This is an excerpt from Second Opinion, a weekly roundup of health and medical science news. If you haven’t subscribed yet, you can do that by clicking here.
A new Canadian study found catching COVID-19 provided strong protection against future Omicron reinfection and hospitalization — especially when combined with vaccination.
The observational study of close to 700,000 people age 12 and over in Quebec, released as a preprint this week and not yet peer reviewed, suggested that having an earlier strain of the virus dramatically reduced the risk of getting the original Omicron variant in the future.
“Even in people who did not receive any vaccine there was protection against Omicron infection,” said lead author Dr. Gaston De Serres, an epidemiologist at the Quebec National Institute of Public Health (INSPQ).
“However, the protection against hospitalization is much higher than your protection against being reinfected — and obviously the good news is if you add vaccine doses, then you add to your protection.”
The landmark study provides the first major glimpse at how protection from vaccination, prior infection and combined hybrid immunity is holding up against Omicron in the real world in Canada and has major implications on our vaccination guidelines in the future.
“You don’t want to get COVID. I mean, that’s clear because it’s unpredictable, you could die, you could wind up in the hospital and you could get long COVID,” said Dr. Eric Topol, a professor of molecular medicine at Scripps Research in La Jolla, Calif.
“However, if you did have COVID before the Omicron wave and you survived — it did provide an edge.”
Health-care workers walk near hospital row, on Toronto’s University Ave. on April 7. Protection from previous infections against Omicron hospitalizations was significant among the unvaccinated, but increased dramatically with additional vaccine doses. (Evan Mitsui/CBC)
Hybrid immunity provides ‘remarkable’ protection
The study also found vaccines were more effective against Omicron infection among the previously infected than the non-infected: increasing to 65 per cent versus 20 per cent for one dose, 68 per cent over 42 per cent for two and 83 per cent over 73 per cent for three.
But prior infection immunity alone didn’t last — with the study showing the risk of an Omicron reinfection dropped from 66 per cent after three to five months to just 35 per cent between nine and 11 months.
Unvaccinated individuals who were asymptomatic after infection also had only an eight per cent reduction in future risk of infection, while symptomatic non-hospitalized patients had a 43 per cent reduction and hospitalized symptomatic patients had a 68 per cent reduction.
“The more severe the infection, the better you’re protected — the more vaccine doses, the more you’re protected,” De Serres said. “And the order of your vaccine doses and infection did not appear to change the degree of protection you had.”
Protection from previous infections against Omicron hospitalizations was also significant among the unvaccinated at 81 per cent, but increased to 86 per cent with one dose, 94 per cent with two and 97 per cent with three.
“What this study did was reinforce that if you got through COVID, you survived it, you will not only have a good protection from hospitalizations, but also you benefit from at least one if not two shots of vaccine,” said Topol.
“In fact, if you got three shots you got to remarkable levels of protection against infection and hospitalization … So it encourages people who are still out there who had prior COVID to go get vaccinated.”
The study also highlights the limited added protection from a booster dose among the previously infected against severe COVID-19 — as opposed to just two shots. (Darryl Dyck/The Canadian Press)
Booster priorities could shift in Canada
But the findings also highlight the limited added protection from a booster dose among the previously infected against severe COVID-19 — as opposed to just two shots.
“Our findings do suggest that the incremental value of a third over second dose in someone who’s previously infected is marginal,” said Dr. Danuta Skowronski, epidemiology lead at the British Columbia Centre for Disease Control who co-authored the study.
“And if there are remaining other groups who have yet to receive even their first or second dose or are otherwise more susceptible — the doses would be better prioritized that way.”
De Serres said that while the study found two-dose effectiveness against hospitalization among the previously-infected did not wane substantially after 11 months, it also did not significantly differ from three-dose effectiveness.
“If someone had been infected recently, should that person run to get the vaccine right after three months? Well, maybe not,” he said, adding that the close to half of Canadians who became infected with Omicron over the past few months had significant immunity.
“The population that was infected during wave five and six may already be quite well protected for the next season and maybe they could be offered an additional dose — but maybe it won’t be so pressing for them.”
The study looked at the original BA.1 Omicron variant between Dec. 26 and March 22, and not the BA.2 subvariant that has since become the dominant strain in Canada or other sublineages like BA.2.12.1, BA.4 and BA.5 that are circulating in other parts of the world.
Nevertheless, the findings call into question the value of the National Advisory Committee on Immunization’s (NACI) decision to recommend a booster shot three months after an infection, when protection against severe illness already remains high with two shots.
“It’s not to say that the third dose didn’t increase it, but it’s from 94 per cent to 97 per cent,” said Skowronski. “It really just begs the question, what are we trying to achieve with this?”
WATCH | WHO estimates nearly 15 million people died in COVID-19 pandemic:
Nearly 15 million people died in COVID-19 pandemic: WHO
1 day ago
Duration 2:01
The World Health Organization estimates almost 15 million people around the world have died as a result of COVID-19 or the pandemic’s burden on health-care systems over the past two years. 2:01
No plans to change booster guidelines: NACI
In a statement to CBC News, a spokesperson for NACI said that despite the implications of the new study, there are no immediate plans to revisit the Canadian guidelines recommending a booster shot three months after a COVID-19 infection.
“NACI is aware of recent Canadian and international evidence suggesting that hybrid immunity following infection and vaccination can provide protection against COVID-19 disease,” the spokesperson said, when asked if the study could affect booster guidance.
“However, it is important to note that the robustness and duration of protection conferred by prior infection may vary due to factors such as the severity of infection, age, presence of comorbidities and the variant causing the infection.”
NACI members also considered the “uncertainty” around whether infections with new variants would have similar hybrid immunity as with previous variants, the challenge in documenting infections and took a “precautionary approach in the face of uncertainty.”
“NACI makes decisions based on the body of evidence on a topic,” the spokesperson said. “Which often extends beyond individual studies.”
But the real-world Canadian research not only provides insight into how the level of population immunity from vaccination and prior infection in Canada is holding up — it also highlights the importance of hybrid immunity in getting the most protection.
People walk in downtown Vancouver, B.C., on March 14. The real-world Canadian data provides never-before-seen insight into how the level of population immunity in Canada from vaccination and prior infection is holding up — and has major implications on our vaccination strategy going forward. (Ben Nelms/CBC)
“We know that this hybrid immunity has an advantage and this study really helped bring that home,” said Topol.
“There’s something different about an infection — it just exposes the whole virus to somebody so there is some edge there that you can’t fully simulate with spike messenger protein vaccines.”
Dr. Isaac Bogoch, an infectious diseases physician at Toronto General Hospital and member of Ontario’s COVID-19 vaccine task force, said the findings could also affect policies around vaccine mandates in Canada.
“If someone is interested in mandating a third dose for whatever reason — you have to consider that two doses plus infection, based on what we know today, is comparable,” he said. “So there are science and policy implications for this study.”
De Serres said that while an infection does provide significant protection against reinfection and severe illness, it’s not necessarily a replacement for a COVID-19 vaccine.
“Are they identical? Maybe not, but I think they are quite comparable. I think that infection, from what we can see, provides at least the protection of one dose,” he said.
“So if you had received two doses and you got infected, you’re well protected, similar to three doses … for severe outcomes they are really quite comparable.”
Skowronski said while the findings do underscore the protection obtained from a previous infection, she wants to make sure people don’t come away thinking intentional infection or so-called “SARS-CoV-2 parties” are a smart decision.
“It’s not the intent that people deliberately get infected, but rather, if they have been infected with up to two doses of vaccine they can be reassured that they’ve got good protection against severe outcomes,” she said.
“And that’s good news for the population at large.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
