Uncertain Times

COVID is an ongoing threat as we move into fall and winter, but predicting the level of danger has become increasingly difficult.

Somewhat mysteriously, case numbers that were expected to rise steadily are now dropping slightly. It's not clear why. More people getting vaccinated? Summer weather extending into fall? People watching Alberta and becoming more careful? A delayed impact from the return to school? Temporary good luck?

It could be any or all of these. And although the good news may continue, health experts are urging caution. As usual, how it plays out depends largely on us.

If transmission rates stay the same as they are now, Toronto would have about 130 daily cases in early December. But even a 20 percent increase in transmission, as people congregate indoors, would produce 600 new cases every day, according to the city's Medical Officer of Health.

Provincial officials have an even wider range of possible outcomes: anywhere from 200 to 5,000 new cases per day by November 1, depending largely on whether restrictions are loosened even further, people move around more, and who we congregate with indoors.

Our best path forward to a best-case scenario involves getting the vaccination rate up from an already-successful 81% to upwards of 90%. According to provincial data released this week, the unvaccinated are seven times more likely to get COVID, 25 times as likely to need hospitalization from it, and 60 times more likely to end up in intensive care.

This weekend, Toronto is making another vaccination push with pop-up clinics across the city. Here in Willowdale, we have the extremely well-run clinic at Mitchell Field still operating seven days a week, with no appointment needed each day between the hours of 1:00 and 7:00.

Other COVID news this week:

Booster shots for seniors in long-term care and retirement homes should be on the way following a recommendation this week by the National Advisory Committee on Immunization (NACI). The advice to introduce a third dose follows studies showing that the effectiveness of COVID vaccines can decrease over time and that a third dose provides added protection, which becomes especially important for seniors and those who are immunocompromised.

The Province has not yet implemented the NACI recommendations, but I expect this is coming soon. I also suspect that Canada may soon follow the lead of U.S. health experts in recommending boosters for anyone over 65 as well as those who have jobs that place them at higher risk.

The province has already expanded eligibility for third doses for patients with specific medical conditions or who are undergoing certain medical treatments. The full list of eligible vulnerable populations can be found here.

Vaccinating Ages 5-11 by Winter?

Following successful clinical trials, Pfizer is expected to apply next month for Health Canada approval for use of its vaccine for the 5-11 age group. It is likely that approvals will be in place by early winter. Toronto Public Health is already working on plans to administer the vaccinations.

Even though children tend to have mild COVID symptoms, there is still some short and perhaps longer-term risk to them getting the virus. Equally important, the virus spreads rapidly through unvaccinated people of all ages, leading to further infections, so getting all ages vaccinated is an essential component of reaching a level of population immunity that will provide greater protection for everyone.

Pfizer Preferred for Young Adults

Pfizer is now the recommended vaccine for young people aged 18 to 24, Provincial health officials announced this week. The decision follows a study showing that one out of 5,000 in that age group who received the Moderna vaccine developed myorcarditis or periocarditis, typically within a week following the second dose, compared with one in 28,000 for those who received Pfizer.

There have been no fatalities associated with the illness. And recovery has tended to be quick. The comparable risk for developing these conditions is 18 times higher for those who get COVID.

Teens 12-17 are already receiving only Pfizer because it is the only vaccine approved for that age group in Canada.

Potential Antiviral Game Changer

Drug maker Merck announced today that it has developed a pill which cut the rate of hospitalization by half among COVID patients with mild to moderate symptoms, if taken early in their infections.

The medication, the first antiviral designed to treat COVID, is expected to receive quick emergency approval by the U.S. Food and Drug Administration and could be available in that country within months. There is no information on when it might be available in Canada.

It is not intended as a substitute for vaccination but may prove effective in significantly reducing hospitalization and death among those most at risk who get COVID.

At least two other companies, including Pfizer, are working on the development of similar medication.