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COVID-19: Doctors, caregivers push for in-home vaccinations for housebound seniors – BradfordToday

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TORONTO — At age 86, diagnosed with Parkinson’s disease and prone to falls, John Bedborough would seem to be at the front of the line amid high-risk Canadians prioritized for a COVID-19 vaccine. 

But it’s those frailties that make it unlikely he’ll be able to visit a mass vaccination site, doctor’s office, pharmacy, or any other locale expected to administer doses when Ontario begins its community rollout mid-March, says his daughter, Diane Tamblyn.

The Peterborough, Ont. woman is among a chorus of seniors and caregivers who are pushing for in-home inoculations lest thousands of vulnerable Canadians be left behind. 

Some geriatricians are also dismissing the suggestion that unique storage and handling requirements prevent home-based deployment of the Moderna and Pfizer-BioNTech vaccines, both often described as delicate and tricky to transport.

Tamblyn says she’s heard nothing about how thousands of housebound seniors like her dad will be protected, noting they are still exposed to possible infection through visiting caregivers and relatives, and highly susceptible to complications.

“If we don’t go to people that are very frail and elderly, how the heck do we expect them to get to these vaccination centres?” says Tamblyn.

“We send the vaccinations into the nursing homes and retirement homes. What would make somebody 85, living on their own that’s housebound (different)? Why wouldn’t we take it to them?”

Specific details about where and how Ontario will administer shots were absent when retired Gen. Rick Hillier outlined the rollout earlier this week, but he insisted the evolving plan would include a variety of venues and that seniors would mostly likely be vaccinated in their own neighbourhood.

Quebec Health Minister Christian Dube seemed to dismiss the prospect of in-home vaccinations outright when he detailed that province’s plans earlier this week, citing precise cold-storage and handling requirements.

But that doesn’t mean at-home inoculations can’t occur, counters Ottawa physician Dr. Alykhan Abdulla, who says thawed vaccines can survive six hours – plenty of time for a paper-route style delivery to housebound seniors in the same neighbourhood.

Abdulla says he’s already reached out to colleagues who are also confident door-to-door inoculation is possible.

“We don’t know when but I can tell you frankly, that it will happen,” says Abdulla, who’s identified about 36 of his own patients he plans to visit personally.

“I have a list of doctors in the province of Ontario, over 4,000 doctors that are willing to do this work, that are willing to drive to people’s homes. They’re willing to look after people wherever they are.”

Toronto geriatrician Nathan Stall of the Sinai Health System acknowledges provincial complaints that federal delivery schedules and restrictive vaccine handling protocols have hampered rollout plans.

Pfizer for instance, packages 195 vials — or 975 doses — in large trays, and requires them all to be transported together after they’re removed from -70 C freezers.

But Stall says Israel managed to vaccinate seniors in their homes by separating some shipments into smaller packages of 50 vials, and he doesn’t see why Canada can’t attempt to do the same. 

“What they did almost immediately was to package vaccine into pizza-sized boxes, so that they took smaller amounts and they went and vaccinated people who are frail older adults living in their homes,” says Stall, who sits on Ontario’s science advisory table. 

“The excuse about the federal supply or our handling does not hold.”

Montreal geriatrician Quoc Dinh Nguyen is open to the idea but raises several logistical hurdles, including the possibility of wasted doses if the delivery route, schedule or patient availability is derailed.

“Six hours is not a lot, and we do have to understand that it’s big packs of vaccines that we can’t just … take 10 (doses) and keep the 900 that are left for a month,” says Nguyen.

In the short term, he says it makes sense to focus on vaccinating the most people possible as quickly as possible, while working on a plan to reach at least 90 per cent of those aged 85 and older – the priority group Quebec invited this week.

“If this is the start of the vaccination period, I think it’s OK that you use mass vaccinations, that you take the low-hanging fruit that works,” he says.

Making sure no one falls through the cracks is a big concern to Dr. Samir Sinha, director of geriatrics at Toronto’s Sinai Health System and the University Health Network, who envisions a mix of family doctors, homecare nurses and paramedics administering doses to some patients at home.

“The problem with all of this is that these are the people we know about,” adds Sinha.

“I would say there’s an equal number of people out there who we probably don’t know about because they don’t actually have a primary care provider, or the families are actually providing all the care on their own, or they’re actually buying their care privately.”

Ontario’s vaccination playbook, which outlines public health guidance, includes a vague mention of on-site and mobile clinics to reach “populations that are too frail to attend a mass immunization clinic” such as long-term care residents, but doesn’t mention those who are homebound in the community.

Still, it’s very likely seniors who receive provincial homecare services would be in line for an in-home shot, suggests Sharon Goodwin of the Victorian Order of Nurses.

Goodwin, senior vice president of home and community care at the non-profit, says some public health units “are engaging home care in the process,” and notes homecare workers are also among those who will be vaccinated in the priority group.

Abdulla points to a variety of creative experiments underway in pockets around Ontario including a drive-through model in Collingwood, Ont., and a pilot program in Toronto that is administering vaccines to about 500 seniors and health care workers in three congregate-care buildings.

As for 94-year-old Toronto resident Nina Rockett, all she wanted for her birthday this week was a vaccine.

“I miss being close to people, you know, hugging people, spending time with them,” she says.

Her daughter Margot Rockett is especially eager for clear information about whether seniors facing barriers to leaving the home but willing to try – despite, for instance, hearing problems, vision loss, incontinence, dementia, or difficulty standing for long periods – will be accommodated.

She herself is uncertain whether to risk taking her mother to a clinic because of mobility problems. 

“Let’s just get out there and figure this out, and find all these people and connect with them.”

This report by The Canadian Press was first published Feb. 26, 2021.

Cassandra Szklarski, The Canadian Press

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Canada allows Pfizer COVID-19 vaccine for children aged 12-15

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(Corrects headline and lead to make clear that Canada was not the first nation as stated by Canadian officials, adds context from Pfizer in fourth paragraph)

By David Ljunggren

OTTAWA (Reuters) –Canada is authorizing the use of Pfizer Inc’s COVID-19 vaccine for use in children aged 12 to 15, the first doses to be allowed in the country for people that young, the federal health ministry said on Wednesday.

Supriya Sharma, a senior adviser at the Canadian federal health ministry, said the Pfizer vaccine, produced with German partner BioNTech SE, was safe and effective in the younger age group.

“We are starting to see the light at the end of the tunnel,” she told reporters.

Sharma and a health ministry spokesman said Canada was the first country to grant such an approval, but a Canadian representative for Pfizer later said Algeria permitted use of the vaccine for this age group in April. The Canadian health ministry said it had no information about the discrepancy.

The U.S. Food and Drug Administration is expected to take a similar step “very soon,” U.S. health officials said.

Separately, authorities reported the third death of a Canadian from a rare blood clot condition after receiving AstraZeneca PLC’s’s COVID-19 vaccine. The man, who was in his sixties, lived in the Atlantic province of New Brunswick.

Jennifer Russell, the chief medical officer of health in New Brunswick, said the province would continue using the AstraZeneca vaccine. Alberta reported a death from clotting on Tuesday and Quebec announced one on April 27.

“There will be rare cases where thrombosis will occur. However, the risks remain minimal compared to the risks, complications and potential consequences of COVID-19,” Russell told reporters.

Canada‘s federal government has bought tens of millions of doses of vaccines but critics complain the pace of inoculation is lagging due to bottlenecks in the 10 provinces, which are responsible for administering the doses.

Alberta will become the first province to offer COVID-19 vaccines to everyone aged 12 and over from May 10, Premier Jason Kenney said on Wednesday, a day after he introduced tighter public health measures to combat a third wave of the pandemic.

Alberta, home to Canada‘s oil patch, has the highest rate per capita of COVID-19 in the country, with nearly 24,000 active cases and 150 people in intensive care.

Around 20% of the 1,249,950 cases of COVID-19 in Canada have been reported in people under the age of 19. Canada has recorded 24,396 deaths.

(Additional reporting by Allison Martell in Toronto and Nia Williams in Calgary;Editing by Chizu Nomiyama and Sonya Hepinstall)

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Younger people filling up COVID-19 intensive care

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By Anthony Boadle

BRASILIA (Reuters) –COVID-19 infections continue to spread fast across the Americas as a result of relaxed prevention measures and intensive care units are filling up with younger people, the director of the Pan American Health Organization (PAHO) said on Wednesday.

In Brazil, mortality rates have doubled among those younger than 39, quadrupled among those in their 40s and tripled for those in their 50s since December, Carissa Etienne said.

Hospitalization rates among those under 39 years have increased by more than 70% in Chile and in some areas of the United States more people in their 20s are now being hospitalized for COVID-19 than people in their 70s.

“Despite all we learned about this virus in a year, our control efforts are not as strict, and prevention is not as efficient,” Etienne said in a virtual briefing from Washington.

“We are seeing what happens when these measures are relaxed: COVID spreads, cases mount, our health systems become overwhelmed and people die,” she said.

Canada continues to report significant jumps in infections in highly populated provinces such as Ontario as well as in less populated territories of the North and Yukon, home to remote and indigenous communities, according to PAHO.

Puerto Rico and Cuba remain significant drivers of COVID-19 cases in the Caribbean, which is facing a new surge of the virus, PAHO directors said.

Cases are rapidly accelerating in the Guyanas and across Argentina and Colombia, where weekly case counts are five times higher today than they were this time last year and hospitals are reaching capacity in large Colombian cities.

In Central America, Guatemala is seeing significant spikes in cases and Costa Rica is reporting record-high infections.

While vaccines are being rolled out as fast as possible, they are not a short-term solution because they are in short supply, said Etienne, the World Health Organization’s regional director.

(Reporting by Anthony Boadle; Editing by Nick Macfie)

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Alberta confirms first death linked to AstraZeneca vaccine

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Reuters) -The province of Alberta reported its first death of a patient from a rare blood clot condition after receiving the AstraZeneca COVID-19 vaccine, its chief medical officer said.

Canada has reported at least five cases of blood clots following immunization with the vaccine, but public health officials maintain the benefits of the AstraZeneca shot outweigh the potential risks.

The Alberta case, of a woman in her 50s, marks the second case of blood clots, and the only death after more than 253,000 doses of AstraZeneca were administered in the province, Alberta’s chief medical officer of health Dr. Deena Hinshaw said in a statement on Tuesday.

“While any death is tragic, it is important to remember that the risks of dying or suffering other severe outcomes from COVID-19 remain far greater than the risk following AstraZeneca vaccine,” Hinshaw said.

AstraZeneca did not immediately respond to Reuters’ request for a comment.

Canada has had 1,243,242 confirmed coronavirus cases and 24,342 deaths, according to a Reuters tally

Last month, the province of Quebec reported Canada’s first death of a patient after receiving the AstraZeneca COVID-19 vaccine.

AstraZeneca, working with the vaccine’s inventor Oxford University, was one of the leaders in the global race to develop a COVID-19 vaccine. Its cheap and easily transportable shot was hailed as a milestone in the fight against the crisis, but has since faced a series of setbacks.

The rare complication, which some regulators including Health Canada are calling Vaccine-Induced Prothrombotic Immune Thrombocytopenia, involves blood clots accompanied by a low count of platelets, cells in the blood that help it to clot.

Dozens of countries paused the use of the AstraZeneca vaccine in March after reports of rare, but serious, blood clots. Several of them have now resumed use either fully or with restricions after health regulators said the benefits of the shot outweigh any risks.

(Reporting by Vishwadha Chander and Sabahatjahan Contractor in Bengaluru, Editing by Sherry Jacob-Phillips and Angus MacSwan)

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