Foreword: The information in this article is what we know as of December 21, 2020 – the pandemic situation is quite fluid and information can change rapidly. I post daily updates on social media and publish a weekly newsletter – click here for all my links and to subscribe.
How are we doing? Part 10
Information as of December 21, 2 pm – Ontario be under lockdown as of Boxing Day.
The lockdown will begin at 12:01 a.m. on December 26 and will last until January 23, 2021, in southern Ontario. Other areas in Ontario will remain in lockdown till January 9, 2021.
This lockdown will be similar to the province-wide shutdown back in March 2020, with only essential businesses remaining open.
Well hello, friends!
Thanks for joining us once again as we chat about everyone’s least favorite topic!
You have no idea how excited I am to have newsletters one day that doesn’t talk about the pandemic!
As we do each week, we will chat through the bad news, the good news, and some silver linings.
I am a realist and passionate about evidence-based information.
I remain an optimist at heart and feel strongly that COVID has the power to teach us some important lessons.
If you are reading this email or blog post, you are lucky.
You are blessed.
And we have a lot to be thankful for, even in this chaos.
Dr. Dina, how are we doing in Canada?
Canada’s case count is around 500,000, with around 15,000 deaths.
This is frightening.
What is most worrisome to me, is the rate of rise.
The increase in cases, ICU admissions and deaths are concerning.
What is 15,000 deaths now, can easily double in a short time.
This pandemic is overwhelming the health care systems of many countries around the world and we are teetering on the edge in Canada.
Manitoba has seen over 550 deaths due to COVID, and more than half occurred in the last 2 weeks.
Ontario has seen > 2000 new cases a day this week, and mounting deaths, have tightened restrictions in five more areas.
Hamilton is moving to the grey, or ‘lockdown’ level (joining with Toronto and Peel).
Brant County and Niagara are moving to the red or ‘control’ zone, and Kingston, Frontenac, and Lennox & Addington are moving to orange, or ‘restrict zone’.
Timiskaming is moving to yellow, ‘protect’ zone.
If you have no idea what the heck this means (like me!), here is a snapshot.
The Ontario Hospital Association (OHA) is very worried.
They are calling for the, “urgent implementation of stricter and more robustly enforced public health measures,” and also asking municipal leaders to get on board to support the action.
“On the cusp of the holiday season, should stricter measures not be put in place, and should the public ignore public health advice and choose to gather over the holiday season, the consequences risk overwhelming Ontario’s hospitals…”Ultimately, every health care system has its breaking point.”
If you take one thing from this newsletter this week, or frankly, ever, I hope it is from this news interview with CBC.
My friend and colleague Dr. Michael Warner, the Critical Care Director for Michael Garron Hospital, puts this better than I ever could ↓↓↓
How is the rest of the world?
As of Dec 19, 2020:
There have been over 75 MILLION cases of COVID-19 reported worldwide.
Over 1.6 MILLION people have died from COVID.
For anyone still calling this a hoax, how dare you.
These are people’s children, parents, brothers, sisters, and friends.
These are real lives lost.
And their families and friends will forever have that loss.
Another common misconception is that we don’t need to be strict to prevent COVID-19 spread.
This is nonsense as well.
An example I hear cited often is that of Sweden.
Sweden has stood out as a country with relatively lax restrictions throughout the pandemic.
However, Sweden has recently seen a rapid increase in COVID cases, and it is putting a real strain on the health care system.
So, they are tightening restrictions by requiring many people to work from home and reducing gatherings in restaurants and stores, and gyms.
No lockdown yet, but I suspect that is coming.
A few weeks ago, I spoke about how impressed I was with how well Africa was faring.
Many African countries locked down even before a single case was noted, and many areas had very few cases till recently.
Unfortunately, COVID-19 doesn’t back down, and without significant restrictions, it wreaks havoc.
Over 900,000 people in South Africa alone have tested positive for COVID-19, with a rapid rise over the last 2 weeks.
More bad news:
The World Health Organization says South African researchers may have identified a new strain of COVID-19.
A new, more virulent, and dangerous strain of COVID-19 was also found in the UK, necessitating a strict lockdown.
What’s the deal with COVID-19 mutations?
Let’s review some virus basics first:
COVID-19 is a coronavirus.
Coronaviruses are RNA viruses – genetic material packed into a shell made of protein.
Once an RNA virus makes contact with the host (like a human), it makes new copies of itself, and these go on to infect more cells.
RNA viruses, as opposed to DNA viruses, are more prone to changes and mutations.
The flu and measles are other common RNA viruses.
COVID-19 has been mutating as well.
Luckily, we haven’t seen it mutate too quickly, and new versions so far seem similar to the original version.
But interestingly, the COVID-19 viruses that are circulating in Canada are different from those in China.
Why does it matter?
There has been some research that demonstrates new strains as more infectious (i.e. easier to pass on, easier to catch).
One such version is “the D614G mutation”.
The mutation here was on the ‘spike protein’, the part of the virus that helps it bind to our cells.
Better binding = easier to infect us.
We don’t yet know if these new mutated versions cause more severe illness or a higher risk of death.
We need more data.
Can we get reinfected with a new strain after recovery from another strain?
Will these mutations affect how much vaccines protect us?
Will it affect the treatment options we have now?
Many unanswered questions.
Welcome to the pandemic!
What’s the good news?
Canada and the US received first doses of the COVID-19 vaccines and started giving them to the most vulnerable groups.
Canada has secured over 400 million doses from multiple manufacturers.
As more vaccines become available, more will be given across the country.
We are told that all Canadians who wish to receive the vaccine can do so by the end of 2021.
Who is being prioritized?
Each province is responsible for deciding who gets the vaccine first, but most will choose to vaccinate those at highest risk of severe illness and death, essential frontline workers, and those living in vulnerable communities first, such as older adults living in long-term care homes.
When will my child receive the COVID-19 vaccine?
I am asked this question dozens of times a day.
I have no idea.
When these vaccines were being studied (remember when we spoke about phase 1, 2, 3 trials way back?), they did not include kids less than 16.
So, while we know that the Pfizer and Moderna vaccine provide 95%+ protection against ILLNESS, they have not been tested in kids.
They may not work in kids.
They may cause untoward side effects.
We don’t know.
It also hasn’t been tested on pregnant or breast-feeding people.
So, the same goes for these groups.
We do not know if it works, and is safe, and testing is upcoming, first in kids 12-16, and later in younger kids.
The above point about 95% effective at preventing illness is key.
Important to note the distinction: Infection vs Illness
According to Toronto Public Health,
‘Two-doses of the vaccine can provide 95% efficacy against symptomatic illness. Even after receiving two doses of the vaccine, it will be important to continue to follow public health measures to prevent the spread of COVID-19. There is currently limited evidence on the efficacy to prevent asymptomatic infection, to reduce viral shedding, to prevent transmission, to use as post-exposure prophylaxis, or to interrupt transmission during outbreaks.’
In other words, what we know is that these vaccines prevent someone from getting SICK from COVID-19.
We DO NOT KNOW if vaccination prevents you from getting COVID-19, albeit mildly or asymptomatically, leaving you possibly still able to INFECT others.
The vaccine MAY NOT prevent new infections.
This is pretty important; if not everyone is vaccinated, and those that are vaccinated can infect others, we will have to keep distancing and wearing masks for a while.
More data is needed.
Alright friends, on to my silver linings.
This will be my festive holiday season silver linings special edition 😃
Bring out the hot cider and eggnog!
1. No holiday concert –
I mean, really! Does anyone like going to these things? Sure, it’s cute to see your kid sing for a minute, but then I have to sit there for 2 hours watching other people’s kids be cute? I’m good, thanks.
2. No huge holiday gatherings –
Look, I love a good party more than most. But they are a pain to organize and come with a fair bit of hassle and anxiety. It is an absolute privilege to consider what my family of 6 will eat this week, and not all the requests and restrictions of friends and family.
3. Way less spending –
We are not traveling (tear!), and we are not buying gifts for every potential person we might possibly see at a holiday get together. Holiday parties are awesome and fun and joyful, but also expensive!
4. No mall-rushes –
If you know me well, you know I have always shopped online, like, forever. I do not have the patience or time to drive anywhere, park, wait in lines, etc. Like, literally no patience. So, I was never one to wait in line last minute to get holiday presents. But for the millions of people who did these crazy things, you get to join me on this side, where we shop from the safe comfort of our home, with a mug of tea or a glass of wine in one hand, and lovely elves deliver packages to our doorstep. More box-waste, but fewer gas fumes… and no panic attack waiting in 2-hour line ups at The Gap. I consider that a win!
Alrighty, friends, that’s a wrap for this week. (ba-dum ching, pun intended!)
I wish you and your loved ones a healthy and joyful holiday season.
May you stay safe and enjoy time with those you hold most dear.
Hug your little (or big!) ones tightly and count your blessings.
There are many, and they deserve more attention than the stresses and negative thoughts.
Cheers to a much less dramatic 2021!
All my love and thanks,
Stay healthy and safe,
Dr. Dina Kulik