Patricia Flemming says she is feeling more motivated and less fearful of catching COVID-19 after getting her booster shots.
The 71-year-old is among the 87 residents at Chester Village to have received a fourth COVID-19 vaccine dose since Dec. 30 at the Toronto nursing home.
“The third one, I noticed a bit of fatigue,” said Flemming, who is a retired nurse from Nova Scotia.
“This one had a little more fatigue associated with it. But other than that, there [were] no real issues.”
Patricia Flemming is suffering from a motor neurone disease.
Photo courtesy: Chester Village
Chester Village was one of the first long-term care homes in Ontario to fully vaccinate almost all of its residents against the coronavirus last January. And now a year later, the not-for-profit facility is offering all eligible residents the Moderna vaccine as a fourth dose.
As the highly transmissible Omicron variant of COVID-19 surges across the country, Canada’s National Advisory Committee on Immunization (NACI) has recommended that moderately or severely immunocompromised Canadians may receive a second booster or fourth shot at least six months after their last dose.
“Many of these individuals are at a higher risk of severe outcomes of COVID-19 and also at increased risk of decreasing protection over time since vaccination,” NACI said in its updated guidance released on Dec. 3.
Besides long-term care homes, the Ontario government is making fourth doses available to residents of the province’s retirement homes, elder care lodges and other congregate settings.
1:17 COVID-19: WHO urges countries to make 2022 year of vaccine equity
COVID-19: WHO urges countries to make 2022 year of vaccine equity
Meanwhile, Manitoba is recommending a fourth dose for “moderately to severely immunocompromised individuals” at least six months after the last received dose.
According to NACI, the intent of a booster dose is to restore protection that may have decreased over time or is no longer sufficient in individuals who initially responded adequately to a complete primary vaccine series.
The World Health Organization (WHO) has repeatedly warned against “blanket booster programmes”, stressing greater equity globally in the distribution of and access to vaccines.
The agency says more people worldwide should be vaccinated with first doses before others receive boosters.
“Booster after booster in a small number of countries will not end a pandemic while billions remain completely unprotected,” said Tedros Adhanom Ghebreyesus, WHO’s director-general, during a news conference on Jan. 6.
But Canada, like several other countries, is pressing ahead with boosting its population amid a surge in infections thanks to the Omicron variant.
“It is, in my view, somewhat early to start thinking of a fourth dose when the third dose itself hasn’t been fully deployed in our population,” said Dr. Ciriaco Piccirillo, an immunologist and senior scientist at the Research Institute of McGill University Health Centre (MUHC).
As of Sunday, 9,810,166 people or roughly 25 per cent of the Canadian population had received a third COVID-19 vaccine dose, according to covid19tracker.ca.
Piccirillo believes a two-dose or triple-dose vaccine series should be “more than sufficient” for people who don’t have pre-existing conditions and who have normal immune systems.
However, subsequent boosters are “likely very important” for the elderly, immunocompromised individuals and cancer patients, he added.
Israel, which is now administering fourth doses of the Pfizer/BioNTech vaccine to people over 60, health workers and immunocompromised patients, has played a leading role in studying the effects of COVID-19 vaccines.
The country was the fastest to roll out two-dose inoculations to a wide population a year ago and one of the first to give third shots as boosters.
Citing preliminary findings of an Israeli study, Prime Minister Naftali Bennett said on Jan. 4, that a fourth dose of COVID-19 vaccine boosts antibodies five-fold a week after the shot is administered.
But in the U.K., the Joint Committee on Vaccination and Immunization has advised the government that there was no need to offer a fourth dose, or second booster, to vulnerable people at this time. It cited data that shows a third shot offers lasting protection against admission to the hospital three months after the dose.
1:52 Fourth doses recommended for immunocompromised Manitobans
Fourth doses recommended for immunocompromised Manitobans – Dec 29, 2021
The purpose of giving a booster is to raise the level of neutralizing antibodies from a vaccine, especially in immunosuppressed individuals, who have difficulty producing antibodies due to a weakened immune system, said Dr. Horacio Bach, an infectious diseases expert at the University of British Columbia.
However, more research is needed to see the impact of a fourth shot before it can be rolled out to the general population, he said.
Dr. Samir Sinha, director of geriatrics at Sinai Health and University Health Network hospitals in Toronto, said while a fourth shot may provide benefit in certain vulnerable populations who are at risk of waning immunity, it still remains to be seen if a mass rollout among the general population is needed going forward.
“This might become one of those illnesses that we need a booster on an annual basis, for example,” he said.
“But right now, we just don’t have that information on whether a fourth shot would truly be beneficial for younger, healthier populations.”
Are boosters targeting variants?
The current booster shots have exactly the same formula as the first two doses.
For now, each dose is targeting the same S protein of the original Wuhan strain of SARS-CoV-2, Piccirillo said. The S protein is the key that the virus uses to dock into cell receptors to enter human cells, causing infection.
Early findings about a single booster in the context of the Omicron variant are promising.
Citing data from the U.S. National Institute of Allergy and Infectious Diseases (NIAID), the United States’ top doctor, Anthony Fauci, has said that the current “booster vaccine regimens work against Omicron,” whether your dose is Pfizer or Moderna.
Research from the University of California indicates boosters can push protection against Omicron back up to roughly 48 per cent. As for preventing severe disease, boosters appear to push that efficacy back up to 91 per cent.
1:38 Booster hesitancy: Why some Quebecers are refusing Moderna
Booster hesitancy: Why some Quebecers are refusing Moderna
Meanwhile, both Pfizer and Moderna, are working to develop booster shots that can specifically target the Omicron variant.
This week, Moderna’s chief executive Stephane Bancel said that the efficacy of boosters against COVID-19 is likely to decline over the next few months and people may need another shot in the fall of 2022.
“I suspect that in … the upcoming months, we will be seeing commercially available booster shots that are variant specific,” Piccirillo said.
Sinha agrees. “There might be a future booster dose that’s tailored more to variants like Omicron or other future variants. But that takes time to develop.”
For now, James Patridge, 76, is looking forward to getting his fourth shot at Chester Village next week so he can move around more freely and “live longer.”
“It protects me from the virus,” he said, urging others to get vaccinated.
James Patridge got his third COVID-19 vaccine dose last year.
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.
Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.
Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.
LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.
The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.
Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.
This report by The Canadian Press was first published Oct. 15, 2024.
Rana Van Tuyl was about 12 weeks pregnant when she got devastating news at her ultrasound appointment in December 2020.
Her fetus’s heartbeat had stopped.
“We were both shattered,” says Van Tuyl, who lives in Nanaimo, B.C., with her partner. Her doctor said she could surgically or medically pass the pregnancy and she chose the medical option, a combination of two drugs taken at home.
“That was the last I heard from our maternity physician, with no further followup,” she says.
But complications followed. She bled for a month and required a surgical procedure to remove pregnancy tissue her body had retained.
Looking back, Van Tuyl says she wishes she had followup care and mental health support as the couple grieved.
Her story is not an anomaly. Miscarriages affect one in five pregnancies in Canada, yet there is often a disconnect between the medical view of early pregnancy loss as something that is easily managed and the reality of the patients’ own traumatizing experiences, according to a paper published Tuesday in the Canadian Medical Association Journal.
An accompanying editorial says it’s time to invest in early pregnancy assessment clinics that can provide proper care during and after a miscarriage, which can have devastating effects.
The editorial and a review of medical literature on early pregnancy loss say patients seeking help in emergency departments often receive “suboptimal” care. Non-critical miscarriage cases drop to the bottom of the triage list, resulting in longer wait times that make patients feel like they are “wasting” health-care providers’ time. Many of those patients are discharged without a followup plan, the editorial says.
But not all miscarriages need to be treated in the emergency room, says Dr. Modupe Tunde-Byass, one of the authors of the literature review and an obstetrician/gynecologist at Toronto’s North York General Hospital.
She says patients should be referred to early pregnancy assessment clinics, which provide compassionate care that accounts for the psychological impact of pregnancy loss – including grief, guilt, anxiety and post-traumatic stress.
But while North York General Hospital and a patchwork of other health-care providers in the country have clinics dedicated to miscarriage care, Tunde-Byass says that’s not widely adopted – and it should be.
She’s been thinking about this gap in the Canadian health-care system for a long time, ever since her medical training almost four decades ago in the United Kingdom, where she says early pregnancy assessment centres are common.
“One of the things that we did at North York was to have a clinic to provide care for our patients, and also to try to bridge that gap,” says Tunde-Byass.
Provincial agency Health Quality Ontario acknowledged in 2019 the need for these services in a list of ways to better manage early pregnancy complications and loss.
“Five years on, little if any progress has been made toward achieving this goal,” Dr. Catherine Varner, an emergency physician, wrote in the CMAJ editorial. “Early pregnancy assessment services remain a pipe dream for many, especially in rural Canada.”
The quality standard released in Ontario did, however, prompt a registered nurse to apply for funding to open an early pregnancy assessment clinic at St. Joseph’s Healthcare Hamilton in 2021.
Jessica Desjardins says that after taking patient referrals from the hospital’s emergency room, the team quickly realized that they would need a bigger space and more people to provide care. The clinic now operates five days a week.
“We’ve been often hearing from our patients that early pregnancy loss and experiencing early pregnancy complications is a really confusing, overwhelming, isolating time for them, and (it) often felt really difficult to know where to go for care and where to get comprehensive, well-rounded care,” she says.
At the Hamilton clinic, Desjardins says patients are brought into a quiet area to talk and make decisions with providers – “not only (from) a physical perspective, but also keeping in mind the psychosocial piece that comes along with loss and the grief that’s a piece of that.”
Ashley Hilliard says attending an early pregnancy assessment clinic at The Ottawa Hospital was the “best case scenario” after the worst case scenario.
In 2020, she was about eight weeks pregnant when her fetus died and she hemorrhaged after taking medication to pass the pregnancy at home.
Shortly after Hilliard was rushed to the emergency room, she was assigned an OB-GYN at an early pregnancy assessment clinic who directed and monitored her care, calling her with blood test results and sending her for ultrasounds when bleeding and cramping persisted.
“That was super helpful to have somebody to go through just that, somebody who does this all the time,” says Hilliard.
“It was really validating.”
This report by The Canadian Press was first published Oct. 15, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
