Essential workers and others who face increased risks related to COVID-19 should be vaccinated against the disease before everyone else, according to new recommendations submitted to the federal government.
Although Prime Minister Justin Trudeau has said that all Canadians will be able to get an approved COVID-19 vaccine for free, the immunizations will not happen all at once. It is expected that several months will elapse between the first doses of the vaccine being made available and a full rollout to everyone who wants to be immunized.
This leads to an obvious question: Which Canadians or groups of Canadians should be prioritized? Who should get to move to the front of the line, and who should have to wait?
One group of medical, pharmaceutical and public health experts is used to considering these questions, although not on this scale. The National Advisory Committee on Immunization (NACI) is a long-established body that makes recommendations to the Public Health Agency of Canada on vaccines and vaccine-related issues. They’ve weighed in on vaccines covering more than a dozen different diseases over the past decades, and their advice helped create the push to expand human papillomavirus vaccine programs to include boys.
Now they’ve turned their attention to COVID-19. On Tuesday, they issued their first recommendations on target populations for COVID-19 immunization.
NACI recommends prioritizing four specific groups:
- ‘Those at high risk of severe illness and death from COVID-19,’ including older populations and other groups to be determined
- ‘Those most likely to transmit COVID-19 to those at high risk of severe illness and death from COVID-19 and workers essential to maintaining the COVID-19 response,’ including those who live with members of the first group, health-care workers, personal care workers and caregivers who work with seniors
- ‘Those contributing to the maintenance of other essential services for the functioning of society,’ including front-line workers such as police officers, firefighters and grocery store staff
- ‘Those whose living or working conditions put them at elevated risk of infection and where infection could have disproportionate consequences, including Indigenous communities,’ including those who live or work in settings where it is difficult to distance and where it is difficult to access health care
The NACI report does not say any of these groups should be prioritized over any of the others, and does not suggest the examples it gives are a full list of who should be included in any of the groups.
It does recommend that decisions around who is vaccinated first among the prioritized groups be made based on factors including vaccine supply, COVID-19 conditions in Canada at the time, the results of a risk-benefit analysis, and characteristics of the vaccine itself.
Dr. Theresa Tam, Canada’s chief public health officer, said Monday in a statement that the NACI recommendations are “just the starting point” when it comes to determining which groups to prioritize for vaccination.
“We know Canadians will understand the need to prioritize some groups during the early weeks of COVID-19 vaccine roll-out until there is enough vaccine for everyone who wants it,” she said.
Tam said she is “cautiously optimistic” that a vaccine could be approved for use in Canada by March 2021.
WHAT DO CANADIANS THINK?
The recommendations are based in part on separate surveys of 74 expert stakeholders and more than 2,100 members of the public.
When given four competing pandemic priorities, respondents to both surveys ranked them in the same order of importance: protect the most vulnerable, then protect the capacity of the health-care system, then minimize the spread of the virus, then protect critical infrastructure.
However, it is less clear from the survey data if there is public support for prioritizing all of the recommended groups. While a majority of respondents were in favour of giving first access to those with underlying medical conditions and the elderly, and there was also notable support for prioritizing health-care workers, all other groups – including essential workers and those who work in long-term care homes – had less than 20 per cent of respondents in favour of prioritization.
The government’s survey also found that willingness to get an effective COVID-19 vaccine appears to be decreasing. While 71 per cent of respondents said in April that they would get a vaccine, that number was down to 61 per cent in August.
In part because of this, NACI recommends that governments do more to promote the benefits of vaccines in general and a COVID-19 vaccine specifically, once one is approved for use.
What Canada's hardest-hit provinces can learn from those that handled COVID-19 best – CBC.ca
When epidemiologist Susan Kirkland opened a Halifax newspaper on Saturday, she was stunned.
“Three protest rallies planned,” the Chronicle Herald headline read, in part.
“Oh, no,” the head of public health and epidemiology at Dalhousie University thought to herself. “Please don’t be anti-vaxxers or anti-maskers.”
As Kirkland read further, she realized they weren’t related to the pandemic at all.
One was a rally for alleged victims of a pediatric dentist, a second to demand reparations for former residents of Africville and the third was an anti-war protest about an upcoming security conference.
“Oh,” she said with relief. “Phew.”
Critical juncture for Atlantic bubble
The situation in the Atlantic bubble has been like night and day from the rest of Canada.
The four Atlantic provinces have managed to control the spread of COVID-19 through tight border restrictions, strict isolation of travellers and comprehensive tracing of outbreaks.
But Kirkland says much of the credit also belongs at an individual level.
“I do feel like the response from the public in the Atlantic region is different than other parts of the country,” she told CBC News.
“I think there’s also a certain amount of pride that we have been able to maintain the bubble, and I don’t think that people want to see it change.”
But it has changed, put on hiatus with the news Monday that Prince Edward Island and Newfoundland and Labrador were pulling out of the bubble due to rising COVID-19 cases in New Brunswick and Nova Scotia.
Nova Scotia reported 37 new cases of COVID-19 Tuesday, its most in a single day since April 23.
“I am worried. I think that we’re on the brink and at a very, very critical juncture,” Kirkland said. “This is the point where we either make it or break it. We’ll keep numbers low or they will, like everywhere else, just begin to escalate and skyrocket.
“The window is narrowing — but we still have the potential to get it under control.”
‘Squandered’ sacrifices in Alberta
Elsewhere in the country, people are facing a much different situation.
Alberta is seeing COVID-19 cases skyrocket at an unprecedented rate, rising to more than 1,500 per day and even outpacing provinces such as Ontario despite only having a third of the population.
“I’ve been worried for many weeks now,” said Dr. Leyla Asadi, an infectious diseases physician in Edmonton. “I don’t know what the next two weeks will bring.”
Asadi says the situation in Alberta isn’t a result of individuals not following public health guidelines necessarily, but instead reflects that the province has been a victim of its own success.
When COVID-19 cases dropped to relatively low numbers in the summer, there was a reluctance to act on the part of the provincial government.
“We had great success and maybe that resulted in our leadership questioning the models and, because crisis was averted, perhaps they thought that the models just weren’t accurate,” she said.
“We’ve squandered our sacrifices from the summer, and now we’re in a really tough place.”
Premier Jason Kenney declared a state of emergency in Alberta Tuesday and implemented new public health measures to address the rising COVID-19 case numbers across the province, but stopped short of a lockdown.
Most indoor social gatherings are prohibited, while outdoor gatherings, weddings and funerals can have a maximum of 10 people. Masks are also mandatory in all indoor work places in Calgary and Edmonton, but not provincewide.
Unlike Nova Scotia, which instituted mandatory mask mandates on July 24 — a day when it reported no new cases — Alberta has hesitated.
Asadi, who was part of a group of experts who penned a letter to provincial leaders last month calling on them to put in place stricter restrictions, said before Kenney’s announcement that masks are “low-hanging fruit.”
“Having masks mandated provincially, that’s not going to negatively impact the economy in any way,” she said.
“If we act earlier then the measures can be more targeted and can be shorter in time. But now, I can’t see anything other than a strict lockdown getting us out of trouble — and it won’t even get us out of trouble.”
Reluctance to act ‘early and hard’ reason for surge
COVID-19 is spiralling out of control in many parts of the country, with a record high 5,713 cases in a single day this week.
In response, Canada’s chief public health officer said provinces and territories need to be more proactive — and act sooner rather than later.
It’s not only the number of cases that are worsening; it’s who is being infected.
“The other huge problem that we have now are the inequities associated with this pandemic,” said Dr. Allison McGeer, an infectious disease physician with Sinai Health System in Toronto.
“Part of the reason I think that we’re not paying as much attention as we should be to the harm is that the harm is not predominantly occurring to the people in power in our society.”
McGeer is watching the worsening outbreaks across Canada through the eyes of a microbiologist who has decades of experience in infection prevention and control.
“I’m a little bit worried about what’s going to happen in Alberta,” McGeer said. “I think we’ll be cancelling surgery again, probably in order to cope with the ICU load three or four weeks from now.”
Surgeries such as hip and knee replacements could be cancelled down the road, as it can take up to two weeks for symptoms of COVID-19 to appear.
“The reason we’re having this surge is because we kept things open longer than we should have,” she said.
“The more cases you have when you act, the longer it takes to slow down and regain control and the more trouble you’re in going forward. So if we had put in measures two weeks before we did, then we might not be cancelling surgery.”
McGeer also acknowledges that politicians in Canada can only re-introduce safety measures when their citizens are behind them.
“If politicians move and they don’t have the population with them, then it’s not going to work either.”
“It’s very clear that if we had been able to start this outbreak early and hard with preventive measures, if we’d been able to do the contact tracing, if we’d been willing to put people up in hotels for quarantine, we might be where Newfoundland is now,” she said. “And that has huge rewards.”
Those tantalizing rewards could help reinvigorate Canadians outside the Atlantic provinces who face a resurgence of COVID-19 cases and the hospitalizations and deaths that could follow the holiday season.
“I get how tired people are; I’m tired of it myself. But this is not about being tired,” McGeer said. “We just need to hold on until we can get vaccines, right? And they are coming.”
Canada adds 4,889 new coronavirus infections as global cases near 60 million – Global News
A total of 2,218 people in Canada remain hospitalized after contracting the respiratory illness, while 273,391 have recovered after becoming sick.
Speaking at a press conference on Tuesday, Prime Minister Justin Trudeau said the government has secured a deal with Eli Lilly to secure up to 26,000 doses of the pharmaceutical company’s therapeutic drug to treat COVID-19 patients.
“To keep Canadians safe, we need access to as many potential vaccines and treatments as possible,” he said.
Trudeau added that Canada will have the option to purchase thousands more doses.
The prime minister also said Canada has signed “strong contracts” with various vaccine companies, adding that the government is “working closely with allies on ensuring that there is a free flow of delivery of contracts.”
Coronavirus: Canada’s top doctor says implementation of rapid tests up to provinces, territories
Trudeau said the leaders of the G20 nations discussed equitable access to a potential COVID-19 vaccine during the virtual summit last weekend.
“It’s really important to ensure that everyone gets access to vaccines around the world because no one place gets through COVID-19 until all places are done with COVID-19,” he said.
New cases in the provinces
In Ontario, 1,009 new cases were detected on Wednesday. The province also saw 14 new fatalities, bringing the death toll to 3,519.
Meanwhile, Quebec saw 1,124 new infections and 45 new deaths, pushing the total case count and death toll to 134,330 and 6,887, respectively.
Between Manitoba and Saskatchewan, 646 new infections were reported.
Manitoba saw 471 new cases and 12 new deaths, while Saskatchewan added 175 new COVID-19 infections.
However, health officials said no one else had died.
In Atlantic Canada, 44 new coronavirus infections were reported.
Nova Scotia added a record 37 new cases, while New Brunswick saw five new infections.
Newfoundland and Labrador saw two new cases, while Prince Edward Island did not report any new infections.
None of the Maritime provinces reported any new fatalities related to the respiratory illness.
Alberta Premier Jason Kenney declared a state of public health emergency on Wednesday, as 1,115 new cases and 16 additional deaths were reported.
The province is implementing more stringent measures for three weeks in order to stem the spread of the virus, including banning indoor social gatherings and expanding the holiday school break.
Meanwhile, British Columbia added 941 new COVID-19 infections, marking a new daily record.
Health officials in the province also said 10 more people have died.
Cases rise in Nunavut
Ten new cases were detected in Nunavut on Wednesday, but health officials said no one else has died.
The new cases push the territory’s total case load to 144. So far, only two of those cases are considered to be recovered.
Neither the Yukon or Northwest Territories saw a new case or death related to the virus on Wednesday.
Global cases near 60 million
The total number of novel coronavirus infections around the world hovered below 60 million on Wednesday.
By 6 p.m. ET, there were a total of 59,597,658 confirmed cases of the virus globally, according to a tally from Johns Hopkins University.
So far, the virus has killed 259,372 Americans.
© 2020 Global News, a division of Corus Entertainment Inc.
Ford differentiates between Ontarians holding private gatherings and establishments defying COVID-19 rules – CBC.ca
Premier Doug Ford drew a distinction between Ontarians flouting public health measures through private gatherings and establishments that openly defy the province’s COVID-19 rules Tuesday.
The remarks came in response to questions about at Toronto barbeque restaurant owner publicly vowing to keep his doors open amid the province’s lockdown for the city.
“They have to follow the rules. There can’t be rules for one group and not another,” he said at a news conference Tuesday, less forcefully than in other instances where the premier has come out swinging against people throwing large parties or weddings, for example.
“When it comes to private parties, that’s a different ball of wax,” Ford said. “I’m not going to get up here and start pounding the small business owner when the guy’s holding on by his finger nails. I differentiate between someone at home being reckless and having 100 people over and partying and renting a public storage place … that’s reckless.
“I don’t condone that he opened up but I feel terrible. My heart breaks for these guys … these business-owners, believe me. “But please, in saying all that, you’ve got to follow the protocols and guidelines.”
WATCH | Ford comments on Toronto BBQ restaurant vowing to stay open during COVID-19 lockdown:
The restaurant was eventually ordered to shut down by the City of Toronto after bylaw officers, public health inspectors and police were called to the site, city officials said in a statement.
Rapid testing begins, auditor general set to release report
The province also announced Tuesday that it has begun deploying rapid testing in long-term care homes, rural and remote areas — something the premier called a “gamechanger.”
The rapid tests, which can produce results in minutes rather than days, have been sent to 36 long-term care homes and 27 retirement homes, as well as some hospitals.
The testing kits are earmarked for a total of 22 hospitals, including two that are already using them, as well as remote
communities and some outbreak areas in hot-spot regions, the government said.
Some will also be sent to corporations such as Air Canada and Ontario Power Generation, while others will be used over several months in a pilot project involving private, public and non-profit sector employers to gauge the value of antigen testing on asymptomatic workers, the province said.
Ottawa began shipping the testing kits to the provinces late last month, but figuring out how to best put them to use has taken some time, and most jurisdictions are also verifying the results of rapid tests with a lab-based test.
The “gold-standard” COVID-19 tests need to be processed in a lab, which can take at least a day. Rapid tests can yield results right where the patient is tested but are generally considered less reliable than lab-based tests.
One type of rapid test looks for the genetic material of the novel coronavirus, as does the traditional lab version. The other looks for the specific markers the virus leaves on the outside of a cell, known as antigens.
Ford said the province will continue to deploy the 98,000 ID Now tests and 1.2 million Panbio tests it has received from the federal government in the coming weeks. Health Minister Christine Elliott says another 1.5 million Panbio tests are expected to arrive in Ontario next month.
The announcement comes as a data error resulted in an artificially low daily total of 1,009 new COVID-19 cases on Tuesday.
It also comes just one day before the province’s auditor general is set to issue a three-part report on the province’s pandemic emergency preparedness and its response to COVID-19, including lab testing, case management and contact tracing.
A spokesperson for Health Minister Christine Elliott said that yesterday’s figure of 1,589 cases (which appeared to be a record high) inadvertently included eight-and-a-half extra hours worth of data from Nov. 22, meaning the total count was inflated. Today’s number adjusts for the mistake.
The new cases include 497 in Toronto, 175 in Peel Region and 118 in York Region. The seven-day average now sits at 1,395.
Other public health units that saw double-digit increases were:
- Waterloo Region: 40
- Windsor: 31
- Simcoe Muskoka: 25
- Ottawa: 19
- Niagara Region: 19
- Durham Region: 16
- Wellington-Dufferin-Guelph: 16
- Hamilton: 10
- Thunder Bay: 14
[Note: All of the figures used in this story are found on the Ministry of Health’s COVID-19 dashboard or in its Daily Epidemiologic Summary. The number of cases for any region may differ from what is reported by the local public health unit, because local units report figures at different times.]
Testing falls to about half of capacity
Today’s additional cases include 270 that are school-related: 223 students and 47 staff. The Ministry of Education said in a statement that the figure is not a one-day increase. Rather it reflects cases identified in schools from 2 p.m. last Friday to 2 p.m. yesterday, and also some others that were not reported Friday because of professional learning days in some boards, including the Toronto public and Catholic boards.
There are currently 703 publicly-funded schools in Ontario, or about 14.6 per cent, with at least one reported instance of COVID-19. Four schools are closed due to the illness, including one in Windsor with 39 cases, the largest school-related outbreak in the province.
There are now 12,917 confirmed, active cases of the illness provincewide, a slight drop from yesterday as 1,082 cases were marked resolved today.
The further infections in today’s update come as Ontario’s network of labs processed just 27,053 test samples for the novel coronavirus, and added 29,316 to the queue to be completed. There is currently capacity in the system for up to 50,000 tests daily. Meanwhile, the province reported a test positivity rate of 5.8 per cent.
The official COVID-19 death toll grew by 14, up to 3,519. So far this month, 374 people with COVID-19 have died in Ontario.
Hospitalizations of people with COVID-19 also jumped, up 27 to 534. Of those, 159 are being treated in intensive care and 91 with ventilators. Public health officials have identified 150 patients in ICUs as the threshold for when unrelated surgeries and procedures are likely to be postponed because of burdens on the hospital system.
Meanwhile, a group of engineers, physicians and other professionals issued an open letter to the province Tuesday, calling for updated COVID-19 guidelines that emphasize the importance of ventilation when it comes to curbing the risk of spreading the virus
‘With winter approaching, our activities are moving indoors and it is therefore imperative that public institutions, workplaces and individuals understand the risk of aerosol transmission as well as the actions that can be taken to combat it,” the letter says.
Backed by 36 professionals, it also calls on the province to mandate and fund ventilation assessments and upgrades of settings like schools and long-term care homes, establishing ventilation standards for reopening, among other measures.
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