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'Lockdown light' failed in Canada's hardest-hit regions. Here's what experts say should happen now – CBC.ca

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There’s no getting around it — lockdown measures don’t seem to be working in Ontario and Quebec the second time around.

Health experts say Canada’s hardest-hit provinces have consistently failed to contain the spread of COVID-19 with inadequate, poorly timed restrictions, leaving little choice but for much more draconian rules to be introduced.

But where exactly did we go wrong? And where do we go from here?

Despite declaring lockdowns as they’d done to control the spread of COVID-19 in the pandemic’s first wave, Ontario and Quebec hesitated to impose strict enough measures to prevent an even deadlier second wave, some experts say.

“The first lockdown was extreme. Everything was closed, everything, and people were really discouraged from even leaving their houses as well. People were terrified and so they were more likely to comply,” said Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa.

“Now, there isn’t a lockdown — some businesses are closed but many are open still. So people are still going about their business, people are still socializing, because the fear is gone.”

‘It just keeps getting worse’

In the spring, when much of the country went into widespread, severely restrictive lockdowns to stop the mysterious spread of a new virus we knew little about, the high level of compliance was obvious.

“Nobody was on the street. It was like a neutron bomb went off,” said Dr. Michael Gardam, an infectious diseases expert in Toronto and senior medical adviser for Health PEI.

“And if you compare that to today, the highways are full, there are people everywhere. There is so much more interpersonal contact now than there was back in the spring, and I think that’s your answer — it’s not the same lockdown at all.”

Ontario Premier Doug Ford imposed what he calls a provincewide lockdown on Boxing Day in an effort to address the alarming rise of COVID-19 cases, hospitalizations and deaths.

Since then, new daily cases have actually doubled — from 2,123 when the restrictions were announced on Dec. 21 to 4,249 on Friday — although the full impact of the measures may not yet be seen.

WATCH | Ontario premier implores people to follow public health protocols, talks about state of pandemic:

Ontario Premier Doug Ford says new models forecasting coronavirus cases will show the province is in ‘a desperate situation’ and he warns new measures are coming to try to curb the spread. 1:03

“We’re in a desperate situation,” Ford said during a news conference Friday. “There will be further measures, because this is getting out of control.”

Despite his alarm, the premier didn’t actually announce any new measures.

But two weeks after the new lockdown was put in place, as the head of the Ontario Hospital Association warns of looming disaster, it’s clear to some experts that much more needs to be done.

“Ontario keeps opting for ‘lockdown light.’ It just doesn’t get aggressive enough, and so you have this slow trickle of increase which has just really worn everybody down to the absolute maximum,” said Gardam. “Everybody in health care is so exhausted and yet there’s more coming and it just keeps getting worse.”

Hesitation led to worsening situation

Ashleigh Tuite, an infectious disease epidemiologist and assistant professor at the University of Toronto’s Dalla Lana School of Public Health, said the problem is that Ontario and Quebec tried to be more strategic with their lockdowns in the second wave.

Non-essential businesses were left open, travel wasn’t restricted effectively, and the provinces only reacted when the situation turned dire.

“At this point, we’re on a pretty scary trajectory if you look at the ICU numbers, if you look at the hospitalizations and if you look at what’s happening in long-term care,” she said. “If you talk to people who work in public health, there is this sense of dread in terms of what is happening right now and what is to come.”

Paramedics transport a resident from Midland Gardens Care Community in Toronto on Tuesday. (Evan Mitsui/CBC)

The situation is so bad that Ontario is now preparing hospitals to transfer potentially hundreds of patients to different regions of the province amid a shortage of beds and an unrelenting rise in COVID-19 levels in several hot spots.

Dr. Susy Hota, an infectious disease specialist at the University Health Network and an assistant professor of medicine at the University of Toronto, said the “critical pressures” on the health-care system are even worse now than in the first wave.

“I’m not sure how much longer the hospitals are going to be able to accommodate the volumes of COVID patients coming in,” she said. “We can maybe hold our fort for a little bit, but at any point in time we can tip over.” 

In response to the worsening situation in hospitals and the unprecedented surge in COVID-19 cases, the Ontario government seems to be hesitating once again before deciding whether to implement new restrictions.

“We need to approach this like the crisis that it is. We also need to adopt the mindset that every day is a new day, and start afresh with our approach if needed,” said Dr. Irfan Dhalla, vice-president of physician quality at Unity Health, which includes St. Michael’s and St. Joseph’s hospitals in Toronto. 

“We need to be communicating clearly, and not sending mixed messages. We need to use restrictions and lockdowns to reduce transmission substantially, and only open up when we have the capacity to contain the virus with public health interventions like testing, contact tracing, and quarantine.”

WATCH | Quebec imposes a curfew: 

Quebec has imposed a nightly curfew from 8 p.m. to 5 a.m. as part of a four-week provincial lockdown aimed at reducing the spread of COVID-19 after record cases have put a strain on the health-care system. 2:00

Quebec has taken the extraordinary step of implementing an 8 p.m. to 5 a.m. curfew, beginning Saturday and running for the next four weeks, which is the first of its kind in Canada since the pandemic began.

“The upcoming month is going to be a critical one,” Premier François Legault said at a news conference Wednesday where he announced the new measures. “We are in a race against time.”

But critics were quick to point out the new restrictions didn’t include any limits on the manufacturing or construction sectors or a prolonged break for schools, which, combined, have accounted for a large portion of outbreaks in recent weeks.

“All policymakers can do is create environments and incentives and disincentives to encourage certain behaviours,” said Deonandan. 

“Ultimately, it’s always up to the people to do what needs to be done.”

Will stricter measures work? 

While the decision to impose a curfew has come under fire from some health experts and advocates and the effect it will have on COVID-19 levels in Quebec remains to be seen, Hota says it will likely make an impact.  

“It certainly sends a clear message to people that the expectation is we don’t see people on the street,” she said. 

Its success will depend on how well it is enforced, she said.

“If you are breaking the rules, then who’s actually going to call you on it? Or are we just going to let it happen?”

Gardam says a stricter lockdown in Ontario would likely help drive cases down to manageable levels. He suspects the government’s hesitance may be due to the potential political fallout. 

“The solution to this is available and it’s been proven,” he said. “It’s just really unpalatable for politicians to do that, and so they keep skirting around it.”

Gardam says if Ontario brought in the type of lockdown that Australia successfully used to control the spread of COVID-19 in its first wave, the province would be in a much better situation. 

When Australia was hit with a surge of COVID-19 cases in late July, it prompted one of the world’s longest lockdowns in Melbourne that closed virtually everything that wasn’t a grocery store or hospital for nearly four months.

“If you brought in a very strict lockdown like that, your cases would go down,” he said. “We’ve got ample evidence of that from other parts of the world.”

He said the length of the lockdown would depend on how quickly cases dropped.

Police officers and soldiers patrol Treasury Gardens as they enforce strict lockdown laws in Melbourne, Australia, on Aug. 5, 2020. (William West/AFP/Getty Images)

Deonandan said he’s concerned more severe lockdowns may lead to more resistance from the public.

“Ultimately, if people are not willing to comply, it’s going to fail,” he said. “The tighter we put these restrictions, the more likely people push back on them.”

While the best approach would be to try to drive the case numbers down as quickly as possible, that may not be politically or psychologically possible, he said.

“Do I think people have a tolerance for that? Honestly, I don’t think so.”

Clear message

But Hota says anything short of drastic restrictions now will once again fall short of addressing a second wave that is quickly on the verge of getting out of control in hospitals.

She acknowledges that’s a lot to ask, given that people have already been told to stay home for almost a year at this point. But the reality, she said, is it’s going to take more than just a four-week circuit breaker-type lockdown to turn things around.

Making it work requires providing very clear advice on what is allowable and what’s not, she said.

“If we choose not to, then we have to live with this, which is not sustainable from my perspective.”

The key as Dhalla sees it, is to better apply all that we have learned in the past 10 months so we can contain the pandemic once and for all.

“Then, we can manage sporadic, local outbreaks the way they are managed in Asia, Australia and New Zealand, all while we continue to vaccinate people as fast as we can.”

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Trudeau says Canada-U.S. relations need to rebuild. Just how bad did it get with Trump? – CBC.ca

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When Justin Trudeau met virtually with U.S. President Joe Biden this week, the prime minister suggested that relations between the two countries had taken a significant hit during Donald Trump’s administration, noting that “there’s a lot to rebuild.”

Tensions over trade culminated in tariff battles during Trump’s term in the White House, and his use of Twitter to blast the prime minister certainly put a chill on their relationship.

However, despite the often-tense relationship between the Trudeau and Trump, tough deals were still forged, including a revamped NAFTA agreement, while the countries continued to co-operate on longstanding issues.

“The relationship between the United States is so deep and so broad that you can’t characterize it simply in terms of whether or not an individual president and a prime minister get along” said David MacNaughton, Canada’s ambassador to the U.S. from 2016 to 2019.

“Having said that, I think it is of huge value if they do,” he said. “There are times when having that kind of close personal relationship can make a difference. So I think it’s desirable, but it’s not essential.”

Yet MacNaughton said the reality was that Canada and U.S. continued to have a constructive relationship on the meaningful files.

David MacNaughton was Canada’s ambassador to the U.S. from 2016 to 2019. (Graham Hughes/The Canadian Press)

For example, the military and intelligence relationship between the two countries continued to be very strong, he said.

While negotiations for the new NAFTA agreement — the Canada–U.S.–Mexico Agreement (CUSMA) — were tough, an agreement was still hashed out, MacNaughton said.

“And frankly, I’m not sure if we were renegotiating NAFTA today, we would have an easier time with [the Biden administration].”

As well, key figures from Donald Trump’s administration were able to forge strong relations with Canada and members of Trudeau’s team. Sonny Perdue, the U.S. secretary of agriculture was a “great friend,” while former treasury secretary Steven Mnuchin and former finance minister Bill Morneau “got along really well,” MacNaughton said.

Governors and premiers

And as CBC’s Aaron Wherry chronicled in his book Promise and Peril: Justin Trudeau in Power, Trudeau’s chief of staff, Katie Telford built a rapport with Trump’s son-in-law Jared Kushner, who was also a senior adviser to the president.

Even Trump’s controversial chief strategist Steve Bannon had said he had developed a good relationship with Trudeau’s Gerald Butts, Trudeau’s principal secretary from 2015 to 2019.

Then there are the on-going Canada/U.S. relationships between governors and premiers, MacNaughton said. On a regular basis, the Atlantic, Western and Great Lakes premiers get together with their New England, Great Lakes and Western governor counterparts.

Steven Mnuchin, right, treasury secretary in the Trump administration, and Bill Morneau, who served as Canada’s finance minister from 2015 to 2020, were said to have had a good relationship despite tension between Trump and Trudeau. (Pablo Martinez Monsivais/The Associated Press)

As well, there are bilateral mayoral, business and union relationships, he said. 

“So to say the relationship was broken is putting too much emphasis on Donald Trump’s M.O.”

Chris Sands, director of the D.C.-based Wilson Center’s Canada Institute, said so much in the Canada/U.S. relationship is managed by unknown bureaucrats who continued working behind the scenes and were “getting important things done.”

That Canada was able to make a deal to keep the border restricted but not closed following the COVID-19 pandemic was a testament to the co-operation and trust we have [for] the Canadians,” he said.

‘Knows how to get things done’

“I don’t want to say that it was magic, but it was really good and it was a sign of a relationship that knows how to get things done,” Sands said.

“There were a lot of things that weren’t fun but they did get done in the Trump era and they’re still getting done now.”

Still, relations “did get pretty bad” as “trust was eroded over the last four years, particularly on the Canadian side toward the U.S,” said former American diplomat Scotty Greenwood, who spent four years as chief of staff of the U.S. Embassy in Canada.

“I do think that the relationship suffered. I do think the relationship between the leaders matters,” she said. “While there’s a certain inevitability of Canada/U.S. relations, there are still times when you really benefit from a good working relationship at the top to solve thorny issue or to create big opportunities.”

Some of the tension between Trump and Trudeau seemed to be sparked by Trump’s ire with Canada/U.S. trade deals and what he saw as Canada having an unfair trade advantage. (Sean Kilpatrick/The Canadian Press)

On that front, relations at the top were at times tumultuous with the president. 

And some of that, at least, seemed to be sparked by Trump’s ire with Canada/U.S. trade deals and what he saw as Canada having an unfair trade advantage.

In 2017, Trump called Canada a “disgrace” for policies that he said hurt American farmers and would tweet a year later that “I love Canada but they’ve taken advantage of our country for many years!”

What eventually followed was the tense renegotiation of NATFA. But before that, Trump in June 2018, in the days leading up to the G7 leaders summit in La Malbaie, Que., slapped tariffs on Canadian steel and aluminum imports.

This prompted a reportedly tense call between Trudeau and Trump over the tariffs. Trump reportedly at one point asked: “Didn’t you guys burn down the White House?” — a reference to the War of 1812.

‘Dishonest and weak’

The rhetoric became more heated after the summit, when Trump got word that Trudeau had said the tariffs were insulting and that Canada wouldn’t be pushed around. Taking to Twitter,  Trump lashed back that the prime minister was “very dishonest & weak.”

Later, Trump’s trade adviser, Peter Navarro, remarked there was “a special place in hell” for Trudeau, while Trump’s chief economic adviser, Larry Kudlow, said Trudeau had “stabbed us in the back.”

Such level of diplomatic vitriol prompted former prime minister Brian Mulroney to observe he had “never seen language like this. Least of all from subordinates of the president directed at the prime minister of their greatest friend and ally.”

WATCH | Trudeau caught complaining about Trump’s lateness:

PM Justin Trudeau, France’s Emmanuel Macron, UK PM Boris Johnson and other VIPs shared a few words at a Buckingham Palace reception Tuesday – and seemed to be talking about U.S. President Donald Trump’s lengthy impromptu press conferences earlier in the day. 0:25

A year later, however, there was another flareup. At a NATO summit reception in Buckingham Palace in London, Trudeau was caught on video complaining to British Prime Minister Boris Johnson and French President Emmanuel Macron that Trump was late because “he takes a 40-minute press conference off the top.”

Trump would later respond that while Trudeau was  “a very nice guy,” he’s “two-faced” and was just upset that he had challenged the prime minister to make a greater financial contribution to NATO.

WATCH| Trump responds to Trudeau:

U.S. President Donald Trump says PM Justin Trudeau ridiculed him last evening because he was upset that Trump called him out over low NATO spending. 0:41

Weeks later, Trump would take another shot at Trudeau when he learned his cameo in the film Home Alone 2: Lost In New York had been edited out of CBC’s broadcast. (CBC said it had cut the scene before Trump was president and did it to make way for commercials.) 

“I guess Justin T doesn’t much like my making him pay up on NATO or Trade!” Trump tweeted.

21-second pause

The relationship would come into focus again in June 2020 when Trudeau made headlines for his 21-second pause after being asked about Trump’s threat to use military force against protestors in the U.S.

WATCH | Trudeau’s 21-second pause:

Asked about U.S. President Donald Trump threatening the use of military force against protestors in the United States, Prime Minister Justin Trudeau paused for 21 seconds before saying “we all watch in horror and consternation.” He did not comment on Trump. 2:59

Relations would be tested a few months later when Trump again slapped a tariff on Canadian aluminum, only to back down after Canada was set to impose retaliatory measures.

Yet despite these tensions, Trudeau was still able to work out and maintain a relationship with Trump, said former Canadian diplomat Colin Robertson.

“It was difficult, but every Western leader had difficult relationships with Mr. Trump.”

Robertson said while other Western leaders gave up, Trudeau kept trying.

Most important relationship

“He had to because it’s our most important relationship,” Robertson said. “The one relationship our prime minister has to get right is the relationship with the United States.”

Greenwood, the former diplomat, said in an ironic twist, Trump’s threats to tear up NAFTA and his disruption of the system made the U.S. much more aware of the importance of Canada.

“What happened was the awareness of the economic relationship between the United States is maybe at an all-time high in Congress,” she said. 

Greenwood, however, wondered if the new U.S. administration will be able to build from this new awareness.

“It seems to me the question is how will the prime minister, the president seize on the kind of awareness that now exists in the U.S … where policy makers appreciate more than ever our interconnectedness with Canada.”

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COVID-19 cases are down across Canada, but hospitals aren’t celebrating yet. Here’s why – Global News

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As provinces clamp down on non-essential travel and Canada continues its rollout of the COVID-19 vaccine, new cases of the novel coronavirus have seen a relative decline across the country.

According to the country’s top public health official, new infections now stand at a national seven-day average of 2,960 cases daily — down from the average 5,270 cases exactly a month earlier. Several health experts and government officials have also said that the country was still on its way to meet its September target of having everyone who wants a vaccine inoculated.

Despite the positive outlook, hospitals and health-care workers aren’t celebrating just yet.

Read more:
Montreal ‘once again the epicentre’ of COVID-19 crisis as city adds hundreds of hospital beds

A report published by the Canadian Institute for Health Information on Thursday found the total number of health-care workers infected with COVID-19 has tripled since July of last year. By Jan. 15, the institute said health-care workers accounted for at least 65,920 — over nine per cent — of Canada’s 695,707 confirmed cases then.

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The CIHI report also added 24 health-care workers have died from the virus since the start of the pandemic, including 12 in Quebec, Ontario, Manitoba and Alberta within the last six months.

Gillian Howard, vice-president at University Health Network in Toronto, told Global News that the organization has seen an overall decrease in COVID-19 patients over the last two weeks, but that the health-care system was still in danger of being overwhelmed.

As of last week, she said 95 per cent of the UHN’s beds were occupied and that ICUs were still full — which could pose problems for health-care workers should the COVID-19 variants trigger a third wave.


Click to play video 'Alberta doctor shares experience designing COVID-19 wards at Edmonton hospital'



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Alberta doctor shares experience designing COVID-19 wards at Edmonton hospital


Alberta doctor shares experience designing COVID-19 wards at Edmonton hospital

“The concern is that the variants, which are present in the community, will drive a third wave and that if patients with COVID are admitted to the ICU, the length of stay is much longer than usual,” she said.

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“The other concern is the delay in surgeries and procedures for patients who require ICU beds following surgery or because of other health issues.”

‘Psychological trauma’ for years to come

The decreasing case numbers of COVID-19 are encouraging, but Dr. Ann Collins, president of the Canadian Medical Association, noted that “it’s too early to celebrate.”

“No question it is good news, but we still have to be very mindful of the variance and what’s happened in other parts of the world,” she said.

The aggressive nature of the variants is concerning, Collins said, adding that health-care workers are still under a great deal of pressure.

“Being stressed is probably an understatement in many ways,” she said.

Read more:
New variants spark fears of turmoil at Scarborough hospitals after 11 straight months of battling coronavirus

Even as cases fall, Collins said many health-care workers — particularly those working in the country’s COVID-19 hotspots — are exhausted, face severe burnout and have been forced to completely isolate themselves from family and friends due to the nature of their jobs.

[ Sign up for our Health IQ newsletter for the latest coronavirus updates ]

Health-care workers have the added stress of working directly with sick patients who have developed anxiety or depression due to their illness.

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“They’ve had to become almost like family to patients that they’ve been caring for in the latter days of their lives because no family has been able to be there with them because of restrictions around visitation and so on,” said Collins.

“We expect to see some psychological trauma well beyond whenever we say that this is over.”


Click to play video 'Some provinces ease restrictions as variant concerns rise'



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Some provinces ease restrictions as variant concerns rise


Some provinces ease restrictions as variant concerns rise – Feb 16, 2021

Anthony Dale, president and CEO of the Ontario Hospital Association, said that COVID-19 has put pressure on our health system that was “unimaginable a year ago.”

As a result, he said hospital staff have also been re-deployed to provide support to a number of non-hospital services — whether it’s running COVID-19 assessment centres and laboratories, working closely with long-term care homes to protect residents or on Ontario’s vaccination rollout.

According to Dale, the only reason such staff redeployments were even possible in the first place was because COVID-19-related hospitalization crowding cancelled most scheduled and elective surgeries.

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Read more:
‘The problem will be mostly staffing’: Ontario ICU doctor on hospital COVID-19 capacity concerns

“Now we have new, highly contagious variants that are circulating in the province, a vaccination roll out that continues to be delayed and a health care system operating under significant stress,” he said.

“A month ago we saw an all-time high of 420 COVID-19 patients in our ICU, while that number has decreased we remain at an alarming 325 patients, which represents almost 20 per cent of open ICU beds today.”

Some provinces seeing improvement

Out of the country’s ten provinces, many say hospitals are now less full than they were at the height of the pandemic, though several still warn of several regions continuing to face strain in terms of capacity.

Last month, Ontario’s hospitalizations peaked at 1,701 patients — including 385 in the ICU, though the numbers have dropped dramatically over the last month to just 680 current hospitalizations due to the virus.

The COVID-19 Modelling Collaborative — a joint collaboration between doctors and scientists from the University of Toronto, University Health Network and Sunnybrook Hospital — said this week that ICU resources were still strained in “every region” and that 43 per cent of Ontario’s surgical ICU’s had fewer than two available beds, however.

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Saskatchewan also peaked last month at a total of 238 hospitalized patients, including 33 in the ICU, due to the virus. The number has lowered to that of 135 receiving inpatient care and 16 in the ICU as of Saturday.

Manitoba also saw a gradual decline after peaking at just over 360 hospitalizations in December. As of Saturday, the province registered 189 current hospitalizations due to the virus, of which 27 were admitted to the ICU.

A spokesperson from Manitoba’s Department of Health and Seniors Care said in a statement there were no hospitals within the province currently at or approaching capacity.

Read more:
‘Tremendous cost’: Coronavirus hospitalizations soar as vaccine raises hope

“As of midnight today, 206 individuals are in hospitals throughout the province due to COVID, the lowest number seen in this province since early- to mid-November. This includes both active patient cases and those who are past the infectious period but still sick enough to require inpatient care,” the statement read.

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Alberta’s demand on its health system from the spread of COVID-19 had also peaked in late December. Despite the decline, the province said that the demand still remained high and warned that a rapid growth in cases would have consequences on its health system.

“We are maintaining the health system’s high capacity right now. If Alberta experienced the same sort of rapid growth that occurred in November and December while hospitalizations remain high, the health system would be severely impacted,” read the government’s website.


Click to play video 'Quebec worries new COVID-19 variants could derail progress'



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Quebec worries new COVID-19 variants could derail progress


Quebec worries new COVID-19 variants could derail progress – Feb 11, 2021

A total of 5,000 people have been hospitalized there due to COVID-19 since the start of the pandemic, with the province currently at 262 hospitalizations — 51 of which are in ICU.

British Columbia health minister Adrian Dix said last week that the province was in a “fairly stable situation with respect to available beds.”

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He said B.C.’s health-care system was currently operating at 74 per cent capacity, for a total of 3,531 available regular and surge beds. Meanwhile, he added ICU is operating at 51.7 per cent capacity with 367 available beds.

Quebec, which remains the hardest hit among all provinces, now currently sits at 599 hospitalizations, of which 112 are in intensive care.

The numbers are a far cry from the over 1,870 concurrent hospitalizations the province registered during the first wave of the pandemic, though health experts there have recently warned of a possible “nightmare scenario” of having to pick which patients are admitted to ICU and who will die should hospitalizations rise to similar numbers again.


Click to play video 'Coronavirus: Long-term care home residents make up only small fraction of Ontario COVID-19 ICU admissions'



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Coronavirus: Long-term care home residents make up only small fraction of Ontario COVID-19 ICU admissions


Coronavirus: Long-term care home residents make up only small fraction of Ontario COVID-19 ICU admissions – Feb 11, 2021

New Brunswick currently has one person in-hospital with COVID-19, though health systems there have previously warned of staffing and bed shortages caused by the onset of the pandemic.

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In Nova Scotia, there is only one person in-hospital with COVID-19, who has been set up in the province’s ICU, while 10 are currently in-hospital with COVID-19 in Newfoundland and Labrador.

P.E.I. currently does not have any patients with COVID-19 admitted to hospital.

© 2021 Global News, a division of Corus Entertainment Inc.

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U.S. approves Johnson & Johnson's single-dose COVID-19 vaccine – CBC.ca

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The U.S. is getting a third vaccine to prevent COVID-19, as the Food and Drug Administration (FDA) on Saturday cleared a Johnson & Johnson shot that works with just one dose instead of two.

Health experts are anxiously awaiting a one-and-done option to help speed vaccinations, as they race against a virus that already has killed more than 510,000 people in the U.S. and is mutating in increasingly worrisome ways.

The FDA said J&J’s vaccine offers strong protection against what matters most: serious illness, hospitalizations and death. One dose was 85 per cent protective against the most severe COVID-19 illness, in a massive study that spanned three continents — protection that remained strong even in countries such as South Africa, where the variants of most concern are spreading.

“This is really good news,” Dr. Francis Collins, director of the National Institutes of Health (NIH), told The Associated Press Saturday. “The most important thing we can do right now is to get as many shots in as many arms as we can.”

Shipments of a few million doses to be divided among states could begin as early as Monday. By the end of March, J&J has said it expects to deliver 20 million doses to the U.S., and 100 million by summer.

A person is administered the Johnson & Johnson vaccine at a hospital in Cape Town, South Africa, on Feb. 17. (Nardus Engelbrecht/The Associated Press)

J&J also is seeking authorization for emergency use of its vaccine in Europe and from the World Health Organization. Worldwide, the company aims to produce about 1 billion doses globally by the end of the year. On Thursday, the island nation of Bahrain became the first to clear its use.

Health Canada is still reviewing the vaccine. Canada has ordered 10 million doses from Johnson & Johnson with options for up to 28 million more, if necessary. Most of those shots are expected to arrive by the end of September.

‘We’re champing at the bit to get more supply’

On Sunday, a U.S. advisory committee will meet to recommend how to prioritize use of the single-dose vaccine. And one big challenge is what the public wants to know: Which kind of vaccine is better?

“In this environment, whatever you can get — get,” said Dr. Arnold Monto of the University of Michigan, who chaired an FDA advisory panel that unanimously voted Friday that the vaccine’s benefits outweigh its risks.

Data is mixed on how well all the vaccines being used around the world work, prompting reports in some countries of people refusing one kind to wait for another.

WATCH | Will Canadians be able to choose which vaccine they get?:

Doctors answer questions about the latest COVID-19 vaccine news including whether Canadians will be able to choose which one they get. 5:48

In the U.S., the two-dose Pfizer and Moderna shots were 95 per cent protective against symptomatic COVID-19. J&J’s one-dose effectiveness of 85 per cent against severe COVID-19 dropped to 66 per cent when moderate cases were rolled in. But there’s no apples-to-apples comparison because of differences in when and where each company conducted its studies, with the Pfizer and Moderna research finished before concerning variants began spreading.

Collins said the evidence of effectiveness shows no reason to favour one vaccine over another.

“What people I think are mostly interested in is, is it going to keep me from getting really sick?” Collins said. “Will it keep me from dying from this terrible disease? The good news is all of these say yes to that.”

Also, J&J is testing two doses of its vaccine in a separate large study. Collins said if a second dose eventually is deemed better, people who got one earlier would be offered another.

The FDA cautioned that it’s too early to tell if someone who gets a mild or asymptomatic infection despite vaccination still could spread the virus.

There are clear advantages aside from the convenience of one shot. Local health officials are looking to use the J&J option in mobile vaccination clinics, homeless shelters, even with sailors who are spending months on fishing vessels — communities where it’s hard to be sure someone will come back in three to four weeks for a second vaccination.

WATCH | Canada’s procurement minister on Johnson & Johnson vaccine:

The CBC’s Tom Parry asks Procurement Minister Anita Anand how many doses of Johnson & Johnson’s COVID-19 vaccine Canada will receive after it’s approved by Health Canada. 4:56

The J&J vaccine also is easier to handle, lasting three months in the refrigerator compared to the Pfizer and Moderna options, which must be frozen.

“We’re champing at the bit to get more supply. That’s the limiting factor for us right now,” said Dr. Matt Anderson of UW Health in Madison, Wisconsin, where staffers were readying electronic health records, staffing and vaccine storage in anticipation of offering J&J shots soon.

The FDA said studies detected no serious side effects. Like other COVID-19 vaccines, the main side effects of the J&J shot are pain at the injection site and flu-like fever, fatigue and headache.

The FDA said there is “a remote chance” that people may experience a severe allergic reaction to the shot, a rare risk seen with the Pfizer and Moderna vaccines.

The vaccine has been authorized for emergency use in adults 18 and older for now. But like other vaccine makers, J&J is about to begin a study of its vaccine in teens before moving to younger children later in the year, and also plans a study in pregnant women.

All COVID-19 vaccines train the body to recognize the new coronavirus, usually by spotting the spike protein that coats it. But they’re made in very different ways.

WATCH | Provinces offer different timelines for COVID-19 vaccine rollout:

When Canadians will be able to get a COVID-19 vaccine may depend on where they live. The provinces have started revealing their rollout plans, but the timing of who can get a shot varies across the country. 1:58

J&J’s shot uses a cold virus like a Trojan horse to carry the spike gene into the body, where cells make harmless copies of the protein to prime the immune system in case the real virus comes along. It’s the same technology the company used in making an Ebola vaccine, and similar to COVID-19 vaccines made by AstraZeneca and China’s CanSino Biologics.

The Pfizer and Moderna vaccines are made with a different technology, a piece of genetic code called messenger RNA that spurs cells to make those harmless spike copies.

The AstraZeneca vaccine — which was approved for use in Canada on Friday and is already in use in numerous other countries — is finishing a large U.S. study needed for FDA clearance. Also in the pipeline, Novavax uses a still different technology, made with lab-grown copies of the spike protein, and has reported preliminary findings from a British study suggesting strong protection.

Still other countries are using “inactivated vaccines,” made with killed coronavirus by Chinese companies Sinovac and Sinopharm.

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