Tuesday, January 19, 2021  |  Category: COVID-19

State of the Pandemic: January 2021

In a series of daily newsletters in early January 2021, I summarized developments in the COVID19 pandemic over the past month. This page brings them together in a single spot for reference. (Click here to subscribe to the free daily emails.)

Over the winter break, in many ways the pandemic continued its inevitable, inexorable, and entirely predictable course. (Remember the key lessons from the 5 graphs in my COVID101 series.)

Pandemic Update

Since my last Monday round-up on Dec 14, the COVID19 pandemic has been continuously setting and breaking new records for cases, hospitalizations, ICU beds and deaths. (It’s not been pretty.) Optimism at the prospect of imminent vaccines has given too many people a false sense of relief, with more infectious variants accelerating the seasonal surge, and the real impact of holiday gatherings still to come.

As global COVID19 deaths surpass 2 million, and Canadian cases approach 700,000,  some regions see the peak of holiday infections – although inconsistent testing leaves doubts, and the mortality peak is still a few weeks away.

 

Globally, in less than a month we’ve gone from 72.2M cases to 89.7M (a 24% increase). Global deaths have climbed from 1.6M to 1.93M (a 21% increase). The UK has seen case counts skyrocket, with 30,000 deaths in the past 30 days. In London, 1 in every 30 people is infected and hospitals are at the breaking point. Surgeries are being cancelled, ambulances are waiting hours for available beds, and oxygen is in short supply with >20,000 COVID19 patients in hospital. Hospitals in Ukraine are overwhelmed, with one medical college converted into a makeshift hospital with hundreds of patients in lecture halls. At 2 hospitals in Egypt last week, every COVID19 patient in the ICUs reportedly died when oxygen supplies were depleted.

“Huge numbers of patients are just piling up on the front door.” – Mervin Singer, Prof of Intensive Care Medicine, UC London

 

America has seen case counts increase from 16.9M to 22.2M (31%), and deaths rise from 308,293 to 381,483 (24%). It is now seeing ~300,000 new cases and >4,000 COVID19 deaths each day – 1 death every 22 seconds! (Sadly, one of them was Dawn Wells, the actress who played MaryAnn on Gilligan’s Island.)

Hospitalizations have surged to >132,000, particularly across the South, where 13 states set new records this past week. 40 hospitals across Georgia can no longer accept new patients. In Los Angeles, medical facilities are running out of oxygen, and ambulance crews have been told to declare patients dead on the scene rather than bring them to hospital if they have little chance of survival. Even with sufficient oxygen, older hospitals are finding their oxygen pipes are freezing up from overuse. Refrigerated trucks are being dispatched across California as mobile morgues. Arizona now has 69 of every 100,000 residents hospitalized with COVID19 – the highest rate in the country – thanks to a “very lax policy environment.”

“We’re no longer in a wave or surge, or surge upon a surge. We really are in the middle of a viral tsunami.” – Robert Kim-Farley, Medical epidemiologist, UCLA

 

Biden Time

 

The transition team has made it clear that president-elect Joe Biden plans to sign “roughly a dozen” executive orders on Wednesday afternoon, following his inauguration, and dozens more in the following 10 days. His top priority is to deal with COVID19…

COVID19: On Day 1, Biden will bring the US back into the World Health Organization, and launch his “100-Day Masking Challenge,” making facemasks mandatory on federal property and during any interstate travel. He will also focus $20B of federal resources on coordinating vaccine distribution and vaccinations, “one of the most challenging operational efforts every undertaken by our country.” FEMA and the National Guard will be mobilized to thousands of vaccination sites, and Biden promises to vaccinate 100 million Americans in his first 100 days. A further $50B will go towards COVID19 testing, and $130B to retrofit schools, since we’ll be living with this pandemic for a while yet.  New York Times

Travel Restrictions: On Monday (for some reason) Trump ordered an end to the ban on travellers from Europe and Brazil, set for Jan 26. Biden intends to rescind that order on Wednesday, and to “strengthen public health measures around international travel in order to further mitigate the spread of Covid19.”  New York Times

Healthcare: In the early days, Biden will reopen and promote the Affordable Care Act insurance marketplaces, allowing Americans to sign up for Obamacare over more than just 6 weeks in December and January. Biden has been opposed to Medicare-for-all, a single-payer system more like Canadians enjoy. Washington Post

American Rescue Plan: Biden has proposed a $1.9 trillion package of economic stimulus and pandemic relief, which will need the support of every Democrat in the Senate to pass. It includes $400B for vaccine deployment, $350B for state and local governments, and $1,400 direct payments to individuals – along with more unemployment benefits, paid leave for workers, and subsidized childcare.  New York Times

“Millions of Americans are still hurting through no fault of their own. The basic story is simple: if we don’t act now, things are going to get much worse and harder to get out of the hole later, so we have to invest now.” – Joe Biden, US President-Elect

 

We can only hope that Biden’s administration is able to bring the explosive pandemic under control in the US, and that more rational thinking will prevail among the public worldwide.

 

 

Canada hasn’t done better, jumping from 460,000 to 656,000 cases – a 43% increase in 4 weeks! Our own COVID19 fatalities have risen from 13,553 to 16,894 (25%).

The Atlantic bubble burst back in November, although Newfoundland and Labrador reports no new cases for the past 4 days, and has just 4 active cases. PEI has just 8 active cases. With 171 active cases and 30 new cases on Saturday alone, all of New Brunswick is at “orange alert,” and has prohibited all nonessential travel in the province. Nova Scotia reported 3 new and 31 active cases this weekend. Students returning from anywhere other than PEI or NL are “encouraged” to book a COVID19 test halfway through their 14-day quarantine.

Quebec has been reporting more than 3,000 new cases daily, and now has 24,589 active cases.

 

Ontario has been reporting >4,000 new cases daily, and new modelling to be released this week will make Ontarians “fall off their chairs.” Premier Doug Ford warns, “we are in a crisis. It is scary.” More than 1,400 COVID patients are in Ontario hospitals, 400 of them in ICUs. Ford warns that Ontarians will have to be vigilant until April or possibly June. Field hospitals are being pressed into service in Oakville and Burlington. Windsor Regional Hospital has opened a new temporary morgue, and Western U’s University Hospital is using a refrigerated truck trailer as an overflow morgue.

New COVID Variants

Worse may be yet to come in the pandemic. Back in August I reported that the COVID19 “G-Variant” had emerged in Europe in Feb 2020 and quickly become the dominant strain on the planet, because it was more readily transmissible than the original from Wuhan. We’ve discussed several times since the risk of zoonotic transmission to and from animals like minks, as an accelerant of genetic mutation. In fact, there are >3,500 genetically distinct branches of the COVID virus mapped at NextStrain.org (and that’s just a selection of all that exist).

The UK Variant

In mid-December, a new variant of COVID19 was identified in the UK (SARS-CoV-2 B.1.1.7) with 23 genetic mutations, which is 56% more infectious than the original, and seems to be more contagious among children. This new variant seems to be a key driver in the rapid escalation of cases which have led to a third national lockdown. Although many countries banned travellers from the UK in response, the UK variant has now spread to the US, Canada, and many other countries. Disturbing new modelling out of Queen’s U projects that the new strain could become the dominant one in Ontario as soon as late February, and that it could double the cases every 10-15 days instead of every 40.

Last week, a uTexas study concluded that the Pfizer/BioNTech vaccine appears to remain effective against one mutation (N501Y) in the UK variant, but more work remains to be sure it will be effective against all 23 mutations involved. Nonetheless, the accelerated spread of the UK variant means even more pressure to speed vaccinations, and raises the threshold for effective herd immunity.

“Before the new variant I was more hopeful of a summer that would allow people to go to camp and travel and that sort of thing. I’m less sure about that now. That just makes this a much harder problem… It’s certainly not good news.” – Marc Lipsitch, Epidemiologist, Harvard

 

The African Variants

Scientists seem to be more concerned about the E484K mutation, in the new South African and Nigerianvariants (501Y.V2). And of course, experts fully expect more mutations and variants of COVID19 to come.

A US Variant?

On Friday, news outlets reported a new, highly-contagious “US variant,” which is currently just a hypothesis proposed by Deborah Birx, of the White House coronavirus task force. “This fall/winter surge has been at nearly twice the rate of rise of cases as the spring and summer surges. This acceleration suggests there may be a USA variant that has evolved here, in addition to the UK variant that is already spreading in our communities and may be 50% more transmissible.”

The Brazil Variant

And just last night, Japan’s health ministry reported yet another COVID19 variant with 12 mutations, in 4 travellers from Brazil. It reportedly differs from the UK and African variants, and tests are being conducted on the effectiveness of existing vaccines on it.

“It is highly likely there are many variants evolving simultaneously across the globe. However, it could take weeks or months to identify if there is a single variant of the virus that causes Covid19 fueling the surge in the US similar to the surge in the UK.” – Jason McDonald, CDC spokesperson

 

Several new variants are accelerating the spread of COVID19 worldwide, and will make it tougher for vaccination efforts to flatten the curve. Last week I mentioned the UK and South African variants, and rumours of a US strain. Now, researchers at Southern Illinois U say that a new US variant (20C-US) from Texas “may already be the most dominant variant” in the country. Ohio State U researchers have identified a second US variant, which quickly became dominant in Columbus OH over the past month, and a third in a single patient so far.

 

 

COVID on Campus

The number of cases in CdnPSE slowed significantly during the holiday shutdown, but nonetheless there are 25 I have added to my master spreadsheet, which so far has tracked 1,071 since the fall term began:

Dalhousie U confirmed a student case of COVID19 in residence on Jan 5. The student sought testing “at the onset of symptoms” and is now in isolation. (Total 5 since Sept.) Dal

Durham College reported 2 more COVID19 cases at its Oshawa campus on Dec 18. (Total 39 since Sept.) DC

McMaster U reported 5 more cases on campus, Dec 20 and Jan 4-8. 4 of the cases involved staff members, while 1 was an international grad student in quarantine on campus. (Total 22 since Sept.) McMaster

Redeemer U had a total of 5 student cases last month. CBC

St Francis Xavier U students are returning to Antigonish NS to quarantine before classes recommence. Just before the break, I shared the happy news that StFX had made it through the fall term with zero cases of COVID19. Unfortunately, the same cannot be said for students’ hometowns, as 2 students have now returned to campus and tested positive. Toronto Star

uWindsor confirmed 8 more cases of COVID19 on campus in December, and 1 on Jan 1. (Total 19 since Sept.)  uWindsor

uWaterloo reported a new case on campus Jan 7. (Total 18 since Sept.) CTV

 

 

Global Lockdowns

The real issue, as always, has been that governments have been too slow to impose lockdowns, waiting until the epidemiological trajectory is already past the point of no return.

 

UK: Third Time’s the Charm?

Back in June, the British government urged the public to “eat out to help out,” spending Ł500M to subsidize restaurant bills – and driving one-sixth of new COVID19 outbreaks in the country. The UK finally imposed a month-long national lockdown on Oct 31, and another on Jan 4 – but critics say that repeated “dilly-dallying” by a “laissez-faire” government has made the UK situation the worst in Europe.

The third national lockdown, starting Jan 4, will last for at least 6 weeks, closing all K-12 schools and colleges for in-person learning “except for the children of key workers and vulnerable pupils.” Universities students will not return until at least mid-February.

Scotland is moving university and college teaching online until “at least” the end of February. Students should remain where they are during the current lockdown.

“Why is this prime minister [Boris Johnson], with all the scientific expertise at his disposal, all the power to make a difference, always the last to grasp what needs to happen? The prime minister hasn’t been short of data, he has been short of judgment.” – Jonathan Ashworth, Labour Party health critic

 

Second Wave with a Vengeance

Many countries that appeared to have the pandemic under control are now being forced to impose strict lockdown measures.

In the face of skyrocketing infections, Israel has imposed a full national lockdown that will close most schools and nonessential workplaces for at least 2 weeks. (Without the lockdown, projections were for 46,000 new cases daily by February!)

Lebanon is tightening their lockdown with an 11-day, 24-hour curfew starting Thursday. They relaxed restrictions prior to Christmas, hoping to boost the economy, and allowed bars and nightclubs to reopen. Daily case counts are expected to rise beyond the current 5,000 record.

Germany remains under a strict lockdown until Jan 31, and has limited nonessential travel to a 9-mile radius. Daycare centres and most schools are closed, while parents are getting an extra 20 days of leave.

After a year resisting it, Sweden’s parliament just passed emergency legislation, effective yesterday, to permit health restrictions and lockdowns.

Norway has suspended university lectures and imposed a 2-week nationwide ban on serving alcohol in restaurants and bars, and on visitors at home.

Indonesia is imposing new restrictions in parts of Java and Bali.

China has imposed travel restrictions and bans on gatherings in rural villages in the outskirts of Beijing. More than half a million people were locked down yesterday “to stamp out a handful of cases.” One asymptomatic case was a driver for a ride-hailing service – so the government has suspended all taxi-hailing services in the district.

PS: 22M people are now in lockdown in Shijiazhuang, Xingtai, and Langfang (communities near Beijing) within days of a “handful” of COVID19 cases, arising from a village wedding. (That’s double the size of the lockdown last January, which the world considered extreme.)

 

 

 

Japan Pays the Price

Japan has taken baby steps towards imposing restrictions after declaring a limited state of emergency in Tokyo, until at least Feb 7. Some would say they are now paying the price for “complacency,” depending on facemasks instead of restrictions since May, and introducing a subsidy program (like the UK) to encourage tourism and dining out last fall, through December. Live sports, with somewhat reduced crowds of spectators, resumed in Japan in early October. The result has been surging cases of COVID19 since November. And the Olympics are still scheduled to open in Tokyo in <200 days. (I wouldn’t hold my breath…)

 

US Campuses

We heard yesterday just how bleak the pandemic is, south of the border. The CDC lays some of the blame at the feet of campus administrators who insisted on reopening…

 

Measuring Campus Impacts

A new CDC report concludes that county-wide COVID19 cases increased 56% within 3 weeks when large colleges held F2F classes this fall, but they dropped 17.9% when classes were held remotely.

 

Backing Off on January

UNC Chapel Hill, site of a disastrous outbreak in August that canceled F2F classes, has decided that classes will be online for the first 3 weeks of the winter term, until Feb 8. Penn State plans to keep classes online until Feb 12, while numerous other colleges in Pennsylvania and New York and across the US are moving back the start of classes. The start of the winter term has been delayed until Feb 8 at Syracuse U (NY).

In California, Stanford reported 43 new student cases last week, and cancelled its plans to bring first and second year students back to campus for the winter quarter. (It still hopes to bring third and fourth years back in the spring.)

The uCalifornia system, on the other hand, announced yesterday that it plans to bring most students back to campus for in-person classes this fall. The California State U system, the nation’s largest, made a similar announcement back in December.

 

Canadian Lockdowns

Most of Canada is in the grip of tightened restrictions, but not all…

 

Nova Scotia Eases Up

Despite lobbying from the Town of Antigonish and St Francis Xavier U, among others, the Nova Scotia government has relaxed its rules for mandatory testing of students arriving in the province. In September, arriving students were required to take 3 COVID19 tests during their quarantine; now the PHO merely “encourages” students to get one test, if possible. (Even without mandatory testing, NS universities have reported 5 new cases in the past few days. Students arriving from New Brunswick in particular are now subject to quarantine. International students are particularly frustrated by the requirement to quarantine in a hotel for 14 days, at their own expense, in some cases even if they are paying for their own off-campus apartment.

St Francis Xavier U advised their students of the new NB quarantine requirement, and encouraged students “not to rush their return to Antigonish in an effort to avoid the implementation of this new rule.” Classes will begin online Jan 13, and F2F classes have been postponed until Jan 25 to permit time for quarantine. Students coming from NB were required to arrive no later than Jan 10. Students from PEI, NL or other parts of NS are not to return to Antigonish until Jan 24.

 

“Electroshock” in Quebec

Last Wednesday, Quebec Premier François Legault announced an “electroshock” lockdown for 4 weeks, closing nonessential businesses, imposing a curfew from 8pm-5am, and reducing activity in manufacturing and construction. Nonetheless, elementary school classrooms resumed in-person yesterday, despite polls that find 60% of Quebecers consider it “unsafe,” and over objections from the Provincial Association of Teachers. A recent study out of uMontréal found that schools were a strong vector of COVID19 transmission in Quebec, with infections among children preceding adult outbreaks by a few weeks.

“When you have a case in school, you may have one, two, three other cases at home that are not counted as school cases, but of course they are counted as home cases.” – Olivier Drouin, Creator, CovidEcolesQuebec

 

“I really believe think that right now limiting in-person schooling as much as possible would actually be the right solution.” – Simona Bignami, Professor of Demographics, uMontréal

 

More than 100 physicians, on the other hand, are insisting the province reopen schools “regardless of the epidemiological situation” to preserve student mental health. (School outbreaks have dropped to zero over the holiday, naturally, but in mid-December they accounted for 30% of all outbreaks in Quebec.) Universities and CEGEPs are being encouraged to offer online learning, as much as possible, and will be subject to the curfew. (See “Bad Behaviour” below for some examples of how the curfew is playing out.)

 

Scary Times in Ontario

Ontario imposed a provincewide lockdown on Boxing Day (Dec 26) for at least 28 days, and last week pushed back the start of in-person elementary classes in Southern Ontario 2 more weeks until Jan 25 – just days after the education minister wrote parents to assure them classes would resume Jan 11 as planned. (Elementary classes in most of Northern Ontario resumed in-person yesterday.) The COVID19 positivity rate among elementary-aged children nearly tripled over December, to 15.66%. (And the new UK variant seems considerably more contagious among children.) The Elementary Teachers’ Federation (ETFO) has called for online learning so long as the province is in lockdown. (And I would agree!)

Although epidemiologists tried to explain the pandemic projections to premier Doug Ford on Dec 21, apparently the reality is only sinking in now. Cabinet heard Friday that Ontario will hit 6,000 new cases daily by the end of January, and that the provinces ICUs will be completely full early in February. Doctors will have to make tough decisions about who lives and who dies.

Ford is expected to make announcements about further restrictions today. Many have been speculating that he will impose a curfew like Quebec’s, but sources deny it. Ontario may re-impose a state of emergency, as it did in the spring, and perhaps order businesses to close by 8pm, or ensure people are allowed to WFH.

“We’re in a desperate situation, and when you see the modelling, you’ll fall out of your chair. There will be further measures, because this is getting out of control.” – Ontario Premier Doug Ford, Jan 8

 

Ontario has designated PSE as “essential,” and it therefore operates under different rules than K-12 education or other organizations. Most have announced quite similar restrictions, such as the following:

Algonquin College will allow only designated health programs and those with 10 or fewer persons to begin F2F classes this week. Others will be adjusted, with make-up activities or rescheduling. Most apprenticeships will be postponed until Jan 25.

Canadore College has adjusted its academic and service delivery plans to operate under the rules of lockdown. It will deliver as many courses as possible remotely.

Carleton U will keep athletics and library facilities closed, has suspended all in-person events, will operate campus dining as take-out only, and is operating residences “with increased mitigation measures.”

Queen’s U says students should avoid returning to Kingston until after the lockdown ends Jan 23, “unless absolutely necessary.” F2F classes will be delayed except for prioritized health programs.

Western U has announced that in-person classes will be postponed until Feb 21, after reading week, instead of beginning Jan 25 as planned. The return of students to residence will also be staggered through Jan and Feb. “If you can stay where you are for now, we encourage that.”

 

Stricter Measures for Ontario

As expected, Ontario premier Doug Ford announced new lockdown measures yesterday, effective tomorrow, including a state of emergency until Feb 9, sweeping stay-at-home and WFH orders, 8pm curfew for non-essential stores, more intense testing in workplaces, limits on non-essential construction, and of 5 persons for outdoor gatherings. Projections for Feb include up to 20,000 new COVID cases and 100 deaths daily. K-12 schools will be closed for in-person learning in Toronto, York and Peel Regions, Hamilton and Windsor-Essex. (MCU will be following up on regulations today, but most Ontario PSEs do not seem to expect any change to their current operations.)  Globe & Mail

 

 

Frustrations in Manitoba

Manitoba imposed remote learning in January, optional for elementary but mandatory for secondary students. Parents and students are of course frustrated, but teachers are particularly challenged by the demands of blending remote and in-person delivery. “That’s doing two different jobs.”

Red River College is operating in “restricted/orange” mode. On-campus activity is permitted only where necessary and essential. The majority of staff will WFH.

 

Online in Saskatchewan

uSaskatchewan president Peter Stoicheff told the CBC that students may be learning online throughout 2021. Plans for the fall term will depend upon vaccine availability, distribution, and efficacy – but he hopes they can be announced by May.

 

Stubborn in Alberta

Alberta, with the highest rate of hospitalization and second-highest rate of COVID19 deaths in the country, is extending health restrictions including restaurant closures and a ban on gatherings until at least Jan 21. Premier Jason Kenney resisted imposing restrictions all last year, instead appealing to Albertan’s “personal responsibility.” Despite the exploding cases and overloaded hospitals, in-person K-12 classes resumed in Alberta yesterday.

Olds College is extending restrictions until Jan 21: no social gatherings or in-person meetings are permitted. Lunchrooms, lounges and fitness facilities are closed. WFH is mandatory where effective. Classes can continue as before.

 

Sitting Tight in BC

Since Nov 19, British Columbia has banned socialization beyond the immediate household, and prohibited all social gatherings including weddings and funerals, religious services, sports and fitness activities, and will extend those restrictions until at least Feb 5.

 

Bad Behaviour

 

No matter what the restrictions, some people just don’t like to follow the rules…

Quebec Police handed out 750 tickets worth thousands of dollars to people violating the 8pm curfew over the weekend. In Montreal alone, 185 tickets worth at least $1,000 each were issued.  CTV

A Sherbrooke couple were fined $3,000 for walking towards downtown at 9pm on Saturday – despite the creative argument that the woman was out walking her dog, because her husband was, in fact, on a leash! CTV

Fanshawe College’s student news, the Interrobang, reports that London Police have pressed charges against a 20-year-old man who hosted a large indoor gathering on Thurman Circle on Nov 13. The London Free Pressemphasizes that the party was near Fanshawe College.

uVic students apparently haven’t learned their lessons from last year. This weekend, Oak Bay Police assisted campus police in breaking up a party with >100 attendees, and fined a couple who were uncooperative $320 each.  Daily Hive

 

Solid Advice

Quick, Strong Responses Work Best

Recent research from Oxford concluded that the 2 Canadian provinces with the “least-strict approaches” to COVID19 last summer (AB and SK) wound up with the highest rates of infection and hospitalization during the second wave this fall. The provinces in the Atlantic Bubble, on the other hand, intervened quickly and were able to keep COVID19 rates “near-negligible.” Basically, “a stronger, faster response results in a better-controlled epidemic.”

 

The “Canadian Shield” Approach

The COVID Strategic Choices Group warns that our current pandemic trajectory will lead to a third wave around Easter (Apr 4), before vaccinations for the general public are expected to begin. They recommend a “Canadian Shield approach,” including an intense 4-6 week lockdown, aggressive measures to keep the case count dropping thereafter, and providing direct support to individuals and businesses. Modelling suggests the approach would save 5,000 lives by the end of April, and improve the economy by $37B. >360 scientists and health professions have called for more aggressive measures to contain the virus, like the zero COVID policies in New Zealand, Taiwan, or Australia.

“When you concentrate the economic lockdown upfront, it might be harsher in the beginning but it then allows us to fully recover and not face a third wave of lockdown restrictions before vaccines get more widely available.” – Christopher Cotton, Economics, Queen’s U

 

27 Days of Christmas

Regular readers doubtless remember the “Month-Long Mortality Lag” I included in COVID101, my pandemic primer in 5 graphs. In Canada, we saw the Thanksgiving turkeys come home to roost with rising infections by Oct 23, and hospitals starting to overflow in November.

With an average of ~27 days from COVID19 infection to fatality report, we’re going to see a crest of unwanted “Christmas presents” around about Jan 21, and many unhappy returns from NYE celebrations on or about Jan 27.

When epidemiologists warned of an impending crisis, this is what they meant. Ontario is estimating daily COVID19 deaths will double to 100 in the next 6 weeks. As we saw yesterday, governments around the world tried to relax pandemic restrictions over the holidays, thinking that people would just break the rules anyway.

One exception was Italy, which announced Dec 2 a ban on all travel between regions of the country, to go into effect from Dec 21 to Jan 6. On Christmas Day and New Year’s Day, they would not even be allowed to leave their own towns. Travel to second homes was prohibited. The governor of Lombardy called the order “crazy.”

 

Spreading the Love

Last-Minute Shopping

Ontario had already locked down the worst-hit regions around Toronto, but as the holidays approached the premier announced a province-wide lockdown to begin on Boxing Day. As usual, the advance warning only served to spark a frenzy of shopping activity, and hundreds of thousands living in lockdown zones simply drove to neighbouring regions to pack into shopping malls. Cellphone mobility data for the week before lockdown shows that in some regions, up to 70% of people were out and about, and those same regions show the steepest rise in infections now. Mall data shows that traffic from Toronto shoppers more than doubled over last year. During the holidays, Ontario’s case rate rose 23%, as Torontonians “spread the joy” across Southern Ontario.

“The few days before the lockdown… did the most damage of all the weeks leading up to Boxing Day. It was a big mistake to say, ‘Pretty please don’t gather for Christmas, but the day after Christmas, we’re putting down the sledgehammer.’” – Jody Lanard, risk communications expert

 

Home for Christmas

Over the holidays, indoor gatherings were limited to 10 people in NS and PEI, and 20 in NB and NL. In all other provinces, the public were told not to socialize with anyone outside their own household. And yet, a national Leger poll found that almost half of Canadians admitted to visiting family or friends over the holidays, and 15% did so several times. Respondents in BC, AB, SK and MB were least likely to have done so at all, while 72% of those in Atlantic Canada did so, and 45% did so more than once (4x the rate in the rest of the country). Predictably, young people (aged 18-34) were most likely to have done so, and 61% admitted it.

Manitoba extended the province-wide “code red” restrictions on Jan 8 because of “a spike in illegal gatherings at private homes during the holiday season.” Such parties resulted in 355 new COVID19 cases, and so far 1,900 close contacts.

Most CdnPSE campuses sent students home over the winter break, and many have even extended it into late January or February. But recognizing the dangers of international travel, some ensured that students could tough out the holidays on an almost-empty campus. In Thunder Bay, Lakehead U and Confederation Collegesent about 100 international students a take-out Christmas dinner on Dec 29.

Personally, as someone who sacrificed all family contact this year, and hosted Christmas via Zoom for three generations of Steeles, I admit I am angered by the selfishness of so many others. But those who gathered at home were not the worst offenders…

 

Holiday Hooligans

 

Believe it or not, some people still think it’s OK to travel in the worst global pandemic of the century…

 

Corona on the Beach

It’s certainly not good news that 961,000 tourists flocked to the beaches of Cancun and district in Mexico for the holidays – almost half of them Americans. (The Europeans have better sense.) Tourism traffic was down just 25% from the previous year, and most hotels, gyms, and other facilities were operating at 50-70% capacity. The COVID19 positivity rate in that state of Mexico is ~50%, and weekly deaths quadrupled after Christmas.

Some Caribbean destinations enforced quarantine more strictly than others. Skylar Mack, an 18-year-old student at Georgia’s Mercer U, travelled to the Cayman Islands in November. Instead of observing the mandatory 14-day quarantine upon arrival, she slipped off the electronic monitoring bracelet 2 days later, so she could watch her boyfriend compete in a jet ski championship, without wearing a mask. They were both sentenced to 4 months in prison (later reduced to 2 months). The maximum penalty for violating quarantine in the Caymans is a $10,000 fine and 2 years in prison. A number of high-profile tourists have also been caught violating quarantine in Barbados.

“In the most popular tourist destinations, you’re going to have epidemic activity increase again in a big way.” – Mauricio Rodríguez, National Autonomous University Mexico, Medical School

 

Airborne Transmission

But it’s not just Americans of course. On Christmas Eve, dozens of flights departed Canadian airports for sunny destinations in the Caribbean. All promised health officials they would quarantine upon their return, of course, but many experts are very concerned about the lack of enforcement. And they suspect the federal government has not implemented a ban on non-essential travel because of lobbying from the airline industry.

Just one disgusting example will have to suffice: Dominique Baker, the acting manager of the Office of Border and Travel Health at the Public Health Agency of Canada, accepted an all-expenses-paid holiday in Jamaica courtesy of Air Canada Vacations in November, “even as her agency has been advising Canadians since March to avoid non-essential travel to combat the spread of COVID19.” (How on earth did she think it was ethical to accept such a complimentary trip??) Air Canada claims not to have known Baker was employed with the government.

Naturally, Jan 3 was the busiest US air travel day since the pandemic began, with 1.3 million people flying that day alone. Just as Mexico and the US hit record-breaking COVID19 infection levels, and the new UK variant began to appear.

“It’s safe to travel. It’s the parts after you’ve travelled and come back that are more problematic.” – Karl Moore, Management Prof, McGill U

 

Hypocrites Redux

 

While selfish tourists recklessly spreading a deadly virus worldwide are deplorable, still more outrageous are the innumerable examples of political leaders breaking the very rules they have imposed…

 

Just One Month Ago

In early December, we explored the ways in which toxic masculinity and a youthful sense of invincibility were contributing to defiance of common-sense health restrictions, and in particular I focused on hypocritical politicians who broke their own rules, hosting weddings or large dinner parties. Most examples at the time were American, and typically Democrats – because the Republicans simply didn’t impose restrictions in the first place. I did, however, single out the health minister of Newfoundland & Labrador, and the hospital staff at Western’s University Hospital. (More on that in a moment!)

But the Thanksgiving turkeys were nothing compared to what Christmas brought to light…

 

Privileged Politicians

Despite months of federal and provincial government advisories to avoid all non-essential travel, the list of Canadian politicians caught vacationing in sunnier climes last month is too long to do it justice. From east to west, they include:

In Quebec, Liberal member Pierre Arcand was asked to return from vacation in Barbados, and stripped of his critic role. Liberal MPs Sameer Zuberi, Patricia Lattanzio, Alexandra Mendes, and Lyne Bessette all recently admitted to travelling internationally for a range of reasons. Zuberi and Khera have stepped down.

In Ontario, Finance Minister Rod Phillips headed to St Barts on Dec 13 when the Toronto region was already in lockdown. On Christmas Eve, he thanked healthcare workers on Twitter, writing “as we all make sacrifices this Christmas, remember that some of our fellow citizens won’t even be home for Christmas dinner over Zoom.” Phillips cut his vacation short when the premier expressed displeasure, and has resigned from cabinet. Steve Tanner, Halton Police Chief, apologized for travelling to Florida, and although there is no word yet on his future, the mayor of Oakville has resigned from the board for approving the trip.

In Manitoba, Clerk of Executive Council David McLaughlin spent the latter half of December working from his family home in Ontario. The premier’s office denies he was on vacation, and his status as a government official apparently exempted him from the need to quarantine upon his return. MP Niki Ashton was stripped of her role as critic after visiting Greece. James Teitsma, the MLA for Radisson, travelled through Saskatchewan, Alberta and British Columbia over the holidays with his household. He won’t face any penalty.

“We’ve got to subordinate our individual selfish desires to a sense of community, and it’s critically important that our politicians communicate this. It’s critically important that they walk the walk, and not just talk the talk.” – Arthur Schafer, uManitoba bioethicist

 

In Saskatchewan, Minister of Highways Joe Hargrave travelled to Palm Springs with his wife, ostensibly to sell a home there (although it wasn’t listed until Boxing Day). After several discussions with the premier, he stepped down from his cabinet position. Gordon Barnhart, leader of the Municipalities of Saskatchewan, former Lieutenant-Governor, and former interim president at uSaskatchewan, apparently vacationed in Hawaii. MuniSask has publicly expressed its disappointment.

In Alberta, fully 10% of UCP MLAs have admitted to travelling abroad in December, and 7 have resigned or been demoted. Minister of Municipal Affairs Tracy Allard stepped down over her vacation in Hawaii. Pat Rehn, Alberta MLA for Lesser Slave Lake, wished his Facebook friends a Merry Christmas from Cancun, “despite having also posted government messaging encouraging Albertans to stay home.” Jamie Huckabay, premier Kenney’s Chief of Staff, was asked to resign over his trip to the UK.

Perhaps most moving was the outrage of Lia Lousier, mother of a terminally ill 9-year-old who had to cancel their Make-A-Wish trip to Hawaii last year because of the pandemic. She called Tracy Allard’s trip to Hawaii “a huge kick in the teeth to average people.”

“Millions of Albertans have made real sacrifices over the past 10 months to help keep each other safe. They are right to be angry about people in positions of leadership vacationing outside of the country.” – Jason Kenney, premier of Alberta

 

Even in the Northwest Territories, “at least two” senior officials travelled over the holidays. The newly-appointed head of the COVID19 secretariat, Associate Deputy Minister of Health Russell Neudorf, travelled to Kelowna BC with his wife. Bruce Cooper, the Deputy Minister of Health, travelled to Newfoundland for the holidays with his wife and children.

 

Hospital CEOs

Tom Stewart, the CEO of St Joseph’s Health System in Hamilton ON, and also a member of a provincial health advisory panel, vacationed in the Dominican Republic over the holidays – while his frontline staff were fighting off COVID19 outbreaks. He was fired Jan 6, but “without cause” – so he also gets a belated Christmas gift of >$1M in severance pay.  CBC

Martine Bouchard, CEO of St Boniface Hospital in Manitoba, travelled to her family home in Quebec over the holidays to visit her husband and children. While she was away, “hospital officials were asking healthcare workers to voluntarily give up their booked time off in late December and January, in exchange for vacation pay.” Winnipeg Free Press

Paul Woods, the CEO of London Health Sciences Centre who publicly excoriated his staff for taking breaks in cramped lunch rooms and sparking a catastrophic series of COVID19 outbreaks, was all the while travelling back and forth to the US on 5 separate occasions, including during the Christmas holidays. “We must set ourselves to a higher standard when it comes to living and modelling public health guidelines both inside and outside our workplace,” he wrote on Nov 19. “Willfully choosing to not adhere to our critical safety practices while at work may result in disciplinary action, up to and including termination.” Accordingly, the board fired him on Monday, although it is unclear whether with or without cause.  CBC

“Our nurses have been restricted from getting together with their loved ones over the holidays, but I guess those rules don’t apply to [CEO Paul Woods].” – James Gibbons, Nurse, LHSC

PS: CEO Paul Woods was terminated by the London Health Sciences Centre board, and it would appear they did so with cause, since he has launched a $2.5M defamation and wrongful dismissal lawsuit. And Amy Walby, the chair of the board, has resigned her position.  CBC

 

University Administrators

So far, few CdnPSE leaders have made headlines for their holiday plans, but…

Peter Berman, head of UBC’s School of Population and Public Health, should obviously have known better than to travel to Hawaii during the winter break. He has apologized.  Global

PS: Perhaps predictably, Peter Berman resigned as director effective last Friday.  Vancouver Sun

 

Pandemic Ethics

It is truly saddening to see how many people seem unable to grasp the simple ethical principles of “Do unto others” or even Spock’s Vulcan philosophy…

Following the bad example set by their political leaders, >1,500 flights have taken thousands of Canadians to tropical destinations since Oct 1, particularly Cancun and Montego Bay. Since Dec 1, PHAC has flagged ~500 flights with potential COVID19 exposures. A new poll has found that 70% of Canadians have avoided international travel, and >60% want to see a complete ban.

 

The Needs of the Many…

Whether you’re a manager of Border and Travel Health, a Minister of Health, a hospital CEO, or just any Canadian at all, York U philosophy prof Alice MacLachlan points out that Immanuel Kant’s simple question would have stopped their travel plans before they began: “What would happen if everyone acted on the principle I’m following right now?” And UBC political science prof Max Cameron observes that Aristotle believed “politicians should be exemplary citizens.”  CBC

 

A Real Shot in the Arm

 

If there’s one thing that will determine what Fall 2021 looks like for higher ed, it’s the efficacy of COVID19 vaccines, and the efficiency of vaccination efforts. TONS has happened over the past month, and again I can’t squeeze it all into one issue.

Today, let’s start with the vaccines themselves. (The Regulatory Affairs Professional Society tracks 63 vaccines, approved or in development. The New York Times details 93 vaccine candidates.)  

 

The Pfizer/BioNTech vaccine was the first to start clinical trials, last May. It is a 2-dose messenger RNA vaccine with 95% efficacy, but must be stored at -70°C. (Most other vaccines can be stored at 2-8°C). It has now been cleared for use in 49 countries across North America, Europe and the Middle East. Pfizer plans to produce 1.3B doses this year, and has contracts for 816M: 300M to the EU, 200M to the US, 120M to Japan, and 20M to Canada. (This week, Canada secured another 20M doses for this spring.)

The Moderna vaccine is also a 2-dose mRNA vaccine, and it was 95% effective in large-scale trials. Of 400M doses committed, half are to the US, and 40M to Canada.  The UK approved it for emergency use on Jan 8, and it has also been approved in Canada, the EU, Israel, UK, France and Switzerland.

Russia’s Sputnik V vaccine, from the Gamaleya Research Institute of Epidemiology and Microbiology in Moscow, has apparently proven 91% effective in trials with 40,000 subjects. It received government approval for use a month before clinical trials began, in September. India has committed to buy 200M doses, Russian 160M, and Brazil 100M, but so far only Russia and Palestine have actually authorized its use.

The Oxford/AstraZeneca vaccine is more a traditional adenovirus vaccine, which also requires 2 doses. It got into clinical trials in late August, with some mixed results, but has proven 70% effective in trials with 65,000 subjects. Countries have placed orders for 3B doses, including 1B for India, 300M for the US, and 20M for Canada. With 53M doses on hand, Australia is debating whether its efficacy is good enough, when compared to the mRNA alternatives. So far, it has been approved by the UK, India, Argentina, Dominican Republic, El Salvador, Mexico, and Morocco. The EU regulator is currently considering it, and could approve it later this month.

“The question is really whether it is able to provide herd immunity. We are playing a long game here. We don’t know how long that will take.” – Stephen Turner, President, Australian and New Zealand Society for Immunology

 

China has 3 vaccines in production:

Private-sector company Sinovac Biotech started trials in July for its CoronaVac vaccine, and received government approval in September, long before any results were available. 10 countries have already signed orders for 380M doses, particularly 50M doses to Indonesia, 50M to Turkey, and 46M to Brazil. On Monday, Indonesia authorized the CoronaVac vaccine for emergency use, and it hopes to have 1.5M medical workers inoculated by February. (The full 182M population will take 15 months.) But there is considerable controversy over its efficacy: Sinovac claims 78% efficacy with 2 doses, but trials around the world have found wildly different results: 86% in the UAE, 91% in Turkey, 65% in Indonesia and barely 50% in Brazil. The issue seems to be whether “efficacy” refers to complete immunity, prevention of severe illness, or prevention of death. China claims it is “100% effective in preventing severe cases, could reduce hospitalizations by 80%.” A December poll found that just 37% of Indonesians were willing to be vaccinated.

“I’m not rejecting vaccines, I’m rejecting Sinovac’s.” – Yusdeny Lanasakti, Doctor, East Java

 

State-owned Sinopharm started clinical trials in July with 50,000 subjects, and received early approval in late August before any results were known. Hundreds of thousands of doses were administered in China before results in December. It claims 50% efficacy with 2 doses. It has commitments to deliver 88M doses to Pakistan, 75M to the Middle East, and 60M to Indonesia.

“As wealthier countries deploy vaccines with efficacy rates greater than 90%, poorer countries have been left with fewer options. As a result, health analysts warn, the developing world probably will be dealing with the coronavirus for far longer than wealthier nations.” – Washington Post

 

India’s Bharat Biotech reportedly took a “regulatory shortcut” instead of waiting for results from late-stage clinical trials, leaving many skeptical as the country starts inoculating 30M front-line health workers. The sudden approval of Covaxin on Jan 2 was either because it may “hypothetically” be effective against the UK variant, or out of national pride. (India approved a version of the AstraZeneca vaccine on Jan 1, being manufactured locally by Serum Institute of India.)

 

Plenty of other vaccines are in development, but here are a sampling in phase 3 clinical trials…

CanSino Biologics has a single-dose vaccine which was approved for the Chinese military almost 3 months before clinical trials began. It is currently in phase 3 trials, but results are still unknown. It has contracts for 35M doses to Mexico, and 15M to Indonesia.

The Johnson & Johnson vaccine started clinical trials in September with 70,000 participants. What’s exciting about it is that it requires just a single dose, and it can stay stable in a refrigerator. Early results are promising, with 90% of phase 2 participants creating neutralizing antibodies within 29 days. Of 346M doses committed, 200M are to the EU, 100M to the US, 30M to the UK, and 10M to Canada. Results from the trialshould be released in the next few weeks, but the company is already 2 months behind schedule for production.

Sanofi/GlaxoSmithKline has commitments for 300M doses of its vaccine to the EU, 100M to the US, 60M to the UK, and 52M to Canada. It is currently in phase 1 clinical trials.

A small US company, Novovax, is in phase 3 clinical trials with 45,000 volunteers in the US and Mexico for its new vaccine. Results of the trial are still pending, but Australia has committed to purchase 51M doses by mid-year if it proves effective. India has committed to 1B doses, the US 110M, and Canada 52M. The US Operation Warp Speed committed $1.6B in development funds.

 

Two Canadian vaccine candidates are still in early stages…

Medicago is a company based in Quebec City, with a plant-derived COVID19 vaccine candidate. Phase 1 clinical trials launched in July are promising: 2 doses caused a significant neutralizing antibody response in 100% of trial subjects – higher than in people who had recovered from COVID19 infections. Canada has contracted for up to 76M doses, subject to approval by Health Canada. Phase 2 trials will launch soon.

VIDO-InterVac, at uSaskatchewan, has developed another COVID19 vaccine, which will start phase 1 human clinical trials this month in Halifax.

 

The prospect of vaccines on the horizon make 2021 decidedly brighter than 2020 – but there remain many uncertainties, plenty of logistical challenges, and political and psychological barriers to go from vaccines in vials to vaccinations in arms. While millions of us wait patiently for our turn, society remains in “vaccine purgatory.”

 

 

Vaccine Roll-Outs

 

Since December, vaccine approvals and distribution have ramped up worldwide, although unevenly…

 

China and Russia bypassed phase 3 trials to authorize their homegrown vaccines in July and August, and have already administered ~10M doses.

 

The US rollout was chaotic with jurisdictional disputes and finger-pointing between federal, state, and local health authorities. Although Trump promised 20M shots by Dec 31, the reality was 2.8M. Reports of vaccines sitting unused for weeks or even being discarded are frustrating.

 

Israel, the UAE, and Bahrain lead the world for vaccinations per person, followed closely by the UK and US. (Of course, that doesn’t include Palestinians.) The Bloomberg global vaccine tracker reports 39.7M doses given to date in 51 countries worldwide, now averaging 2.44M per day.

 

The US is now at 13.7M, and are making quick work in Alaska, West Virginia, North and South Dakota. California’s Disneyland is now a vaccination supersite. The UK has vowed to get 15M people their first shot by mid-February, and that every adult in the country will be offered a vaccine by autumn.

 

Manufacturing delays at Pfizer’s European vaccine facility will mean Canada receives just half the expected doses over the next month, although they promise to deliver 4M doses by Mar 31 as planned. Still, the delay will give the virus more momentum early in the fight. Moderna, with the only other vaccine approved in Canada so far, is expected to deliver 2M doses by Mar 31. (The AstraZeneca and J&J vaccines are in “rolling review.”)

“Science has succeeded, but solidarity has failed. Vaccines are reaching high income countries quickly, while the world’s poorest have none at all.” – Antonio Guterres, UN Secretary General

 

Canada started slowly, administering 387,899 vaccinations in the first 29 days, or enough for about 1% of the country to get a first dose. “At that pace, it would take 5,800 days to give every Canadian two doses,” meaning we’d finally be done in… 2036! As usual, there is plenty of finger-pointing: PM Trudeau was concerned that the provinces were administering the doses too slowly, while the premiers were complaining about looming shortages. (Toronto’s University Health Network had to reschedule 800 vaccination appointments when they ran out.) And that was all before the Pfizer slowdown was announced. The president of Shoppers Drug Mart says Canadian pharmacies could vaccinate up to 3M people a week, once the government says the word.

“At that pace, it would take 5,800 days to give every Canadian two doses of vaccine, meaning the final shots would be given in 2036.” – CTV News

 

So far, Nova Scotia, Newfoundland & Labrador are trailing other provinces in terms of immunization per capita. Ontario hospitals were told to prioritize “speed over precision,” so some employees who are not strictly speaking “front-line workers” received shots before more vulnerable groups. The province hopes to get a first shot to all residents, staff and caregivers in nursing homes in Toronto, Peel, York, and Windsor/Essex by Jan 21, and to have “everyone” vaccinated by August. Manitoba has converted Winnipeg’s RBC Convention Centre into a vaccine supersite, but sick staff had it operating at less than one-third capacity last week, with appointments falling behind schedule. Dental hygienists are offering to help the vaccination effort in Alberta. Yukon’s CMO claims they will vaccinate 75% of the eligible adult population by April, effectively approaching herd immunity within 3 months. Residents can book their vaccination at the “This is Our Shot” website.

“I’d love to see the province of Ontario done by the end of July or early August… But until we get the vaccine allocation, until we know what’s coming, we just can’t do it.” – Rick Hillier, head of Ontario’s vaccine distribution

 

4 Vaccine Uncertainties

 

Naturally, as we try to outrace the pandemic at “warp speed,” the science is still out on some things…

 

1) More allergic reactions have been reported to the Pfizer vaccine, likely to polyethylene glycol – which is also an ingredient in the Moderna vaccine. The FDA is investigating 5 US cases which are similar to 2 in the UK. The FDA also reports 2 cases of serious adverse effects in patients who had “dermal fillers” such as collagen: it is theorized that the Moderna vaccine prompted a delayed immune response to the cosmetic implants.

 

2) After a single vaccine dose, there is some evidence for a lower-level immune response 10 days later, at least in the short term. Pfizer’s vaccine may be 52% effective after a single dose, but the booster shot is what activates T cells and long-term immunity, about 12 days afterwards, with >90% efficacy. The Oxford/AstraZeneca vaccine may be 64% effective after only one dose, and the Moderna may be 80% – but there is in fact no evidence regarding the effectiveness of that first dose after 3 weeks, when participants in the clinical trials received their second doses. (There might be no lasting protection at all.) These scientific uncertainties, combined with supply chain uncertainties, make it a tough choice to push ahead with “half measures,” but many countries are doing so anyway. The US is releasing its second doses, rather than holding them in reserve. Experts believe the 21-28 day timing of boosters can be extended: BC plans to give them 35 days apart, and Alberta up to 42 days apart.

 

3) Protection or Immunity? While clinical trials have demonstrated that the approved vaccines protect patients from serious symptoms, hospitalization, or death, they have not been proven to grant “immunity”: even once vaccinated, it is still possible to catch and spread COVID19. Pfizer offers 95% protection against “symptomatic COVID19,” and AstraZeneca 62% (depending on how you read the data).

 

4) Unknown duration of Immunity. Because vaccine development has been moving at “warp speed,” we have no long-term data about the protection vaccines offer. Perhaps immunity will be permanent, or perhaps we will need regular booster shots. Some studies suggest natural COVID19 immunity lasts at least 5 months, but still permits reinfection and transmission. Another finds “immunological memory” up to 8 months after infection. A uToronto study suggests the immune response to COVID19 is weaker over time than it is to influenza. One researcher says that the immune response seems “fairly stable” and could likely last for years. (By analogy, people infected with SARS in 2002 still have T-cells that recognize the virus 17 years later.) Then again, if the coronavirus manages to mutate enough to circumvent the vaccines, we may need annual vaccinations, much as we do for influenza.

“We seek herd immunity… that outcome will depend on the longevity of protection, the coverage of the population… and the impact on transmission, which are yet to be determined for any vaccine.” – Greg Hunt, Australian Health Minister

 

Vaccine Hold-Outs

Once vaccine distribution is running smoothly, the biggest challenge will be vaccine hesitancy and resistance among the public…

Anti-Vaxxers and Conspiracy Theorists

US president Donald Trump is such a fan of COVID19 vaccines and therapeutics that he wants to keep them all for “America First,” trying to cut $4B from funding for global vaccine alliance GAVI. But among his most ardent supporters, vaccine hesitancy remains high, and it might even be understandable for pregnant women. Conspiracy theories scare people away from vaccines with myths about infertility, disease, or having their DNA rewritten. (Perhaps the “dumbest” conspiracy theory claims a “5G circuit” – actually the wiring diagram for an electric guitar pedal – is somehow embedded in the vaccine.)

 

Healthcare Saboteurs

Surprisingly, even those educated in healthcare fields can be vaccine-hesitant. Just 57% of staff in BC long-term care homes wanted the vaccine in December, and some care homes in BC and Alberta report 50% of staff still refusing it. The Canadian Nurses Association reports that some of its members are definitely hesitant. As many as 80% of staff in US nursing homes were refusing the vaccine, more than 3 weeks into vaccinations. At veterans’ homes in Illinois, 90% of residents – but just 18% of staff – got vaccinated. Administrators have been offering incentives ranging from free breakfasts at Waffle House to a car raffle for employees who get the shot.

“I don’t think anyone wants to be a guinea pig. At the end of the day, as a man of science, I just want to see what the data show. And give me the full data.” – Stephen Noble, Cardiothoracic Surgeon, Portland Oregon

 

Far worse, a hospital pharmacist in Milwaukee tried outright sabotage: he has been fired and arrested on 3 felonies, including “reckless endangerment,” because he deliberately spoiled 570 doses of Moderna vaccine by removing them from refrigeration, and then putting them back.

 

Vaccine Purgatory

Waiting for Herd Immunity

As The Atlantic puts it, “the next 6 months will be vaccine purgatory.” We know the vaccine is coming, but it is tantalizingly out of reach for most of us right now. It is a waiting game – and in the meantime, we can expect fights over vaccine priority, confusion over precautions and immunity, and all sorts of variation between jurisdictions. “Ultimately getting out of purgatory will require reaching herd immunity.” Herd immunity, most immunologists tell us, will require 60-75% of the population to have developed natural immunity (recovery from infection) or vaccination.

 

Squabbling over Priority

By September, the federal government is promising we will have 60M doses in Canada, enough to vaccinate 30M of 38M Canadians (79%). But as this winter drags on, and we watch celebrities, royalty, politicians and front-line healthcare workers get their first doses, cabin fever is setting in for the rest of us. Canadian snowbirds reportedly started getting vaccinated in Florida 2 weeks ago, and one Florida hotel is even encouraging Quebecers to fly down for “vaccines and good weather.” Teachers’ associations in Saskatchewan, and the Canadian Teachers’ Federation, are calling for school staff to get priority access. (Currently they will likely wait until May or June.) In New Jersey, diabetics and 2 million smokers (of any age) can get the vaccine now, before teachers or transit workers. College faculty who teach in person are considered front-line workers with priority access to vaccines in New York, South Dakota, and Arkansas, so far.

 

Your Spot in the Queue

If you’re anxious to know when it’ll be your turn, check out the Vaccine Queue Calculator, developed by uGuelph grad Jasmine Mah and a UK physicist, Steven Wooding. Based on my age, there are up to 22,456,373 people in front of me in line, and I shouldn’t expect to be vaccinated until about August. (That’s about what I expected.)

Our students, of course, will be even further down the priority list, since most of them are substantially younger than I am. The ACHA is urging the CDC to recommend that all college students get vaccinated before heading home this summer, to prevent asymptomatic spread of COVID19 to their hometowns.

 

The Prognosis

Returning to Campus next Fall?

As our institutions gradually reopen to staff and students, perhaps as early as September, precautions like face masks and social distancing will still be necessary, to some degree, since the vaccines do not seem to prevent coronavirus transmission. Right now, many border agents and college campuses are requiring a negative COVID19 test result before allowing people through. One of the challenging questions we’ll face this fall will be whether to require proof of vaccination, perhaps a vaccination passport, before allowing a return to work or study on campus.

 

Mandating the Vaccine?

Healthcare employers are expected to require the vaccination, and many others may do likewise once it moves beyond emergency use authorization. But what if students and staff demand exemptions for religious or medical reasons? Ford Motor Co has purchased ultra-cold freezers to distribute the vaccine to its own employees. Facebook is “encouraging,” but not requiring, employees to get the shot before returning to the office. US retail chain Dollar General is encouraging front-line workers to get vaccinated, by offering them 4 hours’ pay to do so. Employers with a WFH policy may well take a hybrid approach, allowing people to refuse the vaccine if they continue to work remotely. But here in Canada, 64% of the general public appears to favour making the shot mandatory for everyone.

 

 

After 5 straight Insiders to catch up on a month of the pandemic – on new variants, and lockdowns, on irresponsible parties, shopping, and travel, on the state of vaccine development, and finally on the vaccination roll-outs and hold-outs – I’m going to do my best to ignore COVID19 topics for the rest of the week, aside from campus updates as necessary.

In fact, if the pandemic continues on its predictable trajectory, perhaps I can resort to summarizing it on a biweekly or even monthly basis going forward! (Wish me luck!)

Thanks for reading. Stay safe out there!