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HealthCare 365 Update
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Dear HealthCare 365 Family,

We hope you are all doing well and want to remind you that you can call our main office line to reach our nurse on call service during the holidays.

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

2020 has been a year unlike anything most of us have ever experienced. We have seen illness and death in numbers not seen since the World Wars. We continue to struggle with the economic outcomes of attempting to contain the spread of COVID 19. The number of personal economic hardships, are higher than ever. COVID has taxed us emotionally and mentally. Individuals, families, relationships, businesses have suffered. 

Yet, out of this chaos, humanity and resilience has manifested. We have reached out to each other, and especially to those in need, showing kindness and support emotionally and financially. We have appreciated family, friendships and mentorships more than ever. Many families have grown stronger and more connected. Humour and creativity have appeared in the most unlikely places. “Breaking Bread” and baking bread at home ( maybe a bit too much of that…), creatively spending time together, has given families enjoyment and a shared purpose. 

As the Holidays approach, please reach out to those who live alone, who may be lonely (but might say nothing).

For those who celebrated Hannukah, or Diwali, I hope your celebrations were warm and full of light. For those who celebrate Xmas and for those who do not, but enjoy this time of year, I wish you all Happy Holidays and Merry Christmas!

With 2021 appearing on the horizon, I wish you all health, peace, love and happiness. May your resilience persevere as we maneuver into a New Year, with its new possibilities and opportunities.

Happy New Year!

Stay safe,…practice hygiene measures, stay distanced, wear masks, and AND once available GET THE VACCINE!

We will keep you apprised of new developments.

Best,

- V

COVID-19 UPDATES

New ”British  COVID virus strain; This is NOT a super virus!

Viruses mutate (make changes in their genetic code). This is normal behaviour for viruses, for example, influenza virus mutates yearly.

  • Viral survival depends on mutations. Mutations help the virus withstand immune response, or evade the body’s immune response.  As more people are exposed to the virus, and vaccinations occur, these mutations allow the virus to survive, spread, or escape detection by the immune system. A major reason to vaccinate is to get herd immunity 80-95% of the population needs to be immunized. With less people able to be infected due to vaccination the virus has less opportunity to spread and mutate.
  • There are many other variants of the COVID 19 virus in circulation. Scientists have found thousands of mutations in the virus as it travels all over the world. “British COVID” has 23 mutations. It was first noted in Sept 2020 in southern England.

What we have learned about this COVID-19 virus:

In modelling studies, the British COVID strain appears to be very good at spreading, (making more copies of itself) with a transmission rate of up to 70%. Modelling studies look at data gathered directly from sources in time and over populations and then analytically evaluate it using various tools to make predictions.

In South Africa, COVID virus with one of the mutations that the British one has, in infected individuals has been shown to have a higher concentration in the respiratory tract, and therefore more severe disease.

A COVID virus showing deletions (removed genetic material )in the spike protein has shown up in Mink farms, probably due to the overcrowded conditions there. Mink get the COVID virus from humans. The virus mutates in the mink. Unlike humans, many Mink die from the virus. They can pass the new strain back to humans. This mutated strain of COVID shows deletions in the spike protein. Preliminary laboratory data shows it is less sensitive to convalescent plasma treatment (the mutated COVID virus is exposed to plasma containing antibodies to the dominant COVID virus).

All variants to date have responded to the effectiveness of general measures, social distancing, hand washing and ventilation.

What are the concerns:

  • The mutations may make children more susceptible to the virus.
  • Other animals may be infected with the virus.
  • Laboratory studies to confirm this prediction are in progress.

Where do the new mutations come from?

  1. Mutations happen spontaneously, the more rapidly the virus divides.
  2. In a typical infection, the coronavirus multiplies days before a person mounts symptoms. The virus is most abundant before the body mounts an immune response. As the immune response against the virus increases, the abundance of the virus decreases. In a few weeks most people clear the virus out of their system. In individuals with weak immune systems, the virus can persist for months. During this time the virus has time to mutate many times as it continues to replicate (make more copies) in the body.
  3. People who have been treated for the virus, may develop viruses resistant to present treatments.
  4. Animals may become a reservoir for new mutations.

Do the mutations make the vaccine ineffective?

This is an ever changing landscape. The present scientific opinion is that while not impossible, it is unlikely now. it simply raises a question that needs to be answered in further scientific investigations. These Investigations are underway worldwide. To make the vaccine ineffective requires multiple mutations to occur specifically to the spike protein. The mutation would have to change the shape of the spike protein. That takes time.

COVID-19 VACCINATION IN ONTARIO
There are 2 vaccines that use injected Messenger RNA (mRNA) to teach the body to make antibodies against the spike protein.
  • BNT162b2 Pfizer vaccine - already approved in Canada
  • Moderna vaccine - approved by Health Canada on December 23
Both the Pfizer and Moderna vaccine have RNA code for the spike protein, presently on the virus, and teaches our immune system to make antibodies against it. When a vaccinated person is exposed to the virus, antibodies produced by the vaccine attach to the viral spike protein, and prevents the virus from entering the cell. Viral Spike protein interacts with the host cell to gain access to the host and cause infection.

A two-dose regimen Pfizer vaccine provided 95% protection against Covid-19 in persons 16 years of age or older. Safety over a median of 2 months was similar to that of other viral vaccines.

Is the vaccine safe?
Although the duration of the data is not long (2 months) no serious short term side effects from either vaccine have been seen. Minor effects similar to that from any other vaccine are observed (for example sore arm). 95% of people receiving the vaccine in the clinical trials were protected.

Why did these vaccines take only take 9 months to produce when the quickest vaccine to date to be produced (Measles/ Mumps/ Rubella) vaccine took 4 years?
Collaboration internationally (never before seen) between private industry, academia and governments maximized funding for intense research worldwide for the vaccines. Collaboration, communication, and simultaneous international evaluation of scientific data emerging from ongoing research by thousands of experts in the fields of (but not exclusive to) virology, biology, immunology, safety, ethics, population studies, and statistics, have all hastened progress.

Who is recommending the vaccine be administered?
NACI (Canada) CDC (USA) and virtually every scientific community in the modern world.

Dr. Fauci, the USA leading infectious disease expert, said that individuals with compromised immune systems, whether because of chemotherapy or a bone marrow transplant, should plan to be vaccinated when the opportunity arises.

Fauci emphasized that, despite being excluded from clinical trials, this population should get vaccinated. "I think we should recommend that they get vaccinated," he said. "I mean, it is clear that, if you are on immunosuppressive agents, history tells us that you're not going to have as robust a response as if you had an intact immune system that was not being compromised. But some degree of immunity is better than no degree of immunity."

Allergy concerns with Vaccine
  • It is safe for most people with history of allergies.
  • The vaccine is contraindicated in anyone with allergies to polyethylene, glycol found in laxative preparations for colonoscopy, some cough syrups and skin products.
  • Anyone with a known history of severe allergic reaction to any vaccine should speak with their MD.
Who can get the vaccine?
People 16y and over and seniors. It is highly effective over age, sex and ethnicity. It is not recommended for children, pregnant or breastfeeding women, until more data is available. Immune suppressed individuals, or those on biologics should speak with their health providers individually, as there is insufficient data on the effectiveness of the vaccine in these groups.

Should you get the vaccine when it becomes available? YES (exceptions above)
Will I get the vaccine when it becomes available? YES

Vaccine Dosing
Pfizer vaccine - 2 doses, 21 days apart for immune protection.
Moderna Vaccine - 2 doses, 28 days apart for immune protection

Vaccine Availability
  1. Phase 1A (~2500 vaccines) - Pilot phase testing the readiness of provinces to receive the vaccine, the logistics of delivery of vaccine and managing its specific requirements, tracking post vaccination information (experiences, side effects, etc.). UHN and Ottawa Hospital have received the vaccine (not available to the public).
  2. Phase 1B (~90,000 doses) - Vaccination of healthcare providers, to 17 other hospitals and to long term care homes, retirement homes or other living settings for seniors (not available to the public).
  3. Phase 2 - Sometime in winter 2021, as more vaccine is available the vaccinations will proceed to more healthcare workers, more residents of long term care institutions, retirement homes, home care patients and indigenous communities.
  4. Phase 3 - Vaccine is available for anyone desiring vaccination.
For more detailed information click here.

General principles for priority of immunization:
  • Residents, staff, essential caregivers working or living in congregate communities. Residents of these settings at highest risk for infection due to their age, (starting with the eldest > 75y, then adults 16-64y with high risk medical conditions).
  • Providers of essential care (this will include a family member caring for an elder or chronically ill individual) and for example for those who cannot work remotely and provide essential services.
  • Transportation, food production, etc.
  • Health Care workers.
  • First Nation communities.
  • Adult recipients of chronic home care.
 Why is the vaccine rolled out in this manner?
  • Decrease death and serious illness as much as possible
  • Preserve functioning society
  • Reduce the extra burden COVID 19 is having of people already facing disparities.
What can you do to help?
  1. Follow Public Health Recommendations for restriction on gatherings, wearing masks, distancing, and practicing hand hygiene.
  2. Continue to do this even after vaccination until advised by Public Health that it is safe to do otherwise.
  3. Download the COVID App. It’s free, and identifies if one may have been exposed to the virus.
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 © 2020 HealthCare 365, All rights reserved.


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