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Getting a flu shot during the COVID-19 era: Here's what you need to know – CBC.ca

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Canadians are about to face yet another challenge in the COVID-19 pandemic: the arrival of flu season. 

Hoping to avoid what some have termed a “twindemic” — an influx of people becoming ill as influenza and the new coronavirus circulate at the same time — health experts say it’s more important than ever to get the flu shot. 

“If you haven’t received the vaccine in previous years, this is the year to get it,” said Dr. Danuta Skowronski, an infectious disease expert specializing in influenza and emerging respiratory illnesses at the B.C. Centre for Disease Control. 

Anticipating an increased demand for the flu shot, the provinces and territories have collectively ordered 22 per cent more doses of the vaccine (13.7 million) compared to the amount ordered by the same time last year (11.2 million), according to the Public Health Agency of Canada. 

“This is the highest order ever placed in Canada for seasonal influenza vaccine,” the agency said in an email to CBC News. 

Here, experts weigh in on some questions you may have about getting a flu shot during the pandemic.

Why is it so important to get the flu shot this year?  Will it protect me from COVID-19?

No, the flu shot won’t protect you from COVID-19. But it’s important to protect yourself from influenza for several reasons, experts say. 

‘If you haven’t received the vaccine in previous years, this is the year to get it,’ says Dr. Danuta Skowronski, an infectious disease expert at the B.C. Centre for Disease Control. (B.C. Centre for Disease Control)

Flu often takes an enormous toll on the health-care system, so it’s vital that people do what they can to reduce their chances of getting it. Otherwise, hospitals and health-care facilities could become overwhelmed if they need to treat both flu and COVID-19 patients. 

There is an “overlap” in the people who are at especially high risk of critical illness from influenza and from COVID-19, Skowronski said, including seniors and people with underlying health conditions.   

“It is particularly important this year that those with high-risk conditions receive the influenza vaccine so that we are not utilizing critical hospital beds for influenza that could be used for those with COVID, [where] there is currently no vaccine,” she said.   

Getting a flu vaccine could also help reduce “unnecessary testing” for COVID-19, Skowronski said, because several symptoms of both illnesses are similar. 

In addition, it’s not known whether people will become co-infected with both flu and COVID-19 at the same time — and what the consequences of that combination could be, said Dr. Jacob Rosenberg, a pediatrician in Woodbridge, Ont. 

At this point, children don’t appear to be highly susceptible to COVID-19, Rosenberg said, but they’re at high risk for flu. It’s not clear what would happen if they contracted both. 

“It is super important for every child over six months of age to get the flu vaccine,” he said.  

Pediatrician Dr. Jacob Rosenberg (pictured before the COVID-19 pandemic) says it’s critical for children over six months of age to get the flu vaccine this year. Children are considered high risk for influenza and although they don’t usually get critically ill from COVID-19, it’s not known whether co-infection with flu could change that. (Craig Chivers/CBC)

Pediatric immunization against influenza will not only help protect the child, but also protect others who are vulnerable, Rosenberg said, because unlike with COVID-19, children are often “super-spreaders” of the flu. 

When can I get my flu shot?

The flu vaccine is expected to be available at its usual time in Canada this year, starting in mid-September with most deliveries completed by the end of October, the Public Health Agency of Canada said in an email. 

But it’s already available in some parts of the U.S.  Shouldn’t it be available in Canada sooner if the demand is high?

Rosenberg used to practise in New York, where the flu vaccine was available in early September and sometimes even late August.

In Ontario, his clinic usually receives the vaccine in early October, he said.  Normally that’s OK — but this year he and his colleagues are worrying about how they will vaccinate all their patients before the flu season picks up, with the combination of increased demand and the inability to give the shot to as many patients each day due to the COVID-19 physical distancing requirements that have put an end to crowded waiting rooms. 

CBC News asked the Public Health Agency of Canada why the U.S. gets its vaccine supply before Canada, but the agency was unable to provide an answer before deadline. 

Skowronski said it’s partly because the U.S. has to vaccinate many more people, given their population is so much larger than Canada’s. 

Drive-through flu vaccine clinics, similar to this drive-through COVID-19 assessment centre in Toronto, may be an option this year to keep both patients and health-care workers safe from coronavirus transmission. (Evan Mitsui/CBC)

But she’s confident that Canadians will get their flu vaccinations in time, noting that in the past, “we have deliberately gone … with an end of October, beginning of November-type rollout because we want to ensure that the protection is optimal when we expect influenza to be circulating and in particular when it’s peaking.”

That peak normally happens around January, Skowronski said, and health-care providers want to ensure the protective antibodies from the flu vaccine last right through to the end of influenza season in the spring.  

In many jurisdictions, high-risk groups, including people in long-term care homes, hospitals and seniors will be prioritized to get the earliest available flu vaccine doses.   

Will COVID-19 change how I get the flu shot this year?

Yes. In previous years, you may have gone to a crowded doctor’s office or walked into your local pharmacy to get a flu shot on the spot. 

This year, physicians, nurses and pharmacists will be wearing personal protective equipment, spacing out when patients arrive to ensure physical distancing, and requiring them to wear a mask while they get their flu shot.   Patients will also be screened for COVID-19 symptoms or exposure and should stay home and reschedule their appointment if they don’t feel well. 

Shelita Dattani, director of practice development with the Canadian Pharmacists Association, expects that pharmacists will give even more flu shots than usual this year because of increased demand and reduced in-person access to some primary-care providers during COVID-19. (Canadian Pharmacists Association)

About 35 per cent of flu vaccinations in Canada are given by pharmacists each year, said Shelita Dattani, director of practice development with the Canadian Pharmacists Association.  She’s expecting that as some family practice clinics have cut down on in-person appointments during COVID-19, pharmacists may be giving many more flu shots this year — and they’ve been preparing for months, she said. 

“For sure, we are going to be having to do things differently this year,” Dattani said. 

You may need to make an appointment instead of just walking in, she said, noting that some pharmacies have already been taking reservations for flu vaccinations. 

Other safety measures may include having people wait outside instead of “sitting in the pharmacy or browsing through the greeting card aisle.”

For the first time this year, pharmacists in some jurisdictions, including Ontario, will be able to administer the high-dose influenza vaccine for seniors. 

Public health agencies are also suggesting that primary care providers set up drive-through flu vaccination clinics or outdoor clinics when possible.  Community centres with a lot of space where physical distancing is possible have also been suggested.  

Will the flu shot put me at greater risk of getting COVID-19?

No.  That’s misinformation that has been refuted multiple times, said Skowronski, the infectious disease expert.

“Receiving the seasonal influenza vaccine will not affect your risk of COVID-19. It will neither protect you from COVID-19, nor will it increase your risk of COVID-19 infection,” she said. 

Skowronski has reviewed many studies and conducted research in this area herself after people expressed this fear about the influenza vaccine in relation to other respiratory illnesses in years past. That research included a series of randomized placebo-controlled trials involving thousands of children and elderly participants.   

When people started raising the question again after COVID-19 emerged, she and her colleagues did another analysis last spring, looking for any association between influenza vaccinations and increased risk of infection with other coronaviruses and found none.  

“Vaccines are specific in their effects. If that were not the case, we would have a universal vaccine against all respiratory infections, and we don’t,” she said.

Would the flu shot have an impact of the effectiveness of a COVID-19 vaccine, should one be developed soon?

No — the same logic applies, Skowronski said. 

The flu vaccine has a specific effect on stimulating immunity against influenza strains, while an effective COVID-19 vaccine would provide protection against that coronavirus.  

How long does it take the flu vaccine to work?

Antibodies begin building right away, Skowronski said, but it takes two weeks to reach the full level of protection. 

How many people got the flu shot last year?

In the 2019-20 influenza season, 42 per cent of Canadian adults got the flu shot, according to the Public Health Agency of Canada.  The number was much higher — 70 per cent — among seniors 65 years of age and older.

What do we know about how effective this year’s flu vaccine will be?

The effectiveness will depend on how close a match there is between the influenza strains this year’s flu vaccine protects against, and which strains end up circulating in Canada’s flu season.

As usual, the World Health Organization made its recommendations in February on which strains of Influenza A and B vaccine-makers should prepare for. 

But as for which strains will circulate, it’s too early to tell, both public health and infectious disease experts say, because normally predictions are made based on flu infections in Australia, which has its peak influenza period during Canada’s summer. But this year, the number of  flu cases were so low that it’s difficult to collect data. 

That’s largely because the same precautions for COVID-19 — physical distancing, handwashing, staying home when sick and wearing a mask  — also help prevent the spread of other respiratory illnesses such as the flu, Skowronski said.  

An infectious disease specialist answers viewer questions about a COVID-19 vaccine including what stage vaccine development is in and when the public could expect one to be ready.  2:58

In addition, she said, her global counterparts reported an increase in the number of people who got the flu shot  — so the combination may have contributed to “exceptionally low influenza activity” in the southern hemisphere. 

She’s optimistic because the World Health Organization changed some of the influenza strains in this year’s vaccine to better match what was actually circulating last flu season. 

Plus, Skowronski said, the low influenza activity in the southern hemisphere means the virus may be less likely to have mutated by the time it reaches the northern hemisphere, because it wasn’t pressured to adapt to people’s immune systems as much as usual.  That could also make this year’s vaccine more effective, she said. 

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The financial impact of COVID-19 on Manitoba Liquor and Lotteries – CTV News Winnipeg

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WINNIPEG —
Manitoba Liquor and Lotteries Corporation’s net income was $24 million below the budget, according to the province’s fiscal update.

The numbers, released Tuesday, states the lower than anticipated revenue is due to impacts from COVID-19, including declining attendance and the closure of casinos and VLT networks in March.

The Casinos of Winnipeg began experiencing declining attendance in the last month of 2019/20, and on March 18, 2020, the provincial government required all Manitoba casinos to close.

For March 2020, revenues were nearly 70 per cent lower than the same period of 2018/19. 

The annual report said revenue from casinos dropped $8.6 million this year, a 3.4 per cent decline.

During the month of March, bars and restaurants across Manitoba began to close voluntarily due to reduced business, as patrons heeded physical distancing and stay-at-home recommendations. VLT revenues were 40 per cent lower compared to March 2019, and liquor sales to licensees were also down 24 per cent in March 2020 compared to the prior year. 

All other liquor channels experienced strong sales in March 2020, led by Liquor Marts at 29 per cent above March 2019.

Liquor revenue jumped by $13 million, mostly from sales at Liquor Marts.

Cannabis sales nearly doubled, bringing in nearly $51 million in 2020, compared to just under $27 million.

Casinos in Manitoba began reopening on July 25. 

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Coronavirus: 429 new cases as public health officials ‘less optimistic’ than last week – The Irish Times

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A further 429 confirmed cases of Covid-19 were reported by the National Public Health Emergency Team (NPHET) on Wednesday. This brings to 36,155 the total number of cases of the disease in the Republic.

Some 189 of the new cases are in Dublin, and 60 in Cork. There were also 31 cases in Donegal, 28 in Galway, 18 in Kildare, 15 in Wicklow, 15 in Clare, 12 in Limerick, nine in Meath, nine in Louth, seven in Cavan, seven in Longford, six in Laois, five in Offaly, five in Westmeath, with the remaining 14 cases in eight counties.

One further death was reported to NPHET, bringing the total number of deaths to 1,804.

The reproduction number, an indicator of how widely the disease is spreading, now stands at between 1.2 and 1.4, according to Prof Philip Nolan, chair of the NPHET epidemiological modelling advisory group. A reproduction number of less than 1 means an epidemic is dying out; a figure greater than 1 signals it is spreading.

“While we are cautiously optimistic about Dublin, we have seen relatively high case numbers in the last few days, and it will be a number of days yet before the pattern is clear,” Prof Nolan told a briefing on Wednesday.

“Case numbers are clearly rising across the country. We need to remain vigilant, to ensure we do not lose the ground that we have gained across the capital city since we moved to Level 3, and to ensure we do not see further deterioration outside the capital.”

Of the new cases, 203 are men and 226 are women. Sixty-five per cent are under 45 years. Officials say 45 per cent are associated with outbreaks or are close contacts of cases, while 77 cases involved community transmission.

There are currently 130 people with Covid-19 in hospital, including 15 admissions in the past 24 hours, according to acting chief medical officer Dr Ronan Glynn.

“Recently we asked everyone to halve their social contacts,” he said. “Reducing the number of people that we meet – and engaging safely with a small core group – remains the cornerstone of our collective effort to reduce the spread of this virus and its impact on our health and the health of the people that we care about.”

He said that while school-age cases were stable, there had been a sharp rise in cases among 19-24 year-olds and the rise in cases among over-65s was of concern.

Older people were at “grave risk” of a spillover of cases among people of working age, he said.

Rejecting the “narrative” that the disease was less severe of dangerous than before, Prof Nolan said Covid-19 was “as fatal as it ever was to some sectors” while young people were vulnerable “in a different way”.

Public health officials gave examples of recent clusters that have occurred in the west.

One cluster of 30 cases arose after a young couple went away for a weekend and attended a house party. This resulted in six to eight cases, and cases in three to four households. On the second day of their trip, they went with friends to a town centre, resulting in four more cases.

They attended a bar, where six people at an adjacent table, and four staff, tested positive. They then went on to a “drinks venue”, where four more cases occurred.

In another cluster of 24 cases involving intergenerational social mixing, the outbreak started in a small rural place where middle-aged people had gathered. There was socialising in a pub and workplace and further transmission occurred in the pub over the weekend. Fourteen of the cases were directly linked to socialising and 11 involved people aged between 45 and 70. In the outbreak, there were three family clusters, three schools were affected and also one workplace.

A third example arose from two student parties on the same night. There was mixing between the parties, leading to 21 cases among those on attendance. One of these people then had dinner with a university friend, who later went to class. Later 15 out of 26 people in the class tested positive, giving 36 cases in total. The students were masked and observed social distancing, but public health officials believe transmission occurred during break-time.

So far, 87 cases have been detected in schools, out of 4,455 tests carried out, the briefing heard.

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Race for a COVID-19 vaccine raises cost, safety—and trust—issues – The Georgia Straight

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As COVID-19 numbers rise again, the prime minister has re-emerged as a regular fixture at daily government briefings.

On September 25, Justin Trudeau announced that the federal government has signed another agreement to buy a vaccine. This time with AstraZeneca for up to 20 million doses of its COVID–19 vaccine.

That brings the number of agreements signed by the government with vaccine manufacturers to seven. The others are with Sanofi, GlaxoSmithKline, Johnson and Johnson, Novavax, Pfizer, and Moderna.

Three of the companies have vaccine candidates in phase three trials. In all, the government has committed to purchasing some 300 million doses from vaccine manufacturers.

The Trudeau government has also announced its participation in the COVID-19 accine Global Access Facility, or COVAX. It’s part of the World Health Organization’s (WHO) effort to deliver “fair, equitable and timely access to COVID-19 vaccines.”

The Canadian government is contributing $220 million to the facility. Its mandate includes delivering vaccines to “low- and middle-income countries.” Canada’s participation in the effort gives it the option of purchasing another 15 million doses of a vaccine.

“We cannot beat this virus in Canada unless we end it everywhere,” Trudeau says.

But while Trudeau is pushing an international approach to find a vaccine, other countries are going it alone.

The COVAX facility is backed by some 172 countries, but the U.S. is not supporting the effort. Neither is China or Russia.

And while the race to find a COVID-19 vaccine has seen unprecedented cooperation between nations, some experts say it seems to be headed for the kind of scenario that plagued the search for a vaccine for AIDS in the ’80s and ’90s.

Back then, pharmaceutical companies and their research and development backers chased profits, making what treatments became available unaffordable for many, especially in the developing world.

In Canada, where large pharmaceuticals enjoy high-level access in Ottawa, who pays for a COVID-19 vaccine and whether it is subsidized are also emerging questions.

Canadians could be asked to pick up some of the cost.

“There’s a lot of money on the table,” says Thomas Tenkate, an associate professor at Ryerson University’s School of Occupational and Public Health.

He notes that pharmaceutical companies and their shareholders have historically placed a steep price on their research and development of new drugs.

While vaccines developed in the world have been distributed universally—polio comes to mind—the scenario with COVID-19 is shaping up to be much different. In all likelihood there will be multiple manufacturers distributing their own variations of the vaccine in different countries.

“With so many clinical trials on the boil you’ve got to think there will be a range available,” Tenkate says.

Tenkate says most researchers and countries will be looking to see what the U.S. does. “There’s a lot of political pressure in the U.S. to have something done [a vaccine] quickly.”

FDA approval usually opens the floodgates to approvals in other countries. But not necessarily in Canada, where Health Canada rules around the approval of new drugs are notoriously stringent.

At his press conference, Trudeau made a point of stressing that any vaccine approved for distribution in Canada will have to pass Health Canada standards. But that process can also be prone to politics.

Questions of transparency, for example, were recently raised about the government’s own Vaccine Task Force. The task force is made up of infectious disease experts and representatives of pharmaceutical companies. It’s advising the government on what research projects to explore.

Gary Kobinger, director of the Infectious Disease Research Centre at the Université Laval, quit the group last week citing potential conflicts among group members as a reason. “You need people to trust the vaccine,” Kobinger told the CBC.

The government responded by bringing in protocols that require potential conflicts of task force members to be made public.

It usually takes anywhere from five to 10 years to develop a vaccine. But the big money is on a vaccine for COVID-19 by next spring or a little later. That’s a year and a half roughly since the onset of the disease.

Russia is already claiming to have developed a vaccine. The U.S. says it’s close. China has said a vaccine may be ready by November. The predictions are overly optimistic. Most of the larger clinical trials have just started in recent months.

There are some 126 clinical trials on the WHO’s radar. Some 26 involve human trials. Nine of those have reached phase three, but none will be completed until late 2022 at the earliest.

The largest human trial of 60,000 participants by Belgium-based Johnson and Johnson company Janssen Pharmaceutica won’t be completed until 2023, according to documents submitted to WHO.

The company says that it “anticipates the first batches of a COVID-19 vaccine to be available for emergency use authorization in early 2021, if proven to be safe and effective”.

Further monitoring of subjects after the trials are completed will be needed to make sure any side effects are manageable.

Tenkate worries that “corners may have to be cut because of the reduced timelines” to find a vaccine.

Whatever vaccine we end up with in the short term will be more akin to treatment than a cure.

When politicians talk about a vaccine for COVID-19, it’s easy to jump to conclusions, but there is no magic pill. And there won’t be for some time, given that almost 20 years later there is no vaccine for SARS—COVID-19’s, genetic predecessor.

The danger with a COVID vaccine is that we will, in all likelihood, not know enough about the side effects.

Each country will have its own approval process. And while the rules around those “are pretty consistent around the world,” says Tenkate, there are differences. What is greenlighted for sale in Russia may not receive approval in other Western countries.

For Canada, it will come down to “understanding the risks,” Tenkate says, particularly with the possibility of multiple vaccines. “Ultimately, for a lot of people, it’s going to come down to trust.”

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