Covid-19 Update - February 2021

​Hello everyone,

We’d like to update you all once more regarding Covid-19, and have some important information to
share regarding the state of the pandemic here in BC, vaccines, and perhaps most importantly, variants
of Covid-19 that have started to appear not just in other parts of the world, but here too. This will be a
mixed picture of some good news (regarding the vaccines), but some serious concerns regarding the
Covid-19 variants as well.

As before, we will begin with a summary of the key points that everyone should read, and more detailed
information below for those who are interested.

Key Points

1. The pandemic in BC is essentially in a state where it is ‘simmering’. The levels are not huge. Hospitals are not overwhelmed. But it is there. People are sick. Too many are still dying. And this could get worse quite fast. We could have dramatically larger numbers within as little as a few weeks. It’s critical to remember that if we wait until the numbers go up, it is too late. The only way to keep this virus at bay, is to stay ahead of it, and take action before there is a problem.
2. There are now a few variants of Covid-19. This occurs when portions of the virus mutate enough to change their function. At least one of the variants is *much* more contagious than the original Covid-19, and somewhat more dangerous.
3. There are now highly effective vaccines available, and virtually all adults should get it (like around 99.999% of you reading this). We will review the exceptionally rare cases where people shouldn’t get it below.
4. The vaccine rollout in Canada has been very slow so far, but thankfully that is about to change. The remainder of February will still be slow. It will however pick up in March. We are anticipating a massive roll-out beginning in April. This will initially be through mass immunization clinics (not family doctor offices). Additional information from the BC CDC available here: http://covid-19.bccdc.ca
5. Please avoid calling the office about this as our phone lines are already overwhelmed a lot of the time. We WILL update you. Probably monthly.
6. The timing of eligibility for vaccine will be based almost exclusively on age. That is, over 80 year olds in March. Over 70 year olds starting some time in April. Over 60 year olds likely in May. And so on. We (your doctors) have either already been vaccinated, or will be in March.
7. Health conditions such as diabetes, heart disease, hypertension, immunosuppressed state, history of cancer, active cancer etc will *not* affect the date you are offered the vaccine. These conditions do increase ones’ risk, but not as much as age does.

The Details

So what is happening with the pandemic?
It has unfortunately been rough in some parts of the world, while others have frankly tamed it very
effectively using straightforward (which does not mean ‘easy’) measures. Much of the USA, Europe, and
numerous other countries have experienced second waves (and even third ones) that were at least as
large as the first. Canada was no exception. BC had an obvious second wave, but with increased control
measures this has settled down *somewhat*. Many of these locations had relaxed various control
measures, and had to re-instate them in varying degrees. Some places went back into extreme
measures, with closing of all non-essential businesses, and schools. These measures are costly, but it is
100% crystal clear that they work. New Zealand, Australia, Hong Kong, Taiwan, and Vietnam are notable
for their highly aggressive measures. In some of these locations, just a few cases lead to a widespread
lockdown there. They have had incredibly good control with this, and while it is very hard initially on
their economies, they are able to relax their restrictions far beyond what we have done. In recent
months, Australia has had theaters open, they have had concerts and sporting events with audiences.
This has *nothing* to do with the fact that they are an island, and everything to do with the safety
measures, and the unity of action by their societies. Places like Vietnam have enjoyed excellent control
as well.

How do the new variants affect this?
In short, badly. Ireland went from having 500 cases per day, to *8000* cases per day in 2 weeks. That
is quite astonishing. They entered a hard ‘lockdown’ and brought it under control. The UK, where that
variant was first identified fared similarly. All schools in both those locations have been closed since
around January 1 st . That variant does not generally stay under control unless increased measures are
taken, *beyond* what was done for the original strain we were dealing with for the past year. That
being said, it *can* be controlled, just like the original. All the new strains can. In Ireland’s case, they got
it back down to about 1000 cases per day, where it has been simmering ever since. This isn’t all about
cases. Hospital admissions, critical cases, and deaths followed the increase in cases by about 1-3 weeks.
The key takeaway from this is that this is not over just yet. In fact, if we are not careful, and if we do not
respond rapidly enough, then we will certainly face a massive outbreak just like occurred in numerous
other countries. We are not ‘special’, and it can happen to us too. This means that you must continue to
wear masks in all indoor spaces AND try to keep your distance from others. If you have to get close to
someone, inside or out, WEAR A MASK AND MINIMIZE THE CONTACT TIME. 5 minutes is starting to be
long. 10 minutes is very long. This is why we are trying to keep our office visits with you short, and do as
much of the talking as possible by phone or video consult. Avoid going out if you don’t really have to.
Severely limit your travel. There is exactly one way these bugs got here in the first place. There is exactly
one way they move from one location to another – through us.

It is furthermore important to note that immunity to the original strain from prior infection may *not*
last, and may not be protective against the newer strains. Manaus is a city in Brazil that had a massive
first wave – so large that it was thought perhaps the population had truly developed herd immunity.
That was incorrect – at least as far as the new strains are concerned, and they are now in the midst of
going through that all over again with a new massive outbreak. How bad is it there? In this city of 2
million people, hospitals ran out of oxygen tanks. They couldn’t provide sick patients oxygen. Let that
sink in. These new strains are NOT to be taken lightly.

So why haven’t we done more here?
This is a choice made at the governmental level. Societies’ tolerance and stamina for these measures
play a role. If the new variants spread here, it is highly likely that our safety measures will have to
increase.

Are schools still safe?
We continue to have relatively few outbreaks in schools here, but it is important to recognize that other
locations have had large outbreaks. While there was suspicion for some time that children got and
transmitted Covid-19 less than adults, there is more and more evidence that this theory is incorrect. To
be clear, children definitely don’t get severe illness as often, and studies do suggest that children
become sick *slightly* less often than adults. There is growing evidence that they transmit the virus just
as much as (and possible more than) adults do. That being said, the measures taken in schools here so
far (which focus on clustering students together into large bubbles to prevent spread between them,
keeping windows open, and keeping some distance between students) have been at least partly
effective. High school students now have to wear masks most of the time. Grade-school children do not
yet have a mandate to wear one, but they would likely be highly beneficial to preventing the spread of
Covid-19.

For this reason, if you have children in grade school, we now *very strongly recommend* they wear a
mask indoors at school at all times (except to eat). Just because there is no mandate, does not mean you
can’t choose to do more than that. Some of us have our own kids in grade school, who have been
wearing masks at school for months. It’s very do-able, and is likely very temporary at this point. The
vaccines are coming (more on this just below), and masks may only be needed for months.

The new Covid-19 strains may have a serious impact on this. They are clearly much more contagious,
including among children. This is part of the reason we are recommending people go beyond the current
public health mandates and have school-age children wear masks starting right now. We don’t want to

wait for these strains to start spreading. We need to stop them. We need to hold on long enough for the
vaccines to be distributed. We need to buy time.

Okay, what about the vaccines??!
The good news is they work!
Really really really well.

The vaccine story is just about the best possible outcome anyone could have hoped for. The initial
studies done on tens of thousands of people showed that they were extremely safe, and reduce the
likelihood of getting serious illness from Covid-19 dramatically. Since then, the vaccines have been rolled
out heavily in a few countries, most notably Israel, where about 30% of the country has been
vaccinated. They used an age-based approach, and so around 90% of those over the age of 60 have been
vaccinated. The country is now witnessing a very dramatic drop in Covid-19 in those over the age of
60,*even while illnesses among the under-60 unvaccinated population were continuing to increase*.
The dominant strain there is the more highly contagious and dangerous one identified in the UK. So the
vaccine is doing just fine against it.

Better still, while it remains slightly early to confirm this officially, there are some good indications that
the vaccine not only prevents serious illness, but actually strongly reduces transmission of the virus. This
is key, and means the vaccine will likely play a critical role in helping to actually end the pandemic.

Of course this means people have to actually get the vaccine. At the moment we have a terrible supply
problem in Canada. Once that starts to change next month, essentially ALL OF YOU, we repeat
essentially ALL OF YOU, should be getting the vaccine.

Who shouldn’t get the vaccine? If you previously had the Covid-19 vaccine and had an allergic reaction
to it, then this needs to be discussed in detail with your doctor. If you previously had an allergic reaction
to a substance called polyethylene glycol (PEG), this should be discussed with your doctor. If you have
had an anaphylactic reaction to an unknown substance then you should discuss this with your doctor.
That’s it.

People with a history of allergies in general will be getting the vaccine, but may be observed on site for a
short time right after the shot. Tens of millions of doses of the vaccines have been given. By the time any
of you reading this get it, it will likely be over 100 million people worldwide. We already know right now
that the likelihood of an allergic reaction is about the same as the odds of you getting hit by lightning in

the next 18 months. Is getting hit by lightning this year something you were worried about? You should
be exactly that worried about an allergic reaction to the vaccine.

What about other allergies? This is generally not an issue. Allergies to one thing generally don’t predict
allergies to something else. If you are allergic to nuts, we don’t tell you to avoid milk. They have nothing
to do with each other. Out of abundance of caution, there will be protocols in place to collect your past
allergy information from you, and you may be asked to remain at the vaccine site for a short time. This is
because in the rare case of an allergic reaction, the vast majority occur within 11 minutes of the vaccine
being given. The vast majority of allergic reactions have been easily treated *on site*. A small number
have had to go to hospital, and 100% of people worldwide who had allergic reactions to the vaccine,
including anaphylactic reactions, recovered with standard treatments for that, within a few hours.
Furthermore, they still developed some degree of immunity to Covid-19 from the 1 dose.

Which vaccine should I get?
Whichever one is available to you first. DO NOT WAIT. Period.

Will kids get the vaccine?
Probably. Studies have been launched for kids, and results should be available by late summer. It is
always important to do these studies, but at the same time, it would be unusual for there to be any
issue. In all likelihood the results will be exactly like in adults, the vaccines will be approved for those age
groups, and kids will get vaccinated too, but later in the year. In the meantime, if adults are all
vaccinated, community transmission should subside and this will help protect our children. They should
still get the vaccine later on because they are still susceptible, and some children do still get seriously ill,
especially to the new strains that are starting to circulate. A worrisome scenario is if adults are all
vaccinated and safety measures are relaxed, but the bug is still around, then cases among children could
skyrocket, with large numbers of children getting very sick.

The future is looking brighter, but we know everyone is tired of all this. Hang in there, let us know how
we can help you through this, we are hopefully at a turning point.

Best wishes, and stay safe,

North Shore Medical Group