up, the demand on our health system increases and vulnerable people are put at risk. This ends up with the government having to impose a lockdown as has happened in Toronto and Peel districts this week. In my opinion this is something that might have been avoided if collectively we had followed the rules. But enough people do not respect those guidelines and the result is that the restrictions have to be enforced. We have a choice. We can follow the advice that our politicians and public health officials have been giving us for the past several months or we can circumvent their recommendations and end up in lockdown.

In Kingston, we have continued to be very lucky to have avoided the burgeoning numbers seen in some other cities in Ontario. Our lower caseload in the KFLA district has allowed our Public Health workers to trace and isolate potential close contacts, thereby limiting spread in the community. In some other Canadian jurisdictions, this has become unmanageable and the virus is spreading quickly. We have seen, and will see, waves of COVID-19 activity that have the potential to swing out of control if we don’t buckle down. There have been cases where the source is not clear and if this cohort increases it will mean that our risks of randomly being infected will increase if we are not extra cautious.

Recent vaccine news has been encouraging and eventually vaccination will bail us out of this situation if enough people elect to take it. Although a number of vaccines may get approved soon, it will take several months to distribute them and have them be effective. My guess is that the current wave of infection will abate somewhat but there may be a third surge in late winter. We will be needed to be extremely cautious until about May when vaccination has been introduced and the better outdoor weather is upon us once again. Please ask yourself if there is some way that you can tighten up a bit more for the sake of the your own well-being as well as that of your community. And then do it.

The next few months will be a challenge. Without widespread cooperation and discipline as we await more widespread suppression of the virus we will only prolong the pandemic and cause repercussions that will affect us either in terms of our community health or economic damage that is more severe than voluntarily complying with recommended interim personal restrictions.

If you have made it this far, here’s a bonus reward for your perseverance. This is an interesting YouTube video that talks about how the world coped with a similar pandemic 100 years ago. I found it encouraging to know that despite all the global disruption COVID-19 is causing now, there is hope to get back to a some sense of normal. Here’s to a Roaring 20’s decade!

COVID-19 update. Numbers, Numbers, Numbers.

Posted on July 29, 2020 by johnageddes

I will start with some good news. For the first time since late March, Ontario registered less than 100 new cases (76 to be exact) in the past 24 hours. Most of these cases were concentrated in a few districts that have had a particular struggle with the virus but even those regions are showing improvement. Hospitalizations and COVID-19 deaths are also down across the province. We shouldn’t get too smug about this, however, as the figures do vary from day to day and can change with very little provocation. The trend, this week, is in the right direction.

Across Canada there are varied results. Canadian numbers were generally trending downward until about 10 days ago when a definite uptick occurred. At the end of June, Canada’s new daily case rate was averaging around 300 per day but it has been creeping up with recent averages being near 450. Alberta and British Columbia, provinces that had been experiencing very low rates and were held as examples, have led the numbers of new cases. Similarly in countries that had been deemed examples of low infection rates (eg. Australia, Israel, Hong Kong) there have been significant regional outbreaks and increases in both infection rates and deaths resulting in renewed lock-downs.

Canada’s death rates attributed to COVID-19 have remained low despite the increase in new cases. This likely has several explanations. The vast majority of early deaths due to COVID-19 were in elderly people with predisposing factors and associated with long term care facilities. Many of the very vulnerable have succumbed. We are being more attentive and cautious with this population in order to lower their risks. Treatment options for those who are severely ill has also refined and become more effective as we learn more about the virus and what treatments are likely to bring better outcomes.

Another somewhat worrisome factor is that in new cases the demographics have shifted to involve many more people in the under 40 age group. Although these folks would be less likely to be severely ill or die, it has been suggested that some of those who have been infected may have undetermined long-term health consequences . Minimally symptomatic young folks might also serve as a reservoir for the virus in the community and be a source of spread to people who are more vulnerable.

In the last month there have been ten new cases diagnosed in our KFLA Health unit. Eight of those cases are reportedly people in their 20’s or younger. Some are known contacts of other cases or associated with our previous nail salon outbreak but five are also listed as having travelled outside our region as where they acquired the virus. It is probable that travel was not the only risk since people in this age group are tending not to be so cautious with social distancing or wearing masks. I often see collections of young adults on the street, not wearing masks and not keeping the proscribed six-foot distance from each other. Dr Kieran Moore, the KFLA Medical Officer of Health, continues to provide updates to the community. His most recent can be found here or at the end of this post.

Currently we have only 3 active cases, all in isolation, in Kingston. This means our risk at the moment of acquiring infection in the community is low. But it is not zero. I worry that we will get complacent and lower our guard.

I wonder what will happen at the end of the month when college and university students from outside our area return to Kingston. Queen’s may be very diligent about contact on campus but many of these students will be living in houses together and I can imagine that house parties, known to be one of the main ways of transmission in North America in this young adult group, will happen. How can this be managed to avoid breaking our (so-far) very successful Kingston bubble?

Bars will also be open and as cooler weather follows, so will the tendency to move indoors from the well-ventilated patios we are now enjoying. Add other respiratory viruses to the mix and we may be in for a difficult fall and winter season. Will elementary and secondary schools also be open and will it be practical or successful to be able to maintain distancing and lower risk of transmission in these indoor clusters? What happens when the border with the U.S.A. opens up? We will be entering a tricky new phase with more services open and activities moving indoors as fall approaches.

We are going to have to continue to be diligent, or even more diligent than we are being now, when the cooler weather comes. We must limit the number of people in any indoor space so we can keep physically distanced. We will need to become accustomed to wearing a mask when gathering indoors, on public transport and even in some situations outside. It really is not that difficult. Like wearing a seat-belt in the car or a helmet on a bicycle, face masks will become second nature. Even if face coverings only make a small difference to transmission, that effect might end up being a significant help to protect our community.

It is encouraging to know that there are around 150 vaccines being developed around the world and five of them are either in 3rd stage trials or about to start. This is the final step before approval but it will take a few months to reach the next stage. Even when vaccines are approved (probably by the end of the year) it will take some time to have them produced, distributed and administered so it will be well into 2021 before we will be seeing an effect from vaccine-induced immunity. But it will come.

Until that time, we are stuck with doing our best to curtail spread within our community. We will have peaks and troughs of COVID-19 outbreaks happening sporadically in different geographical pockets. In some cases this may lead to renewed local shut-downs and travel restrictions. We have no choice. We must come to the realization that we need to keep disciplined and follow Public Health recommendations if we are to mitigate the effects this COVID-19 pandemic on our Health Care System, our economy and our families. It will end. But not before a few more months of responsible community effort.