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Health Canada says AstraZeneca shot is safe as U.S. questions vaccine’s clinical trial data

Health Canada said today Canadians should not be concerned about the safety of the AstraZeneca vaccine — even as a U.S. regulatory body raises concerns about the company’s clinical trial results.

Marc Berthiaume, the director of the bureau of medical science at Health Canada, said the issues flagged Monday by a U.S. federal health agency relate to the product’s published efficacy rate, not to whether it’s safe to use.

Berthiaume said Health Canada’s decision to authorize the product was not based on any of the clinical trial information U.S. authorities are now probing. He said Canada based its approval largely on data that emerged from AstraZeneca trials in the United Kingdom and Brazil, and on studies published in countries where the shot has been in use for some time.

“I think it would be alarmist to suggest that the results of additional clinical testing could lead to a change in the approval status of AstraZeneca here in Canada,” Berthiaume said.

“The additional information that was collected in the U.S. will be sent to Health Canada in the coming weeks. If there’s a need to readjust, then we’ll do that with Canadians later.”

Millions of people have received the AstraZeneca shot worldwide, including more than 17 million in Britain and the European Union — almost all without serious side effects.

Health Canada ‘concerned’ about vaccine hesitancy  

Dr. Supriya Sharma, Health Canada’s chief medical adviser, said U.S. questions about the efficacy rate change nothing for Canadians at this point. She conceded the barrage of headlines about the AstraZeneca shot are “something of a concern to us” because they could make some Canadians reluctant to take vaccines.

“We’ve said this many times before — that even the most effective vaccine only works if people trust it and agree to receive it,” she said.

“It’s like any other reputation. Once there’s some doubt that creeps into that reputation, it’s that much more difficult to gain that back. The press and the concerns around the AstraZeneca vaccine don’t help.”

WATCH: Health Canada says federal recommendations on AstraZeneca vaccine are not changing 

Dr. Supriya Sharma, Health Canada’s chief medical adviser, says federal recommendations on the use of AstraZeneca’s COVID-19 vaccine are not changing at this point in time. 1:40

In a statement released last night, the National Institute of Allergy and Infectious Diseases (NIAID) in the U.S. said the Data and Safety Monitoring Board (DSMB), which keeps an eye on clinical trials, found “outdated information” may have been reported by the company when it released some information yesterday.

The agency said the British-Swedish pharmaceutical giant may have released information that gives an “incomplete view of the efficacy data.”

“We urge the company to work with the DSMB to review the efficacy data and ensure the most accurate, up-to-date efficacy data be made public as quickly as possible,” the agency said — without stating what sort of data may have been  included improperly.

The statement came only hours after AstraZeneca released the results of its U.S.-based phase three clinical trials, which began last August and wrapped up earlier this month. Phase three is the point in a clinical trial when a vaccine maker gathers more information about safety and effectiveness and studies the effect of different doses on various groups.

The company said its COVID-19 vaccine had a 79 per cent efficacy rate for preventing symptomatic COVID-19 and was 100 per cent effective in stopping severe disease and hospitalization. Investigators said the vaccine was effective for adults of all ages, including older people — something which previous studies in other countries had failed to establish.

The product has not yet been authorized for use in the U.S.

Speaking to ABC’s Good Morning America on Tuesday, Dr. Anthony Fauci, U.S. President Joe Biden’s chief medical adviser and the head of the NIAID, said the monitoring board was surprised by the the better-than-expected efficacy results published by AstraZeneca.

“They got concerned and wrote a rather harsh note to them and with a copy to me, saying that in fact they felt that the data that was in the press release were somewhat outdated and might in fact be misleading a bit, and wanted them to straighten it out,” Fauci said.

The board members pegged the vaccine’s efficacy at between 69 per cent 74 per cent — up to 10 points lower than what AstraZeneca itself reported — and said the company’s decision to issue a press release with better results served to erode public trust.

“We told the company they better get back with the DSMB and make sure the correct data get put into a press release.”

In response to the blowback, AstraZeneca said the efficacy numbers it released yesterday were current as of February 17 — a month before the clinical trial was actually completed. In a statement, the company said it would “immediately engage with the independent data safety monitoring board” and provide the U.S. regulator with “the results of the primary analysis within 48 hours.”

This is just the latest public communications issue the company has faced over the last three months.

Earlier this year, a number of European countries halted vaccinations in response to questions about the product’s efficacy in people over the age of 65, only to restart them after new evidence emerged.

After Health Canada approved the shot for all adults, the National Advisory Committee on Immunization (NACI) recommended the product be used only on people under the age of 65, citing a dearth of clinical trial data on the vaccine’s effectiveness in older people.

NACI changed course last week after reviewing three “real-world studies,” saying the two-dose viral vector vaccine can and should be used on seniors.

The European Medicines Agency has also had to assure European Union member countries that the product is safe to use after reports of post-vaccine blood clots in a very small number of patients.

The agency concluded that the benefits of protecting against COVID-19 — which itself results in clotting problems — outweigh the risks.

The Public Health Agency of Canada has said it’s “possible” the vaccine may be associated with “very rare but serious cases of blood clots associated with thrombocytopenia” — a condition associated with very low levels of blood platelets. Health Canada has maintained that the benefits of the AstraZeneca COVID-19 vaccine continue to outweigh the risks.

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Is AstraZeneca vaccine safe for people who’ve had blood clots? Your COVID-19 questions answered

We’re still answering your COVID-19 questions. We’ve received more than 71,000 since the start of the pandemic. But vaccine questions are the main theme right now. We publish a selection of answers online and also put some questions to the experts during The National and on CBC News Network. Send your questions and stories to COVID@cbc.ca, and we’ll address as many as we can.

The AstraZeneca-Oxford COVID-19 vaccine has been in the headlines recently over concerns that some people were developing blood clots after receiving the shot. Some European countries suspended use of the vaccine, but many have since resumed.

You may be wondering what all of this means for you when it comes to taking the vaccine. Here’s what the experts are saying.

What are the latest findings on AstraZeneca’s safety?

A recent review from the European Union’s drug watchdog found the vaccine is not linked to an increase in the overall risk of blood clots. The European Medicines Agency (EMA) also concluded that the benefits of protecting against COVID-19 — which itself results in clotting problems — outweigh the risks.

At the same time, the EMA said it could not definitively rule out a link between the vaccine and specific, rare types of blood clots associated with thrombocytopenia, or low levels of blood platelets.

WATCH | AstraZeneca vaccine is safe, says EU drug regulator:

The AstraZeneca COVID-19 vaccine is safe and does not appear to cause blood clots, says the European Medicines Agency, after a review by an expert committee. But the EMA couldn’t rule out a link to blood clots entirely. 1:22

Specifically, it noted 18 cases of an extremely rare type of blood clot called cerebral venous sinus thrombosis (CVST), a condition that is much more common in women than men. Most of the incidents occurred within 14 days of receiving the AstraZeneca shot, and the majority were in women under the age of 55.

In its investigative document, the EMA said it would expect to see just 1.35 cases of CVST in the time period it looked at — but instead its researchers saw 12.

“A causal link with the vaccine is not proven, but is possible and deserves further analysis,” the agency said in its findings.

Around the same time the EMA released its report, researchers in Germany and Norway announced they had found a mechanism that could cause the AstraZeneca vaccine to create the blood clots in very rare circumstances, in addition to identifying a possible treatment for it.

Dr. Theresa Tam, Canada’s chief public health officer, acknowledged the possible link said in a statement on Sunday.

“It is possible that the vaccine may be associated with very rare but serious cases of blood clots associated with thrombocytopenia,” she said.

Overall, Health Canada has maintained that the benefits of the AstraZeneca COVID-19 vaccine continue to outweigh the risks. 

WATCH | Benefits of AstraZeneca vaccine outweigh risks, Tam says:

Canada’s Chief Public Health Officer Dr. Theresa Tam says the benefits of the AstraZeneca COVID-19 vaccine outweigh the rare risks. 1:53

Meanwhile, AstraZeneca announced on Monday that scientists found no increased risk of clots among the more than 20,000 people who received at least one dose of the shot in a late-stage study in the United States. The vaccine has not yet been given the green light in the U.S.

The company said the study also showed the vaccine provided strong protection against disease and complete protection against hospitalization and death across all age groups.

Is AstraZeneca safe for people with a history of blood clots?

Amid the developments, many readers are still wondering if having a history of blood clots means they’re at a higher risk of developing them after getting an AstraZeneca jab.

Some of the experts we spoke to said no, the vaccine is safe, even for people with a history of blood clots.

“Anyone who has a history of blood clots might have an increased risk of blood clots at any point anyway,” Dr. Lynora Saxinger, an infectious disease specialist at the University of Alberta in Edmonton, said in a recent CBC News interview.

“But I don’t believe that there would be a rationale to make a recommendation against using [the vaccine],” she said.

A medical worker receives a dose of the AstraZeneca vaccine in Taipei, Taiwan, on Monday. (Ann Wang/Reuters)

Dr. Cora Constantinescu, an infectious diseases specialist from the Vaccine Hesitancy Clinic at Alberta Children’s Hospital in Calgary, said if you are still worried about blood clots, you should be more concerned about catching the coronavirus than the vaccine.

“If you looked at five million people hospitalized with COVID-19, you would expect 100,000 to 500,000 of them to have clots,” Constantinescu said in a recent interview with CBC News Network.

“Keep in mind the risk of the disease itself is so much higher, and the more you wait to [get the vaccine], the less protected you are.”

On the other hand, Dr. David Fisman, an epidemiologist at the University of Toronto’s Dalla Lana School of Public Health, said Germany’s data offered a “compelling picture” that the rare blood clots were potentially linked to the vaccine in rare cases.

“I find myself in disagreement with Health Canada’s guidance on the use of AstraZeneca,” Fisman said.

“I do think that the use of this vaccine should be suspended in Canada until we have more data. At a minimum, I do not think it should be used in women aged 20 to 50 until we know more.”

Have blood clots been associated with the other vaccines?

If the overall rate of reported blood clots after AstraZeneca is no more than the rate in the general population, a number of readers, including Carolyn W., wanted to know why we’re not hearing similar issues with the Pfizer and Moderna vaccines.

“That’s a great question,” Constantinescu said.

In terms of a blood clot, she said, the numbers appeared similar “across the board” for all of the vaccines, including the mRNA vaccines.

Constantinescu tried to put the figures into perspective.

“If you took five million people, you would expect 5,000 to 15,000 cases of blood clots versus the 37 that were noted,” she said. “So if anything, even in the vaccinated population, there seemed to be a lower baseline rate than you would [have] in the general population.”

WATCH | Can AstraZeneca vaccine overcome mixed messaging, distrust?

Top U.S. infectious disease expert Dr. Anthony Fauci says interim data shows that the AstraZeneca-Oxford COVID-19 vaccine is 78.9 per cent effective overall. 1:05

There haven’t been any substantial reports of clotting during the clinical trials for the vaccines, Saxinger noted.

Most of the vaccine data has been “basically equal in the vaccine versus placebo recipient group,” she said. “And there certainly hasn’t been a strong population-based signal specifically for [deep vein thrombosis or pulmonary embolism] so far.”

What if you’re immunocompromised?

If you’ve got an autoimmune disease or are taking an immunosuppressant drug, it’s probably a good idea to talk to your doctor.

That’s because each condition is so different, Dr. Isaac Bogoch, an infectious disease physician in Toronto and a member of Ontario’s COVID-19 Vaccine Distribution Task Force, advised in an earlier article.

In general, the experts we spoke to said AstraZeneca is probably safe for immunocompromised people, but we’re still learning more.

The National Advisory Committee on Immunization (NACI), which makes recommendations on the use of newly approved vaccines in Canada, notes there is currently no data on COVID-19 vaccination in individuals who are immunosuppressed, as they were not included in the clinical trials.

“The concern is not so much about a safety issue,” Saxinger said, noting that AstraZeneca is considered as safe as any other non-live vaccine. You can read more about different types of vaccines here.

British Prime Minister Boris Johnson reacts after receiving his first dose of the AstraZeneca vaccine in London on March 19. (Frank Augstein/Reuters)

The real issue, Saxinger said, is “whether or not your particular immune change will allow you to get a fully protective response.”

“That’s where we’re still learning more.”

But even if immunocompromised people have slightly less protection than others, they should go ahead and get the vaccine, she said, because even a partially protective response against a severe COVID-19 infection is worthwhile.

Constantinescu added that it’s likely immunocompromised people may need booster doses in the future.

If you’re offered AstraZeneca, can you refuse?

Sure. No one is going to force you to take any one vaccine if you don’t want it. COVID-19 vaccines aren’t mandatory.

But that doesn’t mean you will immediately be offered another vaccine. That would depend on the province you live in, Constantinescu said.

For example, Quebec’s director of public health has said that people who refuse to take the AstraZeneca-Oxford vaccine will be bumped to the back of the line and have to make another appointment.

And waiting could be risky, especially as some provinces are seeing case counts rise, Constantinescu said.

“You are putting yourself at risk waiting for a different vaccine when we know that this vaccine works really well at preventing hospitalization, severity and death,” she said.

Have a question? 

Send your questions to COVID@cbc.ca

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Underwhelming women’s weight room in NCAA bubble prompts questions of inequity

The teams had barely landed in Texas when complaints of inequity between the women’s and men’s tournaments roared over social media posts noting the women’s weight training facilities in San Antonio were severely lacking compared to what the men have in Indianapolis. Both tournaments field 64 teams.

In an Instagram post, Stanford sports performance coach for women’s basketball Ali Kershner posted a photo of a single stack of weights next to a training table with sanitized yoga mats, comparing it to pictures of massive facilities for the men with stacks of free weights, dumbells and squat racks.

“These women want and deserve to be given the same opportunities,” Kershner tweeted. “In a year defined by a fight for equality this is a chance to have a conversation and get better.”

Several top former college and current WNBA players quickly tweeted support for the women and criticism of the NCAA.

“That NCAA bubble weight room situation is beyond disrespectful,” tweeted A’ja Wilson, who led South Carolina to the 2017 national championship and now plays for the Las Vegas Aces in the WNBA.

NCAA Senior Vice-President of women’s basketball Lynn Holzman said the governing body would try to quickly improve the equipment available at the women’s tournament. The original setup was limited because of a lack of available space in San Antonio, with plans to expand once the tournament field shrunk in the later rounds.

“We acknowledge that some of the amenities teams would typically have access to have not been as available inside the controlled environment. In part, this is due to the limited space and the original plan was to expand the workout area once additional space was available later in the tournament,” Holzman said. “However, we want to be responsive to the needs of our participating teams, and we are actively working to enhance existing resources at practice courts, including additional weight training equipment.”

Middle Tennessee State coach Rick Insell said his team hasn’t seen the weight room yet, but has not seen anything else to indicate that the women are getting anything less than the men.

“I saw something on Twitter about the men’s weight room is a lot different and things were being given to the men that were not being given to the women, but I haven’t seen any of that here,” Insell said. “Now, maybe later on we’ll get to see what’s going on. But, right now we’re kind of just going to practice, going to eat and going to your room.”

COVID test results

The NCAA has administered nearly 2,700 tests so far and only one has come back positive which was a great sign for the women’s basketball tournament.

NCAA Senior Vice-President of women’s basketball Lynn Holzman revealed the numbers on a media call Thursday morning, but did not identify who tested positive.

“From the report I received this morning over the past two days, close to 2,700 tests were performed that included the members of the travel parties, bus drivers and staff and only one confirmed positive test,” she said. “It’s a testament to all those involved in our championship. So given the sheer number of individuals involved in this, where we sit currently today, I’m pleased where we’re at.”

Holzman also said that all 64 teams announced Monday in the bracket have arrived safely in Texas so none of the replacement teams will be needed.

“We continue to emphasis the need for us to make sure we’re conducting our championship in a safe manner,” she said.

Everyone will continue to be tested daily.

Obama makes his pick

Former President Barack Obama picked Baylor to win the national championship this year beating Stanford in the championship game.

Obama had N.C. State and Maryland in the Final Four with the two No. 1 seeds. That would mean that the Terrapins, who Obama had picked against a few years ago in his bracket when his niece was playing for Princeton and they were tournament opponents, would knock off Dawn Staley’s South Carolina team in the regional final.

Staley had some fun with Obama on Twitter.

“@BarackObama I’m telling @MichelleObama……it’s obviously you did not confer with her. We will forgive not forget. You’re still our guy tho.”

Obama mostly went with the better seeded teams to advance in the first round. He did have No. 6 Oregon being knocked off by 11th-seeded South Dakota.

Draft deadline

The WNBA announced April 15 as its draft date for this season.

Every eligible player who would like to make themselves available for the draft must opt-in by renouncing their remaining intercollegiate eligibility.

A player who wishes to opt-in must email the league no later than April 1. If a player is competing in the Final Four, the player has up to 48 hours after her last game finishes to let the league know if she plans on entering the draft.

In the past, players who have run out of college eligibility are automatically entered into the draft. This became more of an issue this season when all the players were granted an extra year of eligibility by the NCAA because of the coronavirus pandemic.

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Should I be worried about the AstraZeneca-Oxford vaccine? Your COVID-19 questions answered

As Canada announced it is recommending the use of the AstraZeneca-Oxford COVID-19 vaccine for those 65 and older, some countries overseas are suspending its use over safety concerns.

More than a dozen countries in the European Union — including its largest members Germany, France and Italy — have halted AstraZeneca inoculations pending the outcome of an investigation by the European Medicines Agency (EMA) into isolated cases of bleeding, blood clots and low platelet counts.

Non-EU countries, such as Indonesia and Congo, have also suspended use of the vaccine.

With such divergent guidance on the vaccine, many are asking if it’s safe.

Here’s what you need to know.

How many people have been affected?

Out of the approximately five million European residents who have received AstraZeneca’s shot, about 30 have experienced “thromboembolic events” — clots forming in blood vessels — and a very small number of deaths have been reported.

Denmark was the first country to halt its use of the AstraZeneca vaccine last week after reports of blood clots in some people, including one person who developed multiple clots and died 10 days after receiving at least one dose.

Danish health authorities said the suspension would last for at least two weeks while the cases were investigated, even as they noted that “it cannot be concluded whether there is a link between the vaccine and the blood clots.”

A medical worker prepares an AstraZeneca vaccine shot in Copenhagen, Denmark, on Feb. 11. Denmark was the first country to halt its use of the AstraZeneca vaccine last week after reports of blood clots in some people. (Liselotte Sabroe/Ritzau Scanpix/AFP via Getty Images)

Norway soon followed suit after authorities reported that four people under the age of 50 who had gotten the AstraZeneca vaccine had an unusually low number of blood platelets, which could lead to severe bleeding.

In Britain, where 11 million doses of the AstraZeneca vaccine have been administered — more than any other country — there have been reports of about 11 people who developed blood clots after getting a shot.

Is there proof the vaccine is responsible?


The EMA says there is “no indication that vaccination has caused these conditions.”

The EU regulator said its investigation was continuing and was conducting a “rigorous analysis” of all data, adding that while its review was ongoing, the benefits of the AstraZeneca vaccine outweighed the potential side-effects.

WATCH | EMA sees ‘no indication’ COVID-19 vaccine caused blood clots:

The European Medicines Agency is investigating whether there is a causal link between AstraZeneca’s COVID-19 vaccine and a small number of instances of blood clots. But at this point, it believes the vaccine is safe. 1:31

EMA executive director Emer Cooke said it was carrying out a case-by-case evaluation of incidents and was expected to complete a review on Thursday.

AstraZeneca Plc on Sunday said it had conducted a review of people vaccinated with its COVID-19 vaccine, and no evidence has been found of an increased risk of blood clots. The review covered more than 17 million people vaccinated in the European Union and United Kingdom.

The World Health Organization (WHO) and EMA have joined AstraZeneca in saying there is no proven link.

If not the vaccine, what else could be the cause?

Some doctors pointed out that since vaccination campaigns started by giving doses to the most vulnerable people, those now being immunized are more likely to already have health problems.

Others, such as Dr. Lynora Saxinger — an infectious disease expert at the University of Alberta in Edmonton — said cases of adverse effects are increasing because so many people are now getting vaccinated.

Saxinger also noted that blood clots are fairly common, so investigators will look at overall numbers of people who received the AstraZeneca vaccine compared with those who reported the condition.

“There’s so many people receiving vaccines daily that any health event that happens to anyone around the time they get their shot may or may not be related,” Saxinger told The Canadian Press.

Why did countries stop using the vaccine?

Any time vaccines are rolled out widely, scientists expect some serious health issues and deaths to be reported — simply because millions of people are receiving the shots, and problems would be expected to occur randomly in a group so large.

The vast majority of these end up not being connected to the vaccine, but because COVID-19 vaccines are still experimental and there is no long-term data, scientists must investigate every possibility that the shot could have unforeseen side-effects.

WATCH | No evidence AstraZeneca vaccine causes harm, epidemiologist says:

Despite millions of AstraZeneca-Oxford COVID-19 vaccinations in Europe, there is no evidence of harm from the doses there, says Dr. Christopher Labos, a cardiologist with a degree in epidemiology. 6:01

Governments say they acted out of an abundance of caution when suspending the use of the AstraZeneca vaccine, with German Health Minister Jens Spahn stating on Monday that the decision was not political but based on expert advice.

WHO’s chief scientist, Dr. Soumya Swaminathan, said officials at the United Nations health agency “don’t want people to panic” amid the reports. She noted that of the 300 million doses of coronavirus vaccines that have been given to people globally, “there is no documented death that has been linked to a COVID vaccine.”

Should Canadians be worried?

Prime Minister Justin Trudeau said the AstraZeneca-Oxford COVID-19 vaccine is safe, and Canadians should have no concerns about receiving it. Regulators are “following what has been happening with a specific batch used in Europe,” he said.

Some vaccinologists point to a possible contamination of a certain batch of the vaccine as a potential explanation for the blood clots, but Trudeau said that none of the AstraZeneca doses deployed in Canada have come from the batch that’s under scrutiny in Europe.

WATCH | Health Canada is monitoring Europe’s investigation of AstraZeneca vaccine:

Marc Berthiaume, director of the bureau of medical sciences at Health Canada, says the department is monitoring Europe’s investigation into adverse effects experienced by some people after receiving the AstraZeneca vaccine. 1:54

All of Canada’s current supply is manufactured by the Serum Institute of India, which secured separate regulatory approvals from Health Canada.

That version, which is biologically identical to the AstraZeneca shot but is manufactured under different conditions, has been branded “Covishield.”

Health Canada, which approved AstraZeneca for use on Feb. 23, said there is “no indication” the vaccine causes blood clots, and no adverse events from AstraZeneca doses have been reported in Canada so far.

Are there concerns with other vaccines?

The EMA is currently examining whether COVID-19 shots made by Pfizer-BioNTech, Moderna Inc. and AstraZeneca might be causing low levels of blood platelets in some patients, a condition that could lead to bruising and bleeding.

Data from Health Canada shows 0.085 per cent of doses administered in the country from mid-December to March 5 resulted in an adverse reaction, with 0.009 per cent considered serious. Pain, redness and swelling at the vaccination site were the most common effects.

Most of those doses would have been mRNA vaccines (such as Pfizer and Moderna), which are generally eliciting stronger reactions than the viral vector jabs (such as AstraZeneca).

A health worker administers a COVID-19 vaccine in Montreal on Monday. (Andrej Ivanov/Reuters)

Additionally, experts say that side-effects from vaccines may actually be a sign that they’re working.

“If you have a vaccine that doesn’t produce a reaction in people, the resulting immune response is weaker,” Earl Brown, a microbiologist at the University of Ottawa, said in an interview with The Canadian Press.

Brown said vaccines work by stimulating our immune cells to grow and communicate with each other, giving directions on where to set up for an impending attack by the virus. That results in inflammation, with some of those cells travelling to lymph nodes and causing swelling.

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Can vaccinated grandparents finally see their grandkids? Your coronavirus questions answered

We’re answering your questions about the pandemic. Send yours to COVID@cbc.ca, and we’ll answer as many as we can. We publish a selection of answers online and also put some questions to the experts during The National and on CBC News Network. So far, we’ve received more than 69,800 emails from all over the country.

Is it safe for vaccinated grandparents to see their grandkids?

It’s been an incredibly long and difficult year for so many Canadians, especially for the grandparents who’ve written to us to say they’ve gone 12 whole months without hugging, or even seeing, their grandkids over fear of getting sick or worse.

“We have stayed put at home like good little girls and boys for the past year,” wrote grandmother Gaille M. who wanted to know if vaccination might mean the family members can finally get together.

The short answer is, it’s complicated.

Despite mass vaccination campaigns underway across the country, the Public Health Agency of Canada (PHAC) is still recommending that we all “avoid or keep exposure very brief” with people outside of our immediate households. 

“This is a really controversial question,” said Dr. Zain Chagla, an infectious diseases physician and medical director of infection control at St. Joseph’s Healthcare Hamilton, in a recent CBC News Network interview.

“We know the vaccines are going to reduce those grandparents’ risk of death and disability if they do get COVID-19,” said Chagla, and while vaccines “probably” reduce the risk of the grandparents transmitting it to their grandchildren, he warned it’s not entirely risk-free, especially because children cannot yet be immunized.

“When you start mixing crowds with different degrees of vaccination, where those people can go into other settings, it is a whole lot trickier,” Chagla said. That’s because the virus may spread from grandkids to other family members, or vice versa

Even if you have both doses, you may still be at risk of potentially catching the virus, explained Maria Sundaram, an infectious disease epidemiologist who studies vaccines.

“It’s likely that if you were, you might not notice it or you might have a milder illness,” Sundaram said in a recent CBC News Network interview. “So I’d say still try to take some precautions … that you’ve been taking.”

Health Canada’s Chief Medical Advisor Dr. Supriya Sharma said waiting until both parties are vaccinated offers the best level of protection.

“We don’t want to give people the sense that as soon as you’ve got your vaccine, you’ve got this cloak of invincibility and you can never get [COVID-19],” said Sharma. “They’re excellent, but there still is a potential risk.”

People should assess their individual risk tolerance, she said.

“Each situation is a little bit different, but we’re not at a place, unfortunately, yet that we can say as soon as somebody has got a vaccine, that they can go back … and do all of those things that they were doing before,” she said.

But as we learn more about the vaccines in a real-world setting, the public health guidance could soon change.

Can fully-vaccinated seniors safely get together?

A senior receives the Pfizer-BioNTech COVID-19 mRNA vaccine from at a pharmacy prototype clinic in Halifax on Tuesday, March 9, 2021. Health Canada’s Chief Medical Advisor Dr. Supriya Sharma says holding off on visits until both parties are vaccinated offers the best level of protection. (Andrew Vaughan/The Canadian Press)

Yes. People who are fully vaccinated interacting with other fully vaccinated people is “pretty low-risk” said Sundaram.

Chagla agreed, and pointed out that there are long-term care facilities that have allowed their vaccinated seniors to have controlled group activities.

“If you have two people that are vaccinated together in a single room, they’re the lowest risk people in that sense,” he said.

Though all of the approved vaccines offer a high level of protection, they don’t offer 100 per cent protection, said Sharma. 

“It’s possible someone who is vaccinated could still get and transmit COVID-19,” she said.

Public Health guidelines same for everyone in Canada

A spokesperson for Health Canada confirmed on Monday that PHAC has not updated its guidelines and for the time being and remain the same for everyone, whether vaccinated or not.

Meanwhile in the U.S., the Centers for Disease Control and Prevention (CDC) recently updated guidelines to say it’s OK for fully vaccinated people to visit with other fully vaccinated people indoors, without wearing masks or physical distancing.

The CDC also says fully vaccinated people in the U.S. can “visit with unvaccinated people from a single household” without masks or physical distancing if they are “at low risk for severe COVID-19.” 

It is important to note the number of fully vaccinated people in Canada remains low. As of Tuesday, only 1.5 per cent of the population has received two doses. 

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AstraZeneca doses set to arrive tomorrow — but questions remain about who gets them first

The first batch of Canada’s supply of the AstraZeneca-Oxford vaccine is set to arrive tomorrow — but public health officials still have some distribution issues to sort out before they can deliver those shots.

Health Canada approved the AstraZeneca product last Friday. The National Advisory Committee on Immunization (NACI), the independent panel that sets the guidelines for vaccine deployment, is not recommending that these shots be used in people aged 65 and over.

While Health Canada has determined the product is safe to use on all adults, NACI said there isn’t enough clinical trial data available to determine how effective this product is in preventing COVID-19 infection among people in this older cohort.

Health officials will be under pressure to quickly establish priorities for distribution of the AstraZeneca shots because 300,000 of the 500,000 doses set to arrive this week from the Serum Institute of India will expire in just a month’s time.

Dr. Theresa Tam, Canada’s chief public health officer, said NACI is prepared to update its guidance “as they see more and more real world data accumulating,” but for now the AstraZeneca product should be directed at younger Canadians.

“Don’t read their recommendations as sort of static. But this is what they’ve recommended at this point,” Tam said. “Just watch this space.”

It’s up to the provinces and territories to decide how to put these AstraZeneca shots to use. Some scheduling adjustments will be required because most jurisdictions are focused on vaccinating the elderly at this early stage of the immunization campaign.

Tam said some of the groups that were “potentially prioritized a little bit later on” will have a chance to get their shots earlier than planned because of the NACI guidance.

Most provinces have said that — after the elderly, front line health care workers and Indigenous adults are vaccinated — essential workers and people who face a greater risk of illness should be next in line for the second phase of shots.

Maj.-Gen. Dany Fortin, the military commander leading the federal government’s vaccine logistics, said the shots will be “expedited as quickly as possible” to prevent wastage.

WATCH: Procurement Minister Anita Anand says AstraZeneca shots will arrive Wednesday

Procurement Minister Anita Anand says the first shipment of AstraZeneca’s COVID-19 vaccine is scheduled to arrive in Canada on March 3. 1:06

Asked why Canada purchased vaccines that are set to expire during the first week of April, Procurement Minister Anita Anand said the federal government was responding to demands from the provinces to acquire more shots.

“They have repeatedly told the federal government that they want vaccines as soon as possible and that they’re ready to administer vaccines,” she said.

Beyond the question of who will get these shots, there’s a debate over just how long people should wait between the first and second doses.

NACI has recommended that provinces and territories follow the guidelines set by the manufacturers and approved by Health Canada regulators: 21 days between shots for the Pfizer product, 28 days for Moderna and between four and 12 weeks for the AstraZeneca doses.

Some provinces, notably Quebec, have ignored these guidelines from the beginning, preferring instead to administer as many first doses as possible to tamp down infection risk.

NACI ‘considering evidence’ on dosing intervals

Dr. Bonnie Henry, B.C.’s provincial health officer, announced Monday that the province would be extending the interval between doses for all three products to 16 weeks.

Tam said NACI is now “considering evidence” from the latest scientific studies about the intervals between shots and will provide an updated recommendation sometime this week.

Christine Elliott, Ontario’s health minister, said that while public health officials in her province have complied with NACI guidelines, they would shift gears to deploy first doses to more people if vaccine experts give them the green light to delay those second doses.

“We are anxiously awaiting NACI’s review of this to determine what they have to say and their recommendations,” Elliott said. “We want to make sure that the decisions that Ontario makes are based on science.”

Tam said data from B.C. and Quebec suggest there may be good reasons to wait longer.

“They’re vaccinating seniors in long-term care facilities and so on and we’re seeing quite a high level of protection. It also seems that the protection is obviously lasting even after the first dose,” she said.

In a recent analysis paper published in the New England Journal of Medicine, Dr. Danuta Skowronski of the British Columbia Centre for Disease Control and Dr. Gaston De Serres from the Institut national de sante publique du Quebec suggested that a single shot of the Pfizer vaccine might be almost as good as two.

The doctors found that, by waiting two weeks after vaccination to start measuring the rate of new infections, researchers recorded 92 per cent fewer COVID-19 cases among those who had received a single dose of the vaccine compared to those who got a placebo.

“With such a highly protective first dose, the benefits derived from a scarce supply of vaccine could be maximized by deferring second doses until all priority group members are offered at least one dose,” the doctors wrote in their paper.

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Do we know how effective vaccines are against the variants? Your COVID-19 questions answered

We’re answering your questions about the pandemic. Send yours to COVID@cbc.ca, and we’ll answer as many as we can. We publish a selection of answers online and also put some questions to the experts during The National and on CBC News Network. So far, we’ve received more than 67,000 emails from all corners of the country.

Are the vaccines effective against all the variants of concern?

Both Pfizer-BioNTech and Moderna say their COVID-19 vaccines appear to be effective against two variants of concern first identified in the U.K. and South Africa, based on blood samples from people who have been vaccinated. But more research is needed on the pair of vaccines, while other vaccine candidates already have some real-world data on their effectiveness against the variants. 

The good news is the coronavirus that causes COVID-19 doesn’t seem to mutate as much or as quickly as the influenza virus that causes the flu. Even with the current, more transmissible variants of concern, people who’ve been vaccinated are not falling severely ill or dying from COVID-19 in large numbers.

But to prepare in case that starts to happen, drugmakers are already re-working their vaccines.

Phil Dormitzer, one of Pfizer’s top viral vaccine scientists, said last week that his company has already made a template for a prototype vaccine targeting the variant first identified in South Africa.

The re-tooling work took on new urgency after South Africa paused its rollout of the AstraZeneca vaccine after data from a small trial suggested the vaccine did not protect against mild to moderate illness from the B1351 variant now dominant in the country.

Despite that, Dr. Zain Chagla, an infectious disease physician at St. Joseph’s Healthcare in Hamilton, Ont., told Dr. Brian Goldman of CBC’s The Dose that he remains optimistic the existing vaccines can fight the coronavirus variants. That’s because five different vaccines have been submitted to Health Canada for approval, Chagla said, and each may play a role in controlling the variants.

“The best vaccine is the one that’s administered,” Chagla said. “Every Canadian should be hopeful that they can get one of these vaccines, period.”

The clinical trials of both Moderna and Pfizer-BioNTech were completed before the variants of concern took off worldwide.

Dr. Noni MacDonald, a pediatrics professor at Dalhousie University in Halfax and a vaccine safety researcher, said as experts gain a more detailed and sophisticated perspective on how the COVID-19 vaccines work, they’ll also gain a better understanding of what types of protection they offer.

Studies suggest the AstraZeneca vaccine isn’t highly effective against the variant first identified in South Africa. Do we know how effective other vaccines are against it?

Yes, we do have some information about the other vaccines.

So far, three drugmakers — Johnson & Johnson, Oxford-AstraZeneca and Novavax — have data comparing how well their vaccines work against the B1351 variant first identified in South Africa.

The variant has a mutation that changes the shape of the viral spike protein.

As a result, lab experiments suggest the antibodies that our body produces have a harder time attaching to the spike protein, reducing the effectiveness of the vaccines, virologists say.

But infectious disease experts say the vaccines could still save lives amid B1351 cases by preventing admissions to intensive care from serious COVID-19, which reduces strain on our health-care systems — the goal of flattening the curve.

WATCH | Re-tooling vaccines to keep up with coronavirus variants:

New coronavirus variants won’t necessarily mean new vaccines or vaccine boosters are needed. And if adjustments are needed, they would take less time to develop than the original vaccines. 2:01

Preliminary data from Johnson & Johnson’s single-dose vaccine suggested it was 72 per cent effective against moderate to severe COVID-19 in the U.S. compared with 57 per cent effective in South Africa, where a more contagious variant was circulating at the time of the research.

The Novavax vaccine also showed some protection against the B1351 variant, said Dr. Isaac Bogoch, an infectious diseases physician with Toronto’s University Health Network. 

In a news release, Novavax said the efficacy of its vaccine in studies from the U.K. was 89 per cent compared to 60 per cent in South Africa. 

Protection can refer to not getting the infection as well as protection against severe infection, hospitalization and death.

“So, while it isn’t perfect, while it isn’t the same, Johnson & Johnson, Novavax and very likely Pfizer and Moderna still provide some element of protection against that variant of concern,” said Bogoch, who is also a member of Ontario’s COVID-19 vaccine distribution task force.

We’re hearing the variant first identified in the U.K. can be more deadly. Is this across all age groups?

“Based on the limited evidence we have, it does seem to be across all age groups,” Maria Sundaram, an infectious diseases epidemiologist based in Toronto, told CBC News Network.

In January, British Prime Minister Boris Johnson said two studies presented to his government suggested the B117 variant “may be associated with a higher degree of mortality.”

Patrick Vallance, Johnson’s chief scientific adviser, said the previous average death rate of 60-year-olds in the U.K. from COVID-19 was about 10 per 1,000. With the new variant, roughly 13 or 14 per 1,000 infected people might be expected to die.

The relative increase in the case fatality rate “appears to be apparent across age groups,” the researchers wrote. “The absolute risk of death per infection remains low.”

Do you anticipate we’ll need booster shots to protect against variants even after we’ve received both doses of a vaccine?

The answer is yes, said Bogoch.

For the first-generation of COVID-19 vaccines, Bogoch said he expects people will eventually need a booster dose.

“Down the line, and I am not sure how much farther down the line, we’d likely need a booster dose with a vaccine or an updated vaccine that accounts for the new variants of concern that are emerging,” he said.

A health-care worker is seen at a COVID-19 testing centre at Ridge Meadows Hospital in Maple Ridge, B.C., earlier this month after a case of a coronavirus variant was detected at a nearby secondary school. (Ben Nelms/CBC)

MacDonald said major regulators such as Health Canada, the U.S. Food and Drug Administration and their counterparts in the U.K. and Europe are meeting virtually to discuss how to evaluate the effectiveness of vaccines against variants.

She said the regulators may ask drugmakers for what are called non-inferiority studies.

Unlike clinical trials to evaluate the efficacy of a vaccine that involve 40,000 to 50,000 people, MacDonald said non-inferiority trials need 400 to 500 people and can be done relatively quickly.

“We’ll do non-inferiority,” MacDonald said. “That is a simpler, easier process and it’s just saying, ‘Are you good if not better than what you had before?'”

Alyson Kelvin, a virologist working on COVID-19 vaccine candidates at VIDO-InterVac in Saskatoon, said surveillance in Canada and around the world will be important to see what variants people are commonly being infected with, both in vaccinated and unvaccinated populations.

“I am optimistic that we’ll still have effective vaccines and we won’t get into as frequently a cycle of vaccination and changing the vaccine formulations as we do with influenza,” Kelvin said.

A lab technician works on blood samples taken from people taking part in a Johnson & Johnson COVID-19 vaccine study in Groblersdal, South Africa, northeast of Johannesburg, on Feb. 11. The five different vaccines submitted to Health Canada for approval may each play a role in controlling the variants. (Jerome Delay/Associated Press)

When someone is infected with the original version of the virus and they develop antibodies, those antibodies have been shown to be less effective against some new variants of concern with altered spike proteins.

Researchers have documented cases of reinfection with the variant first identified in Manaus, Brazil. But reinfections are difficult to prove since doctors need genetic proof showing a distinct coronavirus strain caused each instance of infection. 

Our bodies generate antibodies to fight off a natural infection. Besides antibody-based immunity, our immune system also has T-cell immunity, or cell-based immunity. T cells are a type of white blood cell. 

Kelvin said cell-based immunity is often broader than what we get from just antibodies.

Immunologists say antibodies are also relatively short-lived compared with some T cells

Kelvin said it will be important for researchers to watch for any breakthrough infections from a variant that suggest both arms of immunity are no longer effective.

Alyson Kelvin, who is working on different coronavirus vaccine candidates, is seen in her lab at VIDO-InterVac in Saskatoon, last March. She says she’s optimistic we will still have effective vaccines against the variants. (Liam Richards/The Canadian Press)

Brian Lichty of the McMaster Immunology Research Centre in Hamilton, who is also working on COVID-19 vaccine candidates, said genes for the variants can be swapped into an existing mRNA vaccine, such as those made by Pfizer-BioNTech and Moderna.

“Technically, it’s really simple,” Lichty said. “I can, with my laptop, design a new vaccine in 20 minutes sitting on my couch.”

Then, in the lab, the new gene is synthesized. Finally, the new vaccine is mass manufactured — the step that takes the most time, he said.

Looking ahead, drugmaker GlaxoSmithKline (GSK) said it will work with the German pharmaceutical company Curevac to develop an mRNA vaccine against the variants.

The advantage of existing mRNA vaccines from Pfizer-BioNtech and Moderna compared with vaccines based on older technologies is they don’t need cells or tissue culture to grow. That’s one reason why it is easier to change recipes in their manufacturing lines to address the variants, MacDonald said.

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Why are the variants more transmissible? Your COVID-19 questions answered

We’re answering your questions about the pandemic. Send yours to COVID@cbc.ca, and we’ll answer as many as we can. We publish a selection of answers online and also put some questions to the experts during The National and on CBC News Network. So far, we’ve received more than 67,000 emails from all corners of the country.

With the COVID virus mutating all the time, why do we only hear of three variants? 

Viruses mutate all the time. Many of the mutations are inconsequential, virologists say.

What sets the coronavirus “variants of concern” such as those first identified in the U.K., South Africa and Brazil apart is they spread more easily, may cause more severe illness, or current vaccines may be less effective against them, according to the Public Health Agency of Canada. 

Fiona Brinkman co-leads data analytics for the Canadian COVID-19 Genomics Network (CanCOGeN) that’s tracking the coronavirus. The experts use genome sequences of the virus to detect new variants and improve public health responses to the ones that pose a risk to public health.

“We start to identify certain mutations that are clearly conferring a significant benefit,” said Brinkman, a professor of molecular biology and biochemistry at Simon Fraser University.

A common feature of the variants of concern is they have an unusually high number of mutations than what scientists expect, Brinkman said.

More mutations are a sign to check more closely if the virus now has new, unusual properties through computational analysis, laboratory experiments and particularly epidemiological studies of patients, she said. 

Why and how are variants more transmissible?

Che Colpitts, a molecular virologist at Queen’s University in Kingston, Ont., said the three variants of concern all have mutations in their spike protein on the surface of the virus, which it uses to grab onto our cells.

“They stick better to the cell more easily,” she said.

The variants of concern seem to spread more easily and quickly than the versions of the coronavirus that circulated earlier in the pandemic.

Specifically, Brinkman said the three variants share one mutation in the spike protein that’s like a flap that’s normally in the closed position. Consequently, it can’t easily bind to our receptors.

Pedestrians wearing masks against coronavirus walk past an advertisement from the British government about COVID-19 in London on Feb. 2. One of the variants of concern is associated with reinfections. (Alastair Grant/The Associated Press)

“This mutation allows it to keep this open conformation,” Brinkman said, adding it “spread like wildfire” because it allowed the virus to infect humans more easily.

The B117 variant first flagged in Britain seems to infect better than previous versions of the virus, and that’s why it’s able to spread faster. There’s also evidence now that it causes more severe disease, Brinkman said.

Colpitts said some variants have a mutation in the spike protein to interact or grip more strongly with a key receptor on our cells called ACE2.

Brinkman said the B1351 variant first identified in South Africa also has “notable immune escape mutations” that potentially could allow it to evade the human immune system more effectively.

Charu Kaushic, a professor of pathology and molecular medicine at McMaster University in Hamilton, Ont., said when the virus starts to replicate or copy itself in the presence of immune responses, the immune responses want to eliminate the virus. But the virus plays a part, too.

“There is this push and pull between the immune response and the virus where the virus is trying to change so that the immune responses are not able to eliminate it and the immune responses are changing to make sure that the virus can be eliminated,” Kauchic said.

In an immune escape, the virus changes itself enough that the immune response can’t completely eliminate it or significantly disarm it.

The P1 variant first traced to travellers from Brazil has another feature.

WATCH | Scientists keep watch for a variant ‘first identified in Canada’:

A group of scientists are on the hunt for coronavirus variants in Canada. They tell Adrienne Arsenault about what they’ve found and why a Canadian variant of concern isn’t out of the question. 5:04

“What ends up happening is it’s easier for somebody potentially previously infected to actually get infected again,” Brinkman said.

Would it be possible for the virus to mutate such that the same variant develops separately in two different countries?

Colpitts said to some extent that’s what we’ve seen already.

“It seems like viruses are independently coming up with the same strategy in different parts of the world, just to be able to grab on to the cell surface better and infect cells more easily,” she said.

Considering the variants and how quickly they transmit, should we change the way we interact with other people apart from what we’re already doing for the “regular” coronavirus?

Dr. Isaac Bogoch, an infectious diseases physician with Toronto’s University Health Network, said the same rules apply for the variants.

“We should still be practising physical distancing, we should still be wearing masks, we should still be avoiding closed, crowded, confined settings,” Bogoch said on CBC News Network. He is also a member of Ontario’s COVID-19 vaccine distribution task force.

A laboratory technician wearing protective equipment works on the genome sequencing of the virus that causes COVID-19 and its variants at the Pasteur Institute in Paris in January. Canadian researchers also use genome sequences of the virus to detect new variants and improve public health responses to them. (Christophe Archambault/AFP/Getty)

“It’s pretty clear that with a more contagious variant, you could pick this up with a shorter exposure,” he said. “But still, physical distancing, masking, safer indoor environments that include better ventilation is all protective, so at an individual level, I don’t think there’s much that we would change. It’s more what do we do from a policy standpoint.”

Colpitts echoed that sentiment, saying the same public health measures should be effective against the variants.

“They haven’t found new ways to go through your masks or anything, so the same measures will stop the variants just as well as the original strain.”

Brinkman suggested paying particular attention when you’re in close quarters with other people.

“Some people have suggested that we want to be a little extra vigilant, more careful with keeping those interactions very short.”

WATCH | How to up your mask game:

Canadian respirologist Dr. Samir Gupta explains the latest COVID-19 mask recommendations and demonstrates simple hacks to make yours more effective. 2:38

What about taking the elevator?

Health officials in Peel Region west of Toronto have identified 200 variant cases so far. This week, hundreds of condo residents in Mississauga, Ont., were tested after five cases of B1351 were found.

Dr. Lawrence Loh, Peel’s medical officer of health, said B1351 shows signs of spreading easily in common areas of the condo building.

“Transmission may have been driven not by traditional close contact interactions, rather, proximity in common elements such a corridors and elevators driven over mere minutes.”

People enter an elevator that uses foot pedals for floor selection as a hands-free preventive measure against the spread of coronavirus at a shopping mall in Bangkok last May. Variants are a new reason to take precautions against riding crowded elevators. (Lillian Suwanrumpha/AFP/Getty Images)

Colpitts said the variants offer another reason to try to steer clear of the close confines of a crowded elevator.

“These days I avoid taking the elevator with any other people,” Colpitts said. “I would just take the elevator either alone or take the stairs.”

A study of an outbreak in an office building in South Korea last March suggested people were exposed to coronavirus in the lobby and elevators — before the variants of concern started to take hold.

But tips to ride the elevator safely from the early days of the pandemic still hold, such as stand away from others, wear masks, face away from others, touch as little as possible and wash your hands frequently.

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What are the coronavirus variants and how should we respond to them? Your COVID-19 questions answered

We’re answering your questions about the pandemic. Send yours to COVID@cbc.ca, and we’ll answer as many as we can. We publish a selection of answers online and also put some questions to the experts during The National and on CBC News Network. So far, we’ve received almost 67,000 emails from all corners of the country.

Canada’s chief public health officer, Dr. Theresa Tam, warned Wednesday that variant strains of the coronavirus had been found in eight provinces, and that they could quickly reverse the gains the country has made in recent weeks in the battle against COVID-19.

At least two of three variants of concern are spreading in Canada, in some cases with no known link to travel, and have already led to devastating outbreaks in long-term care homes.

Here’s a look at some of the most common questions Canadians have about the variants.

Have a question or something to say? CBC News is live in the comments now.

What is it about the new coronavirus variants that makes them more transmissible?

As a virus infects people, it can mutate as it makes copies of itself. Some mutations can be harmful to a virus, causing it to die out. Others can offer an advantage and help it spread.

“Not every mutation is created equal,” Mary Petrone, who studies infectious diseases at Yale University, told The Associated Press. “The virus is going to get lucky now and again.”

There are many variants circulating around the world, but health experts are primarily concerned with the emergence of three

  • B117, first discovered in the U.K., which has “a large number” of mutations, according to the U.S. Centers for Disease Control and Prevention (CDC).
  • B1351, first discovered in South Africa, which shares some of the same mutations as B117.
  • P1, which was first discovered in Japan, in four travellers who had been in Brazil. 

Dr. Eric Topol, a U.S. physician, scientist and clinical trials expert who heads the Scripps Research Translational Institute in California, told CBC News in January that the variant first found in the U.K. exhibits changes in the spike protein — a key component of how the coronavirus binds to human cells.

He said those changes are likely behind its higher transmission, with the altered spike protein potentially allowing the coronavirus to infect cells more easily. The other two variants of concern also have changes to the spike protein.

WATCH | Dr. Bonnie Henry ‘confident’ variant transmission isn’t widespread:

B.C.’s provincial health officer says the province is aiming to control the spread of more infectious coronavirus variants over the next few weeks as it ramps up vaccinations. 1:14

If the variants are more contagious, do we need to distance more?

Ashleigh Tuite, an infectious diseases epidemiologist and assistant professor at the University of Toronto’s Dalla Lana School of Public Health, noted to CBC’s Adam Miller earlier this month that the 15-minute exposure time and two-metre distance guidelines from the federal government are “arbitrary.” 

“The new variants, I think, provide us with a reason to re-evaluate those rules and I think that’s something that hasn’t necessarily been well-communicated to the public,” she said. “There’s nothing magical about that distance that was based on science, that’s based on sort of what we know about how airborne pathogens are spread. But I think the science has evolved, or at least our thinking has evolved.” 

Erring on the side of caution makes sense, she said.

Dr. Lucas Castellani, an infectious diseases specialist at Sault Area Hospital, told CBC News Network on Feb. 2 that there’s no set distance the virus can travel, regardless of variants.

“We know it potentially can go farther and there are a lot of factors involved,” he said in regards to a question about smoking or vaping during the pandemic. “How heavy the person has been breathing, how good the ventilation is in the room or the space you’re in.”

At the same time, Castellani said he suspected based on the mutations that it’s not a case of the virus hanging in the air longer or travelling farther.

“Based on the type of mutations they have, it is unlikely that those are the types of characteristics that are leading to the change that we’re seeing,” he said.

WATCH | With COVID-19 variants, questions of whether guidelines go far enough:

The spread of the highly transmissible COVID-19 variant first found in the U.K. has some Canadian doctors wondering if our current distancing recommendations are enough. 2:02

Should we be wearing better masks?

Yes. Experts say we should consider finding better quality masks, wearing two at a time and/or wearing them more often.

In fact, the CDC released new guidance on Wednesday that said a lab experiment had found two masks meant double the protection.

The CDC said a cloth mask worn over a surgical mask can tighten the gaps around the mask’s edges that can let virus particles in.

The researchers found that wearing one mask — surgical or cloth — blocked around 40 per cent of the particles coming in during an experiment. When a cloth mask was worn on top of a surgical mask, about 80 per cent were blocked.

WATCH | COVID variants can cause cases to increase exponentially, Ontario health official says:

There is obvious community transmission of COVID-19 variants, according to York Region Medical Officer of Health Dr. Karim Kurji, who says the virus needs to be contained as it has the capacity to increase case numbers exponentially. 7:51

Canada recommends the use of three-layer non-medical masks with a filter layer to prevent the spread of the virus, but has not updated its recommendations since November, before the emergence of the new variants. 

Dr. Zain Chagla, an infectious diseases physician at St. Joseph’s Healthcare Hamilton, told CBC News that while three-layer non-medical masks are a good “minimum standard,” Canadians should opt for masks that offer better protection whenever possible.

Those include surgical masks, which are a step below N95s and KN95s and come in three different filtration levels determined by the American Society for Testing and Materials (ASTM).

“When I go to the grocery store now, I wear my very best mask,” said Linsey Marr, one of the top aerosol scientists in the world and an expert on the airborne transmission of viruses at Virginia Tech. “Before I was wearing an OK mask that was comfortable and easy.”

She said a cloth mask can “easily filter out half of particles, maybe more, but we’re at the point where we need better performance.” 

WATCH | Must detect variant COVID-19 cases quickly to stop spread, immunologist says:

In order to limit the spread of COVID-19 variants, cases must be detected quickly to ensure isolation occurs, says microbiologist and immunologist Craig Jenne. 3:21

Erin Bromage, a biology professor and immunologist at the University of Massachusetts, Dartmouth, who studies infectious diseases, said a tight-fitting mask is more important than ever due to the emergence of variants.

“It’s not that double-masking provides extra protection if the mask was fitting well,” he said. “Double-masking helps the mask that is closest to your skin fit more snugly, meaning more air goes through that mask.”

If you’re already wearing a high-quality mask that fits well, with air going through the material rather than out the sides, Bromage said there’s no extra benefit in throwing an extra mask on top.  

He recommends looking at yourself in the mirror before you go out to make sure your mask isn’t too loose fitting.

“I really want people to look at them and think, is all the air going through the material? And if it’s not, work out a way to do that,” he said. “And that may be putting a second mask on or finding a different mask that fits their face.” 

WATCH | Simple hacks to make your face mask more effective:

Canadian respirologist Dr. Samir Gupta explains the latest COVID-19 mask recommendations and demonstrates simple hacks to make yours more effective. 2:38

Are the variants more deadly?

It’s possible. There is some evidence the variant first found in the U.K. carries a higher risk of death than the original strain, the British government’s chief scientific adviser said in January.

“The verdict is still slightly out but theoretically, yes, it’s possible,” Castellani, the infectious diseases specialist at Sault Area Hospital, told CBC News. “And unfortunately that’s the way viruses work and the way mutations potentially catch up with us.”

WATCH | The race between COVID-19 vaccines and variants continues despite concern about efficacy:

South Africa has halted its rollout of the AstraZeneca COVID-19 vaccine after a study showed it offered minimal protection against mild infection from a variant spreading there. While experts say it’s cause for concern, they say vaccines can be reconfigured to protect against mutations. 2:01

Is it possible to be re-infected from any of the variants?

“Yes, it is possible to be re-infected,” Castellani said on Tuesday. “We’re seeing that in some parts of the world, in particular South Africa, that some individuals are in fact being re-infected with the virus. It’s felt that once you get the immunity from the virus it may last for some time, but not everyone’s will last the same as the next person.”

Dr. James Hamblin, a Yale University public health policy lecturer and a writer with the Atlantic, told CBC’s Front  Burner that a raging outbreak in the Brazilian city of Manaus also pointed toward re-infection.

“It’s been very tragic there: places running out of oxygen, people being buried in mass graves,” he said. 

The city was hit so hard by the coronavirus in the spring that researchers estimated that 76 per cent of the population had been infected, which makes the severity of this recent outbreak unexpected and concerning.

Hamblin said the leading theory is that it’s a combination of fading immunity given that the first surge in Manaus was about nine months ago, along with the dangers of the P1 variant. 

The variant “shares a mutation that the South Africa variant also has, which gives it a propensity to evade immune responses.”

Front Burner21:02A mutating virus and the need for global herd immunity

Does giving one dose of the vaccine and waiting beyond recommended days for the second dose help the virus adapt?

“It can,” said Dr. Isaac Bogoch, a Toronto-based infectious diseases specialist and member of Ontario’s vaccine task force, in an interview with CBC News Network on Monday. 

He said the concern is if you only give one dose of a two-dose vaccine regimen you can create an environment that allows the virus to “selectively evade that protection, and that’s certainly a theoretical concern.”

However, he said, in Canada most people will get the second dose on the optimum day (21 or 28, depending on the vaccine), and if not, within the recommended 42 days. 

Is there concern that 14 days is not long enough to quarantine and protect others from virus variants?

Bogoch said that while the variants of concern may have greater transmissibility or the ability to evade vaccination more readily, the incubation time or duration of the illness hasn’t changed.  

“Obviously we have to be open-minded, we have to be humble, there might be new data that results in a change in policy, but I think the 14-day [quarantine] should be fine for now.”

However, Alberta did strengthen its quarantine rules, because the variants are more easily spread through households.

“If cases choose to stay home during their isolation periods [rather than other isolation options], their household contacts will need to stay at home as well in quarantine, until 14 days have passed from the end of the case’s isolation period, for a total of 24 days,” said Dr. Deena Hinshaw, Alberta’s chief medical officer of health, during a news conference last week.

“Given how easily this variant is spreading in homes, this enhancement is necessary to prevent spread in the community.”

WATCH | AstraZeneca vaccine can be used against coronavirus variant first found in South Africa, says WHO:

WHO’s expert advisory group says there is a ‘plausible expectation’ that the AstraZeneca vaccine will be effective against severe disease from the coronavirus variant found in South Africa, despite a small study that prompted concerns. 2:09

We’re answering your questions every night on The National. Last night, we asked our experts about the impact of stress — nearly one year into the pandemic.

A physician and psychiatrist talk about the impact that stress is having on mental and physical health a year into the COVID-19 pandemic and what the longer-term effects might be. 6:10

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Oxford-AstraZeneca’s COVID-19 shot OK to use despite variant questions, WHO panel says

The Oxford-AstraZeneca’s COVID-19 vaccine is safe and effective and should be deployed widely, including in countries where the variant of the coronavirus first identified in South Africa may reduce its efficacy, a World Health Organization panel said on Wednesday.

In interim recommendations on the shot, the Strategic Advisory Group of Experts on Immunization (SAGE) panel said the vaccine should be given in two doses with an interval of eight to 12 weeks, and should also be used in people aged 65 and older.

Even in countries such as South Africa, where questions have been raised about the AstraZeneca vaccine’s efficacy against a newly emerged variant of the SARS-CoV-2 coronavirus, “there is no reason not to recommend its use,” SAGE’s chair, Alejandro Cravioto, told a briefing.

“We have made a recommendation that even if there is a reduction in the possibility of this vaccine having a full impact in its protection capacity, especially against severe disease, there is no reason not to recommend its use even in countries that have circulation of the variant,” he said.

Health Canada is considering authorization of the AstraZeneca vaccine, which is cheaper and easier to store than the two mRNA vaccines already approved for use in this country.

AstraZeneca‘s product was also less efficacious (70 per cent) in clinical trials than the Pfizer-BioNTech (95 per cent) and Moderna vaccines (92 per cent) rolling out to Canadians. 

Health Canada “is currently completing its review of the submitted data and expects to make a decision on the authorization of the AstraZeneca vaccine in the coming days,” a spokesperson said in an email on Tuesday. “While the Department collaborates with other regulators, it remains committed to conducting an independent and thorough scientific review of all COVID-19 vaccines.”

South Africa this week paused part of its rollout of the AstraZeneca vaccine after data from a small trial showed it did not protect against mild to moderate illness from the variant of the coronavirus now dominant in the country.

Option for Canada?

Dr. Caroline Quach, chair of Canada’s National Advisory Committee on Immunization (NACI) that makes recommendations to governments on the use of newly approved vaccines for humans, said AstraZeneca’s vaccine is better than nothing. 

“Let’s say it becomes available in the next two or three weeks when there is no Pfizer or Moderna,” Quach said. “I think people who are healthy and not at risk could benefit entirely.”

The WHO said the preliminary findings from South Africa “highlight the urgent need for a co-ordinated approach for surveillance and evaluation of variants” and their impact on vaccine efficacy.

“The important thing to remember is the AstraZeneca vaccine is an efficacious vaccine,” said Dr. Katherine O’Brien, head of WHO’s immunization department. “It is an important vaccine for the world given the short supply that we have.”

WHO’s expert panel recommendations about the AstraZeneca vaccine, which was developed at Oxford University in Britain, largely mirror those issued earlier by the European Medicines Agency and Britain’s drug regulator.

The AstraZeneca vaccine forms the bulk of the stockpile acquired so far by the UN-backed effort known as COVAX, which aims to deploy coronavirus vaccines to people globally.

COVAX plans to start shipping hundreds of millions of doses of the vaccine worldwide later this month, pending WHO approval for the shot, vaccine stocks and countries’ readiness to receive it.

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