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Why guidelines for what Canadians can and can't do after getting COVID-19 vaccines are still unclear – CBC.ca

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Canada has delayed second doses of COVID-19 vaccines by up to four months — the longest interval recommended by a country so far — but has yet to provide any new guidance to Canadians on what they can or can’t do while waiting for the second shot.

The National Advisory Committee on Immunization (NACI) changed its guidelines earlier this month on the recommended time between doses of COVID-19 vaccines from three weeks to four months.

NACI said it based its revised guidelines on emerging real world evidence and the reality of Canada’s limited supply of COVID-19 vaccines, although there is no research yet on the long-term effect the delay could have on immunity to the coronavirus disease.

The decision was also informed by findings from the British Columbia Centre for Disease Control that determined that one dose of the vaccine was actually more effective than clinical trials had initially shown. 

NACI said if second doses were stretched to four months across the country, close to 80 per cent of Canadians over 16 could get at least one shot by the end of June. 

But Canada’s chief science adviser, Mona Nemer, has said the decision to delay second doses amounted to a “population level experiment.”

The United Kingdom has delayed second doses by up to three months, but no other country is known to have delayed them by up to four months. Spokespeople from Pfizer and Moderna said they recommend sticking with intervals of three and four weeks for their respective vaccines as studied during clinical trials. 

What can Canadians do after being vaccinated?

Many Canadians are wondering what they can do after getting vaccinated and if they can safely see their families, other vaccinated people or generally feel less at risk from COVID-19 after a year under strict public health measures. 

But the recommendations still haven’t been updated weeks after the change was made — meaning Canadians could be tempted to make up their own rules in the interim.

The U.S. Centers for Disease Control and Prevention released guidelines on March 8 for fully vaccinated individuals, saying they can safely meet indoors without masks or physically distancing with others who had received both shots.

The CDC also said those who have had both shots can visit with unvaccinated people from a single other household who are at “low risk for severe COVID-19,” as well as skipping quarantine and testing if exposed to COVID-19 without showing symptoms. 

But unlike Canada, the U.S. hasn’t delayed second doses by up to four months and answers to those questions have been harder to come by for Canadians weeks after guidelines changed and close to 5 million doses administered.

Canada’s Chief Public Health Officer Dr. Theresa Tam said during a news conference Tuesday that the issue is being actively discussed with the provinces and territories and that while new guidance is coming, the country is in the “early days” of its vaccine coverage.

“For now, the key message is that everyone needs to keep up with their personal protective measures which are wearing a mask, handwashing, watching your distance and avoiding closed, crowded conditions,” she said. 

“I think as more and more people get vaccinated I would expect the advice to evolve as we go along, but it’s a little bit too early.” 

WATCH | ‘Too early’ to update guidelines for vaccinated Canadians: Tam

Canada’s Chief Public Health Officer Dr. Theresa Tam says guidance for Canadians who have been vaccinated will likely evolve as more people get vaccinated, but it’s too early in our roll out to update recommendations yet. 1:35

Tam said the spread of coronavirus variants across Canada amid already high levels of community transmission should factor into “local decisions” on what public health measures need to be put in place or lifted for vaccinated individuals.

She provided no timeframe for when Canadians can expect to see new guidance from the Public Health Agency of Canada on what they can and can’t do after being vaccinated. 

Guidelines for Canadians with only one dose even less clear 

And what about guidelines for Canadians who have only had one dose? 

“It’s maybe not clear to the general public, but it should be clear that you’re only fully vaccinated after two doses,” said Prof. Alyson Kelvin, an assistant professor at Dalhousie University and virologist at the Canadian Center for Vaccinology.

“I can completely sympathize that it’s been a long haul for everybody, but it’s really important that we continue with those public health measures until we have a low level of virus transmission within the community.” 

She says until Canada’s hardest-hit regions have significantly lowered their rates of community transmission, Canadians will have to continue practicing physical distancing, proper hand hygiene, avoiding crowds and wearing masks in public.

“You’re still at risk even though you’re fully vaccinated,” says Kelvin, who is also evaluating Canadian vaccines with the VIDO-InterVac lab in Saskatoon.

“Even with two doses, you can still be infected and transmit the virus — you just might not be as ill as somebody who wasn’t vaccinated.”

A team from Humber River Hospital administer first doses of the Pfizer-BioNTech COVID-19 vaccine to parishioners of St. Fidelis Parish church on March 17, 2021. (Evan Mitsui/CBC)

Until Canada has a large proportion of vaccinated people across the country who can help decrease overall COVID-19 levels, Kelvin says it makes sense for hard-hit regions to hold off on relaxing public health measures. 

Dr. Nathan Stall, a geriatrician at Mount Sinai Hospital in Toronto, says communication from public health officials on what people can do after getting a COVID-19 vaccine has been lacking — especially for older Canadians. 

“I’ve had patients who have showed up at the vaccination clinic expecting to get their second shot and have been turned away, so they are devastated emotionally, I’ve had people who have found out immediately beforehand,” he said. 

“I think their questions are very reasonable, which [are]: ‘Do we have evidence to support this? Am I going to be at higher risk? How does this impact my behavior during the third wave now?'”

WATCH | The science behind delaying the 2nd dose of COVID-19 vaccines

Federal government scientists have put their support behind delayed second doses of COVID-19 vaccines — which several provinces were already doing — and ongoing research shows some of the benefits of the adapted strategy. 2:04

Stall, who is a member of NACI but does not speak on behalf of the committee, said it’s important for public health officials to be transparent about the emerging data on delaying second doses and that the guidelines will likely change.

“I think we need to do a much better job of messaging,” he said. “Because this population [of older seniors] has been living in terrible isolation for a year.” 

Dr. Lynora Saxinger, an infectious diseases physician and an associate professor at the University of Alberta, says updated guidelines will likely come in the near future as new data emerges.

She said it was important to note that the recommendations allowed for a maximum interval of up to four months, though the actual interval between doses could be shorter and the guidelines revised if new data showed certain groups were at higher risk. 

“So the main thing is to kind of stay light on your feet and make changes that make sense to try to protect everyone the best we can,” she said. 

Saxinger said the second dose delay made sense given Canada’s limited vaccine supply, because it allowed for an expanded vaccination rollout and offered protection to a greater number of vulnerable Canadians.

“It really will actually save a great many lives,” she said. 

“But if there’s populations where deferring the second dose will actually make them less likely to be immune in the longer term, then obviously that’s a place that has to be readdressed.”

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Ontario hospitals may have to withhold care as COVID-19 fills ICUs

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By Allison Martell and Anna Mehler Paperny

TORONTO (Reuters) – Doctors in the Canadian province of Ontario may soon have to decide who can and cannot receive treatment in intensive care as the number of coronavirus infections sets records and patients are packed into hospitals still stretched from a December wave.

Canada‘s most populous province is canceling elective surgeries, admitting adults to a major children’s hospital and preparing field hospitals after the number of COVID-19 patients in ICUs jumped 31% to 612 in the week leading up to Sunday, according to data from the Ontario Hospital Association.

The sharp increase in Ontario hospital admissions is also straining supplies of tocilizumab, a drug often given to people seriously ill with COVID-19.

Hospital care is publicly funded in Canada, generally free at the point of care for residents. But new hospital beds have not kept pace with population growth, and shortages of staff and space often emerge during bad flu seasons.

Ontario’s hospitals fared relatively well during the first wave of the pandemic last year, in part because the province quickly canceled elective surgeries.

The College of Physicians and Surgeons of Ontario told doctors last Thursday that the province was considering “enacting the critical care triage protocol,” something that was not done during earlier waves of the virus. Triage protocols help doctors decide who to treat in a crisis.

“Everybody’s under extreme stress,” said Eddy Fan, an ICU doctor at Toronto’s University Health Network. He said no doctor wants to contemplate a triage protocol but there are only so many staff.

“There’s going to be a breaking point, a point at which we can’t fill those gaps any longer.”

In a statement, the health ministry said Ontario has not activated the protocol. A September draft suggested doctors could withhold life-sustaining care from patients with a less than 20% chance of surviving 12 months. A final version has not been made public.

Ontario’s Science Advisory Table had been forecasting the surge for months, said member and critical care physician Laveena Munshi. During a recent shift she wanted to call the son of a patient only to discover he was in an ICU across the street.

“The horror stories that we’re seeing in the hospital are like ones out of apocalyptic movies,” she said. “They’re not supposed to be the reality we’re seeing one year into a pandemic.”

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In COVID-19 vaccination pivot, Canada targets frontline workers

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By Anna Mehler Paperny

TORONTO (Reuters) – Canada is shifting its vaccination campaign to target frontline workers, moving away from a largely age-based rollout as the country tries to get a handle on the raging third wave of the pandemic.

Canada‘s approach thus far has left unvaccinated many so-called “essential workers,” like daycare providers, bus drivers and meatpackers, all of whom are among those at higher risk of COVID-19 transmission. Provinces are now trying to adjust their strategy to tackle the surge driven by new variants.

Targeting frontline workers and addressing occupation risk is vital if Canada wants to get its third wave under control, says Simon Fraser University mathematician and epidemiologist Caroline Colijn, who has modelled Canadian immunization strategies and found “the sooner you put essential workers [in the vaccine rollout plan], the better.”

Initially, Canada prioritized long-term care residents and staff for the vaccines, as well as the very elderly, health workers, residents of remote communities and Indigenous people.

Targeting vaccinations by age made sense early on in a pandemic that ravaged Canada‘s long-term care homes, Colijn said. But now, immunizing those at highest risk of transmission brings the greatest benefit.

“If you protect these individuals you also protect someone in their 60s whose only risk is when they go to the store. … The variants are here now. So if we pivot now, but it takes us two months to do it, then we will lose that race.”

Data released on Tuesday from the Institute of Clinical and Evaluative Sciences showed that Toronto’s neighbourhoods with the highest rates of COVID-19 infections had the lowest vaccination rates, underscoring the disparities in vaccination.

‘IT’S A JUGGERNAUT’

On Wednesday, Ontario Premier Doug Ford announced a plan to have mobile vaccine clinics target COVID-19 “hotspots” and high-risk worksites, although he stopped short of giving people paid time off to get the shot.

Karim Kurji, medical officer of health in York Region north of Toronto, characterizes the shift in vaccination priority from age to transmission risk as moving from defence to offence.

“It’s a juggernaut in terms of the immunization machinery, and turning it around takes a lot of effort,” Kurji said.

Meanwhile, officials in the western province of Alberta say they are offering vaccines to more than 2,000 workers at Cargill’s meatpacking plant in High River, site of one of Canada‘s largest workplace COVID-19 outbreaks. Provincial officials said in a statement they are looking to expand the pilot to other plants.

Quebec will start vaccinating essential workers such as those in education, childcare and public safety in Montreal, where neighbourhoods with the highest vaccination rates have been among those with the lowest recorded infection rates.

The people doing the highest-risk jobs, from an infectious disease perspective, are more likely to be poor, non-white and new Canadians, health experts say. They are less likely to have paid leave to get tested or vaccinated or stay home when sick and are more likely to live in crowded or multi-unit housing. They need to be prioritized for vaccination and their vaccination barriers addressed, experts say.

Naheed Dosani, a Toronto palliative care physician and health justice activist, said making vaccines available to high-risk communities is not enough without addressing barriers to access.

“The face of COVID-19 and who was being impacted changed dramatically. The variants seemed to take hold in communities where essential workers live. … This [pivot] is a step in the right direction and will hopefully save lives.”

 

(Reporting by Anna Mehler Paperny; Editing by Denny Thomas and Aurora Ellis)

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Canada finance minister: Pandemic an opportunity to bring in national childcare

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OTTAWA (Reuters) – The COVID-19 pandemic and its damaging impact on women has underlined the need for a national childcare plan, which would also help the economic recovery, Finance Minister Chrystia Freeland said on Thursday.

Since taking up her job in August, Freeland has repeatedly spoken about a “feminist agenda,” and has said childcare will be part of a stimulus package worth up to C$100 billion ($79.6 billion) over three years. She will unveil details in her April 19 budget.

“I really believe COVID-19 has created a window of political opportunity and maybe an epiphany … on the importance of early learning and childcare,” Freeland told a online convention of Canada‘s ruling Liberal Party.

The budget is set to be a springboard for an election that Liberal insiders say is likely in the second half of the year.

Canadian governments of various stripes have mused about a national childcare program for decades but never acted, thanks in part to the cost and also the need to negotiate with the 10 provinces, which deliver many social programs.

Freeland said a childcare program would help counter “an incredibly dangerous drop” in female employment since the start of the pandemic.

“It is a surefire way to drive jobs and economic growth … you have higher participation of women in the labor force,” Freeland said. “My hope … is that being able to make that economic argument as well is going be to one of the ways that we get this done.”

Freeland, who is taking part this week in meetings of the Group of Seven leading industrialized nations and the International Monetary Fund, said U.S. Vice President Kamala Harris and Treasury Secretary Janet Yellen had told her they saw early learning and child care as a driver for economic recovery.

($1=1.2560 Canadian dollars)

 

(Reporting by David Ljunggren; Editing by Leslie Adler)

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