Eduvation Blog

Roll-Outs, Hold-Outs, and Vaccine Purgatory

Good morning, and happy Monday!

One last issue focused on COVID catch-up, and then I want to turn to other topics for the rest of the week. (Promise!)

As COVID19 cases rise in many regions, propelled by at least 6 new more contagious variants, scientific uncertainties, logistical hurdles, and antivaxxers are challenging the vaccine response. We’re in “vaccine purgatory” as most of us wait until at least July for our shots. Read on if you want to calculate precisely how long a wait you will have, and some implications for our fall 2021 campus plans…

 

COVID Catch-up

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.

 

Just 3.2% of infected students were correctly identified using a 15-min lateral flow antigen test at uBirmingham in the UK. Larger studies suggest 57% accuracy, although that still means 43% get a “false negative.” Some suspect the issue is self-administered swabs. (One solution might be robot-administered swab tests, being pilot-tested in China.)

 

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.)

 

8 gorillas in San Diego have tested positive for COVID19, despite the fact the zoo has been closed since Dec 6. One member of the wildlife care team has since tested positive. “Aside from some congestion and coughing, the gorillas are doing well.” 3 snow leopards in Louisville KY also recently became confirmed or presumed positive for COVID19.

 

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.

 

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.

 

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

 

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.

 

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.

 

COVID Cases

Since my report Friday, CdnPSE has reported 12 more cases of COVID19. (Many of course go unreported. My running tally is 1,171 since Sept, in my master spreadsheet.)

Cape Breton U reported another travel-related case on Saturday. A student living off-campus opted for an asymptomatic test. “With our strong encouragement of asymptomatic testing, it comes as no surprise that a second case has been identified.”  (2 since Sept)  CBU

Dalhousie U reported another case in a student living off-campus. (7 since Sept)  Global

Durham College reported another case on their Oshawa campus. (41 since Sept)  DC

McMaster U reported yesterday that an international student already quarantining in residence tested positive on Friday. (25 since Sept)  McMaster

Mount St Vincent U reported yesterday that a student living off-campus has tested positive, in a “travel-related” case. (Their first case since Sept)  MSVU

Red River College reported Friday a case at their Notre Dame Campus in Winnipeg. (18 since Sept)  RRC

Western U’s University Hospital has sadly declared another outbreak, affecting 6 staff members in the ER. (UH faced 11 prior outbreaks infecting 174 and killing 26, Nov 10-Dec 29. Including outbreaks in students residences and among off-campus students, Western has seen ~253 cases since Sept by my count.)  London Free Press

 

Postscripts

UBC Resignation: On Thursday I included Peter Berman, head of UBC’s School of Population and Public Health, in the list of health professionals and politicians criticized for travelling internationally over Christmas. Perhaps predictably, he resigned as director effective last Friday.  Vancouver Sun

SFU Grading Policy: On Friday I summarized the state of compassionate grading policies in CdnPSE – but I didn’t know that an email went out to SFU students Thursday announcing “a new, temporary undergraduate grading system of Pass/Credit/No Credit (P/CR/NC) for the 2021 spring, summer, and fall terms only.” Details are still developing, but there will be a limit of 12 units across the 3 terms.  SFU

Mea Culpa: Eagle-eyed readers noticed that I misspoke on Friday. UBC and York have existing policies that allow undergrads to convert up to 12 credits (not courses) to pass/fail credits. (Sorry, it was a late night!) I have corrected the story online.

 

#ICYMI

Don’t Put Your Dreams on Hold

St Mary’s U (Calgary) launched a couple of amusing commercials last month worth a look. In the first, a groggy student complains about his “3-second commute” and eats cold pizza for breakfast while attending an online class. In the second, a student sleeps in, and her puppy licks the drool from her face to wake her in time for class. Well-produced and acted spots!  YouTube

 

 

Thanks, as always, for making it to the end of a long issue. 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.

While the pandemic is in many ways the single most important factor shaping the near and mid-future for higher education, there is so much more I want to share, from politics to technology, labour market to innovations in pedagogy.

So, I hope you’ll join me tomorrow. Meanwhile, stay safe!

Ken

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