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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 continue to work regular hours, and  prioritize virtual options when appropriate. We are here for you and are available to assess and assist with your concerns. The medical team will evaluate all health concerns to determine if you require an office visit.

If you are having difficulty breathing or experiencing other severe symptoms please call 911 immediately.
WELCOMING MICHELLE!

We are very excited to welcome Michelle Colenutt back to our clinical team after her Maternity leave. Michelle- great to have you back! 
 
Michelle will be in the clinic each Wednesday and will be virtually  accessible the rest of the week. Michelle is the COVID-19 Vaccine Facilitator for HC 365. Michelle will be your point person for all COVID related questions and will ensure that you are registered for vaccination when your age group and/or  geographic location becomes eligible.
 
And in big news- much to their relief, most of our clinical staff at HC 365 received their initial COVID vaccination this week. “Getting the first dose was pretty emotional, and a glimpse at returning to a new normal”  texted Michelle after receiving her dose this week.

Our own nurse Erin will be one of the volunteer vaccinators in the Durham region. Way to support your community Erin!

A PERSONAL MESSAGE FROM DR. KOHUT

The first wave of community-based immunizations in Toronto will begin with 80+ year olds. Any 80y+ client at HC 365 who may have concerns about transportation to the vaccination centers please email Michelle at michelle.colenutt@healthcare365.org or call our office to speak with Michelle. We are compiling list of those who may need assistance. We are working on a plan with other groups to address this issue.
 
We are very aware of your desire to get vaccinated as quickly as possible.
Michelle and I will be keeping tabs on vaccination opportunities for those of you who are at increased risk due to your medical conditions but may not be in the age group being vaccinated at that time.
 
Ontario expects to immunize those over 75 years old by mid-April:
70+ years old, vaccination begins May 1st
65+ years old, vaccination begins June 1st
60+ years old, vaccination begins July 1st
 
New information about vaccinating 60-64y range is at the end of Help Me Rhonda.

As spring approaches there is a promise of new beginnings and vaccines to be had.
 
There is an air of hope and also impatience. The vaccine rollout has been slow We are not out the woods yet. The pandemic has been hard on all of us. We need to provide each other with support. We need to be patient. We need to stay the course and maintain our vigilance with behaviors as never before. If we ease up our behaviors and public measures too soon there will be a heavy price to pay.

Let’s not get burned!
 
Wishing you continued resilience, ongoing positive outlook and a reminder to be kind to others and yourself.
V

COVID-19 AND VARIANTS

For a recap on the COVID virus look here.

There had been a global decline in COVID-19 cases -almost 1/2 number of the cases /day from the peak in Jan 2021 until last week.

 Last week worldwide case numbers of COVID-19 rose for the first time in 7 weeks.

COVID cases have stopped falling because people have let their guard down governments and public health measures are being eased and COVID variants are circulating.

Ontario is seeing a drop in cases for the last few days. Our Re numbers 2 days ago were 0.99 (Re = effective reproductive number = estimate of the average number of people that one person with COVID -19 will infect). When Re is less than 1.0 the number of new cases is expected to decrease over time because one person will infect fewer than one other person. If Re equals 1.0 the number of new cases will not change because 1 person infects 1 other person. If the number is greater than one the number of COVID cases is expected to increase. For example If Re is 2 than 1 person will infect 2 people those 2 will each infect 2 more etc. Re greater than one means tighter control measure are needed reduce spread. Re is then translated into projections about spread.

Are we winning this battle against COVID? Much too early to tell. Fast spreading variants are a concern. Despite Public Health cautioning not to do so various provinces and even parts of Ontario are reopening nonessential businesses. "Overall we're still doing well " Dr. Theresa Tam Canada's chief public health officer said during a news conference on Tuesday. "But things could change rapidly.” Tam said. Newfoundland and Labrador is a cautionary tale for the rest of Canada where an outbreak of the variant first identified in the U.K. also known as B117 led to a spike in new cases in the community during a time when public health measures were "less stringent”.

New data on the B117 virus Shows that it stays longer in the body than the wild COVID (13.3 d vs 8.2 days for wild COVID). It may be that one reason this virus is more transmissible (able to be passed on from one person to another) is that an infected person with this variant carries the virus longer infecting a larger number of contacts.

Raywat Deonandan a global health epidemiologist and an associate professor at the University of Ottawa, has stated that a third wave is “mathematically inevitable”. The third wave could be a spike in cases or a number of smaller wavelets in various area of Canada. We know that the third wave occurred in the Spanish Flu in the spring of 1919 at the same point that we are now. Loosening of societal behaviors will help COVID Variants to drive outbreaks.

Variant Viral behavior is unpredictable. For example the South African variant B1351 which drove the spike in transmission there has recently seen a drop in COVID cases But declines in cases may be short-lived. A steady stay of cases may exist for days and months then suddenly the take off. Portugal Spain and the UK were suddenly hit hard by the B117 British variant Recent increases in COVID infection rates In Israel are attributed to new variants notably B117. In Toronto, COVID variants make up more than 40% of COIVD cases.  The numbers of these new variants almost doubled in the past week.

Thousands of new cases mean hundred of new deaths. More testing, contact tracing and travel restrictions need to continue. Preventing super-spreading is key (super-spreading occurs when one or a few infected people attend an event indoors with a large number of people)

Read this fascinating analysis on how we got into trouble with COVID and how have continued to fail to contain COVID.

VACCINATION 

Why vaccinate? Because Vaccines work and are incredibly safe

  • Vaccines protect against severe disease (getting very sick).
  • Vaccines protect against disease in general (getting a bit sick).
  • Vaccines protect against infection in general.
  • Vaccines protect against transmitting infection.

In Israel, thanks to a very aggressive immunization program almost 97% of the deaths and hospitalizations are occurring in the unvaccinated population. Look at this study. 

This video provides good perspective on vaccine side effects.

How effective is the vaccine in reducing the chance of getting COVID -19?

Virtually identical to the original Pfizer studies in Israel (where over a million of people have been vaccinated 7 days or more after the second dose of the Pfizer vaccine the vaccine was 94 % effective in preventing COVID infection and 92% effective against severe disease across ALL age groups.

The Pfizer vaccine may block transmission of the virus. (This data still needs peer review)

Preliminary data suggests that Pfizer vaccine is 70% effective in preventing both symptomatic and asymptomatic COVID infections beginning 3/52 after the first dose.

Pfizer vaccine appears to be effective against the B117 (British) COVID virus.

Vaccine effectiveness in vitro (in the lab) against the South African variant (B1351) is less promising. Antibodies from patients vaccinated with Pfizer vaccine neutralized the virus only 1/3 as effectively as did the antibodies against the wild COVID strain. The extra mutations appear to be the culprit. More studies on how these affect viral attachment to the host are in progress.

ASTRAZENECA VACCINE (AZ) - APPROVED IN CANADA.

This is the First Viral Vector Vaccine approved in Canada.

How does it work?

Viral vector vaccines use a safe virus to deliver information about the virus you want to vaccinate against. The AstraZeneca vaccine uses a chimpanzee cold virus (modified /weakened) that contains genetic information about the COVID-19 spike protein. The chimpanzee cold virus is used because it can’t make people sick but also because people haven’t been exposed to it before and wouldn’t have antibodies against it. 

Viral vector vaccines a hide the instructions for the spike protein in a safe virus. Once injected the safe virus particle infects your cells like a cold virus does. Because the viral vector vaccine is modified it cannot cause infection. It just delivers genetic instructions for your cell to build COVID-19’s spike proteins. Your cell displays the spike protein and your immune system sees it and memorizes it. (the B cells and T cells immune response cells that I spoke about a few Help Me Rhondas ago). Your body then gets rid of the cell with the spike protein and also gets rid of the safe virus particle that delivered the instructions. If you are vaccinated and then exposed to the COVID virus the B and T memory cells are triggered to respond protectively. The viral vector vaccine does not change your DNA or your genetic information.

A comparison in mRNA vaccines the mRNA gives your body information on how to build the spike protein.

Guidance on the AZ vaccine has been a bit confusing.

NACI (National Advisory Committee on Immunization) is NOT recommending use of the vaccine in individuals age 65 due to “insufficiency of evidence of efficacy in this age group at this time”. Health Canada in approving this vaccine did not find safety concerns but has acknowledged that clinical testing of AZ vaccine was limited to those under 65 years of age. The Advisory Committee concern does not mean the AZ vaccine is not effective or carries increased risks post immunization. It has been extensively used in England.

March 2, 2021 Public Health England published a study (not yet peer reviewed) that the vaccine was safe and was 63-73% effective in ages 70 and above. For more details see this article. 

As of Mar 2 2021 Ontario BC Alberta Saskatchewan and PEI will not administer the AZ vaccine to ages 65+.

While its use may be restricted for now to ages under 65 it opens up the opportunity to cast a wider net with vaccinations and vaccinate younger age groups. Because AZ vaccine requires only regular refrigeration it is more versatile

“I ONLY WANT THE BEST VACCINE”

PLEASE accept any effective vaccine when offered.

DO NOT refuse a vaccine if offered in the hope that you can receive the mRNA vaccine at some later date.

DO NOT WAIT if vaccine is offered- please vaccinate.

Vaccines provide protection against symptomatic infection and protect you from getting really sick (you might get a mild cold but you will not end up in hospital).

We are entering the Third wave in Ontario. The “viral charge" will be led by the B117 (British virus) Modeling suggests over 20 000 cases of COVID per day before May 2021. If you are vaccinated you have protection!

If offered the AZ vaccine TAKE IT It provides good protection. Researchers are looking at “boosting" the vaccine with mRNA vaccine dose later on.

The pandemic- lockdowns and other public health measures – will not end until the majority of Canadians are vaccinated. You may not see a general loosening of restrictions you will not see friends and family or travel, in pre- COVID days.

If you wait to get vaccinated and get infected in the meantime you will have more virus in your system than a vaccinated person and may end up in hospital.

The overarching Public Health Goal of vaccination is to take the pressure off the hospitals immunize as many people as possible to reduce viral load in the community and to hopefully reopen the economy.

CLOSER TO HOME - VACCINATION IN TORONTO

FAMILY DOCTORS WILL BE INVOLVED IN PHASE 2 VACCINATION!
 
  • A high volume of AstraZeneca (AZ) vaccines is coming to Ontario, expected by end of next week, and some of those 190,000 doses will be distributed to a subset of Public Health Units (PHUs) and ultimately,  to primary care clinics initially as part of a pilot program, the following week (mid-March). With approval of the Johnson & Johnson (J&J) vaccine in Canada yesterday, more vaccines will be coming in the next weeks and months.
  • The pilot program will see the AZ vaccine administered through select primary care clinics and pharmacies.

In the next week  Ontario Family Medicine Association will be involved in several meetings with the Ministry. Family Physicians will receive  additional training and onboarding on COVAXON (the vaccine registration system) for physicians, starting with those involved in the pilot, including support for technical questions that arise throughout the process.

Check this website for more Toronto COVID Vaccination COVID-19: How to get Vaccinated

Vaccinations will not be occurring in family practice offices any time soon …Vaccinations will take place in mass vaccination centers.

There will be 350 vaccination centers in Toronto.

That network will include the nine city-operated clinics as well as 49 sites operated by hospitals 46 sites operated by community health centers and 249 sites operated by pharmacies

The location of the nine city-operated mass vaccination clinics are as follows:
Vaccine centers will operate 7 days per week and will be open 11 am to 8:00 pm. 

  1. Metro Toronto Convention Centre 255 Front St. W.
  2. Toronto Congress Centre 650 Dixon Rd.
  3. Malvern Community Recreation Centre 30 Sewells Rd.
  4. The Hangar 75 Carl Hall Rd.
  5. Scarborough Town Centre 300 Borough Dr.
  6. Cloverdale Mall 250 The East Mall
  7. Mitchell Field Community Centre 89 Church Ave.
  8. North Toronto Memorial Community Centre 200 Eglinton Ave. W.
  9. Carmine Stefano Community Centre 3100 Weston Rd

Over 1400 staff are in the process of being hired and trained to staff these centers. Vaccinators will be voluntary.

Torontonians can't start pre-registering, read here. Toronto will allow people to book their vaccine appointment ONLY beginning Mar 15. Only individuals who are 80 years old and over will be allowed to register in this first wave.

Vaccination registration has begun in York Region which chose not to wait until the recommended Mar 15 by the Ontario government.

Numerous hospitals are now opening registration for vaccinations. These include Sunnybrook Hospital, St. Michael's Hospital, Michael Garron Hospital and North York General Hospital.

 VACCINE CREATIVITY BATTLES VACCINE HESITANCY

Creative ways have be found to increase vaccination rates. Education posters and discussions won’t be enough. As we slowly take care of vaccinating the older populations we need to attract the younger crowd.

What have we learned from countries where vaccination programs are successful ?

 In Israel:

 1. Pizza and coffee are offered in Tel Aviv to induce people to vaccinate

 2. Israel has introduced a “Passport system” a fully immunized individual will log onto a government site log in the appropriate into a database and if confirmed accurate will be allowed to print a “green passport” imbued with a barcode. Smartphone users get a purple badge. Carriers of a “green passport /purple badge” will be allowed to use facilities such as sports clubs, restaurants, swimming pools etc. Those without these green passports and purple badges cannot. This also attract younger people to vaccinate.Read about it here.

It demonstrate that creative solutions to vaccination improve vaccination rates in general and increases the number of younger individuals who vaccinate

Young individuals are now increasingly a source of COVID infections.

Getting younger people vaccinated is essential.

Numbers in countries ahead of us on the COVID curve are projecting younger people will make up the bulk of COVID diagnoses. In Israel now 4/5 diagnosed with COVID are less than 40 years old.

Back in Canada. Who is now taking up ICU beds. It is not who you think. It is mostly people UNDER the age of 70. One third are people between ages 20-59. Getting younger people vaccinated is essential.

FINAL COMMENTS - VACCINATE!

AZ VACCINE IS NOW AVAILABLE.

If you are between the ages of 60-64, you can get an AstraZeneca ( AZ) vaccine next week. Call: 647-748-3784 or visit this website: AZ pre-register.

Vaccinate! Take any vaccine that is offered.

Encourage your friends and family to be vaccinated.

Go to credible sources for vaccine information: here.

Vaccine parody

If you have any questions please call our office and speak with any member of our medical staff.


Wishing you health, safety and enjoyable family time!

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


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