Scientific understanding of the coronavirus variant is changing quickly. Here’s a recap of the most important findings.
Citing new evidence that vaccinated Americans with so-called breakthrough infections can carry as much coronavirus as unvaccinated people do, the Centers for Disease Control and Prevention last month urged residents of high-transmission areas to wear masks in public indoor spaces, regardless of their vaccination status.
The announcement reversed the agency’s recommendation in May that vaccinated people could forgo masks. The vaccines remain highly effective at preventing severe illness and death, but the highly contagious Delta variant and persistent vaccine refusal have taken the country in an unexpected direction. Infections have spiked to the highest levels in six months.
“If the war hadn’t changed, I wouldn’t have felt the need to take such a widely unpopular action,” Dr. Rochelle Walensky, the C.D.C.’s director, said in an email.
Dr. Walensky has repeatedly said that breakthrough infections are extremely rare. But the agency does not tally national figures on breakthrough infections that don’t result in hospitalization or death, and, in any event, its numbers lag by a few weeks. The exact incidence of these infections, as well as their outcomes, is unknown.
Breakthrough infections seemed to be vanishingly rare when previous versions of the coronavirus dominated in the United States. But recent outbreaks suggest that the numbers may be higher with the arrival of the Delta variant.
“A modest percentage of people who are fully vaccinated will still get Covid-19 if they are exposed to the virus that causes it,” Dr. Walensky said in the email.
Still, most vaccinated people with a breakthrough infection are likely to have mild symptoms. And they may even benefit, in the long run: Every exposure to the virus is an opportunity for the immune system to strengthen its defenses against variants that may emerge in the future.
Booster shots and mild natural infections can both increase the immunity initially gained from the vaccines, said Dr. Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health. “This is why young adults and adults don’t get sick — it’s because as a kid you get an opportunity to see these pathogens over and over and over,” he said.
The vaccines were designed to prevent severe illness, not infection.
The vaccines were intended to prevent hospitalization and death, the worst outcomes of infection, in large part the result of damage to the lungs and other organs. The vaccines produce antibodies in the blood that prevent the coronavirus from taking root in those organs.
But the infection begins when people inhale or ingest the virus through the nose or the throat. Some antibodies produced by the vaccines do seem to be present in nasal secretions and saliva, and were probably enough to thwart previous variants of the virus. Delta offers a tougher challenge.
Early in the infection, when people are most likely to be contagious, the Delta variant seems to replicate in amounts that are perhaps 1,000 times as much as those seen in people infected with other variants, defeating immune defenses in the nose and throat.
“It’s just way more virus that’s going to potentially overwhelm that initial firewall,” said Jennifer Gommerman, an immunologist at the University of Toronto.
To prevent both severe illness and infections, the vaccines would need to produce long-lasting antibodies in the blood and the nose. “That’s a really tall ask for a vaccine,” Dr. Gommerman said.
Breakthrough infections are likely to be uncommon, but data is lacking.
It’s unclear exactly how common breakthrough infections are; most estimates rely on figures predating the Delta variant’s rise in the United States. There is also too little testing in the country to get an accurate assessment.
“I think that if we started to test people just randomly on the street, we would find a lot more people who test positive,” said Dr. Abraar Karan, an infectious diseases fellow at Stanford.
Some experts believe breakthrough infections are likelier after exposure to the Delta variant than to prior forms of the virus. Even when more recent data becomes available, however, it still is likely to show that a vast majority of hospitalizations and deaths from Covid-19 occur in unvaccinated people.
“Epidemiologically and clinically, I’ve still not seen really any severe cases among fully vaccinated people who are immunocompetent,” Dr. Karan said. “The pattern that I’m seeing is still primarily unvaccinated who are making it to the I.C.U.”
The C.D.C. reports that as of Aug. 2, more than 7,500 people with breakthrough infections had been hospitalized or had died. And a New York Times analysis of data from 40 states shows that fully immunized people accounted for less than 5 percent of hospitalizations and less than 6 percent of deaths from Covid-19.
The real danger from breakthrough infections is to the unvaccinated.
Breakthrough infections are unlikely to pose a serious health threat to most people who are fully immunized. The risk is greater for people around them who are unprotected — either because they are unvaccinated, or because their immune defenses are weakened by age or certain medical conditions.
Vaccinated people are certainly less likely than the unvaccinated to become infected. But on those occasions, vaccinated people can carry as much virus in their nose and throat as unvaccinated people, according to new data from the C.D.C.
The virus should not last very long, because antibodies and immune cells will quickly rally to suppress it. But infected people can transmit the virus to others very early, even before they feel symptoms.
So breakthrough infections could contribute to viral spread in a community, if less often and for a shorter period of time than infections in unvaccinated people. It’s just one more way for the virus to find unvaccinated people.
In some rare cases, breakthrough infections may lead to persistent symptoms.
“Long Covid” is a poorly understood set of symptoms that can plague people for several months after an active infection has ended. While those symptoms eventually resolve in many patients, “there are this subset of people who have long Covid who just aren’t able to recover at all,” said Akiko Iwasaki, an immunologist at Yale University.
Only a couple of small studies have investigated how common or severe long Covid may be after breakthrough infections. It is likely to be rare, some experts say, because breakthrough infections are uncommon to begin with and shorter in duration.
In one study in Israel, about seven of 36 people with breakthrough infections had persistent symptoms for more than six weeks. And in a survey of Covid-19 survivors, 24 of 44 people with a symptomatic breakthrough infection reported lingering problems.
“We really need a wider national or even international survey,” Dr. Iwasaki said.
Breakthrough infections may offer an unexpected advantage.
If you get through a breakthrough infection relatively unscathed, you are likely to walk away with more robust protection against variants. The infection essentially acts as a booster shot, researchers say, strengthening your immune system’s ability to recognize and fight the virus.
Studies have shown that when people who recover from Covid-19 receive even one dose of a vaccine, their antibody levels skyrocket. “I expect similar things would happen when you have a breakthrough infection,” Dr. Iwasaki said.
The vaccines train the immune system to recognize a piece of the original virus, a strategy that may leave us vulnerable to future variants. But every exposure broadens the repertoire of immunity, Dr. Mina said.
Eventually, through booster shots or through repeated infections, our bodies will gain an education in the virus sufficient to counter versions with new mutations, he said, adding, “But we’re not there yet.”
Canadian kids were at low risk of severe COVID-19 early in the pandemic, before Delta: study – Global News
Severe cases of COVID-19 were very rare among Canadian children during the first waves of the pandemic, according to a new study by researchers who warn the findings should not be taken as a reason not to vaccinate youth.
The study was published Monday by the Canadian Medical Association Journal and looked at 264 reported cases of children hospitalized in Canada between March 25 and Dec. 31, 2020, before the more infectious Delta variant emerged.
Of those cases, 43 per cent had been hospitalized for another reason, such as a fracture, and it was only after they were admitted that the positive test came to light.
Nearly 34,000 Canadians of all ages were hospitalized during the same time frame.
“If you look at the numbers in total, that’s only 150 children hospitalized with COVID during the first two waves here in Canada,” said study co-lead author Dr. Fatima Kakkar of Montreal’s Ste-Justine Hospital.
“These are very small numbers, when you compare with what has happened in adults.”
The study was conducted before the emergence of the more infectious Delta variant, which now accounts for most COVID-19 infections in Canada.
The research also took place before COVID-19 vaccines were authorized for youth aged 12 and older. Of the cases studied, 77 involved kids aged 13 to 17. Pfizer has said it intends to seek authorization soon for a vaccine intended for kids aged five to 11.
Researchers originally believed that children may be at higher risk for severe disease, since this is typically seen with respiratory infection in the pediatric population.
Among the 150 children admitted directly because of the coronavirus, the most common symptoms were fever (70 per cent) and cough (34 per cent).
COVID-19: the upward trend in cases among children
Half had a severe form of the disease, with 21 per cent admitted to intensive care and 13 per cent needing respiratory or cardiac support.
Researchers add that more than three per cent of Canadian children — a high among all age groups in the country — have recently been shown to carry antibodies to COVID-19, indicating that they have been exposed to the virus.
But the relatively small number of pediatric admissions shows that children had less severe infections than adults, even though they were potentially infected more often, Kakkar said.
Overall, 39 per cent of children and youth hospitalized for COVID-19 had at least one co-morbidity and those with severe disease were more likely to have an underlying health condition including obesity, neurological or respiratory issues.
“We often talk about children who have comorbidities and who are sicker, (…) but 60 per cent had no comorbidity,” she said.
“They were healthy children who were hospitalized for the disease. On the other hand, when we look at the severity, the most severe cases were in children who had comorbidities, such as obesity, major neurodevelopmental disorders.”
Deaths of children infected with COVID-19 were also very rare, confirming the findings of other studies.
But even with the encouraging conclusions, parents should not take from it a false sense of security and not vaccinate their child, Kakkar said, given children in good health also ended up in hospital.
“We do not know, among these children who are in good health, which will be the sickest, and we know that when we have a severe disease, we have consequences,” Kakkar said.
“A child intubated in intensive care needs months of rehabilitation, and unfortunately we cannot predict which child will fall into this category.’
An unvaccinated child will also be more likely to continue the spread of the virus within their own family and friends.
She also noted the Delta variant is much more transmissible and currently wreaking havoc among unvaccinated adults.
“I do not want to discourage parents at all from having their child vaccinated,” she said.
“We really have to look at the total well-being of the child: what will allow them to have a normal life, to do activities, to play sports, to see friends? It’s vaccination.”
Still, Kakkar said the benefits of attending school and seeing friends are essential to development.
“There is a lot of anxiety among parents about the risk of COVID in children,” Kakkar said.
“It is important to reassure parents, it is not the same disease as in adults, (so) I hope that will allow the children to live a little more normal life.”
© 2021 The Canadian Press
More COVID-19 vaccination opportunities planned for Sudbury area – The Sudbury Star
Public Health Sudbury and Districts staff are determined to get more shots in arms and have planned a series of COVID-19 vaccination opportunities in the region this week.
Eligible individuals looking to get their first or second dose can book an appointment or visit a walk-in, mobile, or pop-up vaccination clinic.
Vaccination is available every Tuesday at the Carmichael Arena in Greater Sudbury, and every Wednesday at the Espanola Mall.
Vaccination is also available by appointment every Wednesday at the health unit’s Chapleau office and every Thursday by appointment at its Sudbury East office in St. Charles.
This week’s vaccination clinic schedule is:
Tuesday, Sept. 28
- Mobile clinic at TownePlace Suites located at 1710 Kingsway.
- Appointment and walk-in clinics at Carmichael Arena. and at Manitoulin Secondary School located at 107 Bay St. in M’Chigeeng.
Wednesday, Sept. 29
- Mobile clinic at Food Basics located at 1800 Lasalle Blvd.
- Pop-up clinics at the New Sudbury Centre (centre court) located at 1349 Lasalle Blvd. and at the Salvation Army (Community and Family Services) located at 634 Notre-Dame Ave.
- Appointment and walk-in clinic at the Espanola Mall (storefront inside the mall) located at 800 Centre St.
- Appointment-only clinic at Public Health’s Chapleau office.
Thursday, Sept. 30
- Appointment-only clinic at Public Health’s Sudbury East office.
Friday, Oct. 1
- Mobile clinics at the Garson Community Centre/Arena located at 100 Church St. and at the Skead Community Centre located at 3971 Skead Road in Skead from 2 to 6 p.m.
- Pop-up clinic at Valley East Public Library located at 4100 Elmview Dr. in Hanmer.
Saturday, Oct. 2
- Appointment and walk-in clinic at Carmichael Arena.
Sunday, Oct. 3
- Pop-up clinic at the New Sudbury Centre (centre court) located at 1349 Lasalle Blvd.
Everyone born in 2009 or earlier is eligible to receive their first dose of an mRNA vaccine.
Those aged 18 and older can get either the Pfizer or Moderna vaccines (these two mRNA vaccine can be safely interchanged).
Those aged 12 to 17 are only eligible to receive the Pfizer vaccine in Canada.
Anyone who received their first dose of the Pfizer vaccine more than 21 days ago or the Moderna vaccine more than 28 days ago is eligible to receive their second dose.
Those looking to receive their second dose can attend a walk-in, pop-up or mobile vaccination clinic or book their second dose online at www.covid-19.ontario.ca/book-vaccine or call 705-674-2299 from 8 a.m. to 8 p.m.
Public Health reminds people it is possible there won’t be enough doses to offer vaccine to everyone who attends a walk-in, pop-up, or mobile clinic.
More vaccination opportunities may be added throughout the week.
For regular updates, follow Public Health on social media @PublicHealthSD or visit their website at www.phsd.ca/COVID-19/vaccine-clinics.
Visit www.covid-19.ontario.ca/vaccine-locations for a list of pharmacies in Ontario offering COVID-19 vaccination and for booking information or contact your primary care provider.
Visit www.phsd.ca/COVID-19 or call Sudbury’s health unit at 705-522-9200 for more information.
The Local Journalism Initiative is made possible through funding from the federal government.
Ontario health units preparing for COVID vaccinations of kids aged five to 11 – The Globe and Mail
Ontario health units are developing plans for the vaccination of children aged five to 11 once COVID-19 shots are approved for them.
Toronto Public Health said Monday that it had formed a planning group that includes health partners, school boards, community representatives and the province, while top doctors for Peel Region, Middlesex-London, Hamilton and Ottawa also said they were making arrangements.
Toronto Mayor John Tory said plans are being made now so that young children can be vaccinated as soon as possible after Health Canada authorizes a COVID-19 shot for them.
“This will help keep our kids safe and provide greater protection in our schools and communities across the city,” he said in a statement, noting Toronto was home to approximately 200,000 children in the five-to-11 group.
Peel Region’s top doctor said his public health unit is “ready to deploy a vaccine strategy” for that cohort, pending approval from Health Canada and guidance from the province, and would keep residents informed on a timeline.
The top doctor for the Middlesex-London said his health unit was working with pediatric care providers to ensure clinics were “appropriately designed to support young children and young families.”
“We are working with families and children to make sure that we’ve thought of all of the potential aspects of this,” Dr. Chris Mackie said in a statement. “We very much hope and expect to hit the ground running as soon as that announcement is made.”
Ottawa Public Health said it is working with stakeholders on different scenarios for vaccinating the city’s 77,000 kids in that age group.
Those scenarios, which will depend on timing of vaccine approval, include looking at increasing staffing and clinic locations as well as outreach to children and their families.
Hamilton’s medical officer of health said her health unit was hoping to announce a plan for vaccinating young children as soon as possible.
“We recognize the anticipation and interest community members are feeling as they wait for a potential announcement regarding COVID-19 vaccine approval for this age group, and the peace of mind and strong protection being fully vaccinated would mean to these young people and their loved ones,” Dr. Elizabeth Richardson said in a statement.
Children born after 2009 are currently not eligible to receive any of the COVID-19 vaccines approved for use in Canada. Pfizer has said it intends to seek authorization soon for a vaccine intended for kids aged five to 11.
In Toronto, the city’s top doctor said Monday that public health is aiming to be ready for a November start to their immunizations.
Dr. Eileen de Villa noted that COVID-19 infection rates have been increasing among children aged four to 11 in the last three weeks. Last week, that cohort had the highest rate of infection in the city for the first time since the start of the pandemic, she said, at 64 cases per 100,000 population.
That trend isn’t surprising given that children born after 2009 can’t be vaccinated against COVID-19, de Villa said. But she urged families to get vaccinated to protect those who can’t get the shots.
“It is absolutely key for parents to get vaccinated to help ensure the safer reopening of school and the ability to provide ongoing in-person learning,” she said.
She also flagged that “work that has yet to be done” in vaccinating people between the ages of 30 to 49, many of whom may be parents. She said 25 per cent of that age group in the city is not fully vaccinated.
Ontario health units are responsible for administering COVID-19 shots with guidance from the provincial government.
Provincial data as of Monday showed 80 per cent of youth aged 12 to 17 had at least one COVID-19 vaccine dose and 70 per cent were fully vaccinated.
Vaccination clinics have been run at or near Ontario schools in the weeks since students have returned to classes in an effort to boost vaccination for eligible students, staff and families.
School staff in Ontario must be vaccinated against COVID-19 or be regularly tested for the virus.
No such rule is in place for students, but de Villa wrote to the city’s board of health this month, asking that it request the province to require COVID-19 vaccination for eligible students. The board voted in favour of her recommendation Monday.
In her Sept. 13 letter to the board of health, de Villa referenced the nine other diseases covered under the Immunization of School Pupils Act, which students enrolled in school must be vaccinated against.
COVID-19 is currently not one of those designated diseases, and de Villa wrote that the safety and effectiveness of approved vaccines has been proven in children 12 and older.
“Given the current epidemiology of COVID-19 and the need to support the safe reopening of schools, it recommended that the province require COVID-19 vaccination for students who are eligible based on their age/year of birth,” she wrote.
The province’s top public health doctor has said the province is looking into adding COVID-19 vaccinations to the list of those required for students by law, which allows for some exemptions.
– With files from Noushin Ziafati.
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