Can we throw away our masks now?

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Well, hello friends!

It’s been a wild few weeks and we are back for another update!

I hope you and your family had a lovely holiday, and you stayed healthy and safe.

Thank you for all your love and support in these last months.

The pandemic has been difficult for all of us, and I have truly felt your compassion and appreciation.

Thank you.

Each week I am asked how you can ensure your family or friends receive this newsletter. It is so simple!

I wish I had incredible news to share; but alas, I really do not.

In typical fashion I will share the bad news, then the good news (cause we all want to end on a high note) and then my silver linings for this week.

 

Dr. Dina, what is the bad news?

How is Ontario doing?

Unfortunately, Ontario is in the worst position yet during the pandemic.

There are over 4000 new cases a day, increasing hospitalizations, more people are dying and ICU admissions are on the rise.

Hospitals are under serious strain.

Ontario has plans to transfer patients across the province due to hospital bed and healthcare provider shortages.

Many people are worried about running out of beds and ventilators, but the real rate-limiting step is healthcare workers.

Most kids admitted to hospitals will be sent to Sick Kids.

From all over the GTA or even Ontario.

Your loved one may be admitted to a hospital 50-500 km from your home.

There are discussions about rationing care to those that are very sick.

This is real and scary stuff.

 

How are we doing in Canada?

There have been around 650,000 cases of COVID-19 in Canada and almost 17,000 deaths.

Quebec announced a 4-week curfew to help curb new infections.

Their healthcare system is strained.

Alberta has seen the first case of the South African variant of COVID-19. This individual is a recent traveller and is in quarantine.

Prime Minister Trudeau says that every Canadian who wants a COVID-19 vaccine will have access by September 2021.

That means 100,000 doses a day every day till then…

I am cautiously optimistic.

But also, a realist.

The government pharmacy ran out of flu vaccines in November 2020.

For the YEAR.

The number of Canadians who did not receive a flu shot this year is staggering.

Resource: The Montreal Gazette

How is the world doing?

There have been around 90 MILLION cases of COVID-19 reported in the world.

HOLY MOLY!

Almost 2 million people have died from COVID-19 infection.

Read those numbers again.

Unfathomable!

My heart aches for all these families and friends.

In the United States, around 4,000 people are dying from COVID-19 a DAY.

They are reporting 275,000 new cases a day.

Holiday gatherings are being blamed for this rise.

Vaccinations are not being rolled out as quickly as expected.

Around 6 million doses have been given so far.

Brazil has had over 8 million cases, with over 200,000 deaths.

The United Kingdom has the world’s fifth-highest mortality rate from COVID-19 at over 80,000.

Their hospitals are overwhelmed and at risk of catastrophe.

Prime Minister Boris Johnson said, “our hospitals are under more pressure than at any other time since the start of the pandemic, and infection rates across the entire country continue to soar at an alarming rate.”

The World Health Organization has confirmed that the UK COVID-19 variant is in fact more easily transmitted and people who get infected have a higher viral load.

This can lead to more severe illness.

Japan is in a state of emergency as cases increase, and they have a curfew of 8 pm.

Australia, which as you know is my poster child for how we should be managing the pandemic has remained very conservative and vigilant.

Brisbane went into lockdown when they found a new COVID-19 variant that may be more virulent.

In Israel, there is a huge push to vaccinate all adults by the end of March.

They also have a tight national lockdown due to a rise in cases.

Resource: Wikipedia

Resource: New York Times

 

Asymptomatic Spread

I have been quite open about my concern for the asymptomatic spread of COVID-19.

I have seen many patients and family members get COVID, despite no confirmed case exposure.

I suspected a ton of asymptomatic spread.

I have gone so far as to say I think 70-80% of COVID infected individuals are asymptomatic, and I still believe this to be true.

This week we found out through a study published in the prestigious, Journal of the American Medical Association, that at least 50% of new cases are transmitted from people with no COVID symptoms.

That means at least half of COVID patients were infected by someone who had no symptoms (and may not know then, or ever, that they had COVID).

The good news here is that many more people have been infected with COVID, and therefore the mortality rate and the rate of severe illness from COVID is far lower than we thought.

If you had COVID and didn’t even know it, and you didn’t get sick or die, that means the percentage of the population who have been infected is higher, but the percentage of the population who die or get really sick from COVID is less.

However, it also means that we cannot assume anyone does not have COVID.

I have preached this since March 2020. Please assume every surface has COVID on it and every person you interact with has COVID.

Keep your distance.

Wash your hands.

Wear a mask.

This study highlights that effective control of the pandemic will require reducing spread from people who do not even know they have COVID.

We need better ways to identify who has been infected, and we cannot rely upon only testing people with symptoms.

A runny nose can be COVID.

A sore throat can be COVID.

Diarrhea can be COVID.

And NO SYMPTOMS can be COVID.

Another study published this week in another prestigious journal called The Lancet showed that more than 75% of people who required hospitalization due to COVID infection have residual symptoms up to 6 months later.

That’s a lot of people.

This study found that 63% experience fatigue and weakness, 26% have difficulty sleeping, and 23% report depression or anxiety.

Patients who were more severely ill during hospitalization are at risk of developing long term respiratory problems and decreased lung function.

If you get really sick from this illness, you may die, and if you don’t die you may suffer for a long time.

This is very sad and very scary.

We need long term follow-up of these patients to best support them, even once they are back home.

 

Dr. Dina, what is the good news?

The good news is that there are some highly effective vaccines for COVID-19 and these are being given around the world.

I am asked about the vaccines dozens of times a day.

I will address some of the most common questions I am asked here.

 

Can you still get COVID-19 if you receive the vaccine?

Yes, you can still get infected even if you get the vaccine.

Here is why:

Immunity takes time!

Immunity from vaccines takes time.

That is the reason why the current COVID vaccines require two doses, given 3-4 weeks apart.

They are training the immune system, just as the flu vaccine does or MMR or tetanus.

If you are exposed to COVID-19 before you get the vaccine, or in between doses or before you have enough immunity, you can become infected.

According to the CDC, ‘it’s possible a person could be infected with the virus that causes COVID-19 just before or just after vaccination and still get sick.’

It isn’t 100% effective.

The current vaccines are super effective, quoted at 95% (7-14 days after the second dose).

Researchers are not sure if the vaccines are protective against all infections, or whether they prevent symptomatic, and in particular, severe, infections.

The CDC currently recommends that people should not assume they are completely immune after being vaccinated, but rather they are 95% protected from illness and death from COVID-19.

Importantly, this 95% number came from vaccine trial studies, testing the vaccines in healthy adults.

They have not yet been tested in children, pregnant people or individuals who are breast/chest feeding.

It is possible it is less or more effective in these populations.

So that 95% number may be higher or lower in the general population.

 

Can you get COVID-19 from the vaccine?

No, you cannot get infected with COVID-19 from the vaccine.

The vaccine does not contain the live virus.

The current vaccines contain a stretch of genetic material called mRNA.

This tells cells to make the spike protein of COVID-19.

The body then makes antibodies against the spike protein.

When the body is then exposed to COVID-19, the antibodies that recognize the spike protein attack the virus.

The COVID-19 vaccines cannot make you sick with COVID-19.

 

How long does immunity last from the vaccines?

Unfortunately, we do not know how long the vaccines provide immunity.

Sometimes immunity from vaccine wanes, which is why we give some vaccines every so often.

The flu vaccine is given yearly.

The tetanus vaccine every 10 years.

We may require booster shots for the COVID vaccines.

More to come as research is completed.

 

Will the COVID-19 vaccines still work if the virus mutates?

We covered the concept of COVID-19 mutations in previous newsletters, but essentially the current vaccines work by triggering an immune response against the current spike protein.

The concern is that the virus has mutated and will likely continue to mutate.

That is what viruses do.

If the vaccines are targeted at a very specific part of the virus, and that virus changes itself, the vaccine may not work as well or at all against new virus strains.

Luckily, the technology to alter the COVID vaccines is designed to be easily adapted, and in a few weeks or months could be altered to protect against new strains.

 

Can we throw away the masks?

Nope!

Please NO!

Current evidence shows that it is possible that someone who received the vaccine can be an asymptomatic carrier of COVID and COULD pass it to someone else.

Therefore, the CDC still says that vaccinated people should continue wearing a mask, practicing social distancing, washing hands and staying home when possible.

 

Should I get the COVID-19 vaccine if I am pregnant, breast/chest feeding or planning to get pregnant?

These groups were not represented in vaccine trials.

We do not know if it is safe or works as well in these populations.

Some groups think they should not be vaccinated, and other groups think they should.

Best to discuss this with your healthcare provider if you are in these groups.

 

Do kids get COVID?

Unequivocally yes, kids do get COVID.

In my own patient population, I have seen a dramatic rise in the number of positive cases.

And not just my child patients.

Their parents, family members, classmates and other close contacts have been infected as well.

Kids can get COVID and they can pass it on.

Especially when community transmission is high.

Yes, kids get COVID.

Yes, they can pass it on.

But children do not tend to get as sick as adults.

Young children in particular rarely get very sick at all, and teenagers fare better than adults.

 

Should schools close?

I do believe we should do everything in our power to allow schools to stay open.

Kids do better emotionally and physically when they are in school.

Their parents do too (I know you feel this way!).

School provides structure, routine, and the opportunity to socialize and learn from other kids.

In some cases, schools provide a much-needed respite from challenging situations at home.

When the numbers are as high as they are, we should be doing everything we can to reduce transmission.

This may mean closing schools.

BUT I think they should be the last thing to close and the first thing to open.

Very few things are as essential as schools.

I do believe most businesses should be closed if that means schools can be open, as long as they are open in the safest ways possible.

We know how to do this.

It is challenging and expensive, but we know.

Improve ventilation.

Keep small class sizes.

Lower the threshold for testing.

Spend as much time outdoors as possible.

Mandatory masking for all children, faculty and staff in the school.

Maintain distance between students and educators.

In Ontario, many areas will see schools closed till at least January 25.

But are there other things we can do to minimize the rate of rise?

Many people are still at risk of getting COVID due to poor workplace conditions, inability to take time off work, concern over job security and poor isolation protocols.

People are still travelling.

People are having family gatherings.

There are parties.

So many things can still be better managed to control the pandemic without needing to close schools.

Closing schools exacerbate inequities.

Vulnerable and racialized populations are hardest hit, by COVID-19 and by school closures.

These kids have less access to technology for school, food scarcity and increased isolation.

We should make it a priority to provide as much support as possible to vulnerable groups, and open schools as quickly as safely possible.

 

A quick note

I recognize that if you are reading this newsletter and you follow me as a patient or social media follower or friend, you likely are on the same or similar page as me.

I doubt you are going to parties or being reckless.

But you likely know someone who is.

I want to share some personal thoughts.

I am not one to beat around the bush.

I tell it like it is, and I am no bull.

I like transparency.

This last year has SUCKED!

I am so sad to see my kids stuck at home.

I am so sad to not be able to see my friends and family and celebrate and enjoy other people’s company.

I am sad that my business has been turned upside down and we cannot safely see people in the office the way I would like.

I am sad that I am putting my staff at risk every day, just for coming to work.

I am sad that I cannot travel.

And that the countries I most want to travel to are impoverished and are being devastated by this illness that ravages the poorest and most vulnerable citizens.

I am sad that families are facing strife. And inequities.

I am sad that people are dying and getting sick.

I am sad that my healthcare colleagues are scared.

That they are getting sick.

That they have to literally risk their lives every day in a way that we cannot be prepared for.

But I am mad about some things too.

I am mad that many people continue to refuse to wear a mask when in public.

I am mad that people continue to congregate and assume they are not at risk.

I am mad that people with symptoms continue to go to workplaces and schools as they ‘don’t have COVID’.

I am mad that people are travelling, symptomatic or not, to other countries that have poor healthcare infrastructure, poverty, and significant inequities.

That privileged people are risking bringing COVID to other countries, where they will be served by those that are at the highest risk of becoming sick or dying from COVID.

I am mad by the flagrant disregard for others.

I am mad that we know better but are choosing to act this way.

And all these feelings of sadness and anger are making me tired.

How do I explain to my kids why we can’t get this thing under control?

Should they feel helpless?

Should I feel helpless?

My husband told me yesterday that I am not an optimist or a pessimist.

I am a realist.

And I agree.

I am optimistic that we can get back to a normal way of life.

I am optimistic that my kids will go to school again, play with their friends, not worry about distance or masking.

I am optimistic that I will dance and sing at a concert or a party one day.

That I will share meals and drinks with my friends again.

That I will travel again.

But we really have to get our ____ together people.

And maybe you need to hear this.

Or maybe your friend or family member does.

But the more you have playdates in garages or have ‘small extracurricular activities’, or coffee dates with friends with masks off, the longer this is going to last and the more people that are going to die.

Your daily actions DO have an impact.

Every single person has to control themselves now to get this under control.

For real.

Ok, end rant.

 

Please send this to whoever you think needs to read this.

I am usually very diplomatic and subtle.

But today I am shouting from the rooftop!

 

Ok, silver lining time!

This has been a long one, so I will share just one.

This holiday season was definitely a different one.

We did not have big holiday gatherings, and we did not travel.

That was disappointing.

But it was awesome.

It really was.

We were so super present with our kids.

We didn’t go farther than our front yard.

We baked and did crafts and played tag and made-up games.

We sang and had dance parties and had snowball fights.

We were together as a family and really bonded with the kids.

I have never felt more connected to my kids or my husband.

I have never chatted with them more.

I have never known them this well before.

That is an incredible blessing and a silver lining.

I never want to take my family for granted again.

Thank you for continuing to take this crazy journey with me.

I hope you and your family and loved ones are safe and healthy and happy and continue to be.

All my love,

XO

 

 

Dr. Dina