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HealthCare 365 Update
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Dear HealthCare 365 Family,

If you have any concerns about your health or questions for our team, please call the office or email your care coordinator. We are still working regular hours, but will try to deal with as much as we can virtually. We are here for you and are available to asses and assist with your concerns. The medical team will evaluate all health concerns virtually and determine if you require an office visit.

If you are having difficulty breathing or experiencing other severe symptoms please call 911 immediately.
A PERSONAL MESSAGE FROM DR. KOHUT

I am asked about the COVID vaccine every day.

  1. Where is the vaccine?
  2. How are decisions being made about vaccine roll out?
  3. Who is getting the vaccine now and why?
  4. When am I going to get the vaccine ?

As I attempted to answer these questions in the information below, I was struck by the emotional intensity behind these questions.

We are all becoming fatigued with “COVID life.” We yearn for a return to normal, and yet we also wonder if “normal” will ever look like it did before.  The pandemic has changed us all.

As we go through yet another lockdown, the restrictions seem more difficult to tolerate - even if we know they are necessary.

COVID replication must be slowed. We need to buy time to get vaccine into peoples’ arms and vaccinate we must. We need to get close to vaccinating 80% of Canadians. Only then will viral replication slow sufficiently for COVID to be effectively contained. Note, I did not say disappear.

As a Canadian you will be eligible to receive the COVID vaccine. Whether you will get it in our clinic or elsewhere remains to be seen. The vaccine has not filtered down to community physician offices. It is also possible that it may NOT. I provide an explanation in the newsletter below.

If the newer vaccines are rolled out as planned and if Pfizer and Moderna can deliver the vaccines as promised, then YES every Canadian will be able to get vaccine by Sept 2021.

All older patients (starting with the most senior) and those with chronic conditions and their primary caregivers will have priority. The reality is that not everyone can be at the front of the line. Someone has to be in the middle and someone has to be at the end of the line.

There will be no way to “jump the line” to get a vaccine. The vaccines will be provided through Public Health and they determine who, where and when people can get them. I am involved in the discussions on the roll out of the vaccine to the community. I will keep you posted, as I know more.

The logistics to manage vaccine availability and its distribution are challenging. Unfortunately, the recommendations of leading medical experts and Public Health are not the only influencers in the above decision processes. They are being addressed, hiccups and all. We make mistakes, we learn as we go.

New questions arise. How long will the vaccine last for? The latest information from Moderna is about one year. Then what? Booster? Research and science will continue to provide answers.

In the interim, we will continue to live, respecting the behaviour of this COVID virus, by wearing masks, practicing scrupulous hand hygiene and practicing social distancing.

We will overcome!

Be patient, stay healthy, stay safe, stay well.

Best,

- V

VACCINATION IN ONTARIO

Vaccines - Where are they?

  1. Every province has received some vaccine.
  2. The variability in vaccine roll out is a product of our Constitution because healthcare is provincial matter and not a federal one.

Who provides the scientific/medical advice on vaccine distribution?

In Canada, Pubic Health drives the medical/scientific decisions for vaccine rollout. The Public Health objective for vaccination is to limit the complications of COVID. Decisions are based on 2 criteria;

  1. Who is at risk of getting infected with COVID? (highest to lowest risk based on consultations and evidence from all over the world)
  2. What is the risk of a bad outcome if an individual gets infected?

Vaccinations are being administered to frontline hospital medical staff, to staff and residents in group living locations (long term care institutions, nursing homes, retirement homes, etc. and essential care providers.)

What affects vaccine availability and distribution? 

  1. Federal government is responsible for purchasing vaccines and managing the logistics of vaccine delivery to the provinces /territories.
  2. Internal and external political pressures (federal, provincial, local/municipal and well intentioned groups pressuring to move people to the front of the line for vaccination) affect decisions
  3. Vaccine properties (stability, storage, maintaining the “Cold Chain”)

NACI has now released information that extends the interval between doses. A second dose will now be able to be given up to 6 weeks after the first dose. This will allow the provinces to look at rolling out the vaccine with more flexibility. The vaccine may be made available to more people or to keep some doses back for the second dose. We know the after 1 dose there is at least 90% efficacy (how well it works) against the virus. However, we do NOT know how long this efficacy lasts.


Vaccine “Cold Chain”

A cold chain is a temperature-controlled supply chain. An unbroken cold chain is an uninterrupted series of refrigerated production, storage and distribution activities, along with associated equipment and logistics to maintain the effectiveness of the vaccine to the point of injection.

Pfizer Vaccine must be kept frozen at -70C to maintain its effectiveness. To maintain a cold chain, 975 doses need to be delivered to one location. Each vaccine vial needs to be used within 6 hours once the vial is punctured. One vail provides 5-6 doses of vaccine. Therefore, immunization has to be done in large population environments.

Moderna Vaccine remains stable at -20° C (-4°F) for up to six months, at refrigerated conditions for up to 30 days and at room temperature for up to 12 hours.

These vaccine properties have driven the locations for injection sites (mostly hospital and institutional settings). This is the primary reason that the vaccine has not filtered down to the community family physician level. It is also possible that it may NOT. There is increasing discussion across all the provinces that the vaccinations will occur with Public Health supervision to predetermined large groupings and not to individual physician offices.
 

MORE VACCINE UPDATES

Vaccine Update

 4 vaccines are now available internationally:

  1. Pfizer
  2. Moderna
  3. Oxford-AstraZeneca
  4. Johnson and Johnson

The first 2 vaccines have been approved in Canada, and shipments have been arriving in Canada. They are mRNA vaccines. A third vaccine the Astra Zeneca vaccine will likely get approval in Canada in the next month.

mRNA vaccines (94-95% effective) teach our cells to make the COVID viral Spike protein. The vaccine containing the mRNA is injected and the process begins. The mRNA is translated by our cells into a protein, and mRNA is destroyed by the body.  The mRNA that we receive cannot be altered to DNA (cellular genetic material) as there is no enzyme (another protein) that can convert this RNA into cell genetic material. This means there is no mechanism by which the vaccine can alter human DNA (our genetic material) that could potentially cause future disease.

The next 2 vaccines are similar; they are DNA vaccines using different viruses as a vector (a way to transmit information to cells). DNA is less fragile than RNA and the viral external protein coat protects the genetic material inside. Vaccine storage is easier.

Oxford-AstraZeneca Vaccine

Uses inactivated Chimpanzee cold virus (It cannot make copies of itself). DNA code is injected into virus. When that is injected into a person this DNA gets converted to an mRNA template that codes for the spike protein. Vaccine effectiveness to date is 70+%

Johnson and Johnson Vaccine

This might be a game changer. Only ONE dose is required Storage is at 2-4C (regular refrigerator temperature) for up to 3 months. A gene (coding for Covid Spike protein) is added to an adenovirus that affects humans. Once injected, the virus can enter a cell but cannot divide (like Oxford-AstraZeneca). The injected virus DNA codes for mRNA that provides a template to make the spike protein.

BIG NEWS: Pfizer is now beginning testing vaccine on 12 -15 year olds. This data will become available in 6 or more months.


COVID-19 Virus Mutations

Replication of the virus across the world is very frequent and rapid. There are two known variants:

  • B117.  British virus
  • 501Y.V2. South African virus

Both of these new variants have mutations in common. The South African has a second mutation to the spike protein. With rapid replication this variant may produce more mutations -and that may affect the vaccines effectiveness against the spike protein in the future. This is a driving reason for vaccines to be rolled out as soon as possible.

Should this become a problem, we can easily “recode” (make changes) to the mRNA to adapt the vaccine to the new viral types..

A recent Study in Texas has shown the mRNA vaccines present have the same level of effectiveness against the new mutations, as the original (we call it “wild” virus). Vaccine effectiveness studies against the viral mutations are ongoing in various laboratories in the world.

Vaccine information: check out this site for great info on COVID vaccine, It is updated regularly.


Vaccine Adverse Events

Every vaccine has been given CONDITIONAL APPROVAL in Canada. This means that each company must continue to monitor the population vaccinated and report on any adverse events.

Serious adverse events are low: 0.5% for the available mRNA vaccines (Pfizer and Moderna). Similar results are being reported for the Oxford vaccine. I will deal with anaphylaxis separately.

Minor side effects:

  • 80% of vaccinated individuals had a sore arm
  • Symptoms such as headache, fatigue, muscle aches are similar to symptoms noted with other vaccines like influenza vaccine.

Anaphylaxis (serious life threatening reaction):

  • The frequency of these reactions is very low, 1/100,00
  • It appears to have occurred in individuals with hypersensitivity issues and significant allergies.  

Contraindications to Vaccine

Allergy to Peglyte - Speak to our medical team if you have further questions.

Why everyone should be vaccinated

  1. 1 out of 13 people affected by COVID require hospitalization. 
  2. 3 out of every 100 COVID patents die 
  3. COVID has killed more People in Canada in 10 months than influenza does yearly.
  4. Even individuals with mild infection, are experiencing longer term complications of COVID infections such as debilitating fatigue, cardiac, respiratory, cognitive complications etc.
If you have concerns about getting the vaccine, speak with our team. We will speak more about immunizing advice for individuals with specific medical conditions in the following Help Me Rhonda bulletins.
ADDITIONAL RESOURCES
If you have any questions please call our office and speak to our staff.

Wishing you health, safety and enjoyable family time!

The HealthCare 365 Team
Copyright © 2021 HealthCare 365, All rights reserved.


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