Covid-19 Update - December 2020

Hello again everyone,
 
We wanted to provide you another update regarding the Covid19 pandemic. A lot has changed since our last communication, and we felt it was important to answer some of your questions, and provide some guidance on all this.
 
As with previous emails on this subject, we start with a brief summary of critical points. For those interested in additional details, please read on below. This will be a bit of a mix of caution, but also hope.
 
Key Points:

1. We are clearly in a second wave of the pandemic.
2. The pandemic in BC is not being adequately controlled at this time. Our current trajectory is not sustainable (although there may have been a levelling off in the last few days).
3. The only way to change that trajectory is to change our behavior. 
4. Numerous countries have shown us that this pandemic can be controlled by changing our behavior. They did it. We can do it. Period.
5. The biggest risk factors for getting infected are: Being indoors, with no mask, for over about 10-15 minutes in the presence of others.
6. There are now at least 3 vaccines that appear to be safe and effective, and which will start becoming available here in January *for select groups*. 
7. This is really important: The vaccines will not change our public health measures for *many* months, and possibly a year or more to come. This is because it may well take that long for the vaccine to become widely distributed enough for herd immunity to occur (approximately 70% of the entire population).
8. Our office will be maintaining strict public health protocols for months to come. Please follow our instructions closely. Please be kind to our staff. This is stressful for everyone.

 
The details:
As most of you have no doubt seen, as society in BC opened back up, Covid-19 began spreading once more. It has started spreading quite a bit, with a doubling of new cases per day roughly every 3 weeks over the last 2 months. It is critical to recognize that that is *not* sustainable. That curve has not been flat, it has been rising, steeply. Continuing for even a couple of more months along this path would likely lead to an overwhelmed health care system, much like occurred in other places such as Italy and New York. Additional measures were therefore put in place by the Public Health Office, such as requiring masks for all public indoor locations (other than schools), and limitations on athletic activities and visits to your home. These measures are entirely appropriate. What is not clear, is if they are enough. There has been a slight levelling off in the last few days. The challenge is that while cases, hospitalizations, and deaths can be kept low if there aren’t many in the first place, it’s very hard to get them low again once they go up. So far, no other country has successfully done so, without measures substantially more aggressive than we currently have in place. The flip side of that, is that several other countries have repeatedly demonstrated that they are able to suppress surges in viral infections. They have shown us how. We ‘just’ need to do it.
 
It is critical in this environment, to understand where virus transmission becomes a risk. We have known for some time that virus is spread partly by ‘droplets’, invisible fluid we expel when we breathe and which tend to travel up to about 6 feet, and then settle toward the ground. It is now clear that there is ‘airborne’ transmission as well. This means that not all of the virus settles to the ground, but rather hovers in the air for a much longer time (the duration of which remains unclear, but is probably 2-3 hours), and may travel a significant distance that way (around 20 feet or more depending on air currents, fans etc). This is why keeping distance from others is so essential, and why it is hard to maintain enough distance indoors. Masks can add a layer of protection and decrease the likelihood that you breath in the virus while in the presence of others. It is not a full-proof shield though, and should be seen as a *back-up* method of protection. Keeping your distance is much more important. Lastly, minimize your time in close contact with others as much as you can. You are less likely to get infected if you are next to someone for only a few seconds. With about 5-15 minutes of exposure time though, the risk goes up…a lot...even with a mask on. You can see from this why most infections are being passed on in people’s homes, at many places of work, dine-in restaurants, and gyms/sports facilities. You can also see why transmission outdoors is much lower (but not zero) risk.
 
What about kids? This remains a frustratingly controversial topic. As previously noted, there is some limited evidence that kids *under 12* become infected less than older kids or adults. Since we last updated you, there is growing evidence that if they do get infected, they transmit it to others just as well as anyone though. So while they may get it less, and while they get sick less, they nonetheless spread it just as well as anyone. Kids can wear masks though, and it would seem clearly helpful for everyone over age 2 to wear a mask whenever they are in close contact with others, indoors or outdoors. We need to turn this around somehow.
 
When will we have the vaccine?!??
It certainly feels like it can’t come soon enough. There are currently a few vaccines about to be released to the public. It appears that they are highly effective. Their safety profiles are fantastic. They have been tested on tens of thousands of people, with zero serious adverse events. Canada will have access to these, and it is expected the first doses will be delivered here within a couple of weeks. *However*…it will take a *long* time to roll them out. These will arrive in batches, with early doses dedicated to various high-risk groups. The order of release will be something along these lines:

1. Hospital workers
2. Nursing homes (staff and residents)
3. Community health workers
4. High risk patients (over 65 with chronic health conditions)
5. Those over 65 regardless of health issues
6. Adults over 18 (16 for 1 of the vaccines)

 
It is impossible for us to know, but we expect groups 1-3 above will take until at least March-April 2021. So few (if any) of you reading this will likely be getting the vaccine until at least late Spring. Hopefully many people in the community can be vaccinated during the late Spring and Summer. Vaccines for kids (current vaccines are for adults only) will probably come available right around then, and hopefully many kids can be vaccinated before school starts next Fall.
 
Some key points about the vaccines:

• Once you are vaccinated, you will STILL have to maintain public health measures *just like now*. This will be the case at least until September probably. Maybe for all of 2021. This is because the virus may continue to spread a lot until at least ~70% of the population is vaccinated. Also, the vaccines are very good, but not perfect, and we need to crush this bug completely. 
• We don’t know yet how long immunity lasts. It’s at least 3 months. It’s probably much longer, but we can’t know until enough time using the vaccine passes. By the time you get yours in a few months, we will hopefully be able to say it lasts at least 6-9 months of protection. Most vaccines last a minimum of 2 years, many (like tetanus) for 10 years, and some (like for measles) last a lifetime. We’ll have to wait and see. If immunity is not long-lasting, this could become an annual event. This will make things much more difficult.
• These are not live vaccines. So, just like the flu shot, YOU CANNOT GET COVID FROM THE SHOT. PERIOD. You can have a side effect (we’ll discuss those when the time comes), but getting sick with Covid19 is NOT one of them.
• There are around 37 million Canadians. The vaccines are all set up as 2-dose series (around 1 month apart). This means we need to distribute and complete around 52 million doses to achieve herd-immunity. That’s around 142000 doses per day for 365 days to put it in perspective. This doesn’t happen overnight. Once the vaccine is available, we will be working very hard to get it out. We learned a lot from this years outdoor flu-vaccine campaign, and are prepared to roll out a highly efficient Covid one.

 
This isn’t over yet. But we are on the cusp of turning this fight around. We are moving from defense to offence. We need everyone to work together to get there though. So please do your part. Think of those around you. Take responsibility for your actions, even if you see others fail to. Whatever you do will help, and you will have made a valuable contribution to society by being kind, smart, and safe.

North Shore Medical Group Physicians