Signs are emerging that point to the beginnings of a summer wave of COVID-19 in Ontario, the head of the province’s science advisory table is warning.
Dr. Fahad Razak, scientific director of the science table, points to a rising COVID wastewater signal, increasing test positivity and a surge of public health units experiencing exponential growth in cases.
There has been a gradual increase in the provincewide wastewater signal since the beginning of June along with test positivity that has been going up for the past three to four weeks. Then there’s the fact, he says, that about 40 per cent of public health units now have a reproduction number greater than one — all amounting to evidence the province has entered another wave.
“Putting all of this together, I think we’re seeing the beginning of a wave,” Razak said. “But it does not look like it has the intensity in terms of amplitude or pace of what we saw with the start of the Omicron wave. How fast it will rise and what the peak will be are unclear.
“Based on everything that we’re seeing, both in Ontario and globally, this is likely to be a less severe wave than what we’ve experienced in the past with less direct pressure on the health-care system.”
Razak’s red flag comes as the National Advisory Committee on Immunization recommended this week that additional boosters be given to a larger portion of the population in the fall. Other regions are also seeing a rise in hospitalizations driven by Omicron subvariants, including Quebec, which recently experienced a surge in community transmission and cases in health-care workers.
Meanwhile, the World Health Organization reports that infections are growing in 110 countries driven by the BA.4 and BA.5 subvariants, resulting in an overall 20 per cent increase in global cases.
Several infectious disease experts say fourth doses should be offered to all residents now ahead of a possible fall wave, while others say only those who are deemed at higher risk should be getting a second booster.
“If you’re someone who is higher-risk or is in a situation where you’re being exposed to a lot because you’re on TTC twice a day, in and out of work or something like that, it would be very reasonable to go and get that fourth shot now,” Razak said. “On the other hand, if you are otherwise low-risk and you have very little day-to-day exposure, it is reasonable to wait to get that booster dose until you’re closer to the fall or there’s more concretely a rise happening.”
At a press conference Thursday, Dr. Theresa Tam, Canada’s chief public health officer, said up-to-date vaccinations are the “foundation of our protection” and that those who had two doses and a booster shot had hospitalization rates that were five times lower than unvaccinated people during the Omicron wave in April and May.
She also reiterated NACI’s recommendations that those at risk of severe illness receive a fourth shot now, as boosters “increase protection by activating your immune response to restore protection that may have decreased over time.”
Dr. Gerald Evans, the chair of the division of infectious diseases at Queen’s University, said it’s uncertain whether fourth doses will be effective enough against BA.4 and BA.5 for the larger population. Those subvariants have an alteration within its genomes, making it more difficult for antibodies to bind to the spike proteins, which in turn makes these variants more likely to have immune-evading properties, he explained.
Pfizer and Moderna are developing vaccines that will specifically target Omicron, known as bivalent vaccines, which will likely be available in the fall. Both companies say they’ve tested their vaccines and they appear to be highly effective against Omicron, and plan to submit their data to governments in the next few months.
“I do totally agree that we should be rolling out boosters in the fall,” said Evans. He predicts a wave will occur in the late fall or early winter, and another will follow in the late winter or early spring because that’s how the COVID-19 virus has behaved previously, similar to other illnesses in the coronavirus category, he said.
NACI also announced in a release Wednesday that everyone aged 12 to 65 may be offered another dose in the fall, regardless of the number of previous doses, but that recommendation is “discretionary” and not categorized as a strong recommendation.
Those groups include all residents over 65; people 12 and older who have underlying medical conditions; Indigenous adults; racialized and marginalized communities that have been harder hit by the virus throughout the pandemic; migrant workers; residents of shelters, correctional facilities and group homes.
Recommendations will be provided on the type of COVID-19 booster dose that should be offered as evidence emerges on bivalent vaccines.
NACI said in its press release that “cases of COVID-19, including associated hospitalizations and deaths, are currently declining in Canada. However, the likelihood, timing, and severity of a future wave of COVID-19 is uncertain.”
Colin Furness, an infection control epidemiologist at the University of Toronto, said he is afraid the increasing signals Ontario is experiencing could mean we are approaching endemicity.
“My belief is that when we took masks off on the TTC, we started to harmonize different wastewater signals across the GTA. In other words, mixing people together on the TTC is not going to cause the signal at one wastewater treatment plant to go down, it’s going to cause the other ones to come up to match,” he said.
“If you think about that logically, that kind of synchronization, that’s a path to endemicity. Not a wave that comes and then subsides, but a new normal where the line is flat but it is at a very elevated level.”
He added that the elevations in wastewater signals, as well as cases in public health units, reflect the dropping of mask mandates earlier this month.
“But it’s not just that. It’s the mindset that goes with it. We see more and more people who ought to know better engaging in crazy, risky behaviour,” Furness said. “If I can be on the TTC and I don’t need to have a mask, then I can go out to dinner because that’s obviously less dangerous and if that’s the case, I can definitely go see a movie.
“It’s causing self-destructive logic to take hold.”
Olivia Bowden is a Toronto-based staff reporter for the Star. Reach her via email: email@example.com
Kenyon Wallace is a Toronto-based investigative reporter for the Star. Follow him on Twitter: @KenyonWallace or reach him via email: firstname.lastname@example.org
Monkeypox call seen as catch-up bid – Chinadaily.com.cn – China Daily
US’ health emergency declaration may come too late to halt spread, experts say
The administration of US President Joe Biden on Thursday declared the country’s monkeypox outbreak a public health emergency, but many health experts fear that it may be too late to contain the spread of infections.
Criticism of the White House’s response to the disease outbreak has been building, with experts saying the authorities have been slow off the mark in distributing treatments and vaccines.
The White House’s declaration signals that the monkeypox virus now represents a significant risk to citizens. The Secretary of Health and Human Services, Xavier Becerra, is considering a second declaration that would empower federal officials to expedite medical countermeasures, such as other potential treatments and vaccines, without going through comprehensive federal reviews.
That also would allow for greater flexibility in how the current supply of vaccines is administered, Becerra said.
Some 6,600 monkeypox infections have been reported in the United States, a number that has risen sharply over the past weeks.
Lawrence Gostin, a public health law expert at Georgetown University, said the declaration of the health emergency “signals the US government’s seriousness and purpose, and sounds a global alarm”. But he told The Associated Press that the action was overdue.
Gostin said the government has been too cautious and should have declared a nationwide emergency earlier.
On July 23, the World Health Organization declared a global health emergency over the outbreak, with cases in more than 70 countries.
California, Illinois and New York have all made declarations recently, as have New York City, San Francisco and San Diego County.
Since doctors diagnosed the first US case on May 27, the virus has been spreading rapidly in the country, with the highest rates per capita reported in Washington, New York and Georgia.
More than 99 percent of the infections are among men who have sex with men.
The virus is transmitted mostly during close physical contact. So far, no deaths from the disease have been reported in the US.
The country now has the highest case count among nonendemic countries, and the number is expected to rise as surveillance and testing improve.
Monkeypox is endemic in parts of Africa, where people have been infected through bites from rodents or small animals. Classification as endemic means a disease has a constant presence in a population but is not affecting an alarmingly large number of people, as typically seen in a pandemic.
On its website, the Centers for Disease Control and Prevention says of the virus: “Monkeypox virus is part of the same family of viruses as variola virus, the virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder, and monkeypox is rarely fatal. Monkeypox is not related to chickenpox.”
There is increasing concern that the US may have lost its chance to contain the monkeypox virus. Some public health experts have pointed fingers at the administration for its slowness in rolling out vaccines and treatments.
“The window for containing monkeypox is rapidly closing,” Gostin warned in an interview with CNN late last month. He had called for the US to declare a national public health emergency and make more vaccine doses available.
“I do think it’s still possible to contain, but it’s also equally possible that this may become endemic in the United States,” he said.
Supplies of a monkeypox vaccine called Jynneos have been limited even as demand surges. The administration has been criticized for moving too slowly to expand the number of doses.
Federal officials have identified about 1.6 million people as being at the highest risk for monkeypox, but the US has received enough Jynneos doses to fully cover only about 550,000 people.
The shortage of vaccines was caused in part because the Department of Health and Human Services failed early on to ask that bulk stocks of the vaccine it already owned be bottled for distribution, reported The New York Times, citing multiple unnamed administration officials familiar with the matter.
The government is now distributing about 1.1 million vaccine doses, less than a third of the 3.5 million that health officials now estimate are needed to fight the outbreak. It does not expect the next delivery, of 500,000 doses, until October.
Health unit to host monkeypox clinic Sunday – BlackburnNews.com
Health unit to host monkeypox clinic Sunday
August 6, 2022 6:00am
The Windsor-Essex County Health Unit is making a limited supply of the monkeypox vaccine available.
The health unit will set up a monkeypox vaccine clinic on Sunday from 11 a.m. to 4 p.m. at Windsor-Essex PrideFest, centred at Lanspeary Park. Acting Medical Officer of Health Doctor Shanker Nesathurai said the clinic will be geared toward high-risk individuals.
“The term is sometimes described as ‘pre-exposure prophylaxis’, and that will be offered at the Pride event this coming weekend,” Nesathurai said during a media briefing Friday morning.
Chief Nursing Officer Felicia Lawal said the health unit will work with PrideFest and Pozitive Pathways to operate the mobile clinic.
“Public health nurses will be available to provide health information and resources on monkeypox, as well as pre-exposure vaccination for those who meet criteria and qualify,” said Lawal.
Nesathurai said the health unit will have about a hundred doses available at the clinic, and that the unit had distributed monkeypox vaccines in the past.
The health unit also emphasized that even though the biggest risk group continues to be men who have sex with men, anyone can get the virus, which can be transmitted through close contact. Nesathurai added that the PrideFest clinic will be the best way to raise as much awareness of the virus as possible, but the health unit is working not to stigmatize any segment of the population.
So far, there has been just one confirmed case of monkeypox in Windsor-Essex.
Complete information about monkeypox and vaccines can be found on the health unit’s official website.
Monkeypox: Concerns over potential further spread in Canada – CTV News
Monkeypox infections continue to rise in Canada as the U.S. and the WHO declare the outbreak an emergency, leaving some experts concerned about the risk of further outbreaks.
There have been fewer than 1,000 confirmed cases in Canada since May, as of Friday. But on a per capita basis, the number of monkeypox cases in total in Canada has surpassed the United States.
On July 27, Chief Public Health Officer Dr. Theresa Tam encouraged those at highest risk from monkeypox to get vaccinated, saying an “urgent” response is needed to address the outbreak.
But even though monkeypox has spread primarily among men who have sex with men, Dr. Donald Vinh, an infectious disease specialist at McGill University Health Centre in Montreal, tells CTV National News that there is a strong chance the infection could spread outside of that community.
“I’m not saying that we have to panic. I think we just need to be prepared that there’s a possibility that this virus could spread to the larger general public, and so we shouldn’t be surprised of that possibility,” he said.
Monkeypox often presents as a flu-like infection with a rash and spreads through close personal contact with someone who is symptomatic.
While monkeypox has been endemic to certain parts of Africa for decades, it has also been neglected, Vinh said.
And while the smallpox vaccine does protect against monkeypox, questions remain over whether those who were inoculated decades ago will still be protected from the disease today.
“And so this is something else that we need to learn, and learn pretty quickly,” Vinh said.
The Biden administration in the U.S. declared monkeypox a public health emergency on Thursday.
This came after the World Health Organization (WHO) declared monkeypox a public health emergency of international concern on July 23.
However, Canada has yet to make a similar declaration
In a statement to CTVNews.ca, a spokesperson for the Public Health Agency of Canada (PHAC) said the Government of Canada “acknowledges the WHO’s determination and recognizes that the global monkeypox outbreak requires an urgent global response.”
The spokesperson said more than 80,000 doses of the smallpox vaccine Imvamune have been sent to provinces and territories.
“PHAC also continues to work closely with international, provincial and territorial health partners to gather information on this evolving outbreak and to determine the best course of action to stop the spread of monkeypox in Canada,” the statement said.
“Canada will also continue to work with the WHO and international partners to strengthen the global response to the current monkeypox outbreak.”
Asked what Canada’s current vaccine stockpile status is, and the ability for Canada to increase its supply through additional procurements, the spokesperson said the agency “does not disclose details concerning medical countermeasures held by the NESS (National Emergency Strategic Stockpile), including types or quantities, due to security implications and requirements.”
At the local level, some are making efforts on the vaccination side.
This weekend, the public health unit in Windsor, Ont., will host its first monkeypox vaccine clinic at Sunday’s Pride event.
But on Friday, Ottawa Public Health announced it had to cancel its monkeypox vaccine clinics for the day “due to an unforeseeable short-term vaccine supply issue.”
Kerry Bowman, an assistant professor in the Temerty Faculty of Medicine at the University of Toronto, said it’s still unclear where the monkeypox outbreak is going, but he believes there is more Canada can do.
“There’s a picture of a lack of clarity as to who’s eligible and the vaccination process itself is quite limited,” Bowman said.
Health officials have recommended vaccinations for high-risk groups, including health-care workers and men who have sex with men and have recently had multiple sexual partners.
But Bowman says he is also concerned about monkeypox spreading to non-human animals.
“I would like to see it contained because my fear is that it will become endemic — embedded — that it will get into non-human species the way I’ve seen it do in Africa, it will just keep circulating and coming back on people regularly,” he said.
With files from CTVNews.ca’s Rachel Aiello, The Associated Press and CNN.
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