Canada's COVID Concerns

"...A bit of subtlety and nuance needs to be applied to people who are providing care on the front lines.' "People working in emergency departments and ICUs are a different beast than your average Canadian."

"It is not only a health and wellness issue, but a human resources issue."

"I have sent people under the age of 40 into the ICU. This wave is much more pronounced than the first two. The sheer volume of younger, healthier people coming in is quite something."

Dr.Michael Herman, Emergency physician, Queensway-Carleton Hospital, Ottawa

"[The faster vaccines can get into more arms], the sooner our community will be safe. [We would like to see front-line health workers get fully vaccinated]."

"Many of our team are exhausted, and the staffing gaps we have as a region are significant. Hopefully we can show them how much they are valued, appreciated and will be protected."

"We would welcome it if there was an opportunity for health-care workers to get their second doses sooner if there is sufficient vaccine supply."

Queensway Carleton Hospital statement

"[It is common for emergency physicians to not yet be fully vaccinated and there is a] growing unease [among them about the situation with the third COVID wave continuing to place unprecedented pressure on hospitals in Ontario]."

"They [doctors, nurses, health-care staff] feel vulnerable."

"We are not asking to be preferentially vaccinated for personal protection. We are asking for full vaccination to maintain the integrity of the emergency health system, which is fragile."

Dr. Alan Drummond, Emergency doctor, co-chair, public affairs, Canadian Association of Emergency Physicians

 

The federal government, acting on advice from health specialists appointed as a consulting body for the government which had determined that given Canada's exceedingly tight supply of vaccines, it made sense to inoculate as many Canadians in descending order of age and profession as possible, with a first dose of vaccine. Extending the time for the second dose well beyond what the pharmaceutical companies have tested for in their research and efficacy-testing trials for best practise. With the aim to vaccinate as many Canadians as possible with at least one protective dose, available vaccines would go further the experts hypothesized, and the second dose could be safely delayed.

This is the route the government chose, and the provinces, which administer health care, set about vaccinating high-risk people in descending order from the frail elderly, the health-compromised, health-care community, racialized, front-line workers in service industries and hard-struck communities to the point later on where anyone over age 18 could make appointments for vaccination. First dose given, the wait for the second would be four months on; sixteen weeks. Which does render a high degree of protection from the SARS-CoV-2 virus for most people.

However, those in the medical community who come in direct contact on a daily basis with large numbers of COVID-19 patients, in particular those suffering from the effects of strains of concern like the UK, South African or Brazilian variants should, sensibly, be given the ultimate protection of two doses, not in the time scheduled for everyone else but as originally intended by the vaccine manufacturers in line with their research results for potency and safety.

 

Emergency room physician Dr. Laura Shoots is seen in this photograph. (Natalie Johnson/CTV News Toronto)

 

The United Kingdom found itself in a situation of raging contagion and insufficient vaccines, and it pioneered the method of leaving a wider gap between the first and follow-up doses, of 12 weeks, to enable it to inoculate greater numbers of people against COVID. Canada has followed suit, but extended the wait period by an additional month. Canada is now contemplating the issue of mixing vaccines; the original vaccine dose not necessarily followed by the same vaccine administered for the second dose.

Again, the manufacturers cannot guarantee safety and efficacy with this kind of massive departure from their products' protocol. Mix-and-match is not endorsed by the makers of the vaccines. But it has been broached in light of the very real fact of vaccine shortages and the anxiety involved in ensuring that a good proportion of a country's population is vaccinated in the interests of achieving the vaunted 'herd effect' and an eventual return to social normalcy, so countries can get back to work, children back to school.

In Canada, roughly 38 percent of the population has now had one dose of vaccine, similar to the European Union where about 34 percent have received their first dose. Where Canada stands in the more refined issue of full vaccination leaves a mere 3 percent of Canadians having received both doses, as compared to nine percent in the EU. For the U.K. its 12-week gap between doses was initiated in the interests of reducing the death and communicability rate. based on:

1. How well a single dose of a vaccine prevents serious and  hospitalized COVID-19 cases;
2. The overall efficacy of a single dose of the vaccine;
3. Whether the protective effects of a single dose persist over the extended [up to 12-week] period.

Points one and two are fairly well assured; all major vaccines have a high degree of efficacy following the first dose; preventing death and hospitalization. It is point three where uncertainty steps into the picture, with no reasonably reliable evidence that a 12-week gap works; untested and unknown. Pfizer is known to have cautioned that it cannot vouch for the longevity of protection the first dose confers, all the more so with Canada's lengthy dosing interval of up to 16 weeks.

Little wonder that the medical community, reliant on the data they are aware of, through their professional understanding, and acutely aware of the vulnerability of their personal safety through constant exposure to people suffering serious effects from COVID, and likely carrying high viral loads more readily communicable, have good reason to be concerned. For themselves, for their families, and for their patients.

The government of Canada rates a  high failure mark for a number of issues critical to the COVID situation and the need to address a pandemic that has so far demolished all hope that it will be readily settled and life as normal is on the near horizon. Its first massive error was relying on China as a vaccine partner. Which led to late contracts with pharmaceutical companies to provide their vaccines for Canada. Leading to a desperation to try something experimental in the hopes that more people could be vaccinated, sooner, to reach the goal of COVID control and normalization.

Federal Health Minister Patty Hajdu prepares to receive a first dose of COVID-19 vaccine from Brian Gray, Director of Oak Medical Arts – Mountdale Pharmacy, in Thunder Bay, Ont., Friday, April 23, 2021. THE CANADIAN PRESS/David Jackson-Pool