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Why Canada's confusing COVID-19 vaccine guidelines could be leaving seniors at risk – CBC.ca

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This is an excerpt from Second Opinion, a weekly roundup of health and medical science news emailed to subscribers every Saturday morning. If you haven’t subscribed yet, you can do that by clicking here.


Canada’s reluctance to follow evolving real-world data has led to potentially confusing COVID-19 vaccination guidelines that some experts say leave vulnerable seniors at risk in the community and could fuel vaccine hesitancy.

The National Advisory Committee on Immunization (NACI) recommended last week that Canadians over 65 not receive an AstraZeneca-Oxford vaccination despite emerging evidence from countries around the world demonstrating its ability to prevent severe COVID-19 in older adults.

The recommendation led provinces to reorganize their vaccination plans for seniors. The result was people aged 60-64 could receive AstraZeneca-Oxford shots ahead of older age groups, who are at greater risk of hospitalization and death from COVID-19.

Quebec is the only province so far to ignore the national recommendations. Officials there said this week they would administer the AstraZeneca-Oxford vaccine to seniors in direct contrast to what the province considers outdated NACI advice.

Other countries such as France and Germany initially advised those 65 and older not to receive the shot, but overturned their decisions earlier this month after new evidence showed the vaccine significantly reduced hospitalizations in that age group.

One Shoppers Drug Mart location in Toronto’s east end started catering to walk-ins for AstraZeneca-Oxford shots for those aged 60 to 64, which prompted a long lineup near Danforth and Coxwell Avenues on Thursday.  (Michael Charles Cole/CBC Toronto)

But the NACI recommendations were based largely on AstraZeneca-Oxford’s clinical trial data and didn’t examine real-world evidence past Dec. 7 — months before the effectiveness of the vaccine was fully realized in other countries for older age groups.

“We are trying to do the best that we can with the data that we have,” NACI chair Dr. Caroline Quach told The National‘s Andrew Chang this week.

She said the volunteer national advisory committee isn’t able to pivot to emerging data quickly.

“We are not a committee that is able to make a recommendation on Monday to be published on the Tuesday.”

Quach confirmed to CBC News on Friday that NACI met this week to discuss revising the AstraZeneca guidelines for those over 65, and said they would likely be updated “in the next few days” as shots continue to roll out across the country for younger age groups.

‘Disconnect’ between COVID-19 vaccine guidelines

NACI’s decision to advise against AstraZeneca-Oxford shots for older Canadians in spite of emerging evidence is in direct contrast to another recent recommendation it made to delay second doses of COVID-19 vaccines by up to four months.

That decision was based on real-world data from Quebec, B.C., Israel, the U.K. and the U.S. that showed “good effectiveness” of between 70 and 80 per cent from a single dose of the vaccines in preventing severe illness “for up to two months in some studies.”

“People would see a bit of a disconnect,” said Dr. Isaac Bogoch, an infectious diseases physician and member of Ontario’s COVID-19 vaccine task force. “You’ve got to have the trust of the general public.”

WATCH | Benefits outweigh risks with AstraZeneca-Oxford COVID-19 vaccine, experts say:

Despite some European countries temporarily halting use of the AstraZeneca-Oxford vaccine after 30 cases of blood clots, experts maintain it is still safe to use in Canada. 2:01

Bogoch said NACI needs to be “very careful” with its messaging around vaccination recommendations in an “open, honest and transparent way” with Canadians, in order to avoid eroding trust in vaccines. 

“How we word things matters…. If you’re going to make those recommendations, you’ve got to stand up in front of the country and explain why,” he said.

“We’re already getting issues with people who are saying, ‘I’m not going to take the AstraZeneca vaccine, I’m going to wait.’ It’s going to be a challenge.”

Raywat Deonandan, a global health epidemiologist and an associate professor at the University of Ottawa, said the recommendation against the AstraZeneca-Oxford vaccine for seniors sends the “wrong message” to Canadians.

“I’ve got people telling me they don’t want AstraZeneca, so they’ll rather wait until they can get a Pfizer dose,” he said. “We need to get sufficient numbers of doses in the right people so that herd immunity happens and case numbers drop.” 

Alyson Kelvin, an assistant professor at Dalhousie University in Halifax and virologist at the Canadian Center for Vaccinology, says there are no safety concerns with AstraZeneca-Oxford for older individuals and that its effectiveness is on par with other vaccines such as Pfizer-BioNTech and Moderna.

Monique Prud’homme, one of the first Albertans to receive the Covishield/AstraZeneca-Oxford vaccine, on Thursday, told Alberta Health Services she is ‘so excited’ and looks forward to someday having her grandchildren stay over, hosting family meals at home, visiting friends and her father. (Alberta Health Services)

“If a vaccine is available to you, it’s really important that you’re taking it,” she said.

And that’s especially true for people over 60, she said.

“This group of individuals makes up about 97 per cent of our COVID-related deaths in Canada, and to keep a vaccine from them … hurts my heart.”

Bogoch said that each of the four vaccines approved in Canada will significantly reduce the risk of hospitalization and death for older Canadians, so it’s important to keep that in context when considering national recommendations.

“We’re in the middle of a public health crisis,” he said. “So the strategy should be to vaccinate as many people over the age of 60 with any of the available vaccines in as short a time frame as possible.”

‘No indication’ AstraZeneca-Oxford vaccine tied to blood clots

Adding to the confusion around the AstraZeneca-Oxford vaccine this week were reports of an undisclosed number of blood clot cases after vaccinations in Europe, which ultimately led Denmark, Norway and Iceland to stop using the vaccine out of an abundance of caution.

Health Canada released a statement Thursday night, more than eight hours after CBC News requested comment, saying “there is no indication that the vaccine caused these events” and the “benefits of the vaccine continue to outweigh its risks.”

The U.K.’s drug regulatory agency said that of the 11 million doses of the AstraZeneca-Oxford vaccine that have been administered, reports of blood clots were no greater than expected in the general public.

WATCH | ‘No cause for alarm’ after Denmark pauses AstraZeneca vaccinations, says doctor:

There’s no reason to be overly worried after Denmark said it was temporarily stopping inoculations with the AstraZeneca COVID-19 vaccine to investigate a small number of blood clots, says infectious disease specialist Dr. Isaac Bogoch. 2:16

Bogoch told CBC News that while it’s important to watch the situation carefully in order to instill confidence in the vaccine’s safety, Canadians have to keep it in context. 

“This vaccine has been given to millions and millions of other people globally, including in the United Kingdom,” he said.

“We have not yet heard of any signal amongst the noise for blood clots in any other jurisdiction and there have been other places that have been giving this vaccine for … months.”

Age ‘greatest risk’ factor for COVID-19

Experts say the confusion around vaccine safety recommendations this week is unfortunate, especially given the number of seniors in Canada at risk of severe COVID-19 complications who have yet to be vaccinated. 

While long-term care home residents were prioritized in Canada’s vaccine rollout after the first shipments arrived in mid-December, seniors living in the community have only recently been offered a vaccine across much of the country. 

“When you actually look at the data about who’s the greatest risk from getting seriously ill and dying from COVID-19, the No. 1 factor is age,” said Dr. Samir Sinha, director of geriatrics for the Sinai Health System and the University Health Network in Toronto. 

Carmelo Bolpe, 67, gets his first dose of the Pfizer-BioNTech COVID-19 vaccine at Caboto Terrace in Toronto on Thursday. Nurses from Humber River Hospital were on site as part of an initiative to vaccinate seniors in congregate living settings. (Evan Mitsui/CBC)

Sinha says Canada should have better prioritized community-dwelling seniors in its initial rollout, especially given the significant drop in hospitalizations and deaths among long-term care residents after vaccination.

More than 14,000 long-term care residents have died of COVID-19 in Canada since the pandemic began. Sinha says about 4,000 of those residents were in Ontario, while another 2,000 of the province’s deaths were seniors living in the community. 

“We have to remember that, yes, 70 per cent of our deaths in Ontario have been amongst those living in our long-term care retirement homes,” he said. “But another 26 per cent have been among community-dwelling seniors.” 

Deonandan says he was “shocked” that age wasn’t more of a priority for initial COVID-19 vaccine rollouts across the country given that it is the single biggest risk factor by far.

“It comes down to, what is the goal that we’re trying to achieve here?” he said. 

“The goal should be twofold: to keep the health-care system up and running, and to make the crisis go away, and you get that by focusing on age.”


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Factbox-Details of funeral service planned for Britain’s Prince Philip

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LONDON (Reuters) -Following are details of the funeral this Saturday of Britain’s Prince Philip, Queen Elizabeth’s husband, who died on April 9 aged 99.

THE FUNERAL

The funeral, which will be broadcast live, will take place at St George’s Chapel at Windsor Castle at 3 p.m. (1400 GMT).

As planned, it will be a ceremonial royal funeral, rather than a state funeral, with most of the details in keeping with Prince Philip’s personal wishes.

However, it has had to be scaled back because of COVID-19 restrictions. There will be no public access, no public processions and the funeral will take place entirely within the grounds of Windsor Castle.

The service will begin with a national minute of silence. At the end of the service Philip will be interred in the chapel’s Royal Vault.

WHO WILL ATTEND?

Only 30 mourners are permitted because of COVID-19 rules. These will include the queen, all senior royals including the duke’s grandchildren and their spouses, and members of Prince Philip’s family including Bernhard, the Hereditary Prince of Baden, and Prince Philipp of Hohenlohe-Langenburg.

Members of the Royal Family will be wearing morning coat with medals, or day dress. The congregation will adhere to national coronavirus guidelines and wear masks for the 50-minute service.

A small choir of four will sing pieces of music chosen by the prince before his death and there will be no congregational singing. The queen will be seated alone during the service.

THE DETAILS (note: all times local, GMT is one hour behind British Summer Time)

At 11 a.m., Philip’s coffin, covered by his standard (flag), a wreath, his naval cap and sword, will be moved by a bearer party from the Queen’s Company, 1st Battalion Grenadier Guards from the Private Chapel in Windsor Castle – where it has been lying in rest – to the Inner Hall of the castle.

At 2 p.m. the ceremonial aspect begins, and within 15 minutes military detachments drawn from Philip’s special military relationships such as the Royal Navy, the Royal Marines, the Grenadier Guards, the Royal Gurkha Rifles, the Intelligence Corps and the Highlanders will line up in the castle’s quadrangle.

The Foot Guards and the Household Cavalry will line up around the perimeter of the quadrangle.

Between 2.20 p.m. and 2.27 p.m., the royals and members of Philip’s family not taking part in the procession will leave by car for St George’s Chapel.

At 2.27 p.m., a specially-coverted Land Rover that Philip helped design will enter the quadrangle.

At 2.38 p.m., the coffin will be lifted by the bearer party from the Inner Hall.

Bands in the quadrangle will stop playing at 2.40 p.m. and the coffin will emerge from the State Entrance one minute later.

The royals in the procession including Philip’s four children – Princes Charles, Andrew, Edward and Princess Anne, along with grandsons William and Harry – will leave the State Entrance behind the coffin, which will be placed onto the Land Rover.

At 2.44 p.m., the queen, with a lady-in-waiting, will leave the Sovereign’s Entrance in a car known as the State Bentley. The national anthem will be played and as the car reaches the rear of the procession, it will pause briefly.

At 2.45 p.m., the procession will step off with the band of the Grenadier Guards leading. The Land Rover will be flanked by pall bearers.

As it moves to the chapel, Minute Guns will be fired by The King’s Troop Royal Horse Artillery and a Curfew Tower Bell will sound.

The queen’s Bentley will stop outside the Galilee Porch where she will be met by the dean of Windsor, David Conner, who will escort her to her seat in the quire of the Chapel.

The coffin will arrive at the foot of the west steps of St George’s Chapel at 2:53 p.m. to a guard of honour and band from the Rifles. Positioned in the Horseshoe Cloister will be the Commonwealth defence advisers from Canada, Australia, New Zealand and Trinidad and Tobago.

The west steps will be lined by a dismounted detachment of the Household Cavalry. A Royal Naval Piping Party will pipe the “Still” once the Land Rover is stationery at the foot of the steps. A bearer party from the Royal Marines will lift the coffin from the Land Rover as the Piping Party pipe the “Side”.

The coffin will pause for the national minute of silence at 3 p.m. A gun fired from the East Lawn will signify the start and end.

The coffin will then be taken to the top of the steps where it will be received by the dean of Windsor and the Archbishop of Canterbury, Justin Welby. As the chapel doors close, a piping party will pipe the “Carry On”.

The coffin will move through the nave to the catafalque in the quire, with senior royals processing behind.

Philip’s “insignia” – essentially the medals and decorations conferred on him, his field marshal’s baton and Royal Air Force Wings, together with insignia from Denmark and Greece, will be positioned on cushions on the altar.

The funeral service will then be conducted by the dean of Windsor. After the coffin is lowered into the Royal Vault, Philip’s “Styles and Titles” will be proclaimed from the sanctuary.

A lament will then be played by a pipe major of the Royal Regiment of Scotland and “The Last Post” will be sounded by buglers of the Royal Marines.

After a period of silence, “the Reveille” will be sounded by the state trumpeters of the Household Cavalry and then the buglers of the Royal Marines will sound “Action Stations” at the specific request of the Duke of Edinburgh, as Philip was officially known.

The archbishop of Canterbury will then pronounce the blessing, after which the national anthem will be sung.

The queen and the other mourners will then leave the chapel via the Galilee Porch.

(Reporting by Michael Holden and Guy Faulconbridge; Editing by Frances Kerry and Catherine Evans)

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Canadas Immigration Problems Solved by Invisible Border Walls

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Canadas’s immigration story is seen by the world as too liberal that gives them a good image through out but there seems to be some lesser-known information. It is not only liberal but conservative as well and they hide this fact all too well. This is only made possible by the invisible border walls that Canada has instore.

No this is not something out of sci-fi novel. This is actually true and will be discussed further down the article. But first we need to see what happen in the 1980s.

Since the 1980s, Canada has consistently been a high-immigration country, at least relative to the U.S. As a result, the proportion of Canadians born outside the country hit 21.9 percent in 2016. That same year, America’s foreign-born population was 13.4 percent. That’s a record high for the U.S.—but it’s been 115 years since Canada’s foreign-born population was at such a low level. As Derek Thompson put it in his article analyzing how Canada has escaped the “liberal doom loop,” Canada’s floor is America’s ceiling.

So, the question remain why has Canada managed to sustain popular acceptance and cross-party support for so much legal immigration?

Well firstly, this is because the intake of the Canadian population has been so law abiding and orderly so to be undisruptive and thus not being newsworthy. Canada unlike the neighbor USA is a country where mostly come in from the front door, in the open and during the daylight hours.

Everyone coming to Canada would have to apply from there home countries to come to Canada before they are granted access to the country, they have to go through a huge line of people already waiting after which they are subjected to extensive vetting by the Canadian authorities. Those who make the cut are then let in the country. In short it is not only you that chooses Canada but Canada would also have to choose you. For this to work.

For those who choose to trespass and try to enter Canada by illegal means well that where the invisible border walls come in. that right Canada has a border wall. In a sense of course. In fact, there are 5 of them. Four geographic and 1 bureaucratic. All of which have been effective at sustaining the legitimacy and popularity of Canada’s immigration policy.

Three of the walls are the dumb luck of geography: the Atlantic, Pacific, and Arctic oceans. You can cross the Aegean from Asia to Europe in a dinghy, but unless you can get your hands on a ship and a crew trained in navigating thousands of miles of difficult water, you aren’t sailing to Canada. So far in 2018, Canada has received exactly 10 asylum applications at sea ports.

The fourth wall is Canada’s southern border with the U.S. The world’s leading economy has historically been a magnet for people, not the reverse. In the late 19th and early 20th century, the volume of emigrants from Canada to the U.S. was at times so high that Canadians actually feared for the future of their country. The strength of the American economy long meant that few immigrants would think to use the U.S. as a back door into Canada.

The fifth wall is the bureaucratic barrier that Canadian governments, both Conservative and Liberal, have meticulously maintained to cover any gaps in the other defenses.

This is the underlying reason for Canada having an amazing immigration system, that would present itself as liberal but is actually more a concern of some natural luck.

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How to Immigration System in Canada has Changed Since the Covid-19

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Before we jump into the current situation we need to look into what Canada and its immigration system has been for people all around the world. Canada has been a keeper of refugees; for people that are involved in international controversies, religious persecution etc from there country of origin.

We see this in the 1947-1953 Canada welcomed thousands of Hungarians and Vietnamese “boat people”. In the late 1970s and Syrians in the 2010s.

This still continues to date since the immigration and retention of people from Hong Kong.

But all of this would begin to change since the beginning of the covid 19. The real question is Canada has suffered far worst and still managed to land on its feet. Will this time be different? Only time will tell.

The History of Immigration in Canada:

Canada has a history of coping with situation that limited its ability to accept newcomers to its country. The First World War saw immigration to Canada drop precipitously; in 1915, the intake was only 34,000 people (compared to over 400,000 just two years before).

In the 1920s we began to see an increase in numbers but again dropped sharply with the advent of the Great Depression, dipping still further with World War II. So, the drop in immigration to Canada resulting from the Coronavirus is far from unheralded in Canada’s history.

Canada has also seen great waves of immigration, particularly as part of a response to, and recovery from, challenges. Hundreds of thousands of immigrants poured into the country, many to the west, in the decade or so following the establishment of Saskatchewan and Alberta as provinces. Unlike many countries in Europe, which arguably had too many people and not enough land, Canada had the opposite problem.

After the calamity of the Second World War, Canada, unlike many other nations, had emerged strong and stable. But it was sorely lacking in the labor force and skills necessary for the great post-War economy and recovery taking place. Between 1946 and 1953, over 750,000 souls found a home in Canada.

Plans on Immigration After the Pandemic:

The government has announced a goal of settling over 1,200,000 new permanent residents in Canada from now until 2021-2023. In considerable measure, economic and population needs are the motivation for this ambitious plan. Marco Mendocino, the incumbent Immigration Minister, expressed it well in announcing the targets in the following statement:

“Immigration is essential … to our short-term economic recovery and our long-term economic growth … newcomers create jobs not just by giving our businesses the skills they need to thrive, but also by starting businesses themselves.”

Conclusion:

The pandemic has hit the world hard and well Canada has been no stranger to the virus, we have people lost lives and people that have suffered a lot financially and economically. This would have to turn around in the near future but until that happens Canada would have play there cards right for this to work out in the favor of the country and it’s citizens.

I personally think that Canada can still make a difference in the international world. If it were to continue to follow the plan it has set for itself. I am sure that this is going to be difficult but considering previous Canadian track record this is going to be something that Canada would be coming out of with potentially amazing results.

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