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Etches does not support accelerating second doses for front-line health workers – Ottawa Citizen

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Ottawa’s Medical Officer of Health Dr. Vera Etches says she does not support the call to speed up second doses of COVID-19 vaccines for front-line health workers.

Ontario, on the advice of the National Advisory Committee on Immunization, has pushed back second doses of COVID-19 vaccines by up to four months in order to vaccinate as many people as possible with single doses.

But this week, the head of the University of Ottawa Heart Institute, Dr. Thierry Mesana, said that blanket policy is putting health-care workers, patients and the health system at risk.

Eighty per cent protection from COVID-19, which a single dose of the Pfizer or Moderna vaccine provide, is beneficial to the general public, but still leaves patient-facing health-care workers at too much risk, said Mesana. Two doses provide about 95 per cent protection.

At the heart institute, all staff members have received at least one dose of vaccine. Despite that, 14 front-line health workers have become infected with COVID-19 in recent outbreaks at the cardiac centre. Fifteen patients have also been infected in outbreaks that began in early March. The institute remains open but is restricted to urgent care during the outbreaks.

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  1. Thierry Mesana, CEO of the University of Ottawa Heart Institute, is calling for second vaccine doses for all patient-facing health care workers.

    Heart Institute CEO Dr. Thierry Mesana calls for earlier second COVID vaccine doses as outbreaks hit staff

  2. A number of frontline health workers at the University of Ottawa Heart Institute have been infected with COVID-19 after receiving one dose of the vaccine. Sean Kilpatrick/The Canadian Press

    Egan: Vaccinated, still infected with COVID-19 — a real but disheartening possibility

Vaccinated health workers at The Ottawa Hospital have also become infected in ongoing outbreaks there. Nine patients at the Civic campus and one at the General have died after contracting COVID-19 while being treated for unrelated illness at the hospital.

Etches said the plan to vaccinate more people with one dose does more to protect the community.

“I do understand the desire to have health-care workers protected with COVID-19 vaccine as much as possible,” she said during a virtual press briefing Wednesday.

But Etches said with a limited supply of vaccines, “we need to protect as many people in the population as possible and focus on the people most likely to die.”

Most health-care workers are at less risk of death from COVID-19 compared with people over 70, she said.

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Etches added: “I want to reassure people that one dose of COVID-19 vaccine does provide good protection.”

Canada’s move to push back second doses of COVID-19 vaccines has been questioned by others.

Last month, Canada’s chief science adviser Mona Nemer told CTV that the decision to delay second doses amounted to a “population level experiment.”

A recent study recommended second doses not be delayed in the elderly because they might have a less strong immune response to the first dose than younger adults.

A spokesperson for the ministry of health said the province is following National Advisory Committee on Immunization guidelines to extend vaccination doses by up to four months for Pfizer, Moderna and AstraZeneca, which will allow the province to accelerate its vaccine rollout and maximize the number of people protected by one dose.

“The effectiveness of an extended dose interval will continue to be monitored and assessed by the province in partnership with the federal government,” said David Jensen.

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Ontario hospitals may have to withhold care as COVID-19 fills ICUs

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By Allison Martell and Anna Mehler Paperny

TORONTO (Reuters) – Doctors in the Canadian province of Ontario may soon have to decide who can and cannot receive treatment in intensive care as the number of coronavirus infections sets records and patients are packed into hospitals still stretched from a December wave.

Canada‘s most populous province is canceling elective surgeries, admitting adults to a major children’s hospital and preparing field hospitals after the number of COVID-19 patients in ICUs jumped 31% to 612 in the week leading up to Sunday, according to data from the Ontario Hospital Association.

The sharp increase in Ontario hospital admissions is also straining supplies of tocilizumab, a drug often given to people seriously ill with COVID-19.

Hospital care is publicly funded in Canada, generally free at the point of care for residents. But new hospital beds have not kept pace with population growth, and shortages of staff and space often emerge during bad flu seasons.

Ontario’s hospitals fared relatively well during the first wave of the pandemic last year, in part because the province quickly canceled elective surgeries.

The College of Physicians and Surgeons of Ontario told doctors last Thursday that the province was considering “enacting the critical care triage protocol,” something that was not done during earlier waves of the virus. Triage protocols help doctors decide who to treat in a crisis.

“Everybody’s under extreme stress,” said Eddy Fan, an ICU doctor at Toronto’s University Health Network. He said no doctor wants to contemplate a triage protocol but there are only so many staff.

“There’s going to be a breaking point, a point at which we can’t fill those gaps any longer.”

In a statement, the health ministry said Ontario has not activated the protocol. A September draft suggested doctors could withhold life-sustaining care from patients with a less than 20% chance of surviving 12 months. A final version has not been made public.

Ontario’s Science Advisory Table had been forecasting the surge for months, said member and critical care physician Laveena Munshi. During a recent shift she wanted to call the son of a patient only to discover he was in an ICU across the street.

“The horror stories that we’re seeing in the hospital are like ones out of apocalyptic movies,” she said. “They’re not supposed to be the reality we’re seeing one year into a pandemic.”

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In COVID-19 vaccination pivot, Canada targets frontline workers

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By Anna Mehler Paperny

TORONTO (Reuters) – Canada is shifting its vaccination campaign to target frontline workers, moving away from a largely age-based rollout as the country tries to get a handle on the raging third wave of the pandemic.

Canada‘s approach thus far has left unvaccinated many so-called “essential workers,” like daycare providers, bus drivers and meatpackers, all of whom are among those at higher risk of COVID-19 transmission. Provinces are now trying to adjust their strategy to tackle the surge driven by new variants.

Targeting frontline workers and addressing occupation risk is vital if Canada wants to get its third wave under control, says Simon Fraser University mathematician and epidemiologist Caroline Colijn, who has modelled Canadian immunization strategies and found “the sooner you put essential workers [in the vaccine rollout plan], the better.”

Initially, Canada prioritized long-term care residents and staff for the vaccines, as well as the very elderly, health workers, residents of remote communities and Indigenous people.

Targeting vaccinations by age made sense early on in a pandemic that ravaged Canada‘s long-term care homes, Colijn said. But now, immunizing those at highest risk of transmission brings the greatest benefit.

“If you protect these individuals you also protect someone in their 60s whose only risk is when they go to the store. … The variants are here now. So if we pivot now, but it takes us two months to do it, then we will lose that race.”

Data released on Tuesday from the Institute of Clinical and Evaluative Sciences showed that Toronto’s neighbourhoods with the highest rates of COVID-19 infections had the lowest vaccination rates, underscoring the disparities in vaccination.

‘IT’S A JUGGERNAUT’

On Wednesday, Ontario Premier Doug Ford announced a plan to have mobile vaccine clinics target COVID-19 “hotspots” and high-risk worksites, although he stopped short of giving people paid time off to get the shot.

Karim Kurji, medical officer of health in York Region north of Toronto, characterizes the shift in vaccination priority from age to transmission risk as moving from defence to offence.

“It’s a juggernaut in terms of the immunization machinery, and turning it around takes a lot of effort,” Kurji said.

Meanwhile, officials in the western province of Alberta say they are offering vaccines to more than 2,000 workers at Cargill’s meatpacking plant in High River, site of one of Canada‘s largest workplace COVID-19 outbreaks. Provincial officials said in a statement they are looking to expand the pilot to other plants.

Quebec will start vaccinating essential workers such as those in education, childcare and public safety in Montreal, where neighbourhoods with the highest vaccination rates have been among those with the lowest recorded infection rates.

The people doing the highest-risk jobs, from an infectious disease perspective, are more likely to be poor, non-white and new Canadians, health experts say. They are less likely to have paid leave to get tested or vaccinated or stay home when sick and are more likely to live in crowded or multi-unit housing. They need to be prioritized for vaccination and their vaccination barriers addressed, experts say.

Naheed Dosani, a Toronto palliative care physician and health justice activist, said making vaccines available to high-risk communities is not enough without addressing barriers to access.

“The face of COVID-19 and who was being impacted changed dramatically. The variants seemed to take hold in communities where essential workers live. … This [pivot] is a step in the right direction and will hopefully save lives.”

 

(Reporting by Anna Mehler Paperny; Editing by Denny Thomas and Aurora Ellis)

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Canada finance minister: Pandemic an opportunity to bring in national childcare

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OTTAWA (Reuters) – The COVID-19 pandemic and its damaging impact on women has underlined the need for a national childcare plan, which would also help the economic recovery, Finance Minister Chrystia Freeland said on Thursday.

Since taking up her job in August, Freeland has repeatedly spoken about a “feminist agenda,” and has said childcare will be part of a stimulus package worth up to C$100 billion ($79.6 billion) over three years. She will unveil details in her April 19 budget.

“I really believe COVID-19 has created a window of political opportunity and maybe an epiphany … on the importance of early learning and childcare,” Freeland told a online convention of Canada‘s ruling Liberal Party.

The budget is set to be a springboard for an election that Liberal insiders say is likely in the second half of the year.

Canadian governments of various stripes have mused about a national childcare program for decades but never acted, thanks in part to the cost and also the need to negotiate with the 10 provinces, which deliver many social programs.

Freeland said a childcare program would help counter “an incredibly dangerous drop” in female employment since the start of the pandemic.

“It is a surefire way to drive jobs and economic growth … you have higher participation of women in the labor force,” Freeland said. “My hope … is that being able to make that economic argument as well is going be to one of the ways that we get this done.”

Freeland, who is taking part this week in meetings of the Group of Seven leading industrialized nations and the International Monetary Fund, said U.S. Vice President Kamala Harris and Treasury Secretary Janet Yellen had told her they saw early learning and child care as a driver for economic recovery.

($1=1.2560 Canadian dollars)

 

(Reporting by David Ljunggren; Editing by Leslie Adler)

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