With the beginning of fall and a more transmissible strain of the coronavirus than last year’s taking hold, Canadians may wonder about the outlook of the pandemic over the next few months.
Some epidemiologists and infectious disease specialists are expressing cautious optimism, hoping that greater immunity levels just may be able to contain the delta variant that causes COVID-19, and that many jurisdictions could see hospitalization rates coming down.
“I’m always optimistic, and here’s why,” said epidemiologist Raywat Deonandan, an associate professor at the University of Ottawa. “Pandemics have a beginning, middle and end. And where are we right now? Locally, I think we’re near the end.”
Others, however, like B.C. epidemiologist Caroline Colijn, suspect Canada is still heading into a “challenging fall” despite considerable progress, particularly with vaccinations.
“The delta variant is much more infectious than the COVID that we had around last fall and even last spring,” she said.
“I have no idea how long the crisis will last,” said Craig Jenne, an infectious diseases expert at the University of Calgary.
“We may see the flattening of the curve in the coming days, but the real question is, when does that curve start to decline?”
Colder weather means people spending more time indoors, and the potential for an increase of viral transmission. Meanwhile, another delta surge or a new variant could emerge that drastically changes the outlook, some experts say.
Here is a look at the factors at play.
Where we are now
By many measures, the country is in a much stronger position facing COVID-19 than it was this time last year.
Last fall, Canadians were still without vaccines, which wouldn’t be approved until December, when Health Canada gave the green light to Pfizer-BioNTech and, weeks later, Moderna. Approval for Astra-Zeneca would follow a couple months later.
Now, according to the CBC’s vaccine tracker, Canada has reached 70 per cent of its total population and 80 per cent of its eligible population with two doses of a COVID-19 vaccine.
“Look how far we have come,” Deonandan said. “We have extraordinary vaccines at supply levels that all of us here in the rich world can access…. We have a rapid test. We know so much about this disease. We have all the tools needed to control this.”
All the accumulated knowledge about the virus over the past year and a half makes it slightly less unpredictable, Jenne said.
“We know what works to slow it. We know who’s at risk of hospitalization. We know the impact of our public health measures.”
Yet, even though there are successful vaccines and successful vaccination programs, the infectiousness of the virus means they are not quite successful enough, Colijn said.
“It’s so infectious that you really need almost everybody to be immunized,” she said. “So where does that leave us for the outlook? What may happen is that most people who are not vaccinated will get COVID.”
Hospitalizations, waning immunity and the delta variant
Deonandan said he expects greater immunity levels will result in a drop in the hospitalization rate — the proportion of infected people who become hospitalized.
Dr. Christopher Labos, a Montreal cardiologist with a degree in epidemiology, also offered hope that where vaccination rates are higher, and where most restrictions — mask wearing and vaccine passports — are in place, it’s going to be possible to contain the delta variant.
“And, at the very least, even if we do see cases, maybe we won’t see as many people ending up in hospital,” he said
One of the big unknowns, however, is the potential waning of immunity over time. Though Deonandan said he expects the ability of vaccines to protect against initial infection will gradually weaken, he predicts their protection against hospitalization and death “will remain extraordinarily good.”
Based on when most Canadians received their shots, waning immunity could start to be an issue around late October, said Dr. Andrew Morris, an infectious diseases specialist at Toronto’s Sinai Health and University Health Network.
And the question, he said, is whether provinces will anticipate this and offer people booster shots to try to head off the potential problem.
“If all the governments in Canada say they’re going to wait to boost until we sort of see the vaccines aren’t working any longer, it could kind of be a little bit too late,” he said.
However, some health officials suggest another possibility — that the delta variant may have peaked. That’s the analysis of the U.S.-based COVID-19 Scenario Modelling Hub, which consists of a team of professors from across the country who provide projections about the virus.
Its modelling predicts a steady decline in COVID-19 cases in the U.S., with no significant winter surge, NPR reported.
Justin Lessler, a professor in the department of epidemiology at the University of North Carolina who helps run the hub, told NPR that while there is wide-ranging uncertainty in the models, deaths could drop to 100 a day by March. That, he said, is dependant upon children getting vaccinated and that a more contagious variant doesn’t emerge.
Deonandan said it’s certainly possible that some parts of the world, such as the U.K. and some U.S. states, have seen the peak of the delta wave.
“I anticipate that the northern hemisphere should see a decline in the delta wave by the end of this year,” he said.
But both Deonandan and the COVID-19 Scenario Modelling Hub also offered a somewhat grim prediction — that a decline in infection rates would be due in part to the fast-spreading delta variant just running out of people to infect.
With so many delta infections among people who are unvaccinated, those who survive might have sufficient immunity, which “starts us on that herd immunity conversation again,” Deonandan said.
“A combination of sufficient coverage plus unbelievably high vaccination uptake, which we are experiencing in Canada, might mean by January we will see no more waves,” he said.
Having said that, variants will likely continue to emerge, but whether any will become a dominant strain remains to be seen, Labos said. Much will depend on how vaccination efforts ramp up around the world.
“New variants emerge because the virus keeps spreading,” he said. “It keeps copying itself. It keeps mutating. And so the more chances you give it to copy itself, the more chances you give it to have a mutation that can turn it into a different strain that’s more aggressive.”
Deonandan said he is a “tad concerned” that a new variant could emerge that changes factors such as the transmissibility of the virus, the profile of symptoms, and the ability to detect the virus.
But he also pointed out that the COVID-19 vaccines have proven effective against all the coronovirus variants that have emerged so far.
“Therefore, there’s no reason to expect any new variants not to be at least a little bit preventable by our vaccines, and probably preventable by a high amount,” he said. “So I’m not overly concerned about it.”
Morris views things a bit differently.
“I know that there are some experts who feel that the likelihood of a more virulent strain that’s vaccine resistant is extremely unlikely to happen. But, you know, I’m willing to wait and see.”
Get COVID-19 and flu shot at the same time – Windsor Star
You can get a COVID-19 vaccination and annual flu shot at the same time, Windsor Essex County Health Unit director of health protection Kristy McBeth said Thursday.
The National Advisory Committee on Immunization, which makes recommendations on the use of vaccines in Canada, recommended recently that the COVID-19 vaccine can be administered at the same time or any time before or after other vaccines, including the flu shot.
Previously, the committee had recommended that COVID-19 vaccines be administered at least 28 days before or 14 days after other shots as a precautionary measure.
After reviewing the evolving evidence on COVID-19 vaccines and considering the extensive data on administering other routine vaccines at the same time or within days of each other, the committee has determined that the earlier, precautionary approach is no longer necessary.
The new recommendation is expected to help the rollout of the flu shot this fall as well as make it easier for people to get other vaccines they may have missed during the pandemic.
The flu shot is free in Ontario and available at doctors’ offices and pharmacies. Hospitals, long-term care homes, doctors’ offices, walk-in clinics and pharmacies here have already received their supplies.
People over age 65 and those at risk of complications from flu have been given priority and are receiving the vaccine now. The shot will be available to the general public in November.
The health unit will begin promoting the shot more widely next month.
“We will be doing some extra promotion, urging people to get it,” McBeth told the health unit’s board of directors.
Between 150,000 and 200,000 doses are expected to be administered here this season, up from 97,000 last year.
Ontario has ordered 7.6 million doses this year, 1.4 million more than last year, Health Minister Christine Elliott said Tuesday.
There were few cases of flu last season because many people worked from home, their children learned remotely and the economy and society were locked down.
But more cases are expected this season because many people have returned to offices, schools have reopened and many restrictions have been lifted, allowing people to be out in the community more and to socialize and travel.
People are being urged to get the flu shot to avoid overwhelming hospitals that are still caring for COVID-19 patients.
Canada scraps COVID-19 travel advisory; Ontario to end mask, vaccine rules by March
Canada has scrapped an official advisory urging its citizens to shun non-essential foreign travel, given its successful campaign to inoculate people against COVID-19, the country’s top medical officer said on Friday.
Hours later, Canada’s most populous province, Ontario, issued a timeline to lift all remaining COVID-19 restrictions, with the aim of removing all proof of vaccination and mask requirements by March 2022.
Canada’s travel warning was issued in March 2020, when the COVID-19 pandemic erupted.
Ottawa removed the advice to avoid unnecessary travel late on Thursday, however it is still telling people to avoid cruise ship travel outside of the country.
“The beginnings of the transition away from the more blanket approach really recognizes vaccines are very effective at preventing severe outcome,” Chief Medical Officer Theresa Tam told a briefing.
According to official data, just under 82% of eligible Canadians had been fully vaccinated against COVID-19 by Oct 8.
Tam said the latest surveillance data showed “a continued decline in disease activity nationally and in most jurisdictions.”
“Now is not the time to just freely go wherever,” she added, citing high cases of coronavirus in some nations.
Ontario laid out a six-month timeline to lift all COVID-19 restrictions, starting with removing capacity limits in the “vast majority” of public venues on Oct. 25, and culminating in an end to all mask and proof of vaccination requirements by March.
The timeline will be dependent on “the absence of concerning (pandemic) trends,” it said in a statement.
“This plan is built for the long term,” Premier Doug Ford said. “It will guide us safely through the winter and out of this pandemic, while avoiding lockdowns and ensuring we don’t lose the hard-fought gains we have made.”
Ontario spent much of the past 18 months in some form of lockdown due to high infection rates and hospital bed occupancy of COVID-19 patients.
(Reporting by David Ljunggren in Ottawa and Moira Warburton in Vancouver; Editing by Paul Simao and Bill Berkrot)
COVID-19 vaccines not linked to pregnancy loss; mixing vaccines may confer greater protection
The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that have yet to be certified by peer review.
COVID-19 vaccines not linked with pregnancy loss
Two studies in major medical journals add to evidence that COVID-19 vaccines are safe before and during pregnancy. One study, published in The New England Journal of Medicine on Wednesday, tracked nearly 18,500 pregnant women in Norway, including about 4,500 who had miscarriages. Researchers found no link between COVID-19 vaccines and risk of first-trimester miscarriage, regardless of whether the vaccines were from Moderna, Pfizer and BioNTech, or AstraZeneca. Overall, the women with miscarriages were 9% less likely to have been vaccinated, according to the researchers’ calculations. In a separate study published on Thursday in The Lancet, researchers tracked 107 women who became pregnant while participating in trials of AstraZeneca’s vaccine in the UK, Brazil and South Africa. Seventy-two of the women had received the vaccine while the others got a placebo. AstraZeneca’s vaccine had no effect on the odds of safely carrying the pregnancy to term, the researchers reported. “It is important that pregnant women are vaccinated since they have a higher risk of hospitalizations and COVID-19-complications, and their infants are at higher risk of being born too early,” the authors of the Norwegian study wrote. “Also, vaccination during pregnancy is likely to provide protection to the newborn infant against COVID-19 infection in the first months after birth.”
Vaccine combinations with different technologies may be best
Healthcare workers in France who got a first shot of AstraZeneca’s COVID-19 vaccine and then the Pfizer/BioNTech vaccine for their second shot showed stronger immune responses than those who had received two shots of the Pfizer vaccine, in a recent study. Combining different technologies is known to boost immune responses to other viruses, and the current study suggests it may be true for the coronavirus as well. Both vaccines in the study deliver instructions that teach cells in the body to make a piece of protein that resembles the spike on the coronavirus and that triggers an immune response. But they do it in very different ways. Both protocols provided “safe and efficient” protection, said Vincent Legros of Universite de Lyon in France, coauthor of a report published on Thursday in Nature. But combining the AstraZeneca shot with the Pfizer/BioNTech vaccine “conferred even better protection” than two doses of Pfizer’s shot, including against the Delta variant, Legros said. The two technologies combined induced an antibody response of better quality, with more neutralizing antibodies that could block the virus, and more cells that have been “trained” by the vaccine to have increased defense potential, he said. Combination vaccination “is safe and may provide interesting options… for clinicians to prevent SARS-CoV-2 infection,” Legros concluded.
Cognitive problems seen in middle-aged COVID-19 survivors
A “substantial proportion” of middle-aged COVID-19 survivors with no previous dementia had cognitive problems more than half a year after diagnosis, researchers have found. They looked at 740 people who ranged in age from 38 to 59. About half were white, and 63% were female. On tests of thinking skills, 20% had trouble converting short-term memories to long-term memories, 18% had trouble processing information rapidly, and 16% had trouble with skills needed for planning, focusing attention, remembering instructions, and juggling multiple tasks. The average time from diagnosis was 7.6 months. About one-in-four patients had been hospitalized, but most of them were not critically ill. “We can’t exactly say that the cognitive issues were lasting because we can’t determine when they began,” said Dr. Jacqueline Becker of the Icahn School of Medicine at Mount Sinai in New York City, who co-led the study published on Friday in JAMA Network Open. “But we can say that our cohort had higher than anticipated frequency of cognitive impairment” given that they were relatively young and healthy, Becker said.
Data support use of Pfizer vaccine in children and teens
The Pfizer/BioNTech COVID-19 vaccine showed 90.7% efficacy against the coronavirus in a trial of children ages 5 to 11, the U.S. drugmaker said on Friday in briefing documents submitted to the U.S. Food and Drug Administration but not formally published. The children were given two shots of a 10-microgram dose of the vaccine – a third of the strength given to people 12 and older. The study was not primarily designed to measure efficacy against the virus. Instead, it compared the amount of neutralizing antibodies induced by the vaccine in the children to the response of recipients in their adult trial. Pfizer and BioNTech said the vaccine induced a robust immune response in the children. Outside advisers to the FDA are scheduled to meet on Tuesday to vote on whether to recommend authorization of the vaccine for that age group. A separate study from Israel conducted while the Delta variant was prevalent and published on Wednesday in The New England Journal of Medicine, compared nearly 95,000 12- to -18-year-olds who had received Pfizer’s vaccine with an equal number of adolescents who had not been vaccinated. The results show the vaccine “was highly effective in the first few weeks after vaccination against both documented infection and symptomatic COVID-19 with the Delta variant” in this age group, the research team reported.
Click for a Reuters graphic https://tmsnrt.rs/3c7R3Bl on vaccines in development.
(Reporting by Nancy Lapid; Additional reporting by Michael Erman; Editing by Bill Berkrot)
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