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Are schools driving Alberta's COVID-19 spread or are they the victim of it? Dr. Hinshaw believes the latter – CBC.ca

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The reopening of schools has been highlighted as a potential driver of recent COVID-19 surges in other parts of Canada and around the world, but Alberta’s chief medical officer of health doesn’t believe they are causing the high rate of new cases in this province.

“I do not see evidence in Alberta of schools driving that increasing community transmission,” Dr. Deena Hinshaw said.

“It does seem to be the reverse, with community transmission causing increased pressure in schools.”

Alberta continues to see record-high levels of COVID-19 cases among school-aged kids, but that is not unique to their demographic. Virtually every age group in Alberta has recently seen its highest rate of new cases on record, as the province experiences its largest surge in virus spread to date.

Researchers and physicians in other jurisdictions have been warning that schools may be a significant driver of COVID-19 spread, after numbers surged shortly after classes resumed.

The timing of Alberta’s latest surge is consistent with what you would expect if schools were driving an increase in spread, says Malgorzata Gasperowicz, a developmental biologist and independent researcher who has been tracking Alberta’s COVID-19 data closely.

Gasperowicz had previously warned in October that, given the trajectory in Alberta’s COVID-19 spread at the time, the province could be seeing 1,000 cases per day by Nov. 11. Alberta nearly reached that level on Nov. 7, when the province reported 919 new cases of the disease.

She noted that, after plateauing for some time throughout the summer, the disease spread suddenly accelerated in mid-September to a pace where new cases were doubling every 2½ weeks.

“It sort of switched into this faster growth around Sept. 17, which is 16 days after the schools reopening,” she said.

She cautioned that this correlation does not imply causation. In other words, it doesn’t prove schools are driving the spread, but it doesn’t rule it out.

“For me, that shows we cannot dismiss schools as a contributor to the spread,” Gasperowicz said.

Schools and COVID-19 surges in other places

Quebec experienced a similar surge of COVID-19 cases in September, and some physicians in that province have been drawing a link to the resumption of in-person classes.

“Schools were the driver to start the second wave in Quebec, although the government did not recognize it,” Dr. Karl Weiss, president of the Association des Médecins Microbiologistes Infectiologues du Québec, told the Montreal Gazette last week.

More physicians recently spoke out about the situation to CBC Montreal, noting many schools are old and have poor ventilation. Quebec has also had relatively loose requirements for students wearing masks.

The Quebec government introduced stricter measures in schools in October, more than a month after classes opened. (Ryan Remiorz/The Canadian Press)

Still, Quebec’s public-health director, Dr. Horacio Arruda, maintains schools are not the main cause of the province’s recent surge. He says the cases among school-aged kids are more of a reflection of transmission in the broader community.

Globally, the reopening of schools has also been connected to increases in viral-transmission rates, according to University of Edinburgh researchers who analyzed data from 131 countries and published their findings in The Lancet, a prestigious medical journal.

On Tuesday, Manitoba announced a provincewide “code red” situation due to rapid growth in COVID-19 cases. The province ordered the closure of non-essential retail stores, gyms, movie theatres, salons and churches, as well as a shutdown of recreational facilities and sports activities. Social gatherings of any kind will also be banned as of Thursday.

Manitoba schools and child-care centres will remain open, however. Despite hundreds of cases among students and staff, there have been only a small number of confirmed transmissions directly within the school system, said Manitoba’s Chief Provincial Public Health Officer Dr. Brent Roussin.

Case growth and origins

In Alberta, cases of COVID-19 have been rising quickly among older kids and teens, but not quite as fast as among the 20-to-29 age group, on a population-adjusted basis.

On average over the past week, there have been about 18 new daily cases per 100,000 people aged 10 to 19, compared with about 23 new daily cases for people in their 20s.

Case growth has been significantly slower among kids aged five to nine, at about 10 new daily cases per 100,000 children in that age range.

There’s also the source of infection to consider, which can be difficult to determine.

But Alberta Health says the data points more heavily toward non-school settings than in-school transmission.

From September to mid-October, Hinshaw said just six per cent of COVID-19 cases among school-aged kids were found to be acquired in school.

‘Invisible spread’

Alberta Health also said last week that slightly more than half of active cases — across all age groups — were of unknown origin. That figure has been increasing lately, as contact tracers struggle with the sheer volume of newly infected patients.

All this makes pinpointing the primary drivers of the recent surge in cases a difficult task.

“Everything is tangled together,” Gasperowicz said.

She noted there could also be a “data acquisition bias” when it comes to kids, in particular. 

“A big percentage of children are asymptomatic, so we don’t test them,” she said. “So there could be invisible spread.”

Developmental biologist Malgorzata (Gosia) Gasperowicz has been tracking the COVID-19 data in Alberta closely and notes the acceleration in case spread began in late September, just over two weeks after in-person classes resumed at many schools. (CBC Calgary News at 6, NIAID-RML/Reuters)

From all the available evidence, though, Hinshaw believes schools, themselves, are not a primary driver of Alberta’s latest surge.

She says there are “many factors” that have changed since the summer that are likely contributing to the spread.

“With the fall and cooler weather, people are spending more time indoors,” Hinshaw said. “There’s less of those opportunities, perhaps, for socializing outside that we had in the summertime. And, of course, there are other activities that start up in the fall in addition to school. There’s other, recreational-type activities that people are engaging in.”

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Canada plots course to fully vaccinated return to gatherings in fall

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Canada on Friday said there would be a gradual return to a world with indoor sports and family gatherings as more people get vaccinated, but it did not go as far as the United States in telling people they could eventually ditch their masks.

Canada has administered one dose of a COVID-19 vaccine to just over half its adult population, and the country may be over the worst of its current third wave of infections, Chief Public Health Officer Theresa Tam said.

On Thursday, the U.S. Centers for Disease Control and Prevention (CDC) advised that fully vaccinated people do not need to wear masks outdoors and can avoid wearing them indoors in most places, guidance the agency said will allow life to begin to return to normal.

On Friday, Canada‘s public health agency offered guidelines to the 10 provinces, which are responsible for public health restrictions.

The agency says once 75% of Canadians have had a single dose and 20% are fully vaccinated, some restrictions can be relaxed to allow small, outdoor gatherings with family and friends, camping, and picnics.

Once 75% of those eligible are fully vaccinated in the fall, indoor sports and family gatherings can be allowed again.

“I think masks might be the last layer of that multi-layer protection that we’ll advise people to remove,” Tam told reporters, noting that in Canada colder temperatures meant people would start spending more time indoors in the fall.

“We are taking a bit of a different approach to the United States,” she added. While in most of Canada masks are not required outdoors, they are mandatory indoors.

Less than 4% of Canada‘s adult population has been fully vaccinated compared to more than 36% of Americans.

Prime Minister Justin Trudeau, who has promised that everyone who wants to can be fully vaccinated by September, this week spoke of a “one-dose summer” and a “two-dose fall” without explaining what that might look like.

 

(Reporting by Steve Scherer and David Ljunggren; Editing by Hugh Lawson)

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Delayed 2nd Pfizer/BioNTech shot boosts antibodies in elderly; COVID-19 obesity risk higher for men

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The following is a roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Delaying second Pfizer/BioNTech dose boosts antibodies in elderly

Delaying the second dose of the Pfizer/BioNTech COVID-19 vaccine beyond the originally recommended three-week gap used by the companies in clinical trials appears to induce a stronger antibody response in the elderly, UK researchers found. Shortly after the vaccine became available, UK health officials advised that the second dose should be given 12 weeks after the first to allow more people to get protected by a first dose early on. In a new paper seen by Reuters and expected to appear on medRxiv on Friday ahead of peer review, researchers found that among 175 people ages 80 to 99, those who got their second dose at 12 weeks had antibody responses that were 3.5 times higher than those who got it after three weeks. Antibodies are only one part of the immune system, and vaccines also generate T cells that fight infections. The peak T cell responses were higher in the group with a three-week interval between doses, and the authors cautioned against drawing conclusions on how protected individuals were based on which dosing schedule they received. (https://reut.rs/3wjPK9B)

Impact of obesity on COVID-19 risks may be greater in men

The known increased risk of severe COVID-19 and death linked to obesity may be even more pronounced for men than women, new data suggest. Researchers studied 3,530 hospitalized COVID-19 patients with an average age of 65, including 1,469 who were obese. In men, moderate obesity was associated with a significantly higher risk of developing severe disease, needing mechanical breathing assistance and dying from COVID-19. (The threshold for moderate obesity is a body mass index (BMI) of 35. In an 5-foot, five-inch tall (1.65 m) adult, that would correspond to a weight of 210 pounds (95 kg). In women, however, only a BMI of 40 or higher, indicating severe obesity, was linked with the increased risks. In a report published in European Journal of Clinical Microbiology & Infectious Diseases, the researchers note that while obesity is known to be linked with body-wide inflammation, patients’ levels of inflammatory proteins did not appear to explain the association between obesity and severe illness. For now, they conclude, “particular attention should be paid” to protecting patients with obesity from the coronavirus, “with priority to vaccination access, remote work, telemedicine, and other measures given the higher risk of adverse outcomes once they are diagnosed with COVID-19.” (https://bit.ly/3eO6GiA)

COVID-19 testing rates low among symptomatic Americans

Sick Americans appear to be passing up opportunities to get tested for coronavirus and thus are likely unknowingly spreading the infection throughout their communities, new research shows. Among 37,000 adults across the United States who participated in a smartphone app survey between March and October 2020, nearly 2,700 reported at least one episode of fever and chills. But according to a report published in JAMA Network Open, only a small fraction reported receiving a COVID-19 test result within seven days of the onset of illness. At first, as tests became more accessible, the numbers improved. In early April 2020, less than 10% of survey participants reporting illness with fever received test results within a week. By late July, that proportion had increased to 24.1%. Throughout the summer and fall, as tests became easier to find, the number of sick participants who reported getting tested remained flat. By late October, only 26% reported receiving a test result within a week of febrile illness. “It’s shocking to me that when people have a fever they’re still not getting tested,” said coauthor Dr. Mark Pletcher of the University of California, San Francisco. “Tests are easy to come by. People might have coronavirus, might be spreading it to their friends and neighbors, and they’re not getting tested.” (https://bit.ly/2QUyMzf)

Open  in an external browser for a Reuters graphic on vaccines in development.

 

(Reporting by Nancy Lapid, Alistair Smout and Ronnie Cohen; Editing by Bill Berkrot

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U.S. CDC says Fully vaccinated people can remove their masks in most places

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The U.S. Centers for Disease Control and Prevention (CDC) on Thursday advised that fully vaccinated people do not need to wear masks outdoors and can avoid wearing them indoors in most places, updated guidance the agency said will allow life to begin to return to normal.

The CDC, which hopes the guidance will prod more Americans to get vaccinated, also said fully immunized people will not need to physically distance in most places.

The turnaround came just 16 days since CDC issued revised guidance that left many restrictions in place for vaccinated people. The agency came under fire in March for initially discouraging immunized grandparents to fly to visit loved ones.

CDC Director Rochelle Walensky said the new guidance was based on a sharp reduction in cases, expansion of vaccines to younger people and vaccine efficacy against coronavirus variants.

“We followed the science here,” Walensky.

President Joe Biden emerged at the White House for remarks without a mask. “I think it’s a great milestone, a great day,” he said.

“If you’re fully vaccinated and can take your mask off, you’ve earned the right to do something that Americans are known for all around the world: greeting others with a smile,” he said, flashing a brief smile himself.

Biden earlier shed his mask during a meeting with lawmakers, Republican Senator Shelly Moore Capito told reporters. Some journalists at the White House also removed their masks.

The CDC had faced criticism, even from public health officials, that it has been too cautious in its guidance. Critics have said people need to see more benefit of getting vaccinated in terms of returning to normal activities.

“In the past couple of weeks, we have seen additional data to show these vaccines work in the real world, they stand up to the variants, and vaccinated people are less likely to transmit the virus,” the agency said in a news release.

It added, “We needed to take the time to review the full body of evidence to get this right, and that’s how we came to this decision.”

‘NEED A REWARD’

Dr. William Schaffner, an infectious disease doctor at Vanderbilt University Medical Center, said he supports the new guidance that many had been calling for.

“People in state health departments and infectious disease doctors have been saying this for some time because they’re so impressed with the effectiveness of the vaccine, and also, they have the feeling that people who are vaccinated need a reward,” he said.

Republican Senator Susan Collins called the guidance “overdue.”

“If people find they cannot do anything differently after a vaccine, they will not see the benefit in getting vaccinated,” she said.

The revised guidance is a major step toward returning to pre-pandemic life, but the agency still recommends vaccinated people wear masks on planes and trains, and at airports, transit hubs, mass transit and places like hospitals and doctor’s offices.

Officials in several states said they would immediately review existing mask requirements.

The Retail Industry Leaders Association said the announcement creates ambiguity because it fails to fully align with state and local orders.

“It is critical for customers to remember the CDC announcement is guidance and that many state and local jurisdictions still have mask mandates in place that retailers must follow.”

Supermarket chain Kroger Co said it would keep its mask requirements in place “at this time.”

Target Corp said it will continue requiring coronavirus safety measures in all stores, including masks and social distancing, while it reviews the guidance.

The United Food and Commercial Workers International Union (UFCW), which represents 1.3 million retail and grocery workers, called the new guidelines “confusing,” adding it “fails to consider how it will impact essential workers who face frequent exposure to individuals who are not vaccinated and refuse to wear masks.”

The U.S. government last month extended mask requirements across transportation networks through Sept. 13. The Transportation Security Administration said it would “work closely with the CDC to evaluate the need for these directives.” Walensky said CDC will soon issued updated transit guidance.

The new guidance says vaccinated Americans can resume all travel, do not need to quarantine after international trips and do not need to be tested for COVID-19 if exposed to someone who is COVID-19 positive but asymptomatic.

However, Americans still face some international travel restrictions, including non-essential trips to Canada.

Masks became a political issue in the United States with then-President Donald Trump resisting mandating face coverings while President Joe Biden embraced masks and mandated them for transit hubs. Some U.S. states issued aggressive mask mandates while others declined or dropped them months ago.

The CDC said fully vaccinated people should still wear masks where required by federal, state, local, tribal or territorial laws, and abide by rules and regulations set by local businesses and workplaces.

In late April, the CDC said fully vaccinated people can safely engage in outdoor activities like walking and hiking without masks, but recommended their continued use in public spaces where they are required.

Immune-compromised individuals should consult doctors before shedding masks, and those who are not vaccinated should continue wearing them, Walensky said.

(Reporting by David Shepardson; Additional reporting by Steve Holland and Nandita Bose in Washington, Richa Naidu, Lisa P. Baertlein and Julie Steenhuysen in Chicago; Editing by Franklin Paul and Bill Berkrot)

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