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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.
A PERSONAL MESSAGE FROM DR. KOHUT

Today I will review controversies surrounding the AZ vaccine, vaccination, delay between vaccination doses, and vaccine efficacy.

COVID-19 is a dreadful disease. In one year, COVID-19 has rewritten the top 10 causes of death in Canada. It may even become the number one cause of death for 2020.

All of us individually, and Canada as a whole, is COVID -19 fatigued. Economic recovery is a concern. The need to avoid extensions on social interactions limitations, while potentially easing some of the public protective measures, is driving the vaccine rollout.     

Insufficient vaccine availability has caused the Public Health Agency of Canada to make decisions regarding the timing of receiving a second dose of the vaccine doses. Many of us feel anxious about the extensions in the vaccine protocols. I know I initially did. 

However, by delaying the second dose in a two-dose vaccine series, we have a chance at getting 50% of the entire population vaccinated by July, in time for the largest shipment of vaccine to come into Canada. “Needles Into arms “- that is the overarching need.

In Canada, we are free to choose - to vaccinate or not. That is the luxury of living in a free society. But with that freedom comes social responsibility-“the greater good".

The more vaccines our population receives,  the greater the odds our society has as a whole in combating COVID-19. How quickly we can roll out the vaccine to as many Canadians as possible, will determine the outcome of COVID-19 pandemic in our country.

Unwelcome news this morning. There has been a sharp increase in COVID-19 cases in Ontario again. New data has shown that the new COVID-19 variants are not only more infections but are associated with  more hospitalizations. This comes at a time when the Province is loosening the restrictions against the advice of Public Health and their medical advisors. 

Please vaccinate when offered the opportunity to do so. Please persuade others to do so. Send them to some of the reputable sites suggested in Help Me Rhonda.

If you have any questions about COVID-19, COVID vaccinations, whether to vaccinate or not, or any concerns about your health in general, please reach out to our medical team. We are here for you.

Stay well, stay safe, mask, practice good hygiene, continue to socially distance, and please DO vaccinate.


V

GETTING TO THE BOTTOM OF THE AZ VACCINE CONTROVERSY

AZ Decision Review

Feb 26, 2021-Health Canada approves vaccine - no restrictions.

Mar 1, 2021 NACI (National Advisory Committee on Immunization) decision to place an age restriction up to age 64 on the AZ vaccine came from initial study trial data.

Real world data encompassing over 22 million people became available from countries that did not place an age restriction on the AZ vaccine, from which the data  and they found the vaccine to be effective and safe.

Mar 16, 2021NACI changed its recommendation to provide that vaccine to the over 65 age group based on this data.

Mar 19 2021 Clotting (Thrombosis) and AZ vaccine.

Surveillance (monitoring) for significant side effects is standard with the introduction of any new vaccine. 

During AZ monitoring, reports of a very small numbers of patients with clotting problems post AZ vaccine appeared (initially 35 or so... tracking ongoing) compared to the 22 million immunized with the vaccine to date. There were 35 cases and 3 deaths. 18 out of those 35 cases showed an extremely rare serious form of clotting (CVST = cerebral venous sinus thrombosis). CVST occurred at a higher frequency than would be expected from the literature. This is normally an extremely rare disorder affecting mostly women under the age of 55, many in the post delivery period. These events, however, occurred within 14 days of the AZ vaccinations.

The EMA (European Medicines Agency), an agency that monitors the safety of Medicines in the EU recognized the need to evaluate this data further, but concluded that the benefits of protecting against COVID-19 — which itself results in clotting problems — outweigh the risks. It also stated that it could not definitively rule out a link between the vaccine and specific, rare types of blood clots associated with, or low levels of blood platelets. They advised that anyone experiencing unusual bleeding, difficulty breathing or neurologic symptoms within 14 of vaccination should seek immediate medical assistance.

Many questions still remain. The science on this clotting pattern is unclear. The mechanism of this clotting is not yet known. Why these few individuals were so adversely affected - unknown.

Since then, the WHO, CDC, Public Health Canada and numerous Scientific Bodies have echoed that while there may be a causal link with the vaccine, it is not proven, and requires ongoing analysis.

Differences of opinion exist. Dr David Fisman, an epidemiologist at the University of Toronto, Dalla Lana School of Public Health, said publicly that the German data offered a "compelling picture”that the rare blood clots were potentially linked to the vaccine in rare cases. He feels restrictions on AZ vaccine use is needed. Some countries have chosen to suspend the use of AZ vaccine. Many others have continued immunizing with the AZ vaccine, agreeing that benefits outweigh risk.

WHAT DO WE KNOW ABOUT AZ VACCINE AND CLOTTING AND COVID -19?

  • There is NO evidence that The AZ vaccine increase the risk of clotting above the rate than naturally occurs in the population.
  • The benefits of protecting against COVID-19 — which itself results in clotting problems — outweigh the risks.

Let’s compare clotting incidence between COVID -19 infection and this rare clotting event (Incidence =number of individuals who develop a specific disease or experience a specific health-related event during a particular time period for example month, year).

  1. Blood clots occur in about one in 20 people hospitalized with COVID-19 and about one in 100 patients who have COVID-19 but were not hospitalized.
  2. The incidence of those rare clots,(cerebral sinus vein thrombosis =CVT) occurred at a rate between one in 250,000 and one in 500,000 people who received the vaccine.

Thrombosis Canada (an organization made up of physicians specializing in blood clots and dedicated to furthering Research and Education in Thrombotic disease) has stated:

Based on all available evidence, people who receive the AstraZeneca vaccine are not at increased risk of developing blood clots when compared with the general population.

“Thrombosis Canada strongly recommends that people receive vaccinations for COVID-19, including the vaccine made by AstraZeneca”.

 Thrombosis Canada further strongly recommends that the following groups of people receive vaccinations for COVID-19:

  1.  people who have had a previous blood clot.
  2.  people with a family member who has developed a blood clots.
  3. people with a hereditary clotting tendency (e.g., factor V Leiden mutation).
  4. people who are receiving blood thinner medications.
Best advice based on data today:
Any AZ vaccinated individual with unusual symptoms such as unusual bruising or persistent headache after vaccination should report their symptoms to our office immediately and proceed to the Emergency Department and mention the AZ vaccination date. 

Goals of vaccination
  1. Personal- to reduce the risk of COVID-19 infection (getting sick) and its complications of COVID, which include hospitalization (getting really sick) and death.
  2. National- to increase number of COVID-19 immune people, thereby slowing the spread of COVID-19 (and its mutations).

IMPORTANT VACCINE INFORMATION

Why has the dosing time between vaccines been extended? 
Answer:  We do not have enough vaccines!

Planned Vaccine roll out:
    First quarter of 2021: 6 million doses
    Second Quarter 2021 (April): 22 million doses 
    July 2021: 55 million doses 

1. ALL vaccines provide protection against COVID-19 hospitalization and death. A single dose provides >= 80% protection.

2.Protection does not wane (disappear) quickly. Vaccines take about 14 days to “ramp up “the body’s immune response. Once good vaccine protection is established, immunity does not suddenly disappear but rather weakens gradually.

3.There is some evidence that a delay in the second dose increases the antibody response after the second dose (long-lasting immunity) Scientists and Infectious disease experts looked at modeling studies, at countries vaccinating their population before us, and evaluated the findings of other 2 dose vaccine regimens. Longer intervals between the first and second doses increased the immune response to the second dose up to 16 weeks. Data from Quebec* is supporting these predictions. 

Why were the initial dose schedules shorter?    
Answer :
 To get the vaccine out to the public because of the pandemic.

 4.We need to reach that 80% level of immunity to as much of the population as possible, to get closer to HERD immunity and slow viral replication and mutation.

5.We are in a THIRD wave. COVID mutations now make up 60 % of the COVID cases. They are more transmissible (3 weeks earlier they made up 10% of the COVID-19 infection numbers).

The lack of immunity in the human population allows the virus to spread quickly from person to person worldwide. Rapid spread of the virus results in frequent genetic mistakes while making copies of itself. Some of these mistakes help the virus better survive. These are the COVID-19 mutations or variants of concern. These are often more transmissible.

New mutations- South African and Brazilian are creating lots of concern. More mutations put everyone at risk, and more mutations potentially can impact the effectiveness of the available vaccines. 

This example from Dr A. Morris and Dr A. McGeer (Infectious Disease Specialists in Toronto) on the rationale for extending the time between doses. There are only 2 COVID vaccine doses.There is a mother and a father. Do you give 2 doses to one and none to the other or do you give each a dose ….?” 

VACCINE EFFICACY

All Vaccines available in Canada have similar efficacy.

All vaccines available in Canada have been shown to protect against COVID complications, hospitalization and death. For example, Johnson and Johnson vaccine was 100% effective in preventing hospitalizations and death in COVID affected immunized patients.

So why are we hearing the different efficacy rates - 95 % with Pfizer and Moderna, and AZ and Johnson and Johnson vaccines in the mid 60% range? 

 Answer: Different vaccine trials used different outcomes measures in their studies.  (Outcome measures =“change in the health of an individual, group of people, or population that is attributable to an intervention or series of interventions.”  Examples of outcome measures are symptomatic infections, asymptomatic infections, death, etc,)

Therefore, it is a bit like comparing apples and oranges.

 

A good video on efficacy here.

 ADDITIONAL RESOURCES FOR VACCINE INFORMATION

Vaccine side effects see here.
For more vaccine information.
For more information on phase 2 vaccination. Please note: HC365 will be reviewing patients who fit the medically related criteria. Michelle will be reaching out to those individuals to inform them to secure their COVID-19 vaccine appointment.

Information on COVID, vaccination and vaccination rollouts, are changing almost daily. Never in history of health information and vaccination, has the volume of new information appeared so frequently. At HC365 we will advise you of any significant changes in information on any of these topics. If new data advises otherwise, I will retract any information that contradicts or edits what I have written previously.

 V


Please Vaccinate!

FINAL COMMENTS - VACCINATE!

A final note on masks….

How should a surgical  mask be put on?

  1. Nose wire should be at the top.
  2. Most of the time the darker color is on the outside.
  3. If any question regarding this color- look at the pleats in the mask… the pleats on the mask should open DOWN.

If you have any questions about COVID-19, COVID vaccinations, whether to vaccinate or not, or any concerns about your health in general, please reach out to our medical team. We are here for you.

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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