Tuesday, September 29, 2020  |  Category: Eduvation Insider

Reality Check: Race for the Cure

Good morning!

You can tell we’re officially into autumn: there’s a chill in the air along with just a hint of coronavirus. Here in Canada, daily new COVID19 cases have tripled in the past month, mostly among young people, and PM Trudeau has declared that we likely won’t be able to gather for Thanksgiving, although “we still have a shot at Christmas.”

Quebec has elevated Montréal and Quebec City to “red zone” status, ordering theatres and museums, bars and restaurant dining rooms closed for at least 28 days, and banning guests from private homes. In-person school attendance, however, remains mandatory (Sheesh). Ontario has set an all-time high of new daily cases, and premier Doug Ford warned yesterday that the second wave “will be worse than the first.” Despite calls from doctors and medical experts, Ford announced no new restrictions to control the problem (Double sheesh).

Of course, it could be worse. British health minister Matt Hancock hasn’t ruled out the possibility that university students might have to stay away from home over Christmas. And south of us, the US appears to be on course for a THIRD wave of the pandemic. Although Western has referred 100 students for investigation after campus police broke up some small dorm parties this weekend, it’s nothing compared to those crazy Americans: an illegal gathering of about 500 college students in a Delaware park resulted in 2 shootings, and a police helicopter was used to break up a party of >1,000 people near Florida State U (I’m running out of sheeshes).

“A single and coordinated strategy might have brought us to a different place. Even within some states, counties may proceed independently. There is wide variation in the credence given to misinformation, some sourced from the Administration and even the President.” – Jon Samet,Dean, Colorado School of Public Health

My main focus today, though, is to explore the evidence so far to describe the pandemic in 2021. Today I’ll focus on testing and the development of a COVID19 vaccine, and then tomorrow we’ll turn to the question of Fall 2021 and 2022.

But first, a few updates…

COVID on Campus

4 New CdnPSE Cases

Brock U has 1 new case (total now 2 this fall)

Queen’s U has 3 new cases (total now 13)

Winter 2021

Since yesterday…

George Brown College has announced that most programs will be delivered online for the winter 2021 semester.

uManitoba’s winter term will be delivered “primarily remotely, with the exception of a small number of in-person courses,” like the fall.

UPEI has announced a blended delivery model for the winter semester, with courses primarily online except for labs, accredited and performance programs, post-degree and grad studies.

CdnPSE Updates

Positive enrolment news from Redeemer and USP, more financial aid at uWindsor and MSVU, and some details on new positions and programs…

Mount St Vincent U reports its fall enrolment is stable, despite a slight decline in incoming undergrads, thanks to increased grad enrolment and student retention. Due to declines in ancillary revenues, MSVU has approved its first deficit budget this year, coming up short about $974,000 – including an additional $350,000 in student financial aid, $300,000 in online learning, and several new positions to support diversity.  MSVU

Redeemer U, which has pursued an ambitious “dual-delivery model” this fall, reports its largest incoming class in history. About 80% of students are studying in-person on campus this fall. Since reducing domestic tuition -42% for 2019, total enrolment has increased +30%.  Redeemer

U Saint-Paul reports the strongest enrolment growth in its history this fall, with a +19% increase in registered students (+17% domestic and +23% international). Rector Chantal Beauvais credits in particular programs in ethics, bioethics, conflict studies and social innovation. (USP is bilingual, and the founding college of uOttawa.)  USP

uWindsor is committing an additional $700,000 to international student scholarships and experiential learning supports, which now exceed $1.2M. Additionally, 130 campus work placement positions will be created for international students.  PIE News

Asymptomatic Testing

Somewhere between 20-40% of those infected with COVID19 are completely asymptomatic – and this is particularly true for young people. Self-screening questionnaires, apps, and temperature checks are merely “pandemic theatre” that do little to actually monitor the spread of the virus, or help contain it, on campus. (Yes, if you have symptoms, you should stay home – but just because you pass the quiz doesn’t mean you’re safe.) Sound approaches to managing campus contagion would require frequent random testing of asymptomatic students, faculty and staff – which isn’t cheap…

Testing Every 2 Days is Ideal

A study from Harvard and Yale researchers concluded that bringing students back to campus safely would require testing them for COVID19 every 2 days, coupled with strict behavioural strategies like hand hygiene, masks, and social distancing. “This sets a very high bar — logistically, financially, and behaviorally — that may be beyond the reach of many university administrators and the students in their care.” Testing kits can cost between $10 and $50 each, and false positives would create considerable demand for quarantine facilities. There were no circumstances in which symptom-based screening alone would be sufficient to contain an outbreak. JAMA

$3 Million to Test Twice a Week

Brandeis U, near Boston, plans to provide a residential campus experience for 2,000 undergrads, beginning mid-August, and will be testing them twice per week for COVID19. Brandeis will also be testing about 1,500 grad students, faculty and staff once per week. At $30 each, such “aggressive… universal testing” will be a $3M expense. Like other Massachusetts colleges, Brandeis has contracted Harvard/MIT’s Broad Institute to process the tests within 24 hours. WGBH

Rationing Tests

Although new, faster and cheaper approaches are in development (from trained sniffer dogs to wall-mounted sensors and simple saliva tests), the most reliable COVID19 tests currently take time to administer, time to culture in a lab, and are costly. Perhaps due to capacity limits, budget constraints, the desire to prioritize at-risk populations, or simply to avoid reinforcing negative messages in an election year, many PHOs have backpedalled on asymptomatic testing. I have heard from CdnPSEs across the country that adequate testing capacity is simply not available…

Contradictory CDC Guidance

The US CDC was recommending random testing of asymptomatic individuals to monitor the spread of COVID19 in communities across the country, until late August when it inexplicably reversed its position. The Trump administration has been pushing for less testing to “improve” the optics of rising case counts, and Anthony Fauci reports he was “under general anesthesia” when the change was made. (The Association of American Medical Colleges called the change “irresponsible” and “a step backward.”) Then 3 weeks later, the CDC reversed its reversal, once again recommending that people without symptoms get tested if they have come into close contact with someone known to be infected – and moreover calls for those people to self-isolate for 14 days, even if they test negative for COVID19.  Vox

Constrained Testing in Ontario

Throughout the summer, Ontario’s messages to the public were consistent and clear: anyone who wanted a COVID19 test should go get one. But after weeks of hours-long lineups and processing backlogs, last Thursday the province announced that COVID19 assessment centres would be reserved for those with symptoms, vulnerable populations, or contacts of confirmed cases, in order to reduce so-called “reassurance testing.” The previous day, premier Ford announced that 60 pharmacies across the province would be offering COVID19 tests to asymptomatic people who need a negative test (in order to visit a relative in long-term care, or return to work or school after illness, for example). Education workers, notably, are included in the definition of “high-risk groups.”  CTV

“We want to ensure we have the testing capacity for our priority populations. If you have no contact, no symptoms and are not part of a high-risk setting, you’re not getting a test now.” – Matt Anderson, CEO, Ontario Health

Redefining Asymptomatic

On Friday, the Ontario government proposed another way to reduce demand for COVID19 testing, by narrowing the definition of “symptomatic” for schoolchildren. The current list of 17 symptoms includes many not among the 11 symptoms of COVID19. BC’s Ministry of Health has already removed 10 symptoms from their list for schoolchildren, including sore throat, runny nose, headache, fatigue, dizziness, conjunctivitis and skin rashes.

Race for the Cure

The most optimistic estimates now are that a COVID19 vaccine might be proven through phase 3 clinical trials and ready for manufacturing by December…

A Range of Pandemic Patterns

Although immunity will have little effect on the initial pandemic peaks, long-term containment of COVID19 will depend on the nature and duration of immunity: can a person be reinfected? How soon? Can they spread the virus while immune? A recent study in the journal Science examined potential impacts of numerous variables, including vaccine hesitancy, vaccine effectiveness, and continuing practice of masking and social distancing. Such variations “can lead to dramatically different immunity landscapes and burdens of critically severe cases, ranging from sustained epidemics to near elimination.”  Princeton

Promising Immunity

A recent study of 30,000 people in Iceland suggests that antibodies to fight COVID19 last for at least 4 months, suggesting to Harvard scientists that “immunity to this unpredictable and highly contagious virus may not be fleeting.” Although the first wave of antibodies may peak within 28 days, a second wave forms after 30-60 days, and seems more stable and long-lasting.  Global

Let the Dust Settle

Biostatisticians take time to collect the data from clinical trials and assess the safety and efficacy of a vaccine. The scientific process to develop a COVID19 vaccine is under considerable public scrutiny and political pressure, with the potential that prematurely leaked information in the popular press “can lead to a lot of confusion and chaos.” Advises one biostatistician: “let the dust settle a bit… information that’s a few days old is more reliable than information today.” The Verge

More than One Vaccine

Ultimately it may take more than one vaccine to beat COVID19 – and I don’t just mean you’ll need 2 shots. The first vaccine released might just barely meet the FDA expectation that it work in 50% of people. Later versions might have higher efficacy rates, be enhanced for the elderly, or be adapted for a single-dose regimen. They might not require ultra-low freezers for transportation, which would significantly streamline the logistical challenges of distribution.  Discover

Vaccine Hesitancy

Production is just the first hurdle: distribution of the vaccine will be even more challenging…

6-9 Months to Immunize

CDC Director Robert Redfield estimates it will take 6-9 months to vaccinate enough Americans to achieve reasonable immunity. (And that’s not even considering the anti-vaxxers…)  Politico

Two-Thirds will Refuse It

A poll of 1,000 Americans (Aug 28-31) found that 67% of voters will not try to get a vaccination as soon as it becomes available, and 23% won’t ever take it. 41% say they would refuse it if the government required they be immunized. “I don’t plan on being anyone’s guinea pig,” says one. Many distrust the Trump administration’s “warp speed” rush to deploy a vaccine, while many Trump supporters are opposed to immunizations of any kind. The challenge is that 70-80% of the population need to be immune, which means even more will need to be immunized.  USA Today

Canadians are Less Hesitant

Canadians are much more trusting of our government and of medical expertise: an Angus-Reid poll in early August found that 75% of us would be willing to get vaccinated, half of us right away. The least trusting appear to be in Saskatchewan (64%), Manitoba (64%), and Alberta (67%), while the most trusting are in BC (81%).  Global

Mass Vaccinations in China

Since July, China has inoculated at least 400,o00 of its people with COVID19 vaccine, before the completion of clinical trials or regulatory approval, under an “emergency use” designation. Major Chinese companies are securing vaccine supplies for their employees, even though their efficacy has yet to be proven. Canada was experiencing a months-long delay in receiving a shipment of the CanSino vaccine in early August, likely as “retaliation” over the arrest of Meng Wanzhou.

Tomorrow we’ll wrap up (at least for now) this extended effort to forecast our reality for Fall 2021. Meanwhile, stay safe and be well!