Keeping the Momentum Going

There is now a new category of haves and have nots. The haves – those fully vaccinated – will be able to safely resume most aspects of daily life, albeit with some precautions. The unvaccinated will not. As hundreds of millions of people get vaccinated worldwide, large bodies of evidence are emerging weekly about how well vaccines guard against COVID infection and, even more remarkably, how effective they are at preventing hospitalization and death among the small percentage of vaccinated people who do get sick. After two doses, those with one of the mRNA vaccines (Pfizer or Moderna) are shown to be more than 90% protected, even against the highly-contagious Delta variant. Among the 10% or less who still catch COVID despite vaccination, a very small percentage get sick enough to be hospitalized and very few die from it. This is the case for all vaccines approved in Canada, including AstraZeneca. But this is true only for those who have received two doses, following the two-week period needed for the vaccine to fully arm your body's protective mechanism. Conversely, there is plenty of real world evidence that the unvaccinated are fertile ground for more dangerous variants, even in countries with high rates of vaccination. The UK and, more recently, Israel have been caught off guard by this. I suspect that the United States, where vaccination efforts have stalled and the have-nots tend to cluster, is about to learn this lesson too. In Toronto, meanwhile, we are doing very well. More than 75% of our population has already received a first dose; 35% of adults in the city now have two, with that number rising rapidly each day. The easing of restrictions this time around has been cautious and science-based. Toronto's average daily new cases is down to 57; Ontario's seven-day average is 305. The number of ICU patients in the province, stretching hospitals to the breaking point at close to 1,000 two months ago, is now at 284. This means that hospitals can start dealing with the backlog of surgeries, the postponement of which has endangered many lives, a COVID statistic that doesn't register as part of the official pandemic death total. So, if you are still among the 20-25% who haven't yet been vaccinated – or if you know anyone who is – please consider the risks of failing to act. While nothing in life, including a drive to the grocery store, is 100% safe, the Pfizer and Moderna vaccines in particular have demonstrated that they are extremely, extremely so. Your chances of getting COVID, and getting seriously ill from it, are much, much higher. Two New Reasons to Take This Seriously: Infectious disease experts are tracking a "Delta Plus" variant, potentially more dangerous than the Delta variant, that is sweeping through unvaccinated populations around the world. The fear is that this variation of the variant, which has been identified in several countries, could be even more transmissible than Delta, with greater potential to evade vaccines. At least one case has been identified in Canada. Also recently, a U.S. study of two million people who got COVID found that a startling 23% subsequently sought treatment for new medical conditions which seemed unrelated to illness from the virus itself. It was already known that a relatively small percentage of those with COVID symptoms become "long haulers", experiencing related problems that continued for months. But this study group, made up of people of all ages, included those who had no COVID symptoms. Their new ailments were ones they had not experienced previously, such as pain, difficulty breathing, high cholesterol, fatigue and high blood pressure. The study, which has not yet been formally peer reviewed, serves as a reminder about how little we still know about COVID's long-term health implications. Vaccine Update Because the heavy demand for second doses has coincided with people still needing first doses, together with an unexpected reduction in Pfizer shipments, the city's vaccination clinics are temporarily difficult to book. But new appointments continue to come up as people find pop-up clinics and cancel appointments and as more vaccine arrives. Currently, any Toronto resident over 12 is eligible to book a first appointment here and a second appointment if you received your first dose of Pfizer or Moderna before May 30 or your first dose of AstraZeneca at least eight weeks before the scheduled second dose. Sometime next week, perhaps by Monday morning, the Province will be opening up second doses to anyone across Ontario, causing increased demand for appointments, but I expect that the City will have opened up bookings for the week of July 5 by then, after receiving information about its allotment from the Province. Other vaccine information:

  • Because the supply of Moderna has increased just as Pfizer shipments have been both slower to arrive and smaller than anticipated, expect to receive a dose of Moderna at city-run clinics over the next several weeks. Because Pfizer is the mRNA vaccine you've heard the most about, some people have incorrectly think it is better than Moderna. In fact, Pfizer and Moderna are virtually identical, are completely interchangeable, and are equally safe and effective.

  • Because Pfizer is the only vaccine approved for those 12-17, the relatively small number of Pfizer doses available are being prioritized for that age group. Again, that's not because one is safer than the other; it's simply because Pfizer was the first to apply for approval for that age group. Moderna has now done so and will likely get approval soon.

  • Those who received a first dose of AstraZeneca can choose to receive either a second dose of AstraZeneca or of Pfizer and Moderna. There are emerging indications that mixing vaccines provides greater protection.

  • For those who were unhappy that their second vaccine dose was delayed past the initial manufacturer's recommendation of three weeks (Pfizer) and four weeks (Moderna), it now appears that waiting 8-12 weeks increases your overall protection. This has been seen in real-world studies as opposed to the manufacturer's shorter clinical trials. This wasn't known when the delay was announced, in order to get more first doses out faster, but has turned out to be a beneficial unintended consequence.

-John